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Randomized trials in cardiology

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https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28139220/usefulness-of-drug-eluting-balloons-for-bare-metal-and-drug-eluting-in-stent-restenosis-from-the-ribs-iv-and-v-randomized-trials
#7
Fernando Alfonso, María José Pérez-Vizcayno, Bruno García Del Blanco, Arturo García-Touchard, José-Ramón López-Mínguez, Manel Sabaté, Javier Zueco, Rafael Melgares, Rosana Hernández, Raul Moreno, Antonio Domínguez, Juan Sanchís, Cesar Moris, José Moreu, Angel Cequier, Rafael Romaguera, Fernando Rivero, Javier Cuesta, Nieves Gonzalo, Pilar Jiménez-Quevedo, Alberto Cárdenas, Cristina Fernández
Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared...
January 5, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28130653/addressing-knowledge-gaps-in-the-2013-acc-aha-guideline-on-the-assessment-of-cardiovascular-risk-a-review-of-recent-coronary-artery-calcium-literature
#8
REVIEW
Vasanth Sathiyakumar, Roger S Blumenthal, Khurram Nasir, Seth S Martin
PURPOSE OF REVIEW: Coronary artery calcium (CAC) has been proposed as an integrator of information from traditionally measured, non-traditionally measured, and unmeasured risk factors for coronary atherosclerosis. The 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk identified several knowledge gaps regarding CAC, including radiation risks, cost-effectiveness, and improving discrimination and reclassification of estimated risk over the Pooled Cohort Equations in the ACC/AHA Atherosclerotic Cardiovascular Disease Estimator...
February 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28104075/challenges-in-infective-endocarditis
#9
REVIEW
Thomas J Cahill, Larry M Baddour, Gilbert Habib, Bruno Hoen, Erwan Salaun, Gosta B Pettersson, Hans Joachim Schäfers, Bernard D Prendergast
Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations...
January 24, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28077091/transradial-versus-transfemoral-approach-for-coronary-angiography-and-angioplasty-a-prospective-randomized-comparison
#10
Fayaz Ahmad Bhat, Khalid Hamid Changal, Hameed Raina, Nisar Ahmad Tramboo, Hilal Ahmad Rather
BACKGROUND: PCI has been done traditionally through transfemoral route. But now transradial and transbrachial routes are also coming up in practice. We compared transradial versus transfemoral routes for ease of operability, time for procedure, complications, and failure rates through a prospective study. METHODS: Four hundred Patients admitted in department of cardiology for percutaneous interventions were enrolled in the study. 200 patients were assigned to each group randomly...
January 11, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28068415/same-day-discharge-versus-overnight-stay-in-the-hospital-following-percutaneous-coronary-intervention-in-patients-with-stable-coronary-artery-disease-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#11
Pravesh Kumar Bundhun, Mohammad Zafooruddin Sani Soogund, Wei-Qiang Huang
BACKGROUND: New research in interventional cardiology has shown the demand for percutaneous coronary interventions (PCI) to have increased tremendously. Effective treatment with a lower hospital cost has been the aim of several PCI capable centers. This study aimed to compare the adverse clinical outcomes associated with same day discharge versus overnight stay in the hospital following PCI in a population of randomized patients with stable coronary artery disease (CAD). METHODS: The National Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized Controlled Trials and EMBASE databases were searched (from March to June 2016) for randomized trials comparing same-day discharge versus overnight stay in the hospital following PCI...
2017: PloS One
https://www.readbyqxmd.com/read/28028979/a-controlled-trial-of-the-efficacy-of-a-training-walking-program-in-patients-recovering-from-abdominal-aortic-aneurysm-surgery
#12
Bartosz R Wnuk, Jacek Durmała, Krzysztof Ziaja, Przemysław Kotyla, Marek Woźniewski, Edward Błaszczak
BACKGROUND: Major surgical procedures as well as general anesthesia contribute to muscle weakness and posture instability and may result in increased postoperative complications and functional disorders resulting from an elective operation. OBJECTIVES: We aim to state the significance of backward walking as a form of interval march training with patients after abdominal aortic aneurysm surgery. MATERIAL AND METHODS: Sixty-five patients were randomly divided into three subgroups and three various models of physiotherapy were applied...
