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

[Ani Anyanwu]

Don
 
I really dont know much about the insurance system and who has or hasnt got insurance. Being in an acadamic practice we would just treat whoever was in hospital. If the patient came in via the emergency room with chest pain then - insurance wouldn't have a bearing on what treatment they got (actually it would be better for hospital to stent uninsured patients as it is cheaper than doing a CABG). For an elective patient you would not get either PCI or CABG in my hospital if you did not have insurance. This particular patient must have insurance though because she had staged PCI (went home and came back for second procedure) and we are evaluating her for destination LVAD or transplant (absolutely impossible without insurance). 
 
BTW thanks for the article - i thought it was good actually and wish you had it in a more international forum. One problem you had though is that your results were very good in the conventional group that there was a limit in how much improvement one could get with anaortic.
 
Ani
 
 
 



> From: donross at bigpond.com> Subject: Re: [HSF] Another Victory for the LAD Stent.....> Date: Sat, 9 Feb 2008 12:02:01 +1100> To: OpenHeart-L at lists.hsforum.com> CC: > > 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> > >> _______________________________________________> 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> > >> -----------------------------------------> > _________________________________________________________________> > Share what Santa brought you> > https:// > > www.mycooluncool.com_______________________________________________> > 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> -----------------------------------------
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