Pioneer Heart Patient Marks Medical Field’s 30-Year History

WASHINGTON, Oct. 22 — Few of the doctors in the crowded ballroom had ever met him, but Adolph Bachman was the patient who needed no introduction at this cardiology conference.

Thirty years ago in Zurich he became the first person to have a blockage in a heart artery cleared without undergoing traumatic surgery — a procedure known as angioplasty that gave rise to an entire field of medicine in which doctors known as interventional cardiologists now specialize. More than 15 million patients have followed the trail Mr. Bachman blazed.

I feel compelled to give you all a big hug, Mr. Bachman, 68, said to doctors here in a short talk. He recalled his angioplasty and Dr. Andreas Gruentzig, the charismatic doctor who invented the procedure and taught it to thousands of others before dying in a plane crash in 1985.

Mr. Bachmans gratitude was a welcome balm for the doctors here at the Transcatheter Cardiovascular Therapeutics conference, an annual gathering for the interventional cardiology field. Their specialty has been clouded in the last year by debate about whether some innovations — like stents to prop open arteries after blockages have been cleared — are being overused and may even be compromising some patients health.

The number of angioplasties performed fell 10 percent last year because of the climate of calamity, according to Dr. Martin Leon, a conference organizer.

The meeting began Saturday with scientific sessions and will run through Thursday. The biggest priority for many in attendance, who include device makers and their investors, has been to overcome the staggering impact of safety questions about the most widely used devices: stents coated with drugs that are meant to deter subsequent blockages.

In session after session, speakers here are dwelling on the small number of deaths associated with the safety issue — a reported tendency for deadly clots to form in the stents long after they are implanted. Various studies show that the clot risk is slight — 0.2 percent to 0.6 percent annually, or a handful of patients among every 1,000 — and that overall death rates are no different than for patients who use older bare-metal stents.

Many of the sessions have questioned the reliability of the studies that raised the safety issues. The single most alarming study published in the last year, a report comparing patients in Sweden who got drug-coated stents to those receiving bare-metal stents, was superseded by subsequent findings of no difference in outcomes, based on an additional year of data.

And last month, a peer-reviewed report in The New England Journal of Medicine that tracked Canadian patients suggested that death rates were actually lower with the drug-coated stents, presumably because patients were not exposed as often to the risks of repeat procedures to clear blockages.

But Dr. Leon and Dr. Gregg Stone, another conference organizer, voiced a caution in a joint introductory session this morning. They said that no clinical trials in the field had been big enough to clarify the safety profiles of all the different stents or to truly gauge angioplastys advantages in various types of patients. As a result, they said, no single study should govern doctors recommendations to patients.

Angioplasty begins with inserting a thin tube into the circulatory system — usually through a major vein in the thigh — and threading it into the blood vessels that sustain the heart. Once the doctor reaches the constricted artery, a tiny balloon at the end of the tube is inflated to open a pathway through the blockage.

We thought it was borderline insanity, said Dr. Leon, recalling when, as a Yale University medical student in the late 1970s, he first heard of Mr. Bachmans procedure.

These days companies like Boston Scientific and Johnson & Johnson earn billions of dollars annually making devices to treat coronary blockages without chest surgery. And those fortunes are being plowed into developing new therapies using related technology, like replacing heart valves without surgery.

Mr. Bachmans short talk and an introduction by Dr. Bernhard Meier, the Swiss doctor who took over his case when Dr. Gruentzig moved to Atlanta in 1980, highlight how the field has changed. In 2000, after 23 years of feeling healthy — Mr. Bachman noted he took Dr. Gruentzigs advice to quit smoking and eliminated the stress in his life from overwork and a troubled marriage — he told Dr. Meier his chest pain was returning.

X-rays showed a new blockage near the site that had been cleared in 1977. Dr. Meier said he told Mr. Bachman it was not serious enough to warrant even a low-risk procedure like angioplasty.

After Mr. Bachman continued to complain, Dr. Meier inserted a catheter into the artery to perform a diagnostic test that showed strong blood flow through the narrowing. The test is one that some doctors think should be more widely used to avoid unnecessary stenting, but Dr. Meier is among the majority who believe it is generally not worth the additional time and cost.

Despite the results, Mr. Bachman insisted on not only getting the angioplasty but on getting a stent inserted. Two months later, he was back at the hospital in need of a procedure to clear a new blockage in the bare-metal stent.

Today, Mr. Bachman said, he is active, singing in two choirs, hiking, gardening and playing cards, and is pain free while taking only aspirin.

His story to date represents the broad experience with interventional cardiology — good results for most patients, a growing variety of tools and tests that can add to costs, and the increasing involvement of patients in determining their therapy.

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