State mandates review of stent necessity

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Following notorious cases of overstenting, the Maryland General Assembly passed legislation that mandates independent review of coronary stent placement and whether it is medically necessary, MedPage Today reported.

Maryland has received quite some media attention with two high-profile stent cases originating from the state, including Mark Midei, formerly with St. Joseph Medical Center in Towson, Md., and John McLean, of Salisbury, Md. The legislation is part of a larger bill to establish guidelines for cardiac surgery and stenting.

The bill, which mandates external peer review, aims to create evidence-based guidelines for the use of stents. However, some physicians say the bill doesn't go far enough in that it should require both internal and external peer review, according to Christopher White, president of the Society for Cardiovascular Angiography and Intervention, in the MedPage Today article.

The state mandate on stenting reviews--now on its way to the governor's desk--comes on the heels of the ABIM Foundation Choose Wisely campaign, in which nine physician specialty associations spelled out their lists of overused tests and procedures. The American College of Cardiology pointed to stents as one of them.

"Patients experiencing a heart attack and undergoing a procedure called percutaneous coronary intervention (PCI) should not have stents placed in an artery or arteries beyond those responsible for the heart attack," according to the American College of Cardiology's list of recommendations.

For more information:
- read the MedPage Today article
- see the ACC statement

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