Angioplasty Patient Often Misled

The most frequent heart surgery performed in the USA is elective angioplasty (also known as PCI). In 2004 about a million PCI procedures were performed on patients with stable coronary artery disease. Simply put they had narrowed arteries in their hearts but were not in the midst of a heart attack.

Many of these patients do not even have angina but were simply shown to have one or more significantly narrowed coronary arteries. Understandably when patients are told they have narrowed coronary arteries from atherosclerotic plaques they become concerned about having a heart attack. Often their physicians tell them with the advanced disease they have they could have a heart attack and die at any moment. Patients want to know what can be done and more often than not their doctors promote angioplasty to open up their most narrowed coronary arteries. Now if angioplasty cut their risk of suffering a heart attack or dying from one then an elective procedure would certainly make sense. The problem is that the results of the COURAGE study clearly showed angioplasty was of zero benefit for cutting the risk of having a heart attack or dying from a heart attack. Indeed, the COURAGE trial showed PCI is only modestly more effective than standard pharmacological treatment alone for reducing angina. Most of the interventional cardiologists are well aware of the fact that PCI is of little benefit for the treatment of angina and useless for preventing heart attacks or saving lives. Dr. Rita Redberg at UC San Francisco recently told Heartwire in an interview that, “Everyone, even the interventionalists, came out after the COURAGE trial and said, ‘This is nothing new, we know that PCI doesn’t prevent heart attack or make you live longer; we don’t do PCI for that reason.’”1 Unfortunately, while those doing the PCIs may know the truth about the limited benefit of what they are selling and profiting from doing they are apparently doing a very poor job of informing their patients about what PCI can and cannot do. Table 1 below shows a survey of 350 patients who underwent PCI in 2006 and 2007. Dr. John Lee presented the results of his survey at the American Heart Association meeting in New Orleans. Dr Lee reported that 71% of these patients believed their angioplasty had cut their risk of having a heart attack. Most believed they would live longer and one-third believed their elective procedure was actually an emergency and 42% believed it saved their lives. None of these beliefs are true. Indeed, the only thing angioplasty actually accomplishes is a modest reduction in angina. Because patients feel the angina they actually know whether the procedure made much difference. Only 31% of patients believed their angioplasty reduced their angina symptoms.

Bottom Line: It is likely that if all cardiologists doing these procedures told their patients the truth about their disease and the little or no benefit they could expect from PCI the number of these procedures would be declining rapidly and this is not the case.The simple truth is that atherosclerosis is largely caused by a poor diet and other lifestyle choices and can usually be reversed if people consumed a diet composed largely of whole grains, fruits, vegetables, modest amounts seafood, and a lot less salt. In addition exercise and quitting smoking and for some statin or other drugs would shrink the atherosclerotic plaques, get rid of the angina, and dramatically cut the risk of dying from a heart attack. Simply put, diet and lifestyle can potentially deliver what most people who undergo angioplasty are being misled into believing they are getting from angioplasty. By James J. Kenney, PhD, RD, FACN 1. theheart.org/article/print.do?primaryKey=920657 Table 1.The percentage of patients who had elective angioplasty that believed the following were true:

Patient Beliefs	%
Procedure would help prevent a heart attack	71
Procedrue would extend life	66
Procedure saved their life	42
Procedure was an emergency	33
Procedure decreased angina symptoms	31

The most shocking finding is that only 31% actual thought the procedure reduced their angina, which tells you that while the improvement in angina is statistically significant, it is clinically not very impressive as most patients do not perceive a benefit.The initial cost of angioplasty procedures typically run about $20,000 to $30,000 but that does not include the cost of Plavix for a year or longer to prevent blood clots and the cost of complications, which include retenosis (re-clogging), damage to the lining of blood vessels (that probably speeds up atherosclerosis), blood clots and occasional death. The cost can be higher with the drug eluding stents that can cost $2000 to $3000 each and some patients have several put in in one procedure.