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Can Pressure Wire Really Help Reduce Heart Attack Risk?
Blockage in the coronary vessels, if serious, might lead to heart attack and even death. In fact, coronary heart disease is the second main cause of death in Singapore. When doctors suspect their patients have blockage, they will try to locate the blockage by injecting into the blood vessels using a catheter (a small tube) through the upper thigh or arm. Such technique, known as a coronary angiogram, requires the use of X-rays or CT scans. Any arteries that seemed significantly narrowed on the angiogram are then propped open with stents. In some cases, bypass surgery may be implemented instead. This traditional method, however, has its limitations. While it is not difficult for a doctor to spot visually through an angiogram a severe blockage of 90 percent and an insignificant blockage of say n10 percent, it might not be easy for the doctor to assess cases involving blockages of 50 or 60 percent. These borderline cases involving moderate vessel blockages might occur in up to a quarter of heart disease patients. A recent study by United States researchers reported that Pressure Wire might help doctors better decide the placement of stents in their heart disease patients thus reducing health risks such as myocardial infarction and death by 30 percent. The findings were published in the New England Journal of Medicine in January 2009
By following 1,005 patients in Europe and the United States for 12 months after they received stents, the study found that patients having the pressure-sensitive wire used on them were less likely to have a repeat stent placement or bypass surgery, suffer a heart attack or die. The results also showed that only 13.2 percent of such patients suffered these complications, compared with 18.3 percent of patients on whom the device was not used. Pressure Wire is a tiny diagnostic device measuring about 0.35 mm in diameter. Equipped with a pressure sensor at its tip, this tiny device allows doctors to objectively measure pressure flow within heart arteries. This technology is not new. Both the National Heart Centre (NHC) Singapore and National University Hospital (NUH) have been using it since the early 2000s. Nevertheless, it has not been popular until recently. The device works in this way: when there is a blockage in an artery, a drop in pressure across the site of narrowing would be seen. The more severe the blockage in the blood vessel, the greater will be the drop in pressure. The Pressure Wire must be threaded through the catheter during an angiogram in order to measure pressure flow within arteries. In addition to the cost of an angiogram, patients usually need to pay about S$1,000 to 1,500 for the Pressure Wire. Perhaps, that is why many doctors still use the eye-balling method to visually estimate artery blockages. On the other hand, the need for unnecessary angioplasty or stenting, as well as costs, can be reduced if scientific measurements are used. For example, patients with moderate blockages can always be treated with medication alone. However, Pressure Wire technique has some risks too. It is an invasive procedure that is done during a heart disease patient is undergoing a coronary angiogram. In very rare instances, threading wire into the blood vessel could cause disruption to the plaque building up in the artery thus triggering a heart attack.
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