Angioplasty and Heart Stents Overused By Many Cardiologists: Study

About 15 percent of all cardiac stent implants and angioplasty procedures are probably unnecessary, according to the findings of a new study by U.S. researchers. 

The findings were published this week in the Journal of the American Heart Association, and come at a time when federal investigators in several states are looking into allegations that some doctors performed unnecessary heart stent implant procedures for financial gain. However, the problems with inappropriate heart stents and angioplasty procedures likely extends beyond just a few rogue doctors.

Heart stents and angioplasty are procedures meant to prevent heart attacks and other cardiovascular problems in patients with clogged arteries. The procedures are collectively known as percutaneous coronary intervention (PCI).

The study looked at more than 500,000 percutaneous coronary intervention procedures, and found that 15 percent of the procedures overall were likely cases where patients underwent inappropriate or questionable heart surgery.

There are about 600,000 percutaneous coronary intervention procedures are performed every year in the United States, most involving stent implants.

Researchers found that in cases where the patient suffered from acute conditions, nearly all of the stents were appropriate. However, in cases where patients had non-acute conditions, such as being at high risk for angina, a large number of procedures were either outright inappropriate or questionable.

In recent years, a handful of doctors have come under scrutiny for performing unusually high numbers of coronary stent implants, resulting in investigations of surgeons in Maryland, Pennsylvania and Tennessee. In some of the cases, a subsequent review of the records showed that some patients barely had any signs of blocked arteries, even though doctors told them it was urgent to get a stent implanted.

The most high-profile case has involved Dr. Mark Midei, who was removed from his post at St. Joseph Medical Center in Towson, Maryland after an investigation revealed that he may have implanted nearly 600 unneeded stents in patients from 2007 through mid-2009. That stent controversy has resulted in a number of stent lawsuits by patients who received the unnecessary procedures, and closer scrutiny over stent implant procedures and policies nationwide.

Stents are designed to prop open arteries that are significantly blocked, costing $10,000 or more. Typically it is necessary for there to be at least a 70% artery blockage for a stent implant to be deemed necessary. However, allegations raised over implant procedures at St. Joseph and other hospitals indicate that some patients are being told they require coronary stent implants for blockages that are much less than 70% and in some cases so small as to be considered insignificant.