The American journal of cardiology
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Review Meta Analysis
Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection.
Numerous studies have examined whether plasma D-dimer (DD) can be used to identify patients with acute aortic dissection (AAD). These studies have been inconclusive because of their limited sample sizes and the different cut-off values employed. We aimed to conduct a systematic review and meta-analysis to examine the utility of plasma DD as a screening tool for AAD. ⋯ Negative LR showed an excellent discriminative ability (0.06, 95% CI 0.03 to 0.12), whereas positive LR did not (2.43, 95% CI 1.89 to 3.12). In conclusion, our meta-analysis suggests that plasma DD <500 ng/ml is a useful screening tool to identify patients who do not have AAD. Plasma DD may thus be used to identify subjects who are unlikely to benefit from further aortic imaging.
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This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared to drug-eluting stenting (DES) in patients with diabetes mellitus and multivessel coronary artery disease (CAD). CABG has been the preferred revascularization strategy in patients with diabetes compared to DES. Drug-eluting stents reduce the rate of target vessel revascularization compared to bare-metal stents. ⋯ There was no significant difference in death (OR 0.85, 95% CI 0.52 to 1.39) or myocardial infarction (OR 0.82, 95% CI 0.41 to 1.61). Patients in the CABG group had a higher risk for cerebrovascular events (OR 2.15, 95% CI 0.99 to 4.68). In conclusion, PCI with DES is safe and may represent a viable alternative to CABG for selected patients with diabetes with multivessel CAD.
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The aim of this study was to compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease. The current American College of Cardiology and American Heart Association guidelines recommend CABG for the treatment of patients with ULMCA disease on the basis of clinical trials demonstrating a survival benefit with CABG compared to medical therapy. DES reduce the rate of target vessel revascularization compared with bare-metal stents in ULMCA PCI and may be a safe alternative to CABG. ⋯ At 1-year follow-up, there was no significant difference between the CABG and DES groups in the risk for death (odds ratio [OR] 1.12, 95% confidence interval [CI] 0.80 to 1.56) or the composite end point of death, myocardial infarction, or stroke (OR 1.25, 95% CI 0.86 to 1.82). The risk for target vessel revascularization was significantly lower in the CABG group compared to the PCI group (OR 0.44, 95% CI 0.32 to 0.59). In conclusion, PCI with DES is safe and could represent a good alternative to CABG for selected cases in patients with ULMCA disease.
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Review Meta Analysis
An evidence-based review of the cardiovascular risks of nonsteroidal anti-inflammatory drugs.
Nonsteroidal anti-inflammatory drugs (NSAIDs), both nonselective and cyclooxygenase-2-specific inhibitors, are commonly used medications for the relief of acute and chronic pain associated with a wide range of medical conditions. Because of the extensive use of these agents, adverse events that occur infrequently may still affect the overall risk/benefit ratio of this class of medications. ⋯ The investigators review the key clinical trials, meta-analyses of clinical trials, and epidemiologic studies on the subject of the CV safety of NSAIDs and identify key variables that define the CV risk of the NSAIDs. In conclusion, it is important that cardiologists, who are not among those physicians frequently prescribing NSAIDs, have a particular responsibility to have up-to-date, thoughtfully synthesized information about the CV risks of these drugs, especially when administered to patients receiving low-dose aspirin for cardioprotection.
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Review Meta Analysis
Review and meta-analysis of randomized controlled clinical trials of remote ischemic preconditioning in cardiovascular surgery.
To determine whether remote ischemic preconditioning (RIPC) is beneficial for patients who undergo cardiovascular surgery (CVS), a systematic review and meta-analysis of randomized controlled clinical trials of RIPC for the prevention of myocardial injury in CVS was performed. All prospective randomized controlled clinical trials of RIPC versus control that enrolled patients who underwent CVS were identified using a 2-level search strategy. First, a public-domain database (Medline) was searched using a Web-based search engine (PubMed). ⋯ In total, this meta-analysis included data on 184 patients who underwent CVS randomized to RIPC or control. Pooled analysis of the 4 trials demonstrated a statistically significant reduction in biomarkers of myocardial injury with RIPC relative to control (standardized mean difference -0.81, 95% confidence interval -1.29 to -0.33, p = 0.0010). In conclusion, the present study, the first systematic review and meta-analysis of randomized controlled clinical trials, demonstrated a statistically significant benefit of RIPC over control for reduction in biomarkers of myocardial injury in CVS patients.