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Patient’s Individual Cardiologist Best Judge For Deciding Appropriate Treatment In Chronic Coronary Artery Diseas

n, noninvasive angioplasty using balloons and/or stents to open clogged arteries, or coronary artery bypass graft (CABG) surgery to reroute blood through new vessels grafted into place.

After the cardiologists made their recommendations, the patients were randomly assigned to receive a treatment. After one year, all records were reviewed to determine the percentages of patients who had died, experienced heart attacks or required additional procedures to treat blocked arteries.

According to the research, patients assigned to receive their physician-recommended treatment showed a significantly lower incidence of problems. In contrast, patients assigned to a different course of treatment experienced a statistically significant increase in negative events (p = 0.02).

The most common – and only statistically significant – issue affecting this second group was the need for additional procedures to treat blocked arteries (p = 0.007.) No significant differences were found in either heart attack or death rates.

"Our data are a reminder that physician judgment remains an important predictor of outcomes," said Alexandre C. Pereira, MD, a cardiologist at the University of Sao Paulo Heart Institute and one of the study's co-authors.

"We should always remember that the therapeutic decision option is the final result of a complicated equation that uses both objective and subjective variables, which will not necessarily be acquired by lab tests, imaging exams or objective questions in a clinical questionnaire," Dr. Pereira said. "In this scenario, physician judgment – with all of the subjectivity that it may imply – still appears to be the best test or exam that a patient may have."

Ori Ben-Yehuda, MD, associate professor of medicine and director of coronary care at the University of California, San Diego, Medical Center, was not connected with the research but said it highlights why medicine will always be "an
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