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COMMENTARY cations. Although findings from these trials are largely un- Brahmajee K. Nallamothu, MD, MPH disputed, the use of ad hoc PCI raises challenges for incor- Harlan M. Krumholz, MD, SM porating their lessons into routine practice. Specifically, ad hoc PCI provides less opportunity for pa- D HOC IS A LATIN PHRASE, LITERALLY MEANING “FOR tients and their physicians to thoughtfully consider a range this.” It typically implies a solution designed for of clinically equivalent treatment options after the coro- a particular problem or task—that is, something nary anatomy is known. By making the diagnostic test an Anot broadly generalizable. When the term was in- automatic gateway to the therapeutic procedure, pressure troduced more than 2 decades ago to cardiologists in the is placed on the cardiologist and patient to make immediate context of percutaneous coronary intervention (PCI), it sug- decisions that may favor PCI even in elective settings. In one gested the unique circumstances that justified combining study, for instance, patients with stronger indications for coronary angiography and PCI into the same setting. This coronary artery bypass grafting were more likely to be rec- approach was uncommon in the early years of PCI when ommended surgery after coronary
JAMA – American Medical Association
Published: Nov 10, 2010
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