Peripheral Vascular Disease and Outcomes Following Coronary Artery Bypass Graft Surgery

Ted Collison, MD; J. Michael Smith, MD; Amy M. Engel, MA

Arch Surg. 2006;141:1214-1218.

Hypothesis There is an increased operative risk in patients with a history of peripheral vascular disease (PVD) who undergo coronary artery bypass grafting (CABG). There are also outcome differences associated with these patients.

Design A study from a 10-year hospitalization cohort with prospective data collection.

Setting Multiple hospitals in the Greater Cincinnati area with 1 surgical group of cardiac surgeons.

Participants Cases were CABG patients with PVD, which was defined as having a history of type 1 neurologic injury, prior vascular surgery, or current vascular disease (n = 1561). Controls were CABG patients without PVD (n = 6328).

Interventions The study examined 42 potential confounding risk factors and 16 outcome variables.

Results Twenty-nine potential risk factors were found to be significantly different between CABG patients with and without PVD. Twenty-six confounding risk factors were correlated with 3 factors. Logistic regression analysis showed that even after controlling for sex, significant associative disorders, and other procedures, CABG patients with PVD still experienced more arrhythmias requiring treatment (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.03-1.33; P = .01), neurological complications (OR, 1.7; 95% CI, 1.43-2.07; P<.001), pulmonary complications (OR, 1.4; 95% CI, 1.23-1.62; P<.001), low output (OR, 1.3; 95% CI, 1.09-1.45; P = .001), and intraoperative complications (OR, 1.39; 95% CI, 1.06-1.83; P = .02).

Conclusions Patients with a PVD history undergoing CABG had more coexistent risk factors. These patients also exhibited higher rates of cardiac, systemic, renal, neurologic, and pulmonary complications.

Author Affiliations: Department of Surgery, Good Samaritan Hospital (Drs Collison and Smith), Cardiac, Vascular, and Thoracic Surgery, Inc (Dr Smith), and E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio (Ms Engel).

Wordworks2001 and Jeff Brailey
wish everybody out there
health and happiness during
this holiday season!

Most of you don't know this, but in 2004, I had been on Social Security Disability for a little over three years. I was a homeless derelict, a compulsive gambler, I didn't own anything more than the clothes on my back. But in January of that year, an angel came to my rescue. She made me feel like living again. Later on, in May, she supported my decision to get a second opinion when an Indiana cardiologist told me I was a "walking time bomb" that could go off anytime causing a heart attack, stroke, or worse - death, if I didn't get an immediate coronary artery bypass. Needless to say, it's been two and a half years and I'm still around. Plus, I am working in my chosen field on an oil rig in Nigeria. All because I met an angel and got a second opinion.

Grace and Truth to You: Reasons Why Tea Totalers Should Be Excluded from Southern Baptist Leadership and Missions Ministry

Grace and Truth to You: Reasons Why Tea Totalers Should Be Excluded from Southern Baptist Leadership and Missions Ministry

At right angles to Health - health articles, medical articles, pharmaceutical articles.: Heart Disease: Preventing Heart Disease in the General Popula

At right angles to Health - health articles, medical articles, pharmaceutical articles.: Heart Disease: Preventing Heart Disease in the General Population

More Proof -- CABGs Can be Hazardous to Your Health

FRIDAY, Dec. 15 (HealthDay News) -- The U.S. Food and Drug Administration on Friday slapped a stronger "black box" warning on labeling for Trasylol, an injectable drug given to patients before undergoing heart surgery to limit bleeding and the need for transfusions.

Because use of the medication has been associated with serious kidney damage and an increased risk of death, congestive heart failure and strokes, the FDA is also limiting its approved use.

Trasylol, which is derived from the lung tissue of cattle and marketed by Bayer Pharmaceuticals, was first approved by the FDA in 1993.

"Our new changes reflect results of the discussions from the Cardiovascular and Renal Drugs Advisory Committee advisory committee as well as results from the ongoing review of Trasylol safety," Dr. Dwaine Rieves, FDA's deputy director of the Division of Medical Imaging and Hematology Products at the Center for Drug Evaluation and Research, said during a teleconference on Friday afternoon.

The black-box part of the label has been modified to give a better description of the risk of potential patient reactions, including fatal reactions, Rieves said. "Now the black box warning states that Trasylol should be administered only in an operative setting where cardiopulmonary bypass can be rapidly initiated," he said. "We are also narrowing the indicated patient population."

The new labeling specifies that Trasylol should only be given to patients who are at an increased risk for blood loss and blood transfusion while undergoing coronary bypass graft surgery or for those who are put on a heart/lung machine during surgery.

The new labeling rules out administering it to patients with a known or suspected previous Trasylol exposure during the past 12 months, he added.

Also included is a new warning about the danger of an increased risk for kidney dysfunction and the possible increased need for dialysis after surgery, Rieves said. The new label also gives ways to manage the risk of post-use kidney dysfunction.

In addition, there is a new adverse reaction section on the label that is based on Bayer's review of its global database, Rieves noted. "There is also an alteration of the dosage and administration section to carry over the emphasis on the risk for renal dysfunction and to more clearly describe the dose-administration procedures," he said.

These changes follow an extensive FDA safety review, which began in January and was followed by an FDA public health advisory issued on Feb. 8.

The review was based on the results of two studies. One found the possibility of kidney failure, heart attack and stroke in patients treated with Trasylol compared with those treated with other drugs. The other found an increase in kidney damage, compared with other drugs, but did not find an increased risk of heart attack or stroke.

Get the whole story in the Washington Post.

