Overuse of Coronary Stenting Charged
“The entire field of angioplasty has been led astray by a preoccupation with restenosis, which study after study has shown has no prognostic value.”
That was the theme of an impassioned and surprising talk by Dr. Yusuf at a joint meeting of the European Society of Cardiology and the World Heart Federation.
Called on at the meeting to comment on reports from two metaanalyses of safety data from clinical studies of the currently approved drug-eluting coronary stents, Dr. Yusuf admonished the cardiology community about its overuse of all forms of coronary stenting, including both bare-metal and drug-eluting models.
“We're chasing problems that are iatrogenic,” he said. “The best way to prevent restenosis is to not do PCI [percutaneous coronary intervention] at all.”
Dr. Yusuf acknowledged that stenting is the best way to deal with acute myocardial infarctions and unstable angina. But he focused on the problem of using PCI on patients with stable angina, a use that now constitutes about 50% of all coronary stenting.
“There is no evidence that it prevents clinical events,” he said. And many studies show “it's cost ineffective. We should use PCI sparingly and judiciously.” Patients instead should receive full medical management, he asserted.
“We have had a perverse financial incentive on the practice of cardiology. It's time to step back and reevaluate,” he concluded. He called on the European Society of Cardiology to develop new recommendations on the role and use of PCI and drug-eluting stents.