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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).

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