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July
6, 2011 -- 11:30pm PDT
A Perspective on the Appropriate
Use of Angioplasty and Stents
Dr. Ralph Brindis is the Immediate
Past President of the American College of Cardiology
and helmed the National Cardiovascular
Data Registry (NCDR) since its inception in 1997
-- this is the registry that was the source for the
data analyzed and reported in yesterday's JAMA study,
"Appropriateness
of Percutaneous Coronary Intervention."
In my exclusive
interview with Dr. Brindis, I talked
with him about the study, his feeling
about what it showed, both the positive findings
and what he calls "opportunities for improvement."
While there
was almost 100% adherence
to guidelines for acute angioplasties (which made
up 71% of the total angioplasties performed) the
study also pinpointed the fact that PCIs
for non-acute patients had a
higher rate of "inappropriates", as defined by
the ACC/SCAI Appropriateness Criteria -- and that
this rate
varied widely from hospital to hospital. This means
that those hospitals with higher than average "inappropriate"
PCIs needed to look at their cases, their decision-making
process and work to bring it closer to the norm.
The crazy thing about much of the
news reporting about the publication of this study
in JAMA is the implication that an "investigative
team uncovered previously unreported data" and
exposed the fact
that "up
to half of angioplasties performed may not be beneficial."
The fact is that none of this data would
exist if it were not for the ACC, SCAI and physicians
like Dr. Brindis,
who is a co-author of the JAMA study. And
the point of the study was specifically to take a
"look-see" at how PCIs were being done in the U.S.
and that
look showed only 4% of all PCIs could be classified
as "inappropriate". Most importantly, the study
showed precisely where the inappropriates were happening,
and opened up a discussion about how to reduce that
number and improve the use of angioplasty.
Speaking of inappropriate, I'll be discussing
the inaccurate reporting of this study
by most of the mainstream media in an upcoming post,
but for now, read over
our
interview with Dr. Brindis. (We'll be posting
a companion piece,
talking to the study's lead author, Dr. Paul Chan,
tomorrow.)
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