Too Many Heart Caths

When a patient is having a large heart attack, urgent catheterization with assessment of the coronary arteries is critical. The goal is to get the blocked artery open as quickly as possible, and we actually measure the door-to-balloon time, which is the number of minutes from the moment the patient hits the hospital doorway until we have an angioplasty balloon inflated in the heart in order to open up the blocked artery. Wasted minutes kill heart muscle cells, and rapid catheterization saves lives.

We don't do such a good job when we perform elective (non-urgent) diagnostic catheterization in patients with suspected, but not confirmed, coronary heart disease. Duke University researchers recently reviewed elective cardiac catheterizations in nearly 400,000 patients. In each case, doctors judged that the evidence for coronary heart disease was strong enough to justify this invasive procedure. How often were they correct? Thirty-eight percent of the time. Just over one-third of patients had obstructive coronary artery disease.

Can we do better? Yes. Before ordering a cardiac catheterization, we need a thoughtful and honest appraisal of the likelihood that a person really has coronary artery disease. Is the chest pain typical? Does the person have risk factors for coronary heart diseases? Would a noninvasive stress test help with the decision? Both your doctor and you should ask some questions before an elective trip to the cardiac cath lab.

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