PCI and Interventional Cardiology

[LGMD]

With the recent study publication regarding PCI, will this affect the number of interventions performed by cardiologists in the future? and also, has this affected the number being performed in the present?

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[BlackSails]

Could you post a link/reference to the study?

 

[duncan11]

I assume that you are talking about the COURAGE trial in the New England journal a couple months ago. Although there was also a JAMA SWISSI II trial earlier this month on PCI and silent ischemia.

I don't see the COURAGE trial really changing the practice of many cardiologists. It did not actually demonstrate anything that was not previously known. PCI for stable angina does not have a mortality benefit although it may help for symptomatic relief of angina refractory to medical treatment. All the STEMI or NSTEMI caths are still going to be done, it doesn't change the management of these conditions. Many patients are much more of mixed picture, they may have a low ejection fraction that warrants a cath, as an ischemic cardiomyopathy can improve with revascularization.

 

[LGMD]

I was talking about the COURAGE trial. Thanks

 

[joti]

With the recent study publication regarding PCI, will this affect the number of interventions performed by cardiologists in the future? and also, has this affected the number being performed in the present?

If you are looking at the recruitment of the trial only 10% of the patients they screened participated in the study. This itself shows this is applicable to only to a minority of population. Also many times the patient's choice is to go for PCI. So I dont think this trial has a great impact on US.

However, this is a very positive study to the countries outside US who usually select patient population looking at the cost effect ratio. This will give reassurance to the Cardiologists and patients outside US.

This is my gut feeling.

 

[itsachik]

Take it from a practicing cardiologist: the COURAGE trial will have a major impact on the practice of Cardiology. Most academic minded cardiologists already knew that angioplasties were useful only for symptom control. However, majority of the procedures were being performed putatively to prevent MIs. This is the first randomised control trial which clearly debunks the myth. While the patient population was selective, these are the kind of patients referred for 70% of stents: hence the applicability of the results is wide.
Its a matter of time before somebody comes out with a cost effectiveness analysis and reimbursements for cardiac interventions start decreasing.