scholarly journals MODERN SURGICAL APPROACHES TO THE TREATMENT OF COMBINED ATHEROSCLEROTIC DAMAGE OF THE CORONARY AND CAROTID ARTERIES

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
R RAKHIMOVA ◽  
D ALIMOV
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Randomized Clinical Trials ◽  
Carotid Artery Disease ◽  
Artery Bypass ◽  
Carotid Stenting ◽  
Risk Level ◽  
Surgical Approaches ◽  
Number Of Patients ◽  
Artery Disease

The number of patients with brachiocephalic artery disease and coronary artery disease (CHD) is steadily increasing. Despite the achieved results in the surgical treatment of patients with lesions of the brachiocephalic arteries and concomitant coronary artery disease, the world has not yet reached a consensus on the tactics of treating this group of patients. Most patients with concomitant coronary and carotid artery disease have a combination of two or more risk factors for neurological complications. In addition, for elderly patients, the time of artificial circulation and the duration of the operation are of decisive importance. An increase in this time is inevitable with a single-stage surgical operation. Carotid endarterectomy or carotid stenting is indicated before or simultaneously with coronary artery bypass grafting in symptomatic patients with 80% carotid stenosis (LE: C). However, until data from randomized clinical trials are available, the surgical approach to patients with severe coronary and carotid lesions will be individualized, based on the specific risk level of each patient and the experience of the institution.

scholarly journals Effect of redundant clinical trials from mainland China evaluating statins in patients with coronary artery disease: cross sectional study

BMJ ◽  
2021 ◽  
pp. n48
Author(s):  
Yuanxi Jia ◽  
Jiajun Wen ◽  
Riaz Qureshi ◽  
Stephan Ehrhardt ◽  
David D Celentano ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trials ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Randomized Clinical Trials ◽  
Mainland China ◽  
Statin Treatment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Artery Disease

Abstract Objective To identify redundant clinical trials evaluating statin treatment in patients with coronary artery disease from mainland China, and to estimate the number of extra major adverse cardiac events (MACEs) experienced by participants not treated with statins in those trials. Design Cross sectional study. Setting 2577 randomized clinical trials comparing statin treatment with placebo or no treatment in patients with coronary artery disease from mainland China, searched from bibliographic databases to December 2019. Participants 250 810 patients with any type of coronary artery disease who were enrolled in the 2577 randomized clinical trials. Main outcome measures Redundant clinical trials were defined as randomized clinical trials that initiated or continued recruiting after 2008 (ie, one year after statin treatment was strongly recommended by clinical practice guidelines). The primary outcome is the number of extra MACEs that were attributable to the deprivation of statins among patients in the control groups of redundant clinical trials—that is, the number of extra MACEs that could have been prevented if patients were given statins. Cumulative meta-analyses were also conducted to establish the time points when statins were shown to have a statistically significant effect on coronary artery disease. Results 2045 redundant clinical trials were identified published between 2008 and 2019, comprising 101 486 patients in the control groups not treated with statins for 24 638 person years. 3470 (95% confidence interval 3230 to 3619) extra MACEs were reported, including 559 (95% confidence interval 506 to 612) deaths, 973 (95% confidence interval 897 to 1052) patients with new or recurrent myocardial infarction, 161 (132 to 190) patients with stroke, 83 (58 to 105) patients requiring revascularization, 398 (352 to 448) patients with heart failure, 1197 (1110 to 1282) patients with recurrent or deteriorated angina pectoris, and 99 (95% confidence interval 69 to 129) unspecified MACEs. Conclusions Of more than 2000 redundant clinical trials on statins in patients with coronary artery disease identified from mainland China, an extra 3000 MACEs, including nearly 600 deaths, were experienced by participants not treated with statins in these trials. The scale of redundancy necessitates urgent reform to protect patients.

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