Artery-opening procedures sometimes used inappropriately
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Having a clear coronary artery is better than having a blocked coronary artery, it’s safe to say. And procedures such as angioplasty as a means of increasing blood flow are considerably less invasive than the old-fashioned surgical alternative. But doctors may be turning to even these less-invasive options a bit too readily, a new review suggests.
In nearly 12% of non-emergency situations in which the nonsurgical procedures — known as percutaneous coronary interventions — were used, they were unnecessary, researchers said Wednesday. The procedures were deemed appropriate only 50% of the time, and uncertain 38% of the time, according to the report.
The most well-known of these procedures is angioplasty, in which a catheter attached to a balloon pushes artery-clogging plaque out of the way, against the side of the artery. A stent is often inserted to keep the blood vessel open.
Again, those numbers are only for non-emergency situations. In the vast majority (nearly 99%) of emergency situations, such as heart attack, the procedures were found to be warranted.
Such conclusions are based on an analysis of about half a million PCIs performed nationwide in 2009 and 2010. The results were published online Wednesday in the Journal of the American Medical Assn.
When the procedure was misused, the authors say, the hospital, or even an individual doctor, is likely to blame. Researchers found that some hospitals had no inappropriate uses of PCI for non-urgent situations, and some hospitals used it inappropriately 55% of the time. The variation was wider still among individual cardiologists.
They comment in the paper: “Better understanding of the clinical settings in which inappropriate PCIs occur and reduction in their variation across hospitals should be targets for quality improvement.”
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