Percutaneous Transluminal Coronary Angioplasty (PTCA) Versus Thrombolysis in Patients With Indications for Neither

June 28, 2000

BACKGROUND

The ongoing debate regarding the use of PTCA versus thrombolysis in the setting of acute coronary syndromes has been described extensively. However, there has never been a study evaluating these two interventions in people who didn't need them. We performed an unnecessarly long and drawn-out study to evaluate the effect of these two therapies on patients with no indication for these two therapies.

METHODS

We evaluated 2004 consecutive patients presenting to Our Lady of Perpetual Misery Medical Center in Cleveland, OH. Unfortunately, none of them were eligible, so we waited for another 2004 people to show up. They were no good either. So we changed our criteria and took the next 637 patients that walked through the door (we ran out of funding after that). After excluding those with a complaint that could be construed as cardiac in nature, there were only 3 patients left, so we called everyone back and kept them all in the study anyway. These people were then randomized to receive either thrombolysis with the cheapest agent available, or PTCA in our state-of-the-art cardiac catheterization and Dolby Surround Sound Home Theater laboratory. The endpoints measured in this study have been outlined elsewhere and frankly, we're sick of repeating them.

RESULTS

Of the 318 patients randomized to receive PTCA unnecessarily, all of them were rather annoyed at being subjected to the procedure. This was despite the fact that we showed "The Lion King" intra-operatively and offered an extensive array of beverages. Patients receiving thrombolysis were annoyed at a rate of only 33%, and most of those patients were apparently upset because they had really wanted to see "the movie with the Witch and the Wardrobe."

CONCLUSION

We found that the majority of people, regardless of whether they received PTCA or thrombolysis, were pretty pissed off about receiving treatments that they did not need. This suggests that these interventions should NOT be undertaken unless specifically indicated by traditional clinical signs and symptoms. If we had had the funds, we might follow the clinical courses of our subjects for the next 50 years. Or, we might get the heck out of Dodge while we still have the chance. Anecdotal reports suggest we do the latter.

Remember: Quality Without The Q Is Just Uality!