Are stents the only option after an angina attack?

MATTERS OF THE HEART: It's essential for all heart patients to get a second opinion before going in for a stent.

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New Delhi: Dr RK Khullar, a leading cardiologist was arrested recently for allegedly playing with the lives of several patients. Dr Khullar inserted a stent in his patient's absolutely normal hearts in exchange for bribes from stent suppliers.

Dr Khullar's recent arrest has sparked off a serious debate — are stents the only option after an angina attack? and what should all heart patients be demanding from their doctor.

If your doctor says your chest pain or angina is caused by blockages in your arteries, and suggests that you need to get those blockages taken care of, the most essential is finding out if you are a high or low risk patient.

Sr Cardiologist Max Hospital, Dr Praveen Chandra says, "We identify high risk and low risk patients by means of investigation, low risks can be managed by medication and a healthy lifestyle, angioplasty will not serve any benefit."

A stent is a tiny wire mesh that opens clogged arteries, improving blood circulation. In fact, many doctors consider them critical to cardiac care. But according to a landmark study the five-year courage trial, done across 50 medical centers in the US and Canada says — stents do not reduce the chances of death, heart attack or other major cardiovascular problems. And yet last year, Johnson & Johnson sold more than two million stents worldwide — which questions the overuse of stents.

"We have come to a stage where medicated stents should not be given to all patients, we can identify who does better with medicines and who does better on metal stents," adds Dr Chandra.

In 2007, a study found an increase in risks related to drug-coated stents, sparking off a huge debate. But as of December, the US FDA concluded that especially with high-risk patients, this needs to be a case-by-case decision.

Here is some essential information for all heart patients.

• Ask for the angiography film — if you don't have a blockage and your doctor advises stenting, then it can be fatal.
• Angioplasty is needed only if the blockage is 70 per cent or more.
• Bypass surgery is needed only if blockage is more than 75 per cent in three or more arteries.
• Seek a second opinion from an expert, not from friends or relatives.
• If you don't need stents and if a healthy diet can save your life — weigh that option carefully.