It is often said that medicine is both an art and a science. In an imperfect world this is both inevitable and desirable. But it is extremely important that the two should not be confused with each other. In particular, because the “science” side of the equation has achieved overwhelming prestige and authority, it is…
Don’t Confuse the Art and Science of Medicine: PCI vs CABG for Left Main Disease
August 20, 2020 by 1 Comment
Off-Pump CABG Raises Long-Term Mortality Risk
August 16, 2017 by Leave a Comment
–Significant risk over on-pump grafting found at 5 years in ROOBY trial. It seemed like a great idea. Perform coronary-artery bypass grafting (CABG) without stopping the heart and you can prevent the dangers of cardiopulmonary bypass. But it didn’t work out. After growing in popularity over the previous decade, in 2009 the first large, well-conducted…
After a Decade, CABG Pulls Ahead of Meds for HF
April 4, 2016 by Leave a Comment
–Life-saving benefit of CABG now clear in long-term trial follow-up Finally, after 10 years of follow-up, the life-saving benefits of coronary artery bypass graft (CABG) surgery in heart failure patients with coronary artery disease are clear. More than 15 years ago, the NIH funded the original STICH trial to answer a question that was already…
Hospital Quality Helps Explain Some Of The Racial Disparities In Outcomes After CABG
January 8, 2014 by Leave a Comment
It has long been known that racial disparities exist in health care. A large body of research has found that nonwhite patients have worse outcomes than whites. But it has been difficult to understand the underlying reasons for these disparities. Now a new study offers evidence that, at least in the case of bypass surgery,…
Stents Lose In Comparisons With Surgery And Medical Therapy
December 3, 2013 by Leave a Comment
Despite the enormous increase in the use of stents in recent decades, there is little or no good evidence comparing their use to the alternatives of CABG surgery or optimal medical therapy in patients also eligible for these strategies. Now two new meta-analyses published in JAMA Internal Medicine provide new evidence that the alternatives to PCI remain attractive…
New Insights Into Surgery Versus Stents For Diabetics With Multivessel Disease
October 17, 2013 by Leave a Comment
Last year the large NHLBI FREEDOM trial demonstrated that bypass surgery was superior to PCI when treating diabetic patients who have multivessel coronary disease. CABG resulted in significant reductions in death and MI, but this was offset slightly by a higher rate of stroke in the CABG group. Now a new report from FREEDOM published in JAMA suggests that…
Two Trials Explore On-Pump Versus Off-Pump Bypass Surgery
March 11, 2013 by Leave a Comment
Two large trials presented at the American College of Cardiology meeting in San Francisco and published simultaneously in the New England Journal of Medicine provide important new information about the ongoing debate over whether CABG should be performed with or without cardiopulmonary bypass. The combined results suggest that both techniques can be effective, and that surgeons…
CABG Highly Cost Effective In Diabetics With Multivessel Disease
January 2, 2013 by Leave a Comment
In November the main results of the FREEDOM trial showed that diabetics with multivessel disease do better with CABG than PCI. Now the findings of the trial’s cost-effectiveness study, published online in Circulation, demonstrate that CABG is also highly cost-effective when compared with PCI. Elizabeth Magnuson and colleagues found that although CABG initially cost nearly $9,000 more…
2012 In Review: A Bad Year For Conventional Wisdom
December 24, 2012 by 3 Comments
This was a really grim year for anyone who thought we had things pretty well figured out. Time and again conventional wisdom was thrown out the window. 2012 forced the cardiology community to reconsider what it thought it knew about HDL cholesterol, platelet function tests, aspirin resistance, triple therapy, IABP, and more. One device company,…
FREEDOM Lends Strong Support To CABG For Diabetics With Multivessel Disease
November 4, 2012 by 3 Comments
Editor’s note: The embargo on FREEDOM was lifted early after a press release was published by mistake.) Diabetics with multivessel disease do better with CABG than PCI, according to FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), a large NIH-sponsored study presented at the American Heart Assocation in Los…
No Benefit Found For Exercise Echocardiography In Asymptomatic Patients Following CABG Or PCI
May 15, 2012 by 1 Comment
Routine exercise echocardiography in asymptomatic patients after revascularization does not lead to better outcomes, according to a new study published in Archives of Internal Medicine. Although guidelines generally discourage the practice, post-revascularization stress tests are still commonly performed. Serge Harb and colleagues performed exercise echocardiography on 2,105 patients following CABG surgery or PCI and followed…
Revascularization In New York State: High Questionable Rates For PCI But Not CABG
May 14, 2012 by Leave a Comment
A large study looking at real world usage of elective coronary artery bypass surgery (CABG) and stenting (PCI) in New York State finds that nearly two-thirds of PCI procedures have inappropriate or uncertain indications. By contrast, 90% of CABG procedures were deemed appropriate and 1.1% inappropriate. In a paper published in the Journal of the…
ASCERT Observational Study Finds Long Term Advantage for CABG Over PCI in High Risk Cases
March 27, 2012 by Leave a Comment
A very large observational study finds that long-term mortality in high risk patients is lower after bypass surgery than after PCI. The results, which were previously revealed in January at the annual meeting of the Society of Thoracic Surgeons (STS), were presented in final form at the American College of Cardiology by William Weintraub and published simultaneously…
Appropriate Use Criteria for Revascularization Updated
January 30, 2012 by Leave a Comment
The ACC, AHA, and other organizations have released updated appropriate use criterial for coronary revascularization. The 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update incorporates data from the SYNTAX trial on the indications for PCI and CABG in patients with symptomatic, multivessel disease, as well as data from the CathPCI registry. Here are some of the…
Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High Risk Patients
January 30, 2012 by Leave a Comment
Although PCI has a small, early mortality benefit compared to CABG in high risk patients, after the first year a striking survival advantage for CABG develops, according to results of the ASCERT study, presented on Monday at the annual meeting of the Society of Thoracic Surgeons (STS) meeting. Fred Edwards presented the high-risk subset of…
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