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PCI numbers will not drop after Courage

August 19, 2008

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

the impact will be small. The study is not a big surprise. No cardiologist thought he is saving lives stenting arteries in stable patients. The study required every one to get an angiogram if they had an abnormal stress test to qualify. We probably already not refer every abnormal test for cath using clinical judgement and severity of the abnormality. It is somewhat of a surprise that stents the way there are applied in real life actually do not have a negative outcome result. Once an angiogram is done. many factors interfere including patient expectations, some clinical factors and unfortunately some unethical financial incentive that will probably cause the PCI to still be done in most patients exactly like before courage. The study does not affect unstable angina and acute MI obviously. PCI in these conditions should continue unchanged. Until a study comes that empowers the non-invasive cardiologist to not refer pts with abnormal stress test for LHC, PCI will not drop.

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