Heart procedure misunderstood, overused: doctors

Patients who sign up for common procedures to clean out blocked arteries in the heart often believe they are cutting their risk of heart attack and death, when in fact they aren't.

That's the conclusion of a new survey from a large Massachusetts hospital that shows doctors fail to make clear the real benefits - or lack thereof - of a treatment that may cost as much as $17,000 and has significant, though rare, side effects.

During the procedure, called percutaneous coronary intervention or PCI, patients often receive stents (small metal mesh tubes) to help keep the artery open.

PCI is done in more than one million Americans every year, a rate many doctors say is unnecessarily high. When used to remove a blood clot after a heart attack, the procedure reduces the odds that a patient will suffer another attack in the future.

But in those with stable chest pain due to narrowed arteries in the heart - the population surveyed in the new study - clinical trials show the only benefit is to ease the pain.

"I think doctors do a great job of explaining the procedure itself," Dr. Michael Rothberg, who led the survey, told Reuters Health via e-mail.

"What they don't say (or the patients don't understand) is that improving the blood flow will not prevent a heart attack or make the patient live any longer."

Dr. Rothberg, of Baystate Medical Center in Springfield, Massachusetts, and colleagues surveyed 153 patients with stable chest pain, also known as angina.

The patients had all signed up for a test known as coronary angiography, in which cardiologists guide a thin plastic tube (a catheter) to the heart via an artery to look for signs of cholesterol plaques. These plaques narrow the arteries and limit blood supply to the heart, which can cause chest pain and other symptoms during physical activity.

If there is substantial narrowing, the doctor may then choose to do a PCI. This is done by inflating a balloon at the end of the plastic tube, which breaks up the cholesterol buildup. Then the doctors place a stent to prop open the artery.

Nearly all the patients in the survey said they understood why their doctor might perform a PCI, and more than half felt they were part of the decision making.

However, more than eight in 10 thought the procedure would cut their risk of suffering a fatal heart attack. Most of their doctors, on the other hand, indicated they knew that not to be the case.

"The informed consent process failed," said Dr. Alicia Fernandez, of the University of California, San Francisco, who wrote an editorial about the findings.

"Patients often undergo invasive procedures without a clear understanding of expected benefits. This is distressing, particularly when non-invasive options may be just as good."