Unnecessary stents?

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Thomas Jefferson University Hospital comes through again.

Do you really want a surgery you don’t need?

Coronary artery disease (CAD) is the most common form of heart disease in the US, and hd-coronary-adkills over 370,000 Americans each year. It involves a blockage in an artery carrying blood to the heart and can cause damage to the heart muscle and death.

The common form of treatment for a blocked coronary artery is a balloon angioplasty, and procedure that uses an endoscope to move a balloon to the blockage and inflate it, increasing the width of the artery and allowing blood to flow. The procedure may include placement of a stent to keep the artery open permanently. It’s a simple procedure and fairly common.

There are risks to the procedure, and about 3.3% of patients die. Risks include blood clots that can originate at the site of the blockage and travel to organs or the brain.

Oddly, while heart disease can occur anywhere in the US, it is most common in the Southheart_disease_deaths.png and lower Midwest, in states including Kentucky, Alabama, Mississippi, Arkansas, Louisiana and Oklahoma. What people eat in this region may put them at particular risk.

Doctors at Jefferson have found that some doctors mistake “coronary spasms” for CAD. The Jefferson team routinely treat patients with nitroglycerin prior to placing a stent, and noticed that for some patients, the nitroglycerin was sufficient to solve the patient’s medical issues.  The stent was unnecessary.

Their conclusion is that some angioplasties may be unnecessary.

According to Michael Savage, M.D., Director of the Jefferson Angioplasty Center and senior author of the report:

“Interventional cardiologists [cardio surgeons] should be especially suspicious of coronary artery spasm when they encounter a patient under the age of 60 with disease isolated to a single vessel. We recommend that future guidelines include intracoronary nitroglycerin for these patients.” (5)

However, nitroglycerin is not now part of treatment guidelines.  Thus the concern that some people are being put through surgeries that are of no value to them, and incur unnecessary cost and risk.

The surgery is of no value for artery spasms, as these can easily recur at a different place in an artery after the stent is installed.


Sources:

  1. US Centers for Disease Control and Prevention, “Coronary Artery Disease (CAD).” https://www.cdc.gov/heartdisease/coronary_ad.htm
  2. US Centers for Disease Control and Prevention, “Heart Disease facts.” https://www.cdc.gov/heartdisease/facts.htm
  3. Steve Sternberg and Geoff Dougherty, “Angioplasty: Risks and Benefits,” US News, 11 February 2015. https://www.usnews.com/news/articles/2015/02/11/angioplasty-risks-and-benefits
  4. Vishnevsky, A., et al. Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines. Catheterization and Cardiovascular Interventions, March 2017 DOI: 10.1002/ccd.27034
  5. Thomas Jefferson University. “A simple fix to avoid unnecessary coronary stents is overlooked by cardiologists and current cardiovascular guidelines.” ScienceDaily. ScienceDaily, 20 March 2017. <www.sciencedaily.com/releases/2017/03/170320125633.htm>.

 

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