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Editorial |

Behavioral Factors, Bias, and Practice Guidelines in the Decision to Use Percutaneous Coronary Interventions for Stable Coronary Artery Disease

Mauro Moscucci, MD
Arch Intern Med. 2007;167(15):1573-1575. doi:10.1001/archinte.167.15.1573.
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In September of 2007, it will be exactly 30 years since the first percutaneous coronary intervention (PCI) was performed by Andreas Gruntzig. In the initial report of his first 5 cases,1 Gruntzig concluded that the technique, “if it proves successful in long-term follow-up studies, may widen the indications for coronary angiography and provide another treatment for patients with angina pectoris.” Despite the exponential growth in the number of PCI procedures during the next 3 decades, it took 15 years to complete the first of those long-term follow-up studies2 and an additional 15 years to complete the most current one.3 As of today, while available data have supported the superiority of PCI when compared with medical therapy in patients with acute coronary syndromes, its effectiveness in improving outcomes beyond a relief of angina in patients with stable coronary artery disease (CAD) remains unproven. In addition, recent data have questioned its effectiveness in reducing adverse events in patients with stable CAD who are undergoing noncardiac surgery.4

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