A large study finds that it is OK to have a non-emergency procedure to open clogged heart arteries in a hospital that doesn’t have surgeons ready to operate if something goes wrong. The results could help make this much more available in rural areas and at smaller community hospitals.
The procedure, called balloon angioplasty, has become so safe that surgical backup is no longer needed when treating low-risk, simple cases, doctors say. Only about 20 states allow this now, and hospitals in some areas have sued so they can offer it.
“The intent of this project was not to expand the number of centers doing angioplasty” but to give policymakers an idea whether it is safe, said study leader Dr. Thomas Aversano of Johns Hopkins University. He presented results at an American Heart Association conference in Florida.
In Paducah, both Lourdes and Western Baptist hospitals offer balloon angioplasty to destroy blockages killing cells in the body. Both facilities have cardiac catheterization laboratories for this procedure and to add stents to patients’ arteries to keep blockages from reoccurring. The two hospitals are expanding to have catheter labs with state-of-the-art imaging and surgery in the same suite to perform the least-invasive procedures possible.
“I did the first balloon angioplasty in western Kentucky many years ago,” said Dr. Patrick Withrow, a cardiologist and Western Baptist’s chief medical officer. “We’ve done nearly 300 balloon angioplasties in the first three quarters of this year, and all of them have gone from the door to the balloon in under 90 minutes, which is the recommended length of time to beat.”
Withrow added that new procedures offer less risk to patients than surgery and create less pain, expense and recovery time. Some patients may even see their arterial blockages reduced through medication. Only in cases of severe multiple blockages may surgery be the first option.
“Nearly a million angioplasties are done each year in the United States. Most are non-emergency cases for people having chest pain because clogged arteries are keeping enough blood from reaching the heart.
The treatment involves pushing a tube into an artery and inflating a tiny balloon to flatten a clog. A mesh scaffold called a stent often is placed to keep the artery open. In rare cases, a tear in an artery or other complication will require emergency surgery, but these problems have become less frequent as the procedure has grown more common in recent years.
The study was the first large experiment to see if doing it without surgical backup was safe. About 4,500 were given angioplasty at hospitals that had heart surgeons available, and 14,000 others had it at facilities without one. Hospitals without heart surgeons on duty had to complete special training to make sure experienced doctors were doing the angioplasty procedures. And patients were carefully selected to avoid especially troublesome types of blockages.
Six weeks after angioplasties were done, success rates, complications and deaths did not differ between the two groups of patients. Emergency surgery was needed in only 30 cases — patients were transferred to hospitals with that capacity if the one treating them lacked it.
The Associated Press contributed
to this report.