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?
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.