Heart matters
Posted: Wednesday, January 23, 2008 4:41 PM by Sam Singal
By Robert Bazell, NBC News chief science correspondent
It is a debate that has been running through the history of modern cardiology. The first surgery to bypass clogged arteries to the heart was performed in 1967. Ten years later a doctor opened a clogged artery with a tiny balloon on the end of a wire inserted through a vein from the groin to the heart in a procedure called angioplasty.
Since then, tens of millions of Americans have had these procedures. This year alone more than 1.2 million will have angioplasties (most often augmented these days with tiny pieces of wire mesh called stents) and more than 460,000 will have bypass surgeries. These procedures have eliminated enormous amounts of suffering and saved lives. They are some of the major reasons why heart disease deaths have reached their lowest levels in modern times. I have written a personal perspective on the meaning of these procedures.
But the debate has been which procedure is better. Stenting with angioplasty would seem to be preferable but the problem is the unclogged arteries often close up again in the process called restenosis. That is why study after study has found that patients have better outcomes from the bypass even though it involves major surgery.
Tonight’s report on the latest study (and editorial) comes from the best kept records of heart outcome – New York state’s registry. The main conclusion: for people with more than one blocked artery surgery still wins. After 18 months the death rate was 7.3 percent for those who had surgery compared to 6 percent for those who had stents. This study looked at patients who got the new drug-eluting stents designed to limit the restenosis problem.
But these numbers still indicate that the choice is a matter of personal preference. It is important that the patient takes part. All too often cardiac patients go in for a diagnostic test in the same room where stents are placed and the doctor in control says “let’s just put a stent in and get this over with.” For years many doctors and others have charged that interventional cardiologists, as they are known, perform large numbers of unnecessary angioplasties and stents. I was once standing in a hospital in Florida when a doctor (who thought I was another doctor) bragged about performing angioplasties on people who did not even have a heart blockage – just to make money.
And it is important to remember that there is a third option. For large number of patient neither procedure – which costs $15 to 30 thousand dollars -- may be necessary. Often a good regime of medications with diet and exercise can control the problem. But doctors seldom offer that option with the same enthusiasm as they push the high tech, expensive fixes.
