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Specific guide to this web site for:

 1.  Medical School
      Educators 
      in Statistics

 2.  Medical Students

 3.  Science media writers

 4.  High School & College
     Statistic Teachers

   Misadventures:

1. Harvard led MI study

2. JACC study 
   (J. of Amer. Coll.
   Cardio.)

3. NEJM cath study

4. Amer. J. of Cardio.
    review of literature

5. ALLHAT
    controversy 

6. Oat bran study

7. Pregnancy & Alcohol

8. Are Geminis really
    different?
      
9. Columbia 'Miracle' Study  
                                                 

Additional Topics:

Celebrex

Limitations of Meta-Analyses

Large Randomized Clinical Trials

Tale of Two Large
Trials

Advocate meta-analyses

Network meta-analyses

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Letter. Outpatient versus inpatient catheterization. Block P. NEJM 1989; 320:938-939   

To the Editor: We reviewed our data concerning patients who had myocardial infarction. The onset of prolonged chest pain occurred at the time of cardiac catheterization in all instances. Patients were then listed as having a presumed myocardial infarction. No patients had prolonged chest pain or myocardial infarction while being monitored after their return to the surgical day care unit or after ambulation was begun in the outpatient group. Thus, we conclude that outpatient status had no bearing on the development of myocardial infarction.

In reviewing the specific patients who had myocardial infarction, it turned out that the patients who had prolonged chest pain in the cardiac catheterization laboratory were first listed as having presumed myocardial infarction and were then later also listed as having myocardial infarction; hence, each patient was tallied twice. Therefore, our total incidence of myocardial infarction was 0.5 per­cent (2 of 381 patients).

One patient who had a myocardial infarction had diffuse, severe three-vessel disease with stable angina pectoris. Neither embolism nor acute thrombosis occurred at cardiac catheterization to account for the myocardial infarction. The second patient was found to have less than total occlusion of the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was performed. Prolonged chest pain developed, and myocardial infarction was confirmed by enzyme levels later in the hospitalization.  Thus, only one patient had a myocardial infarction. Our conclusion remains that outpatient catheterization seems to be a safe alternative for selected patients in stable condition.

Peter C. Block, M.D. Boston, MA 02114         Harvard Medical School

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