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 …

Interventions for 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 that CABG is superior in the long-term treatment of revascularization in some patients with two-vessel …

The FAME 1&2 Trials

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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 …

SYNTAX Trial after Five Years: Final Results

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In the SYNTAX trial 1800 patients with previously untreated left-main or three-vessel disease were randomized to CABG or PCI. As expected, differences in long-term outcomes of Coronary Artery Bypass Grafting vs. PCI, already present after year one, have continued to become more obvious during the next four years: SYNTAX five-year results for patients with three-vessel disease: SYNTAX five-year results for …

The FREEDOM Trial: Revascularization in Patients with Diabetes

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The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) study enrolled 1,900 patients over a 5-year period from 2005 through 2010. Contemporary PCI and CABG techniques and currently recommended ancillary medical therapies were examined to determine whether CABG or PCI with drug-eluting stents are the superior approach to revascularization in patients with diabetes and …

SYNTAX Trial: Four-year follow-up analysis

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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 drug-eluting stent (DES). Findings In patients with severe, multi-vessel coronary disease, coronary artery bypass grafting (CABG) continues as the standard of care of revascularization. Death and MI rates did become significantly greater in the PCI group after …

Medical therapy often superior than stenting

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There is more and more evidence of the superiority of medical therapy over stenting, not only with coronary artery disease, but also with stenotic arteries in your brain: The 30-day rate of stroke or death associated with stenting (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting in high-risk patients with a 70 – 90 …

Physical Activity and Weight Gain Prevention

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In a paper, published in JAMA in 2010, the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet was examined. The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of …

The MASS II Study

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MASS II [i] is a small, single-center study designed to compare the long term effects of Medical Therapy (MT), Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) among patients with stable angina, multivessel CAD and preserved ventricular function. Patients selected were appropriate candidates for all 3 therapies. In MASS II 611 patients were randomly assigned to CABG (n=203), …

PCI vs. CABG outcomes in Washinton State

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In a large comparative study, interventions for CAD were compared. From 1999-2007 more than 150000 interventions were performed in Washington State. During that period, the volume of PCI procedures increased by 71%, while simultaneously, CABG diminished by almost 40%. In final analysis, PCI was almost five times more likely to happen than CABG. For patients undergoing CABG, the prevalence of, …