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What Doctors Don't Tell You

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October 2018 (Vol. 3 Issue 8)

Balloon angioplasty no better than placebo for the angina patient
About the author: 
Bryan Hubbard

Balloon angioplasty no better than placebo for the angina patient image

It's been seen as one of the wonders of modern medicine, but percutaneous coronary intervention (PCI)—more commonly known as balloon angioplasty because a balloon catheter or stent is used to widen a coronary artery—doesn't actually help the angina patient, a new review has discovered.

Although more than 500,000 PCI procedures are performed in the US every year, the patient with stable angina will fare just as well if nothing is done.

Researchers from Imperial College London, who are running the Orbita study into PCI, monitored the progress of 230 heart patients with stable angina, 105 of whom had a PCI and 95 instead underwent a sham procedure. The main outcome being tracked was an increased ability to exercise six weeks after the procedure, but there was almost no difference between the two groups.

Although there were no deaths in either group, there were four complications in the placebo group, and there were three major bleeds in the PCI group and two in the placebo group.

The findings present a major dilemma for the cardiologist. Although doctors say the patient seems to fare well after PCI, there's been very little research to support their observations, and the Orbita trial is yet another example.

Although PCI is called 'non-surgical' because the insertion of the stent is guided by laser, it's not without its risks. Some patients die as a result of the procedure, but more commonly, the patient can suffer bleeding, and it's reckoned there are complications in 10 per cent of all PCI procedures.


References

(Source: The Lancet, 2018; 391: 31-40)

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