Unnecessary PCIs and other stories . . .

Following the launch of the Academy of Medical Royal Colleges’ Choosing Wisely campaign, all specialties, cardiology included, will be asked to look at procedures that could be reduced or discontinued. Percutaneous coronary intervention (PCI) can save lives in acute coronary syndromes, but evidence indicates that many PCIs are just the result of the “oculo-stenotic reflex,” whereby cardiologists performing angiograms pop in a stent whenever they see a stenosis, even in stable patients. Between 2007 and 2012, 426 046 patients underwent PCI in England and Wales (European Heart Journal 2015, doi:10.1093/eurheartj/ehv113). Of these, 436 (0.1%) sustained an ischaemic stroke/transient ischaemic attack complication and 107 (0.03%) sustained a haemorrhagic stroke complication. Thirteen strokes per thousand procedures may be a price worth paying in exchange for better cardiac outcomes, but not otherwise.

“I’m already rattling, doctor.” Pill taking appeals to some people more than others, despite Osler’s claim that the desire to take medicine is perhaps the main …