CardioExchange Archive

February 4th, 2015

Clinical Significance of Non-IRA Disease in STEMI Patients

Beat J. Meyer, M.D.

Beat Meyer wonders whether and how an observed association between the presence of non-IRA lesions and increased mortality in STEMI patients will affect treatment decisions.

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September 1st, 2014

New Support For Complete Revascularization During Primary PCI

Larry Husten, PHD

Until recently, MI patients receiving emergency PCI would only have the culprit artery opened. Complete revascularization of non-infarct-related arteries was performed later. The conventional wisdom was that revascularization of non-infarct-related arteries could be dangerous. That wisdom began to change last year with the PRAMI trial, which found no evidence of harm and a suggestion of benefit in […]

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July 7th, 2014

Selections from Richard Lehman’s Literature Review: July 7th

Richard Lehman, BM, BCh, MRCGP

This week’s topics include the effect of patients’ risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes, a meta-analysis of revascularization vs. medical treatment in patients with stable CAD, and more.

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October 17th, 2013

New Insights Into Surgery vs. Stents for Diabetics with Multivessel Disease

Larry Husten, PHD

Last year the large NHLBI FREEDOM trial demonstrated that coronary-artery bypass graft (CABG) surgery was superior to PCI when treating diabetic patients who have multivessel coronary disease. CABG resulted in significant reductions in death and MI, but this was offset slightly by a higher rate of stroke in the CABG group. Now, a new report from FREEDOM […]

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January 2nd, 2013

CABG Highly Cost-Effective in Diabetics with Multivessel Disease

Larry Husten, PHD

In November the main results of the FREEDOM trial showed that diabetics with multivessel disease do better with CABG than PCI. Now the findings of the trial’s cost-effectiveness study, published online in Circulation, demonstrate that CABG is also highly cost-effective when compared with PCI. Elizabeth Magnuson and colleagues  found that although CABG initially cost nearly $9000 more than PCI ($34,467 […]

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November 4th, 2012

FREEDOM Lends Strong Support to CABG for Diabetics with Multivessel Disease

Larry Husten, PHD

CABG is associated with better cardiovascular outcomes than PCI in patients with diabetes and multivessel disease.

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October 4th, 2012

Beta-Blockers May Not Work as Well as We Thought: So What Does “Optimal Medical Therapy” Really Mean?

Ajay J Kirtane, MD, SM

Proponents of optical medical therapy believe that the benefits of coronary revasculartion in stable ischemic disease were established in outdated studies. But if beta blockers aren’t very effective, is optimal therapy just aspirin and a statin?

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May 15th, 2012

No Benefit Found for Exercise Echocardiography in Asymptomatic Patients Following CABG Or PCI

Larry Husten, PHD

Routine exercise echocardiography in asymptomatic patients after revascularization does not lead to better outcomes, according to a new study published in Archives of Internal Medicine. Although guidelines generally discourage the practice, post-revascularization stress tests are still commonly performed. Serge Harb and colleagues performed exercise echocardiography on 2105 patients after CABG surgery or PCI and followed them […]

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May 14th, 2012

Revascularization in New York State: High Questionable Rates for PCI but Not CABG

Larry Husten, PHD

A large study looking at real-world use of elective coronary artery bypass surgery (CABG) and stenting (PCI) in New  York State finds that nearly two thirds of PCI procedures have inappropriate or uncertain indications. By contrast, 90% of CABG procedures were deemed appropriate and 1.1% inappropriate. In a paper published in the Journal of the American College […]

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January 30th, 2012

Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High-Risk Patients

Larry Husten, PHD

Although PCI has a small, early mortality benefit compared to CABG in high-risk patients, after the first year a striking survival advantage for CABG develops, according to results of the ASCERT study, presented on Monday at the annual meeting of the Society of Thoracic Surgeons (STS). Fred Edwards presented the high-risk subset of ASCERT (ACCF-STS Database Collaboration […]

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