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PCI: Concerns Mount About Appropriateness

Cheryl Clark, for HealthLeaders Media, August 28, 2014

Three new studies show that too many patients with stable angina are still persuaded by cardiologists to undergo unnecessary elective angiography with subsequent percutaneous coronary intervention.

It's been more than three years since Paul Chan, MD, and colleagues shook the cardiosphere with their finding that 11.6% of non-acute stent procedures cardiologists performed in more than 1,000 U.S. hospitals were "inappropriate" and another 38% were of "uncertain" appropriateness, making about half of them questionable.

This was a big study, culled from the American College of Cardiology's National Cardiovascular Data Registry, which looked at more than 140,000 non-acute procedures performed during a 15-month period ending Sept. 30, 2010.


Inside Cardiology's PCI Problem


What with all the talk about efficiency, and resource stewardship, and bending the cost curve, you'd think things would have changed by now.

Yet a troika of studies published in Monday's JAMA Internal Medicine indicate the same-old, same-old patterns, as recently as 2012 and 2013. They show that an awful lot of patients with stable angina are still persuaded to undergo unnecessary elective angiography, with subsequent percutaneous coronary intervention.

Somehow patients are getting the message—sometimes from their doctors or from somewhere else—that plugging in a few stents will prevent heart attack and death, despite no evidence that is so.

There also may be insufficient information about severe risks, such as perforations—necessitating a rush to bypass surgery—and lesser risks such dye reactions, kidney toxicity, and radiation exposure. Then there is the cost, estimated at about $14,000 per procedure nationally, plus medication costs, a share of which patients have to absorb.

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