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Randomized trials in cardiology

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https://www.readbyqxmd.com/read/28329235/improving-public-health-by-improving-clinical-trial-guidelines-and-their-application
#1
Martin J Landray, Jeroen J Bax, Laurence Alliot, Marc Buyse, Adam Cohen, Rory Collins, Gerhard Hindricks, Stefan K James, Sile Lane, Aldo P Maggioni, Ann Meeker-O'Connell, Gunnar Olsson, Stuart J Pocock, Michael Rawlins, Jonathan Sellors, Kaori Shinagawa, Karin R Sipido, Liam Smeeth, Richard Stephens, Murray W Stewart, Wendy Gattis Stough, Fergus Sweeney, Frans Van de Werf, Kerrie Woods, Barbara Casadei
Evidence generated from randomized controlled trials forms the foundation of cardiovascular therapeutics and has led to the adoption of numerous drugs and devices that prolong survival and reduce morbidity, as well as the avoidance of interventions that have been shown to be ineffective or even unsafe. Many aspects of cardiovascular research have evolved considerably since the first randomized trials in cardiology were conducted. In order to be large enough to provide reliable evidence about effects on major outcomes, cardiovascular trials may now involve thousands of patients recruited from hundreds of clinical sites in many different countries...
March 8, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28316035/management-of-percutaneous-coronary-intervention-complications
#2
REVIEW
Gregory Means, Christopher End, Prashant Kaul
With the recent increase in complex coronary interventions including percutaneous coronary intervention (PCI) for chronic total occlusions and complex higher risk (and indicated) patients, the spectrum of potential periprocedural complications and their prompt management has become even more relevant. Vascular access-related problems remain the most prevalent of all PCI complications and with randomized controlled trial data from over 20,000 patients supporting the superiority of radial over femoral access in reducing bleeding and vascular complications, a default radial strategy should be promoted...
April 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28294862/-revascularization-in-stable-ischemic-heart-disease-whether-to-change-the-approach
#3
L L Bershtein, N O Katamadze, A E Golovina, S A Sayganov
Current international guidelines on stable ischemic heart disease (IHD) state that coronary revascularization is indicated in cases of: limiting ischemic symptoms while on optimal medical therapy (OMT); high risk coronary anatomy; high risk stress test result. At the same time, many results supporting these conclusions were obtained in relatively old studies, conducted when the approaches to medical therapy and revascularization techniques differed greatly from contemporary practice. Many of the conclusions have been based on data from observational studies and subanalyses of randomized clinical trials, therefore methodologically are not sufficiently reliable...
April 2016: Kardiologiia
https://www.readbyqxmd.com/read/28290558/-real-world-data-on-novel-oral-anticoagulants-the-added-value-of-registries-and-observational-studies-focus-on-apixaban
#4
Francesco Pelliccia, Gaetano Tanzilli, Michele Schiariti, Nicola Viceconte, Cesare Greco, Carlo Gaudio
Anticoagulant therapy has been used with great effect for decades for the prevention of stroke among patients with atrial fibrillation. In recent years, the therapeutic armamentarium has been strengthened considerably, with the addition of anticoagulants acting through novel pathways. The currently available novel agents are apixaban, rivaroxaban and dabigatran. These novel oral anticoagulants (NOACs) were approved for use on the basis of major clinical trials clearly demonstrating improved risk reductions compared to warfarin for stroke and/or major bleeding events...
December 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28290162/tavr-in-intermediate-risk-patients-a-review-of-the-partner-2-trial-and-its-future-implications
#5
Sameer Arora, Cassandra J Ramm, Jacob A Misenheimer, John P Vavalle
BACKGROUND: Following publication of the results of the PARTNER trial, the American College of Cardiology/American Heart Association recognized the success of transcatheter aortic valve replacement (TAVR) by incorporating it as a feasible option in high-surgical risk patients, and recommending it as the standard of care for patients at prohibitive risk of surgery. Although this was recognized as a major success in the field of percutaneous valve replacement, surgical aortic valve replacement (SAVR) continued to be realized as the procedure of choice for low and intermediate surgical risk patients...
November 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28289528/clinical-cardiac-regenerative-studies-in-children
#6
REVIEW
Imre J Pavo, Ina Michel-Behnke
Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients...
February 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28286245/pacing-as-a-treatment-for-reflex-mediated-vasovagal-situational-or-carotid-sinus-hypersensitivity-syncope-a-systematic-review-for-the-2017-acc-aha-hrs-guideline-for-the-evaluation-and-management-of-patients-with-syncope-a-report-of-the-american-college-of-cardiology
#7
Paul D Varosy, Lin Y Chen, Amy L Miller, Peter A Noseworthy, David J Slotwiner, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined...
