FEBRUARY 29 2020 LISTENER 21
has improved, but he doesn’t know if that is
to do with his new lifestyle or the stents and
medication. He’s on three drugs for blood
pressure, a statin for cholesterol and aspirin.
“I was afraid I was dying, so I’ve got no
misgivings about having had the opera-
tion. It was a gift that helped address all
the things in my life.”
Both stents and cardiac bypass operationsare common in New Zealand. More than
6500 people a year have angioplasties to
insert cardiac stents in public and private
hospitals and about 1500 have coronary
artery bypass surgery. More than 2600 die
of ischaemic heart disease.
Heart Foundation medical director
Dr Gerry Devlin, a former Waikato Hos-
pital-based cardiologist, was a principal
investigator for the Ischemia study when
it began about seven years ago. He says the
results are “really important” and likely to
change treatment guidelines. “Probably a
lot of people’s bias would say that if you
have blockages, bypassing them or putting
stents in is better. I’ve been putting in stents
for 25 years and intuitively you think you
are going to help someone live longer. The
trial has shown that’s not the case.” The
study excluded patients with severe angina
or blockages in their left main coronary
artery, which supplies blood to about two-
thirds of the heart’s muscle. “It suggests that
if you have angina, that maybe it’s okay
to do a CT scan and, if you don’t have left
main stem disease, we see how things go
with medication.”
Invasive procedures and surgery also
come with risks. “So, if I can treat your
angina well and there is no mortality ben-
efit to you of an operation and your quality
of life improves with a simple tablet, why
not look at that as a first option?”
Importantly, however, the trial did show
that patients with stents or bypasses had
better relief of their angina symptoms,
improving their quality of life. That’s a
crucial consideration if their chest pain
is significantly curtailing their activities,
says Doughty. He says not everyone can
tolerate heart medicines or responds to
drugs in the same way. “We label people
as having angina, but you can line up 100
people with that condition and they are
all different.”
The findings will potentially have a
bigger impact in countries such as the
US, where over-intervention is rife. “Here,
it’s not about, ‘Right, you have a whiff of
chest pain, go and have an angiogram and
a stent.’ It’s about where it fits in for that
individual, what are their risks, what kind
of coronary disease do they have – and then
plan the management.”
New Zealand’s most experienced inter-
ventional cardiologist, John Ormiston,
medical director of Intra (formerly Mercy
Angiography), the country’s biggest private
provider of angiograms and stents, says the
patients who had stents or bypass opera-
tions in the Ischemia study had much less
angina afterwards, although a lot of media
reports on the findings suggested medical
treatment was just as good as those inter-
ventions, which isn’t true.
He says the results aren’t a surprise, “but
they make us more comfortable about notrushing into things”. In New Zealand, he
believes procedures are usually reserved
for people with severe symptoms. “With
minimal symptoms, you’re less inclined to
stent.” Stenting has progressively replaced
open-heart bypass operations as the devices
have been refined. For example, stents thatslowly release drugs to prevent the artery
reblocking have been available since 2002.
He says stenting has become more effective
and efficient and the risks are tiny. “You
virtually never see deaths and the risk of
stroke is infinitesimally small.”
People with progressive coronary artery
narrowing that occurs over years often
don’t think they are symptomatic because
they slow down and exert themselves less,
Ormiston says. “They just think they’reAN
GI
E
HU
M
PH
RE
YSMore than 6500 people a
year have angioplasties to
insert cardiac stents and
about 1500 have coronary
artery bypass surgery.
“I’ve been putting in
stents for 25 years andintuitively you think you
are going to help someone
live longer. The trial hasshown that’s not the case.”
continued from page 17
Rebooting his
health and his life:
Vic Beksinski with
his daughter, Zosia.