PROTECT YOUR HEART AND PROTECT YOUR HEART AND SAVE YOUR LIFE BY SAYING NO SAVE YOUR LIFE BY SAYING NO

TO ANGIOPLASTYTO ANGIOPLASTY

Prof. Nandu BhideProf. Nandu Bhide

Consultant Cardiac SurgeonConsultant Cardiac Surgeon

D Y Patil University, NerulD Y Patil University, Nerul

Wanless Hospital, MirajWanless Hospital, Miraj

Aston university Birmingham UKAston university Birmingham UK

Coronary obstructionCoronary obstruction

Can be prevented or reversedCan be prevented or reversed The correct lifestyle is the answer.The correct lifestyle is the answer.

InterventionsInterventions

AngioplastyAngioplasty Bypass SurgeryBypass Surgery

AngioplastyAngioplasty

Tube passed via a peripheral artery Tube passed via a peripheral artery to reach the lesion.to reach the lesion.

The tube has a balloon at the end.The tube has a balloon at the end. At the site of the lesion the balloon is At the site of the lesion the balloon is

inflated.inflated. Stent placed in the hope to prevent Stent placed in the hope to prevent

collapse.collapse.

Bypass SurgeryBypass Surgery

The lesion untouched.The lesion untouched. Conduit from before to beyond the Conduit from before to beyond the

lesion.lesion. Conduit is own tissue.Conduit is own tissue.

Role of medicines in lifestyle Role of medicines in lifestyle disease.disease.

Medicines neither prevent nor cure.Medicines neither prevent nor cure. Role is supportive till the obstruction Role is supportive till the obstruction

is reversed.is reversed. A lot of side effects.A lot of side effects.

Lifestyle modificationLifestyle modification

The only and The only and right answer to right answer to the problem.the problem.

The right lifestyleThe right lifestyle

FORFOR

EVERYONE.EVERYONE.

InterventionIntervention

In only half the patients.In only half the patients. If the lesion is at a critical site If the lesion is at a critical site And is more than 70%And is more than 70%

Choice of therapyChoice of therapy

Medicines are just supportive.Medicines are just supportive. Unproven therapies are dangerousUnproven therapies are dangerous Right lifestyle is the answer.Right lifestyle is the answer. All need right lifestyle.All need right lifestyle. But if intervention is needed But if intervention is needed

then???????????????????????????????then???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????

Attractive Therapy= AngioplastyAttractive Therapy= Angioplasty

No AnesthesiaNo Anesthesia Short hospital stayShort hospital stay Less painLess pain But is it safe????????????But is it safe???????????? Is it effective in long Is it effective in long

term???????????????????????????????term???????????????????????????????????????????????????????????????????????????????????????

Angioplasty [PCI]Angioplasty [PCI]

Is the current use of PCI in multi Is the current use of PCI in multi vessel disease actually evidence vessel disease actually evidence based? based? 

Are the limitations and risks of PCI Are the limitations and risks of PCI explained to patients?explained to patients?

Does it represent value for money?Does it represent value for money? Do numerous/repeat PCI make Do numerous/repeat PCI make

economic or medical sense? economic or medical sense? 

AngioplastyAngioplasty

Many previous "innovations" have been Many previous "innovations" have been touted to be the solution to problems of touted to be the solution to problems of restenosis. These have included direct restenosis. These have included direct atherectomy, laser atherectomy, rotablater, atherectomy, laser atherectomy, rotablater, brachytherapy which have all been touted brachytherapy which have all been touted previously as the grand solution to previously as the grand solution to restenosis. However the hype for each has restenosis. However the hype for each has subsided over time.All these have been subsided over time.All these have been shown to be ineffective. It is difficult to fool shown to be ineffective. It is difficult to fool nature in the reparative process of placing nature in the reparative process of placing foreign materials in small vessels. foreign materials in small vessels. 

AngioplastyAngioplasty

You insert a foreign substance in the You insert a foreign substance in the human body in PCI. This is nothing human body in PCI. This is nothing but to give a new disease in but to give a new disease in exchange of old one. exchange of old one.

AngioplastyAngioplasty

Blood thinners compulsory after Blood thinners compulsory after stent implantation.stent implantation.

Patient has other organs too that Patient has other organs too that may require surgery in future.may require surgery in future.

Then either you stop the blood Then either you stop the blood thinners and die of heart attack orthinners and die of heart attack or

Bleed to death.Bleed to death.

AngioplastyAngioplasty

Immediate Risk of sub acute Immediate Risk of sub acute myocardial infarction after PCI myocardial infarction after PCI is 37%.is 37%.

Magnetic resonance imaging Magnetic resonance imaging defined a mean loss of 5% of left defined a mean loss of 5% of left ventricular muscle mass therefore ventricular muscle mass therefore function.function.