Do You Want to Make A Difference?

Many of Dr. Wayne's patients or their spouses or children
have contacted me by e-mail to related their personal
stories about this fantastic physician. I would really like
to post them on this blog, with your permission. If you know
any other patients, send this blog address to them so they
also can contribute. We need to let the world know there IS
an alternative to cutting and invasive diagnostic tests.

Spread the word
Let friends and family know about this blog

HELP PEOPLE TAKE CHARGE OF THEIR HEALTH ISSUES AND
MEDICAL CARE LIKE WE DID.

Jeff Brailey
wordworks2001@yahoo.com

Oh those wide eyed medical students...

An apparently bright and exuberent medical student named "Drew" published the following entry in his blog:

Yesterday I was able to see a couple of CABGs. That stands for coronary artery bypass graft, what we affectionately call a "cabbage". It's amazing to see how they harvest veins and arteries so they can bypass bad vessels in the heart. It's even more amazing when the cut open the pericardium - the sac around the heart - and you see the beating heart for the first time. I was thinking, damn, here is the man with his chest wide open and his beating heart right in front of me. It doesn't get much better than that. It was also the first time I had seen a patient go on bypass. That was a bit freaky from my new perspective as his vitals - blood pressure, heart rate, respiratory rate and sats - were essentially zero for quite a while. He came off bypass without too much difficulty and we were able to defibrillate his heart to a normal rhythm. They actually have an electrode that puts the heart into ventricular fibrillation which just keeps the heart quivering. They closed his chest up with steel wire and he was as good as new.

Does anyone who has had a CABG want to comment on this entry? Do any of Dr. Wayne's patients who read this blog want to communicate with Drew?

His blog is at: http://medicatedbyrunning.blogspot.com/2006/12/gas.html

Coronary Artery Bypass Graft Photo Album

Do you think if invasive cardiologists showed these picture to their patients BEFORE surgery, that 660,000 Americans would allow surgeons to split their chests open?

Do you think if you were coerced and scared into a triple or quadruple bypass by your invasive cardiologist and then you found out that 75% to 85% of patients who get a second opinion don't get the surgery, would you be pissed?

Do you seriously believe a Coronary Artery Bypass Graft should be the first treatment for angina?

Make an Invasive Cardiologist's Day

E-mail this page to him!

Stents: A Reflection

Or What Happens When Doctors Focus Too Much on 'Modern' and Not Enough on 'Medicine'

OPINION By NORTIN HADLER, M.D.

Dec. 12, 2006 — - From time to time, every one of us gets a bee in our bonnet.

We have an idea that is so appealing, we can't let it go. It doesn't matter if others are less certain or even call the idea superstitious or unreasonable. But that belief feels so comfortable and so plausible that we defend it vigorously.

That sort of stubborn behavior is human nature. Physicians are human -- and, admittedly, stubborn.

Sometimes our beliefs turn out to be correct, to be prescient. Sometimes they don't.

Not long ago, tonsils were removed because they were swollen and uteruses because they were lumpy. Those surgeries turned out to be not so necessary and not so helpful. We got it wrong with stents, too. Let me tell you how.

Fifty years ago, heart attacks were a scourge. Everyone knew a working-age man who had dropped dead from one. Medicine seemed stymied. It was then that doctors learned what we all know now: The large arteries that feed the heart muscle, the coronary arteries, are clogged by a fatty buildup called atherosclerotic plaque in nearly every heart-attack patient.

Doctors thought cardiac surgery had made great strides in fixing leaky heart valves, so why not fix clogged arteries?

But removing the clog was too difficult, so pioneering surgeons developed ways to create blood vessels that actually went around -- or bypassed -- the obstructing plaques. Thus was born coronary-artery-bypass-graft surgery, or CABG. Experts firmly believed that if the blockage was bypassed, the patient was saved. There were skeptics. Skeptics breed controversy, and controversy sparks progress. Because to prove an idea wrong, skeptics must find a way to challenge and improve that idea.

Thanks to the skeptics, thousands of men with heart pain were soon enrolled in trials in the United States and Europe that compared CABG surgery with medical treatment -- such as drugs and a doctor's lifestyle advice. These studies continued for more than a decade, until around 1980. The results weren't very encouraging for those who believed in heart surgery. With the exception of a small group, the patients who underwent CABG did not live any longer than those treated medically.

Even worse, a lot of the CABG patients died before they could leave the hospital, about half had a stormy recovery, and nearly that many experienced memory loss that lasted a year after surgery.

But it's not easy to give up a belief. Besides, about 3 percent of all patients who have a particular kind of artery blockage, have been helped.

See, said the believers, there is some truth to our belief that plaques were the evil and CABG was the answer.

Doctors thought that as surgical skills got better, CABG surgery would start saving more patients. Instead, progress was slow and uncertain. But doctors didn't think surgery was the wrong idea -- they didn't question their own basic belief. Instead, doctors thought the grafts just didn't last long enough.

That's when another idea came along from Switzerland. Rather than bypass the blockage, just put a balloon into the middle of it and blow the balloon up, thereby smashing the plaque and opening up the vessel. The technique is called angioplasty. It is less invasive than CABG but no more effective. Doctors quickly realized that after angioplasty -- just like after CABG -- the vessel rapidly clogged up again, like a pipe clog that wasn't really fixed.

Maybe that's why angioplasty wasn't as helpful as many believed it should be. Enter stents. Stents are wire tubes inserted into the artery after the plaque is smashed by an angioplasty balloon. Then the artery can't clog again, doctors believed, because the wire stent would prop the artery open.

