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June18

Posted by:John Ellis
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We all know the answer to that question.  That’s why it’s unfair to lump the two outcomes together in evaluating outcomes, say, after carotid endarterctomy, as I discuss in this lecture video.

I “grew up” researching periop MI; lecturing on it far and wide (see a video lecture here).  But over time, the incidence has gone down (less invasive surgery? better preop eval and preparation?  better anesthesia and analgesia? better postop care?)

Now, we should probably be more worried about heart failure and dysrhythmias; brain failure; renal failure; gut failure and sepsis.  In fact, while periop beta blockade (see our 2011 review) may protect against CAD, it may worsen all those other organ failures, as the POISE trial suggested.  Gotta eat crow???

A recent study from the Cleveland Clinic showed:

Reduced incremental cost and unchanged mortality may reflect improving efficiency in the standard management of PMI. An increasing fraction of discharges to skilled nursing facilities seems likely a result from hospitals striving to reduce readmissions.

So, worry about the heart.  But we need to know much more how to prevent other M&M in elderly and high-risk patients.  Some have thought that avoiding “triple lows” might improve outcome, but recent research has questioned that, too.  More about that in the next post.

 




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