Patients' and cardiologists' perceptions of the benefits of percutaneous coronary intervention for stable coronary disease

Michael B Rothberg, Senthil K Sivalingam, Javed Ashraf, Paul Visintainer, John Joelson, Reva Kleppel, Neelima Vallurupalli, Marc J Schweiger
Annals of Internal Medicine 2010 September 7, 153 (5): 307-13

BACKGROUND: It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality.

OBJECTIVE: To compare cardiologists' and patients' beliefs about PCI.

DESIGN: Survey.

SETTING: Academic center.

PARTICIPANTS: 153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists.

MEASUREMENTS: Patients' and cardiologists' beliefs about benefits of PCI. All cardiologists reported beliefs about PCI for patients in hypothetical scenarios. Interventional cardiologists also reported beliefs for study patients who underwent PCI.

RESULTS: Of 153 patients, 68% had any angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous MI. The 53 patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Almost three quarters of patients thought that without PCI, they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for MI. Patients were more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25 [95% CI, 2.31 to 7.79]) or fatal MI (prevalence ratio, 4.83 [CI, 2.23 to 10.46]). Patients were less likely than their physicians to report pre-PCI angina (prevalence ratio, 0.79 [CI, 0.67 to 0.92]). For the scenarios, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief. Of cardiologists who identified no benefit of PCI in 2 scenarios, 43% indicated that they would still proceed with PCI in these cases.

LIMITATION: The study was small and conducted at 1 center, and information about precatheterization counseling was limited.

CONCLUSION: Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits.


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