Patients receiving an angioplasty after a heart attack may benefit from an extra procedure to place a stent in other narrowed arteries, even if blockages are only moderate, researchers said.
Doctors performing surgery in heart attack patients often place stents in arteries believed to be responsible for or associated with the cardiac arrest, but new data suggests that patients may benefit from additional preventive stenting in more than just the "culprit" vessel. Current medical guideline advise against this sort of preventive stenting.
New reports from the long-running "Preventive Angioplasty in Acute Myocardial Infarction" clinical study found that some patients with less severe blockages that were left untreated went on to have negative outcomes, Medscape reported. Overly stringent guidelines for arterial stenting may be excluding patients who would benefit from the implant, doctors cautioned.
Patients with the more severe cases of stenosis, or vessel narrowing, were the most likely to go on to have heart attacks, refractory angina or to die from cardiac causes, but the new data suggests a gradient of risk for patients with less severe blockages.
"You may say, okay, I will only do the really severe lesions; I don’t want to do touch anything that’s severe or only moderately severe," study investigator Dr. Keith Oldroyd said during today’s Society for Cardiovascular Angiography & Intervention 2014 Scientific Sessions. "But, if you cut it off at 95% to 99%, you will identify only 20% of the subsequent events, and you will miss 80% of the events. If you move the cutoff to 75%, this time you pick up 80% of the events, but you still miss 20%. So by sticking with a 50% [cutoff], you will pick up all the events as identified in the trial."
The findings may change the rhetoric for a series of doctors accused of unnecessary stenting.
Maryland cardiologist Dr. Mark Midei and his former employer Catholic Health Initiatives were sued by more than 200 patients who claimed they’d been implanted with unnecessary stents. Maryland stripped Midei’s medical license in May 2012 after the state’s medical board decided that the doctor committed "repeated and serious" violations.
That lawsuit was settled on the eve of Midei’s testimony, reportedly without his agreement.
"I continue to maintain that the patients received necessary and appropriate care," Midei told reporters at the time.
He’s not the only cardiologist accused of over-stenting. Similar accusations were leveled against another Maryland physician, Dr. John Wang, in December 2011. In November of that year, Dr. John McLean, who also practiced in the Old Line State, received an 8-year prison sentence for Medicare fraud related to over-stenting. And last December, an interventional cardiologist in Louisiana began his 10-year sentence after losing an appeal.