Dear Editor,

I have read several articles in the Guyana media suggesting that angioplasty with stenting is the panacea for ischemic heart disease e.g. Angina and heart attacks. Enclosed is a lecture I gave to the Medical Association of Guyana in November last year. There are only three indications for angioplasty with stenting

1. if the coronary artery’s diameter is too small for a bypass

2. if patient had a bypass using a vein and same became blocked again

3. if patient is in shock or going into one after a heart attack and possible after failure of thrombolytic treatment i.e. medical treatment then rescue angioplasty with stenting is indicated.

Angioplasty with stenting was only started in 2002 and after five years of reviews it was found that in many instances once patients are seen early, medical thrombolytic treatment is better than stenting. Further, even with modern stenting blood clots form once in contact with a rough surface or foreign body hence the necessity to use anti-platelet drugs e.g. Clopidrogel was advised for use for a year then later twenty-eight months and now for life because it was never tested for bioavailability until recently, only to find that it was only 15% absorbable.

Also angiogram and angioplasty with or without stenting should be ethically and legally done if surgical (cardiac) facilities are available as a backup in case of complications.

Further, stents rarely last more than five years as opposed to bypass 17-21 years and in diabetics with two or more vessel disease only bypass should be available. Guyana should concentrate on controlling and preventing the predisposing factors like smoking, hypertension, diabetes, obesity, dyslipidemia etc. ECGs, stress tests, echocardiograms etc. should be made easily available. The Medical School of UG should amalgamate with UWI and then with this you would then have better quality of medical persomel and improved quality of graduates and then start pursuing tertiary medical care.

Finally a recent Swiss study showed that drug eluting stents, would only reduce restenosis (blockage of artery) in three to five percent of cases and had no benefit on death or heart attack.

Yours faithfully,
Hughey H. Hanoman