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Patients overestimate the benefits of elective PCI.

It's now clear that percutaneous coronary intervention (PCI) relieves symptoms but doesn't save lives or prevent heart attacks in people with chronic stable angina. This message has been slow to filter through to cardiology patients at one US hospital, who were surveyed during 2008, well after the publication of a landmark trial. All 153 were scheduled for elective coronary angiography followed by a PCI if the investigator found an amenable lesion. Most patients were offered the procedure after a positive stress test. Nearly a third had never had angina, and just 42% (48/115) reported angina serious enough to limit their daily activities.

Nine out of 10 patients who responded to the questionnaire believed that a PCI would cut their risk of a heart attack (88%, 95% CI 81%-93%), and four-fifths also believed it would help prevent a fatal heart attack (82%, 75%-89%). The 37 cardiologists who were also surveyed didn't share their patients' optimism. Most seemed familiar with the limitations of the procedure they were recommending (or performing). The survey failed to establish why cardiologists recommended PCI to patients without limiting angina when they knew the only benefit was relief of symptoms. The authors cite pressure from patients and from lawyers and an intuitive sense that a narrowed artery should be widened if at all possible.

Rothberg MB et al. Ann Intern Med 2010;153:307-313.

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Article Details
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Author:M.B., Rothberg
Publication:CME: Your SA Journal of CPD
Article Type:Brief article
Geographic Code:1USA
Date:Oct 1, 2010
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