To the Editor.
—In the article by Dr Kimmel and colleagues1 purporting to show a relationship between institutional angioplasty procedure volume and major complications, a major potential limitation of the study has not been adequately addressed. The authors excluded 2577 procedures that involved devices other than balloon angioplasty, namely, atherectomy, coronary artery stents, and laser procedures. If these procedures were pooled with the 27 110 balloon angioplasties included in the study, they would represent 8.7% of the total procedure volume.Coronary stenting has been shown to reduce the need for emergency bypass surgery in the setting of acute or threatened arterial closure occurring during coronary angioplasty.2 In particular, the Gianturco-Roubin stent was specifically approved by the Food and Drug Administration in June 1993 for treatment of acute or threatened arterial closure. The dispersion of this technology was delayed for several months because of the need for operators to
Reis GJ. Coronary Angioplasty Procedure Volume and Major Complications. JAMA. 1996;275(8):595. doi:10.1001/jama.1996.03530320019022