nosa47

Hi Niki:

Sorry to hear about your husband. The good news is that they told you it was not a heart attack, based on his blood works. There could be other reasons for his chest pain. It seems to me that the talk about placing a stent before they even did the angiogram to determine the cause of his chest pain is premature.

A lot has been written lately about doctors rushing in to place stents as a routine procedure because it has been such a cash cow for them. So the first step is to confirm through various tests that there actually was no heart attack. The ultimate test to check the condition of his coronary arteries is of course the angiogram which will determine the location and extent (if any) of any blockages (and he is awaiting that.) Based on those results, the decision will be made whether to place a stent/stents. With the controversy about the safety of drug-eluting stents lately, another decision will have to be made whether to place a bare-metal stent instead of the drug eluting stent. A third decision to consider is whether to place any stent at all vs. just doing an angioplasty followed by life-style changes such as medication, diet, exercise, stop smoking, stress reduction etc. However, nowadays, most cardiologists will usually go the stent route rather angioplasty alone. There was a recent study done that showed that such lifestyle changes alone as opposed to angioplasty and stenting produced very similar results after a five year period.

In summary, if he does need a stent, your options are:

1. Angioplasty with placement of a drug-eluting (medicated) stent which will entail a long term anticoagulant therapy i.e. Plavix for at least one year or more (some cardiologists say life-time since the news about late-stent thrombosis) in addition to aspirin. Such long-term therapy carry the risk of bleeding in some patients and in many cases needed surgeries cannot be performed since stopping the plavix to do the surgery raises the risk of thrombosis and heart attack.

2. Angioplasty with placement of a bare-metal stent. Many cardiologists are going back to using this old style stent since the news about the higher risk of the newer drug-eluting stents. There is a higher risk of stenosing with this kind of stent in the early stages after the heart attack but the risk of late-stent thrombosis (which is more dangerous) is less than the drug-eluting stent. The need for plavix on this kind of stent is much shorter in duration and here is where its advantage lies. You still have to be on life-time Aspirin therapy.

3. Angioplasty alone with no stent placement. (Unlikely)

4. Life-style changes alone as mentioned above with no invasive procedures.

Of course, regardless of which route to take, life-style changes still need to be followed.

If a stent has to be placed, ask if they use the latest technology (IVUS) to make sure the stent is properly placed. There has been a study that showed most of the stents placed (without IVUS) were either imperfectly or improperly placed resulting in complications.

Let us hope that you do not have to grapple with any of those decisions since it has not been determined that your husband had indeed suffered a heart attack. Hopefully it was just an anxiety attack or other malady and you will both be spared all the agony. At any rate, get all your questions answered and don't let them rush into doing something that is not needed. If his condition is stable, you have plenty of time to make a decision, get other opinions and follow the best course of action. Best of luck.