[HSF] Another Victory for the LAD Stent.....

[Michael Firstenberg]

Don,
While I can not answer for Ani (although I am sure his situation is  
similar to mine) - the answer is yes.  If I, or any of my partners,   
was consulted on this patient - she would have gotten a CABG in our  
hospital.  20% of our operative cases have no insurance.

-michael


On Feb 8, 2008, at 8:02 PM, Donald Ross wrote:

> Ani,
> Would she have had cabg rather than a stent if she hadn't had any  
> insurance?
> This is sometimes the case in Australia where we have universal  
> compulsory insurance for poorly funded pubic hospitals and private  
> insurance for first rate private hospitals where cardiology  
> practice is somewhat different.
> Don
> On 09/02/2008, at 9:01 AM, Ani Anyanwu wrote:
>
>> Michael
>>
>> What did you do with the patient?
>>
>> Today saw a lady to evaluate for LVAD - she had bare metal stents  
>> to RCA and LAD staged over two weeks in october 2007 (She did not  
>> have drug eluting stents because her insurance company wont pay  
>> for Plavix). At time of her angioplasty, her EF was 60%. She had  
>> an acute MI in December due to occlusion of her LAD stent and now  
>> is inotrope dependent with an EF of 15%. Cant have transplant  
>> because of severe peripheral vascular disease, carotid disease, age.
>>
>> I suppose a two vessel CABG could have prevented this state of  
>> affairs - who knows. How could we scientifically make this  
>> determination?
>>
>> Ani
>>
>>
>>
>>
>>> Date: Fri, 8 Feb 2008 10:51:26 -0500> From: msfirst at gmail.com>  
>>> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] Another  
>>> Victory for the LAD Stent.....> > All we know about this guy, we  
>>> got from his driver's license.> > 59 year/old - called EMS from a  
>>> local hotel with chest pain.> > Found in obvious respiratory  
>>> distress with severe C.P.> Scooped and run to our ED - intubated  
>>> in ED instantly, then taken to cath> lab...... very quick door to  
>>> needle time.> > Cath - multiple LAD stents - occluded prox.  
>>> unable to pass a wire> Circ - occluded, severe RCA disease> Has  
>>> ICD> > tachycardic to 120-150's> mild hypotension> > echo in cath  
>>> lab ----> almost dead heart.> > severe pulm edema, severe  
>>> respiratory acidosis (ph: 6.9 pCO2=90 sats in> 70's)> given  
>>> lasix, heparin, reopro> > we are called........> > > > I guess he  
>>> has not read the recent studies..............> > > > -michael>  
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