For stable heart disease, getting a stent right away did not lower the risk of death or heart attack over 25 years, a study of veterans finds

People with stable coronary artery disease, meaning heart arteries narrowed by plaque but not causing a heart attack, did no better over as long as 25 years when they got a stent right away plus medicines than when they started with medicines alone, according to a study published in JAMA and led by Dr. Neel Butala of the University of Colorado Anschutz Medical Campus.

By 25 years, an estimated 93.3% of veterans who got the early procedure had died or had a heart attack, compared with 91.0% of those who started on medicines, a difference small enough to be chance.  Those numbers are high because the patients were older, high-risk veterans followed for decades.  Death alone was 83.9% versus 82.2%, and heart attack 54.6% versus 54.0%.

What it means for patients

The procedure, called angioplasty or percutaneous coronary intervention (PCI), threads a tiny balloon into the artery to open it, usually leaving a small metal mesh tube called a stent.  It can relieve chest pain, and in some heart attacks it is lifesaving, the researchers note.  The question here was narrower:  whether a planned procedure for stable disease prevents heart attacks or helps people live longer.  It did not, the study found.  The findings “do not support a routine strategy of elective up-front PCI” to reduce long-term death or heart attack in stable disease, Butala said when presenting them, Medscape reported.

When someone is told they have a blockage in a heart artery, the natural reaction is to want to open it.

He said opening a blockage can relieve symptoms, but it had been unclear whether it changes the chances of a heart attack or of living longer.  Waiting does not rule out a procedure:  more than half of the medicine-first group eventually had an artery opened.

How the study worked

The original COURAGE trial randomly assigned 2,287 patients with stable disease to either approach and found no reduction in death or heart attack after about 4.6 years, and no longer survival after about 12 years.  The new analysis followed 959 of them, veterans treated at 15 Veterans Affairs hospitals, through their VA health records for a median of 15 years and up to 25.

The authors list limits:  it is a later look at a subset rather than a new trial, the veterans were sicker than the full trial group, heart attacks were counted from routine records, and today’s stents are more advanced than those used when the trial began.  The results were presented at the American Heart Association’s Scientific Sessions.

Source:  *JAMA*:  Percutaneous Coronary Intervention and Long-Term Outcomes in Stable Coronary Artery Disease (Butala et al.); CU Anschutz news release, Nov. 13, 2026; JAMA Network media release, Nov. 7, 2026; Medscape report on the presentation.