Are cardiologists too eager to stent?

Interventional cardiologists are gun dogs. A cardiologist who spots a stenosis wants to rush off and do something, like a springer spaniel hearing the rustle of a pheasant in the covert. Following the COURAGE study, we are trying to retrain our cardiology springers to ignore stable angina on optimal medical treatment: “No, Doc! Sit! Stay!” we tell them, as they quiver and make whimpering noises. But the PRAMI study will let them off the leash to stent at their hearts’ content when faced with acute myocardial infarction. Patients with ST elevation MI in five large British hospitals were randomised to receive immediate percutaneous intervention for the “culprit lesion” alone, or for as many significant stenoses as the cardiologist felt worth stenting. The trial was stopped early when it was clear that there was a big benefit from the latter approach: “Hazard ratios …were 0.34 (95% CI, 0.11 to 1.08) for death from cardiac causes, 0.32 (95% CI, 0.13 to 0.75) for nonfatal myocardial infarction, and 0.35 (95% CI, 0.18 to 0.69) for refractory angina” during a mean follow-up of 23 months. Woof!
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums