To the Editor.
—I read with interest the article by Graboys et al.1I find their data interesting; however, their conclusions are quite bothersome. The suggestion that 50% of the catheterizations performed in the United States are unjustified is simply not supported by the data.
Several points should be emphasized. The study involved only 171 patients at an institution that must certainly have performed several thousand catheterizations over the 7 years included in the study. The fact that the initial recommendation for the procedure generated enough patient anxiety that a second opinion was sought leads me to believe that there was a high degree of inappropriate test ordering in the sample group. The study patients therefore do not constitute an adequate sampling of patients undergoing cardiac catheterization.
The clinical course of the patients studied was not completely benign since it included 11 deaths and 19 new infarctions. In the
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