Article Text

Download PDFPDF
Middle-aged man who could not afford an angioplasty
  1. Vivek Podder1,
  2. Amy Price2,3,
  3. Madhava Sai Sivapuram4 and
  4. Rakesh Biswas5
  1. 1 Department of Medicine, Tairunnessa Memorial Medical College and Hospital, Gazipur, Bangladesh
  2. 2 Department of Continuing Education, University of Oxford, Oxford, UK
  3. 3 Stanford MedicineX, University of Stanford, School of Medicine, Stanford, USA
  4. 4 Department of Medicine, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinoutapalli, Andhra Pradesh, India
  5. 5 Department of Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
  1. Correspondence to Professor Rakesh Biswas, rakesh7biswas{at}


Coronary artery disease managed by percutaneous coronary intervention (PCI) has been noted for profit-driven overuse medicine. Concerns mount over inappropriate use of PCI for patients in India. We describe the case of a 55-year-old Indian man who presented for a second opinion following an urgent recommendation for PCI by two cardiologists following a recent acute myocardial infarction even though the patient was symptom-free and out of the window period for primary PCI. The proposed intervention placed the patient at financial risk for insolvency. This case report highlights the challenges and consequences of inappropriate overuse of PCI. Also, we outline the current lack of shared decision-making among patients and physicians for the PCI procedure. The challenges, inherent in the assumptions that overuse of PCI is evidence-based, are discussed including recommendations for the practice of evidence based medicine for this intervention.

  • interventional cardiology
  • ischaemic heart disease
  • ethics
  • healthcare improvement and patient safety
  • medical management

Statistics from


  • Contributors Collecting information: MSS and VP. Writing original draft preparation: VP, RB, AP and MSS. Review and editing: RB, VP and AP. Conducting background research, drafting and producing a finalised version of this paper: VP, AP and RB. RB was integral in raising aspects of the patient’s care to be investigated further and provided feedback during the draft stages to create the final report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Amy Price is The BMJ Patient Editor (Research and Evaluation).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.