Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Ann Intern Med. 2010 Sep 7;153(5):307-13. doi: 10.7326/0003-4819-153-5-201009070-00005.
It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality.
To compare cardiologists' and patients' beliefs about PCI.
Survey.
Academic center.
153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists.
Patients' and cardiologists' beliefs about benefits of PCI. All cardiologists reported beliefs about PCI for patients in hypothetical scenarios. Interventional cardiologists also reported beliefs for study patients who underwent PCI.
Of 153 patients, 68% had any angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous MI. The 53 patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Almost three quarters of patients thought that without PCI, they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for MI. Patients were more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25 [95% CI, 2.31 to 7.79]) or fatal MI (prevalence ratio, 4.83 [CI, 2.23 to 10.46]). Patients were less likely than their physicians to report pre-PCI angina (prevalence ratio, 0.79 [CI, 0.67 to 0.92]). For the scenarios, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief. Of cardiologists who identified no benefit of PCI in 2 scenarios, 43% indicated that they would still proceed with PCI in these cases.
The study was small and conducted at 1 center, and information about precatheterization counseling was limited.
Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits.
None.
目前尚不清楚患者是否了解经皮冠状动脉介入治疗（PCI）仅可减轻慢性稳定型心绞痛，而不能减轻心肌梗死（MI）或相关死亡率。
比较心脏病专家和患者对 PCI 的看法。
调查。
学术中心。
153 名同意接受选择性冠状动脉造影和可能的 PCI 的患者、10 名介入心脏病专家和 17 名转诊心脏病专家。
患者和心脏病专家对 PCI 益处的看法。所有心脏病专家均根据假设情况报告了对患者进行 PCI 的看法。介入心脏病专家还报告了对接受 PCI 的研究患者的看法。
153 名患者中，68%有任何程度的心绞痛，42%有活动受限的心绞痛，77%有阳性应激试验结果，29%有既往 MI。53 名接受 PCI 的患者比未接受 PCI 的患者更有可能有阳性应激试验结果，但两组患者的心绞痛情况相似。近 3/4 的患者认为，如果不进行 PCI，他们可能会在 5 年内发生 MI，88%的患者认为 PCI 可降低 MI 的风险。患者比医生更有可能认为 PCI 可预防 MI（流行率比，4.25 [95%CI，2.31 至 7.79]）或致命性 MI（流行率比，4.83 [CI，2.23 至 10.46]）。患者比医生更有可能报告 PCI 前有胸痛（流行率比，0.79 [CI，0.67 至 0.92]）。对于这些情况，63%的心脏病专家认为 PCI 的益处仅限于缓解症状。在 2 个场景中，有 43%的认为 PCI 无益处的心脏病专家表示，他们仍会在这些情况下进行 PCI。
该研究规模较小，仅在 1 个中心进行，且关于导管插入术前咨询的信息有限。
心脏病专家对 PCI 的看法反映了试验结果，但患者的看法并非如此。在进行 PCI 之前与患者进行讨论时，应更好地解释预期的益处。
无。
