Most stents don't prevent heart attacks or extend life
Kelly Brewington has a good piece in today's paper on stents for coronary arteries. Stents have been in the news because the leadership at St. Joseph Medical Center send letters to hundreds of patients indicating they may have received unneeded stents from Dr. Mark Midei. These patients got stents when their arteries weren't significantly blocked, the hospital says. The implication, of course, is that the hype surrounding stents and the inducements of handsome reimbursement impelled St. Joseph and Midei to install more than were needed.
But as Brewington notes, unless a patient is in the middle of a heart attack, implanting a stent is a tough call even if arteries are substantially blocked. The key info is from Dr. Mark Hlatky at Stanford, a professor of cardiovascular medicine at Stanford University.
[For stable patients,] stents only relieve symptoms; they don't make you live longer, Hlatky said, adding that he falls on the conservative side of the debate. The first question any physician and patient should ask is if interventions are needed at all or whether a person's symptoms could be helped with drugs alone, he said.
And some doctors argue that they don't even relieve symptoms -- the chest pain of angina -- for very long. A landmark was the 2007 publication of the COURAGE study, which showed that stenting DID NOT REDUCE HEART ATTACKS even in patients with substantially blocked vessels. So why is the system spending billions of dollars on stents? Here is last week's column on St. Joseph and stents, which said:
Don't let the situation at St. Joseph, where patients received stents when they might have had only slightly blocked arteries, obscure the big picture. Most people getting stents don't need them even if scans show substantial blockage, studies suggest. Stents can be dangerous, too.
Comments
wasn't aware that your full range of genius included the medical field....
Posted by: KMG | January 25, 2010 9:46 AM
Dr. Midei is one of the best doctors to ever practice in Baltimore - this is just a personal vendetta from the rest of the doctors who weren't good enough to be bought by MedStar when they were with MidAtlantic. If we had more doctors like Dr. Midei, this country would be in a much better place.
Posted by: Concerned Citizen | January 25, 2010 10:19 AM
One of the benefits of the health reform package passed by the Senate would be the move to electronic records. This aspect of the bill has been portrayed as bringing a benefit via fewer tests, etc. However, it actually brings with it a far more significant benefit.
Over time as our skills and abilities in data mining increase, we will be able to take the raw data in thousands and millions of medical records and use it to answer questions such as "Does drug X really work." "If a 45 year-old African American male patient shows the ABC constellation of symptoms, what is the best course of treatment." And, of course, when, if ever, are stents medically advisable.
The famous Framingham heart study only followed about 5,200 people. If we have a unified electronic medical records system, we could multiply that sample by, literally, 10,000, and with much finer granularity in terms of the variables we would follow.
Posted by: Stuart Levine | January 26, 2010 12:57 AM