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JAMA. 2004;291:1803.

Off-Pump Coronary Artery Bypass Outcomes
Prior studies suggest favorable in-hospital outcomes for patients having off-pump coronary artery bypass (OPCAB), but longer-term clinical outcomes have not been evaluated. Puskas and colleagues (SEE ARTICLE) report early and 1-year results of a single-surgeon, randomized trial of patients assigned to OPCAB or conventional coronary artery bypass graft (CABG) surgery. There were no differences in graft patency or rates of stroke, death, myocardial infarction, angina, or reintervention in either group at 30 days or 1 year. Health-related quality of life was similar in both groups and only hospital costs differed, being significantly lower for patients having OPCAB. In an editorial, (SEE ARTICLE) Peterson and Mark discuss discrepant results from prior studies of OPCAB and raise questions that need resolution before OPCAB can be considered the new standard for bypass graft surgery.

Economics of Evidence-Based Hypertension Treatment
Evidence-based hypertension treatment improves clinical outcomes, but its economic effects have not been assessed. Fischer and Avorn analyzed prescription and clinical data from elderly patients with hypertension to compare their prescribed medications with those suggested by evidence-based guidelines, and they calculated the costs of the prescribed vs the recommended regimens. Their analyses suggest that adherence to the evidence-based guidelines would result in an estimated annual US savings of $1.2 billion.

(SEE ARTICLE)

Glucose Metabolism and Coronary Heart Disease
Patients with derangements in glucose metabolism are at higher risk of coronary heart disease morbidity and mortality, but the relationship of these abnormalities to severity of atherosclerosis has not been clearly defined. Sasso and colleagues reviewed coronary angiograms from men with normal glucose tolerance and correlated the degree of vessel narrowing with measures of glucose metabolism. Although levels of fasting plasma glucose were similar in all patients, they found that abnormalities in postload glycemia, fasting and postload insulinemia, glycosylated hemoglobin levels, and insulin resistance were independently correlated with the number of involved vessels and found that postload glycemia and glycosylated hemoglogin levels were significantly higher in men with more severe atherosclerosis.

(SEE ARTICLE)

Statin Use and Cardiovascular Risk in the Elderly
Optimal preventive pharmacotherapy requires a matching of medication to a patient's risk profile, with patients at highest risk receiving the most aggressive therapy, but whether physicians routinely take risk criteria into consideration is unclear. Ko and colleagues sought to examine the association of statin therapy (as a measure of treatment aggressiveness) with baseline cardiovascular risk in a cohort of elderly patients with a history of cardiovascular disease or diabetes. They found a paradoxical, inverse relationship between baseline cardiovascular disease risk and the prescription of statins.

(SEE ARTICLE)

Allocation of Donor Livers
Discrepancies between the supply and demand for deceased-donor organs and the clinical exigencies of optimizing graft and patient survival complicate the distribution of organs. After Trotter and Osgood reviewed data from liver transplant recipients including patient characteristics reflected by their Model for Endstage Liver Disease (MELD) score and graft and patient survival, they compared the data from large and small organ procurement organizations (OPOs). They found that graft and patient survival were similar across OPOs. However, patients in small OPOs had lower MELD scores when they underwent transplant surgery, reflecting a less severe clinical status and suggesting that organs are not consistently allocated according to medical need, contradicting current allocation policy.

(SEE ARTICLE)

A Piece of My Mind
"I believe in working toward solutions but I do not yet see the path that leads us to a kinder, gentler, more effective health care system." From "Keeping the Fire Alive."

(SEE ARTICLE)

Medical News & Perspectives
Researchers are evaluating how "off-pump" coronary artery bypass graft surgery, which is performed on a beating heart without the aid of a heart-lung machine, stacks up against the conventional procedure.

(Photo Credit: John D. Puskas, MD)

(SEE ARTICLE)

EBV in Pediatric Multiple Sclerosis
Children with pediatric multiple sclerosis had a greater likelihood of prior Epstein-Barr virus (EBV) infection than age-matched healthy controls, suggesting a possible association between EBV infection and pediatric multiple sclerosis.

(SEE ARTICLE)

CLINICIAN'S CORNER
Depression and Drug Dependence
When depression co-occurs with substance dependence, antidepressant medications can be beneficial, but specific treatment for the addiction is also needed.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about coronary artery bypass graft surgery.

(SEE ARTICLE)

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