Tag Archives: CABG

Dear Sirs, Research on sex difference in mortality after myocardial infarction (MI) since the 1990s has been debated and increased. Several observational studies have shown that younger women, in particular, seemed to have higher mortality rates than men of similar age during the two-year or longer follow-up, although these studies were mainly from the USA.1-3 Recent American studies have also found that, even after full adjustment for potential risk factors, excess risk for in-hospital mortality for women was still noted, particularly among those <50 years old with acute ST-segment elevation MI, leading to 98% (odds ratio [OR] 1.98, 95% c

Introduction Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is recommended for up to one year following acute coronary syndrome (ACS) in order to reduce the risk of further cardiac events.1,2 Gastrointestinal bleeding is the main hazard of this treatment; however, although the incidence of bleeding is low, it results in significantly increased morbidity and mortality in these patients,3-5 and proton pump inhibitors (PPIs) are often prescribed to selective patients to reduce this risk. PPIs act by reducing the secretion of gastric acid, neutralising gastric pH, increasing clot formation and decreasing the lysis of blood clots. Th

Case presentation A 73-year-old woman presented with six-month history of progressively worsening exertional shortness of breath. The patient had previously undergone coronary artery bypass grafting (CABG) two years ago for symptomatic, severe, left-sided coronary artery disease using left internal mammary artery (LIMA) graft to left anterior descending (LAD) artery, left radial artery to obtuse marginal branch of circumflex artery and left cephalic vein graft to diagonal branch of LAD artery with good symptomatic relief. The choice of conduits at the initial operation had been dictated by a history of deep vein thrombosis (DVT) and varicose

FREEDOM: CABG beats PCI in diabetes patients with multi-vessel disease Coronary artery by-pass graft (CABG) surgery was associated with better outcomes than percutaneous coronary intervention (PCI) in patients with diabetes with multi-vessel coronary artery disease in the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial. Senior FREEDOM investigator, Dr Valentin Fuster (Mount Sinai School of Medicine, New York, USA), said the results (table 1) would change practice. He estimated that patients in this study represent about a quarter of patients undergoing PCI. In

CORONARY: off-pump and on-pump CABG similar The largest trial ever to compare off-pump and on-pump coronary artery bypass surgery (CABG) has shown no difference between the two techniques in terms of the primary composite end point. There were, however, some differences in certain end points, leading to the suggestion that the decision as to which approach to choose could be individualised with each patient. Table 1. Main results from the CORONARY trial The CORONARY trial enrolled 4,752 patients who were randomised to off-pump or on-pump surgery. At 30 days the primary end point – a composite of death, myocardial infraction (MI), kidney fai

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

So there I was, sitting in one of our twice-weekly multi-disciplinary team (MDT) meetings. I was proffering my sixpence worth on the merits of surgery (coronary artery bypass graft [CABG]) or percutaneous coronary intervention (PCI) (occasionally neither, and – rarely – both), as a succession of clinical data, scans of various types and coronary angiograms were laid before us. And I got to thinking, “is this the way it should be?” We have come a long way in tailoring treatment to patients. When PCI, or percutaneous transluminal coronary angioplasty (PTCA) as it was then, emerged as a young and promising technique in the late seventies

Dear Sirs We read with interest the recently published article and subsequent letters concerning the radial artery as a preferred access site for percutaneous coronary interventions (PCI).1 We think this debate should also include our cardiothoracic surgical colleagues. Although the radial artery has been used as a coronary artery bypass conduit for over 30 years,2 the initial results were disappointing due to problems with spasm and intimal hyperplasia and the technique was soon abandoned. With the availability of antispasmodic drugs and improved surgical techniques, the radial artery has once again become a popular conduit for coronary bypa