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Updated: Apr 12, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease
Michael B Rothberg1, Senthil K Sivalingam2, Reva Kleppel3
1Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
Informed decision-making is often lacking before procedures like percutaneous coronary intervention (PCI). Better discussions about stable coronary disease lead to fewer patients choosing angiography and possible PCI.
Area of Science:
- Cardiology
- Health Services Research
- Medical Decision Making
Background:
- Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) often lack adequate information regarding procedure benefits.
- The quality of informed decision-making prior to angiography and potential PCI is not well understood.
Purpose of the Study:
- To evaluate the quality of informed decision-making in cardiology consultations.
- To determine the association between informed decision-making and patient choices regarding angiography and PCI.
Main Methods:
- Cross-sectional analysis of recorded cardiology practice conversations (August 2008-2012).
- Assessment of 7 key elements of informed decision-making.
- Evaluation of patient decisions to proceed with angiography and possible PCI.
Main Results:
- Only 3% of conversations included all 7 elements of informed decision-making; 14% met a limited definition.
- Discussions on uncertainty, patient role, alternatives, and preferences were linked to lower rates of choosing angiography/PCI.
- Better informed patients were significantly less likely to opt for angiography and possible PCI (OR per additional element, 3.2).
Conclusions:
- Informed decision-making is frequently incomplete in consultations for stable angina.
- More comprehensive patient-physician discussions correlate with a reduced likelihood of patients undergoing angiography and possible PCI.
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