By Shawn Pichette

Caused by the formation of plaques within arteries• Plaque is made up of

macrophages• Cholesterol crystals• Calcification

Advances in Atherosclerosis are chronic, slowly progressive, and cumulative

Leads to thrombus (blood clot)

Leads to myocardial infarction (heart attack)

EARLY INTERVENTION LATER INTERVENTION

Cessation of smoking/ diet/ exercise

Statins (Lipitor, Crestor, Etc.)

Dietary supplements: Niacin (Vitamin B3), Omega-3 Fatty Acids, Other Vitamins (C, E, and K2)

Beta Blockers Ace Inhibitors

Antiplatelet Agents (Plavix)

Thrombolytic Therapy Coronary Artery Bypass

Surgery Primary Coronary

Intervention - Angioplasty

“Any endovascular procedure that reopens narrowed blood vessels and restores forward blood flow” (Taber’s Cyclopedic Medical Dictionary)

Utilizes a stent that is inflated to a fixed size using water pressure from 75 to 500 times normal blood

pressure

Generally performed on coronary, carotid, or peripheral artery

Thrombolytic Agents

Open Heart Surgery

Plavix Angioplasty

Invasive? No Yes No Yes

Adverse Events

Intracranial Hemorrhage, Fever, Irregular Heartbeat, Low Blood Pressure, Allergic Reaction to Streptokinase

Stroke, Myocardial Infarction, Acute Renal Failure, Stenosis, Nonunion of Sternum, General Surgical Complications

GI Hemmorhage (2% Incidence),Neutropenia (0.05% Incidence)

Ischemia, Stroke, Myocardial Infarction, aortic dissection

Performed By:

Physician (or Under Physician’s Supervision, Nurse Practitioner

Cardiovascular Surgeon, Cardiovascular Anesthesiologist, Etc.

Patient Orally (Prescription Required)

Interventional Cardiologist; Trained MD

Failure Rate in MI

~ 20% 5 – 10% - < 5%

Cost $11,788-$14,438 $44,000-$60,000 $448.02 for 90 75mg tablets ARP

$94,000

Duke University Study• Compared angioplasties to medical therapy

alone in high risk patients

Used Duke Activity Status Index to measure patient outcomes

Also used cost effectiveness

Angioplasty group showed better health outcomes after four months

Both groups showed similar health outcomes at one to two years

Angioplasty group costs were over $7,000 higher than medical therapy group over two years

Where and when can one get an angioplasty/ bypass/ thrombolytic agent?• For example, rural areas, time of day, day of week• Quality of surgeons in local hospital

What is the tradeoff for failure rate vs. cost?• Also long term vs. short term treatment

How long term should long term be?• Note age of patient• Other diseases that patient may have

Even at its high cost, angioplasties are the best treatment for most patients suffering from atherosclerosis or myocardial infarction, especially in short term

It may not be economical in certain situations• For example, patients with cancer

It may not be possible in some situations• For example, patients in rural areas

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6. Kowalczyk, Liz. Hospital ratings complicate care of sickest - Mass. General Rethinks When to Do Angioplasties ." Boston Globe 01 Apr 2009: News - National.

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Apr 2009 <http://www.webmd.com/heart-disease/thrombolytics-for-heart-attack-and-unstable-angina#te7965>.

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