24. Assessing New Therapies - Take 2

Let me be really clear because some people accuse me of being indirect or obscure. There is no survival or MI benefit to CABG or PCI over Medical Therapy at one year. NONE! Moreover, there is no benefit to CABG over medical therapy, no advantage of PCI over medical therapy. There is no known test that can predict who is going to have a perioperative MI. The risk from preoperative medical therapy for coronary artery disease is lower than the risk for risk stratification plus CABG or PCI followed by the original planned surgery. Finally, and this one is really, really important. The risk from PCI followed by surgery without anti-platelet drugs is the greatest of all (20% mortality). If you want a SERIOUS, LIFE THREATENING OR FATAL EVENT, do a PCI and turn off the anti-platelet drugs, and do elective surgery.

There is no survival or MI benefit to CABG or PCI over Medical Therapy at one year.

	No benefit to CABG over Medical Therapy at one year.
	No benefit to PCI over Medical Therapy at one year.
	No test that can prove who will have a cardiac event.
	Risk from preoperative medical therapy for CAD is lower than risk for risk stratification + CABG or PCI followed by original surgery.
	Risk from PCI followed by surgery without anti-platelet drugs is greatest of all (20% Mortality)