Overuse of Percutaneous Coronary Interventions
JAMA Intern Med. Published online January 16, 2018. doi:10.1001/jamainternmed.2017.7828
Since Gruentzig first used a balloon to inflate the left anterior descending of a young man with angina in 1977, there have been hundreds of millions of percutaneous coronary interventions (PCI) done worldwide. Most PCI are performed on patients who are asymptomatic or who have not had a trial of optimal medical therapy,1 which is equally effective in preventing myocardial infarction or death. Furthermore, in symptomatic patients there is no benefit to PCI in reducing symptoms or improving quality of life compared with a placebo procedure.2 This carefully performed analysis3 from the China PEACE study adds to the concern of overuse of PCI. It documents yet another commonly known but little discussed contributor to inappropriate PCI—the inaccuracy of angiographic readings. Visual assessments tend to systematically overestimate the magnitude of the stenosis, meaning that patients will get an intervention on a lesion that is not hemodynamically significant. In a painstaking analysis of 1295 patients who underwent PCI in China, Zhang et al3 compared physician visual assessment with quantitative coronary angiography (QCA). They found systematic overestimation of angiographic stenosis by 10% for patients with acute myocardial infarction (AMI), and 16% for patients without AMI./.../
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