Document Detail


Randomized trials of coronary artery bypass surgery: impact on clinical practice at Duke University Medical Center.
MedLine Citation:
PMID:  2933183     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Trends in practice patterns at Duke University Medical Center were assessed in patient groups comparable to those enrolled in the three major randomized trials of coronary artery bypass grafting (CABG). In addition, changes in practice patterns that appeared unrelated to the randomized trials were examined. Most patients with 75% or greater left main stenosis have been treated surgically after publication of the Veterans Administration Cooperative Study, but little change was noted in the proportion of patients with 50% left main stenosis who have been treated surgically. A trend towards selection of surgical therapy for patients with three-vessel disease and normal left ventricular function was evident before the publication of the European Coronary Surgery Study, although one-third of patients in this category continue to be treated nonsurgically after publication of the results of the trial. For the past decade, most patients who would have been eligible for the Coronary Artery Surgery Study have been treated nonsurgically. We have also documented trends in practice patterns that are independent of the results of randomized trials. The advent of percutaneous transluminal angioplasty has provided another therapeutic alternative that has been used increasingly. In addition, growing numbers of patients with advanced age, unstable angina, or markedly depressed left ventricular ejection fraction are being evaluated with cardiac catheterization despite the lack of supporting randomized trials. Randomized trials have placed our understanding of the effects of CABG on a sound foundation, but it is evident that clinicians continue to consider many other factors when therapeutic decisions are made.
Authors:
R M Califf; M A Hlatky; D B Mark; K L Lee; F E Harrell; R A Rosati; D B Pryor
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  72     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1985 Dec 
Date Detail:
Created Date:  1986-01-15     Completed Date:  1986-01-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  V136-44     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Angioplasty, Balloon
Clinical Trials as Topic
Coronary Artery Bypass* / mortality
Coronary Disease / mortality,  surgery*,  therapy
Female
Heart Catheterization
Humans
Male
Middle Aged
North Carolina
Random Allocation
Grant Support
ID/Acronym/Agency:
HL-17670/HL/NHLBI NIH HHS; HS-04873/HS/AHRQ HHS; LM-07003/LM/NLM NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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