HEALTHY LIVING


Do You Really Need a Cardiac Stent?


New study challenges current guidelines. :: BY CHRIS ILIADES, M.D. H


eart disease is still the No. 1 cause of death for Americans, but there is good news.


Fatal heart attacks have been


dropping steadily over the past 20 years.


According to the Centers for


Disease Control and Prevention (CDC), heart attack deaths have decreased from 87 deaths per 100,000 people to 38 deaths, a drop of over 50%. The decrease is due to fewer


heart attacks and more effective treatments. “One treatment that has led to


better survival is balloon angioplasty and the use of cardiac stents,” says Farshad Forouzandeh, M.D., Ph.D., associate professor of medicine and cardiology at Case Western Reserve


University School of Medicine and an interventional cardiologist who performs these procedures. Over 1 million stents are placed in


the U.S. every year, so it is likely that you or someone you know has one. So, when a healthcare think tank


called the Lown Institute warned that 1 out of every 5 stents being placed in Medicare patients are unnecessary, it got media attention. A USA Today headline read:


“Once every seven minutes, a Medicare patient gets a coronary stent they don’t need.” But a new study, called Orbita-2,


presented just a few months ago at the American Heart Association’s annual scientific meeting suggests many stent placements considered unnecessary under the current guidelines may improve chest pain, exercise capacity, and quality of life.


STENT BASICS Angioplasty, also called percutaneous coronary intervention (PCI), is the procedure performed to open a blocked heart artery and restore blood flow to the heart. Blood vessels that supply the heart


muscle can become narrowed from coronary artery disease, decreasing blood flow to heart muscle, called ischemia. Ischemia causes a type of chest pain called angina. Coronary artery disease with


severe ischemia can cause a more dangerous type of angina, called unstable angina. If a blood clot forms in an already


narrowed artery, unstable angina may quickly become a completely blocked artery, causing a heart attack. This requires an emergency PCI and stent procedure. During this procedure, usually


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