Why Stents Might Not Protect You From Future Heart Attacks
By all accounts, coronary stents seem like a miracle of modern medicine. Inserted into narrowed arteries to restore blood flow, they’re often portrayed as a frontline defense against heart attacks — a life-saving intervention that “fixes the problem.”
But what if that’s not the full story?
In recent years, a growing body of research has turned conventional wisdom on its head, revealing a surprising truth: For many people with stable heart disease, stents may not prevent future heart attacks — or extend life at all.
“We’ve entered an era where more isn’t always better,” says Dr. Andrew Rudin, a board-certified cardiologist and educator. “Patients deserve to know what’s actually effective versus what just feels reassuring.”
Let’s break down the facts — and why it’s time to think critically before agreeing to a stent.
What Is a Stent, and Why Is It Used?
A coronary stent is a small mesh tube placed inside a blocked or narrowed artery to keep it open. The procedure, known as angioplasty, involves threading a catheter through the blood vessels, inflating a balloon to widen the artery, and inserting the stent to prevent it from collapsing again.
In emergency cases, like when someone is having a heart attack, stents are crucial. They restore blood flow immediately, reducing the damage to heart muscle and saving lives.
But that’s not where most stents are used.
In fact, tens of thousands of stents are inserted every year into patients with stable chest pain (angina) or even no symptoms at all — cases that aren’t emergencies.
And that’s where things get controversial.
The ISCHEMIA Trial Changed Everything
In 2020, a major study called the ISCHEMIA trial was published, tracking over 5,000 patients with stable heart disease. Half were treated with stents or bypass surgery. The other half were treated with medications, diet, and lifestyle changes.
The conclusion? No meaningful difference in rates of future heart attacks or deaths between the two groups.
Patients who managed their condition through non-invasive therapy did just as well — without the risks or recovery time of surgery.
“We’ve known for a while that stents help relieve symptoms,” says Dr. Andrew Rudin. “But when it comes to preventing that next heart attack — unless you’re in a crisis — they just don’t deliver the way people expect.”
The Real Cause of Most Heart Attacks
Here’s something most people don’t realize: Heart attacks don’t usually happen where there are big, obvious blockages.
Instead, they occur at sites of smaller, unstable plaques — the ones you can’t easily predict or see. These vulnerable plaques can rupture, triggering a clot that blocks the artery completely.
Inserting a stent into a “tight” blockage doesn’t address the underlying systemic disease — the inflammation, high cholesterol, high blood pressure, and insulin resistance that affect arteries throughout the body.
So while a stent might open one section of artery, the real danger may still be lurking somewhere else.
When Are Stents Truly Necessary?
Despite the headlines, stents do have an important role in cardiology — particularly in emergencies.
They are strongly recommended if you are:
- Having a heart attack
- Experiencing unstable or worsening chest pain
- Unable to control symptoms despite medication
- Diagnosed with a high-risk blockage in a critical area
But if your symptoms are stable — or non-existent — there is often no rush to intervene.
“In non-emergency situations, we should always ask: ‘Will this procedure improve your quality of life, or just give you a temporary sense of reassurance?’” says Dr. Andrew Rudin.
The Risks of Unnecessary Stenting
Like any procedure, stents come with risks:
- Bleeding or vascular damage during insertion
- Blood clots forming inside the stent
- Re-narrowing of the artery (called restenosis)
- Allergic reactions to dye or anesthesia
- Complications from medications required afterward (e.g., blood thinners)
There’s also the psychological risk: many patients who receive stents assume they’re “fixed,” and stop prioritizing lifestyle changes or medication — the very things that have the greatest long-term benefit.
“We see this often,” Dr. Andrew Rudin warns. “People walk away from the procedure thinking they’re in the clear, when in fact, the real work of managing heart disease has just begun.”
What Actually Works for Long-Term Heart Health?
The good news? You have more control than you think.
For patients with stable heart disease, optimal medical therapy often works just as well — if not better — than a stent. That includes:
✅ Statins to lower cholesterol
✅ Aspirin or antiplatelet medications
✅ Blood pressure control
✅ Smoking cessation
✅ Weight loss and regular exercise
✅ Mediterranean-style diet rich in whole grains, lean protein, fruits, and vegetables
✅ Stress management and improved sleep
These aren’t just “nice to have” — they are clinically proven to reduce the risk of future heart attacks and cardiovascular death.
“It’s not flashy,” says Dr. Andrew Rudin, “but it works. If we treated lifestyle with the same urgency as we do procedures, we’d change the trajectory of heart disease in this country.”
Questions to Ask Before Getting a Stent
If you’re told you need a stent and it’s not an emergency, here are five questions worth asking:
- Is my condition stable or urgent?
- Have I tried medication and lifestyle therapy first?
- What are the risks of this procedure — and the benefits?
- Will this improve my long-term health, or just short-term symptoms?
- Is there time to seek a second opinion?
These questions aren’t confrontational — they’re empowering. And a good cardiologist will welcome them.
The Bottom Line
Coronary stents are a remarkable tool — but like all tools, they need to be used for the right job, at the right time.
In emergency situations, they can save lives. But for those with stable heart disease, they often offer no added protection against heart attacks, and may come with unnecessary risks.
It’s time to rethink the “quick fix” mentality and embrace a more thoughtful, long-term approach to heart health.
“Think before you stent,” says Dr. Andrew Rudin. “When patients understand their choices, they make better decisions — and ultimately, they live longer, healthier lives.”
💬 Join the Conversation
Have you or someone you love been advised to get a stent? What did you learn during the process? Share your thoughts in the comments — and let’s open up this important discussion around heart health, prevention, and patient empowerment.