Wednesday, May 03, 2006

News From Korea - Opening totally blocked heart arteries

I was at a meeting in Korea where much evidence was presented which showed that re-opening heart arteries blocked for 3 years or more is possible and helpful. When these arteries are opened, the patients live longer, their heart function improves, and they have better ability to withstand future artery blockages. For a long time, this was not known because it was very difficult to re-open arteries that have been blocked for more then 2 years.

The procedure is like the basic angioplasty, except that there is a need for some special equipment and, of course, operator skill. The early equipment available were crude and the chance of success was low, about 20-30%. Even when we manage somehow to open them, they tended to close again (50-70% will re-close). Presently, as shown over and over again at this meeting, with the current equipment available, the better expertise and knowledge available, the chance of success in opening chronically, totally blocked artery is about 70% (80% in some good Japanese centers). With the current drug-eluting stents available, the ability to keep them open is about 80-90%. This is certainly good news for the many patients who have chronically blocked heart arteries who have been advised to go for surgery. Perhaps, the lessons from Korea and Japan will offer them another way.

What is the downside? Well angioplasty pprocedures to open chronically, totally blocked heart arteries tend to be very long (lasting 5-6 hours) with considerably high X-ray exposure, and the equipment tended to be costly, may cost up to twice ot three times more then the usual angioplasty. The cost is worth it if you succeed (like everything in life). Should you spend all that maney and develop a complication, or if you failed, then there is much to answer for.

So, is Malaysia ready for this procedure?

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