Every year, more than half a million Americans undergo procedures to have a narrowed coronary artery propped open with a small metal mesh tube, or stent. In an emergency, when someone is having a heart attack, the operation can be lifesaving.
But far too often, studies show, stents continue to be implanted in patients who stand to gain little if any benefit. Last month, two of the country’s largest medical organizations identified the procedure commonly used to place a stent — called a percutaneous coronary intervention, or angioplasty — as one of five highly overused medical interventions.
Their report focused only on elective procedures performed on patients with stable coronary artery disease, a type that can cause chest pain and other symptoms during physical exertion but generally not at other times. Studies show that in these particular patients, inserting a stent is generally no better at preventing a heart attack or an early death than taking medication alone.
And yet many patients continue to undergo such procedures, even when there is the prospect of harm and the unlikelihood of benefit. The two groups that issued the report, the American Medical Association and the Joint Commission, said that roughly 1 in 10 elective angioplasty procedures performed nationwide may be “inappropriate,” and another third questionable. The operation typically costs around $30,000, and in rare circumstances it can cause tears in blood vessel walls, major bleeding and other problems.
“Major complications are not very common,” said a member of the panel that issued the report, Dr. Stephen D. Persell of the Northwestern University Feinberg School of Medicine. “But when it does occur, it can be catastrophic.”
One recent recipient of a coronary stent was former President George W. Bush. Few facts are known about his case, but a spokesman said Mr. Bush had a stent inserted at a Dallas hospital last week after a blockage was discovered during his annual physical.
