NEJM PCI vs. CABG article...

[windsurfr]

Anyone read this yet? Here's the abstract. Any thoughts...


N Engl J Med. 2005 May 26;352(21):2174-83.

BACKGROUND: Several studies have compared outcomes for coronary-artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI), but most were
done before the availability of stenting, which has revolutionized the latter
approach. METHODS: We used New York's cardiac registries to identify 37,212
patients with multivessel disease who underwent CABG and 22,102 patients with multivessel disease who underwent PCI from January 1, 1997, to December 31, 2000. We determined the rates of death and subsequent revascularization within
three years after the procedure in various groups of patients according to the
number of diseased vessels and the presence or absence of involvement of the
left anterior descending coronary artery. The rates of adverse outcomes were
adjusted by means of proportional-hazards methods to account for differences in
patients' severity of illness before revascularization. RESULTS: Risk-adjusted
survival rates were significantly higher among patients who underwent CABG than
among those who received a stent in all of the anatomical subgroups studied. For example, the adjusted hazard ratio for the long-term risk of death after CABG
relative to stent implantation was 0.64 (95 percent confidence interval, 0.56
to 0.74) for patients with three-vessel disease with involvement of the
proximal left anterior descending coronary artery and 0.76 (95 percent
confidence interval, 0.60 to 0.96) for patients with two-vessel disease with
involvement of the nonproximal left anterior descending coronary artery. Also,
the three-year rates of revascularization were considerably higher in the
stenting group than in the CABG group (7.8 percent vs. 0.3 percent for
subsequent CABG and 27.3 percent vs. 4.6 percent for subsequent PCI).
CONCLUSIONS: For patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting.

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[Smoke This]

This predates drug-eluting stents.

 

[retroviridae]

and so continues the battle ... interventionalists vs cardiothoracc surgeons.

this is why you should pick a fellowship you like, not one which pays well. If someday in the future, CABG is ruled superior to most blockages, interventionalists may find themselves with much less work (I'm not saying this will happen). Same thing for virtual colonoscopies ... if they can fine tune the thing, gastro may find itself losing its main source of income. The tides, they turn quickly.

 

[windsurfr]

I liked the last paragraph's intro:

"Thirty years after we began PCI we are still asking many of the same questions"

 

[G0S2]

http://forums.studentdoctor.net/showthread.php?t=202385

 

[TommyGunn04]

Same thing for virtual colonoscopies ... if they can fine tune the thing, gastro may find itself losing its main source of income. The tides, they turn quickly.

I've often heard it said that there aren't even enough GI docs to do all the colonoscopies necessary to properly screen our population. If that's true, then virtual colonoscopy might help us achieve a more adequate screening of the US population. And if there aren't enough GI docs around, I doubt there are enough scanners around either, at least not enough to screen everyone. So in the end we'll probably need BOTH modalities, perhaps a win/win situation for GI docs and radiologists. Furthermore, when you consider that a positive virtual scope automatically results in a real colonoscopy, since polyps can't be removed in a scanner, I'm inclined to think GI docs will do just fine. I hear it's the polypectomies that REALLY make them money anyway, not the routine scopes.