The cardiologist who performed the stent procedure on George W. Bush said in an interview with the American Heart Association that he decides whether to advise stress tests like the one performed on the former president based on each patient’s specifics.
Since the Aug. 6 procedure on the 67-year-old Bush, many have questioned the need for annual stress tests for people with no heart disease. But in his first published interview since, Tony Das, M.D. – who did not discuss the specifics of Bush’s treatment – said risk factors and other considerations should drive an individualized stress test decision for every patient.
“If you can convince me that you have the exact same risk factor profile, and that you had testing done that suggested an abnormality that was different from an abnormality that didn’t exist previously, and you have the exact same clinical profile as President Bush, I would say by all means you should get a stress test,” Dr. Das, director of peripheral interventions at Texas Health Presbyterian Hospital Dallas, told the American Heart Association on Friday.
However, if “you just want to go and see if maybe do I have coronary heart disease, and maybe is there an abnormality [on a stress test], and you don’t have previous smoking history and high cholesterol — both of which are publicly known about the president — I think that’s probably not appropriate,” he said.
Stress tests are often indicated when symptoms such as chest pain or shortness of breath with exercise have occurred. Dr. Das said there may be other reasons to be considered in deciding whether to order a stress test, including risk factors for coronary heart disease such as high blood pressure, a family history of heart disease or new abnormalities in other testing. One common heart test, for example, is an electrocardiogram.
Stress tests are a common way to detect coronary heart disease, where plaque builds up and narrows arteries, restricting blood flow to the heart, especially with exertion. Areas of plaque, even if not severe enough to cause symptoms, can create a risk for cardiovascular diseases, including heart disease and stroke, the nation’s No. 1 and No. 4 killers.
The American Heart Association does not recommend stress tests for patients with no symptoms and no cardiac risk factors.
Dr. Das, an interventional cardiologist with Cardiology and Interventional Vascular Associates, inserted a stent — a tiny metal mesh tube—into a coronary artery supplying Bush’s heart a day after a stress test performed at the Dallas-based Cooper Clinic suggested a problem.
The procedure used to insert a stent into the artery is called angioplasty. One of several percutaneous coronary interventions, it is non-surgical. Stenting, which is not always recommended, is also not always necessary, Dr. Das said.
During the stenting procedure, a coronary artery stent is threaded through a catheter and into one of the coronary arteries supplying the heart muscle. Once in position, a balloon placed inside the stent is inflated to open the stent in the narrowed section of the artery. The stent works by holding open a narrowed segment of the artery that has been widened by the angioplasty so blood can flow freely to the heart muscle.
Although recent research has shown heart stents are not more effective than the optimal medical treatment for patients with stable coronary artery disease, they remain an option. About 492,000 PCI procedures were performed in the United States in 2010, 67 percent on men. Of the total, about 51 percent were performed on people age 65 and older.
For more information from the American Heart Association:
- American Heart Association scientific statement on stress tests
- American Heart Association interview with Dr. Das
- Learn more about stress tests
- Watch how a coronary heart stent works
- Watch how an angioplasty works
- Learn about coronary angioplasty and stenting
Photo by the American Heart Association.