There were enough problems with the execution of this story, which presents results of a study comparing open-heart surgery to angioplasty in patients with serious heart disease, that, in the end, one could question the decision to publish it. The story failed to evaluate the quality of the evidence and to emphasize factors which raise questions about that quality:
- The results were reported at a medical meeting and have not been published or peer-reviewed. (See our primer on the potential pitfalls of reporting on such stories.)
- It was financed by a leading maker of stents.
- Patients were followed for only one year.
The surgery-vs.-stent topic is highly controversial, even emotional, raising questions of benefits, risks, doctors’ self-interest and medical costs – all against a background of contradictory research. Publishing an article on this topic for a mass audience without raising more questions about the quality of the evidence is not in the public interest.
Having said all that, the reporter follows many health journalism best practices, including reporting absolute risks, quoting sources with no connection to the research, revealing the study’s funding source and providing context about previous research into stents.
Experience suggests that the decision to report a story like this can result when a reporter attends a medical conference and feels obligated to "come back with something." This invites overselling of the story by the reporter or the editor.
This tension may be apparent in the lede, which seeks to present a novel viewpoint on the findings. The reporter suggests the findings mean the choice to have surgery or angioplasty "may come down to one question: How many procedures would you like to have?"
That’s a spurious question. This research does nothing to change the established considerations that should drive a surgery-vs.-stent decision: Underlying patient health, disease state, death risk, stroke risk, recuperation time, access to a highly skilled surgeon and so on.
To imply this potentially life-changing decision should rest on "how many procedures" you want to have is foolish.
The costs of open-heart-surgery and stenting should have been mentioned. Given the fact that the study implies comparable effectiveness and risks, cost is at least a legitimate matter of interest.
Surgeries can cost more than four times as much as stenting.
The story reports absolute rates of death, stroke and need for an additional procedure. It does not describe the rates of relief from angina.
It also adequately describes the size, duration and methodology of the study.
The study mentions the potential harms of surgery and stents, including death and need for additional procedures.
But the story fails to distinguish in meaningful way between the 2 percent risk of stroke linked to surgery and the 8 percent greater chance of requiring a second procedure linked to stents compared to heart surgery. Stroke is a potentially debilitating, life-shortening condition; a second angioplasty presumably carries a very low risk of serious side effects.
The story fails to mention the demonstrated risks of heart attack and cognitive dysfunction linked to the surgery option.
Further, the story fails to indicate whether a "second procedure" means a heart surgery or a stent, and how that varies for each treatment group. Would someone with a stent require a heart operation as a second procedure, or another stent? That’s a big difference. Without this information, it’s impossible to compare the risks of the first procedures properly.
The story is based on results of a study that were presented at a conference and sponsored by the maker of a stent. The results cover only one year. The research has not been peer reviewed. The results may be specific to the stent used in the procedures included in the study. The story never emphasized these factors to comment on the quality of the evidence.
The story does nothing to exaggerate the risks or prevalence of heart disease.
As noted above, the story is based on a presentation at a conference, not on published literature.
But the report uses adequate sourcing otherwise. It quotes three credible cardiology experts with no connection to the research presented. It also cites an important recent article published in the New England Journal of Medicine.
The story is simply wrong when it states, "When arteries become blocked, doctors have two main options." There is no mention of drug therapy. For left main coronary artery disease, the two-option statement is perhaps defensible – although there isn’t good modern survival data on that condition treated with current optimal drug therapy. But for the subset of patients with 3-vessel disease in the COURAGE trial, drug therapy provided a similar survival to stents. So the absence of a discussion about drug therapy may suggest to readers that only angioplasty (stenting) and surgery are appropriate treatment options.
Even if one didn’t know how widely available are stents and bypass surgeries, the story makes enough reference to how widespread are these approaches.
It’s clear from the story that both approaches have been in use for a long time.
The story does not appear to draw from the press release issued by Boston Scientific, which paid for the study.