is eleven stents a death sentence?

[nellofree]

I had a massive heart attack March 8, 2010.  Doctor put in 5 stents.  Dr. said everything looked good, even though I was having heart attack symptoms.  I switched doctors, new doctor immediately did a heart cath, enlarged all the 5 stents put in by the first doctor, then added 3 more, and am scheduled for 3 more soon.  Dear Lord, where will something like this end.  I read endless posts, that speak of heart cath after heart cath after heart cath, stent after stent, on and on.  Should doctor have known that maybe bypass would have been the best option, or is the money he makes after many heart caths a incentive??

[ed34]

"longer effectiveness of bypass surgery today"

In my case, stents have been far more beneficial. My first one placed in Feb 07 is virtually impossible to see on an angiogram, if it wasn't in my records where it was placed, I doubt anyone would see it. My bypass lasted three months.
I don't think it's a simple case of adding up the successful stenting procedures and matching them to successful bypass surgery cases because this could be very misleading. I think some people just don't seem to accept stents as well as others do. The same with bypass surgery. My veins were in very good condition before grafting and yet they were rejected in their new position for some reason. Some people have vein graft that last for 20 years so it just shows how people differ. I think more research is needed to try and establish why some people benefit more from either of the techniques and then perhaps there will be a lot more success. I met a few people in hospital in 2008 when my bypass collapsed, and I was shocked how many had been through the same problem as me. One Man managed 2 weeks with his bypass but the failure numbers shocked me, apparently it isn't as rare as I had thought.

[erijon]

Thanks Fly, I was hoping you would throw in your two cents. I have been accused of being too trusting of the medical profession, perhaps it's true. I just know how I've been treated and how those medical professionals I associate with act.

Having said this, I am in no way as qualified as Fly, Ed or Ken as I have not had to go through what they all have. I know in my case, I have a cardiologist who knows when to say no to tests. She understands that there needs to be a reasonable expectation to find something significant in order to go forward with a test. Even when discussing something as simple as repeating an echo or stress tests, she won't without good cause and just because I want one is not a good enough reason for her practice. Her fear is the false positive that pops up when too many tests are done leading to risky and invasive procedures. She is certainly not motivated by money or she could make a fortune off of me.

I can also tell you that the cardiologists where I spend some of my free time hate to have to put in a stent, but they see them as a necessary step. In discussing the topic with them, they would prefer it was cut and dried, bypass or meds, especially given the decreased risk and longer effectiveness of bypass surgery today. They see too many cases where there is a very aggressive form of CAD which will require multiple stents in the future but guidelines require they stent. They like the patient's prognosis with bypass in the long run. I don't think any of them place stents based on a cash incentive, but I'm sure there may be some out there that do.

Again, these guys have been there and know more about this than I do, just my two cents as well.

[Flycaster305]

I'll wade in with eight stents, all between 2005 and  2007.  I have gone to the same doctor(s) since 2000 when I had my first heart attack.  In my case, I went into the stent scene during a particularly intense period of CAD, and got them one or two at a time.  Seven were because of CAD, one was to repair what was termed a spontaneous dissection.  My cardiologist told me recently that if I had shown up one day needing all the stents I would have had bypass, but it just didn't shake out that way.  I've lost a lot of weight and no longer have to inject or take pills for diabetes, a huge risk of CAD.  I also exercise almost every day and bought into the Meditteranean diet, no stents of blockages since then.  Do I think that some doctors suggest stents when not needed?  Yes.  Do I think some doctors suggest bypass surgery when not needed?  Yes.  Are the vast majority honest in their assessments?  Absolutely.

[ed34]

I don't quite understand how Cardiologists in the states benefit from using more stents than necessary? Are they paid money by the stent companies? are they paid by the number of surgical procedures they perform? If it's just down to money, then obviously the cardiologists in question are not concerned about anything more than the bucks in their pockets. Maybe they should alter the way they are paid to remove the over incentive?

[kenkeith]

QUOTE: "For those with angina, the case is put to a weekly meeting of top Cardiologists who evaluate each case and decide the best approach. Until the case is discussed, the patient is stabilised as best as possible on medication. How is it done in the states?"

Jon has described what can and does happen in the event of an emergency.  From what I have read and the hospital for my therapy has a CT scan and an angiogram can be done in hours that used to take very much longer.

But that aside my comments were directed to get a second opinion before any cardiac intervention and that would pertain to non emergency cases.  And specifically to the OP's unfortunate experience, it may be a good idea to get an evaluation by a competent, independant cardiologist.

The UK has a procedure that appears to be appropriate to optimize good health decisions and monetary controls.  The USA has no established controls and the recommended guidelines are not always observed and what has become known as the 50% asymptom guideline for not intervention is what some interventional cardiologists have abused...may be other circumstances!

There has been a survey of doctors (names are confidental) , non-cardiologists, interventional and non interventional cardiologist from leading hosptials were asked what is the best way to make PCI decisions.  The results of this survey suggest that the majority of non-cardiologists and cardiologists in this academic medical center believe collaboration between two or more physicians involved in a case is the best way to make PCI decisions.



So one can see there is dissention within the cardiac medical community who want to do what is right and have recognized a problem exists.  The UK has a procedure PCI application that one may feel more confident.
____________

Background
Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI) decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center.
BMC Medical Informatics and Decision Making.

