Below you'll find a list of all posts that have been categorized as “Professionals”
Point-Counter point 1 Best way to revascularize patients with main stem and three-vessel lesions. Patients should be operated! [i] An abundance of clinical trials has proven that coronary artery bypass surgery (CABG) is superior to Stenting (PCI) in almost every type of multivessel or left main Coronary Artery Disease (CAD.These days however, even the most complex coronary lesions are treated with …
“Primary composite outcomes” (lumping complications together into one composite complication), allows shading of negative results that only become visible with careful study of a publication. In the CREST study described below, the authors combined procedural death, stroke and myocardial infarction together into a composite complication. In doing so they found no outcome difference between Carotid artery stenting (CAS) and Endarterectomy …
“Primary composite outcomes” (lumping complications together into one composite complication), allows shading of negative results that only become visible with careful study of a publication. In the CREST study described below, the authors combined procedural death, stroke and myocardial infarction together into a composite complication. In doing so they found no outcome difference between Carotid artery stenting (CAS) and Endarterectomy …
Yet another article compares Medical therapy with PCI (Stenting) in patients with stable Coronary Artery Disease. This time the focus was on control of angina symptoms, rather than survival. However, its conclusions were similar in that in this group of stable patients, medical therapy alone has become just as effective as PCI (75% vs. 77% control of symptoms). What surprised …
A non-invasive and much cheaper test for coronary disease is available when a diagnosis of CAD is uncertain. Until recently, CT Coronary Angiography (CTCA)could not adequately identify coronary artery blockages. While not accurate enough to provide a pathway necessary to identify and treat these lesions, it avoids the risks and high costs of cardiac catherization, an important benefit. CTCA is most …
(From: Low Diagnostic Yield of Elective Coronary Angiography, Manesh R. Patel, M.D.,et al.,N Engl J Med 362;10, 886-895) …slightly more than one third of patients without known disease who underwent elective cardiac catheterizationhad obstructive coronary artery disease. The authors analyzed data from a national registry on cardiac catheterization, reporting only 38% of elective, diagnostic coronary angiograms showed obstructive lesions, and 39% of …
The BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease In this study, the authors report the findings of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, involving 2368 patients with both diabetes and coronary disease. Patients with type 2 diabetes and stable ischemic heart disease were randomly assigned to …
In a study, published on-line in the journal Circulation on April 13, 2010, cardiologists were asked under what circumstances they would order a cardiac catheterization. 29% of physicians ordered the test for other than clinical reasons, foremost amongst them malpractice concerns. About 25% of the doctors ordered more tests than were necessary, driving up costs. Others did it because of …
The following link from The Kaiser Family Foundation calculates the costs for persons aged 19-64 who have to buy their own health insurance. As a drawback of this calculator it doesn’t compare with costs under the previous system: Calculate the cost of your Healthcare under the new Healthcare Reform Bill
… Published the results of survival of patients with diabetes and MVD after surgical or percutaneous coronary revascularization. Their results showed that in 2766 risk matched diabetics PCI increased five-year mortality by 1.5–3.9 times… In 2,766 patients with diabetes undergoing their first coronary revascularization procedure, improved survival with CABG was the initial revascularization demonstrated. The analysis supported that bypass surgery …