Using biomarkers to prioritise patients with stable angina pectoris for bypass surgery

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.b5414 (Published 20 January 2010) Cite this as: BMJ 2010;340:b5414
  1. Christian Juhl Terkelsen, postdoctoral researcher and senior house officer1,
  2. Werner Vach, professor2
  1. 1Department of Cardiology B, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
  2. 2Clinical Epidemiology, Institute of Medical Biometry and Medical Informatics, University Medical Centre, D-79095 Freiburg, Germany
  1. christian_juhl_terkelsen{at}hotmail.com

    Predicting risk does not necessarily translate to preventing it

    In patients with acute coronary syndrome, timely revascularisation improves outcome. For stable angina pectoris, low risk patients may be safely treated with selective revascularisation instead of preventive revascularisation.1 Moderate to high risk patients with angina pectoris, who are not eligible for percutaneous coronary intervention, are selected for coronary artery bypass surgery.

    Various scores have been proposed for prioritising patients on the waiting list for coronary artery bypass grafting to minimise the number of events that occur while waiting for surgery. These scores have been based on angiographic findings, angina pectoris severity class, recent myocardial infarction, and left ventricular ejection fraction—factors that are directly associated with cardiac events. Nevertheless, studies have not been able to show that the scores predict events in people on the waiting list.2 3

    In the linked study (doi:10.1136/bmj.b5606), Henriksson and colleagues assess the effectiveness and cost effectiveness of a modified risk score in 9935 patients with stable angina awaiting coronary artery bypass surgery, who were followed up for about four years after surgery.4 The risk score incorporated estimated glomerular filtration rate, in addition to age, previous …

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