who is this David L Brown mutt, and who funded his study???
Posted on 02/27/2012 6:48:24 PM PST by neverdem
The common practice of inserting a stent to repair a narrowed artery has no benefit over standard medical care in treating stable coronary artery disease, according to a new review of randomized controlled trials published on Monday.
Stable coronary artery disease is the type of heart ailment that causes angina, or chest pain, after physical exercise or emotional stress but generally not at other times. The review did not include studies of the emergency use of stents for heart attacks.
Stent implantation involves a procedure called percutaneous coronary intervention, or P.C.I., in which a surgeon inserts a mesh tube made of metal into an artery that has become narrowed by accumulated plaque. The tube, threaded through an artery in the leg or arm, expands to hold the artery open at the point where blood flow is restricted.
Some of these devices, called drug-eluting stents, are coated with medicine that helps to keep the artery open. The cost of the procedure varies from about $30,000 to $50,000, and more than one million are performed every year in the United States.
The procedure has certain risks. According to Dr. David L. Brown, an author of the analysis, the risk for death is about one in a thousand, and complications can include stroke, heart attack, bleeding, kidney damage...
--snip--
These results support the current concept of coronary artery disease, the authors wrote — that it is a systemic inflammatory disease of the arteries that cannot be successfully treated by surgical intervention at a particular site on one artery.
According to Dr. Brown, a professor of medicine at Stony Brook University, many doctors cannot accept this. Instead, he said, “interventional cardiologists use the analogy of a pipe blocked in a house — it’s a terrible analogy, but patients accept it. It’s simplistic and erroneous.”
(Excerpt) Read more at nytimes.com ...
I have the bare metal stent. I almost died of coronary artery disease.
A stent is far safer than open heart surgery. It solved my chronic fatigue, sweats and chills, a general feeling of weakness, cold extremities and shortness of breath.
Sure, I take prasugrel for four months but I guarantee this doctor never had a dying heart. Its not fun when the artery blood flow slows to a trickle.
I must be fortunate not to have side effects after my stent was implanted via a cardiac cath procedure.
ping
Interesting how procedures are no longer necessary. Especially since they want to reduce health care costs.
I think they’re talking about cutting care in order to save money. Its not about putting the patient first.
Welcome to the brave new world of Obamacare.
The earlier approach failed the test of rationality ~ in that one they said stents weren't better than coronary bypass surgery under any circumstances.
An old gentleman I was driving to the hospital said if he had to have bypass surgery again just let him die. Fortunately we went to Fairfax and they used stents. He's still around 12 years later ~ had a couple more stents stuck into place and for the most part they don't bother him.
The secondary damage from coronary bypass surgery appears to be something bypass surgeons don't concern themselves with.
I’ve had 6X bypass and 2 stints. Stints are a great treatment.
My mom had stints put in and this article is bull. Back to Obama’s ‘take a pill’.
They performed by pass surgeries on my Dad. He had two of them and lived to be 76.
I’d say stents are more cost-effective. They could have saved money if they had kept me for just one day under observation instead of three.
Apart from the pills, I feel great. I can haul a full backpack load up the stairs without feeling winded and needing to catch my breath.
The only reason I’m alive is because it was an emergency procedure.
Ping
As for the conclusions, it all depends on what the end-points are. Very few things we do in medicine are done because they can be shown to definitely extend life. They are done most often to increase the quality of life. There are clear exceptions, like treating serious bacterial infections, but most things - like knee and hip replacements, and even most bypass surgery - cannot be shown with standard statistical analysis to extend life.
That said, if you are a 50 year old man, and you've developed chest pain, and have been told you have an 80% blockage in a major artery in your heart, you want your life back. If you are told, ‘well, we're going to just give you medications, and we'll keep adjusting it if you have chest pain’, that might not be too satisfying to you.
You might not want to go out and run that 10K with your daughter if you know you have that 80% blockage, regardless of the medicines that you're taking. On the other hand, if you come in on Wednesday, have a stent placed and the 80% blockage is reduced to 0%, and you can go home on Thursday, and you don't have to take as many meds, and you can still train for and run that 10K with your daughter, you probably don't care that statistical analysis can't prove that it will extend your life.
Beware of half-truths couched in statistics. There are, however, many instances in which less could be done medically with equal or even better outcomes. Shop your doctor no differently than you would anyone else you hire in life.
Before more people get upset I hope they note that this study is about stable coronary artery disease, not all coronary artery disease, some of which definitely require stents or bypass.
Good point!
There are statistics, damned statistics and lies.
I have a good quality of life thanks to my stent. I don’t care if I don’t live four years longer than the patient who didn’t get one.
Every patient’s case is different and there is no hard and fast rule an interventional cardiologist will follow about the appropriate treatment.
AARP has said the same thing. many cards are hot to trot to do the billable procedure.
I say this as a physician
AARP has said the same thing. many cards are hot to trot to do the billable procedure.
I say this as a physician
AARP has said the same thing. many cards are hot to trot to do the billable procedure.
I say this as a physician
who is this David L Brown mutt, and who funded his study???
One of the things stints give you is less time under heavy sedation.
like everything else in this country, the innocent will wind up paying for the guilty...
I only remember being given anesthesia when the air ambulance paramedics wheeled me into the cardiac cath room. I must have slept like a baby after that since it was the first time I got enough sleep!
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