Carcinoma of the esophagus is a relatively rare but very lethal disease. 50% of all patients diagnosed will have adeno carcinoma, which has been associated with a very poor long term survival. During my residency, I had the honor of working with F. Henry Ellis, one of the giants of esophageal surgery in the US. Yet even he confessed that …
PCI & CABG for Diabetics with 3VD
A subset of patients with diabetes and 3VD was examined in a 2nd paper in 2010.The purpose of this study from Washington State was to examine the application of revascularization strategy in this high-risk patient population of patients with diabestes and multi-vessel coronary artery disease. Specifically, it was sought to determine: the revascularization strategies employed in diabetic patients with MVD …
Treatment of 3VD with/without Diabetes in Washington State
A paper from Washington State examines the treatment of patients with multi-vessel coronary artery disease. A second paper, like the BARI-2D study and a much earlier published paper, focuses on patients with diabetes and 3VD. The short as well as long term benefits of CABG for these type of patients have been described in the SYNTAX trial as well as …
Inaccuarte Risk Predictor Calculator sponsored by the Drug Industry?
A September 20, 2010, NYTimes article describes inaccurate outcomes with a point based tool to calculate your chances of developing coronary artery disease & stroke over the next 10 years. The simplified system was developed so doctors and patients would not need a computer. Each risk factor corresponds to a number of points; the more points you have, the higher …
Review of the MASS II study
MASS II is yet another study that shows the benefits of CABG compared to the limits of PCI as a viable long term strategy in stable patients with Coronary Artery Disease. This evidence adds to the ever growing body of literature promulgating the same in other risk groups (SYNTAX, SYNTAX-3 Analysis, BARI-2D, OAT trial, PCI vs. CABG – A Current …
SYNTAX 3 Analysis
At the September meeting of the European Association for Cardio-Thoracic Surgery Meeting three year follow-up data of the SYNTAX trial [9] were presented. I have commented repeatedly on both SYNTAX and reactions it provoked in the professional literature and the lay press [4], [5], [6],[7],[8]. In this analysis, the SYNTAX score was used to separate patients into three groups. This …
SYNTAX three year results
The latest SYNTAX results extend CABG’s superiority over PCI. SYNTAX was an 1800-patient trial, randomizing patients with left main coronary disease and/or three-vessel disease to either CABG or PCI using the Taxus DES. This follow-up analysis further clarifies the limited role of PCI in the treatment of triple vessel CAD and/or LMain Stenosis, while the differences have become more obvious. Key …
Carotid Stents and Stroke
Carotid Stents may raise patient risk for another stroke Confirming an earlier report in February, 2010, The International Carotid Stenting Study (ICSS) study showed a continued higher event rate of stroke, death, or peri-procedural MI with stenting vs. surgery for symptomatic carotid stenosis. (ICSS, which compared carotid artery stenting with carotid endarterectomy in patients with symptomatic carotid artery stenosis, showed …
PCI for STEMI should be limited to infarct related coronary arteries
NEW YORK (From Reuters Health) – Performing percutaneous coronary interventions (PCI) in non-infarct-related coronary vessels along with primary PCI for ST-segment elevation myocardial infarction (STEMI) appears to jeopardize patient survival, Canadian researchers reported online June 8 in the European Heart Journal. Despite guidelines to the contrary, some 10% of STEMI patients with multi-vessel coronary artery disease had non-culprit coronary interventions …
APEX-AMI trial Analysis
Although 40-65% of patients admitted for treatment of an acute heart attack with percutaneous coronary intervention (PCI) have multiple blockages, current guidelines strongly suggest to limit the procedure to the blocked artery (the culprit vessel). PCI in “Non-culprit coronary arteries” is associated with a significantly increased risk of dying, as Armstrong and colleagues of the APEX-AMI trial recently published in …