Percutaneous coronary intervention: obtaining consent and preparing patients for follow-on procedures

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Abstract
In the context of an urgent or emergency diagnostic procedure in a patient with an acute coronary syndrome, consent should always be obtained for both angiography and intervention, as it is routine practice to follow-on when indicated. However, even in patients with stable angina undergoing elective investigation there are significant advantages associated with follow-on intervention including reduced procedural costs, and, at least in the UK, avoidance of the risks associated with going on to a waiting list.3 In order to pursue a strategy of follow-on PCI in these patients, it is necessary to prepare and consent all potential candidates in advance of the diagnostic procedure. Non-invasive testing cannot accurately predict the coronary anatomy and cannot in any event indicate whether the pattern of disease will be technically suitable for percutaneous revascularisation. If it is, then in many patients with single and multivessel disease and preserved ventricular function, the decision between surgery and PCI is largely down to patient preference given the similar long term results of both approaches. Accordingly, we have adopted a policy of consenting all patients undergoing elective coronary angiography for follow-on intervention.

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