There may be good and bad news for people considering having coronary stents implanted as treatment for narrowed arteries.
In the past, people whose coronary arteries were narrowed by heart disease could have up to three stents implanted per year, all paid for by the National Health Insurance. Now, the insurance will provide even more coverage. The Bureau of National Health Insurance on Jan. 1 expanded its coverage plan to pay for up to four coronary stent procedures per year.
Coronary stenting is a surgical procedure used to treat patients with heart disease or a high risk of heart attack. The procedure involves the insertion of a tiny mesh tube into a narrowed coronary artery to keep the artery open.
While some cardiologists say stents can prevent a clot from blocking the artery, thereby increasing survival rates and reducing the risk of a heart attack or sudden cardiac death, others disagree.
TRUSTING YOUR DOCTOR
“Most patients assume when their cardiologist recommends surgical intervention for a partially blocked artery, there’s no alternative. Likewise, many heart patients agree to certain diagnostic tests believing the doctor wouldn’t prescribe them if there was a better way to get information about their heart’s health,” Michael Ozner, a preventive cardiologist and medical director of wellness and prevention at Baptist Health South Florida, wrote in an article titled “6 Cardiac Procedures You May Not Need,” which has been published on several health Web sites.
“In both cases, heart patients should know that certain heart surgeries and diagnostic tests may be harmful to their health,” he wrote.
In recent years, an increasing number of cardiologists have been putting more emphasis on preventive measures such as cholesterol-lowering drugs, which are not only cheaper, but also less invasive.
Andrew Lee (李應紹), associate professor and attending cardiologist at Jen Ai Hospital’s Division of Cardiology, is one of the many cardiologists in Taiwan who believe that interventional methods have been over-used and that some cardiologists recommend procedures such as coronary stents and coronary artery bypass surgery even though some patients don’t really need it.
“In many instances, stents can save lives. However, although a narrowed or blocked artery can be stretched open with a balloon catheter, sometimes it fails and the artery may close up again,” he said.
Lee said heart problems that arise from hardening of the arteries affect the entire body, but interventional methods such as stent implants and bypass surgery only solve part of the problem by fixing coronary arteries, instead of targeting the root of the problem by treating the underlying biology of the arteries.
“Bypass surgery only solves problems at the present and in the past, but what will kill you are the problems in the future,” he said. “If the only thing wrong with the patient was a blocked artery, then bypass surgery helps very little.”
“We can’t see into the future and expect that opening a blocked artery will solve all future problems. About 10 to 20 percent of the patients still die from a stroke,” he added.
Lee cited a recent study titled “Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation,” which showed that when it comes to treating heart conditions, invasive procedures did not offer more benefits than non-invasive procedures for heart patients.
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