To the Editor.
—The experience of Graboys et al1 reported in their article "Results of a Second-Opinion Trial Among Patients Recommended for Coronary Angiography" is neither surprising nor representative of the overall practice of coronary angiography in the United States. By definition, they are reporting a select population—patients who for one reason or another have sought a second opinion regarding a recommendation for coronary angiography.Evidence that their patients are not representative is found in comparing the severity of symptoms of their 186 patients with 75 999 unselected, consecutive patients with diagnostic catheterization reported to the national registry of the Society for Cardiac Angiography and Interventions in 1991. Class III or IV symptoms were present in only 12% of the patients reported by Graboys et al compared with 48% of registry patients.2 It has long been known through properly randomized studies that stable patients with mild symptoms and
Edward D. Folland. Second-Opinion Trial in Patients Recommended for Coronary Angiography. JAMA. 1993;269(12):1503. doi:10.1001/jama.1993.03500120041010