Are Stent Procedures Overused?

Some medical research suggests that stent procedures have been overused for years.  According to the journal, Circulation, although there has been a dramatic rise in stent placement in order to prevent heart attacks, the rate of heart attacks has remained relatively stable.  Thomas Graboys, M.D. a medical professor at Harvard Medical School has opined that stent placements are virtually useless in stopping the disease itself.  Many doctors believe that most people do well on medication. However, medication does not give the quick fix in relieving chest pain like that typically caused by angina.

Stents are tiny metal cages used to prop open arteries clogged with plaque. They are used in 85% to 90% of all coronary interventions performed in the United States.  Manufacturer's argue that they prevent the need for a more invasive bypass procedure.

The problem is that it appears that stent procedures are performed on far more people than are necessary.  Typically doctors use the standard of at least a 70% blockage to determine if stents are appropriate. However the same cardiologist who determines the percentage blockage typically performs the stent procedure itself.  Given the fact that the cardiologist is compensated at a far higher rate for placing the stent, it is easy to understand why this situation is rife with conflict of interest. Moreover, many of these doctors no doubt believe that the complication rate will be low because they are performing the procedure on someone who is not sick enough to require the procedure to begin with.

Nevertheless, the placement of stents carries risks and when in placed in patients who do not need them, these risks are unnecessary. Risks such as blood clots, unnecessary need for reintervention, infection, and coronary artery aneurysm are but a few of these unnecessary risks.  Additionally, should a patient need another unrelated procedure within the next year, many doctors will refuse to operate for fear of complications.

Hospitals obviously know that stent placements have increased without a corresponding significant health benefit to patients.  Why have they not come forward?  Perhaps because these procedures are not only profitable to the cardiologists involved but are also extremely lucrative for the hospitals.  Many hospitals have sought to attract interventional cardiologists to build up their high margin growth areas.