Monday, May 16, 2011


There is an interesting paper presented at this years Annual Scientific meeting of the American Society of Thoracic Surgery ( STS ), at Philadelphia. Dr Andrew Bardissi researched into the STS data base and came out with an analysis of 1,475,545 CABGs done between 1999 till 2009, to see the changing trends and patients. 1.5 million CABGs is alot of CABGs and will certainly reflect the CABG scene in USA.
He found that over the 10 years ( 1999-2009 ), the patients smoke significantly less. That is about the only good thing in terms of changing patient characteristics. Otherwise, over the 10 years, the trend is that the patients are getting more obesed, have higher incidence of dyslipidemias, are younger and there are more males. There are also more hypertensives.
On the CABG side, everything is better. The mortality has fallen from 2.6% to 1.9%. More internal mammary grafts are implanted ( from 72% to 90% ), and the stroke rates are also down from 1.6% to 0.9%.
In the face of the severe Interventional cardiology challenge, the cardiac surgeons are getting more skillful. What Dr Andrew did not address ( which may not be in the data base, is that there are now, more cardiac centers doing fewer cases. It is no longer like the CABG factories of before. However, we noticed that despite falling numbers of CABGs done, and lesser numbers per centers, their decision making and supervision is much better, giving rise to more consistencies, and better outcomes.
This is to be lauded. They did not cave in, under pressure from the interventionist. They got better. That is what competition should do. Make us all better, so that the patient have good choices.
I have often wondered what our local numbers would be like. What are our true mortality numbers? our stroke risks?, our use of the internal mammary grafts? our graft attrition rates? Are we keeping up with the US numbers?.
Well, only time will tell, as we get our act together.

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