One of the most comprehensive surveys to date vindicated the results. Of 5,827 patients treated with angioplasty between January and June 1991 in the state of New York, 88 per cent were reported as being successful (JAMA, 2 December 1992). However, "no data on post discharge complications are available", stated the report in a throwaway line at the end, but one that hides the real long term efficacy of the treatment.
Ironically, it was The Lancet, the journal that had first announced the new wonder treatment, that was in the vanguard of those voicing concerns. A delegate from the journal attended an angioplasty course in 1991 and wrote that he "tended to take a less favourable view of the outcome than the clinician doing the procedure, and in general the results of coronary angioplasty seemed inferior to those reported in journals" (The Lancet, 14 November 1992).
In the US, an even more damning statement was issued by the American College of Cardiologists: "Observations raise the question of whether cardiology has focused too much on doing coronary angioplasty procedures rather than on addressing who needs it, what are the criteria, and what are the results. Is angioplasty being done for cardiologists or for patients?" This represented a remarkable volte face by a profession normally protective of its procedures.
Far from being an instant miracle cure all, the truth about angioplasty is much more complicated.
It is more effective for simple cases. A study in Boston, Mass., discovered that angioplasty patients with two to three risk factors had a survival rate over five years of just 13 per cent (New England Journal of Medicine, November 5, 1992).
Stenosis (narrowing of the artery) reoccurs within six months after angioplasty with the diameter of the blood vessel being only 16 per cent larger than before treatment (according to the American College of Cardiologists). In one Italian study restenosis occurred in 73 per cent of cases (New England Journal of Medicine, 10 October 1991).
Because of the need for continual retreatment and monitoring, the real costs of angioplasty may be much higher than those for medical therapy in cases of mild angina and single vessel disease. A separate study in Maryland, estimated that hospital charges had doubled in the 10 years angioplasty has been used (New England Journal of Medicine, 2 January 1992).
The efficacy of the treatment in triple vessel disease was further questioned by an Italian study which reported only a 52 per cent success rate in those cases. It was also successful in only 30 per cent of cases of total blockage of the artery (Journal of the American Medical Association, 6 January 1993).
It has a very low success rate with blocked arteries in the lower part of the body. Despite an increase in the use of the treatment from one per 100,000 to 24 per 100,000 from 1979 to 1989 in Maryland, the numbers of leg amputations remained constant at 30 per 100,000 (New England Journal of Medicine, 22 August 1991).
There is also strong evidence that many of the angioplasty operations carried out may be unnecessary. A damning American study (JAMA, 11 November 1992) looked at 171 patients who had earlier been referred for angioplasty and concluded that for half of them the operation wasn't needed or could be safely deferred. They also point out that coronary angioplasty was originally expected to replace bypass surgery, but in fact, both studies have grown in tandem, with neither reducing the frequency of the other. "Evident over the past decade is the ever lowering threshold for carrying out bypass as well as angioplasty. . . even asymptomatic patients are not exempt," they say.