DWINDLING NUMBER OF CORONARY INTERVENTIONAL PROCEDURES

Abstract

A significant reduction has been observed in the number of coronary
interventional procedures being performed especially in USA in the last few
years. The decrease was rather precipitous and too obvious to ignore. This has
important multi dimensional noteworthy effects. Is it the beginning of a new start
or the end of an old journey? Will the pendulum swing in the same direction of
reduction in number or will it swing back to increase? If the number is going to
decrease further then resource allocation and future development of
interventional services have to be reconsidered and rationalized. More
importantly it has to influence training programs for budding cardiologists and the
numbers required for competency development have to be revisited. Question
arises, were we doing too many before or are we doing too few procedures now
and more significantly why?

The clinical scenarios developed include coronary anatomy, as this is the focus of much of the previous literature on coronary revascularization. However, the writing group recognizes that for everyday patient care, symptom status, ischemic burden, and level of medical therapy often play a critical role in decision making even before the coronary anatomy has been defined by angiography. It is important to note that the indications focus on revascularization, percutaneous or surgical, and do not address diagnostic catheterization or coronary angiography; these criteria are currently under development.

Reduction in number of PCIs is a new trend that requires cognizance and action.We must evaluate our local data and reassess our indications especially in the perspective of appropriateness criteria and newer guidelines. We must reassess that our patients are being subjected to interventional procedures for right reasons and indications. And that the procedures are being performed according to internationally established standards.