No benefit from stents in outcomes! 
Old trials have suggested no benefit in symptoms over time as well. Same with ischemia showing no benefit in composite endpoint or in symptoms.
He questions a 2 point change in SAQ summary score seen in ISCHEMIA. What does it exactly mean in clinical world?
He questions a 2 point change in SAQ summary score seen in ISCHEMIA. What does it exactly mean in clinical world?
A reference to ORBITA from @ProfDFrancis . When looked at PCI compared to sham procedure, no major improvement in angina class from PCI.
The third line of arguments from ICs, as Dr Miller, is the gut feeling. Something we feel must be fixed! An example.
However, the PCIs are not without complications!
He also questions the costs that US has paid for PCIs annually.
Now he moves onto the statins. First up is the CTT groups paper in the Lancet showing benefit in outcomes from statins!
Similar results for stroke prevention!
Reduction in events based on baseline risk and by a decrease in LDL!
The algorithm from the guidelines directly.
@ShadenKhalaf
@RBP0612
@cardioimage
@krishnapatel888
@SinghVasvi
@nappicarmela
@Ggrossman11
@SanjayDivakaran
@RezaEmaminia
@CoronaryDoc
@sarahcud
@CesiaGallegos
@RBP0612
@cardioimage
@krishnapatel888
@SinghVasvi
@nappicarmela
@Ggrossman11
@SanjayDivakaran
@RezaEmaminia
@CoronaryDoc
@sarahcud
@CesiaGallegos
IMPACT model shows decrease in 50% CAD death rates over 30 years. Large amount of reduction attributed to lowering cholesterol.
Now comes the heat. The debate is on!
Dr Johnson is back. He debates that the evidence is very clear that the NEWER literature shows benefit as he has pointed out before.
He suggests that ORBITA and ISCHEMIA (where 1/3rd patients did not have any major symptoms) both show improvement in angina and ISCHEMIA shows reduction in events as he has suggested before.
The spontaneous infarcts ARE reduced with PCIs and therefore it could be very distinct from just reducing symptoms. You are stabilizing the unstable plaque and therefore the PCI wins!
Dr Miller back with a point that Statins treat every single iota of the vasculature and not just one small segment of one artery.
Improvement in symptoms could be the only benefit from PCIs per Dr Miller but they dont reduce any events as he has also pointed during his talk.
PCIs do have a death as a complication 1 in 150 patients!
STATINs are five stars 🌟 all the way!
That is it from the first debate!
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