Re: Stenting

dayb...@xxxxxxxxxxx wrote:
My blood results are excellent. I am doing aerobics for collateral
formations, there are no angina symptoms, and my LVEF is > 50%.

This is a normal LVEF.

My
Nuclear stress test is Negative (Good). The sensitivity (ability of the
Nuclear stress test to detect disease) is about 85% and the specificity
(the ability of the test to detect normals) is 85-90%. Thus there is
the possibility of a "false positive" that is the test says there is
disease when there in fact is no disease or a "false negative" where
the test says there is no disease and there is disease present.

More specifically, the test is designed to detect inducible ischemia
rather than disease (coronary atherosclerosis). A person can have
coronary atherosclerosis as determined by a high EBCT calcium score and
yet have a negative nuclear stress test that is a true negative test
result indicating there is no inducible ischemia despite the plaque
burden.

Currently at age of 68, I am doing 10.9 METS aerobics on trademill for
30 minutes. In addition, I am doing many other semi-aerobic exercises
for 1 hour.

Presumably this is without either angina or its equivalent.

I am very confused particularly in view of the following FOUR reasons
as to why some cardiologists are wanting/recommending me to have
stents,

1. Stents are not proven to increase life expectancy. Currently long
term mortality data comparing stents to CABG are limited and short term
data indicate heterogeneity between trial findings and no difference in
mortality.
In comparison to stenting, CABG is associated with reduced events by
55% and with reduced revascularizations by approximately 80% in
multivassel disease and in single vassel disease. There is no
difference in mortality apparent between interventions to date.
2. Stenting runs risk of scar tissue. The greatest disadvantage of
angioplasty is that scar tissue can develop at the site of the
treatment. This problem occurs within 6 months in approximately 30% of
patients.
3. Stents are permanant part of heart, They are not reversible
4. Stents may require restenting in 6 months.

My options right now are
1. Stenting voluntarily now even if no angina symptoms. Go to hospital
now. But again face options 2A, 2B, 2C below
2A.Do nothing now and then later Wait for angina attack or other
indicative symptom and then if I am not dead, get stents
2B Do nothing now and then if I am not dead, go to hospital to have
emergency angina/bypass surgery or
2C Do nothing now and then later have sudden death at home

If I am going to face options 2A, 2B, 2C even after stenting then what
is advantage of stenting now, particularly when it is not proven that
it increases life expectancy.

You have a 3rd option which is the wisest one:

Aggressive medical management where all modifiable risk factors for CAD
progression are identified and treated so that progression is either
arrested or reversed (i.e. reverse cholesterol transport). This is
most likely to happen if a person elects to become lean&trim getting
rid of most if not all visceral adipocytes.

Please post your comments/experience.

You've got it.

Thanks

You are welcome.

All thanks and praises belong to the LORD, Whom I love with all my
heart, soul, mind, and strength.

Prayerfully in Christ's amazing love,

Andrew B. Chung
Cardiologist, Atlanta, Georgia, USA
http://HeartMDPhD.com/HolySpirit

.

Relevant Pages

  • Stenting
    ... Nuclear stress test is Negative. ... Nuclear stress test to detect disease) is about 85% and the specificity ... Stents are not proven to increase life expectancy. ... Stenting voluntarily now even if no angina symptoms. ...
    (sci.med.cardiology)
  • Re: Stenting
    ... Nuclear stress test is Negative. ... Nuclear stress test to detect disease) is about 85% and the specificity ... Stents are not proven to increase life expectancy. ...
    (sci.med.cardiology)
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