A simple question with mammoth repercussions in the revascularization world.
How was the question ? Was it difficult ?
Don’t worry, it wouldn’t be the same even for elite cardiology experts worldwide. It is not a Himalayan task, though, to find an answer. All it requires is a simple FFR run through pre and post PCI (Now RFR, iFR, QFR). Surprisingly, very few inquisitive minds wanted to do this. I can find 5 related papers. The fifth one is very specific: REPEAT-FFR study. Go through at least that one paper and find the answer yourself.
Cardiology fellows it is worth reading about this important study , might be asked in exams.
Final message
The conclusions from these studies are not really baffling, but demand a lot of academic cleansing of our understanding about the relationship between epicardial patency and microvascular flow.”It is obvious from these studies that epicardial PCI never guarantees good revascularization with a FFR backing “
Every cardiologist should ask this question before they scrub, whether the PCI, they are going to do today, would improve the net-myocardial flow, LV function or symptoms . Are we doing justice to our patient (or blindly practicing science) who is quietly lying on the table, with a mix of anxiety and trust, with a complete belief that what they are undergoing is a life-changing or life-saving procedure.
Further, it is our duty to restore the lost glory to the defamed , stigmatised medical management of CAD & Impress our patients that “All that, doesn’t glitter could be pure gold as well”
Reference
For those people who are too busy to click on the link .Summary of REPEAT-FFR study .
Dr.S.Venkatesan MD 
ORBITA trial : First let us do some harm . . . second , we shall . . !?
Posted in Cardiology -Interventional -PCI, Cardiology -Technology, Cardiology -Therapeutic dilemma, cardiology -Therapeutics, Cardiology -unresolved questions, cardiology journal club, cardiology wisdom, Medical education, Medical ethics, Uncategorized, tagged ABUSE OF STENTS, ACC AHA ESC ORBITA GUIDELIES, CHRONIC STABLE ANGINA GUIDELINES, drsvenkatesan, HOW ORBITA TRIAL WILL CHANGE MY PRACTICE, INAPPROPRIATE USE CRITERIA AUC STENTS, LANCET ORBITA STUDY, ORBITA COURAGE BARI2D FAME 2, ORBITA IMPERIAL COLLEGE, ORBITA study, ORBITA TRIAL LANCET, ORBITA trial review and comments, ORBITA VS COURAGE, reviewing ORBITA trial study critically, TCTMD 2017 ORBITA, WAHT WE LEARN FROM ORBITA STUDY on November 6, 2017| 2 Comments »
Cardiologists at confused cross roads !
Perils of limited Intellect & Infinite greed
When not so appropriately trained cardiologists do Inappropriate things “use becomes misuse” . . . then, it won’t take much time for science to become total abuse. That’s what happened with the murky world of coronary stents .No surprise, it’s time to firefight the healers instead of the disease !
Now ,Comes the ORBITA study . Yes , it looks like a God sent path breaking trial that spits some harsh truths not only in cardiology, but also in behavioral ethics .Let us not work over time and hunt for any non-existing loop holes in ORBITA. Even if it has few, it can be condoned for sure as we have essentially lived out of flawed science for too long Injuring many Innocent hearts !
Yes , its enforced premature funeral times for a wonderful technology !
GIF Image courtesy http://www.tenor.com
Meanwhile, let us pray for a selective resurrection of stenting in chronic coronary syndromes and stop behaving like lesser professionals !
Postamble
Extremely sorry . . . to all those discerning academic folks , who are looking for a true scientific review of ORBITA , please look elsewhere !
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