Feb. 11, 2010 -- Former President Bill Clinton's readmission to the hospital Thursday -- for the placement of two stents in a coronary artery -- was perhaps shocking to the public, but not surprising to a cardiologist.
Clinton, 63, was admitted to the Columbia Campus of New York-Presbyterian Hospital for the procedure, according to a statement by Douglas Band, a counselor to the former president. This is the same hospital where Clinton had quadruple bypass surgery in 2004 to free four blocked arteries.
''This is not an unusual occurrence after bypass surgery," says P.K. Shah, MD, director of cardiology at the Cedars-Sinai Heart Institute in Los Angeles. Shah is not treating Clinton and spoke to WebMD about bypass procedures in general.
What might have gone wrong?
Anyone who has had bypass grafts for heart disease is still at risk for heart problems, Shah says. "The bypass grafts themselves can develop plaque buildup and narrowing." When that happens, chest pains are the usual symptoms.
Without knowing the details of Clinton's condition, Shah tells WebMD that three scenarios are possible:
- There could be a problem with a graft.
- A problem could have developed beyond the graft site in an artery that was operated on in 2004.
- A new narrowing or blockage could have developed in an artery that wasn't bypassed.
Isn't this early to develop problems so soon after bypass surgery?
Not necessarily, Shah says. Here's why: ''If he had four grafts [in the original surgery], chances are good that at least one was probably from the leg."
"The vein graft [from the leg], when put into coronary circulation, tends to develop disease rapidly. By five years, 30% to 40% of leg vein grafts are either closed or narrowed."
Typically, the patient undergoes an angiogram to get a visual image of the narrowing, Shah says. Next, the narrowed artery can be opened up with a balloon. A stent can be placed in the artery to keep it open.
Could Clinton have done something to prevent this?
Bypass patients are always advised to follow a healthy lifestyle, including rigorous control of blood pressure, cholesterol, and other risk factors, Shah says.
But, he adds, ''even with rigorous control, disease can still occur."
What's the probable prognosis for Clinton?
Without knowing details, Shah concedes it's difficult to say. ''As long as his heart function is good and there is no significant damage to the heart muscle, the prognosis is generally good."
''If these are drug-coated stents, they will probably have a chance to stay open," he says. "There's a 90% to 95% probability that within the next two to three years they will still be functioning."
The bottom line for Clinton and other bypass patients, Shah says, is: "Once you have bypass surgery, don't assume you are out of the woods. You are not cured by bypass surgery. You still have to follow a heart-healthy lifestyle and [take] medications to control risk factors."
Repeat bypass surgery can be done, if necessary, he says, although the surgery can be difficult. "You don’t want to be a frequent flyer for bypass surgery," Shah says.