Most angioplasty procedures unnecessary???

[Laker]

http://www.webmd.com/heart-disease/news ... nnecessary

This broke a few days ago and just wanted to post something on it. Apparently the drugs are just as good if not better than the stents. This really is going to cut into the "turf" of ICs. I have the same concerns regarding drugs with DWs field.

What are you toughts?

[Flynn]

DH and I have some time together today and I plan on asking him his take on this.

Granted, he's a surgeon through and through but he's always said "we'll pay the price as a society for all these unecessary stents in the future."

I'll email him the article before I log off!

[Momo]

Actually this came out earlier this year. It's just that one of the big cards conferences was going on this week, and the media always runs w/ the big presentation of the day...so this hit the air waves again.

I always send DH articles from on-line, as well as the links to the TV/radio media coverage, on stories like these, because I figure this is the stuff his patients see/hear read and may ask him about.

Bottom line he said he's not too worried about it. His patients are told about their options. Decent ICs will know which cases are better left untouched, which ones to give to their CTS guys, and which ones they should do. My DH said you'd be surprised by the amount of patients that will insist they would rather have the procedure (cath) over prescription drugs!!!??

[pstone]

My DH said you'd be surprised by the amount of patients that will insist they would rather have the procedure (cath) over prescription drugs!!!??

I believe this is because we are 'taught' (incorrectly) that surgery is the best way. Quick fix, lose weight, fix your heart, etc...

I bet they don't go down in number, which will mean lots of Docs care more about billing (hospitals too)

[PrincessFiona]

OK...I'm such an airhead today that I was sitting here thinking "Well, of course most nose jobs are unnecessary" DUH, Kris..that's rhinoplasty....

kris

[Momo]

OK...I'm such an airhead today that I was sitting here thinking "Well, of course most nose jobs are unnecessary" DUH, Kris..that's rhinoplasty....

...oh kris...are you tired???

[Flynn]

Okay I'm going to chime in here.

This is a LAYERED discussion. There are no pat answers here.

There are basically three ways to treat a blockage: drugs, stents, and surgery. In order to get to a surgeon, more than likely you go through a Cardiologist which is a non-surgical speciality. CT surgeons get a LARGE amount of refurrals through cardiologists and cardiologists do the procedure known as stents.

Drugs are very effective for a percentage of people with a blockage. The article that sparked this debate proves this as well as countless others (see the NE Journal of medicine in the last three months). This is nothing new in the surgical community.

Surgery (CABG) is still the best option for a multi - vessel blockage. I have countless articles to prove this but they are all 10 pages or longer...didn't want to post and bore the heck out of you!!! Interestingly the mortality rate for a stent and surgery is the same -- about 2% but as a patient, if you hear "stent vs. surgery" what are you going to choose? The doctor plays a HUGE role here with what the patient has done. HUGE.

Many times the Cardiologist decides whether the patient needs any of these options: drugs, stents, or surgery. This is without consults from other specialities. Stents MAY fix the issue for life. The article provided for this debate proves that drugs are extremely effective for a percentage of patients. Without other issues, surgery does fix the issue (blockage). There is a place for stents. Absolutely.

Are stents overused? (it does seem so based on countless articles)
Why? (it makes a ton of money for the hospital, patients seem to want this procedure, and it's fun to do?)

It seems to me that drugs should be at least tried before any other action is attempted assuming this is a responsible choice for the individual patient. It is up to the doctor to guide the patient and give them all the relevant information.

[Rapunzel]

DH is going into cardio-thoracic imaging (non-interventional - "officially" though he's been focusing on this for awhile now) so we also had quite an interesting discussion about this - particularly given the politics between cardiologists and ct radiologists - interventional and noninterventional.


Mostly he just chuckled.... And, pointed out for the sake of fairness that the study was funded by pharm companies (and the stent companies would have nothing to do with it).


But, his other thoughts - well, I'll just leave that alone. It's the internet after all....