12/20/2012
Austin FraktThe latest results, as summarized by Mark Hlatky in a NEJM editorial:
After 5 years of follow-up, the 947 patients assigned to undergo CABG had significantly lower mortality (10.9% vs. 16.3%) and fewer myocardial infarctions (6.0% vs. 13.9%) than the 953 patients assigned to undergo PCI. However, patients in the CABG group had significantly more strokes (5.2% vs. 2.4%), mostly because of strokes that occurred within 30 days after revascularization. In the CABG group, the primary composite outcome of death, myocardial infarction, or stroke over 5 years was reduced by 7.9 percentage points, or a relative decrease of 30%, as compared with PCI (18.7% vs. 26.6%, P=0.005). These results are consistent with the findings of multiple previous trials comparing CABG and PCI in patients with diabetes, as well as the most recent trials in which drug-eluting stents were used during PCI.
The editorial is worth reading in full. The study it describes is here. Both are ungated.
(I really do think that anyone interested in health policy should try to learn enough medical science to appreciate this debate and those like it in other clinical areas. Click through, read, ask questions. This post may also help. This book may help too.)
UPDATE: Given I’m at work, which confers some access, I may not be the best judge as to whether the papers are ungated.
by Joe Colucci (@wonkinakilt) on December 20th, 2012 at 13:09
I don’t know if you’re familiar with the podcast SMART EM, but it’s a really fantastic way for non-clinicians to get a look at this kind of debate. It’s a podcast & website created by David Newman & Ashley Shreves, two ER docs at Mt Sinai, where they look at the whole history of the literature on some EM-related issue. I’ve been listening through their archives–great discussions of research on thrombolytics for stroke, ACLS drugs, several other topics. I wouldn’t call it super-accessible, but I have zero clinical or even scientific training past AP chem & I follow without a problem. Both of their sites are worth checking out if you have a chance: and http://www.thennt.com/.
by Joe Colucci (@wonkinakilt) on December 20th, 2012 at 13:15
Also, the papers do appear to be gated–at least, they’re not working for me.
by Austin Frakt on December 20th, 2012 at 13:51
Perhaps you are right. Hard for me to tell at work.
by Austin Frakt on December 20th, 2012 at 13:49
Thank you!
by Austin Frakt on December 20th, 2012 at 13:56
The blog portions of those sites appear inactive. But the existing content looks good.