In 2005 some 800,000 Americans had angioplasties, many of them for the second, third, or fourth time.
Even with the best modern techniques, the blockage can return. Up to 20% of all angioplasty patients who have a stent inserted during the procedure will have blocked arteries again within six months.
An extensive study published in 2007 found that over 40% of all angioplasty patients end up having bypass surgery within 10 years. By comparison, fewer than 4% of bypass patients need the operation again over the same period of time.
Angioplasty after heart attack
Angioplasties are often an essential treatment for heart attack patients. As with all parts of heart attack care, timing is crucial.
A Duke University study found that, for many heart attack patients, angioplasty performed more than three days after the attack didn't seem to prevent another attack. Researchers concluded that the procedure should begin within 12 hours.
Angioplasty for women
The benefits of angioplasty are mixed for women. A 2004 study estimated that for every 1,000 women who experience serious heart attacks and undergo angioplasty, the procedure will result in 56 fewer deaths, subsequent heart attacks, or strokes within 30 days of the attack than can be expected to occur with other treatments. The corresponding figure for men was 42 events.
But another study found that nearly 8% of women who underwent angioplasty after a heart attack died within one year, compared with only 3% of men.
Female angioplasty patients tend to be older and sicker than men, and some women may receive inappropriately large doses of blood thinners prior to the procedure, which makes it riskier.
Smaller women also tend to have narrower arteries, which makes angioplasty trickier and potentially more dangerous.
Practice improves outcome
Even though angioplasty is much simpler than surgery, doctors generally need a lot of practice to get it right.
Studies show that the patients of doctors who perform more angioplasties a year tend to fare better than those who perform fewer of them.
The American College of Cardiology and the American Heart Association recommend that angioplasties be performed by doctors who conduct at least 75 angioplasties a year and in hospitals that conduct more than 400 of the procedures each year.