Pub Date : 2017-12-01Epub Date: 2017-11-17DOI: 10.1136/ebmed-2017-110830
Jaspreet Kaur Khaira
Using a highly sensitive assay of serum troponin T in patients with suspected myocardial infarction might help in early diagnosis, but the method needs thorough clinical assessment before implementation. ### Summary box The High Sensitivity Cardiac Troponin T Assay for Rapid Rule-out of Acute Myocardial Infarction trial was a prospective, multicentre, diagnostic study done at 12 sites, across three continents to validate the diagnostic accuracy of the troponin T 0-hour/1-hour algorithm for rule-in and rule-out of acute myocardial infarction.1 Current troponin assays for the diagnosis of myocardial infarction usually require serial sampling between 8 and 24 hours, depending on the specific assay/local protocols. This time interval contributes to ‘rule-in’ delays, delaying treatment, and ‘rule-out’ delays, costing time, …
{"title":"Evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T1.","authors":"Jaspreet Kaur Khaira","doi":"10.1136/ebmed-2017-110830","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110830","url":null,"abstract":"Using a highly sensitive assay of serum troponin T in patients with suspected myocardial infarction might help in early diagnosis, but the method needs thorough clinical assessment before implementation.\u0000\u0000### Summary box\u0000\u0000The High Sensitivity Cardiac Troponin T Assay for Rapid Rule-out of Acute Myocardial Infarction trial was a prospective, multicentre, diagnostic study done at 12 sites, across three continents to validate the diagnostic accuracy of the troponin T 0-hour/1-hour algorithm for rule-in and rule-out of acute myocardial infarction.1 \u0000\u0000Current troponin assays for the diagnosis of myocardial infarction usually require serial sampling between 8 and 24 hours, depending on the specific assay/local protocols. This time interval contributes to ‘rule-in’ delays, delaying treatment, and ‘rule-out’ delays, costing time, …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"235-236"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35563792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-17DOI: 10.1136/ebmed-2017-110861
Jeffrey K Aronson
Journal clubs have many functions, including the provision of a forum for developing skills in critical appraisal, an essential part of being a competent clinician. From early on, journal clubs reported their proceedings in academic journals. The Zoological Journal Club of Michigan , for example, regularly reported its activities in the journal Science (see figure 1). Table 1 lists a selection of other journals that publish journal club articles, showing the wide range of topics covered. Modern methods of conducting journal clubs include the use of online media to encourage interactive discussion,1 including blogs,2 twitter,3 and virtual journal clubs.4 Figure 1 The contents page of Science for Friday 7 December 1900, listing the proceedings of the Zoological Journal Club of the University of Michigan . View this table: Table 1 Some journals that publish articles under the heading ‘Journal Club’ It is therefore appropriate that Evidence-Based Medicine (EBM) should feature a regular journal club report. In order to find out how others run journal clubs and the effects that they …
{"title":"Journal Clubs: 2. Why and how to run them and how to publish them.","authors":"Jeffrey K Aronson","doi":"10.1136/ebmed-2017-110861","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110861","url":null,"abstract":"Journal clubs have many functions, including the provision of a forum for developing skills in critical appraisal, an essential part of being a competent clinician.\u0000\u0000From early on, journal clubs reported their proceedings in academic journals. The Zoological Journal Club of Michigan , for example, regularly reported its activities in the journal Science (see figure 1). Table 1 lists a selection of other journals that publish journal club articles, showing the wide range of topics covered. Modern methods of conducting journal clubs include the use of online media to encourage interactive discussion,1 including blogs,2 twitter,3 and virtual journal clubs.4 \u0000\u0000\u0000\u0000Figure 1 \u0000The contents page of Science for Friday 7 December 1900, listing the proceedings of the Zoological Journal Club of the University of Michigan .\u0000\u0000\u0000\u0000View this table:\u0000\u0000Table 1 \u0000Some journals that publish articles under the heading ‘Journal Club’\u0000\u0000\u0000\u0000It is therefore appropriate that Evidence-Based Medicine (EBM) should feature a regular journal club report.\u0000\u0000In order to find out how others run journal clubs and the effects that they …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"232-234"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35563795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-10-22DOI: 10.1136/ebmed-2017-110783
Bhavin B Adhyaru, Terry A Jacobson
Commentary on : Gupta A and ASCOT investigators. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017;389:2473–81. Several studies suggest that the low adherence rates with statin therapy are related to adverse events, particularly statin-associated muscle symptoms (SAMS).1 Rates of SAMS are found to be much higher in observational studies (10%–20%) compared with randomised controlled trials (RCTs) (1%–3%), which often find little difference in adverse events between statin and placebo groups.2 3 This study, having both blinded and unblinded phases, offers a unique perspective in looking at adverse events with statin therapy. The first trial phase was a randomised, blinded phase that included 10 180 patients aged 40–79 years with …
