Evidenced Based Practice Paper - Essay Example

The patient population affected the significance of the problem, when the problem became significant, and the current practice and probable proposed change in practice will also be discussed. Spirit of Inquiry The topic of coronary artery bypass graft versus percutaneous coronary stent insertion was an interesting topic to me because I have been doing coronary artery bypass surgery for the past twelve years. During these twelve years, a decline in open coronary bypass has decreased in numbers drastically.

Invasive interventional radiology, a new trend in medicine to treat coronary disease without open surgery, has sent the open-heart surgery market down to non-existence. Stent placement has increased, but is it the best treatment? The populations involved in this treatment are adults having acute myocardial infarctions (MI) needing stent placement or open-heart surgery. The adult population being between the ages of 60-70 with an occasional patient in they’re fifties. One problem using stents, instead of opting for open surgery, is that a person could keep coming back for repeat stent placements due to reoccurring angina, thrombosis, and eventually ends up with open surgery after one year anyway (Cohen et al., 2011, p. 1016).

Another problem with stent placement is the incidence of stroke or death and quality of life (Kajimoto, Miyauchi, Yamamoto, Daida, & Amano, 2012, p. 155). This population is targeted because there is a higher incidence of Obesity, Diabetes Mellitus, Hypertension, Hypothyroidism, and Hyperlipidemia that are leading causes of Coronary Artery Disease. This clinical problem became a significant problem when stent placement during a cardiac catheterization is easier to do than open-heart surgery (Arjomand, McCormick, Turi, & et al., 2003, p. 790).

It has decreased open bypass drastically as mentioned above. With the stent placement, patients are on Plavix, which is expensive, and with the open procedure they are not required to be on blood thinners as a rule. I am really not sure if there is preferred current practices per say, but I think it is left up to the Interventional cardiologist. He decides who gets a stent, how many and if they should be consulted out to a heart surgeon. A good clinical example is a patient that was forty-two years old went to the catheterization lab and received four stents, two to the right coronary artery, one to the circumflex, and one to diagonal.

Two months later, the guy came back with angina and back pain. Another catheterization was done and his right coronary stent had a thrombosis and closed off. He then was consulted out to the heart surgeon. If the open procedure with arterial and vein grafts were done first this second catheterization could have been averted. On the other hand, who plays God and makes these guidelines and choices. To understand each procedure, Percutaneous Coronary Intervention (PCI) and Open Coronary Artery Bypass Graft