Are stents the right treatment for heart disease?
In the throes of a heart attack about a year ago, Judith Patton-Fackler of Westerville landed in highly rated Riverside Methodist Hospital in Columbus where a cardiologist opened a blocked artery and inserted three coronary stents to revive critical blood flow. "Had they not done it, I would have died that day," says Patton-Fackler, a retired nurse. She thanked God for highly rated interventional cardiologist Dr. Anthony Chapekis, who implanted the tiny, wire mesh tubes. "In my case, it was a lifesaver."
Columbus-area rates for patients undergoing angioplasty with stents - a procedure in which a balloon-tipped catheter is inserted into an artery, then inflated at the point of blockage to allow the stent to expand and lock permanently into place - rank among the top 15 percent nationally, according to Medicare data compiled by the Dartmouth Atlas of Health Care. The reasons for the area's relatively high stenting rate aren't entirely clear, but local experts speculate factors might include residents' health risks - Ohio ranks 13th in the country for obesity, a contributor to heart disease - and the local concentration of medical centers, including two heart hospitals, which do the procedure.
Judith Hochmann, a cardiology professor at NYU Langone Medical Center in New York City and a national expert on the topic, says many patients benefit from undergoing angioplasty/stenting.
"Stent use in patients who present early after a heart attack is lifesaving," she says. However, performing angioplasty and stenting on stable patients with total blockages identified more than 24 hours after a heart attack is proven to be no more effective than drug therapy alone, she says. Updated guidelines by the American Heart Association and American College of Cardiology also recommend against it. But, she and fellow researchers, in a study released in July, found that this practice remains commonplace at many hospitals, despite risks associated with stenting, including heart attack and stroke. Hochmann declined to name specific hospitals, but estimates doctors performed about 100,000 stent procedures nationwide under these circumstances.
Chapekis, medical director of the catheterization lab at McConnell Heart Hospital at Riverside, says doctors there don't stent stable patients with total blockages identified more than 24 hours after a heart attack. "The vast majority are getting treated within 90 minutes," Chapekis says.
Dr. Vincent Pompili, section director of interventional cardiovascular medicine at The Ohio State University Medical Center, says patients with stable heart disease - those with chest pain that's brought on by exertion but it's not escalating - may get symptom relief from stents. But he says evidence doesn't indicate stents prevent future heart attacks in these patients.
Though emergency situations often stifle long conversations, both say heart patients or their advocates should talk with doctors about treatment options, discuss risks and be realistic about expectations.
Grove City member Richard Helwagen says he's had three heart attacks and five stents put in since 1999 by highly rated Grove City cardiologist Dr. Bruce Auerbach, with minimal complications.
"I still can't do a lot of lifting and heavy work," Helwagen says, and Auerbach has told him to be careful about his diet and closely monitor his blood pressure. But Helwagen says the stents relieved chest pain, reduced shortness of breath and his energy level increased.