Study Finds Most Urgent Angioplasties
TUESDAY, July 5 (HealthDay News) -- New research shows that most
urgent angioplasty procedures performed in the United States are
warranted, but the same can't be said for those done on a
Reviewing data on more than a half million angioplasty
procedures, researchers deemed the artery-opening procedure
appropriate when performed for "acute indications," such as heart
attacks or unstable angina (crushing chest pain) with certain
high-risk features such as progressive pain with no known cause. By
contrast, stable angina occurs only with activity such as a stress
test and is not considered an appropriate indication for
"We found that the appropriateness of angioplasty depended upon whether the patient presented as acute or non-acute," said study author Dr. Paul S. Chan, of Saint Luke's Mid-America Heart and Vascular Institute in Kansas City, Mo.
"In elective, non-acute settings, angioplasty does not save lives and does not prevent heart attacks," he said. "The only role for angioplasty in elective setting is improving the quality of life in patients burdened by angina."
The study, published July 6 in the
Journal of the American Medical Association, included data on patients in the National Cardiovascular Data Registry who underwent angioplasty between July 2009 and September 2010 at 1,091 U.S. hospitals. Of 500,154 procedures included, almost 99 percent of those performed for acute indications were appropriate, but just 50.4 percent of those performed in non-acute situations were classified as appropriate, according to criteria recently developed by six professional organizations.
Appropriate means that the procedures provided definite or
probable benefit to patients, whereas inappropriate means that
there was no established benefit and unlikely to be one.
Angioplasty involves inserting a balloon-tipped catheter into a
blocked heart artery to open it and improve blood flow, relieve
chest pain and/or prevent a heart attack. Physicians usually insert
a device called a stent to keep the artery open. About 600,000
angioplasty procedures are done in the United States each year,
according to the study.
Overall, about 71 percent of the procedures reviewed were for
acute indications and about 29 percent were for non-acute
indications. Heart attack comprised about 59 percent of all acute
procedures, while high-risk unstable angina accounted for slightly
more than 41 percent.
In the non-acute setting, half of all angioplasties are
considered appropriate, one-third may confer a possible benefit,
and one in eight was of no benefit, the study showed.
Unnecessary procedures increase risks as well as health-care
costs, the study authors said. The annual cost of angioplasty is
more than $12 billion a year, they said.
There was no variability among hospitals when it came to
angioplasty procedures for acute indications. But hospitals did
vary in their proportion of inappropriate angioplasty procedures
for non-acute indications. Hospitals in the lowest quartile had
inappropriate angioplasty rates of 6 percent or lower, compared
with 16 percent or higher in hospitals in the highest quartile, the
Taken together, the findings suggest a need to better identify
patients undergoing angioplasty in elective situations, the authors
Dr. William O'Neill, cardiologist and executive dean of clinical
affairs at the University of Miami Miller School of Medicine, said
that "the take-home message is that if you come into the hospital
for an urgent procedure, it is extremely likely that you will get
If your physician recommends angioplasty for mild symptoms
during a routine check-up, ask if there are alternatives, he said.
"In people with stable angina, angioplasty doesn't prevent heart
Dr. Barry Kaplan, vice chairman of cardiology for North Shore
University Hospital in Manhasset, N.Y. and Long Island Jewish
Medical Center in New Hyde Park, N.Y., urged caution in
interpreting the findings.
"These are just recommendations and it is very difficult to apply them to each and every patient," he said.
"There is no doubt that inappropriate angioplasties are performed in this country," he added. "This study is not to say you should not have an angioplasty, just that the indications should be understood."
For more on angioplasty, visit the
American Heart Association.
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