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FUTURE of Angioplasties( Interventional Cardiology) Looking Grim????

Discussion in 'Cardiology' started by Teejay, Mar 26, 2007.

  1. Teejay

    Teejay Team Player

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    The new report that just came out says that most angioplasties done by IC's on patients with stable angina do not improve outcome. The report casts doubt on the effectiveness and succcess of the widely used procedure compared to normal cardiac medications. However, the report could still be flawed in so many ways since it was primarily sponsored by drug companies who are running out of options. Yet, its consequence is that interventional cardiology and their angioplasty dominated profession and procedure maybe looking grim. I don't know any better because i am not a Dr yet but for interventional cardiologist and fellows, what do you think of this development?
     
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  3. hans19

    hans19 I'm back...
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    Thank you for predicting the future of my profession. Do you have any stock tips?
    :rolleyes:

    There will still be a role for revascularization in acute MI for the forseeable future.

    On another note, this study helps highlight a criticism of interventional cardiology in that when all you have is a hammer (angioplasty/stenting) everything looks like a nail (coronaries, peripheral vessels, carotids, renals). However, studies have shown that carotid stenting has no benefit in asymptomatic patients. In the majority of those with high blood pressure, even when there is slight narrowing of the renal arteries, the cause is still essential hypertension. Stents stenose. Drug eluting stents aren't all they are cracked up to be. Can someone help me understand the rational of 'drive by' renal artery stenting? Below the SFA especially below the popliteal, our experience is that the long term patency of stents is pi$$ poor. Can some cardiologists enlighten us? I think kind of behavior has given some radiologists the impression, perhaps unfairly, that cardiologists motivations have more to do with greed than actually benefitting patients.
     
  4. nutcancer

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  5. hans19

    hans19 I'm back...
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    It sure got quiet all of a sudden. Just trying to have a discussion. Any one care to respond or at least defend your profession?
     
  6. It's not just cardiologists. I know vascular surgeons that are stenting like crazy, including tibials, renals, carotids, etc. It's funny, because there is this surgeon that everyone thinks "isn't as good" because he doesn't do the endovascular stuff. He's been saying for years that the stents are overrated and unnecessary in most cases. This report comes out, and suddenly he knows what he's doing. :rolleyes:
     
  7. cowbell

    cowbell need more cowbell!

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    hans19,

    I understand that some participants on this thread raised the ire of radiologists with asinine threads such as "radiology-hyped specialty" and others like it. Most sensible people who read these threads would agree that the whole topic of Cards vs. Rads is utterly unprofessional and nonproductive. I think we would agree that radiology is an essential diagnostic and therapeutic specialty with an ever-growing technology base. We would also agree that the practice of cardiology includes more than just stenting (arrythmia, heart failure, congenital disease, transplant, pulmonary hypertension, noninvasive imaging, ischemia, etc.).

    First, don't you realize that you are arguing with primarily medical students? These participants in the afrementioned errant threads do not include a single cardiologist. You are arguing with people who have NO CLINICAL EXPERIENCE!

    Second, there is a wealth of data regarding very late stent thrombosis (VLST) with drug-eluting stents (DES), and the general cumulative incidence of VLST for on-label use is 0.4% compared with 60-70% reductions in clinical restenosis. The use of DES will continue, with more careful screening of patients for those who can tolerate long term ASA and Plavix therapy. There will be more conservative use of DES for off-label uses until more long-term data is collected.

    Third, very few cardiologists approve of drive-by renal angiograms for many reasons.

    Fourth, it is no surprise to most of us that PCI or CABG does not result in mortality benefit for STABLE CAD (except multivessel disease with decreased LVSF or left main disease). This has been well documented far before COURAGE. I think the big surprise with COURAGE is how effective aggressive medical therapy and risk reduction is, but MOST practicing clinicians already suspected this. The majority of interventions will still be for acute coronary syndromes for which mortality benefit has been well documented.

    hans19, I'm sure you're a fine radiologist, but don't go trashing cardiology as a reaction to a bunch of people with absolutely no clinical experience.
     
  8. lisichka

    lisichka certified demonologist

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  9. hans19

    hans19 I'm back...
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    I rest my case.
     
  10. Adcadet

    Adcadet Long way from Gate 27

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    I actually didn't think COURAGE told us anything we didn't know. I had a number of chronic stable angina patients in early 2006 and my take on the literature then was that PCI wouldn't offer them anything.


    Speaking of ACC'07, I'm also disappointed by Nissen's Torcetrapib. But I didn't believe the Apolipoprotein A1 Milano story either. Regression to the mean, man, regression to the mean. But boy did that article have a great beginning:
    In a small village in Northern Italy called Limone sul Garda . . . ​
     
  11. cowbell

    cowbell need more cowbell!

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    Although we are always mindful of interventions that lead to mortality benefit, much of what we do for patients involve SYMPTOM RELIEF, which in itself is a noble goal. Revascularization is still the standard of care for angina that is refractory to medical management.

    Not nearly as disappointed as Pfizer...
     
  12. spyyder

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    Grow up.

    [​IMG]
     
  13. hans19

    hans19 I'm back...
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    Cardiologists have a vital role in healthcare, that I do not doubt. Radiology also plays a vital role in modern healthcare, whether you wish to acknowledge this or not. If you want to make wholesale disparaging remarks about radiology, I will at engage you with criticisms of cardiology, based on real-world experiences.

    If you do not wish to engage in a dialog or you are incapable of doing so, thats one thing. But trying to ice the debate by throwing up a '******ed' graphic because you can't come up with any compelling arguments of your own... thats weak. Lets keep it professional.

    Maybe you should grow up, Mr. "l33t haXor"?
     
  14. Teejay

    Teejay Team Player

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    From your posts, you must really hate cardiologists' with passion:confused:. What have they done to you?
     

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