Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Surgery

A number of techniques are used to mechanically reduce or bypass atherosclerotic plaque. The definitive study of these techniques is the MASS-II trial. Even three-vessel coronary artery disease, as long as it is stable (no rest pain with ECG changes) has a low mortality and lives are not saved by bypass surgery, in spite of what Bill Clinton’s surgeon claimed. Unstable angina or acute myocardial infarction (due to acute partial or complete blockage of a coronary artery with clot) are indications for thrombolysis (clot busters) or angioplasty. But these situations account for a small fraction of the total number of procedures performed.

These procedures only treat the angiogram and not the vast majority of plaque which is buried in the wall but which can rupture and cause heart attacks.

The MASS-II trial, the best randomized controlled trial to date, showed that angioplasty (PCI) is actually worse than medical therapy (drugs) and is contraindicated in stable coronary atherosclerosis. Disruption of plaque by the balloon inflation causes an immune response to the plaque contents, in particular modified LDL, also called oxidized LDL. Theoretically antibodies to the plaque contents could stimuate an inflammation in the other plaques and increase the chance of rupture of any plaque in the the coronary arteries. Bypass surgery helped anginal symptoms but did not prolong life or prevent heart attacks, as claimed by Bill Clinton’s surgeon, another example of medical terrorism. Bill Clinton is a Rhodes Scholar and did not think to ask the surgeons for the evidence.

Likewise, the judges of the Supreme Court of Canada in the Chaoulli decision made a fundamental alteration in Canadian medical law after listening to a surgeon and said that “patients die as a result of waiting lists for public heath care”. Why do surgeons have such an effect on otherwise intelligent people? Even intelligent people can be terrorized by the big lie.

2 Responses to “Surgery”

  1. […] Surgery […]

  2. fitzie said

    Your disdain for your surgical, and in particular cardiac surgical, colleagues is laughable. You post a study showing a one-year follow up claiming the study to be the definitive MT/PCI/CABG trial when there are several with much longer follow up. You don’t manage CAD in patients in their 50s, 60s and 70s for results at one-year, you do it thinking a bit more long term, at least I would hope that you do.

    Moreover, you totally ignored the 5 year follow-up which showed this:

    At the 5-year follow-up, the primary end points occurred in 21.2% of patients who underwent CABG compared with 32.7% treated with PCI and 36% receiving MT alone (P=0.0026). No statistical differences were observed in overall mortality among the 3 groups. In addition, 9.4% of MT and 11.2% of PCI patients underwent repeat revascularization procedures compared with 3.9% of CABG patients (P=0.021). Moreover, 15.3%, 11.2%, and 8.3% of patients experienced nonfatal myocardial infarction in the MT, PCI, and CABG groups, respectively (P<0.001). The pairwise treatment comparisons of the primary end points showed no difference between PCI and MT (relative risk, 0.93; 95% confidence interval, 0.67 to 1.30) and a significant protective effect of CABG compared with MT (relative risk, 0.53; 95% confidence interval, 0.36 to 0.77).

    We won't even get into the issue of non-stentable lesions or patients with diabetes. Or the fact that the studies which show much higher event rates, including MI, in stented/MT-managed patients rarely if ever deal with the functional ramifications of those MIs e.g. worsening NYHA class, LVEF, or new WMAs on echo. The lack of mortality benefit in CABG at 5 years vs PCI despite a higher STEMI rate in the latter is more a reflection of the management of acute MI than it is a reflection on non-superiority of CABG.

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