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Message |
Guest
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 Posted: Tue Jun 21, 2005 4:21 pm Post subject:
Re: surgery or stent?
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"Patrick B" <tagada@invalid.se> wrote in message
news:1gyiv9w.7nxhyq185m83kN%tagada@invalid.se...
| Quote: | Hawki63@sbcglobal.net> wrote:
hard to do a clinical trial testing one against another....
It has been done, and it is not that hard: compare a group of patients
with metal stents to a group of patients with drug eluting stents.
The results are clearly in favor of drug eluting stents !
Patrick
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sorry...I thought the topic was CABG vs stents per se...not drug eluting vs
non drug eluting...
a retrospective "trial" can be done by examining records..
but a true unbiased trial of two modalities normally involves random
selection ..."you get this"..."he gets that"
personally I think it would be a tad unethical in the surgery vs stent
issue....as the risks and benefits are not comparable..
if it is stents only....I know such data exists....actually it seems to be
common sense!!!
sorry if I misunderstood...
ps look at the subject "surgery or stent"....not "drug or non drug stent" |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
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| Posted: Tue Jun 21, 2005 9:07 pm Post subject:
Re: surgery or stent?
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Hawki63@sbcglobal.net wrote:
| Quote: | "Patrick B" <tagada@invalid.se> wrote in message
news:1gyiv9w.7nxhyq185m83kN%tagada@invalid.se...
Hawki63@sbcglobal.net> wrote:
hard to do a clinical trial testing one against another....
It has been done, and it is not that hard: compare a group of patients
with metal stents to a group of patients with drug eluting stents.
The results are clearly in favor of drug eluting stents !
Patrick
sorry...I thought the topic was CABG vs stents per se...not drug eluting vs
non drug eluting...
a retrospective "trial" can be done by examining records..
but a true unbiased trial of two modalities normally involves random
selection ..."you get this"..."he gets that"
personally I think it would be a tad unethical in the surgery vs stent
issue....as the risks and benefits are not comparable..
if it is stents only....I know such data exists....actually it seems to be
common sense!!!
sorry if I misunderstood...
ps look at the subject "surgery or stent"....not "drug or non drug stent"
|
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
--
David Rind
drind@caregroup.harvard.edu |
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Guest
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| Posted: Tue Jun 21, 2005 9:28 pm Post subject:
Re: surgery or stent?
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"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
| Quote: | Hawki63@sbcglobal.net wrote:
"Patrick B" <tagada@invalid.se> wrote in message
news:1gyiv9w.7nxhyq185m83kN%tagada@invalid.se...
Hawki63@sbcglobal.net> wrote:
hard to do a clinical trial testing one against another....
It has been done, and it is not that hard: compare a group of patients
with metal stents to a group of patients with drug eluting stents.
The results are clearly in favor of drug eluting stents !
Patrick
sorry...I thought the topic was CABG vs stents per se...not drug eluting
vs non drug eluting...
a retrospective "trial" can be done by examining records..
but a true unbiased trial of two modalities normally involves random
selection ..."you get this"..."he gets that"
personally I think it would be a tad unethical in the surgery vs stent
issue....as the risks and benefits are not comparable..
if it is stents only....I know such data exists....actually it seems to
be common sense!!!
sorry if I misunderstood...
ps look at the subject "surgery or stent"....not "drug or non drug stent"
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
--
David Rind
drind@caregroup.harvard.edu
|
that would be tuf to sell....tho I don't doubt it is done...more likely to
be retrospective look backs and not "you get this" "he gets that"..
personally I would be suspect if in ER with an MI and I was not given the
choice of both (with angio results)...not TOLD I was getting a stent!! |
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Guest
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| Posted: Tue Jun 21, 2005 10:56 pm Post subject:
Re: surgery or stent?
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<Hawki63@sbcglobal.net> wrote in message
news:Io1ue.31657$J12.23577@newssvr14.news.prodigy.com...
| Quote: |
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
Hawki63@sbcglobal.net wrote:
"Patrick B" <tagada@invalid.se> wrote in message
news:1gyiv9w.7nxhyq185m83kN%tagada@invalid.se...
Hawki63@sbcglobal.net> wrote:
hard to do a clinical trial testing one against another....
It has been done, and it is not that hard: compare a group of patients
with metal stents to a group of patients with drug eluting stents.
