[HSF] Too scared to touch.....
prasannasimha
prasannasimha at gmail.com
Thu May 3 09:01:55 EDT 2007
Tea - that was what I was saying - the anecdote cannot become the
evidence base (just as much as a badly conducted trial) .
Prasanna
Tea Acuff wrote:
> I would argue that actually, Prasanna, you are mixing and thus confusing descriptions of evidence. Statistics is merely formal (both good and bad) evaluation of populations. An anecdote is a single observation (which actually could included a "single" trial by my logic). What you are calling as "statistics" is, or so it seems to me, reported trials, experiences, etc which usually have some statistical qualifiers. Specifically this represents some selection of (and thus abstraction of) some others experience. What you are implying is that personal observation, one case of which is an anecdote and was used by you as archetypal for personal, is less true than literature. I would argue that the "best evidence" is actually critical (including statistical and experimental and thus more than a merely singular) personal observation.
>
> On the other hand I surmise that you have it right clinically. In this case a life time of contrary evidence of not operating reflexively and emergently on Left Main disease with good results, would trump evidence that left main disease may be more lethal statisically in the literature.
>
> tea
>
>
>
> ----- Original Message ----
> From: prasannasimha <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wednesday, May 2, 2007 7:35:59 PM
> Subject: Re: [HSF] Too scared to touch.....
>
>
> Don, this is how statistics get beat and how anecdotal experience
> becomes the "norm". Incidentally an anecdote is not a virtual national
> practice habit that is being referred to versus a case report.
> The justification is made as if he developed that left main stenosis in
> the zillionth of a second before his angio was done. He has CAD and he
> is at high risk for cardiac death. Why did the "young" man get CAD ?
> obviously because of risk factors. Is he at high risk for sudden death -
> Yes. Is his risk higher than the average population of coronary artery
> disease - that is the question to be asked and there is no literature to
> support that versus those with unstable symptoms.
> Arguing that the young man needed earlier surgery that the older person
> is a different issue of allocation of resources etc.
> Prasanna
> Donald Ross wrote:
>
>> Ani, one good anecdote deserves another.
>> I once sent a young man with stable LM home ( completely asymptomatic
>> and found on speculative stress test) because we had a hospital full
>> of elderly unstable patients who seemed to deserve more urgent
>> attention.
>> The man died in front of his young children a week later!
>> Don
>> On 03/05/2007, at 2:18 AM, Ani Anyanwu wrote:
>>
>>
>>> What is the evidence base for emergent revasularization of Left Main?
>>> When I worked in England few years back we had patients with Left
>>> Main on the waiting list for surgery for as long as a year.
>>>
>>> ANi
>>> ----- Original Message -----
>>> From: prasannasimha<mailto:prasannasimha at gmail.com>
>>> To:
>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>> Sent: Wednesday, May 02, 2007 6:43 AM
>>> Subject: Re: [HSF] Too scared to touch.....
>>>
>>>
>>> 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<mailto: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<http://www.aol.com/>.
>>>>>>> _______________________________________________
>>>>>>> OpenHeart-L mailing list
>>>>>>>
>>>>>>> Send postings to:
>>>>>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>>>>>>
>>>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>
>>>>>>>
>>>>>>>
>>>>>>> All messages transmitted by the OpenHeart-L are subject to the
>>>>>>> policies and
>>>>>>> disclaimers posted at:
>>>>>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
>>>>>>>
>>>>>>> -----------------------------------------
>>>>>>>
>>>>>> _______________________________________________
>>>>>> OpenHeart-L mailing list
>>>>>>
>>>>>> Send postings to:
>>>>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>>>>>
>>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>
>>>>>>
>>>>>>
>>>>>> All messages transmitted by the OpenHeart-L are subject to the
>>>>>> policies anddisclaimers posted at:
>>>>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
>>>>>>
>>>>>> -----------------------------------------
>>>>>>
>>>>>>
>>>>> _______________________________________________
>>>>> OpenHeart-L mailing list
>>>>>
>>>>> Send postings to:
>>>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>>>>
>>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>
>>>>>
>>>>>
>>>>> All messages transmitted by the OpenHeart-L are subject to the
>>>>> policies and disclaimers posted at:
>>>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
>>>>>
>>>>> -----------------------------------------
>>>>>
>>>> _______________________________________________
>>>> OpenHeart-L mailing list
>>>>
>>>> Send postings to:
>>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>>>
>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>
>>>>
>>>>
>>>> All messages transmitted by the OpenHeart-L are subject to the
>>>> policies anddisclaimers posted at:
>>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
>>>>
>>>> -----------------------------------------
>>>>
>>>>
>>>>
>>> _______________________________________________
>>> OpenHeart-L mailing list
>>>
>>> Send postings to:
>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>>
>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>
>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>
>>>
>>>
>>> All messages transmitted by the OpenHeart-L are subject to the
>>> policies and
>>> disclaimers posted at:
>>>
>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
>>> -----------------------------------------
>>> _______________________________________________
>>> OpenHeart-L mailing list
>>>
>>> Send postings to:
>>> OpenHeart-L at lists.hsforum.com
>>>
>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>> http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>
>>> All messages transmitted by the OpenHeart-L are subject to the
>>> policies and
>>> disclaimers posted at:
>>> http://www.hsforum.com/listdisclaim
>>> -----------------------------------------
>>>
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>> OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>> http://mmp.cjp.com/mailman/listinfo/openheart-l
>>
>> All messages transmitted by the OpenHeart-L are subject to the
>> policies anddisclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>>
>>
>>
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
>
More information about the OpenHeart-L
mailing list