Study suggests non-surgical treatment preferable for coronary artery disease

By Tauren Dyson

Jan. 7 (UPI) -- An effective heart procedure to unclog arteries remains unpopular in the U.S., a study says.

Fewer than 1 percent of unprotected left main disease cases used percutaneous coronary intervention, or PCI, to treat the condition, according to research published this month in JAMA Cardiology, with doctors instead opting for the traditional coronary artery bypass, or CABG surgical method.


However, the uptick in ULM PCI procedures between 2010 to 2016 from .7 to 1.3 percent in clinical trials suggests the procedure is becoming more popular among doctors, researchers report.

"Our findings document a slow uptake of ULM PCI performance in the United States despite emerging data suggesting ULM PCI as a reasonable alternative to CABG," the study read.

The left main coronary artery runs up from the aorta sitting over the left cusp and pumps blood into the heart's left side. When fatty plaque builds up in that artery, it causes a narrowing known as stenosis.

During CABG surgery, doctors use a healthy vein or artery to connect to a blocked left main coronary artery, going around the clogged portion to provide another outlet for increased blow flow.


"The study was important, as we do not have a contemporary understanding of unprotected left main PCI to understand the state of clinical practice as compared to more recently published clinical trials," Javier Valle, a researcher at Rocky Mountain Veterans Affairs Medical Center and study author, told UPI. "Understanding the similarities and differences between treated populations in practice versus trials is critical to help understand the generalizability of the trials and their findings."

PCI is what used to be known as angioplasty with a stent. On average, a doctor performs fewer than one PCI per year and medical facilities perform about three.

For the procedure, doctors place a catheter into a blood vessel in the arm or the groin. Once in place, they push the catheter up to the heart near the narrowed artery. Then they inflate a balloon covered by the stent at the end of the tip to push down the plaque into the artery.

The stent remains inside the artery to keep it open.

Part of the reason for PCI's unpopularity is its success rate. According to the study, patients who receive PCI have a higher rate of mortality and strokes.

As with this current study, other research says that PCI is more prevalant among older patients, according to the National Institutes of Health.


"My suspicion is that unprotected left main PCI is occurring most frequently as an option for patients who have been declined for surgery, as opposed to being seen as an equivalent therapy," Valle said.

"I believe it will take some time for ULM PCI to increase in use, and will require increasing levels of operator experience and exposure, as well as changing attitudes towards referral and case selection," he added.

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