scholarly journals Increased patency with comparable mortality and revascularization risk: Is the case for no-touch vein harvesting open and shut?

2021 ◽  
Author(s):  
Makoto Hibino ◽  
Nitish Dhingra ◽  
Subodh Verma
Keyword(s):  
Graft Failure ◽  
Saphenous Vein Graft ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Wound Complications ◽  
Graft Occlusion ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
The Impact ◽  
Vein Harvesting

Since the introduction of the saphenous vein graft (SVG) for coronary artery bypass grafting (CABG) in 19621, the SVG has remained the most commonly used conduit to the non-LAD territories for more than half a century. However, several issues surrounding the use of SVGs, including higher graft occlusion rates and wound complications from the harvesting process, have been identified in clinical practice. As such, significant interest has been dedicated towards developing harvesting techniques that minimize the risk of these acute and late complications. In this issue of the Journal of Cardiac Surgery, Yokoyama and colleagues compared the impact of open vein harvesting (OVH), endoscopic vein harvesting (EVH) and no-touch vein harvesting (NT) on all-cause mortality, revascularization and graft failure, using a network meta-analysis based on randomized controlled trials and propensity-score matched studies. The results showed that the risk of graft failure was approximately halved amongst patients receiving NT compared with EVH and OVH; importantly, though, NT was not associated with lower all-cause mortality or revascularization risk. To further examine whether the use of NT grafts endow patients with better long-term clinical outcomes, such as mortality, myocardial infarction, and revascularization rates, a large-scaled randomized controlled trial or a patient-level combined meta-analysis is required.

scholarly journals Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

2021 ◽  
Author(s):  
Robert Robinson ◽  
Vidhya Prakash ◽  
Raad Al Tamimi ◽  
Nour Albast ◽  
Basma Al-Bast ◽  
...  
Keyword(s):  
Usual Care ◽  
English Language ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Hospitalized Patients ◽  
Randomized Controlled ◽  
Analysis Process ◽  
All Cause Mortality ◽  
The Impact

AbstractBackgroundThe COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir.This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process.MethodsMeta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021.ResultsFour English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients.Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%.ConclusionsThis meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

Statins and Major Adverse Limb Events in Patients with Peripheral Artery Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 120 (05) ◽  
pp. 866-875 ◽  
Author(s):  
Daniele Pastori ◽  
Alessio Farcomeni ◽  
Alberto Milanese ◽  
Francesco Del Sole ◽  
Danilo Menichelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Artery Disease ◽  
Meta Analysis ◽  
Graft Occlusion ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Statin Prescription ◽  
Secondary Endpoints ◽  
Artery Disease ◽  
The Impact

Abstract Background Statins are guidelines recommended in patients with peripheral artery disease (PAD) for the prevention of cardiovascular (CV) events. Comprehensive meta-data on the impact of statins on major adverse limb events (MALE) in PAD patients are lacking. We examined the association of statin use with MALE in patients with PAD. Methods We performed a systematic review (registered at PROSPERO: number CRD42019137111) and metanalysis of studies retrieved from PubMed (via MEDLINE) and Cochrane (CENTRAL) databases addressing the impact of statin on MALE including amputation and graft occlusion/revascularization. Secondary endpoints were all-cause death, composite CV endpoints, CV death, and stroke. Results We included 51 studies with 138,060 PAD patients, of whom 48,459 (35.1%) were treated with statins. The analysis included 2 randomized controlled trials, 20 prospective, and 29 retrospective studies. Overall, 11,396 MALE events, 21,624 deaths, 4,852 composite CV endpoints, 4,609 CV deaths, and 860 strokes were used for the analysis. Statins reduced MALE incidence by 30% (pooled hazard ratio [HR]: 0.702; 95% confidence interval [CI]: 0.605–0.815) and amputations by 35% (HR: 0.654; 95% CI: 0.522–0.819), all-cause mortality by 39% (pooled HR: 0.608, 95% CI: 0.543–0.680), CV death by 41% (HR: 0.594; 95% CI: 0.455–0.777), composite CV endpoints by 34% (pooled HR: 0.662; 95% CI: 0.591–0.741) and ischemic stroke by 28% (pooled HR: 0.718; 95% CI: 0.620–0.831). Conclusion Statins reduce the incidence of MALE, all-cause, and CV mortality in patients with PAD. In PAD, a high proportion of MALE events and deaths could be prevented by implementing a statin prescription in this patient population.

