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.
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.
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.
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.
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.
"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."
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.
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
When depression co-occurs with substance dependence, antidepressant
medications can be beneficial, but specific treatment for the addiction is
For your patients: Information about coronary artery bypass graft surgery.
This Week in JAMA. JAMA. 2004;291(15):1803. doi:10.1001/jama.291.15.1803