Gout: diagnosis and management—summary of NICE guidance

If I ever need a percutaneous coronary intervention (PCI) for coronary artery disease, I think I'd be pleased at the offer of a stress test a year later to make sure everything was tickety-boo. Unfortunately, although this might make me more likely to have another angiogram or further revascularisation, it doesn’t seem to make any difference to the chances of me dying, having a myocardial infarction, or being admitted to hospital for unstable angina in the following year. That’s according to a randomised controlled trial of 1706 high risk patients undergoing PCI who were allocated to usual care or a stress test (nuclear stress testing, exercise electrocardiography, or stress echocardiography) a year later. The authors argue that the study demonstrates the benefits of a “less is more” approach: “if more invasive strategies or testing are performed less frequently, it will result in better patient outcomes,” they say. N Engl J Med doi: 10.1056/NEJMoa2208335