FEATURED EDITORIAL
Percutaneous coronary revascularisation: is it ever worth what it costs?
Correspondence to:
Dr D B Mark, Outcomes Research, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA; daniel.mark@duke.edu
"How could percutaneous coronary intervention without the risks and morbidities of heart surgery not be of benefit to patients? Hard experience teaches that such attractive "pathophysiological" simplifications are unreliable guides to practice and paradoxically may lead to worse rather than better treatment decisions" See also article on page 1238 and viewpoint on page 1188
Abbreviations: ACS, acute coronary syndrome(s); CAD, coronary artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention, QALY, quality-adjusted life year
Keywords: coronary revascularisation
| The first 150 words of the full text of this article appear below. |
Thirty years ago, Andreas Gruentzig changed the course of medical history when he reported his initial clinical experience with percutaneous coronary intervention (PCI) using balloon catheters. Currently, cardiologists in the UK perform over 70 000 PCI procedures a year, which represents about a 400% increase in volume over the past decade.1 Similar increases can be found in many European countries and in the USA.2 Although US doctors perform about 10 times as many procedures as their UK counterparts on a population five times as large, both groups behave as if an ever increasing number of patients with coronary artery disease (CAD) are best served by undergoing PCI. From these observations, and given the growing financial investment implied by the trends, one might conclude that a broad consensus exists about the clinical role of PCI.
The evidence base, however, does not provide the strong support implied by these international practice trends.
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