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Many heart surgery are unnecessary

it Comes to unnecessary medical interventions, landing stent, usually on the front of the list of Suspects. A Stent is a tube, which supports the walls of a narrowed coronary vessel from the inside. Now a groundbreaking American study confirms that Stents disease in stable coronary heart with a survival advantage and often unnecessary. An international team of researchers presented the results of the "Ischemia study" last weekend at the Congress of the American society American Heart Association.

More than 5000 patients from 320 hospitals in 37 countries took part in the long-awaited Ischemia study. They suffered from a chronic heart disease, certain vessels to your heart are narrowed due to deposits. Treat Doctors can medication these circulatory disorders, or with a procedure where they insert a Stent into the affected vessel.

In the case of those patients who suffered due to the constriction and chest pain occurred, the pain with a Stent less likely than in medical treatment.

The Stent is to keep the narrowing permeable. Also, patients with a Stent continue to get drugs. You even have to swallow a blood thinner more than the Treated pure medication.

In half of the patients, the cardiologist implanted a Stent, and the other half treated only with drugs. After four years, there is no difference in the survival rate or the incidence of heart attacks in average. In the first two years after the treatment sections, the purely medically Treated even better. They had a bit better Survival.

An advantage of the Stent-treatment, however, showed the symptoms. In the case of those patients who suffered due to the constriction and chest pain occurred, the pain with a Stent less likely than with medical treatment. Not all patients with circulatory disorders, however, suffer pain on the chest. The frequency of chest pain is also no indication as to the Severity of the disease. Two patients can have the same calcification, and Patient A has pain, Patient B but.


"This is a very important study," says Michael Zellweger, a Professor of cardiology at the University hospital of Basel, "it has amazed me how well the drug treatment is performing." The drugs have improved in the last few years and would have the advantage that they had, not only on the affected vessel, but on the whole body, so also the other perhaps not discovered constrictions mitbehandelten. The use of cholesterol-lowering statins, blood thinners and medications for high blood pressure will come. Also a Change of lifestyle with plenty of exercise, not Smoking and a healthy diet is one of the recommendations.

on the question of whether you implantiere a heart catheter examination by lead or a Stent, it is important to put the patient back at the centre of decision-making, said Frank Ruschitzka, Director of heart center of the University of Zurich. "The results of the study confirm this strongly." As an example, Ruschitzka called the former U.S. President George W. Bush. In the case of an annual Check-up, his Doctors discovered in Texas in 2013, a narrowing in a coronary vessel. Bush, however, had not noticed any discomfort and in sports activities of the narrowing. Nevertheless, the Doctors put him in a Stent, what study, which appears after the Ischemia-questionable.

Stents can save lives

That Stents save lives in an emergency and, for example, in the case of heart attacks is very important, no one denies. However, not all of the stent, the cardiologist in Switzerland, are part of an acute treatment. The debate whether the tiny mesh tubes also make for stable coronary disease sense, has been running for years and can now be regarded as definitely settled. In 2007, a small study had given similar instructions, as well as the orbital study two years ago had participated in England, but only around 200 patients. Ischemia is made much larger, and methodologically very well, as all experts confirm.

the previous studies have Changed the practice in Switzerland, however, nothing. On the contrary, While the cardiologists to use in 2007 in this country 17080 stent, in the year 2017, 25'527 interventions, such as the Figures of the Swiss society of cardiology show. Only around 10'000 of these procedures were emergencies. For the year 2018, there are still no Figures.

the leader of the Inselspital Bern was followed by the Zurich Triemli hospital and the cantonal hospital in Lucerne. The Insertion of a stent costs between 5000 and 8000 francs per engagement.

especially in patients that show no symptoms, are Stents according to the latest study is unnecessary and also associated with risks.

a glance in the pension Atlas of Switzerland to the urgency of the measures is in doubt. So, it is striking that especially many of the Stents are placed, where there are large centers. While in the Canton of Basel-city, Basel-land and Thurgau more than three patients per 100 inhabitants a Stent received in the Valais, only 1.5 per 1,000 inhabitants.

Even more striking, the picture in the heart-catheter examinations without the Doctors put in a Stent. Basel-the city reached a value of 5.2 cases per 1000 inhabitants, the Valais, only 1.6 cases.

"In Switzerland, many of the Stents are placed," says Thomas Rosemann, head of the Institute for family medicine at the University of Zurich. Especially in patients that show no symptoms, this is according to the latest study, unnecessary, and in addition, like any surgical procedure, with risks associated.

Too many heart catheter

The Stent, the cardiologist using a catheter via a blood vessel in the Arm or the groin. Among the rare complications of cardiac arrhythmia or even a heart attack because the blood supply is disrupted to the heart. Also can solve a Deposit in vessel and cause a stroke. Thus, experts also explain why patients with a Stent in the current study have in the first two years after treatment worse values than those with a drug therapy.

researchers at the Institute for family medicine had the can in a 2013 study show that in Switzerland, too many heart catheter examinations are carried out. In a summary work, the scientists showed that 53 percent of the catheter examinations in the connection, no further action was necessary.

"the fact That we have too many cardiac catheter to make investigations, disputes, off-the-record, not a cardiologist," says Rosemann. In the face of constantly rising health care costs – and, a fortiori, according to the new study results would be a change of thinking is urgently needed.

Created: 20.11.2019, 19:20 Uhr

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