A new report finds that heart stents may still be overused. Although lifesaving in some cases, the report found that, in many cases, stents are being implanted in patients who are not really experiencing benefits from the delicate procedure.
More than 500,000 Americans undergo stent procedures annually, according to The New York Times. The procedure involves propping open a narrowed coronary artery with a small, metal mesh tube. During emergency surgery, for instance, when a patient is suffering a heart attack, a stent can save a life. Studies have long revealed, however, that stents are being implanted in patients who do not realize any significant benefit from stent implantation.
In fact, last month, two major medical organizations—the American Medical Association and the Joint Commission—found that stent implantation, known as percutaneous coronary intervention, or angioplasty, is one of five very overused medical interventions, the Times reported. According to the groups, about 1 in 10 elective angioplasties performed in the United States are what might be considered “inappropriate”; another one-third are questionable.
Angioplasty is dangerous and costly, about $30,000 per procedure. In some rare cases, angioplasty can cause blood vessel wall tears, serious bleeding, and other problems, yet the procedure is still being conducted, according to the Times, and sometimes, when not necessary. Experts say that, in some cases, physicians’ reasons for using stents are financial—stent procedures bring big money to hospitals; in some cases, patients and their physicians simply don’t understand the nature of the procedure.
In a study published in The Archives of Internal Medicine, Dr. Lin wrote, “One of the beliefs among primary care physicians and cardiologists is that if you see a blockage and you open it, it must help in some way even if the data suggest otherwise,” according to the Times, “If you’re thinking of the arteries as plumbing and you see a narrowing, then your response is to try to open it.” Lin pointed out that some physicians were performing the elective surgeries for a variety of reasons that had nothing to do with medical necessity, such as because physicians felt the procedure would calm anxious patients; that improved stents would enhance patient health; that there would be guilt feelings if angioplasty was not performed and the patient suffered a heart attack in the future; or that opening the artery just had to help, despite information to the contrary.
We recently wrote that another study found that new medical practices—new medical techniques, screening processes—are often found to be ineffective based on follow-up research. The study involved a review of articles published in Mayo Clinic Proceedings over a 10-year period and revealed that newer medical practices, regardless of how broad their usage, were reversed on evidence-based research in many cases, according to MinnPost. The findings appear in this month’s issue of the journal. Use of stents to treat stable coronary artery disease, was among the practices involved.
A prior study also found that heart stents may be overused in the United States, specifically on patients diagnosed with stable heart disease. Among other things, the study found that when compared to medication alone, stenting with medication failed to result in reduced deaths, nonfatal heart attacks, emergency bypass procedures, chest pain, and other symptoms in four years of follow-up. In fact, one of the study’s researchers argued that there are too many stent procedures performed in the U.S. annually on patients not first offered medication to manage their risk factors for heart attack and stroke.
Although there are known benefits to opening newly blocked arteries during heart attack, many studies have found little benefit for performing angioplasty with or without stents when not in an emergency situation
