Perhaps that stent or bypass could have been avoided simply through use of medication therapy and lifestyle management. A major federally funded study has demonstrated that patients who received drug therapy and performed lifestyle changes did not experience more heart attacks or die earlier than patients who underwent invasive procedures like stents or coronary artery bypasses. This means that invasive procedures have perhaps been overused, and updated treatment guidelines may save hundreds of millions of dollars in the long run. Additionally, many patients now have a have a far less worrisome course of treatment ahead of them.

The study followed patients with moderate to severe ischemia, but who had not had a heart attack within the past two months. Patients were randomly selected to be treated conservatively, via medical therapy, or via invasive procedure like stent or coronary bypass. The patients had narrowed arteries (from plaque buildup) that were discovered via exercise stress tests. Stents are small expandable tubes placed to keep open otherwise narrowing arteries. Coronary bypasses are when a healthy blood vessel from elsewhere in the body is attached to the heart to provide blood flow beyond the blocked arteries.

Notably, excluded from the study were patients with blockages of the left main coronary artery or patients experiencing heart attack. Additionally, the researchers were careful to note that patients with chronic angina (chest pain) would likely gain quality of life improvement through one of the invasive procedures.

Patients are not off the hook, per se, in managing their own heart disease. Key to maintaining success with medical therapy is the patient managing his or her lifestyle, including diet and exercise.

From our perspective, it is encouraging that many patients will receive the same coronary benefit without having to undergo heart surgery with all of the stress, fear, and risk that comes with it. It also means that many patients will not have to make difficult decisions in the face of those procedures when making treatment decisions with their cardiologist. Additionally, the cost of medical therapy is minimal when compared to the cost of a stent or bypass surgery. There, again, benefitting future heart disease patients.

Following this study, updated heart disease treatment guidelines are likely to come within the next year or so.

Read the details of the clinical trial here: [International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA)](https://clinicaltrials.gov/ct2/show/NCT01471522)

Read coverage of the results here: [Stents No Better than Drugs for Many heart Patients: US Study.](https://www.reuters.com/article/us-health-heart-stent/stents-no-better-than-drugs-for-many-heart-patients-us-study-idUSKBN1XQ0MR)