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Posts Tagged ‘More patients need CABG – overstenting and undertreating coronary artery disease’

In a disturbing story out of Maryland, the Heart.org reports that Dr.  John Chung Yee Wang, one of the doctors investigating claims of improper, and unnecessary stenting in the wake of the Mark Midei overstenting scandals has now been charged with unnecessary stenting.

Is this just a sign of how incredibly pervasive this practice is?  Is this an example of the widespread corruption of a specialty due to a lack of outside oversight or accountability – and the incredible ease of creating huge profits [by performing unneeded procedures?]

Or is it as some cardiologists suggest, a crazed witch hunt?   I don’t know – but angiography doesn’t lie, and there have been too many cases of 20% and even 10% lesions being ‘over-called’ and stented as critical disease.  This is particularly important now – as a recent study [the landmark Syntax trial] shows that stents are not the ‘miracle cure’ they’ve been touted as.  In fact – one in ten patients who receives a stent has to be re-hospitalized within 30 days.

Overstenting, stent fractures, sudden stent thrombosis* and stent deformities – in the wake of all of this – we need to stop and consider our other options; the ones that aren’t quite as easy..

* Please note that both of these sources are heavily biased in favor of interventional cardiologists.

Supervised exercise programs as effective as stents

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to be true  – then you know that it’s just about making money.. One of the problems that I see frequently is the ‘underselling’ of appropriate treatment to patients.. ie.. feeding into the ‘fast/ easy / painless’ mantra.. Sometimes the best treatment isn’t easy and it isn’t painless – but the outcomes are worth it..

But, that only works if you tell the patients the truth – instead of some cock-and-bull story about the carefree stent solution..  “But the patient didn’t want surgery..”

http://www.latimes.com/health/la-sci-bypass-angioplasty-20100912,0,630173.story

Updated: September 19, 2011

More patients need CABG – overstenting and undertreating coronary artery disease:

a recent article in thoracic surgery news discusses the role of overstenting in declining bypass surgery rates, “CABG, PCI trends suggest many not treated optimally.”  The key points to consider when reading this, and similar articles – is that when a cardiologist decides to forgo a surgical consultation in a patient with multi-vessel coronary artery disease (CAD) – it effectively eliminates many of the necessary checks and balances in cardiology.  This lack of inter-disciplinary discourse between specialists is part of the problem which led to the overstenting/ unnecessary stenting debacles.

 

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