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(Circulation. 2004;110:3746-3748.)
© 2004 American Heart Association, Inc.

Editorial

Keeping the Patient in View

Defining the Appropriateness of Percutaneous Coronary Interventions

Jeptha P. Curtis, MD; Harlan M. Krumholz, MD, SM

From the Section of Cardiovascular Medicine, Department of Medicine (J.P.C., H.M.K.); the Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.); the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine (H.M.K.); and the Center for Outcomes Research and Evaluation, Yale New Haven Health System (H.M.K.), New Haven, Conn.

Correspondence to Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT 06520-8088. E-mail harlan.krumholz@yale.edu

Key Words: Editorials • revascularization • coronary artery disease • angioplasty

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since the original report by Andreas Gruentzig and colleagues,¹ the obvious esthetic and symptomatic benefit of opening narrowed coronary arteries to improve epicardial blood flow has led to remarkable growth in interventional cardiology. This growth has been fueled in part by advances in our understanding of the biology of atherosclerosis and clinical trials demonstrating that percutaneous coronary intervention (PCI) provides a viable alternative to medical therapy or coronary artery bypass surgery for appropriately selected patients. Nevertheless, the sheer volume of cases² (>1.2 million PCIs were performed in the United States alone in 2000) and the known geographic variations in the use of this procedure³ raise concerns that increases in the use of PCI have outpaced efforts to ensure that this procedure is being used in the most appropriate manner.

See p 3789

What are the benefits of PCI? Current evidence would suggest that outside the setting of an acute myocardial infarction, the principal, if not the only, benefit of PCI is to reduce angina and improve quality of life. Randomized trials of PCI versus medical therapy in patients with chronic stable angina suggest that routine revascularization has no effect on the risk of death or myocardial infarction and that its benefits are restricted to reducing angina and improving exercise tolerance.^4,5 These findings are supported by a meta-analysis of all randomized trials of PCI versus medical therapy in which PCI was associated with a significant reduction in angina but nonsignificant increases in the risk of myocardial infarction, death, and bypass surgery.⁶ . . . [Full Text of this Article]

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