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Beta-blockers lower mortality after non-cardiac surgery

22 May, 13 | by Alistair Lindsay

The use of preoperative beta-blockade to minimise the cardiovascular risks of noncardiac surgery has remained controversial for some time, and recent studies have suggested that preoperative beta-blockade may be now decreasing as a result. The purpose of this study was to determine whether early preoperative exposure to beta-blockers could influence 30-day postoperative outcomes in patients undergoing noncardiac surgery. more…

Timing of surgery for endocarditis

27 Jul, 12 | by Alistair Lindsay

Bacterial endocarditis continues to carry a substantial risk of death.  Whilst surgical intervention in patients with incipient heart failure is recognised as efficacious, the timing and indications for surgical intervention to prevent systemic embolism remain controversial.  In this small, single centre study Kang et al compared the clinical outcome of early surgery versus conventional treatment with antibiotics and prospective future intervention.  Recruiting a total of 76 patients with left-sided infective endocarditis, severe valve disease, and large vegetations (>10mm), patients were randomised in a 1:1 fashion either to early surgery (37) or conventional treatment (39) with the primary end point being  a composite of in-hospital death and embolic events occurring within 6 weeks of randomization.  more…

PCI in centres without surgical backup

4 Jun, 12 | by Alistair Lindsay

As percutaneous coronary intervention (PCI) has advanced, improved technology and increased collective experience have led to a marked reduction in the need for emergency coronary artery bypass surgery (CABG), with only 0.15% of patients requiring emergency surgical intervention in 2002.  In fact, PCI is now commonly practiced in hospitals without on-site cardiothoracic back-up, something that was almost unheard of even a decade ago.  Despite this expansion, the evidence for this approach – patient outcomes in the absence of immediate surgical intervention – remains undefined. more…

Stent vs Surgery – a subgroup meta-analysis

14 Apr, 09 | by Alistair Lindsay

The outcomes of coronary artery bypass grafting (CABG), when compared with percutaneous coronary intervention (PCI) might vary according to the patient characteristics, such as the presence of diabetes or the number of diseased vessels. However, no randomized trial to date has been large enough to provide adequate statistical power for sub-group analysis, and meta-analyses have been hampered by inconsistent reporting in published trials. more…

Stent or Surgery? It depends on the SYNTAX

15 Mar, 09 | by Alistair Lindsay

As percutaneous coronary intervention (PCI) continues to evolve, its ability to treat complex coronary artery disease (CAD) continues to improve.The SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) trial was designed to assess whether modern percutaneous techniques have assumed parity with coronary artery bypass surgery (CABG) for the treatment of complex (3 vessel or left main coronary disease) CAD. more…

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