Unanswered ethical and scientific questions for trials of invasive interventions for coronary disease: The case of single vessel diseaseReportar como inadecuado




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Current Controlled Trials in Cardiovascular Medicine

, 5:2

First Online: 29 March 2004Received: 21 December 2003Accepted: 29 March 2004DOI: 10.1186-1468-6708-5-2

Cite this article as: Jabbour, S., Ravid, S. & Lown, B. Trials 2004 5: 2. doi:10.1186-1468-6708-5-2

Abstract

Trials in the 1990s demonstrated that medical therapy is as effective as invasive therapies for treating single-vessel coronary disease. Yet more recent studies enrolling patients with this condition have focused on evaluating only invasive approaches, namely, stenting versus coronary artery bypass surgery. Several ethical and scientific questions remain unanswered regarding the conduct of these later trials. Were they justified? Why wasn-t a medical therapy arm included? Were subjects informed about the availability of medical therapy as an equivalent option? Was optimized medical therapy given prior to randomization? The absence of clear answers to these questions raises the possibility of serious bias in favor of invasive interventions. Considering that medical therapy is underutilized in patients with coronary disease, efforts should focus more on increasing utilization of medical therapy and proper selection of noninvasive interventions.

KeywordsCoronary heart disease coronary revascularization medical therapy invasive therapy 



Autor: Samer Jabbour - Shmuel Ravid - Bernard Lown

Fuente: https://link.springer.com/







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