Pearls from Dr. Gregg Stone
FREEDOM Trial (NEJM 2012)
- Diabetic patients with multivessel CAD (N=1900)
- Revascularization with CABG reduced mortality (16.3% vs. 10.9%, P=0.049)and MI (13.9% vs. 6.0%, P<0.001) compared to PCI
- CABG associated w/ modest increase in the rate of stroke (2.4% vs. 5.2%, P=0.03).
Posted 03/21/17 09:21:03 AM by Matthew Cummings
BEST Trial (NEJM 2015)
- Non-inferiority trial examining PCI w/ 2nd generation DES vs. CABg for multivessel CAD
- 880 patients (438-PCI group and 442-CABG group) w/ multivessel CAD
- Rate of major adverse CV events higher among those s/p PCI (11%) with the use of everolimus-eluting stents than among those s/p CABG (7.9%).
- Why is CABG typically preferred for multivessel/LM disease? Bypass longer segments of atherosclerosis, pre-emptively exclude vulnerable plaques, avoid future clinical events.
Posted 03/21/17 09:25:27 AM by Matthew Cummings
SYNTAX score -- tool to score complexity of CAD
- Angiographic grading tool to determine the complexity of CAD
- Useful differentiator for the outcome of patients undergoing triple vessel PCI --> highest scores have highest risk
- Sum of the points assigned to each individual coronary lesion with >50% diameter narrowing in vessels >1.5mm diameter
- Coronary arteries divided into 16 segments
- Each segment given a score of 1 or 2 based on the presence of disease and this score is then weighted (e.g. 3.5 for the prox LAD, 5.0 for LM, and 0.5 for smaller branches).
Posted 03/21/17 09:35:27 AM by Matthew Cummings
Posted 03/21/17 09:40:14 AM by Matthew Cummings
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.