HEALTH MATTERS: Angioplasty most often an appropriate and justified procedure, studyQ. My husband recently suffered a small heart attack and had an angioplasty performed and a stent inserted soon after his symptoms began. But I just read a news report about a recent investigation that suggested that almost half of the angioplasties performed may not be necessary. Do you think that my husband really needed it?
By: Dr. Joshua Wynne , Grand Forks Herald
Q. My husband recently suffered a small heart attack and had an angioplasty performed and a stent inserted soon after his symptoms began. But I just read a news report about a recent investigation that suggested that almost half of the angioplasties performed may not be necessary. Do you think that my husband really needed it?
A. Based on the findings in the medical study that you mentioned, the answer is almost certainly “yes.” Let’s look at what the study found in a little more detail. The study looked back at a large number of angioplasties (more than 500,000) that were performed in more than 1,000 hospitals in the United States during 2009 and 2010 and compared the indications for the angioplasty with the current guidelines that we use to help doctors decide what to do in a given situation.
More than two-thirds of the angioplasties were performed during a patient’s heart attack, chest pain or other acute episode (so-called acute coronary syndromes or ACS), just like your husband’s procedure. Ninety-nine percent of those patients had angioplasties that were judged to be indicated according to the guidelines.
So what is the basis for the news report suggesting that half of the angioplasties were not indicated? It turns out that the news report only dealt with the roughly 30 percent of patients who were stable and not having an ACS at the time of their angioplasty. In that group, 50 percent were felt to have appropriate indications for angioplasty, 12 percent were felt to have inappropriate (that is, unjustified) angioplasties, and in the remaining 38 percent of stable patients, it was uncertain whether the angioplasties were appropriate.
It is only if one assumes that all of the uncertain cases were inappropriate that one might conclude that half of stable patients might not have needed an angioplasty. But the study didn’t conclude that. In fact, if one looks at the results for all of the more than 500,000 patients in the study, only about 4 percent of all patients had what were felt to be inappropriate angioplasties — a far cry from nearly 50 percent!
Q. I am trying to convince my wife to lead a more healthful lifestyle, but she isn’t convinced, and says that heart disease is a disease of men. What should I tell her?
A. Tell her that heart disease is the No. 1 killer of women, just as it is with men. While it is true that women suffer from less coronary heart disease during their childbearing years, after menopause they lose that advantage over men.
A recent study showed that the risk of sudden cardiac death in women correlated with four risk factors — cigarette smoking, obesity, physical inactivity, and poor diet. While the overall risk of sudden cardiac death was very small (less than one half of 1 percent over the 26 years of the study), women who didn’t smoke, kept their weight at target levels, exercised for at least 30 minutes per day, and ate a diet that emphasized grains, fruits, nuts, fish and moderate alcohol intake (defined as no more than one drink/day) had a 92 percent lower risk of sudden cardiac death than women who smoked, were overweight, didn’t exercise and ate a poor diet.
I hope that this information helps you to convince your wife to follow a more healthful lifestyle!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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