March 24, 1993

Second-Opinion Trial in Patients Recommended for Coronary Angiography

Author Affiliations

University of Cincinnati (Ohio) Medical Center

JAMA. 1993;269(12):1504. doi:10.1001/jama.1993.03500120041013

To the Editor.  —Since its inception almost 40 years ago, selective coronary angiography has become the cornerstone of both the accurate diagnosis and clinical management of patients suspected of having coronary artery disease. Immense technological advances have rendered the procedure a safe, minimally uncomfortable, and accurate technique that is now often performed in an outpatient setting. The procedure has also documented the fact that the clinical diagnosis of angina pectoris based on history and noninvasive techniques alone can be inaccurate in as many as 15% to 20% of patients in whom it is suspected.1A normal coronary angiogram often frees a patient who would otherwise be suspected of having coronary disease from a lifetime of inappropriate medical therapy as well as from considerable physical and psychological disability. Recognition of several angiographic patterns of coronary disease, such as severe left main coronary narrowing or two- or three-vessel disease with an