Friday, November 26, 2010

Did you say revascularization is no better than medical therapy for stable CAD? Not so fast!

In an era when it's fashionable to point the finger of shame at cardiologists for being greedy and doing too many procedures this new study is of interest. It seems that the intuitive idea that some patients will do better with their plumbing fixed is correct after all.

MASS II is one of many examples of comparative effectiveness research conceived years before policy wonks coined the term. In this study of patients with stable multivessel disease and preserved ventricular function CABG won hands down. There was a strong signal that PCI was better than medical therapy for multiple outcomes but the differences were not quite statistically significant. The patient numbers were somewhat small and the study may not have been adequately powered. Also, it must be kept in mind that the PCI methods were not optimal by today's standards:

 Devices used for catheter-based therapeutic strategies included stents, lasers, directional atherectomy, and balloon angioplasty. Angioplasty was performed according to a standard protocol.7 Glycoprotein IIb/IIIa agents were not used. 

The study differed from COURAGE and BARI 2D in that the patients probably represented more severe disease and the follow up was longer.

Related editorial here.

Via Medicine for Residents.

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