{"title":"Unblinded ASCOT study results do not rule out that muscle symptoms are an adverse effect of statins.","authors":"Bhavin B Adhyaru, Terry A Jacobson","doi":"10.1136/ebmed-2017-110783","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110783","url":null,"abstract":"Commentary on : Gupta A and ASCOT investigators. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017;389:2473–81.\u0000\u0000Several studies suggest that the low adherence rates with statin therapy are related to adverse events, particularly statin-associated muscle symptoms (SAMS).1 Rates of SAMS are found to be much higher in observational studies (10%–20%) compared with randomised controlled trials (RCTs) (1%–3%), which often find little difference in adverse events between statin and placebo groups.2 3 This study, having both blinded and unblinded phases, offers a unique perspective in looking at adverse events with statin therapy.\u0000\u0000The first trial phase was a randomised, blinded phase that included 10 180 patients aged 40–79 years with …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"210"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110783","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35535244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-10-11DOI: 10.1136/ebmed-2017-110815
David A Talan
Commentary on : Daum RS, Miller LG, Immergluck LA, et al . Placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545–55. The primary treatment of a skin abscess is drainage. Past studies of adjunctive antibiotic treatment conducted before and after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the USA and other parts of the world were small and did not clearly demonstrate benefit. In 2016, Talan et al 1 reported a US randomised placebo-controlled trial (RCT) among 1265 mostly adults, including some with co-morbidities, which demonstrated that treatment with an antibiotic possessing in vitro activity against MRSA, trimethoprim–sulfamethoxazole (TMP-SMX), was associated with a significantly higher short-term cure rate among patients with a drained skin abscess ≥2 cm in diameter. TMP-SMX-treated participants also had fewer additional drainage procedures and new site skin infections through 4–6 post-treatment. Overall adverse event rates were similar, with slightly …
{"title":"Adjunctive antibiotics for drained skin abscesses improve clinical cure rate.","authors":"David A Talan","doi":"10.1136/ebmed-2017-110815","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110815","url":null,"abstract":"Commentary on : Daum RS, Miller LG, Immergluck LA, et al . Placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545–55.\u0000\u0000The primary treatment of a skin abscess is drainage. Past studies of adjunctive antibiotic treatment conducted before and after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the USA and other parts of the world were small and did not clearly demonstrate benefit. In 2016, Talan et al 1 reported a US randomised placebo-controlled trial (RCT) among 1265 mostly adults, including some with co-morbidities, which demonstrated that treatment with an antibiotic possessing in vitro activity against MRSA, trimethoprim–sulfamethoxazole (TMP-SMX), was associated with a significantly higher short-term cure rate among patients with a drained skin abscess ≥2 cm in diameter. TMP-SMX-treated participants also had fewer additional drainage procedures and new site skin infections through 4–6 post-treatment. Overall adverse event rates were similar, with slightly …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"214"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35441511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.1136/ebmed-2016-110633
Charles de Mestral
Commentary on : Sutton AJ, Vohra RS, Hollyman M, et al . Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology. Br J Surg 2016;104:98–107. Randomised trial and population-based data support the clinical benefit of early over delayed laparoscopic cholecystectomy for acute cholecystitis.1 Concern of increased risk of major bile duct injury or death with early surgery in the setting of acute inflammation has been refuted and there is 20%–30% risk of recurrent gallstone symptoms if surgery is delayed.2 Early and delayed surgery have also been previously compared with economic models informed by randomised controlled trial and population-based data. While most studies have focused on acute cholecystitis, Sutton and colleagues have considered patients across the spectrum of symptomatic cholelithiasis—biliary colic and cholecystitis—requiring hospitalisation. This study …
{"title":"Don't put off until tomorrow what you can do today: Early cholecystectomy is cost-effective in symptomatic cholelithiasis requiring hospitalization.","authors":"Charles de Mestral","doi":"10.1136/ebmed-2016-110633","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110633","url":null,"abstract":"Commentary on : Sutton AJ, Vohra RS, Hollyman M, et al . Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology. Br J Surg 2016;104:98–107.\u0000\u0000Randomised trial and population-based data support the clinical benefit of early over delayed laparoscopic cholecystectomy for acute cholecystitis.1 Concern of increased risk of major bile duct injury or death with early surgery in the setting of acute inflammation has been refuted and there is 20%–30% risk of recurrent gallstone symptoms if surgery is delayed.2 Early and delayed surgery have also been previously compared with economic models informed by randomised controlled trial and population-based data. While most studies have focused on acute cholecystitis, Sutton and colleagues have considered patients across the spectrum of symptomatic cholelithiasis—biliary colic and cholecystitis—requiring hospitalisation.\u0000\u0000This study …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 6","pages":"221"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9213423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-10-22DOI: 10.1136/ebmed-2017-110825
Claudia C Dobler, M Hassan Murad
Practitioners of evidence-based medicine commonly encounter diagnostic tests with continuous results and no gold standard. In contrast, the traditional critical appraisal teachings assume a binary test (2×2 table) with a gold standard. In this guide, we use the example of the tuberculin skin test to illustrate a simple approach facilitated by using stratum-specific likelihood ratios and odds of developing future patient-important events. This approach can aid practitioners in the interpretation and application of diagnostic tests to patient care.
