3 ms·
Gina Kolata is a fine scientific writer, but I think that the presentation of the exclusions is a bit too brief and subtle. The main controversy being addresse
by carbocation 7y ago
Gina Kolata is a fine scientific writer, but I think that the presentation of the exclusions is a bit too brief and subtle.
The main controversy being addressed is whether revascularization in stable disease has benefit. Not heart attack patients. Not people with significant left main coronary artery disease. COURAGE and this trial address that question in different ways.
It is addressed in the article, but you kind of are left to draw your own conclusions:
> The participants in Ischemia were not experiencing a heart attack, like Senator Bernie Sanders, nor did they have blockages of the left main coronary artery, two situations in which opening arteries with stents can be lifesaving. Instead, the patients had narrowed arteries that were discovered with exercise stress tests.
This doesn't at all address the need for revasularization during a heart attack (about which there is universal agreement). It addresses whether revascularizing people not having a heart attack can be helpful.
- vo2maxer 7y agoThe article in The Washington Post explains it better for the interested reader [1]. There is also this thread with a good discussion [2]. [1] https://www.washingtonpost.com/health/2019/11/16/embargoed-drugs-are-effective-invasive-procedures-patients-with-stable-heart-disease-major-trial-finds/ https://www.washingtonpost.com/health/2019/11/16/embargoed-d... [2] https://twitter.com/rwyeh/status/1194638074765967362?s=21 https://twitter.com/rwyeh/status/1194638074765967362?s=21
- dr_ 7y agoTrue, but that’s pretty much what I took from this article. People with vascular heart disease who have not had an acute coronary event still compromise a significant chunk of the patient population. Many of them still currently receive stents or cabg.
- Dowwie 7y agoWhat brings a cardiology fellow at Mass General to Hacker News? I think it's great that you're here and sharing insight.
- carbocation 7y agoI've been on Hacker News longer than I've been at MGH ;) Thanks for your kind words.