Jupiter Trial

What a joke. Roughly 100 people need to treat at 2 years to prevent 1 MI. So they extrapolate the data to 5 years and state the NNT is 25?

The cost at 2 years to prevent 1 MI. Let's see, 4 dollars a day, 100 people, 400 dollars a day for 2 years is a grand total of 285000 dollars!!

Not to mention the increase in DM.
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Interventional and EP - when to apply??

EP: you can apply at the end of your second/beginning of your third year.

Interventional: is a pain. Some programs go through ERAS and most do not, so you will have 2 waves of applications. The first will be in the middle of your second year through ERAS (I still have nightmares from my residency and fellowship applications), then rest will be paper applications at the end of your second year. So be prepared for 2 waves of letters or recommendation requests to your attendings. There is not a great place for information on all these programs, I will try to put something on this blog soon.

Right Sided EKG for Inferior MI?

How many times have you been asked to get right sided EKG for an inferior MI? I am sure many, but I think it is complete waste of time and at best, a mental exercise. It makes does not make any difference in management or treatment modalities. More than likely, you will manage based on symptoms and not what the EKG shows, so why waste time? If the patient is hypotensive, then you will give fluids, if not, you won't and you are off to the cath lab. So next time you get asked about the right sided leads, stand up for yourself and ask why?

CABG vs. PCI? Yet another study that supports the idea surgery is not better!

Don’t be fooled by the recent study published in Circulation: The end point of CV death in the PCI arm had more deaths due to non-cardiac causes. The numbers need to be looked at a bit more closely to see if indeed that one would still find a difference if you look at only CV causes of death. As these results are very different from previous studies which have looked at CABG vs. PCI.

Randomized, Controlled Trial of Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease
Six-Year Follow-Up From the Stent or Surgery Trial (SoS)

Background— The Stent or Surgery Trial is a randomized, controlled trial comparing percutaneous coronary intervention with coronary artery bypass grafting (CABG) for patients with multivessel disease. Initial results at a median follow-up of 2 years showed a survival advantage for patients randomized to CABG. This article reports survival outcome at a median follow-up of 6 years.

Methods and Results— A total of 988 (n=488 percutaneous coronary intervention, n=500 CABG) patients were randomized at 53 centers during the period from 1996 to 1999. Investigators established survival status from hospital or community medical records or national databases or by direct contact with patients and their relatives. All-cause mortality was compared with hazard ratios and confidence intervals calculated from Cox proportional hazards models. Prespecified subgroup analyses for diabetes mellitus, angina grade, and angiographic severity of coronary disease at baseline were performed with tests for interaction. At a median follow-up of 6 years, 53 patients (10.9%) died in the percutaneous coronary intervention group compared with 34 (6.8%) in the CABG group (hazard ratio 1.66, 95% confidence interval 1.08 to 2.55, P=0.022). Little evidence was found that the treatment effect on mortality differed between subgroups according to baseline angina grade (interaction test P=0.52), the severity of coronary disease (P=0.92), or diabetic status (P=0.15).

Conclusions— At a median follow-up of 6 years, a continuing survival advantage was observed for patients managed with CABG, which is not consistent with results from other stent-versus-CABG studies.

Fellowships

When to apply for fellowship is the next question in your training? For those who want EP and Interventional fellowships, you will apply at the start of your third year in fellowship. This process should be a bit easier than you might think as there are not that many fellows applying for another fwllowhip at the end of training. As always, research helps, but I think your letters and your program director's phone call will make all the difference in the world. Will have a post later on ERAS spots, NRMP programs, etc.

I am Back

I am back...a little time off, now back to blogging!