10-24-2008, 10:40 PM | #21 | |
Senior Member
Join Date: Aug 2005
Posts: 4,016
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Quote:
As I have stated many times the Canadian system is not perfect but it is very good and no, it will not work in the US. |
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10-25-2008, 02:02 PM | #22 | |
Member
Join Date: Sep 2007
Location: Houston, TX
Posts: 471
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Quote:
Many studies like the recent COURAGE studies have major flaws, however. About 1/3 of the patients in the "medical therapy" arm crossed over to stenting, if I remember correctly. So these patients accrued the benefits of stenting but were assigned to the medical therapy arm of the "intention-to-treat" analysis. Also, most cardiologists think you would need follow-up of more like 10-20 years to see a mortality difference between people who have an artery kept open by a stent and those in whom the artery closes off very slowly. Basically, even though it has been difficult to prove, common sense says that we should keep the major coronary arteries open if possible. Once the correct studies are done with long-term follow-up I think that will be proven. I'm just glad that they leave these decisions up to the individual patient and doctor for now, because there isn't enough evidence to guide every decision -- every situation is unique and for the government to impose some cookie-cutter type of algorithm to limit stenting would be wrong. |
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