Perioperative Beta-Blocker for Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Sue Hyun Kim ◽  
Myoung-jin Jang ◽  
Ho Young Hwang
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Beta Blocker ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Randomized Controlled ◽  
Online Databases ◽  
The Impact

Abstract Background This meta-analysis was conducted to evaluate the impact of perioperative use of beta-blocker (BB) on postoperative atrial fibrillation (POAF) after cardiac surgery other than isolated coronary artery bypass grafting (CABG). Methods Five online databases were searched. Studies were included if they (1) enrolled patients who underwent cardiac surgery other than isolated CABG and (2) demonstrated the impact of perioperative use of BB on POAF based on the randomized controlled trial or adjusted analysis. The primary outcome was the occurrence rates of POAF after cardiac surgery. A meta-regression and subgroup analysis were performed according to the proportion of patients with cardiac surgery other than isolated CABG and the timing of BB use, respectively. Results Thirteen articles (5 randomized and 8 nonrandomized studies: n = 25,496) were selected. Proportion of enrolled patients undergoing cardiac surgery other than isolated CABG ranged from 7 to 100%. The BBs were used in preoperative, postoperative, and both periods in 5, 5, and 3 studies, respectively. The pooled analyses showed that the risk of POAF was significantly lower in patients with perioperative BB than those without (odds ratio, 95% confidence interval = 0.56, 0.35–0.91 and 0.70, 0.55–0.91 in randomized and nonrandomized studies, respectively). The risk of POAF was lower in the BB group irrespective of the proportion of nonisolated CABG. Benefit regarding in-hospital mortality was inconclusive. Perioperative stroke and length of stay were not significantly different between BB and non-BB groups. Conclusions Perioperative use of BB is effective in preventing POAF even in patients undergoing cardiac surgery other than isolated CABG, although it did not translate into improved clinical outcomes.

Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions

2019 ◽  
Author(s):  
Jacob A Rohde ◽  
Joshua O Barker ◽  
Seth M Noar
Keyword(s):  
Randomized Controlled Trial ◽  
Psychological Distress ◽  
Medication Adherence ◽  
Patient Outcomes ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Ehealth Intervention ◽  
The Impact ◽  
Clinic Hospital

Abstract Gastrointestinal (GI) illness interventions are increasingly utilizing eHealth technologies, yet little is currently known about the extent of their impact on patient outcomes. The purpose of this study was to conduct a meta-analysis of the GI eHealth intervention literature. We used a comprehensive search strategy to locate studies. To be included, studies had to be a randomized controlled trial comparing an eHealth intervention condition against a no-treatment or waitlist control condition. Studies had to report data on at least one of the following patient outcomes: medication adherence, quality of life (QoL), psychological distress, illness-related knowledge, or number of patient visits to the clinic/hospital. Analyses weighted effect sizes (d) by their inverse variance and combined them using random effects meta-analytic procedures. K = 19 studies conducted in eight countries with a cumulative sample size of N = 3,193 were meta-analyzed. Findings indicated that GI eHealth interventions improved patients’ QoL (d = .25, p = .008), psychological distress (d = .24, p = .017), medication adherence (d = .17, p = .014), and illness-related knowledge (d = .19, p = .002). GI eHealth interventions also significantly reduced the number of patient visits to the clinic/hospital (d = .78, p = .005). Our findings suggest that eHealth interventions hold promise in improving patient outcomes for those with GI illnesses. We suggest the next generation of GI interventions continue developing and evaluating the impact of technology using randomized controlled trial designs, and perhaps consider adapting existing efficacious interventions for burgeoning platforms, such as smartphones and tablets.

P182 Implantable cardioverter defibrillator in old age patients with cardiomyopathy : a meta-analysis and systematic review

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
N Tokavanich ◽  
N Prasitlumkum ◽  
V Kittipibul ◽  
W Mongkonsritragoon ◽  
A Ariyachaipanich
Keyword(s):  
Randomized Controlled Trial ◽  
Prospective Cohort ◽  
Ischemic Cardiomyopathy ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Cardioverter Defibrillator ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Performance Bias