November 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/28007135/sex-based-differences-in-outcomes-with-transcatheter-aortic-valve-therapy-tvt-registry-from-2011-to-2014
#13
Jaya Chandrasekhar, George Dangas, Jennifer Yu, Sreekanth Vemulapalli, Sunil Suchindran, Amit N Vora, Usman Baber, Roxana Mehran
BACKGROUND: A differential impact of sex has been observed in transcatheter aortic valve replacement (TAVR) outcomes from small observational studies and subgroup analyses of randomized trials. OBJECTIVES: The goal of this study was to compare the in-hospital and 1-year outcomes in male and female subjects from the U.S. nationwide TAVR registry. METHODS: National data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were used for in-hospital outcomes, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events...
December 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27993908/implantable-cardioverter-defibrillator-for-nonischemic-cardiomyopathy-an-updated-meta-analysis
#14
LETTER
Harsh Golwala, Navkaranbir Singh Bajaj, Garima Arora, Pankaj Arora
No abstract text is available yet for this article.
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/27931592/the-rationale-for-performance-of-coronary%C3%A2-angiography-and-stenting-before-transcatheter-aortic-valve-replacement-from-the-interventional-section-leadership-council-of-the-american-college-of-cardiology
#15
REVIEW
Stephen Ramee, Saif Anwaruddin, Gautam Kumar, Robert N Piana, Vasilis Babaliaros, Tanveer Rab, Lloyd W Klein
Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy...
December 12, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27909495/the-wearable-cardioverter-defibrillator-toy-or-tool
#16
REVIEW
David Duncker Md, Christian Veltmann Md
After the success story of implantable cardioverter/defibrillator systems, prevention of sudden cardiac death (SCD) remains one of the main duties in cardiology. For patients with unkown or transient risk profile for SCD, a wearable cardioverter/defibrillator (WCD) has been established for temporary and effective prevention of sudden arrhythmic death. Several studies have shown safety and efficacy of the WCD, even though randomized studies proving a mortality benefit are still lacking. This review provides an overview of actual WCD data and usage, special indications and possible risks and complications...
April 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27895488/advances-in-the-management-of-heart-failure-the-role-of-ivabradine
#17
REVIEW
Ursula Müller-Werdan, Georg Stöckl, Karl Werdan
A high resting heart rate (≥70-75 b.p.m.) is a risk factor for patients with heart failure (HF) with reduced ejection fraction (EF), probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If) of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect...
2016: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/27867524/varying-effects-of-recommended-treatments-for-heart-failure-with-reduced-ejection-fraction-meta-analysis-of-randomized-controlled-trials-in-the-esc-and-accf-aha-guidelines
#18
REVIEW
Marius Mark Thomsen, Christian Lewinter, Lars Køber
The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included...
December 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27803727/effectiveness-of-acupressure-on-the-taichong-acupoint-in-lowering-blood-pressure-in-patients-with-hypertension-a-randomized-clinical-trial
#19
Gan-Hon Lin, Wei-Chun Chang, Kuan-Ju Chen, Chen-Chen Tsai, Sung-Yuan Hu, Li-Li Chen
Objectives. To evaluate the effectiveness of acupressure on the Taichong acupoint in lowering systolic and diastolic blood pressure (BP) in hypertensive patients. Methods. Eighty patients with hypertension attending a cardiology outpatient department in central Taiwan were included in this randomized clinical trial. Acupressure was applied to the Taichong acupoint in the experimental group (n = 40) and to the first metatarsal (sham acupoint) in the control group (n = 40). Blood pressure was measured by electronic monitoring before and immediately 15 min and 30 min after acupressure...
2016: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/27777324/the-prognostic-effect-of-cardiac-rehabilitation-in-the-era-of-acute-revascularisation-and-statin-therapy-a-systematic-review-and-meta-analysis-of-randomized-and-non-randomized-studies-the-cardiac-rehabilitation-outcome-study-cros
#20
REVIEW
Bernhard Rauch, Constantinos H Davos, Patrick Doherty, Daniel Saure, Maria-Inti Metzendorf, Annett Salzwedel, Heinz Völler, Katrin Jensen, Jean-Paul Schmid
BACKGROUND: The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. DESIGN: Structured review and meta-analysis. METHODS: Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later...
October 24, 2016: European Journal of Preventive Cardiology
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