A lost story this past couple of weeks has been an “admission” by the American Heart Association that the number of angioplasties performed in the United States is actually half of what the AHA has been saying all these years.
In their most recent 193-page Heart Disease and Stroke Statistics 2011 Update, published on December 15, the AHA now states that 622,000 percutaneous coronary interventions (PCI) were performed in 2007 (the most recent period for which stats have been compiled). Previously the AHA reported an annual volume of around 1.3 million — double the number.
How could this be?
Note the graphic to the right: you’ll see the wire mesh stent mounted on a balloon (shown here expanded). In almost all PCI procedures, a deflated balloon with stent is delivered to the blocked area of the coronary artery. The balloon is inflated, opening the blockage. At the same time, the stent is expanded against the vessel wall. The balloon is then deflated and withdrawn, leaving the stent in place.
Turns out the AHA had been double-counting: procedure one, the balloon is expanded (a.k.a. balloon angioplasty); procedure two, the stent is placed. That was two procedures to the AHA.
Except it’s really only one procedure.
This discrepancy had been pointed out to the AHA for some time, most notably by The Society for Cardiovascular Angiography and Interventions (SCAI) and this year the AHA finally accepted SCAI’s recommendation.
So what? Well, the AHA annual stats are used by many organizations for many reasons. As SCAI president Dr. Larry Dean stated in a press release:
“…accuracy about procedural volume is of utmost importance as the country develops strategies for improving healthcare systems and reducing costs…. It should give everyone pause to realize that the main citation was incorrectly doubled. We hope government agencies, healthcare economists, journalists, and others participating in the healthcare debate with new perspective on the growth of interventional procedures in recent years.”
Right! Like three years ago when the COURAGE study was presented and anti-stent opinion reached fever pitch, with then-AHA president Dr. Raymond Gibbons declaring to the news media that “hundreds of thousands of Americans with stable angina who received coronary stents did not need them “.
Err, I meant half the hundreds of thousands of Americans…err…what did I mean?
COURAGE addressed only patients with stable angina and found that the addition of stents to medical therapy did not decrease mortality or heart attacks in those patients (although they did relieve angina). At the time, interventional cardiologists defended themselves by stating that most patients who received stents were not those with stable angina — and that far less people with stable angina were being treated with stents than was being claimed.