Study questions value of elective angiographies

From the CEBM’s Journal Watch comes this summary that questions the effectiveness of elective coronary angiographies. Before I would let anyone do a surgical heart procedure on me, I would like clear evidence of effectiveness. The abstract of the original article is available at the link at the end of the summary.

http://goo.gl/sPfA

NEJM 11 Mar 2010 Vol 362

886 This study looked at nearly 400,000 elective coronary angiographies performed in US hospitals over 4 years. Although preliminary investigations had been done in 84% of cases, the pick-up rate for significant coronary stenosis on angiography was 37.6%. Even these patients may have had little benefit, since COURAGE tells us that in stable angina, people do as well with optimal medical treatment as with percutaneous intervention. So 250,000 of these angiographies were definitely of no value to the patients, and that probably applies to most of the rest too. We need much better case selection for the catheter lab, with all its attendant risks of radiation and bleeding, not to mention cost in money and cardiologist time.
http://content.nejm.org/cgi/content/abstract/362/10/886

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