The coronary angiogram is often referred to as a road map of the heart. As such, it serves the cardiologist and cardiac surgeon well. It shows where the coronary arteries are, how they intersect, the angles of the branches, etc. There are diagrams of these anatomical features in many textbooks, but the reality is that these characteristics can vary from individual to individual, so it’s necessary to get a road map for each individual in whom an intervention is being contemplated. Then, of course, there’s the issue of narrowings in the coronary arteries. Should these receive stents? Should they be bypassed? Should they be left alone and treated with medical therapy? Continue reading
Category Archives: Heart Attack
Let’s Disagree to Agree: the Not-So-Great Coronary Angioplasty Debate and a Patient’s Right to Speak
I read yesterday morning that I was now a party to “The Great Coronary Angioplasty Debate.” (Note to self: don’t look at Twitter before Sunday brunch.)
This all started a week ago, when Dr. Nortin Hadler posted an op-ed piece on The Health Care Blog, titled “The End of the Era of Coronary Angioplasty.” He opined that angioplasty was unnecessary in the setting of a major heart attack (a.k.a. STEMI) and might even worsen outcomes. His title and thesis was so over-the-top (intentionally so, I’m sure) that I felt obliged to pen a response to his very anti-stent article. Continue reading
How does a physician treat a heart attack where the blood flow to the heart muscle is suddenly cut off by a blocked artery? In the most severe cases, the ST segments on the ECG are elevated, signalling that a major part of the heart muscle is at risk. It’s called a STEMI (ST-Elevated Myocardial Infarction). And, if you subscribe to the concept that the heart and circulation are like the plumbing in your house, like Dr. Charles Dotter did (he invented the concept of angioplasty and, in his offbeat humorous way, he used the graphic to the left as his logo), then you would assume there are two major ways to treat the problem: use Drano to dissolve the blockage or use a mechanical roto-rooter to clear it out. Continue reading
I’m in shock. Dr. Nortin Hadler of the University of North Carolina has proclaimed that the era of coronary angioplasty is over.
Poor, poor angioplasty…you were barely 36 years old, but you’re no longer needed. Guess we’re going to have to find a new name for our web site!
Of course, my first thought upon seeing this Op-Ed piece posted today on The Health Care Blog was that it was yet another article railing against the overuse of stents in patients with stable angina. Continue reading
Yesterday’s edition of USA Today carried an article by Peter Eisler titled, “Six common surgeries often done unnecessarily” — and, you guessed it, angioplasty and stents were at the top of the list of “six common surgeries that carry significant risks of being done without medical necessity, according to federal data and independent studies.”
I was a bit taken aback because I was not aware of any new study, federal or independent, that concluded stents were being vastly over-used. And it turns out that there wasn’t one. Continue reading
A new article about transradial angioplasty (the placement of a stent using the radial artery in the wrist) appeared today in the Cleveland Clinic’s Heart & Vascular Health Blog, authored by their “Beating Edge Team.” Titled, “Unclogging Blocked Arteries Via the Wrist: Angioplasty approach may offer clinical benefits for certain patients,” the article’s purpose seems to be to familiarize patients with this new alternative approach to diagnostic angiography and angioplasty, “now being offered” at the Cleveland Clinic.
Unfortunately this short article, while supposedly an “advertisement” for wrist angioplasty, continues to promulgate several widely-held myths about the radial approach. Continue reading
Something that is “on the table” is defined as an item that is “up for discussion.” And this week The Society for Cardiac Angiography and Interventions (SCAI) issued a consensus statement about the proper use of “ad hoc PCI” — and the patient was definitely on the table, up for discussion, part of the conversation.
Since we’re into definitions, ad hoc PCI is the scenario in which a diagnostic catheterization is followed in the same session by PCI (angioplasty and stents). And this is a common scenario: in New York State, for example, 80% of all angioplasties are done in the same session as the diagnostic angiogram, although the vast majority of these are emergency or primary angioplasties, where a patient in the midst of a heart attack (or close to it) is brought into the cath lab and the blockage is opened up, saving the heart muscle and possibly the patient’s life. Continue reading