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December
6,
2010 -- 1:15pm EST
Kick-Ass Stents
I
wrote about this issue over a month ago (see "To
Stent or Not to Stent: That is the Question!") but today's
newspapers are filled once again with the sad story of Maryland cardiologist
Dr. Mark Midei, St. Joseph's Medical Center and the alleged hundreds
of unnecessary stents placed in patients who didn't need them. This
sudden renewed interest comes as the Senate investigational report
by Senators Baucus and Grassley into this matter was made available
-- and into the mix of the story was added a pig roast, the Philadelphia
mob,
Abbott
Vascular's celebration of Midei implanting 30 of their stents in a
single day and an email from a company executive, suggesting that someone
take a Baltimore Sun reporter outside and "kick his ass!"
Hello PR Department.
I've got a number of thoughts about all this and
will post a more extensive commentary later on, but one major issue
in
this whole saga is whether or not the stent placements were "unnecessary",
and I ask readers to go back to my October
post. Doctors can disagree
on whether a stent is called for -- especially when they are being
guided by the angiogram (X-ray image). And in Midei's case, two
sets of well-known and highly-respected cardiologists have disagreed
in most of the disputed cases.
But a technology exists that would have added a whole
data set to these cases: it's called Fractional
Flow Reserve (FFR) and it yields a
number that can be used as a decision-point about whether to stent
or not. The technology is backed up by two-year results from a
major study (FAME) that showed improved outcomes with less stents when
decision-making was guided by FFR instead of angiography alone --
and the use of FFR has been bolstered by an increased level of evidence
from the recent
AHA/ACC/SCAI Guidelines Update.
So why is it used in only 15% of cath labs?
More later....
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