"Patients managed medically without stenting or bypass surgery tend to be elderly and frail, and in some sense we feel they have been overlooked," says Matthew Roe, a cardiologist at Duke and lead researcher of the study.
"We wanted to find out what clinical factors were funneling them into a medicine-only group and what happened to them, when compared to patients who received stents and bypass procedures," he added.
The team analysed 8,225 patients from a previous study (the Synergy trial), who had undergone cardiac catheterization and had been found to have at least one significant blockage in a coronary artery
The study had compared the effects of two different anti-clotting drugs in heart patients.
About 52 percent of the patients underwent coronary stent implantation to open their arteries, while 32 percent were medically managed, and 16 percent underwent coronary bypass surgery.
The researchers found that the risk of death was highest for the medically managed group and lowest for patients who underwent stenting.
The death rates among medically managed patients increased rapidly during the first three months following release from the hospital, and stayed higher than those in the other two groups.
At one year, the mortality rate among the medically managed group was 7.7 percent, 3.6 percent for patients who underwent stenting, and 6.2 percent among those who underwent bypass procedures.
"It is important to know that the patients in the medically managed group had a higher death rate despite receiving most of the currently recommended medications for this condition from clinical practice guidelines," said Roe.
"What this study tells us is that for these patients who are medically managed, we need to come up with better treatment approaches that lessen their risk of death," he added.
Roe is conducting a new trial that may help in finding possible solutions.
The study appearing in the August issue of the Journal of the American College of Cardiology: Cardiovascular Intervention.