Pulmonary Arteriography: The Gold Standard

To the Editor.  —I read with great interest the article entitled "Diagnosing Pulmonary Embolism Using Clinical Findings" by Hoellerich and Wigton,¹ but their suggestion regarding the "decision rule" left me incredulous.Why in the world would anyone want to discourage the use of pulmonary arteriography for patients with suspected pulmonary embolism (PE), a potentially lethal disease without prompt treatment? Why would any clinician not wish to have a clear, positive or negative diagnosis established with one simple procedure?Pulmonary arteriography in a reasonably equipped hospital can usually be done in less time than pulmonary scans. The mortality rate from pulmonary arteriography in one series was three deaths (0.2%) in 1350 procedures.² The mortality rate of untreated PE is reported to be as high as 30%.³ A negative result shown on a pulmonary arteriogram is of great value because anticoagulant therapy can be avoided, which is quite important as