Revascularization of AMI Patients Persists Despite No Demonstrated Benefit

Cheryl Clark, for HealthLeaders Media, July 13, 2011

Hospital teams commonly perform revascularization procedures more than 24 hours after patients have experienced acute myocardial infarction even though studies have found no benefit because too much muscle damage has already occurred.

The report and accompanying commentary are published in Tuesday's Archives of Internal Medicine.

"I think there has been a very long standing belief – a strong belief – that having an open artery long term is better than having a closed artery. And that belief is coupled by the fact that you can get paid to do the procedure, coupled with the fact that patients...don't want to have a closed artery. They know you can open it up," corresponding author Judith Hochman, MD, said in an interview.

"I don't think it's only for the money" that the practice persists, she said.

She added that another factor is that since the findings in those studies did not show that the patients were significantly harmed from the procedure, there has probably been a delay in implementing practice changes. "To have a negative study may take longer to impact a practice than a positive study," she said.

"And there's another aspect, which is that the whole malpractice issue is a big consideration. You leave an artery closed and the patient has a bad outcome, you're much more likely to be liable than if you say 'I did everything I could.' "

"The reasons are multi-factorial. It takes a long time, sometimes, for a recommendation to filter down to practice."


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