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This Week in JAMA
April 21, 2004

This Week in JAMA

JAMA. 2004;291(15):1803. doi:10.1001/jama.291.15.1803
Off-Pump Coronary Artery Bypass Outcomes

Prior studies suggest favorable in-hospital outcomes for patients having off-pump coronary artery bypass (OPCAB), but longer-term clinical outcomes have not been evaluated. Puskas and colleaguesArticlereport early and 1-year results of a single-surgeon, randomized trial of patients assigned to OPCAB or conventional coronary artery bypass graft (CABG) surgery. There were no differences in graft patency or rates of stroke, death, myocardial infarction, angina, or reintervention in either group at 30 days or 1 year. Health-related quality of life was similar in both groups and only hospital costs differed, being significantly lower for patients having OPCAB. In an editorial,ArticlePeterson and Mark discuss discrepant results from prior studies of OPCAB and raise questions that need resolution before OPCAB can be considered the new standard for bypass graft surgery.

Economics of Evidence-Based Hypertension Treatment

Evidence-based hypertension treatment improves clinical outcomes, but its economic effects have not been assessed. Fischer and Avorn analyzed prescription and clinical data from elderly patients with hypertension to compare their prescribed medications with those suggested by evidence-based guidelines, and they calculated the costs of the prescribed vs the recommended regimens. Their analyses suggest that adherence to the evidence-based guidelines would result in an estimated annual US savings of $1.2 billion.

Article
Glucose Metabolism and Coronary Heart Disease

Patients with derangements in glucose metabolism are at higher risk of coronary heart disease morbidity and mortality, but the relationship of these abnormalities to severity of atherosclerosis has not been clearly defined. Sasso and colleagues reviewed coronary angiograms from men with normal glucose tolerance and correlated the degree of vessel narrowing with measures of glucose metabolism. Although levels of fasting plasma glucose were similar in all patients, they found that abnormalities in postload glycemia, fasting and postload insulinemia, glycosylated hemoglobin levels, and insulin resistance were independently correlated with the number of involved vessels and found that postload glycemia and glycosylated hemoglogin levels were significantly higher in men with more severe atherosclerosis.

Article
Statin Use and Cardiovascular Risk in the Elderly

Optimal preventive pharmacotherapy requires a matching of medication to a patient's risk profile, with patients at highest risk receiving the most aggressive therapy, but whether physicians routinely take risk criteria into consideration is unclear. Ko and colleagues sought to examine the association of statin therapy (as a measure of treatment aggressiveness) with baseline cardiovascular risk in a cohort of elderly patients with a history of cardiovascular disease or diabetes. They found a paradoxical, inverse relationship between baseline cardiovascular disease risk and the prescription of statins.

Article
Allocation of Donor Livers

Discrepancies between the supply and demand for deceased-donor organs and the clinical exigencies of optimizing graft and patient survival complicate the distribution of organs. After Trotter and Osgood reviewed data from liver transplant recipients including patient characteristics reflected by their Model for Endstage Liver Disease (MELD) score and graft and patient survival, they compared the data from large and small organ procurement organizations (OPOs). They found that graft and patient survival were similar across OPOs. However, patients in small OPOs had lower MELD scores when they underwent transplant surgery, reflecting a less severe clinical status and suggesting that organs are not consistently allocated according to medical need, contradicting current allocation policy.

Article
A Piece of My Mind

"I believe in working toward solutions but I do not yet see the path that leads us to a kinder, gentler, more effective health care system." From "Keeping the Fire Alive."

Article
Medical News & Perspectives

Researchers are evaluating how "off-pump" coronary artery bypass graft surgery, which is performed on a beating heart without the aid of a heart-lung machine, stacks up against the conventional procedure.

(Photo Credit: John D. Puskas, MD)
Article
EBV in Pediatric Multiple Sclerosis

Children with pediatric multiple sclerosis had a greater likelihood of prior Epstein-Barr virus (EBV) infection than age-matched healthy controls, suggesting a possible association between EBV infection and pediatric multiple sclerosis.

Article
CLINICIAN'S CORNER

When depression co-occurs with substance dependence, antidepressant medications can be beneficial, but specific treatment for the addiction is also needed.

Article
JAMA Patient Page

For your patients: Information about coronary artery bypass graft surgery.

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