AMA NEWS FLASH, PATIENTS NEED FEWER STENTS

Researchers say patients may benefit from having fewer stents implanted.

The Wall Street Journal (10/15, D3, Winstein) reports, “Heart patients may be better off receiving fewer artery-opening stents,” according to two new studies. These “findings may lead to more careful placement and less use of the tiny scaffolds, which prop open clogged arteries to restore blood flow and relieve chest pains. That could reduce deaths, heart attacks, and repeated surgeries.”

        In the first study, cardiologist Nico Pijls, of Catharina Hospital in the Netherlands, and colleagues recruited about 1,000 patients, and conducted tests to determine “whether a technique to measure blood flow in the blocked artery, known as fractional flow reserve, allowed doctors to better gauge where a blockage was serious enough to do an angioplasty,” Bloomberg News (10/15, Ostrow, Nussbaum) adds. The researchers found that “those tested with a blood-flow meter were given stents one-third less often than a group examined only with angiograms. In the latter group, 18.4 percent died, suffered a heart attack, or needed a bypass surgery or repeat stent procedure after one year, compared with 13.2 percent among those tested with the blood-flow meter.”

        The Milwaukee Journal Sentinel (10/15, Fauber) reports that, for the second study, which was published in the Oct. 15 issue of the Journal of the American Medical Association, lead author Rita Redberg, M.D., of the University of California, San Francisco, and colleagues, analyzed “23,887 Medicare cases and 1,630 commercial insurance cases.” The researchers found that “most elective angioplasties…are done without first checking to see if the procedures are needed by doing a non-invasive stress test.” Therefore, they concluded that “some angioplasties are being done on patients for whom the risk outweighs the benefit, leading to costly, inappropriate, invasive procedures and unnecessary risk.” The Journal Sentinel notes that these findings are “the latest indication that elective angioplasty, which has increased by 300 percent over the last decade, has been overused.”

        HealthDay (10/14, Edelson) pointed out that “guidelines generally say that a stress test…should be performed in such cases.” But, this study “found that just 44.5 percent” of participants “had stress tests before they underwent PCI [percutaneous coronary intervention]. That percentage varied widely, not only geographically, but also by patient characteristics and the age of the doctor doing the PCI.” For instance, “the regional incidence of stress testing varied from 22.1 percent to 70.6 percent…with doctors in the Northeast and Midwest performing best. Stress tests were less likely to be done for women, anyone 85 years of age or older, or someone having other illnesses, such as congestive heart failure, lung disease, or rheumatic disease.” According to Dr. Redberg, some of these issues “may be clarified by new guidelines expected to be released shortly by the American College of Cardiology.” Those guidelines will contain “appropriateness

 criteria that say that in such-and-such a situation, a PCI would be appropriate.” MedPage Today (10/14, Bankhead) also covered the story.

 

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