Have you recently had a non-emergency angioplasty and suffered uncomfortable side effects? According to a new study published this week in the Journal of the American Medical Association, half of all angioplasties performed to widen arteries in non-emergency situations may be unnecessary or "inappropriate". An angioplasty, also known as a Percutaneous Coronary Intervention, is a procedure which widens blocked or clogged arteries. A collapsed balloon catheter is inserted into the blood vessel using a guide wire, then inflated. The inflation causes the fatty deposits within the vessel to be crushed and allows for improved blood flow. The balloon catheter is then deflated and withdrawn.
Artery blockages may be caused by a number of factors including cardiovascular disease, smoking, high blood pressure, diabetes, or a diet high in saturated fat. Typically, angioplasties are performed on patients that have suffered a heart attack, angina (chest pain caused by a lack of oxygen to the heart muscle) or patients with non acute heart disease where only part of an artery or arteries is blocked.
The study was conducted by professionals of six leading heart health organizations including the American Society of Nuclear Cardiology, the Association for Thoracic Surgery and the American Heart Association. These researchers analyzed more than 500,000 angioplasties performed in 2009 and 2010 which were performed at over a thousand hospitals.
According to the researchers, 50% of the procedures were deemed "appropriate," 38% were deemed "uncertain" and 12% were declared "inappropriate". Almost all of the inappropriate procedures were done on patients with low-risk heart conditions. These results varied dramatically from the results pertaining to angioplasties done in emergency situations. In those cases, 98% were deemed "appropriate".
While the authors of the study aren't clear on the overall impact of their results, some commentators have suggested that patients are being forced into unnecessary angioplasties to generate revenue for the doctor and the hospitals these procedures are performed by. The study showed that 71% of patients who had "inappropriate" angioplasties were privately insured. According Caleb Hellerman, CNN's Medical Senior Producer, this is significant because patients that are privately insured are "better able to pay the cost of the procedure, which can run up to several thousand dollars". He suggests that reducing the number of unnecessary procedures could save "hundreds, if not billions" of dollars.
The real question on my mind however is not the financial impact of these "inappropriate procedures", but whether these excessive procedures are harmful to the patients. In other words, does inappropriate mean dangerous? That questions wasn't fully address within the study. One might think that if a patient has a partially blocked artery, it is better to be safe than sorry and just unblock the artery to prevent a future heart attack. However, upon further inspection, that isn't necessarily the case. Patients are at an increased risk of suffering from deadly post-operative side effects including blood clots, bleeding, and pain after having an angioplasty. For this reason, I suggest that you discuss with your doctor the benefits and drawbacks of having a non-emergency angioplasty and whether the procedure is really "appropriate". I also urge the medical community to continue their research on this issue and better clarify how these unnecessary procedures impact patients' lives.