Final results of the five-year SYNTAX trial find CABG surgery delivers better outcomes than PCI for intermediate-high risk patients.
This trend was surprisingly apparent for patients with three-vessel disease and at high risk for surgical complication. However, patients who underwent CABG or PCI that had left main disease with fewer than three vessels affected had equivalent rates of major adverse cardiac and cerebrovascular events (MACCE).
Nevertheless, researchers note that nearly 80% of patients with three-vessel disease have a 79% improved survival rate with surgery over PCI. These results suggest that for high-risk patients, surgery may be the best treatment pathway, demonstrating fewer downstream complications.
SYNTAX trial confirms surgery best for most patients
Eric Bushlow, Cardiovascular Roundtable
A new study finds patients with implanted left ventricular assist devices (LVADs) may not require high-priority status for organ donation given the relatively low risk of complications or adverse events with these devices. Currently, patients with LVADs who are eligible for heart transplant are given 30 days of elective 1A status (the highest-priority category) from the Organ Procurement and Transplantation Network classification system, along with other patients who are potentially less stable.
Study authors argue that improvements in LVAD technology over the past decade have reduced complication rates for these patients to the extent that the need for a high-priority organ status is diminished.
Should LVAD patients be high-priority heart transplant recipients?
After a New York suburban hospital was audited for inappropriate implantable cardioverter-defibrillator (ICD) procedures based on Medicare national coverage determination (NCD) requirements, a subsequent review found only 15% of procedures deemed questionable lacked a reasonable explanation. Researchers performing the review argue that updates in clinical literature do not match NCD regulations, indicating some of these inappropriate exams have clinically justifiable reasons.
Within their review, Steinberg and Mittal highlight the inherent disconnect in practicing evidence-based medicine within the context of significant regulatory oversight. As the evidence base evolves and influences the way physicians practice medicine, regulators can be slow in integrating this new information when evaluating appropriateness. To combat this, the study’s authors suggest more detailed documentation may provide some safeguard against future scrutiny of this kind.
Expert review questions CMS ICD appropriateness scrutiny