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

[prasannasimha]

Even TVD doesn't have evidence base for emergent inhouse 
revascularization. Only Left main.
Prasanna
Donald Ross wrote:
> When they have LM or TVD + poor LV....... most of my patients.
> I hope, therefore, you are not trying to put me out of a job?
> Don
> On 02/05/2007, at 10:53 AM, prasannasimha wrote:
>
>> 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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