Wrong. These plain stents clogged at least as quickly as the artery would have clogged without them. Besides, the patients did no better than if the stent had not been inserted, which was no better than if the plaque had not smashed, which is no better than if the patient had undergone CABG, which is no better than medical treatment (and medical treatment has advanced).

Undaunted and unbowed, the believers leaped at the next idea: Coat the stent with drugs that interfere with clotting, and thereby keep the vessel open. Finally, they made a difference -- for the worse. Patients were worse off for this idea. The Food and Drug Administration recently concluded that drug-coated stents may cause more harm then good.

Despite their own failures, cardiologists and cardiac surgeons still have this bee in their bonnet. They talk about new procedures, new widgets and gizmos but don't wonder whether they are chasing after the wrong idea. They manage to sting over a million American hearts each year with the bee in their bonnet. But maybe gee-whiz gizmos aren't the answer.

You have two options: Avoid the sting of experimental surgeries, or survive it. I prefer the former. If I have heart pain, I'd want a doctor's advice and watchful eye, along with aspirin and a few other drugs. No, I'm not willing to go quietly into the great unknown. But I'm at least as likely to do well with some medications as with letting someone do violence to the plaque in my coronary arteries.

And I am likely to do well. Heart attacks are no longer the scourge they were 50 years ago. My chance of having my first heart attack is 30 percent less than was my father's at my age. And the chance of surviving five years after my first heart attack is 96 percent; his was 50 percent. And I can raise it to 98 percent with a touch of aspirin.

We don't know why heart attacks are no longer so common or so evil. But gizmos, gadgets and drugs deserve little, if any, credit.

I'll take my chances, thank you.

Dr. Nortin M. Hadler is a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at the University of North Carolina Hospitals in Chapel Hill, N.C.

Copyright © 2006 ABC News Internet Ventures

What the Invasive Cardiologists Don't Want You to Know

A Harvard group of cardiologists published two studies in JAMA showing that when patients are sent for bypass surgery or angioplasty, 75-80%% were judged not to require the procedure upon referral for second opinion.

Then, in the journal Circulation, there was no difference in survival between patients
randomized to have either bypass surgery or conservative medical treatment.

Even worse, the Lancet showed that when patients were randomized to have either angioplasty or conservative medical treatment, the angioplasty group actually had more heart attacks and deaths (6.3%%) than the medical group (3.3%%).

Therefore, the published data show that these invasive and expensive procedures
are 75-80%% unjustified and do not improve survival overall.

Heart Frauds

When it comes to heart surgeries, Heart Frauds author Dr. Charles T. McGee writes, "As Harvard professor Braunwald predicted, a financial empire has developed around surgical procedures on the heart. With so many powerful vested interests involved, it will be difficult to change how American doctors treat patients with coronary artery disease. No one who is currently gaining from the system has any incentive to try to stop the unnecessary costs and suffering." In other words, surgery makes money and surgery is what medical professionals are trained to do, so rather than exert the time and energy to try more conservative treatments that could threaten their very careers, medical professionals often turn to surgery as their most immediate and financially logical avenue. "The economic incentive for a physician to operate on you is great. Surgeries make doctors a lot of money. Doctors are human beings and they are not immune to the lure of bigger profits," according to Prescription Medicines, Side Effects and Natural Alternatives by American Medical Publishing.

Dr. McGee's bookk is available from Amazon and you may read another review below and order the book at the same time!

The Heart Attack Grill

Nurse Stacie and the quadruple bypass burger


There is a restaurant in Tempe, Arizona called The Heart Attack Grill. It serves a deluxe hamburg sandwich called the Bypass Burger, I kid you not. You can order anything from a single bypass burger up to the huge quadruple bypass burger. The waitresses wear skimpy sexy "nurse" uniforms and the cooks wear scrub suits and doctor's coats.

I know that this is kind of sickening to patients who have had or are facing a bypass, but one must wonder, Is the Heart Attack Grill owned by a group of interventionalist cardiologists and do they give their patients who eat there a discount?

Check it out for yourself at: www.heartattackgrill.com.

Do You Want to Make A Difference?

Many of Dr. Wayne's patients or their spouses or children
have contacted me by e-mail to related their personal
stories about this fantastic physician. I would really like
to post them on this blog, with your permission. If you know
any other patients, send this blog address to them so they
also can contribute. We need to let the world know there IS
an alternative to cutting and invasive diagnostic tests.

HELP PEOPLE TAKE CHARGE OF THEIR HEALTH ISSUES AND
MEDICAL CARE LIKE WE DID.

Jeff Brailey
wordworks2001@yahoo.com

LATEST MORBIDITY
AND
MORTALITY STATISTICS
ON BYPASS SURGERY
AND
ANGIOPLASTY

Excerpts from Living Longer With Heart Disease:
The Noninvasive Approach That Will Save Your Life

This is Dr. Wayne's newest book, out in 2006. It can be purchased by going to
http://www.heartprotect.com

---

With the exception of the first report in the next paragraph, the following series of reports are presented in chronological order. A common method of describing results is either mortality or freedom from a cardiovascular event such as death, heart attack, stroke or repeat bypass surgery or angioplasty. Mortality figures are presented in a variety of formats such as 3, 5, and 10 year mortality, and so are cardiovascular events. I have modified these figures so that they are on a yearly basis to make comparison easier. The first report (reference 17) is presented out of order because it not only shows the most recent statistics, but it also reflects outcomes in one of the largest group of patients to date.

