Arlen Fleisher, M.D., FACS on Whether Coronary Operations Are Overused

Dr. Ozner raises some extremely important issues regarding the treatment of coronary artery disease in this country. Why are patients being treated by these invasive interments without any data to support these procedures in the vast majority of the patients? And in many cases to the detriment of the patients. Cardiac surgeons have been asking this question for years. Coronary artery bypass surgery has been one of the most studied procedures in the history of medicine. There has never been a study showing that shows angioplasty or stenting as being superior to surgery as far as outcomes. Cardiac surgery patients are older and sicker than ever before. Unlike patients undergoing angioplasty and stents they are diagnosed and evaluated by numerous physicians before being referred to a cardiac surgeon. After all therapeutic options have been fully discussed, this process assures that the appropriate patients have been selected for this procedure.

This process does not exist by patients undergoing invasive interventions by cardiologists. A cardiologist who performs a diagnostic catheritization or someone in the same group will frequently perform the angioplasty or stent. This is most often done immediately after the catheritization ny an invasive cardiologists which in many cases knows nothing about the patient’s history and is simply doing the procedures based on the anatomical findings at the time of the catheritization which may or may not be in the best interest of the patients -- frequently without fully discussing possible alternative treatments with the patient. As long as this practice as self-referral remains the way cardiologists practice in this country patients will continue to receive these invasive treatments regardless of what any what any studies may show.

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