5 ms·
Impressive utility of the single-lead ECG recording, but I have to say that if I'm in charge, that patient's headed for bypass surgery, not stenting.
by aladoc99 6y ago
Impressive utility of the single-lead ECG recording, but I have to say that if I'm in charge, that patient's headed for bypass surgery, not stenting.
- unsrsly 6y agoI'm not sure the HN community participates in the CABG PCI wars, but maybe your comment will lead to a fiery debate.
- ashtonkem 6y agoNever underestimate the ability for HN to participate in an extremely niche flame war.
- Austin_Conlon 6y agoPlease don't make comments like this. We’re also well-equipped to participate in flame wars about the popular culture.
- epmaybe 6y agoEh, I think the data is controversial and case-dependent in two-vessel disease. If this were three vessel disease, the data is far more in favor of CABG. The fluoroscopy doesn't look convincing to me of major stenosis, so a PCI/stent could certainly be placed for symptomatic relief without a CABG. Additionally, the patient definitely did not need emergency CABG. My understanding is that CABG could be completed after stenting, and may very well have happened for this patient without our knowledge.
- Herodotus38 6y agoI’ll take you up on the bypass statement. :) This is an 80 yo woman, that alone would probably make me not want to put her under for bypass. Also, she had a history of paroxysmal afib and prior pulmonary embolism (they don’t state if it wad provoked or not) but is not on anticoagulation. By CHADS2-Vasc criteria she should have been on AC alone, but isn’t. She’s clearly intelligent and has no issues with access to care (engineer, has an Apple Watch) which further makes me think that her underlying health warrants a more conservative approach.
- op03 6y agoI agree. Redoing plumbing of an 80 year old house, makes sense only under certain conditions eg- part of a living history museum.
- Herodotus38 6y agoPlus, I don’t want to risk giving the house a stroke or cognitive injury from the risks of the operation and general anesthesia when a comparable or better outcome could be done with PCI. It’s all about risks and benefits for her.
- azalemeth 6y agoIn three vessel disease, PCI is decidedly worse than CABG [1], but the latest evidence is, AFAIK, equivocal for CABG over PCI in one and two vessel disease [2]. I've personally often thought that this is due to the degree of collatoralisation that goes on in the ischaemic myocardium, even when we are convinced that the reduced FFR is all the story: stenosis does not happen overnight and metabolic adaption to, e.g., decreased O2 starts to begin. In three vessel disease you've burnt your reserves and are desperate for O2. In two vessel disease you're (mal)adapted. Incidentally, this is why my scientific research is focused on using a slightly crazy CMR technique to directly image glycolysis and beta-oxidation in the ischaemic myocardium. We can make PCI kill fewer people if the interventionalists can be told "This region is ischaemic and has shifted towards anaerobic glycolysis due to this branch of (LCx/whatever) artery. Go revascularise". [1] https://academic.oup.com/eurheartj/article/35/40/2821/2293222 https://academic.oup.com/eurheartj/article/35/40/2821/229322... [2] https://openheart.bmj.com/content/3/2/e000489?utm_term=usage-012019&utm_content=consumer&utm_campaign=oh&utm_medium=cpc&utm_source=trendmd https://openheart.bmj.com/content/3/2/e000489?utm_term=usage...