After a diagnostic catheterization reveals a coronary blockage, many physicians and patients prefer immediate stenting, and a new consensus document outlines protocols for this controversial "ad hoc" procedure.
More than a few recent studies have suggested that patients with stable coronary disease do well on optimal medical therapy. Others have shown that an angiographically stenosed lesion might not necessarily be hemodynamically dangerous.
But there are many forces driving the decision to stent, whether now or later. Hospitals make more money on delayed PCI -- when patients come back another day for the intervention -- while insurers prefer PCI performed ad hoc, during the same session as the diagnostic catheterization.
But one of the biggest drivers is patient preference: they want convenience.
To sort through the maze of options and help guide physicians, the Society for Cardiovascular Angiography and Interventions (SCAI) has crafted an expert consensus statement on ad hoc PCI -- an update to the last one published 8 years ago. The statement is published online in Catheterization and Cardiovascular Interventions.