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Health See other Health Articles Title: Artery stents not for everyone For many patients, angioplasty is NOT in their best interest “The landscape of medical history is littered with procedures not in the patient’s best interest.” That’s not just me saying that. It’s actually a quote by an official from a Michigan hospital talking about using balloon angioplasty to place a stent in an artery. Your doctor will probably describe angioplasty as “routine.” But when you consider the full range of this routine (including drugs you’ll be required to take), you can’t help but wonder if it’s really in your best interest. Perception vs. reality First, let’s look at a realistic assessment of the “benefits” in having a stent inserted in an artery. You may be surprised by this 2009 New England Journal of Medicine study that followed nearly 2,400 patients. Half the subjects received drug therapy (statins, aspirin, beta-blockers, etc.), while half received drug therapy and angioplasty. After five years, researchers found no significant difference in rates of death, heart attack, or other major events. And this research confirmed similar results of a 2007 Department of Veterans Affairs study. No significant difference. Hmmm… Unfortunately, that message hasn’t trickled down to patients. In a recent Annals of Internal Medicine study, researchers surveyed more than 150 angioplasty patients and 17 cardiologists. Nearly 90 percent of the patients said they believed the procedure reduced their heart attack risk. And almost three-quarters said they believed they would have a heart attack within five years without the angioplasty. Compare that with these striking responses from cardiologists… More than 60 percent said they believed that angioplasty benefits were simply to relieve symptoms–nothing more. And most amazing: When given two hypothetical scenarios where angioplasty provided no benefits, more than 40 percent of the doctors said they would still go ahead with the procedure! Vicious cycle Relief of symptoms such as shortness of breath is an important benefit for some angioplasty patients. But it might be difficult to talk many of those patients into having the procedure if they knew their heart attack risk would remain unchanged. And, even worse, that they would have new risks to consider… These days, stents are “drug-eluting.” That is, they’re treated with a drug that reduces scarring and inflammation of the artery that’s sometimes caused by stent insertion. But drug-eluting stents sometimes cause blood clots. Yes, you read that right–your stent that is being inserted specifically to reduce your risk of blood clots might actually CAUSE a blood clot! But don’t worry. Your doctor already knows that. And that’s why he will prescribe a blood thinner like Plavix or Effient. Unfortunately, all blood-thinning drugs increase the risk of bleeding. In fact, Effient comes with a black box warning about the risk of death due to “unexplained or excessive bleeding.” So in the end, this “routine” procedure can turn out to be fairly complicated. And for many patients, it becomes down- right dangerous–and provides no real benefit. If your doctor suggests angioplasty, ask why. Unless it’s to relieve some serious symptoms, figure out if there’s a better option for you, like one that actually decreases your chance of having a heart attack. Sources: “Kalamazoo medical community debates use of angioplasty” Julie Mack, Kalamazoo Gazette, 10/23/10, mlive.com “Drug Therapy More Cost-Effective than Angioplasty for Diabetic Patients with Heart Disease” Science Centric, 11/18/09, sciencecentric.com “Patients’ and Cardiologists’ Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease” Annals of Internal Medicine, Vol. 153, No. 5, 9/7/10, annals.org
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