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Are Stents a Scam?

Angioplasty is a surgical procedure often recommended after an arterial blockage has been found in the heart muscle. Your heart requires a strong oxygen and nutrient supply, like other muscles in your body. There are two major coronary arteries that supply the left and right sides of your heart. By branching into smaller arteries they are able to supply the entire muscle with blood.

The goal of coronary artery angioplasty is to repair or unblock the blocked artery. During the procedure the surgeon inserts a thin expandable balloon that is inflated to flatten the blockage against the arterial wall.1 After the balloon is removed, the surgeon often places a stent with the intention of keeping the artery open and blood flowing freely.

There are currently five types of coronary artery stents available, each with different advantages and disadvantages to placement.2 However, while the different types of stents offer options for those for whom a stent is absolutely necessary, research shows those with stable coronary artery disease, stable angina, do not require stents.

Recent Study Finds Stent Placement May Not Be Better Than Placebo

In a recent study published in The Lancet, researchers from Imperial College London investigated the difference between patients who had received a stent for stable angina and those who underwent a placebo intervention.3 In the short video above, lead author and interventional cardiologist Dr. Rasha Al-Lamee, describes the study and its results.

The researchers recruited 200 participants with severe single vessel blockage from five sites across the U.K.4 During the initial six weeks, all patients underwent an exercise test followed by intensive medical treatment. At that point they were randomly assigned to two groups. The first underwent a percutaneous intervention (PCI) during which coronary angioplasty was performed and a stent was placed. The second group also underwent a PCI procedure with an angiogram but without a balloon angioplasty or stent placement.5

For the following six weeks, neither the patient nor the physician knew if the patient received the stent. At the conclusion of the six weeks, patients again underwent an exercise test and were questioned about their symptoms. The researchers found both groups experienced nearly identical improvements in exercise tolerance and no difference in reported improvements of their symptoms.6  From the data, Al-Lamee commented:7

"Surprisingly, even though the stents improved blood supply, they didn't provide more relief of symptoms compared to drug treatments, at least in this patient group. It seems that the link between opening a narrowing coronary artery and improving symptoms is not as simple as everyone had hoped."

The results were presented at the Transcatheter Cardiovascular Therapeutics symposium in Denver. Not surprisingly, the Society for Cardiovascular Angiography and Interventions (SCAI) questioned the conclusions, believing the surgical PCI is the preferred treatment.

The president of SCAI, Dr. Kirk Garratt, commented on the study, saying,8 "In 2017, we don't subject stable patients without symptoms to PCI, so this study doesn't properly reflect current PCI practice. Convenience and medication side effects are also big concerns for patients."

Recent Study Supports Previous Findings

Previous analysis of the benefits of stent procedures supports findings from the featured study. Patients in the U.S. spend $60 billion a year on invasive cardiovascular procedures.9 Although only 5 percent of the world's population lives on U.S. soil, Americans undergo half of the world's bypass surgeries and stent placements. Of these stent placements, up to 50 percent may be done unnecessarily based on current medical guidelines,10 which is inconsistent with Garratt's assertion the procedure is done only when necessary.

In one study involving over 140,000 patients across more than 1,000 hospitals, researchers found nearly half of the stent procedures were unnecessary.11  Senior cardiologist in Apollo Health City, Hyderabad, India, Dr. Manoj Agarwal, commented on the overuse of stents, saying:12

"If you use a stent when the blockage is not significant or if it is in a non-critical artery, that is misuse and unethical. But there is no monitoring in India. The onus of monitoring ought to be on the institutions or hospitals where the procedures are done.

For many patients, undergoing an invasive procedure may put their minds at rest due to the ignorance surrounding the benefit of stents, when in fact a worryingly large majority are undergoing a procedure that will bring absolutely no benefit to their long-term prognosis."

In one study, researchers found 7.6 percent of those undergoing angioplasty experienced at least one serious side effect during hospitalization.13 More recent reports indicate serious complications may be experienced by up to 5 percent of individuals undergoing angioplasty.14 One of the largest hospital chains in the U.S., Hospital Corporation of America (HCA), came under scrutiny in 2012 when allegations were made that thousands of unnecessary heart procedures were performed.15

An investigation into HCA physicians revealed the doctors were unable to justify many of the procedures performed and in some cases made misleading statements in the medical records, making it appear the procedures were necessary to protect the life of the patient.16 Although HCA denied these decisions were financially motivated, cardiac procedures are among the more lucrative measures taken in hospital.17

Edward Hannan, Ph.D., from the University at Albany SUNY, was interested in how well physicians adhered to recommendations by the American Heart Association (AHA) and the American College of Cardiology (ACC). He and his colleagues gathered data from 58 hospitals in New York State and found a mere 36 percent met the criteria to undergo the procedure.18

Thus, while the featured study called into question the effectiveness of most angioplasty and stent insertions, many hospitals are also performing these procedures in unnecessarily large numbers.

Procedure Is Dangerous and Expensive for a Psychological Benefit

More than 1.5 million angioplasty and bypass surgeries are done each year in the U.S., making them the most commonly performed procedures.19 Although Americans are seven times more likely to undergo these surgeries than patients from Canada or Sweden, the death rate per capita is nearly identical in all three countries.

The AHA recommends angioplasty and potential stent placement if you are experiencing consistent chest discomfort or pain, or if the blockage puts you at immediate risk of heart attack or death. Dr. Catalin Toma, director of interventional cardiology at the UPMC Heart and Vascular Institute, commented on the results of the featured study, saying:20

"Telling someone that they have a 90 percent blockage in an artery is an anxiety-inducing concept. And medications will treat the symptoms but not the blockage itself. A patient can have a hard time wrapping his or her mind around that. If the artery is blocked, they might think they need it to be unblocked."

He hopes the study will reduce the "knee-jerk reaction" physicians and patients have that any blockage should automatically require the placement of a stent. Dr. John Mandrola, cardiac electrophysiologist in Louisville, Kentucky, points out that he and many other physicians have watched patients report less chest pain, more energy and greater stamina after an angioplasty and stent.21

Mandrola elaborated that the thinking is that blockages are deadly and must be fixed. Thus, if a physician performs an angioplasty and shows the patient and family pictures of unblocked arteries, everyone is happy and the patient feels better. Mandrola continued:22 "This is a hugely disruptive study. The implications are huge. Billions of dollars have been spent, and many hundreds of thousands of patients have been exposed to the risks of PCI, without any documented benefit."

Dr. Rita Redberg, professor of medicine at the University of California San Francisco added:23 "I've been saying for many years that we don't know if patients feel better from stents, or if they feel better because patients always feel better when we do an invasive procedure. That's how the mind works."

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