Clinical trials: are they really useful for clinical decision making?

I have always maintained that clinical trials are important to provide prognostic information in patients with cardiac disease. However, clinical trials provide prognostic information for the population of patients under study. I still believe that clinical trials provide knowledge and information that improves patient care. As physicians, we should use the results of clinical trials as guidelines for decision making in individual patients. If we are to make clinical decisions based on results of clinical trials, then it is imperative that the patient would have been suitable for entry into that clinical trial. Thus, as always, additional factors remain important when one has to determine the appropriate therapy for any single patient. These factors include persistent symptoms despite aggressive therapy, objective evidence of end points such as recurrent myocardial ischemia, life-threatening arrhythmias, ventricular dsyfunction, and presence of absence of factors that would suggest one therapy or another-for example, coronary artery spasm. If the patient has coronary artery disease, the location and severity of the coronary artery stenosis certainly influences decisions about medical or revascularization therapy, as do the confidence and enthusiasm of the surgeon and the desires of the patient.