From a multicenter study (17) from several major medical centers, using New York State's registry for patients undergoing coronary artery bypass surgery or coronary angioplasty, the mortality rate was tabulated for each procedure. I have listed separately the mortality rate on an annual basis for patients with disease involving two coronary arteries, and for patients with disease of all three coronary arteries. Keep in mind that the annual mortality for patients with two and three vessel disease who are treated conservatively with appropriate medication is less than 1% per year.

In 17, 857 patients with disease of all three coronary arteries who underwent coronary artery bypass surgery, the annual mortality rate was 3.3 %. In 1,294 patients with three vessel disease who underwent coronary angioplasty the annual mortality rate was 4.2 %.

In 9,212 patients with two vessel disease undergoing coronary artery bypass surgery, the annual mortality rate was 2.7 %. In 7,405 patients with two vessel disease undergoing coronary angioplasty the annual mortality rate was 2.3 %.

For mortality related to age, see the National Medicare Experience below.

Dr. Salem Yusuf reviewed the medical literature from 1972 to 1984 and compared the mortality of medical and surgical treatment. (18) There were four studies involving a total of 416 patients. At 10 years the mortality of the surgically treated patients was 33% or 3.3% per year. The mortality of the medically treated patients at 10 years was 34% or 3.4% per year. It is to be noted that this reflects the medical treatment primarily of the Seventies.

Dr. Spencer King of Emory University compared 194 bypass surgery patients with 198 angioplasty patients. The annual mortality for the bypass surgery patients was 2.1% per year and that for the angioplasty patients 2.4% per year. (19)

In a study of mortality rates in different age groups in Medicare patients undergoing either bypass surgery or angioplasty, Dr. Eric Peterson and his associates at Duke University Medical Center found the following. (20)

THE NATIONAL MEDICARE EXPERIENCE

	Mortality After Angioplasty 225,915 patients			Mortality After Bypass Surgery 357,885 patients
Ages	30 Day	1 Year		30 Day	1 Year
	%	%		%	%
65-69	2.1	5.2		4.3	8.0
70-74	3.0	7.3		5.7	10.9
75-79	4.6	10.9		7.4	14.2
>80	7.8	17.3		10.6	19.5

Obviously, mortality rate is related to age. Unfortunately, rarely are these figures quoted to elderly patients when they are urged to undergo these procedures.

In a study of 591 patients from nine medical centers in North America, the in-hospital complication rate was Death 1.5%, Heart Attack 4.2%, Emergency Bypass 3.2% and Total Complications 15.4%. (21) This does not include complication rates after discharge from the hospital.

From the University of Washington in Seattle comes a study of the 15 year survival rate of the Coronary Artery Surgery Study of 6,018 men and 1,095 women who originally underwent treatment between 1974 and 1979. For medical treatment the 15 year survival rate for men was 50% and 49% for women. For those with initial surgical treatment the survival for men was 52% and 48% for women. Thus, there was no significant difference in survival between the two treatments with the annual mortality being 3.3%.

Another interesting study was the CAVEAT Trial (Coronary Angioplasty Versus Excisional Atherectomy Trial).(23) Atherectomy refers to the use of a rotor rooter type of device that is inserted into a coronary artery and the arteriosclerotic plaque is cut up and scooped out. In this study only the frequency of a myocardial infarction (heart attack) was studied in 500 patients undergoing angioplasty and 512 having atherectomy. The incidence of myocardial infarction in the atherectomy patients was 15.2% and it was 6.8 % in the angioplasty patients. The high incidence of heart attacks with both groups was because cardiac enzymes were measured rather than merely getting an electrocardiogram after the procedure. Thus, the reported incidence of myocardial infarction after these procedures is artificially low because insensitive methods of detection are being used.

Another report dealing with mortality rate in elderly patients undergoing cardiac surgery is from Cedars-Sinai Medical Center in Los Angeles. (24) In a study of 528 patients over 80, the 30 day mortality was 8.3%. At one year it was 18% and at 5 years 38%. These figures are very similar to the Duke study.

From the St. Louis University Health Sciences Center (25) a review of 250 patients undergoing coronary artery bypass surgery found that the annual mortality for patients between 60 and 79 was about 7% per year and for patients above the age of 80 it was 13% per year.

From the National Registry of Myocardial Infarction in 3,648 patients undergoing angioplasty who had this procedure done initially as the primary treatment, the in-hospital mortality for patients who were treated under one hour was 6.9%, from 1-2 hours 5.7%, from 2-3 hours 9.1%, and after three hours 9.4%. (26) These are not small numbers. In my experience the mortality rate of a heart attack patient after he or she reaches the hospital is excellent. There is a better than 95% chance of recovery, even better if the patient gets to the hospital early. Thus, the mortality rate for patients treated with angioplasty in this study is twice as great as with conservative medical treatment. A recent Veterans Administration Study showed similar findings in a group of 500 patients with an acute heart attack. There were 21 patients who died in the surgery or angioplasty treated group at nine days, but only six patients who died in the medically treated group in this time period.

Looking at mortality figures alone doesn't tell the complete story. Perhaps a better way to evaluate the outcome of these procedures is to combine all cardiovascular events including death on an annual basis. It is known, for example, the after angioplasty, the coronary artery that was dilated will usually become narrowed again and may close off. The frequency with which this happens is about 50%. How often this will result in repeat symptoms is not precisely known. The following reports describes recurrences of cardiovascular events including death, heart attack, unstable angina, repeat angioplasty and coronary artery bypass surgery.

