[HSF] Too scared to touch.....

[prasannasimha]

Where in literature has it been shown that a patient who is stable after 
an MI benefits from urgent in house revascularization ?
Prasanna

Donald Ross wrote:
> Also, one wonders about the not infrequent peri-op AMIs during 
> non-cardiac surgery that come our way for revascularisation prior to 
> discharge.
> Is this unnecessary surgery as well, given it carries the same 
> indications as regular coronary surgery?
> Don
> On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote:
>
>> Ajit,
>>   I invested the time it took to read all of Prasanna's  abstracts.  I'm
>> still not convinced that medical therapy with beta-blockers  is the 
>> way to go for
>> nearly every case.  Again, if a stress test in an  asymptomatic 
>> patient shows
>> a lot of myocardium with reversible ischemia, it  would be potentially
>> foolhardy not to cath that patient.  Over the years,  we've been 
>> referred lots of
>> patients with left mains or critical 3vd that were  cathed prior to 
>> an elective
>> noncardiac procedure (usually carotid, ischemic leg,  or AAA).  We 
>> did the
>> CABG, they eventually got the vascular procedure, and  they did 
>> fine.  I've yet to
>> recall "graft closure" while the subsequent  case was done.  In light 
>> of the
>> problems with DES, the cardiologists are  much more likely to use 
>> bare metal
>> stents in such scenarios.
>>   I do agree that beta blockade, possible Swan, and a competent  cardiac
>> anesthesiologist suffice for the vast majority of cardiac patients  
>> getting
>> noncardiac surgery.  However, there are plenty of asymptomatic  
>> cardiac time bombs
>> waiting to explode for those that never cath and treat  preemptively.
>> Hal
>>
>>
>>
>> ************************************** See what's free at 
>> http://www.aol.com.
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