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Consumer Reports Gives Incorrect Information About Angioplasty and CT Angiograms

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.