(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 …
Antiplatelet Drugs, Prevention and Treatment of Arterial Thrombosis
Current guidelines support dual antiplatelet therapy with aspirin and clopidogrel (Plavix) in a number of clinical scenarios: ST-segment-elevation myocardial infarction (SEMI), Non-ST-elevation MI, Percutaneous Coronary Intervention. The guidelines are based on strong evidence from several large randomized clinical trials over the last 10 years. Dual antiplatelet therapy is recommended after ST-elevation MI or non-ST-elevation acute coronary syndromes, with aspirin indefinitely …
The BARI 2D Trial Study
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 …
Unnecessary procedures
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 …
Healthcare Costs
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
Survival of patients with diabetes and multivessel coronary artery disease
… 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 …
The BARI-2D Trial
The Impact of Different Treatment Strategies on Cardiac Death and MI Rates in Patients with Type 2 Diabetes and Stable Coronary Disease, N Engl J Med2009; 360:2503- 2515. In patients with type 2 diabetes and stable ischemic heart disease … prompt revascularization significantly reduced major cardiovascular events, as compared with intensive medical therapy, among patients who were selected to undergo CABG …
Elective Cardiac Catherization
…slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease… Low Diagnostic Yield of Elective Coronary Angiography In an article, published in the NEJM in 2010, the authors analyzed data from a national registry on cardiac catheterization, reporting only 38% of elective, diagnostic coronary angiograms showed obstructive lesions, and 39% …
Percutaneous Coronary Intervention (PCI) – Risks & Benefits
A 58-year-old man has chest pain at 9:30 a.m.; 3 hours later, he calls for an ambulance. Paramedics arrive, provide standard treatment, and transport him to the nearest emergency department. On his arrival at a small hospital at 1 p.m., the findings are diagnostic of a myocardial infarction with ST-segment elevation. The emergency department physician recommends immediate transfer to a …
Niacin vs. Ezitimibe, Niacin Therapy
Extended-Release Niacin or Ezetimibe and Carotid Intima–Media Thickness (The ARBITER 6–HALTS trial, Taylor et al., NEJM, 11/15/2009): In a recent study, the effect of extended-release niacin (Niaspan, target dose, 2000 mg per day) was compared with ezetimibe (Zetia, 10 mg per day) in a small group of 208 patients with established Coronary Artery Disease (CAD). All these patients had been …