arrhythmia and shocks your heart back into normal rhythm) have
approached a rate of about 40 percent that of pacemakers.^43 Therefore, the
2014 volume of defibrillators could be estimated at 77,738. The total US
volume of implantable electronic cardiac devices in 2014 is estimated to
have been 272,000 devices. (A study by the European Society of
Cardiology in 2015 showed 500,411 pacemakers and 85,289 implantable
cardioverter defibrillators were implanted in 2013 in the greater European
area.^44 All taken together, the worldwide market for implantable
electronic cardiac devices is set to exceed one million per year.)
Coronary artery stents are small, expandable cylindrical devices made
of metal (and more recently, polymer) that open up coronary arteries. They
have been in use almost a half century, at times facing intense scrutiny
over their potential overuse. Initially made of bare metal, and now
commonly coated with drugs that inhibit the formation of clot and scar
tissue on the stent itself, stents are placed either following an acute heart
attack or in cases of ischemic chest pain. Trying to determine the number
of stenting operations per year with a semblance of accuracy may be one
of the most challenging computations of this book. The New York Times
reports that there are 500,000 such procedures per year,^45 and USA Today
quotes a Vanderbilt cardiologist estimating one million operations per
year.^46 Other estimates claim 700,000 stenting operations annually.^47
The crux of the problem in analyzing stent implantations is the dual
nature of inpatient and outpatient procedures and the large numbers of
patients who are not of Medicare age. A recent report analyzed data from
the Centers for Medicare & Medicaid Services from 2001 to 2008,
concluding that there were 319,567 procedures in 2008.^48 Alternatively, a
Journal of the American Medical Association paper evaluated the NIS,
including all adults, and concluded that 809,400 adults had stent
placement in 2008.^49 No more recent data analysis exists in the medical
literature, and with the population aging, and stenting remaining popular,
it is entirely reasonable that the real number is one million patients per
year undergoing stenting per year in the United States. With over seventy
companies manufacturing stents, the worldwide market is estimated at
$12,000,000,000 (yes, $12 billion) annually.^50
Device-related repair of large vessel aneurysms has dramatically
decreased morbidity and mortality of the dreaded condition. After leaving