Unclogging a blocked artery with balloons and stents saves lives when performed during a heart attack, but a growing body of research says it often does no good in nonemergency situations. One landmark 2007 study found that although stents — wire mesh tubes that help prop open arteries — may help relieve severe chest pain, there is no proof that stents are any better than less expensive drugs in preventing heart attacks or death.
Still, doctors continue to perform the balloon procedure, called angioplasty, and to implant stents, at a cost of as much as $12 billion annually, with much of that expense falling on taxpayers. The federal government, through Medicare, paid out $3.5 billion in 2009 alone for cardiac stents — at a time when runaway medical spending is increasing the huge federal deficit.
Numbers like these trouble Rita Redberg, M.D., a professor at the University of California in San Francisco and editor of the Archives of Internal Medicine.
Redberg, a frequent critic of wasteful Medicare spending, says doctors should know that drug treatment — including aspirin, statins, beta blockers and ACE inhibitors — is less expensive, has fewer side effects and is just as effective as inserting a stent. But most patients haven't gotten the message.
"We have a culture of medicine where technology is frequently seen to be better than medicines or lower-tech solutions," Redberg says. "People think if you open up an artery, that should be better than taking medicine."
Costs aside, there are small but real risks associated with having a stent inserted, she points out. These include having a heart attack or having the stent fail and close off the blood vessel. Even with a stent, many patients must also take Plavix and aspirin to thin the blood, and they carry their own costs and complications.
Paul Chan, M.D., a cardiologist at St. Luke's Mid America Heart and Vascular Institute in Kansas City, Mo., led a 15-month review of some 500,000 angioplasties to see whether the procedures followed the guidelines developed by heart specialists.
The study, published in the Journal of the American Medical Association, found that 99 percent of more than 355,000 angioplasties performed in acute situations, such as a heart attack or high-risk unstable angina, were clearly beneficial.