Nonemergency Angioplasty May Become Available at More Hospitals

Many hospitals carry out emergency angioplasties to open a blocked coronary artery following a heart attack.

Nonemergency angioplasties are elective procedures usually done to open blockages that are causing chest pain. In recent years, as these procedures have become more common the associated risks of surgery have gone down. Let's look at why this is true—and why you should still be careful when considering nonemergency angioplasty.  

Present Restrictions on Nonemergency Angioplasties

The American Heart Association and the American College of Cardiology have recommended that nonemergency angioplasty be done only in hospitals that also have the capacity for open-heart surgery. And many states restrict nonemergency angioplasty to hospitals that offer cardiac surgery. These recommendations and restrictions were based on concerns that emergency heart surgery might be needed to correct complications of angioplasty. In fact, when angioplasty procedures were first done about 40 years ago, as many as 15 percent of them were associated with complications that required emergency surgery. However, results of a study recently presented at the 2011 American Heart Scientific Sessions indicate that the low need for emergency surgery now makes such restrictions unnecessary.

Results of the Study 

Led by Johns Hopkins cardiologist Thomas Aversano, the study examined the results of angioplasties at 60 hospitals. These hospitals each performed a minimum of 200 angioplasty procedures per year. Other centers participating in the study were Duke University and the Maryland Medical Research Institute. Health outcomes were evaluated in more than 18,500 patients. (Patients were randomly assigned to coronary angioplasty and/or stents at hospitals which did or did not have the capability for cardiac surgery.)  The results were very encouraging. The need for cardiac surgery was rare—and the numbers were the same in each type of hospital. The death rate within 6 weeks of the procedure was very low, less than one percent at both groups of hospitals. 

Consider Getting a Second Opinion Before Angioplasty

If many states remove their restrictions on nonemergency angioplasty, it will mean that some patients will not have to travel long distances to have the procedure done. Even so, before undergoing angioplasty patients should make sure that it is really needed, perhaps by getting a second opinion. Recent studies have found that many angioplasties are not necessary. Some cardiologists have apparently looked at the procedure as a kind of cash cow. Two cardiologists in the state of Maryland alone have either been jailed or had their privileges removed for performing unneeded angioplasties. In addition, before having nonemergency angioplasty at a hospital check on the number of procedures they have done and their outcomes.

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