From the Massachusetts General Hospital in a trial of 127 patients undergoing angioplasty or coronary artery bypass surgery, the annual cardiovascular event rate was 7.7% per year for the surgery patients and 17.7% per year for angioplasty patients. (27)

From the Thorax Center at Erasmus University in Rotterdam, a 10 year study of 856 patients undergoing angioplasty revealed an annual mortality rate of 2.2% and an annual cardiovascular event rate of 8.6%. (28)

In the BARI trial (Bypass Angioplasty Revascularization Investigation), 1,829 patients were followed for 5.4 years. (29) Annual mortality was 2.1% per year for bypass surgery and 2.7% per year for angioplasty. Event rate was 4% per year for surgery and 4.3% per year for angioplasty.

In a 10 year study from St. Antonius Hospital in the Netherlands, 351 patients who had angioplasty were followed.(30) Annual mortality was 2% per year and cardiovascular event rate 10% per year.

From the University of North Carolina at Greensboro, 633 patients who were treated with primary angioplasty for their heart attack were followed for 5.3 years. The in-hospital mortality was very high at 9% and the cardiac mortality at five years was another 9%.(31) Total mortality was twice what it should have been.

From the University of Ottawa Heart Institute in Ontario, Canada, a 25 year study of 1,388 patients who underwent bypass surgery at an average age of only 48 years reveals an annual mortality of 2%. Eighteen percent had to undergo repeat surgery during this period. (32)

From the Veterans Affairs Medical Center and the University of Colorado Health Sciences Center in Denver comes a study of 131 patients above the age of 70 with unstable angina who underwent coronary angioplasty for their symptoms. The mortality at 30 days was a striking 13%. (33)

In a comparison of medical treatment versus angioplasty for patients with stable coronary artery disease, 20 centers from the United Kingdom and Ireland treated 1,018 patients. The risk of death or a heart attack was 2.3% per year for angioplasty treated patients but only 1.2% per year for medically treated patients. (34)

In a recent Veterans Administration study known as the VANQWISH trial 920 patients from 15 medical centers with an acute heart attack were randomized to treatment with revascularization (angioplasty or coronary artery bypass surgery) or conservative medical treatment. At the time of discharge from the hospital, 21 patients who had undergone revascularization had died versus only six medically treated patients. At 2.5 years there were 80 deaths in the aggressively treated group versus only 59 deaths in the conservatively treated patients.

There are only a few reports dealing with the use of stents placed within a coronary artery. A stent is a metal tube that can be expanded when placed within a coronary artery. When fully expanded it becomes a scaffolding that helps to keep the artery from closing. Typically, when an artery is dilated with balloon angioplasty, a delayed complication is collapse of the walls of the blood vessel causing the artery to become blocked. Stents were developed to prevent this from happening. This it does, however, although the vessel walls stay apart, the inside of the stent becomes filled with tissue that grows into the stent. Thus, stents often become occluded and the vessel still closes off.

From Harvard University comes a report on 175 patients who had stents inserted. Annual mortality was 2.7% and annual cardiovascular event rate was 10%. (35)

From the Cardiovascular Division of the University of Pennsylvania the three year outcome of 65 patient who underwent stenting was studied. Mortality was 4% per year and cardiovascular event rate was 14.7% per year. (36)

From the University of Giessen in Germany comes a detailed analysis of 300 patients who underwent primary angioplasty for an acute myocardial infarction.(37) Their findings are described in the following table.

	1 Month	6 Months	1 Year	2 Years	3 Years
All Cardiac Events	13%	22%	34%	42%	51%
Cardiac Mortality	4%	5%	6%	7%	9%
Total Mortality	5%	6%	9%	10%	13%
Repeat Angioplasty		20%	23%	25%	31%

---

Maria Iglesias from Mexico City, Mexico, is the wife of one of Dr. Wayne's patients. A few days ago,, she emailed me to tell me she found my blog and she has given me permission to print her letter:

Dear Jeff,

I keep reading your blog. I thank you for writing it, so people can learn the truth.

I liked very much your post from Dec. 5. I could have written that story! I want to share our story with you.

Today (Dec. 7), 3 years ago, my husband, Nicholas was told he needed to undergo CABG immediately after an angiogram showed 2 main arteries 100% blocked.

But "Your heart is in great shape!!" he was told.

We asked every Cardiologist at the hospital how his heart could be in such a good condition if the arteries were completely blocked. We never got a good answer.

Most were similar to "We don´t know, that's very uncommon".

My husband said he was going to have a second opinion.

My father is a cardiologist and he reasserted the hospital's opinion.

My husband decided he preferred to run the risk than having his chest opened.

We started a meticulous search in the Internet. We were mainly looking for alternatives like chelation therapy.

Then I ran into Dr. Wayne's website. (http://www.heartprotect.com) It was like a miracle sent by God. He was exactly what we were looking for although we didn´t know it yet. I didn´t tell my husband at first because I didn´t want him to cherish false hopes.

I printed most of the website and showed it to my father. As a retired cardiologist he was VERY interested. He told me to write to Dr. Wayne as soon as possible.

I sent several emails to Dr. Wayne, but he was having trouble with his Internet connection at the time, so I didn´t get a response.

I finally told my husband and he made a call to Dr. Wayne's office and left a message.

Gypsy (Dr. Wayne's wife and partner) answered back soon and told him strongly, "Reject the surgery. She told him that Dr. Wayne wanted him to increase the Isosorbide dose and she dscribed a little about the dangers of surgery. She gave him an appointment for last January.

Our experience with Dr. Wayne was very similar to yours. We arrived early to the appointment and waited for him in the small reception room. When we met him we thought he was at the most 70 years old.

He explained us in great detail his beliefs about angiograms, angioplasty and CABG. He also talked about angiogenesis and collateral circulation.

