Stents Offer No Long-Term Heart Attack Protection in Stable Patients

Two numbers carry the weight. The estimated chance of having died or experienced a heart attack by the 25-year mark was 93.3% in the procedure group and 91% in the medicine-only group. The gap falls well short of statistical significance. The researchers stress that these figures describe outcomes across decades of observation, not the risk any one patient faces in the coming months.

What is the disease, and what do the treatments do?

Coronary artery disease develops when fatty material builds up inside the arteries that supply the heart with oxygen-rich blood. Over time, the narrowing can cause chest discomfort, especially during physical activity.

Doctors treat it along two paths:

• Medicines that lower cholesterol, control blood pressure and reduce the chance of blood clots — paired with healthy habits such as not smoking, regular activity and a heart-friendly diet.
• Angioplasty, in which doctors insert a small balloon to widen the narrowed artery and usually place a tiny metal tube called a stent to hold it open.

Angioplasty can improve blood flow and relieve chest pain. The open question was whether it also prevents heart attacks many years later. On that question, this study returns a clear answer: for stable patients, no.

Does this mean stents are useless?

It does not. Two cautions frame the result.

First, stents ease troublesome symptoms, and rapidly opening a blocked artery during certain heart attacks can save lives. That emergency use stands untouched by this research, which examined only people with stable disease — not people in the middle of a medical crisis.

Second, the study has real limits. Its later follow-up relied on veterans' health records, so the findings may not apply equally to every patient, and some events could have been recorded inaccurately. The numbers are best read as strong long-term evidence rather than the final word.

What changes at the bedside?

For practitioners, the practical shift is in how the conversation gets framed. Opening one narrowed artery does not automatically prevent future heart problems; the trial data now support that statement over a 25-year horizon. For stable patients, the choice between a procedure and medicines should turn on symptoms, overall risk and an individual discussion with their doctor — not on an assumption of long-term protection.

The evidence says stents relieve; they do not, by themselves, prevent.