1. PROTECT YOUR HEART AND SAVE YOUR LIFE BY SAYING NO TO ANGIOPLASTY

2. Prof. Nandu Bhide Consultant Cardiac Surgeon D Y Patil University, Nerul Wanless Hospital, Miraj Aston university Birmingham UK 3. Coronary obstruction

Can be prevented or reversed

The correct lifestyle is the answer.

4. Interventions

Angioplasty

Bypass Surgery

5. Angioplasty

Tube passed via a peripheral artery to reach the lesion.

The tube has a balloon at the end.

At the site of the lesion the balloon is inflated.

Stent placed in the hope to prevent collapse.

6. Bypass Surgery

The lesion untouched.

Conduit from before to beyond the lesion.

Conduit is own tissue.

7. Role of medicines in lifestyle disease.

Medicines neither prevent nor cure.

Role is supportive till the obstruction is reversed.

A lot of side effects.

8. Lifestyle modification

The only and right answer to the problem.

9. The right lifestyle

FOR

EVERYONE.

10. Intervention

In only half the patients.

If the lesion is at a critical site

And is more than 70%

11. Choice of therapy

Medicines are just supportive.

Unproven therapies are dangerous

Right lifestyle is the answer.

All need right lifestyle.

But if intervention is needed then???????????????????????????????????????????????????????????????????????????????????????????

12. Attractive Therapy= Angioplasty

No Anesthesia

Short hospital stay

Less pain

But is it safe????????????

Is it effective in long term???????????????????????????????????????????????????????????

13. Angioplasty [PCI]

Is the current use of PCI in multi vesseldisease actuallyevidence based?

Are the limitations andrisks of PCI explained to patients?

Does it represent valuefor money?

Do numerous/repeatPCI make economic or medicalsense?

14. Angioplasty

Many previous "innovations" have been touted to be the solutionto problems of restenosis. These have included direct atherectomy,laser atherectomy, rotablater, brachytherapy which have allbeen touted previously as the grand solution to restenosis.However the hype for each has subsided over time.All these have been shown to be ineffective. It is difficultto fool nature in the reparative process of placing foreignmaterials in small vessels.

15. Angioplasty

You insert a foreign substance in the human body in PCI. This is nothing but to give a new disease in exchange of old one.

16. Angioplasty

Blood thinners compulsory after stent implantation.

Patient has other organs too that may require surgery in future.

Then either you stop the blood thinners and die of heart attack or

Bleed to death.

17. Angioplasty

Immediate Risk of sub acute myocardial infarction after PCI is37%.

Magneticresonance imaging defineda mean loss of 5% of left ventricularmuscle masstherefore function.

18. Angioplasty

700% more chances of re-stenosis.

150%more chances of death

Late thrombosis

More adverse events related to heart and brain due to angioplasty

19. Angioplasty- Cost

Two studies have been carried out to compare the costs of angioplasty and bypass surgery.

One was NHS- UK other one was by joint study by researchers in reputed US and British Universities in New York and London.

20. Angioplasty- Cost

Both conclude that the real cost of angioplasty is way higher than bypass.

If you add the high death rate of angioplasty high incidence of heart attack after angioplasty, the cost becomes phenomenally high for angioplasty.

21. Bypass Surgery

Patients own tissues used to re-vascularize.

Cost effective.

Long term solution.

Complete re-vascularization.

Takes care of Future lesions.

Time tested. performed as it was on day one. More than five decades around.

22. The evil

Clinical trials manipulated to sell stents.

The cardiologist is the gatekeeper, and thismay produce aconflict of interest in terms of self-referral;

The disingenuous presentation and inappropriate applicationof results of randomized trials in highly select and atypicalgroups to the whole population; and

The result of what happenswhen evidence-based medicine ischallenged by a multibilliondollar industry.

23. Chuen-Neng Lee, MDNUS Singapore

There are many unanswered questionsconcerning drug-eluting stents:

Will the drugs stay on the stents forever?

What happens whenthe drugs run out?

What will be the effect of the coatingson the arterial walls?

Will the drugs weaken the fibrous capof vulnerable plaquesnearby?

Is there a risk of creatinga new disease by placing the drugsinside the artery?

24. Editorial from the Mayo Clinic proceeding

: "Medicaltherapy has been forgotten options in the current mechanisticage of cardiology, in which, therapeutic results are more oftenmeasured by percentage stenosis rather than by clinical outcomesor long-term survival."

25. David P. Taggart, University of Oxford, Oxford, United Kingdom

Bypass surgery is the best treatment for the coronary patients but the patient needs to know. Unfortunately the patient is not informed about this fact by many of us and therefore denied the chance of best treatment.

continued ----

26. David P. Taggart, University of Oxford, Oxford, United Kingdom

Therefore it is our duty to educate the public so that they become aware of the facts.

This is the only way Out to save the patients from evil.

27. Spencer King at the end of theRITA II trials

"We must be honest with ourselves as wellas our patients if there is no evidence to support improvementin prognosis. The patients need to hear and understand that.In advocating use of drug-eluting stents, there could be situationswhere patients are not fully informed about the prognosis interms of life span, myocardial infarctionor potential long-term complications.

28. Conclusion

Right lifestyle is the answer.

Half the patients need only lifestyle modification.

Those with critical lesion need intervention.

Angioplasty is dangerous, ineffective and costly affair.

Bypass surgery is the right intervention.

29. Thank you. 30. www.bhideheart.com 0-98-6957-5897 SMS ONLY