More stents may reduce chances of survival: study

Doctors should focus on blockages that lead to heart disease

June 09, 2018 12:35 am | Updated 01:55 pm IST - Mumbai

Too many stents in a person’s heart can increase chances of death, and doctors need to restrict them to blockages linked to heart disease, says a study commissioned by the Public Health Department.

The study covered over 4,595 heart disease patients who underwent angioplasty from 2012 to 2016 in more than 110 hospitals across Maharashtra. It was carried out by collaborative partnership between policy makers and academia and published in ‘PLOS One’, an international peer-reviewed, open access scientific journal, on May 24, 2018. It was initiated in 2012 by the then State Public Health secretary Meeta Rajivlochan on concerns of high mortality rates in angioplasty procedures carried out under the State government’s health insurance scheme, Mahatma Jyotiba Phule Jan Arogya Yojana.

Dr. Bhanu Duggal, Department of Cardiology, AIIMS, Rishikesh, said, “The study shows an all-cause mortality of 4.5% (203 deaths) in patients in the one-year period after the procedure, which when compared to western countries is 1.7%.” The study also compared patient outcomes for bare metal stents (BMS) and drug eluting stents (DES). It found that while survival rates in both types was similar, there is a slightly reduced chance of re-hospitalisation and repeat procedures when DESs were used.

The report said involving a team of doctors, including a primary cardiologist, interventional cardiologist and cardiac surgeon in patient assessment, should be a standard practice. “This could lead to a better quality of decision-making and better health outcome.” Dr. Duggal said similar clinical audits need to be carried out every year for every medical procedure to improve the performance for the benefit of citizens.

The report advocates that the physician in charge take a conservative view in deciding which blockages should be stented. “Only blockages specifically shown to cause heart disease by a functional stress test should be stented. If too many stents are implanted, then it can increase chances of death and reduce chances of survival,” said the report. Ms. Rajivlochan said the study is the first of its kind in South Asia. “This is a unique model of collaborative partnership between policy makers and academia. that will give impetus to evidence based medicine and developing guidelines in the national context. Till date guidelines have been based purely on studies done in the west,” she said.

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