Physicians, Academics Clash Over Stents

"There's a vigorous evaluation of cath labs. Processes are being examined for quality. So the SCAI has been way ahead of the curve on these things."

Indeed, there has been a curve, in the unsteady and contradictory studies and reports on the use of stents or angioplasty. One of the most significant and highly publicized was the 2007 COURAGE study (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), which essentially found that patients undergoing medical therapy had outcomes that were just as good as angioplasty or stent placement to relieve their angina.

The study revealed that percutaneous coronary intervention (PCI)—the medical term for angioplasty—offered "no benefit over aggressive medical management when performed in patients with stable artery disease and suggests that PCI may be deferred in patients with stable disease as long as medical therapy is optimized and maintained."

On the flip side, another recent clinical trial gained attention this year because it seemed to favor stenting in particular cases, although it was never completed, prompting even more debate. That study, from St. Jude Medical, a medical technology company, called FAME II, examined the outcomes of 888 patients with significant blockage of at least one coronary artery.