Unwanted Stents Up Chances Of Cardiovascular Disease

Mumbai, 8 June 2018: Chances of cardiovascular disease increase with the number and length of stents used during an angioplasty, revealed the first-of-its-kind study that was funded by department of public health, Maharashtra.

Authors of the study slammed the practice of over-stenting and said responsible stenting can not only improve patient’s survival chances but reduce cost of treatment — in turn reducing patient’s and government’s expenditure. Cardiac stents are small expandable tubes, which are used to treat narrowed or weakened arteries. It is typically made of metal mesh and implanted in narrowed coronary artery.

The study, ‘Survival outcomes post percutaneous coronary intervention (angioplasty with stents): Why the hype about stent type? Lessons from a healthcare system in India,’ was initiated in 2012 by former public health secretary Meeta Lochan and was supported by her successor Sujata Saunik.

Researchers studied 4,595 heart patients across 110 district hospitals from 2012 to 2016. Patients were treated under state-sponsored Mahatma Jyotiba Phule Jan Aarogya Yojana — a medical insurance scheme.

“Lochan, being a visionary, wanted to assess the effectiveness of the scheme considering the number of surgeries being performed under the scheme,” said Dr Bhanu Duggal, research head. 

Practice of over-stenting or performing unnecessary Percutaneous Coronary Intervention without conducting a functional stress test is said to be prevalent in medical fraternity.

“If a patient with 70% blockage can walk for 10 minutes without a heartache, then he or she doesn’t need to undergo angioplasty. But on most occasions, patients are asked to undergo angioplasties where longer and multi-vessel stenting is done,” said a cardiologist working for KEM Hospital.

Duggal and his colleagues found the top five most important predictors of mortality were age, hypertension, prior history of Coronary artery disease, total stent length and stent type; for repeat PCI, the top five predictors were age, CAD history, smoking, total number of stents, and hypertension. There were no difference of mortality in stent type being BMS or DES.

“Best way to resolve the issue is to make it mandatory for the hospitals to have a heart team approach where a general cardiologist, intervention cardiologist and experienced cardiac surgeon on the team to operate a multivessle coronary artery disease,” Dr Duggal added.Hindustan Times