March 9, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28286220/pacing-as-a-treatment-for-reflex-mediated-vasovagal-situational-or-carotid-sinus-hypersensitivity-syncope-a-systematic-review-for-the-2017-acc-aha-hrs-guideline-for-the-evaluation-and-management-of-patients-with-syncope-a-report-of-the-american-college-of-cardiology
#8
Paul D Varosy, Lin Y Chen, Amy L Miller, Peter A Noseworthy, David J Slotwiner, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined...
March 3, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28275942/bioresorbable-polymers-and-stent-devices
#9
REVIEW
Payam Dehghani
Percutaneous coronary interventions will never become obsolete, as evolution is inherent to interventional cardiology. Current drug-eluting platforms have appreciably improved their safety and efficacy profiles in different clinical settings compared to first-generation devices such that it is difficult to consider other alternatives. However, there is definite biological plausibility to consider devices with bioabsorbable polymers and/or scaffolds. It is also an undeniable fact that many patients, based on variety of belief systems, would prefer not to have a permanently implanted device...
February 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28267469/acute-coronary-syndrome-quality-improvement-in-kerala-acs-quik-rationale-and-design-for-a-cluster-randomized-stepped-wedge-trial
#10
Mark D Huffman, Padinhare Purayil Mohanan, Raji Devarajan, Abigail S Baldridge, Dimple Kondal, Lihui Zhao, Mumtaj Ali, Donald M Lloyd-Jones, Dorairaj Prabhakaran
Ischemic heart disease is the leading cause of death in India, and there are likely more myocardial infarctions in India than in any other country in the world. We have previously reported heterogeneous care for patients with myocardial infarction in Kerala, a state in southern India, including both gaps in optimal care and inappropriate care. Based on that prior work, limitations from previous nonrandomized quality improvement studies and promising gains in process of care measures demonstrated from previous randomized trials, we and the Cardiological Society of India-Kerala chapter sought to develop, implement, and evaluate a quality improvement intervention to improve process of care measures and clinical outcomes for these patients...
March 2017: American Heart Journal
https://www.readbyqxmd.com/read/28255434/efficacy-and-safety-of-the-target-specific-oral-anticoagulants-for-stroke-prevention-in-atrial-fibrillation-the-real-life-evidence
#11
REVIEW
Vincenzo Russo, Anna Rago, Riccardo Proietti, Federica Di Meo, Andrea Antonio Papa, Paolo Calabrò, Antonio D'Onofrio, Gerardo Nigro, Ahmed AlTurki
The aim of our article is to provide a concise review for clinicians entailing the main studies that evaluated the efficacy and safety of target-specific oral anticoagulants (TSOAs) for thromboembolic stroke prevention in the real-world setting. Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias that requires anticoagulation therapy to prevent stroke and systemic embolism. TSOAs, dabigatran, apixaban and rivaroxaban have become available as an alternative to warfarin anticoagulation in nonvalvular atrial fibrillation (NVAF)...
February 2017: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/28243397/effect-of-fluoxetine-administration-on-clinical-and-echocardiographic-findings-in-patients-with-mitral-valve-prolapse-and-generalized-anxiety-disorder-randomized-clinical-trial
#12
Reza Jafarzadeh Esfehani, Homan Kamranian, Majid Jalalyazdi
BACKGROUND: Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. OBJECTIVE: The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. METHODS: This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015...
January 2017: Electronic Physician
https://www.readbyqxmd.com/read/28242586/feasibility-and-safety-of-direct-catheter-based-thrombectomy-in-the-treatment-of-acute-ischemic-stroke-cooperation-of-cardiologists-neurologists-and-radiologists-prospective-registry-prague-16
#13
Petr Widimsky, Boris Koznar, Tomas Peisker, Peter Vasko, Filip Rohac, Jana Vavrova, Josef Kroupa, Ivana Stetkarova
AIMS: The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology center. METHODS AND PATIENTS: Single center, prospective observational registry based on the prespecified protocol included 3 months follow-up. The decision to perform acute stroke intervention was done by a neurologist based on the clinical and imaging findings...
