Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease

Stergiopoulos, Kathleen; Brown, David L.

doi:10.1001/archinternmed.2011.1484

Cited by 186 publications

(101 citation statements)

References 43 publications

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“…However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months (2,3). A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%) (4). Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses.…”

Section: Percutaneous Coronary Intervention Versus Medical Treatmentmentioning

confidence: 96%

Almanac 2012: interventional cardiology

Meier¹

2012

Anadolu Kardiyol Derg

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Section: Percutaneous Coronary Intervention Versus Medical Treatmentmentioning

confidence: 96%

Almanac 2012: interventional cardiology

Meier¹

2012

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

“…18 On the other hand, two additional meta-analyses comprising 7,200 and 8,000 patients found no difference in mortality in patients treated with PCI compared to optimal medical therapy. 19,20 The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME 2) trial examined patients with stable CAD for whom PCI was being considered. Approximately 1,200 patients underwent invasive coronary angiography with measurement of fractional flow reserve (FFR) in all coronary stenosis.…”

Section: Evaluation Of Patients With Stable Cadmentioning

confidence: 99%

Diagnostic usefulness of myocardial perfusion imaging in patients reluctant to undergo angiography

Narang¹,

Singh²,

Patel³

2016

RRCC

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Abstract:Patients with known or suspected coronary artery disease are often referred for ischemic testing to aid in risk assessment and guide management when symptoms develop. Invasive coronary angiography and percutaneous intervention are typically reserved for patients with symptoms refractory to medical management. The use of noninvasive modalities with myocardial perfusion imaging is a powerful diagnostic and prognostic tool for patients reluctant to undergo angiography. This review focuses on evaluation of coronary artery disease with myocardial perfusion imaging using single-photon emission computerized tomography, positron emission tomography, myocardial contrast echocardiography, cardiovascular magnetic resonance, and cardiovascular computerized tomography.

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“…Between 30% and 50% of contemporary trials that test established practices show that the practices confer little or no benefit, in contradiction to prevailing assumptions. 22 Examples include percutaneous coronary artery intervention in stable, non-critical coronary artery disease, 23 facility-based cardiac rehabilitation programs following myocardial infarction, 24 vertebroplasty for acute osteoporotic fracture 25 and blood glucose self-monitoring in stable type 2 diabetes. 26 Such discredited practices tend to persist, often for years, 27 sustained sometimes by vested commercial interests, but more often by strongly held professional beliefs.…”

Section: Minimise Errors In Diagnosismentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease

Abstract: Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.

Cited by 186 publications

References 43 publications

Almanac 2012: interventional cardiology

Almanac 2012: interventional cardiology

Diagnostic usefulness of myocardial perfusion imaging in patients reluctant to undergo angiography

Ten clinician-driven strategies for maximising value of Australian health care

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