Then we moved to the next room and he did all his tests. He explained us everything he was doing.

He confirmed Nicholas heart was in great condition. I remember his very first words when he looked at the image in the echo machine: "Piece of cake". I know this may sound silly to most people, but for us, after being bombarded for weeks by the medical terrorists, it came as an enormous relief.

My husband also has high blood pressure. 190/120 while squeezing the instrument. He prescribed medication and told us to come back in a year.

I remember asking Dr. Howard if my husband needed to follow a special diet. His answer was "He's not sick, he's not fat, why do you want to put him on a diet?" :-)

We paid the $1600 and thanked Dr. Wayne. We also thanked God for letting us find him.

And now we are in the search of a new doctor. We are so saddened because of his death.

Besides sharing our story with you, I wanted to suggest you reading this: http://www.medicalconversation.com/showthread.php?t=84426 , though maybe you already know about it.

It´s a discussion of another Dr. Wayne's patient with a cardiologist in Atlanta.


Thanks again for your blog.

Best regards from Mexico City

Maria Iglesias

Thank you Maria. I am confident as long as we follow the medical regimen set forth by Dr. Wayne, we will be able to live to be 83 too. But we must take charge of our own health. We must not listen to the misinfomation of undertrained interventionalist cardiologists. We must seek out physicians who are believe the lives of their patients is more important than the number of zeros in the bank account, doctors who are invested in the health of people, not the wealth of their portfolio.

I urge others to join us in this campaign to make coronary artery bypasses about as common as adenoidectomies. Contact your friends and relatives who may have heart problems and be intimidated by their interventionalist cardiologist. Basically, that's about everyone over the age of 50.

I certainly urge everybody to buy Dr. Wayne's last book by going to his website. I bought two, one to loan to doctors who don't know and to patients of doctors who don't care.

Thanks for visiting my blog. We appreciaye your active support, not financial by any means. Publicity is more important than money in this battle.

Ramblings about Dr. Wayne

I was going through some of the files on my laptop yesterday and I came across a document Dr. Howard Wayne gave me last June during my last checkup with him before his death. He was excited about his book that would becoming out with weeks. I had told the doctor that if he wanted a testimonial or anything, I'd certainly be willing to provide one. I considered Howard Wayne the most giving and caring physician I ever met, and I have worked in the medical field since 1969.

At any rate, he said, "No, but you keep writing your blog and telling people that there is an alternative to coronary artery bypass grafts."

Since I began cranking out more and more articles and commentaries on this blog, I have been receiving a lot of reactions from patients and family members of patients who were treated by Dr. Wayne. It is incredible how similar their experiences with the medical community in general and cardiologists in particular have been with mine.

I have never received information or letters about any of Dr. Waynes' failures. I have searched for evidence that he has ever been sued for malpractice. I find no negative marks against this physician and that alone is a remarkable fete for a doctor who practiced as many years as Dr. Wayne did.

In January, there will be a memorial service in San Diego for Dr. Wayne. I don't have the date, time or place, yet, but when his lovely wife sends me that information, it will be posted on this blog. If I don't have too be in West Africa working on my job that would have been impossible to do had I allowed a cardio-thoracic surgeon to perform a 5-vessel bypass on me almost three years ago, I will be there with you all.
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Do You Want to Make A Difference?

Many of Dr. Wayne's patients or their spouses or children
have contacted me by e-mail to related their personal
stories about this fantastic physician. I would really like
to post them on this blog, with your permission. If you know
any other patients, send this blog address to them so they
also can contribute. We need to let the world know there IS
an alternative to cutting and invasive diagnostic tests.

HELP PEOPLE TAKE CHARGE OF THEIR HEALTH ISSUES AND
MEDICAL CARE LIKE WE DID.

Jeff Brailey
wordworks2001@yahoo.com

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Do No Harm

The oath all doctors take ends in the admonition "...do no harm." Yet interventionalist cardiologists, some well meaning and some just plain greedy, have been breaking that oath on a regular basis.

There are new stents out on the market and they have renewed an old controversey: should the cardiologist take drastic heroic-like measures to ttreat patients with invasive techniniques like angiograms, angioplasty, stents and coronary artery bypass surgery, or should they take a more conservative, less physically traumatic approach.

According to a story in today's Washington Post, there is accumulating evidence that new drug impregnated stents cause blood clots that can reblock the arteries. The Food and Drug Administration is holding an urgent two-day meeting of a panel of outside experts tomorrow to assess the devices, known as drug-eluting stents, including whether their risks outweigh their benefits.

"This is a public health issue of great importance," the FDA's Daniel Schultz said yesterday. "Our goal is to provide the American public with a coherent, understandable explanation of the risks and benefits associated with these products."

The situation, which has triggered an intense, sometimes bitter debate among cardiologists, illustrates the potential dangers of assuming that new technologies are necessarily superior and of adopting them widely before long-term studies are done, experts said.

"Everybody wants to be perceived as doing the most modern thing for their patients and fear being labeled someone who is old-fashioned and not using the latest and greatest thing," said Spencer King of the American College of Cardiology.

The issue also has major financial implications, with worldwide sales of drug-eluting stents now estimated at about $6 billion annually. Boston Scientific Corp. and Johnson & Johnson, which make the two drug-eluting stents sold in the United States, defend the safety of the devices.

The coronary artery bypass graft was in use well before Cleveland Clinic did any studies regarding its safety and efficacy and now noninvasive cardiologists are beginning to agree it is overprescribed. Now if we can only get the surgeons and hospitals weaned off of the big bucks they earn performing CABGs.

