January
4,
2011 -- 5:55pm EST
Angioplasty and Stent Use Cut in Half -- Sort
of...
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 The balloon is then deflated and withdrawn, leaving the stent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."
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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.
Guess so....
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