To the Editor: The Clinical Crossroads article by Drs Carrozza and Sellke1 addresses the therapeutic options for a 69-year-old woman with disease of the left main coronary artery. Their discussion reflects state-of-the-art approaches2 ; promoting these surgical interventions rests on the assumption of the therapeutic inferiority of medical management. However, the medical vs surgical management studies were largely conducted in the 1970s and 1980s, well before aggressive medical therapies were used for management of ischemia (eg, optimizing nitrates, β-blockers, platelet inhibitors, and calcium channel blockers) or risk factor reduction (especially the present ability to dramatically reduce cholesterol levels).3 Current aggressive management of lipid levels leads to reduction of cardiovascular events within 6 months of initiating therapy.4 - 5 It would therefore be prudent to temper the therapeutic suggestions in this case with the caveat that the efficacy of current optimal medical management in disease of the left main coronary artery is unknown.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.