The results are clearly in favor of drug eluting stents !
Patrick
sorry...I thought the topic was CABG vs stents per se...not drug eluting
vs non drug eluting...
a retrospective "trial" can be done by examining records..
but a true unbiased trial of two modalities normally involves random
selection ..."you get this"..."he gets that"
personally I think it would be a tad unethical in the surgery vs stent
issue....as the risks and benefits are not comparable..
if it is stents only....I know such data exists....actually it seems to
be common sense!!!
sorry if I misunderstood...
ps look at the subject "surgery or stent"....not "drug or non drug
stent"
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
|
David....can you give me a specific to read about such trials??
thanks....I always appreciate your knowledgable posts..
| Quote: |
--
David Rind
drind@caregroup.harvard.edu
that would be tuf to sell....tho I don't doubt it is done...more likely to
be retrospective look backs and not "you get this" "he gets that"..
personally I would be suspect if in ER with an MI and I was not given the
choice of both (with angio results)...not TOLD I was getting a stent!!
|
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
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| Posted: Tue Jun 21, 2005 11:50 pm Post subject:
Re: surgery or stent?
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|
Hawki63@sbcglobal.net wrote:
| Quote: | "David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
David....can you give me a specific to read about such trials??
thanks....I always appreciate your knowledgable posts..
|
Sure:
TI - Comparison of coronary-artery bypass surgery and stenting for the
treatment of multivessel disease.
AU - Serruys PW; Unger F; Sousa JE; Jatene A; Bonnier HJ; Schonberger
JP; Buller N; Bonser R; van den Brand MJ; van Herwerden LA; Morel MA;
van Hout BA
SO - N Engl J Med 2001 Apr 12;344(15):1117-24.
and
TI - Coronary artery bypass surgery versus percutaneous coronary
intervention with stent implantation in patients with multivessel
coronary artery disease (the Stent or Surgery trial): a randomised
controlled trial.
SO - Lancet 2002 Sep 28;360(9338):965-70.
--
David Rind
drind@caregroup.harvard.edu |
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Guest
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| Posted: Wed Jun 22, 2005 12:47 am Post subject:
Re: surgery or stent?
|
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"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9ag4v$lhf$1@reader1.panix.com...
| Quote: | Hawki63@sbcglobal.net wrote:
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
David....can you give me a specific to read about such trials??
thanks....I always appreciate your knowledgable posts..
Sure:
TI - Comparison of coronary-artery bypass surgery and stenting for the
treatment of multivessel disease.
AU - Serruys PW; Unger F; Sousa JE; Jatene A; Bonnier HJ; Schonberger JP;
Buller N; Bonser R; van den Brand MJ; van Herwerden LA; Morel MA; van Hout
BA
SO - N Engl J Med 2001 Apr 12;344(15):1117-24.
and
TI - Coronary artery bypass surgery versus percutaneous coronary
intervention with stent implantation in patients with multivessel coronary
artery disease (the Stent or Surgery trial): a randomised controlled
trial.
SO - Lancet 2002 Sep 28;360(9338):965-70.
--
David Rind
drind@caregroup.harvard.edu
|
thanks for these studies...I will search them out
personally I would rather make the choice in this matter....based of course
on all the variables..
thanks again |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
| Posted: Wed Jun 22, 2005 9:01 am Post subject:
Re: surgery or stent?
|
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|
Hawki63@sbcglobal.net wrote:
| Quote: | "David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9ag4v$lhf$1@reader1.panix.com...
Hawki63@sbcglobal.net wrote:
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
There have been randomized trials comparing surgery and stents, although
not comparing drug eluting stents and surgery so far as I know.
David....can you give me a specific to read about such trials??
thanks....I always appreciate your knowledgable posts..
Sure:
TI - Comparison of coronary-artery bypass surgery and stenting for the
treatment of multivessel disease.
AU - Serruys PW; Unger F; Sousa JE; Jatene A; Bonnier HJ; Schonberger JP;
Buller N; Bonser R; van den Brand MJ; van Herwerden LA; Morel MA; van Hout
BA
SO - N Engl J Med 2001 Apr 12;344(15):1117-24.
and
TI - Coronary artery bypass surgery versus percutaneous coronary
intervention with stent implantation in patients with multivessel coronary
artery disease (the Stent or Surgery trial): a randomised controlled
trial.
