Comorbidities, Complexity Need Not Keep Patients From Getting Needed PCI. ACC 2016

April 3, 2016

Focusing on reducing inappropriate use of interventional procedures may be doing a disservice to patients who may be helped by revascularization, according to a presentation at the American College of Cardiology 2016 Scientific Session.

”Lost in this overemphasis of reducing inappropriate cases also is this issue of patients who ought to come to the cath lab never making it there at all,” said Ajay J. Kirtane, MD, SM, of NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City.

Dr. Kirtane outlined the premise for CHIP (Complete Revascularization for Higher-Risk Indicated Patients), noting that some patients may be undertreated based on their risk due to comorbidities or the complexity of their anatomy.

“I’m not talking about PCI versus medical therapy,” said Dr. Kirtane. “I’m talking about revascularization versus no revascularization. In these cohorts, PCI may have a role, particularly for those who are not surgical candidates.”

Patients may, legitimately, wonder why, if their symptoms are real, they are denied treatment simply because an interventionalist isn’t trained or comfortable with advanced PCI techniques. “The indications for the case do not change just because the lesion is ‘harder to treat,’” said Dr. Kirtane. The risk/benefit equation can be modified with training and the use of advanced devices.

“If the patient is going to merit revascularization, you need to figure out how to do it safely and effectively using the appropriate devices and equipment so that patient can reap the benefit of what we have to offer.”

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