{"title":"Interpreting diagnostic tests with continuous results and no gold standard: a common scenario explained using the tuberculin skin test.","authors":"Claudia C Dobler, M Hassan Murad","doi":"10.1136/ebmed-2017-110825","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110825","url":null,"abstract":"<p><p>Practitioners of evidence-based medicine commonly encounter diagnostic tests with continuous results and no gold standard. In contrast, the traditional critical appraisal teachings assume a binary test (2×2 table) with a gold standard. In this guide, we use the example of the tuberculin skin test to illustrate a simple approach facilitated by using stratum-specific likelihood ratios and odds of developing future patient-important events. This approach can aid practitioners in the interpretation and application of diagnostic tests to patient care.</p>","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35535241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-10DOI: 10.1136/ebmed-2017-110727
Erik Solligård, Jan Kristian Damås
Commentary on : Raith EP, Udy AA, Bailey M, et al . Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017;317:290–300. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) has redefined sepsis, now defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ failure defined as a two-or-more-point change in the Sequential Organ Failure Assessment (SOFA) score.1 The new sepsis definition was determined in a retrospective cohort of both intensive care unit (ICU) and non-ICU encounters.2 The quick SOFA (qSOFA) score (altered mentation, systolic blood pressure ≤100 mm Hg and respiratory rate ≥22/min) was also introduced as a possible useful predictive tool among patients outside the ICU. This external validation study compares the discrimination …
{"title":"SOFA criteria predict infection-related in-hospital mortality in ICU patients better than SIRS criteria and the qSOFA score.","authors":"Erik Solligård, Jan Kristian Damås","doi":"10.1136/ebmed-2017-110727","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110727","url":null,"abstract":"Commentary on : Raith EP, Udy AA, Bailey M, et al . Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017;317:290–300.\u0000\u0000The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) has redefined sepsis, now defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ failure defined as a two-or-more-point change in the Sequential Organ Failure Assessment (SOFA) score.1 The new sepsis definition was determined in a retrospective cohort of both intensive care unit (ICU) and non-ICU encounters.2 The quick SOFA (qSOFA) score (altered mentation, systolic blood pressure ≤100 mm Hg and respiratory rate ≥22/min) was also introduced as a possible useful predictive tool among patients outside the ICU.\u0000\u0000This external validation study compares the discrimination …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"211"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35543509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-09DOI: 10.1136/ebmed-2017-110858
Jack O'Sullivan
Forty years after its discovery, a reanalysis of the two largest trials to date, controversially suggests that prostate-specific antigen (PSA) screening may actually be beneficial. Most healthcare organisations do not recommend PSA screening for prostate cancer,1 2 mainly in response to conflicting evidence about the benefits and clear evidence of harms. PSA can lead to false positive or ‘overdiagnosed’ cancer (detecting prostate cells that histologically represent cancer, but will never grow to cause a patient harm). Evidence regarding efficacy has been based on two large randomised controlled trials: The European Randomised Study of Screening for Prostate Cancer (ERSPC)3 and Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).4 These trials are both considered to be of high quality, but the trials came to …
{"title":"Controversies in PSA screening.","authors":"Jack O'Sullivan","doi":"10.1136/ebmed-2017-110858","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110858","url":null,"abstract":"Forty years after its discovery, a reanalysis of the two largest trials to date, controversially suggests that prostate-specific antigen (PSA) screening may actually be beneficial.\u0000\u0000Most healthcare organisations do not recommend PSA screening for prostate cancer,1 2 mainly in response to conflicting evidence about the benefits and clear evidence of harms. PSA can lead to false positive or ‘overdiagnosed’ cancer (detecting prostate cells that histologically represent cancer, but will never grow to cause a patient harm).\u0000\u0000Evidence regarding efficacy has been based on two large randomised controlled trials: The European Randomised Study of Screening for Prostate Cancer (ERSPC)3 and Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).4 These trials are both considered to be of high quality, but the trials came to …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"198"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35593209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-10DOI: 10.1136/ebmed-2017-110837
