High Rates of Same-Session PCI in Stable Patients

Core Concepts

High rates of ad hoc PCI in stable patients may lead to missed opportunities for multidisciplinary evaluation and more appropriate interventions.

Abstract

The study analyzed over 8,000 catheterization procedures in New York State from 2018-2019, revealing a high rate of ad hoc PCI in stable patients with multivessel disease or left main disease. The study highlights the potential drawbacks of ad hoc PCI, emphasizing the importance of multidisciplinary evaluation for treatment decisions. Variability in ad hoc PCI rates among hospitals and physicians suggests the need for standardization and adherence to guidelines.

Key Highlights:

• 78.4% of PCIs in stable patients with multivessel or left main disease were performed ad hoc.
• Ad hoc PCI eliminates the opportunity for a multidisciplinary heart team evaluation.
• Rates of ad hoc PCI varied among different patient subgroups.
• Study findings suggest potential overutilization of PCI and a lack of appropriate interventions.
• Variability in ad hoc PCI rates across hospitals and physicians indicates room for improvement.

Stats

"Among the stable patients with multivessel disease or left main (LM) disease who had PCI, 78.4% of PCIs were performed in the same session as their diagnostic catheterization procedure."
"The percentage for ad hoc PCI ranged from 58.7% for those with unprotected LM disease to 85.4% for patients with two-vessel PLAD."

Quotes

"Ad hoc PCI can be inadvisable when guidelines indicate that patients can realize better outcomes with CABG surgery." - Edward L. Hannan, PhD, MS
"The article provides a striking example of a difference between guideline-directed practice and real-life practice." - James C. Blankenship, MD

Key Insights Distilled From

Same-Session PCI Rates 'Surprisingly High'

by Richard Mark... at www.medscape.com 07-25-2023

http://www.medscape.com/viewarticle/994750

Deeper Inquiries

What factors contribute to the high rate of ad hoc PCI in stable patients?

The high rate of ad hoc PCI in stable patients can be attributed to several factors. One significant factor is the lack of input from a multidisciplinary heart team. Without the evaluation and discussion from a team of experts, interventional cardiologists may proceed with PCI without considering alternative treatments like coronary artery bypass graft (CABG) surgery, which may be more appropriate according to clinical guidelines. Additionally, time constraints during the catheterization procedure may lead to a quick decision for PCI without thorough consideration of all treatment options. Unconscious biases and sincere beliefs of patients and interventionalists that PCI is in the best interest of the patient can also contribute to the high rate of ad hoc PCI in stable patients.

Should there be stricter guidelines or oversight to ensure adherence to multidisciplinary evaluation in PCI procedures?

The findings of the study suggest that there may be a need for stricter guidelines or oversight to ensure adherence to multidisciplinary evaluation in PCI procedures. Guidelines recommending a heart team approach for evaluating patients with complex coronary artery disease are in place to optimize treatment decisions and outcomes. However, the study indicates that these guidelines are not always followed in real-life practice. Implementing stricter guidelines or oversight mechanisms could help ensure that patients receive a comprehensive evaluation by a multidisciplinary team before undergoing PCI. This approach may lead to more appropriate treatment decisions, such as considering CABG surgery when indicated, and ultimately improve patient outcomes.

How can unconscious biases impact treatment decisions in interventional cardiology?

Unconscious biases can significantly impact treatment decisions in interventional cardiology. In the context of the study, unconscious biases may lead interventionalists and patients to prefer PCI over other treatment options, such as CABG surgery, even when guidelines recommend a different approach. These biases can influence decision-making processes, potentially leading to the overutilization of PCI and the forgoing of more appropriate interventions. Additionally, unconscious biases may affect how interventionalists perceive the risks and benefits of different treatment options, potentially influencing their recommendations to patients. Recognizing and addressing unconscious biases through education, training, and increased awareness can help improve the quality of treatment decisions in interventional cardiology and ensure that patients receive the most appropriate care based on clinical guidelines and evidence-based practices.