President Bush’s stent brings overuse debate to forefront

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 - Stent

The announcement that former President George W. Bush received a stent after an annual physical is resuscitating debate about overuse of PCI in certain cases.

According to a statement from Bush’s spokesman, a blockage in his artery was discovered during a routine checkup at Cooper Clinic in Dallas on Aug. 5. “At the recommendation of his doctors, President Bush agreed to have a stent placed to open the blockage,” according to a statement released Aug. 6.

The former president, 67, was sent to Texas Health Presbyterian Hospital, where the procedure was performed Tuesday without complications. He returned home on Aug. 7, according to the Associated Press, citing Bush spokesman Freddie Ford. He is expected to resume normal activities Aug. 8.

“President Bush is in high spirits. … He is grateful to the skilled medical professionals who have cared for him,” the statement continued. “He thanks his family, friends, and fellow citizens for their prayers and well wishes. And he encourages us all to get our regular check-ups.”

CNN reported that in 2006, Bush’s annual exam revealed a “low to very low” risk profile for coronary artery disease and “minimal/mild” coronary artery calcification.

Bush did not show symptoms recently but “the stent was necessary,” Ford told USA Today. “His annual physical includes a stress test. EKG [electrocardiogram] changes during the stress test yesterday prompted a CT angiogram, which confirmed a blockage that required opening."

The case has revived discussions about appropriate use, particularly in asymptomatic patients.  

Steven Nissen, MD, head of cardiology at the Cleveland Clinic, is quoted by Bloomberg News as saying: “This is really American medicine at its worst. It’s one of the reasons we spend so much on healthcare and we don’t get a lot for it. In this circumstance, the stent doesn’t prolong life, it doesn’t prevent heart attacks and it’s hard to make a patient who has no symptoms feel better.”

The same article quoted Paul S. Chan, MD, of Saint Luke's Mid America Heart and Vascular Institute in Kansas City, Mo. Chan’s research has found that most PCIs for acute indications were classified as appropriate compared with only about half when performed for non-acute indications.

“The reality is that we don’t know if we can change the trajectory of disease in people who don’t have symptoms, are doing fine and are physically active,” he told Bloomberg. “There’s no evidence treatment will help them live longer, feel better, or have fewer heart attacks.”

American College of Cardiology President John Harold, MD, used the opportunity to educate the public about risk factors for heart disease. “Every person should know their own situation and know that there are things you can do to reduce your risk of heart disease,” he said in a release. “The earlier you begin, the more likely it is to make a difference.”

The Society for Cardiovascular Angiography and Interventions also posted resources on its website to help the medical community communicate with patients about coronary artery disease and treatments.