‘Interventional cardiology has a bright future unless gene therapy takes over’

Interventional Cardiology is fast gaining grounds in India. According to recent statistics, around 50,000 interventional procedures are performed annually in India and the trend seems to surge. But equally gaining roots are doubts and fears on the risks involved in these procedures. In an interview with Syed Falaknaaz, interventional cardiologist and honorary assistant cardiologist with Bombay Hospital Institute of Medical Sciences, Dr B C Kamath, attempts to clarify the myths and misconceptions associated with interventional cardiology.

After the recent controversy involving sudden clotting of drug eluting stents (DES) in the US leading to death of patients , how safe do you think are interventional procdures?

There is no controversy at all. They have brought those facts to the common man which the doctors knew from the beginning. Interventional procedures are very safe if performed in high volume centres where angioplasty is routinely done. Also the expertise of the doctor doing the angioplasty is important in making the procedure simple.

Restenosis/ re-blockage is not regular, its only two to nine percent in DES, also 20 pe rcent patients still require a bypass due to high incidence of diabetes in India and patients having small artery size. People should not get scared of re-blockage because a good solution like re-angioplasty is available, also a bypass surgery can still be done.

What are the advantages of interventional cardiology over bypass surgery?

Advantages of interventional cardiology are innumerable. First and foremost, it does not involve the cutting of the patient as in a bypass. But a pin hole puncture of the artery is done, through a small catheter the entire complicated procedure is performed with the patient being discharged the next day. Most importantly if the patient does not have re-stenosis within six months to one year he is cured for life. Secondly, there are no chances of sternal infection or a bone infection as in a bypass.

Thirdly, there is very negligible morbidity. Anti-platelet drugs like aspirin, clopidogrel which are very safe can bring down the chances of restenosis considerably. A lot of people do not know that seven to eight per cent of graft closure occurs even in a by-pass surgery if vein grafts are used.

How do you rate the future of interventional cardiology in India?

Brilliant, unless gene therapy replaces angioplasty.

What are the advances made in the field of interventional cardiology?

We have pacemaker insertion for heart rhythm disturbances including AICD (automatic implantable cardioverter defibrillator). This machine gives automatic internal shocks to correct chaotic rhythms ( ventricular tachycardia) and (ventricular fibrillation) which are life threatening arrhythmia , without the shock being actually felt by the patient. Besides, there are dual chamber pacemakers which make life very comfortable for elderly patients. Nowadays, we have come up with bi-ventricular pacing to treat intractable heart failure. Apart from these interventional procedures we are now closing the holes namely Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) etc, vessel connecting aorta and pulmonary artery. Since time immemorial these holes were cut and patched. But in these two years interventional cardiology has advanced to a great extent, such that we now put an umbrella like device across these holes percutaneously.

How do you rate the quality of stents produced in India? Do they match international quality?

No comments.

How does an interventional cardiologist recommend the supply of stents?

Interventional cardiologist does not recommend the supply of stents. We use stents which have documented randomised trials in human beings. Also the artery size and the length of the blockage is taken into account.

Why is an interventional cardiologist still classified as a physician and not as a surgeon?

Because apart from interventional cardiology, we have a lot of clinical practice to perform. We are first doctors, then physicians and then trained to become interventional cardiologists. There are very few interventional cardiologists in Mumbai and not every cardiologist is trained to become an interventional cardiologist which requires 2 to 3 years of training.

Not every patient requires DES. Many patients are treated and for life time completely by routine stents because if the artery size is equal to or bigger than 3.5 mm the restenosis and re-blockage is negligible. Therefore if good stents are used , if the artery blockage is not too long ( less than 15mm) than routine stents are good enough for the treatment.

Which is more cost effective?

Drug eluting stent and surgery can almost cost the same. The cost of an interventional procedure depends on the number of blocks the patient has cause this determines the number of stents that will be used. So, DES can cost more if the number of stents used are more. Lots of patients who had a bypass 10-15 years back are being treated by angioplasty and stenting now. Bypass surgery is a palliative surgery. After all whether the patient undergoes bypass or angioplasty the most important is weight reduction, control of diabetes, avoiding fatty food and regular exercise which help him in keeping him fit for life.