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November 01, 2007
Angiogram protection
FPN also reports from the Society for Academic Emergency Medicine that we should not rely on a history of a normal cath when evaluating a patient with chest pain. This is a most interesting study for a number of reasons. (Tell me if you hit that link that Dr. McMullan, the resident presenting this, doesn't look like Jack.) A retrospective cohort study followed all subjects with normal coronary angiograms between January and May of 2000 for 5 years.
Interesting aspect 1: 182 of the 598 angiograms in this ?5 months were completely normal (and the patients survived that hospitalization). By my rough calculation, that is 30.43%. Almost one-third of all caths done at U Cincinnati (I must be off on that guess because I would have guessed they did that many a month) were cold normal? Is the indication for a cath having a heart? I really wouldn't have guessed that many people walking on the street had normal coronaries, much less a cath population.
Interesting aspect 2: 45 (25%) underwent a repeat cath within the five years. They did not learn their lesson the first time.
Interesting aspect 3: Of those 45, 18 (40%) had developed CAD, and a few more had some irregularities. And 3 of these people died, compared to just one of the other 27 who maintained normal coronaries. Why this is a surprise confuses me.
IA 4: Of the 182 initially normal cath people, 18 (10%) developed CAD. (Actually, we don't know how many others may have, since I assume that these 18 are the aforementioned ones. What of those not cath'd?)
IA 5: In an interview, Dr. McMullen revealed that some of the patients were recath'd after just .4 years (I guess that means less than 5 months later, maybe even during May) and "bad disease" was found. He concludes (with no reason given though I agree with him) that the lesions were missed on the first cath. This is great. A cath can be read as normal falsely. But this is old news, since from the beginning the validity of cath interpretations have been challenged.
So remind me why we do caths?
| By Robert Maddox | 11:25 PM