Study Finds Elective Angioplasty Often Unnecessary

Many of the 600,000 angioplasty procedures performed each year may be unnecessary, according to a new study. The study, published in the Journal of the American Medical Association, is the latest evidence to suggest that cardiac stents are being overused.

Angioplasty procedures, which usually involve the use of heart stents to widen blocked blood vessels, cost the U.S. healthcare system about $12 billion per year. This latest study looked at more than 500,000 stenting procedures conducted at over 1,000 hospitals between July 2009 and September 2010.

The study found that about 70 percent of angioplasties were done on emergency patients who were experiencing heart attacks or were at immediate risk. According to the study, for the most part, those procedures were necessary.

But of 145,000 non-emergency procedures that were conducted in patients without angina or whose diagnostic stress tests showed no heart risks, 38 percent were categorized as questionable and 11 percent were found to be inappropriate. The study authors found that these procedures were unlikely to benefit those patients.

A quarter of the hospitals involved in the study had an inappropriate case rate of 6% or under, while another quarter had an inappropriate case rate of more than 16%.

“This tends to confirm concerns that many people have expressed—that there are many thousands of patients who undergo coronary interventions for very questionable indications,” Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, told The Wall Street Journal.

This is not the first report to point to overuse of angioplasty and cardiac stents. In 2008, a study published in the New England Journal of Medicine called COURAGE—Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation – found that stents weren’t any better than drugs in treating patients suffering from chronic but stable chest pain.

In December, we reported that Baltimore surgeon Mark Midei had come under scrutiny for implanting allegedly unnecessary cardiac stents in hundreds of patients at St. Joseph’s Medical Center in Towson, Maryland. According to a Senate Finance Committee report, Abbott Laboratories, a stent manufacturer, provided Midei with many perks at the time. This included a pig roast to mark an occasion in which the surgeon may have broken an Abbott record by implanting 30 stents in one day. Midei was ranked as one of Abbott’s top-volume surgeons in the Northeast U.S. region, and Abbott’s business plan included funding Midei’s research and sending him on “VIP trips.”

According to the Senate report, Abbott hired Midei as a sales consultant after St. Joseph’s barred him from operating on patients. Midei is now accused of needlessly implanting stents in more than 500 patients, and could lose his medical license. After Midei left the medical center, the number of patients who received stents at St. Joseph’s fell to 116 in 2009 from 350 the year before, according to The Wall Street Journal.

Other instances of stent overuse include a case in which 141 patients underwent unneeded angioplasties at Westmoreland Hospital in Western Pennsylvania in 2010. According to a report from The Pittsburgh Tribune Review, the questionable stents were implanted by Drs. Ehab Morcos and George Bousamra, who voluntarily resigned their privileges at Westmoreland in January.