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Stents, Drugs or Both: Debate May Get New Life

A new study and an editorial in a major medical journal could reignite the debate over whether drugs or stents or a combination of both are better for the millions of Americans with heart trouble.

Last year, the clinical trial named by the acronym "Courage" concluded that cheaper, older drugs worked just as well as expensive stents—the tiny wire mesh tubes that prop open clogged arteries—in treating patients who regularly get angina or chest pain.

Now, researchers have tried to measure the quality of life of patients in the controversial Courage study. They report in "The New England Journal of Medicine" that the patients who got stents had a small but significant improvement over those who just took pills including aspirin and medications for high blood pressure, cholesterol and blood thinners.

But the doctors say the increase in quality of life in the stent patients diminished over time and eventually evened out with the patients taking drugs.

And an editorial that goes along with that report strongly urges doctors to first put their patients with so-called stable angina on drugs before putting in a stent.

Another follow-up study to Courage on the cost effectiveness of drugs versus stents is set to be published in a different medical journal next month. The timing of the reports is set against the backdrop of the presidential campaign where healthcare costs are a big issue.

Johnson & Johnson , Boston Scientific , Medtronic and Abbott Labs make the highly-profitable stents. The U.S. and Canadian governments paid for the study, along with several major pharmaceutical companies.