Abstract Introduction Implantable cardioverter defibrillator (AICD) showed benefit for primary prevention of death in cardiomyopathy, but still controversy in elderly. We performed a systematic review and meta analysis to the benefit of AICD for primary prevention of death in patients age ≥ 65 with cardiomyopathy according to 2017 ACC/AHA guideline for the Management Ventricular Arrhythmias and 2015 ESC guideline for Management of Ventricular Arrythmias. Method We comprehensively searched the databases of MEDLINE, EMBASE and SCOPUS from inception to October 2018. Included studies with prospective and retrospective cohort design. Studies those compared all-cause mortality in elderly patients who has been implanted with AICD versus none. Data of each studies were combined with random effects model, subgroup analysis for each types of studies were done. All the results were reported in hazard ration (HR) and 95% confidence intervals. Result Nine studies from March 2002 to October 2018 were included in meta-analysis (Five randomized controlled trial and Four cohort studies) involving 20,656  patients. AICD implantation showed benefit in reduction of all-cause mortality in patients older than 65 years.( pooled hazard ratio =  0.72, 95% confidence interval: 0.64 – 0.81, I2 = 56.3%),however pool hazard ratio from subgroup analysis with only randomized controlled trial did not demonstrate effectiveness of this intervention. (pooled hazard ratio 0.78, 95% confidence interval: 0.61 – 1, I2= 49.5%) Conclusion  AICD could benefit in reduction of all-cause mortality in aged patients. However randomized controlled trial with larger population in this group is needed. Clinical characteristics of studies Author Year Study type Total population Age of participant (year) Type of cardiomyopathy NYHA FC Median follow up ( months) Outcome definition Quality assessment Bias for RCT Mezu 2011 Prospective cohort 485 ≥ 80 Ischemic and non-ischemic cardiomyopathy II - III 12 All-cause mortality Newcastle - ottawa : Fair Kober (DANISH) 2016 Randomize controlled trial 393 ≥ 68 Non ischemic cardiomyopathy II - III 67.6 All-cause mortality Performance bias Chan 2009 Prospective cohort 852 ≥ 65 Ischemic and non-ischemic cardiomyopathy N/A 34 ± 16 All-cause mortality Newcastle - ottawa : Fair Kadish (DEFINITE) 2004 Randomize controlled trial 157 ≥ 65 Non ischemic cardiomyopathy I - III 29 ± 14.4 All-cause mortality Performance bias Bristow (COMPANION) 2004 Randomize controlled trial 853 ≥ 65 Ischemic and non-ischemic cardiomyopathy III - IV 16.5 All-cause mortality Performance bias Moss ( MADIT II) 2002 Randomize controlled trial 436 ≥ 70 Ischemic cardiomyopathy I - III 20 All-cause mortality Performance bias Groeneveld 2008 Prospective cohort 14250 ≥ 65 Ischemic and non-ischemic cardiomyopathy I - IV 24 All-cause mortality Newcastle - ottawa : Fair Bardy ( SCD HEFT) 2005 Randomize controlled trial 578 ≥ 65 Ischemic and non-ischemic cardiomyopathy II - III 45.5 All-cause mortality Performance bias Pokorney 2015 Retrospective cohort 852 ≥ 65 Ischemic and non-ischemic cardiomyopathy IV 36 All-cause mortality Newcastle - ottawa : Fair Abstract P182 Figure. Forest plot of elderly with AICD vs none

scholarly journals A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Giannoula S. Tansarli ◽  
Nikolaos Andreatos ◽  
Elina E. Pliakos ◽  
Eleftherios Mylonakis
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Content Type ◽  
Randomized Controlled ◽  
Short Course ◽  
All Cause Mortality ◽  
Retrospective Cohort Studies ◽  
Long Course

ABSTRACT The duration of antibiotic therapy for bacteremia due to Enterobacteriaceae is not well defined. We sought to evaluate the clinical outcomes with shorter- versus longer-course treatment. We performed a systematic search of the PubMed and EMBASE databases through May 2018. Studies presenting comparative outcomes between patients receiving antibiotic treatment for ≤10 days (“short-course”) and those treated for >10 days (“long-course”) were considered eligible. Four retrospective cohort studies and one randomized controlled trial comprising 2,865 patients met the inclusion criteria. The short- and long-course antibiotic treatments did not differ in 30-day all-cause mortality (1,374 patients; risk ratio [RR] = 0.99; 95% confidence interval [CI], 0.69 to 1.43), 90-day all-cause mortality (1,750 patients; RR = 1.16; 95% CI, 0.81 to 1.66), clinical cure (1,080 patients; RR = 1.02; 95% CI, 0.96 to 1.08), or relapse at 90 days (1,750 patients; RR = 1.08; 95% CI, 0.69 to 1.67). In patients with bacteremia due to Enterobacteriaceae, the short- and long-course antibiotic treatments did not differ significantly in terms of clinical outcomes. Further well-designed studies are needed before treatment for 10 days or less is adopted in clinical practice.

scholarly journals The impact of selenium administration on severe sepsis or septic shock: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
pp. 277-85
Author(s):  
Lin Kong ◽  
Qing Wu ◽  
Bo Liu
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
The Impact

Introduction: The efficacy of selenium administration to treat severe sepsis or septic shock remains controversial. We con- duct a systematic review and meta-analysis to explore the impact of selenium administration on severe sepsis or septic shock. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020 for randomized controlled trials (RCTs) assessing the effect of selenium administration on severe sepsis or septic shock. Me- ta-analysis is performed using the random-effect model. Results: Five RCTs involving 1482 patients are included in the meta-analysis. Overall, compared with control group in septic patients, selenium administration is not associated with reduced 28-day mortality (RR=0.93; 95% CI=0.73 to 1.19; P=0.58), but results in substantially decreased all-cause mortality (RR=0.78; 95% CI=0.63 to 0.98; P=0.03) and length of hospital stay (MD=-3.09; 95% CI=-5.68 to -0.50; P=0.02). Conclusion: Selenium administration results in notable decrease in all-cause mortality and length of hospital stay, but shows no substantial influence on the 28-day mortality, length of ICU stay, duration of vasopressor therapy, the incidence of acute renal failure, adverse events, and serious adverse events for septic patients. Keywords: Selenium administration; septic shock; randomized controlled trials.

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