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Sophie Ignace Jr, MBBS; Nicolas Girerd Jr, MBBS; Denis Fouque, MD, PhD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with great interest the article by Singh et al¹ about the proliferation of percutaneous coronary intervention (PCI) after acute myocardial infarction in Ontario, Canada, between 1992 and 2004. The authors used an original methodological approach to demonstrate that the growing use of PCI is mainly attributable to factors other than the emergence of published scientific evidence.¹ These findings are of particular importance considering the risk of an underestimated but serious complication: cholesterol crystal embolism (CCE). Indeed, nowadays, the principal risk factor for CCE is the use of invasive vascular procedures.²

Cholesterol crystal embolism is grossly underdiagnosed. In a prospective epidemiological study, the incidence of CCE after an invasive vascular procedure was 4%, whereas it was 7% for contrast nephropathy.³ Diagnosis of CCE is often missed because of the time lag between the procedure and the onset . . . [Full Text of this Article]

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Coronary Angiography Following Acute Myocardial Infarction in Ontario, Canada
Sheldon M. Singh, Peter C. Austin, Alice Chong, and David A. Alter
Arch Intern Med. 2007;167(8):808-813.
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