A major international study finds that many people with stable heart disease may live just as long with medication as with an early stent or bypass procedure.
A major international study finds that many people with stable heart disease may live just as long with medication as with an early stent or bypass procedure. But there is an important exception everyone should understand.
By Webfit News | 11 November 2026
AUCKLAND: Imagine being told that an artery supplying blood to your heart has narrowed. Your first thought might be simple: open the blockage, fix the problem and live longer.
It sounds logical. But a major international study suggests the answer is not always that straightforward.
Researchers followed 5,179 patients with stable coronary heart disease for as long as 13 years. Their finding? Patients who received early invasive treatment, including stents or bypass surgery when appropriate, did not live significantly longer than those initially treated with medication.
The findings, published in the medical journal JAMA on 7 November 2026, could change how patients think about treatment decisions.
The message is not that stents don’t work. It is that opening an artery does not automatically mean living longer.
What did the study find?
The ISCHEMIA-EXTEND trial involved patients from 37 countries. Both treatment groups received recommended medical care.
One group was offered early procedures when appropriate. The other started with medication, with procedures available if treatment was unsuccessful.
Here is what researchers found at 11 years:
|
Outcome |
Early invasive treatment |
Medication-first approach |
|
Deaths from any cause |
25.8% |
26.9% |
|
Cardiovascular deaths |
15.8% |
17.1% |
|
Non-cardiovascular deaths |
9.1% |
8.1% |
The small differences were not statistically significant.
In total, researchers recorded 1,071 deaths during follow-up. The median follow-up was nine years, with some patients followed for more than 13 years.
A separate long-term analysis of the COURAGE trial, also published in JAMA on 7 November, found no significant reduction in death or heart attacks from routinely adding an early stent procedure to optimal medication in its studied population.
So, are stents unnecessary?
Absolutely not.
A stent is a tiny metal mesh tube inserted into a narrowed artery to improve blood flow.
For someone experiencing persistent chest pain despite medication, a stent can provide meaningful relief and improve everyday life.
For someone having a heart attack, urgently restoring blood flow can be lifesaving.
The new research focuses on stable heart disease, not people experiencing a heart attack or other urgent cardiac emergency.
That distinction is crucial.
Stable heart disease versus a heart attack
|
Stable heart disease |
Heart attack |
|
Blood flow is reduced by narrowed arteries |
Blood flow is suddenly severely restricted or blocked |
|
Symptoms may occur during exercise or exertion |
Symptoms can occur suddenly, including at rest |
|
Medication may be an appropriate initial treatment |
Emergency assessment and treatment are essential |
|
Stents may help if symptoms persist |
Urgent procedures may save heart muscle and lives |
The trial also excluded certain high-risk patients, including those with significant left main coronary artery disease, severely reduced heart pumping function and recent acute coronary syndromes.
Its findings cannot automatically be applied to everyone with a heart condition.
What about reports linking stents to cancer deaths?
This is where the research requires particular care.
Investigators observed fewer cardiovascular deaths but more non-cardiovascular deaths in the early invasive treatment group. Neither difference was statistically conclusive.
Earlier analyses raised questions about cancer-related deaths and exposure to procedures involving radiation.
However, the study did not establish that stents, bypass surgery or radiation caused cancer.
Researchers say further investigation is needed.
It would be misleading to turn an unexplained statistical finding into a claim that heart stents cause cancer.
What does this mean for New Zealand patients?
For people in New Zealand living with stable angina or coronary artery disease, the research reinforces the importance of discussing treatment options rather than assuming a procedure is always the best first step.
The Heart Foundation of New Zealand already identifies medication, lifestyle changes and, when necessary, angioplasty or bypass surgery as treatment options for angina.
A treatment plan may include cholesterol-lowering medication, blood pressure management, medicines to reduce clotting risk where appropriate, physical activity, dietary changes and stopping smoking.
Importantly, medication-first treatment does not mean doing nothing. Patients still require ongoing medical care and monitoring.
And a stent does not cure the underlying coronary artery disease.
Five questions worth asking your cardiologist
If you have stable coronary artery disease and a procedure has been recommended, these questions may help you understand the decision:
The answers will depend on your medical history, test results, symptoms and overall heart health.
One warning New Zealanders should not ignore
If you experience new or unexplained chest pain, pressure, breathlessness, sweating, nausea or pain spreading to your jaw or arm, do not assume it is stable angina.
In New Zealand, call 111 immediately if you suspect a heart attack.
If you already have diagnosed angina, follow your prescribed action plan and seek urgent help if symptoms do not settle or become more severe.
The real takeaway
For decades, many patients have understandably assumed that physically opening a narrowed heart artery must offer the best chance of living longer.
The latest research challenges that assumption for many people with stable coronary disease.
A stent can improve blood flow. It can relieve symptoms. In emergencies, it can save lives.
But for some stable patients, carefully managed medication may offer comparable long-term survival without an immediate invasive procedure.
The best heart treatment is not necessarily the most invasive one. It is the one that fits the patient’s condition, symptoms and risks.
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