I am practicing cardiologist in Bangalore and these days I see lots of discussion, debate and publication in lay press and whats app and other social media on angioplasties especially the unnecessary ones, costs of stent and margins by the hospital. Though about 10% what is discussed in these articles could be true they are not scientific publications and generalization is difficult. Which is in turn is creating great difficulty for the people to take decisions in the procedures at the time of emergency and great amount of distresses among the people who have already undergone these procedures as to if they were appropriate or has cost right.
Though I can’t clarify all doubts or change the system or perception some rough guide to help you take informed decisions.
To have or not to have emergency procedure:
- If you have landed in hospital with heart attack or acute myocardial infarction and have chest pain, breathlessness or low BP (Cardiogenic shock) it is must to have angiogram and emergency angioplasty as it improves your chance of survival significantly and in some cases may be only way out.
- If you had visited doctor as an out patient for symptoms but not heart attack than you can have angiogram done and if you want schedule angioplasty procedure separately it should be possible. In majority of the cases it is not a must to be done as single procedure. Only advantage is the hospitalization can be less by a day and discomfort of putting needle in your artery can be less. If you need any clarification please to have done the procedure next day morning unless there other reasons such as complications of angiogram or too critical stenosis in main artery of heart.
- If you are suffering from condition called chronic stable angina or have tread mill test reported as positive but not high risk, you can choose to have trial of medical management, before going for angiogram or Angioplasty or Surgery.
- In case emergency such as heart attack go to place where you have reasonable trust and confidence and follow the doctors advice. Also make sure you go to place which you can afford as lots of time gets lost in going from one hospital to other and many lives are lost in the process.
What stent to choose:
- Once you decide to have procedure of angioplasty done, next decision is choice of stent, again difficult situation
- There are mainly three basic type of stents
- Bare Metal Stent (BMS)
- Drug eluting stents (DES) and
- Bio Absorbable scaffolds
- All three types give same acute or immediate result but the in long term have difference in terms of mainly what we call restenosis (repeat blockage in stented area).
- SO if you choose chances of repeat blockage are higher usually in range of 15-20% but much higher if you are diabetic or small diameter vessel (<3mm) or longer stent needed (>28mm). In such situation its generally recommended that you go for drug eluting stent in other situation if your finances permit go for Drug eluting stent if not go for BMS.
- Next issue you may face is Indian vs imported stents. In strict sense most of the stents are imported only , the one which are projected as Indian are the made in india under license or Biosimilar or mimics of the stents from reputed companies. They are all similar and difficult to say the difference in the outcome. MAIN DIFFERENCE being stents from reputed companies have been put through very rigorous clinical trials and have documented safety and outcomes. But these days we have quite few good low cost DES as well. Which we have been using last couple of years with acceptable similar results.
- A word of caution here is that designs of cheaper stents are slightly different from the expensive ones which may make the more bulky stiff and unsuitable for certain subtypes of blocks.
- Again here finances drive the choice but as long as your cardiologist suggest he can use both than it would be reasonable to choose anyone as per your convenience and comfort and don’t have to break your head or think too much.
That’s it for now. I am not writing here on the costs here because they differ from institute to institute..