This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (8)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Revascularization  • Thrombolysis  • Cardiovascular System  • Surgery  • Surgical Interventions  • Vascular Surgery  • Cardiovascular Disease/ Myocardial Infarction  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

The Balloon and the Needle

James G. Jollis, MD; Patrick S. Romano, MD, MPH

JAMA. 2000;284:3169-3171.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of THE JOURNAL, McGrath and colleagues¹ and Magid and colleagues² examine 2 of the most contentious issues in the provision of cardiac care: the relationship between experience and outcome for percutaneous interventions, and the superiority of percutaneous revascularization (eg, primary angioplasty or other procedures) relative to thrombolytic therapy for acute myocardial infarction (AMI). These 2 issues lead to the question of whether primary angioplasty can be effectively performed in low-volume hospitals and by low-volume physicians. Supporters of both primary angioplasty and volume standards will no doubt refer to these works in their future deliberations.

Two important questions must be addressed in considering data from observational studies such as these. First, do observational studies represent the best level of evidence, or should these clinical issues be examined in randomized trials? In the case of the volume-outcome relationship, trials are . . . [Full Text of this Article]

Author Affiliations: Clinical Research Institute, Duke University Medical Center, Durham, NC (Dr Jollis); Division of General Medicine, University of California, Davis, Sacramento (Dr Romano).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Relation Between Hospital Primary Angioplasty Volume and Mortality for Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic Therapy
David J. Magid, B. Ned Calonge, John S. Rumsfeld, John G. Canto, Paul D. Frederick, Nathan R. Every, Hal V. Barron, and for the National Registry of Myocardial Infarction 2 and 3 Investigators
JAMA. 2000;284(24):3131-3138.
ABSTRACT | FULL TEXT  

Relation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
Paul D. McGrath, David E. Wennberg, John D. Dickens, Jr, Andrea E. Siewers, F. Lee Lucas, David J. Malenka, Mirle A. Kellett, Jr, and Thomas J. Ryan, Jr
JAMA. 2000;284(24):3139-3144.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Case Against Low-Volume Percutaneous Coronary Intervention Centers
O'Neill
Circulation 2009;120:546-548.
FULL TEXT  

Myocardial Infarction Mortality in Rural and Urban Hospitals: Rethinking Measures of Quality of Care
James et al.
Ann Fam Med 2007;5:105-111.
ABSTRACT | FULL TEXT  

Clinical Guidelines and Practice: In Search of the Truth
Kereiakes and Antman
J Am Coll Cardiol 2006;48:1129-1135.
ABSTRACT | FULL TEXT  

The United States Cardiovascular Care Deficit
Kereiakes and Willerson
Circulation 2004;109:821-823.
FULL TEXT  

Regionalization of Care for Acute Ischemic Heart Disease: A Call for Specialized Centers
Topol and Kereiakes
Circulation 2003;107:1463-1466.
FULL TEXT  

Primary Angioplasty vs. Thrombolysis for MI Depends on Hospital Volume
Journal Watch Cardiology 2001;2001:2-2.
FULL TEXT  

Operator and Hospital Volume Still Affect PCI Outcomes
Journal Watch Cardiology 2001;2001:3-3.
FULL TEXT  

Is Outcome Better for Cardiac Patients in High-Volume Hospitals?
JWatch General 2001;2001:1-1.
FULL TEXT