Decision-making in percutaneous coronary intervention: a survey
Catherine R Rahilly-Tierney1,2  and Ira S Nash3

1  Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston VA Healthcare System, Boston, Massachusetts, USA

2  Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA

3  Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA

author email corresponding author email

BMC Medical Informatics and Decision Making 2008, 8:28doi:10.1186/1472-6947-8-28

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6947/8/28

[erijon]

We have hospitals that are designated as cardiac care specialty hospitals, becoming quite popular. Here as well, normal protocol is to rule out heart attack within 90 mins of arrival. If necessary, they can usually have a patient in the emergency cath lab withing 60 mins tops.

Jon

[ed34]

So who gives the true verdict? If you have 10 cardiologists on a panel, judging whether a procedure should have been done or not, then who is correct? Which procedures should be sent for judgement? How does a patient know if they had an unnecessary stent or not?
Who would pay for cardiologists to second glance over a million cases a year and decide if they were necessary or not?
This almost sounds like a huge insurance scam in the making. In the UK, if a patient arrives at hospital suffering a heart attack, they are given emergency angioplasty, to save their lives. For those with angina, the case is put to a weekly meeting of top Cardiologists who evaluate each case and decide the best approach. Until the case is discussed, the patient is stabilised as best as possible on medication. How is it done in the states?

[kenkeith]

Yes, "over-kill" may be the correct definition.

Medciare has an ongoing investigation: Reports continue to pour in from all over the country of doctor's performing unnecessary coronary stent implants. It is perceived that doctors and hospitals are engaging in repeated unnecessary stent placement for financial gain. Indeed, Interventional Cardiology can be a hospital's most lucrative medical practice. Case in point, a single stent implant can generate medical bills and cost upwards of $10,000 to $15,000. The typical hospital with an approved interventional cardiology program can perform anywhere between 5,000 to 10,000 stenting procedures annually.

The lucrative nature of coronary stent implants is undeniable, and at least one physician has been sent to prison for billing the federal government for placing stents that were not medically necessary. Alarmingly, many hospitals and medical institutions have no safeguards, regulations or safety protocols to ensure that their doctors are performing within accepted medical standards of care, and only placing those stents that are medically necessary.

According to the American Heart Association over 1,000,000 stenting procedures are performed each year in the United States. The vast majority of these procedures are complication free and a physician will often inform a patient, after the procedure, as to why the stent was placed. However, stent implants are also dangerous and complications like re-stenosis occur far too often. Other complications include blood clots, failure of the stent,  heart attack, kidney failure and wrongful death.

The only person that can provide credible information specific for your case is another "independant" cardiologist....someone else cannot with their experience that may be true or not true, understood or misunderstood, truthful or untruthful doctor, competent or incompetent doctor, etc. know the specific medical attention and care received to another from a different doctor and different treating hospital.  If you suffered complications from a stenting procedure that should not have been performed, or you have an unnecessary stent in your heart, you may have a cause of action against the doctor and/or hospital who performed the unnecessary procedure.

[ed34]

No I don't believe so. When I had several attacks of MI over three years ago, I would have paid anything to have those pains taken away. They said that if I had left it for much longer, then I probably would have been killed. I looked at a recent angiogram with my cardiologist and couldnt see the stent which had been inserted. Even he had a hard time finding it. No further diseasing and still fully open was a pleasing sight. I have recently had 5 long stents put into my left artery, so I hope they produce the same results.

[kenkeith]

Q: "Should doctor have known that maybe bypass would have been the best option, or is the money he makes after many heart caths a incentive??"

>>>>"Another Maryland cardiologist in hot water over unnecessary procedures
September 2, 2010":  (There are on going investigation from many sources).
Salisbury, MD - "Another cardiologist in Maryland has been accused of performing unwarranted procedures on multiple patients over a number of years [1]. Dr John R McClean has been indicted on fraud charges by a federal grand jury in Baltimore; he allegedly placed hundreds of stents that were not needed and carried out unnecessary ECGs, echoes, and nuclear stress tests worth millions in combined Medicare payments, according to an article in the Baltimore Sun. Lesions were of intermediate severity, defined as 40% to 70% stenosis by visual assessment, and there was no documented evidence of ischemia".

There are guidelines by the American Heart Association, et al. and that is no stents for any lesions less than 70% unless symptoms are not effectively treated with medication.  Whether or not to have stent or bypass intervention to treat coronary occlusions also depends on the location of blockage, length, severity, etc. It seems a good honest diagnosis for stents or bypass can be made based on appropriate tests.

There have many claims there is unnecessary angioplasty, and it involves money as the motivation.  I have a totally blocked LAD) with a development of a natural bypass, 72% blocked circumflex, and 98% RCA stented 6 years ago.  I do well on just mediation since the diagnosis.  My first cardiologist was an interventional cardio and did the RCA stent implant
and a month or so later wanted to do the 72% blocked vessel, and I did not have any symptoms.  Before I told him my decision, he moved to anothe location.  My non-interventional cardiologist has never referred nor suggested I have a stent implant.  Non-interventional cardiologists don't do stent implants but treats with medication.

Human nature as it is, there are fraudulent procedures done by some doctors.  The medical profession is not immune to temptations for excessive and undeserved profits. Sorry to hear of your problems...you may want to get another opinion from a non-interventional cardiologist. Thanks for sharing.  Take care.