Stents, stents, stents for sale, who wants a stent?

Dwight W. Clark, M.D. Medical Director of US-Sino HeartCare. [Photo provided to chinadaily.com.cn]

I was able to meet with Dr. Hu after my arrival in China and discovered we had many shared medical experiences and now shared the same interests. Professor (I think we should be consistent and call him "Dr.")Dr.Hu, like me, had spent the majority of his career practicing invasive and/or interventional cardiology. Each of us had treated thousands of patients who had undergone coronary bypass surgery, angioplasty of the coronary arteries, and/or the implantation of coronary stents. We independently came to the same conclusion that this approach was simply not working. We developed a shared goal of educating both the medical profession and the public that, unless you are in the process of an acute heart attack, coronary intervention is not successful and there is no evidence this will prevent death or early disability.

We wanted to change the focus to one of prevention. Heart attacks and strokes can be prevented andthis is the message we have dedicated ourselves to promoting, and in the process, stopping all of the unnecessary interventional procedures.

Stents can open blood vessels and increase blood supply, which can relieve angina symptoms, but it does not prevent heart attack or sudden death. A stent is a metallic foreign object implanted in vessels, it is also a long-term risk factor for coronary blockage. This blockage can lead to a heart attack and sudden death. The stents we use in China are nearly 100% drug-eluting stents. Although drug-eluting stents can reduce restenosis, it has a greater risk of thrombosis than bare-metal stents. Therefore, patients have to take two medications for the rest of their lives to prevent thrombosis – aspirin and clopidogrel (Plavix)."

The massive overuse of coronary angioplasty and stenting is a worldwide problem that is consuming a huge percentage of scarce medical resources,and producing no tangible positive results.

"Overtreatment has become an epidemic all over the world. Under the market-oriented trend of medical service, overuse of stents now becomes a more important issue in China," Dr. Salim Yusuf from Canada saidat the World Heart Federation conference. "Overuse of stents will kill cardiovascular medicine!"

Overtreatment is mainly due to the for profitmedical system. The solution to this problem will require the cooperation of both the international medical and political community. Everyone should acknowledge the problem of overtreatment and try to find methods to control this overuse of coronary stents.The complete reform of the health system in China, and worldwide,as proposed by President Xi Jinping could provide a total and lasting resolution.