Does a heart stent prevent future heart attacks in stable patients? 25-year follow-up offers new insight

by Laura Kelley, CU Anschutz Medical Campus

edited by Sadie Harley, reviewed by Robert Egan

Sadie Harley

Scientific Editor

Meet our editorial team
Behind our editorial process

Robert Egan

Senior Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

proofread

The GIST Add to Preferred Sources

When doctors find a blockage in a patient's heart arteries, a common treatment option is a procedure to open the artery and restore blood flow. But does getting a stent actually help prevent a future heart attack or help someone live longer?

A new study led by University of Colorado Anschutz researcher Neel Butala, M.D., suggests that, for people with stable coronary artery disease, adding an initial procedure to open blocked arteries to medical treatment does not significantly reduce the long-term risk of death or heart attack.

Published in JAMA and presented at the 2026 American Heart Association Scientific Sessions, the research provides an unusually long look at a longstanding question in cardiology: Does opening a blocked artery offer lasting benefits beyond those achieved through medication and other medical treatments?

"When someone is told they have a blockage in a heart artery, the natural reaction is to want to open it. While opening a coronary blockage can relieve someone's symptoms, it is unclear whether it affects chances of having a heart attack or living longer. We wanted to look beyond whether the procedure works technically and understand what happens to patients over time," said Butala, also an assistant professor of medicine-cardiology at the CU Anschutz School of Medicine.

What did the extended COURAGE study find?

The original COURAGE trial compared two approaches to treating stable coronary artery disease: opening narrowed arteries with a procedure called percutaneous coronary intervention (PCI), commonly known as angioplasty, plus optimal medical therapy, or treating patients with optimal medical therapy alone.

During angioplasty, doctors use a small balloon to open a narrowed artery and often place a tiny metal tube called a stent to help keep it open.

For the new analysis, researchers followed 959 patients from the original trial using linked health records. After a median follow-up of 15 years, with some followed for as long as 25 years, researchers found no significant difference in the combined risk of death or heart attack between the two groups.

The estimated 25-year cumulative incidence of death or heart attack was 93.3% among patients initially assigned to PCI plus medical therapy and 91% among those assigned to medical therapy alone.

Earlier research examined long-term survival following the original trial. This analysis adds heart attack outcomes, addressing an important unanswered question about whether an initial procedure might reduce cardiovascular events over time.

What does this mean for patients?

For people with stable coronary artery disease, the findings suggest that successfully opening a narrowed artery does not necessarily translate into a lower risk of heart attack or death.

"When we open a blocked artery, we know we've improved blood flow through that artery and that relieves symptoms. But the bigger question is whether that translates into a reduction in clinical events such as heart attacks or death for patients over the long term. That's what we wanted to understand with this study," said Butala.

"We found no significant difference in the risk of death or heart attack between the two treatment groups. That's important information for doctors and patients as they consider the best approach to treating stable coronary artery disease."

The findings do not mean stents or angioplasty are unnecessary. These procedures can relieve chest pain and other symptoms, and emergency interventions can be lifesaving for people experiencing certain types of heart attacks. The study specifically examined the long-term outcomes of an initial PCI strategy for patients with stable coronary disease.

The analysis was a post hoc observational follow-up of participants from the original randomized COURAGE trial, rather than a new randomized trial. It included veterans whose health records could be linked to the study, a population with higher baseline health risks than the full COURAGE trial population.

Researchers also noted that identifying heart attacks through routinely collected health records has limitations, although results were consistent with events independently verified during the original trial.

Ultimately, Butala said, the findings highlight why it's important to look beyond whether a procedure successfully opens an artery and ask whether it actually improves a patient's health over time. That distinction can help doctors and patients make more informed treatment decisions with the goal of helping patients live longer and avoid future heart attacks.

Publication details

Neel M. Butala et al., Percutaneous Coronary Intervention and Long-Term Outcomes in Stable Coronary Artery Disease, JAMA (2026). DOI: 10.1001/jama.2026.23488

Journal information: Journal of the American Medical Association

Key medical concepts

Percutaneous Coronary InterventionMyocardial infarctionDeath

Clinical categories

CardiologyCommon illnesses & Prevention Provided by CU Anschutz Medical Campus Who's behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

Citation: Does a heart stent prevent future heart attacks in stable patients? 25-year follow-up offers new insight (2026, November 13) retrieved 13 November 2026 from https://medicalxpress.com/news/2026-11-heart-stent-future-stable-patients.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.