Stents Downgraded by Wall Street Journal: If Only It Were That Simple

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Attn: Burt Cohen Re: Stents Downgraded by Wall Street Journal: If Only It Were That Simple. Dear Mr Cohen, Like you I responded to the article “A Simple Health-Care Fix Fizzles Out” by Keith Winstein of the WSJ, dd 2/22/2010: However, unlike you, I drew somewhat different conclusions: RE: WSJ Simplifies Study Results by Ignoring Key Issues … you define …

A patient with Coronary Artery Disease

Dr. T Cardiac Risks 1 Comment

I thought to post a recent evaluation of a patient who contacted me for consultation: Mrs. XYZ, DOB: 1955 57 years old White Female, with low level Angina and progressive loss of exercise tolerance (fatigue, “can’t do much anymore”). (A significant factor in her care may well have included no health insurance, even though she rendered full payments at the …

Antiplatelet Drugs, Prevention and Treatment of Arterial Thrombosis

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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 …

Copy of a letter to the Editor, Wall Street Journal

Dr. T Ask Doctor T 5 Comments

In regards to your February 11, 2010 article in The Wall Street Journal “A Simple Health-Care Fix Fizzles Out” by Keith Winstein, I would like to add a few comments and perhaps an explanation why, in my opinion, studies such as the COURAGE trial have had little or no effect on the way Coronary Artery Disease (CAD) is treated: COURAGE …

Elective Cardiac Catherization

Dr T Diagnosis, News for Professionals, Professionals 2 Comments

…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

Dr T Chest Pain, Papers, Professionals, Treatment 1 Comment

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 …

Comments on the niacin ezitimibe study

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On Nov. 15 a study compared adjunct therapy (niacin vs. ezitimibe) for patients with known coronary artery disease (CAD) and hypercholesterolemia. The results indicated that patients would be better of with niacin (results published elsewhere on this website). The NYTimes commented on the study outcomes: Study Raises Questions About Cholesterol Drug’s Benefit on November 15, 2009: “For patients taking a …