February 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28236615/effects-of-music-therapy-on-endothelial-function-in-patients-with-coronary-artery-disease-participating-in-aerobic-exercise-therapy
#14
Marina Deljanin Ilic, Radmila F Pavlovic, Gordana Kocic, Dejan Simonovic, Gordana Lazarevic
Context • Pleasant music that evokes a positive emotional response may activate brain pathways of the insular cortex, central nucleus of the amygdala, and lateral hypothalamus, which are involved in the integration of emotional and ambient sensory input, with corresponding autonomic responses. Exercise training can improve endothelium-dependent vasodilatation, both in epicardial coronary vessels and in resistance vessels, for patients with coronary heart disease. Objective • The aim of the present study was to evaluate the effects on endothelial function when patients with stable coronary artery disease (CAD) listened to their favorite music...
February 27, 2017: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#15
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28170357/on-x-valve-the-next-generation-aortic-valve
#16
REVIEW
Rahul Chaudhary, Jalaj Garg, Parasuram Krishnamoorthy, Neeraj Shah, Bruce A Feldman, Matthew W Martinez, Ronald Freudenberger
The On-X valve is a newer generation mechanical bileaflet valve. Its key features include the use of pure pyrolytic carbon (devoid of silicon), a length-to-diameter ratio similar to a native valve, an inlet flared orifice, a leaflet opening up to 90 degrees, a shorter leaflet closing angle, a 2-point leaflet contact, and an actuated pivot. These features have translated into increased strength, improved valve hemodynamics, reduced hemolysis, and thrombogenicity. The 2014 American Heart Association/American College of Cardiology guidelines for the management of patients with valvular heart disease recommend an international normalized ratio (INR) of 2...
March 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28164009/infarct-related-artery-only-versus-complete-revascularization-in-st-segment-elevation-myocardial-infarction-and-multi-vessel-disease-a-meta-analysis
#17
Satyanarayana R Vaidya, Santhosh R Devarapally, Sameer Arora
BACKGROUND: The 2015 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) focused update on primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) only gives a class II b (weak) indication for non-infarct artery intervention at the time of primary PCI. Recent randomized controlled trials, however, suggest strong evidence supporting complete revascularization. METHODS: A systematic search was conducted in PUBMED, MEDLINE, EMBASE and Cochrane central register for randomized controlled trials comparing complete versus infarct artery (IRA) only revascularization in patients with STEMI...
February 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28151503/-contrast-induced-acute-kidney-injury-in-cardiology
#18
Eugenio Genovesi, Mattia Romanello, Raffaele De Caterina
The intravascular administration of contrast media is an important tool in cardiovascular imaging, especially in percutaneous coronary interventions (PCI). Owing to the widespread use of these procedures, contrast-induced acute kidney injury (CI-AKI) has become one of the most common types of acute renal failures. CI-AKI is mainly mediated by mechanisms of oxidative damage, and its onset is associated with prolonged hospitalization and significant morbidity and mortality. Preexisting chronic kidney disease, diabetes, age, heart failure, and characteristics related to the procedure (primary or elective PCI, type and amount of contrast medium) are the most important risk factors for the development of post-PCI CI-AKI...
December 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28144168/a-multicenter-prospective-randomized-study-comparing-the-efficacy-of-escalating-higher-biphasic-versus-low-biphasic-energy-defibrillations-in-patients-presenting-with-cardiac-arrest-in-the-in-hospital-environment
#19
Venkataraman Anantharaman, Seow Yian Tay, Peter George Manning, Swee Han Lim, Terrance Siang Jin Chua, Mohan Tiru, Rabind Antony Charles, Vidya Sudarshan
BACKGROUND: Biphasic defibrillation has been practiced worldwide for >15 years. Yet, consensus does not exist on the best energy levels for optimal outcomes when used in patients with ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT). METHODS: This prospective, randomized, controlled trial of 235 adult cardiac arrest patients with VF/VT was conducted in the emergency and cardiology departments. One group received low-energy (LE) shocks at 150-150-150 J and the other escalating higher-energy (HE) shocks at 200-300-360 J...
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28143414/impact-of-oral-hygiene-involving-toothbrushing-versus-chlorhexidine-in-the-prevention-of-ventilator-associated-pneumonia-a-randomized-study
#20
Claudia Fernanda de Lacerda Vidal, Aurora Karla de Lacerda Vidal, José Gildo de Moura Monteiro, Aracele Cavalcanti, Ana Paula Trindade Henriques, Márcia Oliveira, Michele Godoy, Mirella Coutinho, Pollyanna Dutra Sobral, Claudia Ângela Vilela, Bárbara Gomes, Marta Amorim Leandro, Ulisses Montarroyos, Ricardo de Alencar Ximenes, Heloísa Ramos Lacerda
BACKGROUND: Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP). METHODS: The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0...
January 31, 2017: BMC Infectious Diseases
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