Useless Medicine: The Angioplasty Procedure

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Filed Under: Useless Medicine
Last Reviewed 02/17/2014

Useless Medicine: The Angioplasty Procedure

Angioplasty, also called balloon angioplasty or percutaneous coronary intervention (PCI), is a procedure that involves inflating a balloon on the tip of a catheter inserted into a narrowed artery.

The angioplasty procedure is the standard of care for people who have had a heart attack. It is also a popular therapy for angina and for asymptomatic patients with blockages in the coronary arteries.

However, contrary to popular belief, the angioplasty procedure does not prevent heart attacks or save lives. This is not just my opinion. Research has clearly shown that most people don’t benefit from angioplasty procedures and even worse—some may actually be harmed.

Landmark Study Shows No Benefit From Angioplasty

Eight-five percent of people who undergo angioplasty procedures have stable coronary artery disease (CAD), and 25 percent have no symptoms at all. These are low-risk patients whose chances of dying of heart disease are only about 1 percent per year.

A landmark study, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, was designed to test the hypothesis that in patients with stable CAD, a combination of appropriate drugs, lifestyle changes and the angioplasty procedure was superior to treatment with medications and lifestyle changes alone.

At its conclusion, angioplasty was a bust. More specifically, the patients in the COURAGE trial who did not benefit from angioplasty procedures had the following characteristics:

  • Stable coronary artery disease
  • Angina during exercise
  • At least 70 percent blockage in one or more coronary arteries
  • Evidence of ischemic changes on EKG or exercise stress test

Despite angioplasty’s lack of efficacy in patients with this degree of disease, more than eight of 10 patients who have the procedure fall into this profile.

According to COURAGE, the overwhelming majority of them can be safely treated with dietexercise and appropriate medications.

Other Studies Show Angioplasty Procedures May Cause Harm

Conventional wisdom dictates that angioplasty is best done within 12 hours after a heart attack, but at least a third of patients aren’t treated within that time frame. Nevertheless, “late” angioplasty is routinely performed on the assumption it provides benefit. Well, it doesn’t.

Another large, multi-center study published in the New England Journal of Medicine revealed when angioplasty was done three to 28 days after a heart attack, it failed to reduce occurrence of death, repeat heart attacks or heart failure.

Even worse, during four years of follow-up there were more heart attacks in the group that had angioplasty procedures, compared to those treated conservatively with drugs.

And the Intracranial Angioplasty and/or Stent Placement in General Practice study (intracranial refers to the blood vessels within the skull) presented at the 2011 American Stroke Association’s International Stroke Conference suggests that angioplasty may not be beneficial for treating stroke either.

In fact, according to the study’s lead author Yousef Mohammad, M.D., MSc, his research team found that angioplasty and stent procedures “still carry high immediate complication rates and evidence of their efficacy is sketchy and ambiguous.”

What’s the Bottom Line?

In some cases, an angioplasty procedure is necessary. However, for the vast majority of people, safer alternatives are equally, if not more, effective. That’s why I recommend that if and only if conservative therapy fails to reduce your symptoms should angioplasty be considered.

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