Interventionalists vs. Noninvasives

Here are some comments received about my last diatribe against CABG surgery. They come from an article I posted on http://www.bloggernews.net . I will update comments from this post using the title: Interventionalists vs. Noninvasives

Comment from Nancy Reyes
Time: December 5, 2006, 8:10 pm

SHHH…we docs know about angiogenesis. And if we could be sure that it would happen in our patients, we could spare the bypass surgery.

You see, I’ve been in medicine before they did bypasses, and you know what? Some people with stable angina lived for years, although many were misearable. Some got better. The only “treatment” was diet and exercize and nitroglycerin back then.

Similarly, we knew that a vegetarian low cal diet combined with a gradual increased exercize program would result in improvement almost as much as surgery. We’ve known that since 1970 (maybe before, but I graduated 1971).

Alas, it doesn’t work in the real world. You try telling grandma she needs to stop eating cannoli.

When they did a comparison study of diet/exercize/medicine vs bypass in the VA, they found the first group ended up having more heart attacks or having so many symptoms the guys insisted on the bypass.

You see, in the real world our patients don’t eat correctly, don’t exercize, and want a quick fix.

Now we have a third choice, stents, but they work better for one or two blockages, not someone with arteries that are full of junk.(i.e. diffuse arteriosclerotic placques).

Now, if these new stem cell injections work, maybe we can stop doing bypasses. Then I’ll agree with you.
In the meanwhile, continue what you’re doing. I love it when patients actually take care of their own health.

Comment from wordworks2001
Time: December 6, 2006, 1:38 am

Dr. Reyes, I don’t know if you are a cardiologist, but as a physician, you should know that the American Heart Association and the American College of Cardiologists, in their own standards, state CABGs should not be performed as the treatment of choice for CAD, except on the occassion of three specific locations of blockages, that are fairly rare, or when certain compromises of heart function have occurred. Yet for many America cardiologists, it is the treatment of choice.

My heart was healthy, according to the interventionalist. It was receiving oxygen. It was not eschemeic. Why then did he think a CABG would cure my angina? Didn’t he know about angiogenesis and collateral vessels? Why couldn’t he answer my questions about that then?

Don’t answer. Obviously he was more interested in the fee for the CABG he was going to assist on two days later than treating me appropriately with medication.

What did my noninvasive cardiologist do? He didn’t put me on a special diet. He took me off the Lipitor the interventionalist started and told me to never take it again. In fact, he told me to forget about cholesterol all together. He said he hadn’t had his cholesterol levels checked since he was in medical school and he attended long before you did.

One question doctor, If I was a walking time bomb in the spring of 2004 and I am still walking around the end of 2006, am I a dud of a walking time bomb or is my interventionalist cardiologist a dud?

Comment from wordworks2001
Time: December 6, 2006, 1:51 am

Oh, and Dr. Reyes,

Regarding the VA study you cited. How do you like this one?

Twenty-two Year Follow-up in the VA Cooperative Study of Coronary artery bypass surgery for Stable Angina. Peduzzi, P, Kamina A, Detrie, K, American Journal of Cardiology. 1998; 81; 1393-1399.

Between 1972 and 1974 354 patients with symptomatic coronary artery disease were assigned to conservative medical treatment and 332 with similar symptomatic coronary artery disease were assigned to surgical revascularization. The overall 22 year cumulative survival rate for the medically treated group was 25% while it was 20% in the surgically treated group. The probability of being free of heart attack was significantly higher in the medically treated group (57% vs. 41%). The authors conclude that the trial “provides strong evidence” that initial bypass surgery does not improve survival or reduce the overall risk of a future heart attack. On the contrary, invasively treated patients were much more likely to suffer a heart attack or die compared to patients who are not treated surgically.

I Don't Know What More I Can Do.

It's really difficult to get this message to people who already have had a coronary artery bypass. They are convinced their cardiologist is a saint and if it were not for him, they would have been dead a long time ago. Right, and the tooth fairy takes dentures. I am tired of pussy footing around the subject. If you did not get a second opinion from a noninvasive cardiologist when your interventional cardiologist told you you would have a heart attack or die if you didn't immediately have a bypass, you are a fool.

I started this blog nearly three years ago, after being told by a cardiologist, cardio-thoracic surgeon, and my own primary care physician, that I needed to have a quintuple coronary artery bypass within a day or I could be dead or have a heart attack. "Your heart is great," I was told, "but your coronary arteries are bad, very bad. You are a walking time bomb."

I thought that assessment rather strange. I had been walking this earth for the previous six months with frequent symptoms of angina that occurred each time I engaged in physically stressful activities. When I would rest, they would go away, troubling occurences I realized were cardiac in nature, but not so much that I worried about them.

"But doctor, if I have two coronary arteries that are 100% blocked and three that are 85% or more blocked, why is it my heart is in such great shape? Isn't it the job of the coronary arteries to keep my heart working by bringing oxygen? My heart must be getting oxygen from somewhere, right?" I asked.

Not one of these paragons of American medicine was able to answer my questions, or perhaps, they were able to, but unwilling. As I learned later, that was probably the case. I told my family doctor and the two consultants I hardly knew, no thank you, I do not want my chest cracked open this week, nor do I want to be on an operating table next week. In fact, so adverse am I to scapels, I think I'll get a second opinion. Despite their strong protestations, that's exactly what I did.

