Angiograms: often an unnecessary rip-off

An angiogram lets doctors look for blocked blood vessels. Beginning at the groin (sometimes the arm), doctors thread a catheter through the arterial system until it reaches a coronary (heart) artery. Then they squirt in some dye and take a look at an image of the arterial system that shows up on a screen.

If they see blockage they thread a thin wire through the catheter and across the blockage. Over this wire, they pass a second catheter that holds an expandable balloon on the end. They inflate the balloon, which pushes plaque to the side and stretches the artery open. This is called angioplasty. Often, they also insert a wire mesh tube (stent) into the blocked area to hold it open.

If you have a completely blocked artery, these procedures may be life-saving. But angiograms are frequently performed as elective procedures on people with no symptoms of heart problems. According to the American Medical Association, 35% of the procedures are “inappropriate” and another third are questionable. That’s a lot, especially considering that the procedure typically costs around $8000 and angioplasty costs about $30,000. (An efficient “cath lab” in a hospital can perform around twelve diagnostic angiograms in a day—a big money maker.) Moreover, while major complications are not common, the procedure can cause tears in blood vessel walls and major bleeding.

The thing is, there’s no predicting where a heart attack will originate. It could start anywhere where there is plaque, even if the plaque is not obstructing blood flow. (A heart attack occurs when a clot breaks off the plaque and blocks the artery). A study performed in 2011 found that only a third of heart attacks originated in plaques that were blocking at least half of an artery. The remainder began with the rupture of plaques that appeared to be causing no problems. In other words, the partly blocked area visible in an angiogram is no more likely to be the site of a heart attack than any other plaque.

You will be unhappy to learn that, according to Dr. Gregg W. Stone, a cardiologist at Columbia, “Half the people over 65 have blockages.” We just need to get comfortable with that fact. As Dr. Judith Hochman, a cardiologist a NYU Longone says, “People believe that if they have a blockage, they have to fix it mechanically. It seems logical, but in medicine, many things that seem logical are not true.”

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