More is better, at least in angioplasty

ANN ARBOR, Mich. -- Before patients get their clogged heart arteries re-opened, they may want to ask their doctor just how many such procedures he or she has done, a new study finds. The answer may make a big difference in each patient's risk of suffering a major setback before leaving the hospital.

In the most up-to-date analysis yet of this contentious issue, researchers from the University of Michigan Cardiovascular Center and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium find that the risk of major complications from angioplasty and related procedures is much lower among patients whose doctors perform a large number of those procedures each year. The paper is published in the Journal of the American College of Cardiology.

In fact, the risk of major cardiovascular problems was 63 percent higher among patients treated by doctors who performed less than 90 procedures each year, compared with those who did more than 90.

However, the study found no difference in the risk of death before leaving the hospital among patients treated by low- and high-volume doctors. And, it found that a few doctors who performed fewer angioplasties each year still had very good patient outcomes, suggesting that "practice makes perfect" isn't the whole story for the minimally invasive procedures known as percutaneous coronary interventions (PCI).

The researchers say their data, from 18,504 artery-opening procedures done in 14 Michigan hospitals by 165 physicians during 2002, reflects current angioplasty care, including advanced clot-preventing drugs and devices called stents that hold arteries open after they're cleared. Both advances, and better technology for deploying stents within an artery, have helped make PCI procedures safer.

While previous studies using older data have shown major differences in rates of complications and death depending on how many artery-clearing procedures doctors have done, the new study suggests tha

Contact: Kara Gavin
University of Michigan Health System

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