When individuals are seeking relief from the symptoms of chronic stable angina, in which exercise or stress can cause chest pain, they are faced with three options for treatment: medications, angioplasty and stent, or heart surgery. A new JAMA Internal Medicine study suggests that patients may not always get enough information from their doctors to make the best choice.
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Not covering all the bases
Researchers studied recordings of 59 conversations between cardiologists and their patients about percutaneous coronary intervention (PCI), or balloon angioplasty, a procedure performed through a catheter to reopen arteries and restore blood flow to the heart. Sometimes a wire mesh stent is left behind to prevent additional clogging. They found that only two discussions covered all the information necessary to make an informed decision.
All procedures have benefits and risks. The PCI procedure can reduce pain and prevent heart attacks in some individuals, but there is also risk of infection, blood vessel damage and artery rupture requiring open surgery to repair. Researchers found that physicians discussed alternative treatments in a quarter of the cases, and even less frequently confirmed whether patients understood information or explained the pros and cons of various stents that could be inserted.
Top three considerations
Cleveland Clinic interventional cardiologist Amar Krishnaswamy, MD, did not participate in the study, however he shares the top three things individuals need to understand about such interventional procedures:
- Most of the time, stents do not protect from a heart attack, they only alleviate symptoms that may be the result of heart artery narrowings. There are, of course, exceptions. Stenting during a heart attack can be a life-saving intervention.
- The decision between medical therapy, stent or bypass surgery can only be made after a catheterization to provide understanding of an individual’s unique coronary anatomy. If an individual shows symptoms of heart artery narrowing, this test must be performed before starting medicines alone.
- Often, individuals feel better with medication treatment and may not need stents or bypass. Again, there are exceptions, and talking to a cardiologist will determine the right avenue for a particular individual.
Make the right decision for you.
Not everyone is the same. Be prepared. Ask questions:
- What type of procedure will I be having?
- What are the risks and benefits of having this procedure?
- What can happen if I choose not to have this procedure?
- What are the other possible treatments (and the benefits and risks of those options)?
Together, you and your cardiologist will determine the best treatment for you.
Learn more about Coronary Artery Disease
Learn more about angioplasty and stenting