Angioplasty's Golden Era May Be Fading

March 27, 2008— -- WASHINGTON -- One day last week, three doctors here reached inside a man's leaky heart and plugged a hole that threatened his life.

They did it without slicing open his chest or splitting his breastbone. They did it without touching him much at all.

The 87-year-old patient was too frail to risk open-heart surgery. Instead, they slipped a patch on the tip of a wire through a labyrinth of blood vessels into his heart.

"Very nice. Good job," exclaimed Zuyue Wang, an echocardiographer at Washington Hospital Center as a cardiologist maneuvered the device into place and it blossomed into view on the 3-D ultrasound monitor.

The approach the doctors used is derived from one of the most common procedures in medicine, coronary angioplasty, which is performed 650,000 to 1 million times a year in the USA alone.

But for the first time, independent analyses performed at the request of USA TODAY suggest the meteoric rise of angioplasty during the past three decades has ended.

"The rise of angioplasty procedures has leveled off and appears to be on the decline," says Duke University's Eric Peterson, who reviewed results of the analysis by the National Cardiovascular Data Registry.

Three major studies published in the past two years indicate that using the procedure to open blocked arteries to treat chest pain, or angina, may be riskier and no more beneficial than medication.

The research suggests angioplasty is used too often, and in many cases, the modest benefits don't justify the procedure's cost, which ranges from $10,000 to $12,000. The topic will be debated at the annual scientific session of the American College of Cardiology starting this weekend in Chicago.

The data registry analysis was one of two carried out at the request of USA TODAY. The second was performed by the Santa Fe-based market analysis firm Qforma, using data from the health care information company IMS Health.

The analyses found:

• The number of angioplasty procedures performed each year appears to have declined by 10 percent to 15 percent over the past two years, according to the data registry analysis that examined information from 337 hospitals.

• The use of angioplasty and stents -- mesh cylinders that prop open clogged arteries -- began dropping in June 2006, when results of two landmark studies that cast doubt on the procedure began filtering into the medical community before they were published, the Qforma analysis shows.

• Both analyses note a distinct shift in practice patterns. Doctors increasingly are choosing older, bare-metal stents rather than newer drug-coated versions that have been linked to lethal blood clots.