Vignesh T Packiam, Scott E Eggener
Commentary on : Wilt TJ, Jones KM, Barry MJ, et al . Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017;377:132–42. Screening, diagnosis and management of localised prostate cancer remains controversial. Prostate Cancer Intervention Versus Observation Trial (PIVOT) was a randomised controlled trial that accrued 731 men with prostate cancer (PCa) between 1994 and 2002 from Veterans Affairs hospitals. Patients were randomised to radical prostatectomy (n=364) or observation (n=367). Inclusion criteria was clinical stage T1–T2 (organ confined), prostate-specific antigen (PSA) 10 years. Primary and secondary outcomes were all-cause and prostate-cancer mortality. Median age was 67 years, median PSA 7.8 ng/mL and 45% of patients were clinical stage T2 (palpable on exam). After 19.5 years follow-up (median 12.7 years), cumulative all-cause mortality was similar between surgery and observation (61.3% vs 66.8%; HR 0.84; 95% CI 0.70 …
{"title":"Minimal difference in survival between radical prostatectomy and observation in men with modest life expectancy.","authors":"Vignesh T Packiam, Scott E Eggener","doi":"10.1136/ebmed-2017-110837","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110837","url":null,"abstract":"Commentary on : Wilt TJ, Jones KM, Barry MJ, et al . Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017;377:132–42.\u0000\u0000Screening, diagnosis and management of localised prostate cancer remains controversial.\u0000\u0000Prostate Cancer Intervention Versus Observation Trial (PIVOT) was a randomised controlled trial that accrued 731 men with prostate cancer (PCa) between 1994 and 2002 from Veterans Affairs hospitals. Patients were randomised to radical prostatectomy (n=364) or observation (n=367). Inclusion criteria was clinical stage T1–T2 (organ confined), prostate-specific antigen (PSA) 10 years. Primary and secondary outcomes were all-cause and prostate-cancer mortality.\u0000\u0000Median age was 67 years, median PSA 7.8 ng/mL and 45% of patients were clinical stage T2 (palpable on exam). After 19.5 years follow-up (median 12.7 years), cumulative all-cause mortality was similar between surgery and observation (61.3% vs 66.8%; HR 0.84; 95% CI 0.70 …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"222"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35543508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-04DOI: 10.1136/ebmed-2017-110841
Talla A Rousan, Udho Thadani
Commentary on: Ledwoch J, Fuernau G, Desch S, et al . Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock. Heart 2017;103:1177–84. Early revascularisation improves acute and long-term outcomes of patients presenting with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, which type of stent to use for revascularisation remains controversial. Earlier small single-centre non-randomised study and registry data concluded that a drug-eluting stent (DES) is superior to a bare metal stent (BMS) as it improved clinical outcomes in these patients.1 2 Current European Society Guidelines recommend the use of DES, while American Society guidelines do not. This study examined the impact of BMS versus DES use on clinical outcomes in patients who had participated in the previously reported the Intra-aortic Balloon Pump (IABP) in Cardiogenic Shock II Trial (IABP-SHOCK II) which showed …
{"title":"Stent choice in cardiogenic shock complicating acute myocardial infarction likely does not affect mortality or reinfarction.","authors":"Talla A Rousan, Udho Thadani","doi":"10.1136/ebmed-2017-110841","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110841","url":null,"abstract":"Commentary on: Ledwoch J, Fuernau G, Desch S, et al . Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock. Heart 2017;103:1177–84.\u0000\u0000Early revascularisation improves acute and long-term outcomes of patients presenting with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, which type of stent to use for revascularisation remains controversial. Earlier small single-centre non-randomised study and registry data concluded that a drug-eluting stent (DES) is superior to a bare metal stent (BMS) as it improved clinical outcomes in these patients.1 2 Current European Society Guidelines recommend the use of DES, while American Society guidelines do not. This study examined the impact of BMS versus DES use on clinical outcomes in patients who had participated in the previously reported the Intra-aortic Balloon Pump (IABP) in Cardiogenic Shock II Trial (IABP-SHOCK II) which showed …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":" ","pages":"224"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35522287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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