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Doctors Turning to Cardiac Catheterization Too Quickly
Date:3/10/2010

Study finds only a third of those who get invasive procedure have vessel blockage

WEDNESDAY, March 10 (HealthDay News) -- If you walk into an emergency room complaining of chest pains, the odds are high that you will end up having cardiac catheterization, where a thin wire is snaked into your heart to determine whether a blood vessel is totally or partially blocked.

But if you do have the invasive procedure, the odds are even higher -- nearly two to one -- that it will show no significant blockage, a new study finds.

"To me, what this says is that we need to re-evaluate how we work these patients up from start to finish," said Dr. Manesh Patel, assistant professor of medicine at Duke University, and lead author of a report in the March 11 issue of the New England Journal of Medicine.

More than 10 million Americans each year experience chest pains that can lead to cardiac catheterization, Patel estimated.

He and his colleagues looked at data on nearly 400,000 people with no known heart disease who had cardiac catheterization at 663 U.S. hospitals between January 2004 and April 2008. Of those, just 37.6 percent had obstructed coronary arteries -- slightly less than the 39.2 percent in whom no significant artery blockage was found.

Catheterization is called an invasive procedure because it requires that something be inserted into the body, which always carries a degree of risk. So doctors usually want to do a less risky noninvasive procedure, such as a stress test, to decide whether catheterization is advisable.

But while five of every six people in the study -- 83.9 percent -- did have a noninvasive test before catheterization, those tests did not have an enormous predictive value. Artery blockage was found in 41 percent of those who had noninvasive testing before catheterization and 35 percent of those who didn't.

"We don't know that this finding substantiated the kind
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