But as my colleague Cheryl Clark writes, a study reported this year in the Journal of the American Medical Association noted that inappropriate angioplasty "still goes on—a lot." Of 14,737 non-acute patients who underwent a PCI, 11.6% did not meet the necessary criteria for a 15-month period ending in September 2010.
One of the ways that physicians can evaluate stents is by becoming involved in registries, SCAI's Marshall says. Indeed, the American College of Cardiology report notes that it strongly encourages all laboratories to participate in national registries. That way, "all laboratories can benchmark their performance and make appropriate corrections."
The controversy over the use of stents will not go away, no matter how familiar the little artery openers are to the patient population. From Marshall's perspective, patients' quality of life generally improves with angioplasty or stents. "I think it's very clear, in certain situations—specifically if you are having a heart attack, for instance—the best treatment, and to save lives, is to have a stent," Marshall says.
But, he adds emphatically, "SCAI is very concerned, I would say deeply concerned about any inappropriate use for stenting," referring to the HCA allegations. "There's a real sense of dismay, and that bothers us." Marshall says. "Ultimately, quality of life is what we are most concerned about."