Stents for Chest Pains, Do They Work? (The ORBITA Trial)

Stents for Chest Pains, Do They Work? (The ORBITA Trial)

So if you’ve had a stent, you may not
want to watch this video especially if you’ve had a stent and you felt like it
worked. Maybe you want to close one eye. I’m gonna cover a study called the ORBITA study in which they actually did a sham procedure. They put the patient to
sleep and acted like they did a stent and then put the patient back awake and
followed these patients and compared them to people that actually had a stent.
Guess what they found? So I’m gonna cover that in just a minute.
But first a brief intro. So this was the coverage in the New York Times. This was
a study that I actually covered six months to a year ago. It was done two
years ago and it was called the ORBITA study. It was done in England. And in fact,
many of the experts in the U.S. said there weren’t even sure that a US human
subjects committee would actually agree to this study because again in the US we
think that stents are so powerful and so helpful. So according to the New York
Times, new study found that stents can be life-saving in arteries in patients
having a heart attack but they’re often ineffective for chest pain and yes I’ll
cover that. Actually, let’s just jump over the rest of that text because I’ll cover
this here. What are the major reasons for stent? Having a heart attack treatment
and the stents worked for that. So if you’ve had a stent and it was for
treatment for a heart attack, it probably was something that you needed and
probably did work for it. Here’s the next reason though, to prevent a heart attack.
Those have been shown not to work. That was the COURAGE Trial and then published
in the New England Journal, also a couple of years ago and also covered by me
about six months ago. This study the ORBITA Trial is on angina
or chest pain. Usually when you walk or exercise and again this was the one that
showed mm didn’t work if you had one and you and it did work for you
okay but let’s just let me go through the rest of the video. The fourth reason
is just plain old blockage. In other words, if you’re a hammer, everything
looks like a nail. And if you’re an interventional cardiologist, maybe
everything looks like something that needs to be stented. I’ve got nothing
against interventional cardiologists other than the fact that maybe they get
a little bit too aggressive about using their own learned techniques that
doesn’t make them different from anybody else. Surgeons do that. I do that.
Everybody else does that. Heart disease is still the leading killer of Americans –
800,000 people have heart attacks each year and stenting is a mainstay for
treatment in nearly every hospital. Half a million patients worldwide have
a stent each year to relieve chest pain and the reality is… let’s go back to this
number… it’s probably about a hundred thousand that get a stent for a heart
attack. Whereas for heart attack treatment, the
vast majority are for heart attack prevention or blockage or angina. Again,
total way over a million per year in the US alone should be doing about a hundred
thousand. So again I mean, if we didn’t do them for heart attack prevention,
angina or “blockage,” we’d be doing about a hundred thousand now.
Several companies (including Boston Scientific, Medtronic, and Abbott) sell the
devices and putting them in costs about 11 to 41 thousand dollars. So obviously,
there’s a money issue here this. This is from the New York Times, new study
published in Lancet stunned cardiologists by countering decades of
clinical experience. Here’s what some of the cardiologists sent. “It’s a very
humbling study for someone who puts in stents,” said Brahmajee Nallamothu.
He’s an interventional cardiologist at the University of
Michigan. William Boden, a cardiologist and professor of medicine at Boston U
called results “unbelievable.” David Maron, cardiologists at Stanford,
praised the new study as “very well constructed” but said it still leaves
some questions unanswered. The participants had a profound blockage but
only in one artery, he noted, and they were assessed after just six weeks. So
here’s the study. It was in Lancet. It was published in January of 2018. “Symptomatic
relief is the primary goal of percutaneous intervention…” in other words…
“a stent in stable angina and it’s commonly observed clinically. However,
there’s no evidence from blinded placebo-controlled randomized trials to
show its efficacy.” Well one of the reasons was: how are you going to do a
randomized trial on that? Are you actually going to tell somebody, “Look, we’re gonna put you to sleep, we’re gonna do surgery on you, you may get a
stent or you may not.” That’s exactly what they did with these patients and again
many people said that would never happen in the US. It might now. After this study
has happened, they did this with 230 patients: 105 were given stents and 95
were assigned to the placebo procedure. In the end, the stent did not help
exercise time by more than the effect of a placebo procedure. So I guess one thing
you could guess, guess who funded this. It wasn’t Abbott or or any of the
manufacturers. Pardon the sarcasm. If you’ve made it this far, thank you for
your interest. Looking forward to seeing you in Louisville November 8th and 9th
get all your labs your arterial scan. Spend time one-on-one with me and two
days of intense focus on how to prevent your heart attack, stroke, dementia,
blindness, kidney disease, erectile dysfunction. Looking forward to seeing
you there.

12 thoughts on “Stents for Chest Pains, Do They Work? (The ORBITA Trial)

  1. My LAD was 100% occluded and I had exercise induced angina. Chest and left arm. My RCA had a 70% blockage. 2 stents. No angina since then and I'm a very active person. Ski, trail run, mtn and road bike as well as resistance training. I understand placebo effect but they worked for me.

  2. There's a term used by cardiologists who install stents – it's called "Full Metal Jacket" – and it refers to putting in LOTS of stents – so many that they basically completely fill an artery. From what I can tell, stents MAY or may not give you an opportunity to do something about plaque build-up to avoid or delay a bypass. At least for those of us who've had an MI and survived.

  3. OK I believe you because you're the expert with decades of experience, but I don't understand how stents don't work for blockages. If an artery is so blocked it's causing angina, how can opening up the artery with a stent not help?

  4. This is inline with my doctors that say stenting is not as effective as bypass surgery when you have several blockages like mine. But I still have one doctor out there saying I don't even need bypass surgery! Just meds, exercise, and eating right until there is an event. Then treat. But what if that event is dropping dead? Same thought with those stents. Effective when you have a heart attack. But who wants to wait until you have a heart attack?

  5. Dr ford: a note on video editing from someone who watches allot of videos. No need to do a lead in trailer if your video is less than 30 min. to do the lead in, then the graphics for a 6 min video is not needed. Some constructive criticism as I know you are maturing as a video maker.

    great info though ty

  6. How about a Heart Attack and Stroke Prevention Conference in Reykjavik for Europeans? It's sort of half way between the US and Continental Europe.

  7. Very interesting revelation on the marketing of healthcare. A patient is not capable of interpreting if they are getting healthcare, treatment, and marketing from a doctor. They are at the mercy of the Doctor to have a form of fiduciary responsibility in their ethical treatment of patients.

    In the US a study showing healthcare and treatment as it relates to ability to pay and insurance coverage could be done. I suspect a trend on stents could be observed. They are sold to customers that can buy them.

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