The ORBITA Trial

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Percutaneous Coronary Intervention in stable angina  PCI was no better than a sham procedure at providing relief to stable angina patients, the ORBITA trial showed. Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. The ORBITA …

US General Surgery Residents Readiness for Independent Practice

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“There’s increasing concern that U.S. general surgery residents are not ready to operate independently by the time they graduate.” In an article I published on this website in 2014, I commented on this lack of readiness in detail. Unfortunately, it appears that surgical training programs have made no progress since. It also appears that surgical skills training has been reduced …

SYNTAX and CABG after two years

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A new study, published in the Januari, 2011 issue of the Journal of Thoracic and Cardiovascular Surgery, reviewed 2-year follow-up outcome data of  1468 CABG patients from the SYNTAX trial. Coronary artery bypass grafting (CABG), rather than percutaneous coronary intervention (PCI) continues to be the recommended primary revascularization strategy for patients with stable angina who have coronary triple vessel disease (3-VD) …

Considerations in the Treatment of Coronary Artery Disease

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In determining a treatment strategy for a patient with CAD, there are a variety of considerations that need to be made when selecting the appropriate treatment: Clinical outcomes differ significantly according to the treatment choice, as has been demonstrated by currently available data from the COURAGE, FREEDOM and SYNTAX trials, and emphasize the fact that CABG is superior in the …

Losing weight is hard work!

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Losing weight is difficult, and keeping it off may be even harder. In “Physical Activity and Weight Gain Prevention“, published in the March 24, 2010 issue of The Journal of the American Medical Association, middle aged women of normal weight needed at least an hour of moderate exercise a day to prevent gaining more than five pounds over a three-year …

CABG Superior to PCI

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CABG Superior to PCI in long-term treatment of coronary artery disease As shown in SYNTAX and other studies, CABG is associated with significantly lower rates of death, myocardial infarction (MI) and target vessel revascularization (TVR) vs. PCI. Results K-M Survival curves Sub group analysis Comments SYNTAX  A regional study from Italy[1], published on April 28,2013 in the European Journal Cardio-Thoracic …

Heart health Risks of US Young People

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A new study by the American Heart Association has shown that although the majority of clinical CardioVascular Disease (specifically Coronary Artery Disease and Stroke) events occur at middle and older ages, atherosclerosis begins in childhood and cardiovascular health among adolescents aged 12 to 19 years  is alarmingly poor.  Cardiovascular health in adolescent males by race/ethnicity (aged 12–19 years): Cardiovascular health in adolescent females by race/ethnicity (aged 12–19 years):   Shay …

Interventions for Coronary Artery Disease

Dr T Papers, Professionals 1 Comment

In determining a treatment strategy for a patient with CAD, there are a variety of considerations that need to be made when selecting the appropriate treatment: Clinical outcomes differ significantly according to the treatment choice, as has been demonstrated by currently available data from the COURAGE, FREEDOM and SYNTAX trials, and emphasize that CABG is superior in the long-term treatment of revascularization in some patients with two-vessel …

The FAME 1&2 Trials

Dr T Papers, Professionals

In 1995 Topol[1] first described what vascular surgeons have known for many years: The pressure drop in a fluid flowing through a long cylindrical pipe such as a stenotic artery becomes functionally significant when the obstruction exceeds 70%, first described in the Poiseuille law in 1846[2]. As was stated in Topol’s paper: “Accordingly, before the residual stenosis in an infarct …