CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 8th, 2010

“Cath Lab, We Have A Problem”?

According to a recently published study, a huge disconnect apparently exists between patients’ and cardiologists’ beliefs about the benefits of PCI. The patients had been referred for coronary angiography and possible PCI, had discussed PCI with a physician, and had provided informed consent. Most patients (~88%) believed that PCI would reduce their risks of MI, whereas most cardiologists (83%) reported believing that the benefits of PCI are largely limited to symptom relief. Yet, 83% of patients reported that their questions were answered, and nearly all (96%) reported that they knew why they were having the procedure.

Is it ethical to perform a procedure (e.g., PCI) to allay a patient’s fear of an impending catastrophic event when you don’t believe the procedure reduces the risk of that event?

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2 Responses to ““Cath Lab, We Have A Problem”?”

  1. Richard Kones, MD PhD says:
    September 8, 2010 at 5:44 pm

    No it is not, It would also be quite difficult to defend legally, if that should come about. Fear is not in the ACC/AHA, or ESC guidelines as an evidence-based justification.

  2. ABOUBAKER EL-AGNAF, MD, MRCP,FRCP,DIM,FSCIA,MCS says:
    September 19, 2010 at 1:51 am

    I totally aggree with this, infact the patient should understand that the stents actually increase the risk of MI and that the sole benifite is symptoms releave and the stent is just an form of antianginal theapy.
    the reason, risk of acute, subacute,late and very late stent thrombosis should be given clearly to the patients and the risk of death as result of that should be clearly highlted and discussed and aggreed between the two. and now the second option of the treatment( CABG) should also be discussed and syntax scor measured.
    infact all this can not be done properly if we do the procedure in one stage( diagnostic+ pci).
    and I think this knid of apprach is uneithical and mostly driven by persona interest.