geoffrey modest medical blogs

​The NEJM just printed the recent study of patients with ischemic cardiomyopathy and the utility of CABG (see  chf ischemic cabg plus meds nejm2016  in dropbox, or DOI: 10.1056/NEJMoa1602001), the STICHES trial (Surgical Treatment for Ischemic Heart Failure Extension Study). details: --1212 patients from 22 countries who had coronary artery disease (CAD), ejection fraction (EF) <35% and with coronary arteries amenable to bypass, were randomly assigned to CABG plus optimal medical therapy vs medical therapy alone. patients recruited from 2002-2007 --mean age 60, 12% female, 36% latino or nonwhite/64% white, BMI 27, 76% with MI, 59% hyperlipidemia, 59% hypertension, 39% diabetes, 86% NYHA class 2 or 3, mean systolic BP 120 mmHg. EF 27%, left main disease in 3%, proximal LAD 67%. 1 vessel disease 22%/2-vessel 38%/3-vessel 37%.  no comment on QRS interval. --median followup 9.8 years -- results :     ...

two drug-company sponsored papers were published in new  engl  j of medicine comparing percutaneous coronary intervention (PCI) with coronary-artery bypass grafting ( CABG ), looking specifically at how the newer drug-eluting stents compare with surgery. 1. a large East Asian non-inferiority study with 27 centers randomly assigned patients with multi-vessel coronary artery disease (CAD) to PCI with  everolimus -eluting stent vs  CABG  (see  cad  cabg  vs stent  NEJM  2015  in  dropbox , or  DOI : 10.1056/ NEJMoa1415447 ). details: --880 patients were enrolled (only 1/2 of the anticipated). mean age 64, 70% male, BMI 25, 41% diabetic, 67% hypertensive, 20% current smoker, 53% hyperlipidemia. 47% with stable angina, 43% unstable angina, 9% acute MI in past 90 days; ejection fraction 59%; 77% with 3 vessel disease and 23% with 2 vessel disease (they excluded those with clinically significant ...