Journal and News Scan

This systematic review compares three minimally invasive techniques for surgical treatment of atrial fibrillation: the endocardial Cox-Maze procedure, epicardial surgical ablation and an epicardial surgical and catheter-based endocardial ablation hybrid procedure. According to this analysis, the Cox-Maze procedure is the most effective one and has important safety advantages.

One fourth of lung cancer patients are never smokers, consisting of 53% of women with lung cancer and 15% of men; the majority of these are adenocarcinomas. Estrogens interact with two types of receptors, ERα and ERβ, and may play a role in the development of lung cancer. This is a case-control study to test the hypothesis that there may be an association between ER gene polymorphisms and lung cancer in women who never smoked. ESR1 and ESR2 single nucleotide polymorphism (SNP) data was obtained from a genome-wide association study (GWAS). For ESR1, 2 SNPs were associated with lung cancer and for ESR2, 1 SNP was associated. The risk of lung cancer was higher in women who did not take hormone replacement therpy (HRT) in the setting of an at risk genotype. One potential implication of this finding is to aid in the identification of never-smoking women who may benefit from lung cancer screening.

The investigators of this study compared survival of bare metal stent percutaneous coronary intervention (BMS-PCI) versus drug-eluting stent PCI (DES-PCI) versus single artery CABG (SA-CABG) versus multiarterial CABG (MA-CABG) in patients with multivessel coronary artery disease. They used propensity-matching and Cox regression techniques in more than 8000 patients from 1 institution. The authors found that survival after DES-PCI was higher than after BMS-PCI. Long-term survival after DES-PCI was similar to SA-CABG. However, when compared to MA-CABG, the DES-PCI group showed worse survival at 5 years (86.3% versus 95.6%) and at 9 years (82.8% versus 89.8%; HR 0.45, p<0.001). The authors conclude that MA-CABG should be adopted as the optimal therapy for multivessel coronary heart disease.

The authors conducted a propensity-matched analysis of outcomes and costs associated with TAVR vs. SAVR procedures in patients considered either intermediate risk (STS PROM 4-8%) or high risk (STS PROM >8%) within the Commonwealth of Virginia.  Although the incidence of major morbidity was higher and the length of stay was longer with SAVR, the mortality was higher for TAVR (10% vs. 6%, p<0.047).  Importantly, the median total costs of the implant hospitalization were more than double for the TAVR group in comparison to the SAVR group ($69,921 vs. $33,598).  Not surprisingly, the dominant cost driver for TAVR was the cost of the device, which accounted for 40% of the cost of the implant hospitalization.