Journal of the American College of Cardiology
-
Few issues elicit more emotion from physicians than medical malpractice. The very word "malpractice" implies guilt and immediately places the involved physician on the defensive. ⋯ Numerous solutions have been proposed, but special interests have blocked the implementation of these solutions in most states. Tort reform is necessary to control the escalation of medical costs.
-
J. Am. Coll. Cardiol. · Jun 2010
Randomized Controlled Trial Multicenter Study Comparative StudyRandomized trial of paclitaxel- versus sirolimus-eluting stents for treatment of coronary restenosis in sirolimus-eluting stents: the ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis 2) study.
For patients with sirolimus-eluting stent (SES) restenosis requiring reintervention, we compared a strategy of repeat SES (Cypher, Cordis, Miami Lakes, Florida) implantation with paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts) implantation. ⋯ In cases of SES restenosis, treatment with either repeat SES or switch to PES was associated with a comparable degree of efficacy and safety. Drug resistance at an individual patient level may play a contributory role to the somewhat higher than expected late loss observed with the SES in the current study. (Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for In-Stent Restenosis 2 [ISAR-DESIRE 2]; NCT00598715).
-
J. Am. Coll. Cardiol. · Jun 2010
Multicenter Study Comparative StudyImpact of the extent of coronary artery disease on outcomes after revascularization for unprotected left main coronary artery stenosis.
This study was designed to examine the impact of the extent of coronary disease on long-term outcomes after coronary stenting or coronary artery bypass graft (CABG) surgery for unprotected left main coronary artery (ULMCA) stenosis. ⋯ Stenting appears to be a safe alternative to CABG in patients having ULMCA stenosis combined with additional vascular disease. The advantage of CABG over stenting lies principally in the reduction of repeat revascularization across subgroups stratified by the number of diseased vessels.
-
J. Am. Coll. Cardiol. · Jun 2010
Randomized Controlled Trial Comparative StudyA risk score to predict bleeding in patients with acute coronary syndromes.
The aim of this study was to develop a practical risk score to predict the risk and implications of major bleeding in acute coronary syndromes (ACS). ⋯ Patients with ACS have marked variation in their risk of major bleeding. A simple risk score based on 6 baseline measures plus anticoagulation regimen identifies patients at increased risk for non-CABG-related bleeding and subsequent 1-year mortality, for whom appropriate treatment strategies can be implemented.