Friday, February 12, 2010


When I came into the office this morning, I learn that Mr Bill Clinton ( former US president ) had undergone angioplasty yesterday ( Thursday, 11th Feb 2010 ) at the New York Columbus Presbyterian Hospital. Two coronary stents were implanted. I presumed that they were drug eluting stents. I checked out all the usual websites, and few details of the procedure had been released. I know that he was probably unwell sometime on Sunday or Monday when he rang the NY Presb.Hospital chief of cardiology for an appointment, as he was experiencing chest pains. He was given an appointment in two days. But because of his heavy schedule, he was seen on Wedsnesday and had his angiogram and angioplasty of Thursday. Two stents were implanted in his native coronary artery as one of the venous graft had become stenosed. He took the procedure well and is now recuperating. Of course we all know that Columbus Presbyterain is a world reknown center for angioplasty, hosting the likes of Dr Greg Stone ( of Taxus fame ), Dr Antonio Colombo, Dr Martin Leon, Jeff Moses and many others. The staff interventional cardiology list in NY Presbyterian is like a whose who in interventional cardiology. Maybe that is why their cardio-surgical work is not ranked among the best in USA. I know that Dr Greg Stone was in Rome on Thursday ( probably with Antonion Colombo ), so they could have done the procedure. I really do not know who performed the angioplasty and which stents were used. It would have been nice to know.
It is important to note that Mr Clinton is a hypertensive and has raised lipids. In fact back in 2004, he was put on statins, which he stopped, and the statins were re-instituted, before his quadraple by-pass surgery ( back in 2004 ). There was alot of discussion then, whether stopping the statins had anything to do with his chest pains and unstable angina in 2004, for him to undergo emergency CABG by Dr Craig Smith. Be that as it may, 6 years after CABG, the venous grafts have blocked again, even in the land of the best for the best. He exercises ( 5 mile runs ) but eats the worse kind of diet for a heart disease patient, giant burgers, chips, steaks etc..
Well, I wish to highlight two points. Life style changes are a very important part of heart disease treatment and medical therapy, including the use of statins is very important. Also, re-vascularisation procedures are in many ways, buying time and they all ( whether CABG or angioplasty ) have their limitations and both procedure suffer from the issue of re-narrowing. We would have expected that the CABG ( on the average ) should have lasted 10-15 years. In Bill's case, it was just 6 years. Hopefully, of the 4 grafts inserted in 2004, only one was noarrowed at 6 years, which is the average. The other 3 are presumably healthy. Angioplasty with drug-eluting stents have a re-narrowing rate of < 5%. we always tell our patients that there is a high possibility that you may need a repeat angioplasty in 5-6 years time.
Well, we all wish Mr Bill Clinton a speedy recovery. He is a good campaigner and has done much to help the Haiti disaster.
PS. -
As we get more news, it seems that Mr Clinton was seen by his cardiologist ( wonder who ) on Thursday morning and taken straight to the cath. lab for his angiogram. The indication being recurrent chest pains. The coronary angiogram showed that his LIMA to LAD was fine ( the word used is "pristine"). One of the venous graft was totally occluded and the other two grafts were patent. The interventionist chose to treat the native artery supplied by the occluded venous graft with two DES. It is also noted that Mr Clinton was quite compliant with his diet following the CABG in 2004. He was actually kept on a South Florida diet, and was compliant. His cardiologist feels that he should be well enough for discharge on Friday.

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