It’s one thing for medical researchers to suspect an answer they set out to prove is within the scope of the methods by which they conduct the study. It’s quite another when the results of said study give a totally unexpected conclusion. This is perfectly illustrated in this week’s NEJM, in which investigators show that cardiologists are essentially inappropriately heading right for the high-cost (and apparently low-value) procedure known as the angiogram in attempting to diagnose coronary disease.

Out of almost 400 000 patients studied, investigators found that 4 out of every 10 patients who underwent this procedure (which involves invasive catheterization) had absolutely no findings of disease (blockages). Not exactly half, but you get the idea. Although it’s clear that these subspecialists must do a better job in stratifying the most appropriate patients for this procedure, what’s even more salient is the fact that coronary angiograms — being an invasive procedure — are not without risk. Their implementation carries an approximate risk of 1% of an acute coronary event (ie., heart attack), not to mention the amount of radiation exposure involved. | LINK

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