Netphiles

Angioplasty

A meta-analysis has shown that although angioplasty for coronary artery disease reduces anginal symptoms in comparison with drug therapy, it seems to do so at the cost of an increased risk of infarction, death, and the need for surgery (BMJ 2000;321:73-77).

Both Google (www.google.com) and Altravista (www.av.com) reveal that there are about 10,200 pages with the phrase “coronary angioplasty” on them, a completely unworkable amount of information that hints at the difficulty of getting the results of research into practice. The difficulty of persuading 10,200 authors to revise and update their pages is exceeded only by the difficulty of getting doctors around the world to change their practice.

The pages at www.americanheart.org/Heart_and_Stroke_A_Z_Guide/angioc.html show that almost half a million coronary angioplasties were performed in the United States in 1997 and—whatever the evidence base—an industry like that does not shut down overnight.

Perhaps a certain amount of friction in the system is a good thing: a world in which the publication of a trial 1 day led to an instant revolution in practice the next would be a difficult place in which to live.

Consumer health information about coronary angioplasty is not hard to find. You can download Quicktime movies about having an angioplasty at www.northmemorial.com/nmhc/services/heart/animate.htm. The size of the download will depend on how you set up your Quicktime plug-in (which itself may have to be downloaded). Still, it's worth the wait, with clear animated illustration of the basic anatomic principles and an explanatory soundtrack. And while we're exclaiming at the power of Quicktime, have a look at www.uscuh.com/tour/quicktime/cardiac/cardiac_main.html, a three-dimensional representation of a coronary catheter lab that uses Quicktime VR (virtual reality) to provide a virtual guided tour. Gimmicky perhaps, but used as part of the pre-procedure preparation, it might reduce anxiety.