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

[Donald Ross]

Michael,
My inference was that the patient would have been sent to surgery  
rather than having a stent because of her pecuniary situation which  
is often the case here.
Don
On 09/02/2008, at 12:11 PM, Michael Firstenberg wrote:

> 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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