Angioplasty and Stents Inappropriate Only 4% of the Time

Are Stents Appropriate?A major study of a half-million angioplasties, published today1 in the Journal of the American Medical Association (JAMA), refutes two major myths about angioplasty and stent use in the United States: myth #1, that angioplasty is vastly overused and unnecessary in most cases; and myth #2, that most angioplasty is used in stable patients and therefore has little or no benefit over drugs in reducing death or heart attacks.

Titled “Appropriateness of Percutaneous Coronary Intervention“, this paper is the first comprehensive look at how closely interventional cardiologists in the U.S. are adhering to the practice guidelines for PCI (angioplasty and stenting) most recently published by the professional cardiology and surgical societies in January 2009.

So…cut to the results! Of the 500,154 procedures studied, only 20,731 (4.1%) were deemed “inappropriate”. And more than two-thirds of the procedures were done in patients who were having a heart attack or who were unstable and at an extremely high risk for having an acute event.

“Great work,” Dr. Ralph Brindis, immediate past-President of the American College of Cardiology, told me. He continued:

“What’s so fascinating about this study is the good news: that in general we’re pretty appropriate. An important point is that 71% of all angioplasty is performed for either STEMI, NSTEMI or for acute coronary syndrome (ACS) or unstable angina…. So this is actually in contradistinction from the first page of the COURAGE Trial in the New England Journal which implied that maybe 70% or more of angioplasty is for stable angina in the United States…and that simply is not true! Well over 70% of all angioplasty in the United States is for acute syndromes.

Actually Dr. Brindis was being generous. The COURAGE Trial put the prevalence of angioplasty in stable patients at 85% when it is actually at 29% — the exact opposite!

So, who cares? What does this matter to patients? Isn’t this just another internal dispute in the medical community? Actually, not! The take-home message from this study is of vast importance to patients. Angioplasty, when performed during an acute episode (71% of the time) can save your life. If you think you are having a heart attack, get to a hospital that performs angioplasty ASAP. Angioplasty can stop a heart attack in its tracks!

Angioplasty.Org will be reporting in more detail about this study, and will also be posting exclusive interviews with Dr. Paul Chan, lead author of the JAMA study, Dr. Ralph Brindis, immediate past-President of the ACC and guiding light for the NCDR registry, and Dr. Gregory Dehmer, former President of the SCAI and co-author of the Appropriateness Criteria.

But take the following incorrect and distorted “dreadlines” from today’s news with a grain of salt — unless, of course, you have high blood pressure:

Heart Procedure to Clear Arteries May Be Misused 12% of Time, Study Finds” — Bloomberg News

Angioplasty unnecessary in some cases, study finds
– CNN

Study Finds Too Many Elective Stent Procedures” — MedPageToday

Many US heart stents inappropriate: study
– Reuters

And stay tuned to Angioplasty.Org.

1 Appropriateness of Percutaneous Coronary Intervention ; JAMA. 2011;306(1):53-61.doi:10.1001/jama.2011.916

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Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage

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