February 4th, 2015
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.
September 1st, 2014
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 […]
July 7th, 2014
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.
October 17th, 2013
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 […]
January 2nd, 2013
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 […]
November 4th, 2012
CABG is associated with better cardiovascular outcomes than PCI in patients with diabetes and multivessel disease.
October 4th, 2012
Beta-Blockers May Not Work as Well as We Thought: So What Does “Optimal Medical Therapy” Really Mean?
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medical therapy believe that the benefits of coronary revasculartion in stable ischemic disease were established in outdated studies.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?
May 15th, 2012
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 […]
May 14th, 2012
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 […]
January 30th, 2012
Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High-Risk Patients
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 […]