AngioplastyAngioplasty

700% more chances of re-stenosis.700% more chances of re-stenosis. 150% more chances of death150% more chances of death Late thrombosis Late thrombosis More adverse events related to heart More adverse events related to heart

and brain due to angioplasty and brain due to angioplasty

Angioplasty- CostAngioplasty- Cost

Two studies have been carried out to Two studies have been carried out to compare the costs of angioplasty and compare the costs of angioplasty and bypass surgery.bypass surgery.

One was NHS- UK other one was by One was NHS- UK other one was by joint study by researchers in reputed joint study by researchers in reputed US and British Universities in New US and British Universities in New York and London.York and London.

Angioplasty- CostAngioplasty- Cost

Both conclude that the real cost of Both conclude that the real cost of angioplasty is way higher than angioplasty is way higher than bypass.bypass.

If you add the high death rate of If you add the high death rate of angioplasty high incidence of heart angioplasty high incidence of heart attack after angioplasty, the cost attack after angioplasty, the cost becomes phenomenally high for becomes phenomenally high for angioplasty.angioplasty.

Bypass SurgeryBypass Surgery

Patients own tissues used to re-Patients own tissues used to re-vascularize.vascularize.

Cost effective.Cost effective. Long term solution. Long term solution. Complete re-vascularization.Complete re-vascularization. Takes care of Future lesions.Takes care of Future lesions. Time tested. performed as it was on day Time tested. performed as it was on day

one. More than five decades around.one. More than five decades around.

The evilThe evil Clinical trials manipulated to sell stents.Clinical trials manipulated to sell stents. The cardiologist is the gatekeeper, and The cardiologist is the gatekeeper, and

this may produce a conflict of interest in this may produce a conflict of interest in terms of self-referral; terms of self-referral; 

The disingenuous presentation and The disingenuous presentation and inappropriate application of results of inappropriate application of results of randomized trials in highly select and randomized trials in highly select and atypical groups to the whole population; atypical groups to the whole population; and and 

The result of what happens when The result of what happens when evidence-based medicine is challenged by evidence-based medicine is challenged by a multibillion dollar industry. a multibillion dollar industry. 

Chuen-Neng Lee, MD Chuen-Neng Lee, MD NUS SingaporeNUS Singapore

There are many unanswered There are many unanswered questions concerning drug-eluting stents:questions concerning drug-eluting stents:

Will the drugs stay on the stents forever? Will the drugs stay on the stents forever?  What happens when the drugs run out? What happens when the drugs run out?  What will be the effect of the coatings on What will be the effect of the coatings on

the arterial walls? the arterial walls?  Will the drugs weaken the fibrous cap of Will the drugs weaken the fibrous cap of

vulnerable plaques nearby? vulnerable plaques nearby?  Is there a risk of creating a new disease by Is there a risk of creating a new disease by

placing the drugs inside the artery?placing the drugs inside the artery?

Editorial from the Mayo Clinic Editorial from the Mayo Clinic proceeding proceeding

: "Medical therapy has been : "Medical therapy has been forgotten options in the current forgotten options in the current mechanistic age of cardiology, in mechanistic age of cardiology, in which, therapeutic results are more which, therapeutic results are more often measured by percentage often measured by percentage stenosis rather than by clinical stenosis rather than by clinical outcomes or long-term survival."outcomes or long-term survival."

David P. Taggart, University of David P. Taggart, University of Oxford, Oxford, United KingdomOxford, Oxford, United Kingdom

Bypass surgery is the best treatment Bypass surgery is the best treatment for the coronary patients but the for the coronary patients but the patient needs to know. Unfortunately patient needs to know. Unfortunately the patient is not informed about this the patient is not informed about this fact by many of us and therefore fact by many of us and therefore denied the chance of best treatment. denied the chance of best treatment.

continued ----continued ----

David P. Taggart, University of David P. Taggart, University of Oxford, Oxford, United KingdomOxford, Oxford, United Kingdom

Therefore it is our duty to educate Therefore it is our duty to educate the public so that they become the public so that they become aware of the facts.aware of the facts.

This is the only way Out to save the This is the only way Out to save the patients from evil.patients from evil.

Spencer King at the end of Spencer King at the end of the RITA II trials the RITA II trials

"We must be honest with ourselves as "We must be honest with ourselves as well as our patients if there is no well as our patients if there is no evidence to support improvement in evidence to support improvement in prognosis. The patients need to hear prognosis. The patients need to hear and understand that. In advocating use and understand that. In advocating use of drug-eluting stents, there could be of drug-eluting stents, there could be situations where patients are not fully situations where patients are not fully informed about the prognosis in terms informed about the prognosis in terms of life span, myocardial infarction or of life span, myocardial infarction or potential long-term complications.”potential long-term complications.”

ConclusionConclusion

Right lifestyle is the answer.Right lifestyle is the answer. Half the patients need only lifestyle Half the patients need only lifestyle

modification.modification. Those with critical lesion need Those with critical lesion need

intervention.intervention. Angioplasty is dangerous, ineffective Angioplasty is dangerous, ineffective

and costly affair.and costly affair. Bypass surgery is the right Bypass surgery is the right

intervention.intervention.

Thank you.Thank you.

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