I found Dr. Howard Wayne on the Internet. He ran the NonInvasive Heart Clinic of San Diego
and he personally answered my email within a few hours and by that evening we were talking on the phone. He told me not to let anyone cut on me and we set up an appointment for the folling month in his San Diego office. The visit cost me $1600 out of pocket expense that my insurance would not cover. Far less costly than the quintuple bypass Indiana doctors wanted me to receive.

When I arrived at Dr. Wayne's office, I found a man who looked 15 years younger than his 81 years. In fact, it was only after his death while on vacation at Lake Tahoe this last October 23, that I learned Dr. Wayne's true age. He ran his clinic without a receptionist or nurse. But he did have medical equipment that must have cost a fortune. He didn't have a medical technician to do the tests, Dr. Wayne was a one man show.

After around two and a half hours of poking and prodding my chest with doppler devices and microphone looking gizmos, and listening very carefully to many areas of my heart through earphones, he announced, "Yeah, your coronary arteries are pretty useless. But that's not causing your angina."

"It's not?" I replied, surprised. "Nope. You've got high blood pressure," he said confidently without having yet measured my blood pressure.

"I've never had high blood pressure doctor," I politely responded. "It's always 120/70 or thereabouts."

"You don't know it, but every time you get angina pain, it is caused by hypertension," he said flatly.

Then he had me lay on the examining table and he put a blood pressure cuff on my left arm. He carefully put the stethescope bell on my arm and gently pumped the cuff up. He released the air slowly and then announced, "120/70."

"See, I told you," I said, a bit too smugly. "Now take this instrument and hold it in your right hand and squeeze it as hard as you can while holding your right arm up in the air. I took the grip-measuring device and did as I was told. A minute into the exercise, he took my blood pressure. It was 230/130. I was dumbfounded. He was right.

Dr. Wayne started me on a medication regimen and the angina went away. I won't get into what the drugs are, they are found in other threads on this blogsite. I will tell you why Dr. Wayne wasn't worried about my coronary artery disease.

Males, over 50, have a remarkable ability to generate new blood vessels whenever the ones they were born with are compromised by injury, or in my case, by the normal aging process. Yes, coronary artery disease is not really a disease. Often bypasses damage the new vessels a body is creating, doing more damage in the long run.

Let's look at what the American Heart Association says about angiogenesis, the creation of new blood vessels:

Angiogenesis is a natural process in the body that involves the growth of new blood vessels. It can occur during coronary artery disease, peripheral artery disease and stroke when there's insufficient blood supply and oxygen to the tissues, a condition known as ischemia. The body's first response to less blood flow to the heart is to grow tiny new "collateral" vessels to help blood flow around the blockage. For unknown reasons, the process eventually switches off. Some proteins in the body can help trigger new blood vessl growth and so increase the oxygen supply to the ischemic tissue. Such angiogenic proteins include the endothelial growth factor, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). Scientists are using gene therapy to copy this natural process by delivering angiogenic genes to ischemic tissue. For example, let's say the goal is to create or improve blood flow in peripheral (leg) or coronary (heart) arteries damaged by vascular disease. Then, the ability to "turn on" the angiogenesis gene could be a potentially powerful way to "grow" new blood vessels. Several scientific studies involving gene therapy trials for cardiovascular disease in humans are under way and look very promising. However, gene therapy still needs many improvements before it becomes routine treatment for cardiovascular disease in the clinic.

Yes, my body was building its own bypasses around the blocked arteries and Dr. Wayne said the medication will help nature take its course. He said within a year or so, my collateral vessels will replace the blocked arteries. Again, lets see what the American Heart Association says about collateral circulation:

What is collateral circulation?

This is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply. Everyone has collateral vessels, at least in microscopic form. These vessels normally aren't open. However, they grow and enlarge in some people with coronary heart disease or other blood vessel disease. While everyone has collateral vessels, they don't open in all people. How does collateral circulation help people with heart disease? When a collateral vessel on the heart enlarges, it lets blood flow from an open coronary artery to an adjacent one or further downstream on the same artery. In this way, collateral vessels grow and form a kind of "detour" around a blockage. This collateral circulation provides alternate routes of blood flow to the heart in cases when the heart isn't getting the blood supply it needs (myocardial ischemia) (mi"o-KAR'de-al is-KE'me-ah).

These are things your cardiologist doesn't want you to know. If you did, their scare tactics and coercion would be obvious. The Coronary Artery Bypass Graft is the most over-prescribed surgery in America and doctors should be ashamed that they violate their Hyppocratic Oaths with 95% of the CABGs they perform.

EXAMPLES OF COLLATERAL VESSELS

And the countdown continues

Well, the surgeons just couldn't let Chile's Pinnochett die a peaceful death at the age of 91. Nope, the old tyrant was going into heart failure so they simply had to strap him to an operating table and crack those ribs! I'm sure the old codger will have a much better quality of life after he recovers from his bypass.

Speaking of quality of life, my angina symptoms have pretty much disappeared and my BP is hanging in right where I want it to be, about 90/50. I can't say I am as good as new, but for a fellow who will be 59 next month and didn't allow the cutters to give him a quintuple bypass nearly three years ago to extend my life beyond the three months they said I would probably live, I feel a helluva lot better than Augusto Pinnochett.

If you are told you need a coronary bypass IMMEDIATELY or you may die or have a heart attack, tell your interventionalist cardiologist to put his pen in his pocket and throw away those permit papers with your name on them -- you are going to get a second opinion from a noninvasive cardiologist! And then get that second opinion.

Dr. Howard Wayne may be gone, but his website is still up and full of great lifesaving information. Visit it at www.heartprotect.com.

I am writing several articles a week for Blogger NewsNet. Check them out at www.bloggernews.net