f you had a heart attack, a stent saves your life. If you have stable chest pain on exertion — the kind that gets better when you stop walking — a stent adds zero years to your life. The ORBITA trial proved that in 2017. The COURAGE trial implied it ten years earlier. American cardiologists still place 400,000 elective stents a year. The patient usually has no idea the evidence looks like this.
Two very different procedures, same name
The word "stent" describes a metal scaffold that holds a coronary artery open. Placed during an acute heart attack — when a plaque has ruptured and a clot is cutting off blood — it restores flow and stops the death of heart muscle. That is a life-saving procedure, and if you're ever offered it in that setting, take it.
Placed electively, for stable angina, it is a different procedure. The artery is narrowed but flow is still adequate. The stent opens it more. You feel better for a while because you believed it would work (placebo is powerful; ORBITA demonstrated this with a sham-surgery arm). Your mortality risk is unchanged. Your chance of a future heart attack is unchanged.
The FFR test nobody orders
Fractional flow reserve is a wire threaded through the artery that measures actual pressure drop across the narrowing. An FFR above 0.80 means the narrowing is physiologically insignificant — meds only. Below 0.75, the narrowing matters. Between 0.75 and 0.80 is the gray zone.
If you're being offered a stent without an FFR measurement, ask why. The answer is usually that the cath lab is busy and FFR adds twenty minutes. That's not a reason to cut you.