Many patients with coronary artery disease are not treated optimally

As we have reported repeatedly in previews of the SYNTAX trial, the rate of CABG surgeries declined by approximately one-third and that of PCI procedures fell by 4% between 2001 and 2008, according to another study published in JAMA in May, 2011. There was a "substantial," statistically significant, 38% decrease in the annual rate of CABG surgery, from 1,742 per million adults in the first year of the study period to 1,081 per million in the final year.

"Whether these patients were appropriately treated ... during these years of ?high enthusiasm? for drug-eluting stents is uncertain," the investigators noted.

"We see elective mutli vessel PCI every week, in patients with stable angina. The local word is familiar country wide (Occulostenotic reflex). One of my interventional cardiology colleagues remarked that "they are pioneers, inventing new uses of stents, and where ever there is a stenosis, there is a stent". Coronary interventions aside, we see the same trend with peripheral vascular disease and stenting of carotids in patients who are pefectly good candidates for endarterectomy. I think the combination of lack of awareness of the referring internists and family practitioners, uneducated patients, industry pressure, and the hospitals desire to cash in on the procedural dollars are some of the important contributors. As surgeons, and patient advocates, we need to be more vocal, with patient and referring physician education, presence at cardiology cath conferences, and not bowing to the threat of referring physicians cutting you off for standing up for evidence based practice," M. Salik Jahania, on 09/16/2011 in CTSNET Journal and News Scan.

Ref:

1: the SYNTAX trial (N. Engl. J. Med. 2009;360:961-72)

2: Coronary Revascularization Trends in the United States, 2001-2008, Andrew J. Epstein, PhD et al. JAMA 2011;305:1769-76