SO - Lancet 2002 Sep 28;360(9338):965-70.
--
David Rind
drind@caregroup.harvard.edu
thanks for these studies...I will search them out
personally I would rather make the choice in this matter....based of course
on all the variables..
thanks again
|
Remember that no one is ever supposed to be enrolled in a randomized
trial without consent. These were people who chose to participate. They
could, instead, have said they wanted one procedure or the other and
then would not have been part of the trial. Lots of people refused to
participate.
--
David Rind
drind@caregroup.harvard.edu |
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| Back to top |
|
|
Jim Chinnis
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1030
|
| Posted: Wed Jun 22, 2005 1:48 pm Post subject:
Re: surgery or stent?
|
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|
<Hawki63@sbcglobal.net> wrote in part:
| Quote: | personally I would rather make the choice in this matter....based of course
on all the variables..
|
This makes sense if you know how the trial will come out in
advance, or have reason to feel that you are not representative of
the study group. Sometimes you might have an idea, but usually
controlled trials are done where there is a substantial
uncertainly about which treatment is better.
--
Jim Chinnis Warrenton, Virginia, USA |
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Guest
|
| Posted: Wed Jun 22, 2005 2:23 pm Post subject:
Re: surgery or stent?
|
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|
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9bgdr$afp$1@reader1.panix.com...
| Quote: | Hawki63@sbcglobal.net wrote:
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9ag4v$lhf$1@reader1.panix.com...
Hawki63@sbcglobal.net wrote:
"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:d9a6k9$fia$1@reader1.panix.com...
There have been randomized trials comparing surgery and stents,
although not comparing drug eluting stents and surgery so far as I
know.
David....can you give me a specific to read about such trials??
thanks....I always appreciate your knowledgable posts..
Sure:
TI - Comparison of coronary-artery bypass surgery and stenting for the
treatment of multivessel disease.
AU - Serruys PW; Unger F; Sousa JE; Jatene A; Bonnier HJ; Schonberger JP;
Buller N; Bonser R; van den Brand MJ; van Herwerden LA; Morel MA; van
Hout BA
SO - N Engl J Med 2001 Apr 12;344(15):1117-24.
and
TI - Coronary artery bypass surgery versus percutaneous coronary
intervention with stent implantation in patients with multivessel
coronary artery disease (the Stent or Surgery trial): a randomised
controlled trial.
SO - Lancet 2002 Sep 28;360(9338):965-70.
--
David Rind
drind@caregroup.harvard.edu
thanks for these studies...I will search them out
personally I would rather make the choice in this matter....based of
course on all the variables..
thanks again
Remember that no one is ever supposed to be enrolled in a randomized trial
without consent. These were people who chose to participate. They could,
instead, have said they wanted one procedure or the other and then would
not have been part of the trial. Lots of people refused to participate.
--
David Rind
drind@caregroup.harvard.edu
|
yes I thought of that...another thought is how to "match" two patients whose
pathoanatomy, other risks,,,etc closely enuf to make the data
meaningful....which I assume is how they try to do retrospective studies...
still...I learned something!! always willing to learn..and thanks for that!! |
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Guest
|
| Posted: Wed Jun 22, 2005 2:25 pm Post subject:
Re: surgery or stent?
|
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|
"Jim Chinnis" <jchinnis@SPAMalum.mit.edu> wrote in message
news:ft1jb15j51jkdffu41ct6gqla42dijae9r@4ax.com...
| Quote: | Hawki63@sbcglobal.net> wrote in part:
personally I would rather make the choice in this matter....based of
course
on all the variables..
This makes sense if you know how the trial will come out in
advance, or have reason to feel that you are not representative of
the study group. Sometimes you might have an idea, but usually
controlled trials are done where there is a substantial
uncertainly about which treatment is better.
--
Jim Chinnis Warrenton, Virginia, USA
|
I guess that there is also the issue of what condition the "patient" is in
when a choice is offered!!!..
the "good" thing about angioplasty and stents(in my h.o.) is that it can be
done quite quickly....and not having general anesthesia and "pump head"
risks...well...guess I don't see that the risks are comparable...
but surely these studies help to advance the practice of medicine... |
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Andrew B. Chung, MD/PhD
medicine forum Guru
Joined: 25 Mar 2005
Posts: 8540
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