Heart and Vascular Health
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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Scooped by Seth Bilazarian, MD
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Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis

Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis | Heart and Vascular Health | Scoop.it

Although clinical practice guidelines carry a higher class of recommendation for CABG surgery (Class IIa) than for catheter-based deployment of drug eluting stents (DES) (Class IIb), when revascularization is indicated for patients with ischemia due to significant stenosis in CAD isolated to the PLAD, a comprehensive registry in the state of New York found no differences between these approaches in either mortality rates or the combined rates of mortality, MI, and/or stroke, although CABG was associated with lower rates of repeated revascularization.

Seth Bilazarian, MD's insight:

For many years we have had good evidence that there is not a significant difference in death or other major hazard between bypass surgery or angioplasty with stents.  This information from the New York State registry adds important information because of its size and the use of drug eluting stents.  The one significant difference is that the angioplasty group needed more repeat procedures over 3 years; Repeat procedures were needed in 1 in 17 of the bypass patients and 1 in 9 of the stent patients.  This information is welcome addition to help our patients make an informed decision about whiich option is best for them.

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Nonemergency PCI (angioplasty) at Hospitals with or without On-Site Cardiac Surgery

Nonemergency PCI (angioplasty) at Hospitals with or without On-Site Cardiac Surgery | Heart and Vascular Health | Scoop.it

A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point.

Seth Bilazarian, MD's insight:

Good news for community hospitals doing quality work and for patients relying on local care for heart disease and treatment with angioplasty (PCI). In Massachusetts, safety and efficacy of balloon angioplasty & stenting in community hospitals (without On-site cardiac surgery) to treat patients with coronary artery disease was not different than large academic hospitals (with surgery on site).  Study conducted by physicians at hospitals with on-site cardiac surgery.

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Are Drugs Better Than Carotid Stents?

Are Drugs Better Than Carotid Stents? | Heart and Vascular Health | Scoop.it

My comment: This is an important question for our patients and unfortunately we will porbably never get an answer because the study would be expensive and there is no likely source for funding an outcomes study that would be needed.  With all blocked arteries (heart, head or legs) the options for treatment are medications to control or slow the progression of the blockage OR stents OR surgery.  The benefits and safety hazards are improving for all three so making comparisons using older data is not useful,.  For now we know stents are about equivalent to surgery in blocked carotid arteries.  Is medicine equal or even better? 

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A debate is taking place among physicians over whether drug therapies to prevent stroke have surpassed stents or carotid artery surgery as the best treatment for many patients with artery blockage in the neck.

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The passion for procedures to fix ailing arteries and hearts may be misguided

The passion for procedures to fix ailing arteries and hearts may be misguided | Heart and Vascular Health | Scoop.it
How gaps in medical knowledge affect matters of the heart
Seth Bilazarian, MD's insight:

David Jones, medical historian gives a review of the history of coronary bypass (CABG) and angioplasty (PCI). The essay does a good job putting into perspective the growth of these procedures. The medical approach has evolved from a belief that patients are "all fixed" when they receive a stent or have coronary bypass to our current understanding. We now recognize that these procedures need to be part of optimizing patients risk factors so the disease does not continue to worsen.
My concern about headlines like this is that patients will believe that stents are not appropriate under any circumstances and there is strong evidence that treatment for patients in the setting of a heart attack or threatened heart attack is valuable and often life saving.

Stents are not always valuable or appropriate, but a blanket impression that all stent procedures should be avoided puts patients at serious risk.

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CNN Lifestream Video

CNN Lifestream Video | Heart and Vascular Health | Scoop.it

Dr. Sanjay Gupta discusses coronary stents with Steve Nissen and Jeffrey Marshall president of SCAI

Seth Bilazarian, MD's insight:

Its reassuirng that Dr Gupta admits that the video is misleading when it implied that the patient profiled was mistreated and then went to Cleveland Clinic and was treated only with cholesterol medication.

Dr. Nissen takes a provocotave position not supported by the evidence (or my expereince) that most patients are being treated without preventitive efforts.  Its just not true. (It's irresponsible and misleading).  Of course we could do better.

Dr. Marshall makes a strong case that stents are critical and life saving in the setting of heart attaclks and threatend heart attacksd.  Scaring the public about stents does a huge disservice if patuients are discouraqged from recieving stents in the setting of a heart attack.

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