US Pharm. 2007;32(3):12.

Blockage of the coronary arteries is a major cause of heart disease and heart attacks. Technological advances in the treatment of blocked arteries include the introduction of coronary artery bypass graft (CABG) surgery, or cardiac revascularization, in the late 1960s and percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty, in the late 1970s (now often called percutaneous coronary intervention). Both procedures are preceded by cardiac catheterization, which measures the location and extent of coronary artery blockage. The use of CABG, PCTA, or an alternative procedure depends on various factors, such as location of blockage, number of blockages, and extent of blockage.

In 1996, the FDA established a Product Code for the coronary artery stent to ensure its safety and effectiveness. Stenting is performed in combination with the PCTA procedure. Since the mid-1990s, angioplasty has been used increasingly with the insertion of stents because of the lower renarrowing rates of opened arteries (restenosis). According to the American Heart Association, 70% to 90% of PCTA procedures involve the placement of a stent.

From 2002 to 2003, there were more than 500,000 hospital discharges involving at least one coronary stent insertion procedure among adults 45 and older. Between 1996 and 1997 and 2002 to 2003, the rate of coronary stent insertion procedures for adults 45 and older more than doubled from 22 to 49 per 10,000 population. Among adults 75 and older, the rate of hospitalizations that included this procedure more than tripled from 23 per 10,000 population in 1996 to 1997 to 73 per 10,000 population in 2002 to 2003. For persons ages 45 to 64, the rate of stent procedures per population stabilized after 1999, but the rate continued to rise in persons 65 and older, in part because PTCA and stenting are considerably less invasive than CABG and can be performed on older persons who are likely to have other medical conditions that preclude more extensive open-heart CABG surgery. In contrast to rising rates of stent insertions, rates for CABG procedures declined among adults ages 45 to 64 and remained stable for adults 75 and older.

Medical innovations developed during the last 30 years, such as CABG, PCTA, and the intracoronary stent, have contributed to improved survival for heart attack patients. It is estimated that around 70% of survival improvement in heart attack mortality is a result of these technological changes. Furthermore, new drug-eluting stents show promise of reducing restenosis and subsequent heart attacks.

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