Stents, surgery not for all cases: Study

Hyderabad: Use of stents and invasive surgeries for heart problems is not for all and medicines should be the first line of treatment. This is the finding of a new study which has established new guidelines for treating certain types of heart problems and has created something of an uproar in the medical fraternity.

Sponsored by NYU Langone Health and with 15 universities participating, ‘International Study of Comparative Health Effectiveness With Medical and Invasive Approaches’ released in the United States is followed by heart specialists across the world. The study states that blockages of up to 99 per cent in blood vessels must also be tackled with medicines first.

The contention of the study is that the blood vessel with a blockage of 70 per cent can be controlled with a stent which will ensure that the blood vessel will not burst. But there is a possibility that the blood vessel with a 30 per cent blockage can burst due to pressure and that too can lead to a heart attack. The study of around 5,179 patients in 37 countries conducted over a period of 10 years has taken into account those who managed with medicines, and those who used stents and had bypass surgeries. The study found that those with stents and bypass surgery also suffered heart attacks and sudden death among some.

Dr Sashi Kanth, senior cardiologist at Yashoda Hospital, does not entirely agree with the findings of the study: “Blockage in the left artery cannot be set aside as it requires surgical intervention. This is very important and it has to be tackled. It must also be noted that those who have undergone stent procedures have a prolonged and good quality of life. It would be wrong to say that stents and surgeries are not required,” the doctor said.

The right side of the heart and the blood vessels on that side even if they have blockages are to be managed with medicines, the study states.  But experts say that patients with a moderate problem are generally managed with medicines at present. Stents and bypasses are used only if the case is severe and chronic.

Dr Immamuddin Syed, head of the cardiology department at Osmania Medical College says, “Stress tests on the treadmill are now carried out for all as there were false positives. For this reason we are now using the conservative approach to medicine in those who can be managed. The reason for this trial is that there is too much use of stents across the world. They want that there must be more parameters set up for use.”

How will this impact India, where more than one lakh stents are used every year?

There are apparently targets set for the use of stents in cardiology departments under pressure from hospital administrations.

“Stress tests on the treadmill are now carried out for all as there were false positives. For this reason we are now using the conservative approach to medicine in those who can be managed.”  
Dr Immaunddin Syed
Osmania Medical College

“At present, those who come with more than 70 per cent (blockage) are treated with invasive surgery of stents. But the new guidelines state that even at 90 per cent we must manage only with medicines. This is highly risky”
Dr S.S. Mukherjee
Medicover Hospitals

“Blockage in the left artery cannot be set aside as it requires surgical intervention. This is very important and it has to be tackled. It must also be noted that those who have undergone stent procedures have a prolonged life.”
Dr T. Sashikant
Yashoda Hospitals