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InSeeking patients' consent: the ethical considerations, the General Medical Council (GMC) has issued clear guidance on the issue of obtaining consent.1 In the past it has often been the case that junior medical staff with little or no experience of cardiac catheterisation have obtained consent for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). This is no longer acceptable. The GMC guidelines do allow delegation of the task of obtaining consent to a “suitably trained and qualified person who has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved”. However, periprocedural sedation and anxiety preclude obtaining valid consent for a follow-on PCI immediately after the angiogram.2 Therefore, follow-on PCI requires that consent be obtained by either a consultant interventional cardiologist or a suitably experienced trainee (usually a specialist registrar) before the diagnostic procedure is performed.
Who should be consented for follow-on intervention?
In the context of an urgent or emergency diagnostic procedure in a patient with an acute coronary syndrome, consent should always be obtained for both angiography and intervention, as it is routine practice to follow-on when indicated. However, even in patients with stable angina undergoing elective investigation there are significant advantages associated with follow-on intervention including reduced procedural costs, and, at least in the UK, avoidance of the risks associated with going on to a waiting list.3 In order to pursue a strategy of follow-on PCI in these patients, it is necessary to prepare and consent all potential candidates in advance of the diagnostic procedure. Non-invasive testing cannot accurately predict the coronary anatomy and cannot in any event indicate whether the pattern of disease will be technically suitable for percutaneous revascularisation. If it is, then in many patients with single and multivessel disease and preserved ventricular function, the decision between surgery and PCI is largely …