Meta-analysis comparing culprit vessel only versus multivessel percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock.
Humans; Recurrence; Retreatment; Percutaneous Coronary Intervention/methods; Coronary Artery Disease/therapy; Myocardial Infarction/mortality/therapy; Renal Insufficiency/epidemiology; Shock Cardiogenic/mortality
Cardiogenic shock (CS) after a myocardial infarction continues to be associated with high mortality. Whether percutaneous coronary intervention (PCI) of noninfarct coronary arteries (multivessel intervention [MVI]) improves outcomes in CS after acute myocardial infarction (AMI) remains controversial. MEDLINE, Cochrane CENTRAL, and Scopus databases were searched for original studies comparing MVI with culprit-vessel intervention (CVI) in AMI patients with multivessel disease and CS. Risk ratios (RRs) and 95% confidence intervals were calculated and pooled using a random effects model. Thirteen studies, consisting of 7,906 patients (n(MVI) = 1,937; n(CVI) = 5,969), were included in this meta-analysis. Overall, the MVI and CVI groups did not differ significantly in the risk of short-term mortality (RR: 1.06 [0.91, 1.23]; p = 0.45; I(2) = 75.82%), long-term mortality (RR: 0.93 [0.78, 1.11]; p = 0.37; I(2) = 67.92%), reinfarction (RR: 1.16 [0.75, 1.79]; p = 0.50; I(2) = 0%), revascularization (RR: 0.84 [0.48, 1.47]; p = 0.54; I(2) = 83.01%), bleeding (RR: 1.15 [0.96, 1.38]; p = 0.09, I(2) = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80, I(2) = 0%). However, significantly increased risk of renal failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004; I(2) = 0%). On subgroup analysis, it was seen that results from retrospective studies showed higher short-term mortality in the MVI group in comparison with prospective studies (p = 0.003). The certainty in estimates is low due to the largely observational nature of the evidence. In conclusion, MVI provides no additional reduction in short- or long-term mortality in AMI patients with multivessel disease and CS. Additionally, the risk of renal failure may be higher with the use of MVI.
Khan MS; Siddiqi TJ; Usman MS; Riaz H; Khan AR; Murad MH; Kalra A; Figueredo VM; Bhatt DL
The American journal of cardiology
2019
2019-01-15
Copyright © 2018. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2018.09.039" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2018.09.039</a>
PMID: 30420183
Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomized trial.
*Quality of Life; 80 and over; Adult; Aged; Bone Neoplasms/complications/psychology/*radiotherapy/*secondary; Dose Fractionation; Emotions; Female; Health Status; Humans; Male; Mental Health; Middle Aged; Pain Measurement; Pain/diagnosis/etiology/*prevention & control/psychology; Radiation; Retreatment; Surveys and Questionnaires; Time Factors; Treatment Outcome; Young Adult
PURPOSE: We previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. It is unknown whether alleviating pain also improves patient perception of quality of life (QOL). PATIENTS AND METHODS: We used the database of a randomized trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPI-PS), is associated with patient perception of benefit, as measured using the European Organisation for Resesarch and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI). Evaluable patients completed baseline and
Chow Edward; Meyer Ralph M; Chen Bingshu E; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Nabid Abdenour; Tissing-Tan Caroline J A; Oei Bing; Babington Scott; Demas William F; Wilson Carolyn F; Wong Rebecca K S; Brundage Michael
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
2014
2014-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1200/JCO.2014.57.6264" target="_blank" rel="noreferrer noopener">10.1200/JCO.2014.57.6264</a>
Safe Readministration of Intravenous Thrombolysis in Recurrent Basilar Thrombosis.
Aged; Basilar Artery; Basilar Artery – Drug Effects; Basilar Artery – Physiopathology; Basilar Artery/diagnostic imaging/*drug effects/physiopathology; Cerebral Angiography – Methods; Cerebral Angiography/methods; Computed Tomography Angiography; Drug Administration Schedule; Fibrinolytic Agents – Administration and Dosage; Fibrinolytic Agents – Adverse Effects; Fibrinolytic Agents/*administration & dosage/adverse effects; Humans; Infusions; Intracranial Thrombosis; Intracranial Thrombosis – Drug Therapy; Intracranial Thrombosis – Physiopathology; Intracranial Thrombosis/diagnostic imaging/*drug therapy/physiopathology; Intravenous; Magnetic Resonance Imaging; Male; medication safety; Recombinant Proteins – Administration and Dosage; Recombinant Proteins/administration & dosage; Recurrence; recurrent stroke; Repeat Procedures; Retreatment; thrombolysis; Thrombolytic Therapy – Adverse Effects; Thrombolytic Therapy – Methods; Thrombolytic Therapy/adverse effects/*methods; Thrombosis; Time Factors; Tissue Plasminogen Activator – Administration and Dosage; Tissue Plasminogen Activator – Adverse Effects; Tissue Plasminogen Activator/*administration & dosage/adverse effects; Treatment Outcome; Treatment Outcomes
We report a patient who had recurrence of stroke in the basilar artery territory because of repeat thrombosis, and was administered intravenous recombinant tissue plasminogen activator (IV-rtPA) twice within a span of 3 weeks without any adverse events, with radiological evidence of successful thrombolysis. Because of minor and improving stroke symptoms with IV-rtPA, endovascular therapy was not performed and there was radiological evidence of recanalization with IV-rtPA alone. This report adds to the very limited literature on the topic demonstrating safe and successful use of repeat IV thrombolysis following a previous recent stroke.
Khan Alina; Itrat Ahmed
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.066" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2017.09.066</a>