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Consumer Reports Gives Incorrect Information About Angioplasty and CT Angiograms
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June 8, 2007 -- Last week Consumer
Reports posted their recommendations on angioplasty and CT angiograms,
as part of their CR Medical Guide web site. The article, titled "Angioplasty:
Resist the rush -- New view of heart disease stresses simpler, safer
methods", is available to the public without a
subscription.
The article is riddled with incorrect information
and assumptions and leaves one with the impression that coronary
artery disease is best treated with medications alone, or bypass
surgery, if it is severe. Angioplasty is characterized as a risky,
invasive procedure that "Hundreds of thousands of Americans
each year are being needlessly rushed into" and that CT angiography
is a completely useless test.
When the print version of this article was originally
published in March 2007, the leadership of The Society of Cardiovascular
Computed Tomography (SCCT), a professional society of more than 3,400
members, wrote a strongly worded Letter
to the Editor (PDF), disputing a number of the article's
conclusions and statements. For example, the original Consumer Reports
article stated that “CT angiography uses an ultra fast scanner
to measure the amount of calcium, a major component of plaque, in
the artery walls”. This was incorrect, and confused a test known
as CT Calcium Scoring with the more sophisticated test called CT
angiography. To their credit, the CR editors corrected this mistake.
But they let stand most of their other statements.
Angioplasty.Org often publishes corrections and
commentary on press reports that may incorrectly portray medical
information about interventional cardiology. But in this article,
there are so many faulty conclusions and "facts", that
we have listed the major flaws below, with corrections.
| Consumer Reports Claims: |
The Reality Is: |
| Overconfidence in CT angiography and drug-eluting
stents has encouraged the 3-fold increase in angioplasty over
the past decade |
Drug-eluting stents were only approved in the U.S.
a little more than 3 years ago; multislice CT scanners were just
becoming available in 2002-2003 -- other factors can account
for the increase, partially that the procedure became safer and
more predictable. |
| CT Angiography has little value |
Several studies have shown that non-invasive multislice
CT angiography has a high negative predictive value -- it can
definitively rule out coronary artery disease quickly, inexpensively
and with little or no risk. Since 1/3 of standard invasive angiograms
show no disease present, and 3-6% of patients experience complications
(bleeding, vascular, etc.) from these more invasive tests, the
use of CT angiography for intermediate patients whose stress
tests are inconclusive is most definitely valuable. |
| Angioplasty saves lives only when done shortly
after a heart attack. |
Angioplasty is considered the "gold standard" of
treatment for people in the midst of a heart attack. It's done during a
heart attack, not "shortly after". It literally stops
the heart attack in its tracks and saves the heart muscle. |
| Angioplasty can trigger a heart attack in 1 to 2 percent of
patients |
The New York State Angioplasty Registry for 2003 shows an in-hospital
mortality rate for elective (non-emergency patients) 5 times
lower than CR states -- only 0.32% |
| Drugs are better and safer than angioplasty and
can prolong life |
The recent COURAGE trial only showed that adding
angioplasty to drug therapy didn't prolong life or reduce heart
attacks. But it didn't increase any negatives either. Both treatments
were shown to be equally safe and equally effective. Furthermore,
not only did the angioplasty patients experience less angina,
one-third of the "drug therapy only" patients wound
up crossing over to get angioplasty because their angina was
not being controlled sufficiently. |
| People with angina should almost always start with
lifestyle changes and medication, not angioplasty. |
This is exactly what the AHA, ACC and SCAI recommend,
and what is currently considered "best practice guidelines".
Start with "optimal medical therapy" of lifestyle change
and drugs and move to an intervention (angioplasty or surgery)
only if the pain is not controlled. (An interesting lesser publicized
finding: 1 in 4 patients were still experiencing angina after
5 years, regardless of which treatment they received.) |
What is completely omitted from Consumer Reports
article is the importance of recognizing the symptoms of a heart
attack quickly and calling "911" -- and getting immediately
to a hospital which can perform emergency angioplasty. All the major
heart associations and professional groups have banded together in
a "Door-to-balloon" initiative to treat heart attack victims
more effectively.
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