[Interventional cardiology--can medical and economic requirements be united?].

Interventional cardiology in a private practice might be problematic for the following reasons: 1) High-risk patients might be rejected in order to avoid complications. 2) The indication for PTCA might be extended to "cosmetic cases". 3) Over cautious dilatation (residual stenosis greater than 50%) might save time and expensive balloon-material. 4) A 24-hour service is unprofitable and might therefore not be offered. This, however, is not acceptable according to medical, ethical, or entrepreneurial reasons, and it is not the philosophy of the two private practices which currently perform PTCA in Germany in Hospital settings. From 1986-1990, 6300 PTCA-procedures were performed in our institution: 83% of patients had complicated stenoses (type B/C), 48% had multivessel disease, 36% had unstable angina, 16% EF less than 40%, and 9.8% were older than 70 years. More than 50% came from other hospitals with catheterization facilities. The primary success rate was 92.2% (stenoses) and severe complications were rare: emergency-CABG 0.3%, in hospital mortality 0.3%. The reasons for this extremely low complication rate are: 1) Large experience due to high volume. 2) Continuous quality control. 3) Much of the profit is reinvesed in employees and equipment hardware. Our example illustrates that economical aspects are not necessarily inconsistent with medical aspects. If interventional cardiology will be extended to other private practices, however, it seems crucial to: 1) allow benefit also to non private laboratories (university, general hospital), 2) establish a program of quality control for all institutions.