Why Angioplasties Are Next To Useless

What do you know or have to say about cardiac bypass ornery graft, CABG surgery? What does the evidence say about this? What is the information? What do you have to tell us about this? Coronary artery bypass grafting is a fairly major surgical procedure to try and improve the blood supply to the heart. It was a boom industry in the 80s and 90s and has suffered greatly

because of the interventionalists and now most patients have stents. Stents are done for the same thing. They are done to unblock narrowings in the arteries that feed the heart. It's hard to understand people don't see how the heart needs blood because it's full of blood but it actually needs its own blood supply and that's the problem. And that's what causes a heart attack if that gets

blocked. Unfortunately though, the larger high quality studies where people have had this procedure compared to just taking drugs or other medical treatments or not having it done at all, have shown that for what we call stable angina which is not somebody having a heart attack right now but somebody with heart disease, that having this procedure is not better than not having all the alternatives. And having

a stent for a stable angina or just heart disease that's visible on a scan is the most common reason for having it done. So it's one of the most common surgical procedures. It's very common with hundreds of thousands of being done. And yeah, there is some evidence for it in acute situations but for most of the time it's not better than not having it. And again,

it's hard to get that message across because it makes sense. But you're narrowing a tight artery that must be better. Yeah, but there's other things that happen when you do that. There's there's an unintended consequences. The heart has developed. So the blood supplies to make up for that narrowing and there's all these sort of complicated issues that go into it. But there's spent some high quality

studies showing that it's not better than medical or non surgical alternatives. Let me see if I can clarify what Dr. Geros said. And he he traipsed on to stents and angioplasty in a question that was regarded as a problem. And I think it might have been a little bit confusing for the audience, but he gave a good answer. But I'll see if I can describe the

literature. And I'd love to hear criticisms of what I'm saying and seeing it. See if what I've read is correct for corner already bypass crafting the only successful prolongation of life, the only improvement in mortality is in the left main disease, right? It's a two centimeter piece of artery that is in the left main disease. And I think it's a two centimeter piece of artery that

is in the left main disease. And it connects up to other major arteries that surround the heart. Now, if you plumb your way around that, and that's what corner already bypass crafting is, it's a simple conceptually and it makes sense in a certain kind of a way. But the only study is that have shown improvement in lifespan have been in plumbing around the left main artery,

not in any of the other arteries, right? So these guys, these surgeons conceptually, it seems to make sense. People have coronary blockages in multiple places. They do five, six plumbarounds. And they see improvement in the way the heart looks in the chest. But the only improvement in mortality in lifespan is this plumbing around the left main, the left main equivalent, which is plumbing all three of

the arteries simultaneously, does not produce an improvement in mortality, right? And the improvement in mortality is only 20%. At five years, I mean, let's see if I remember exactly. But it's a small improvement mortality for this one specific instance. And the entire edifice of coronary artery bypass crafting, the surgery stands upon this one bit of evidence that only applies to left main disease, right? Now, traipsing

on to the other subject, which is the competing industry, which is angioplasty. These guys have proven with their studies, the cardiologists, that the only time that they make an improvement in mortality, which is all you really care about, is if you have an acute event, you're really sick, you've got chest pain, and you're in trouble. You have what's called an ST elevation myocardial infarction, which, which

is an obvious sign in the EKG, and it's actually relatively rare in terms of heart attacks. And Dr. Harris said it properly, and he made the point correctly, that 95% plus of the angioplasty is done in disease, which is chronic. They may not even have chest pain. But the, you know, they come, they go into the doctor's office, they get a stress test, and then they

get angioplasty, angiogrammed, and they find these, these lesions, and they're not symptomatic. And they, they're not symptomatic. But they, 95% plus of angioplasty, and stints are done on people without chest pain at all. Right? And so, so they, they, they supposedly they can get a big improvement in the people with chest pain. But I frankly, I looked at the numbers and I analyze it in my

book, and I, I think the entire effort is unfounded, and my references, Norton hadlers work. And he, he, he, he, he, he, he. He runs over the numbers, and I looked at them all, and I, I think that basically angioplasty's are, are next to useless. And stints are absolutely without foundation. They, they, they got these drug, secreting drug eluting or drug secreting stints. And it just

doesn't, it doesn't improve mortality, which is all you care about. And, and, and the only instance where it supposedly works, are a small percent of the, of the heart attack. where they have ST segment elevation, they're very sick. And these people, they, they take them to the calf lab, and they die in the calf lab in, in, in some, you know, in some percentage way that,

that mimics the, you know, I mean, the whole thing is a, is a crazy effort. And I think these industries should be discredited. They're about, we spend about the same on coronary artery bypass grafting as angioplasty instead. And they, they, they, they, they, they, they, they, they, the surgeon or the cardiologist. I'm, I'm curious about what doctor Abrams has to say about what I just said

because I know he knows these numbers. Yeah. Um, excuse me. I agree. Um, I think there's a wonderful natural experiment that has happened. Ontario, Canada, uh, controls the number of facilities that can do cardio pulmonary bypass surgery, uh, carton, coronary bypass surgery. And so, in Ontario, there's one fifth, the number of facilities that do the procedure. As there are in Pennsylvania, which has the same population.

So in Ontario, the doctors have to decide which fifth of the patients are going to get the bypass surgery. Uh, and Pennsylvania has an open door. What they found is that the more talent, there's absolutely no mortality difference between Pennsylvania and Ontario. Uh, after an MI. Um, and what it shows is, at the very least, that the, doctors in Canada can figure out which fifth of

the, uh, percent, 20% of which 20% of the patients who are having an MI, um, deserve, uh, uh, coronary bypass surgery, compared to the people in Pennsylvania. And it goes back to this idea that, that we have a market based medical system. You can make money if your hospital does bypass surgery. There's no question about that. But we're not making people better in proportion of the

amount of money that's being spent on it. Plus, it's very important to remember that it's major surgery and a significant portion of folks in proportion to their age have mental status changes after their bypass surgery. So it's not without medical costs either. Three to nine percent of them die and 30% of them have brain fog that last months is measurable neurological deficits. Right. MUSIC