This systematic review and meta-analysis of 12 randomized clinical trials with over 7,000 patients compared outcomes of percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) in patients with stable coronary artery disease over a mean follow-up of 4.9 years. The analysis found no significant differences in all-cause mortality, cardiovascular death, nonfatal heart attack, or need for revascularization between PCI and OMT. Patients who received PCI had greater freedom from chest pain symptoms compared to those receiving OMT alone. The review indicates that PCI does not provide additional clinical benefits over OMT for stable coronary artery disease patients, though it may improve chest pain.
"If you don't take a temperature, you can't find a fever...(The House of God)" James Sartain cleverly uses case studies to highlight attitudes, issues and management of acute pain in ICUs. He'll make you think as he uncovers the discrepancies between guidelines and clinical practice. This podcast was recorded at BCC4.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
This document summarizes an article about how clinical informatics tools can help make patient consultations more efficient. It provides guidelines for assessing the severity of asthma exacerbations in children and outlines the steps for acute asthma management in an emergency department. Recording clinical data from patient encounters enables clinicians to better understand local service needs, compare performance to other health systems, and continuously improve care over time.
The document discusses definitions of remission for rheumatoid arthritis (RA) and the goals of treating RA. It provides context on the history of RA treatment goals moving from symptom relief to preventing joint damage and achieving remission. The key points are:
1) Definitions of remission have evolved from the original ACR criteria to the 2011 ACR-EULAR definition, which includes boolean and index-based definitions for use in clinical trials.
2) Achieving early remission through aggressive treatment is associated with better long-term outcomes for RA patients.
3) The 2011 definition was developed for clinical trials but needs validation for use in practice to guide treatment and measure remission.
This document summarizes recent evidence on medical treatments, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for stable coronary artery disease. Key findings include:
1) Large clinical trials found no significant difference in outcomes between PCI and optimal medical therapy for stable CAD patients.
2) CABG was shown to reduce mortality, myocardial infarction, and repeat revascularization compared to medical therapy or PCI for multi-vessel disease.
3) For left main coronary artery disease, CABG may be preferable to PCI for patients with high anatomical complexity scores.
4) Ongoing trials like ISCHEMIA are further evaluating optimal revascularization strategies for stable CAD patients with ischemia.
This document summarizes the history of cardiac catheterization and key figures in its development. It describes how William Harvey discovered the circulatory system in the 17th century. A French researcher in 1844 first used catheters in horses to record heart pressures, coining the term "cardiac catheterization." In 1929, Werner Forssmann performed the first human cardiac catheterization by inserting a catheter into his own heart, advancing the field. In 1958, Mason Sones accidentally injected dye into a patient's coronary artery, allowing visualization of coronary arteries and advancement of bypass surgery. Andreas Gruentzig later developed balloon angioplasty to treat coronary artery disease.
Left main disease pci vs cabg excel trial 2016Kunal Mahajan
This randomized controlled trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) for the treatment of left main coronary artery disease. The primary outcome was a composite of death, stroke, or myocardial infarction at 3 years. PCI was found to be non-inferior to CABG for the primary outcome. At 30 days, PCI had fewer adverse events like infections and bleeding, but more deaths, strokes and MIs. Between 30 days and 3 years, ischemia-driven revascularization was more common with PCI. Longer follow-up is still needed given differences in long-term medication use and revascularization between the treatments.
"If you don't take a temperature, you can't find a fever...(The House of God)" James Sartain cleverly uses case studies to highlight attitudes, issues and management of acute pain in ICUs. He'll make you think as he uncovers the discrepancies between guidelines and clinical practice. This podcast was recorded at BCC4.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
This document summarizes an article about how clinical informatics tools can help make patient consultations more efficient. It provides guidelines for assessing the severity of asthma exacerbations in children and outlines the steps for acute asthma management in an emergency department. Recording clinical data from patient encounters enables clinicians to better understand local service needs, compare performance to other health systems, and continuously improve care over time.
The document discusses definitions of remission for rheumatoid arthritis (RA) and the goals of treating RA. It provides context on the history of RA treatment goals moving from symptom relief to preventing joint damage and achieving remission. The key points are:
1) Definitions of remission have evolved from the original ACR criteria to the 2011 ACR-EULAR definition, which includes boolean and index-based definitions for use in clinical trials.
2) Achieving early remission through aggressive treatment is associated with better long-term outcomes for RA patients.
3) The 2011 definition was developed for clinical trials but needs validation for use in practice to guide treatment and measure remission.
This document summarizes recent evidence on medical treatments, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for stable coronary artery disease. Key findings include:
1) Large clinical trials found no significant difference in outcomes between PCI and optimal medical therapy for stable CAD patients.
2) CABG was shown to reduce mortality, myocardial infarction, and repeat revascularization compared to medical therapy or PCI for multi-vessel disease.
3) For left main coronary artery disease, CABG may be preferable to PCI for patients with high anatomical complexity scores.
4) Ongoing trials like ISCHEMIA are further evaluating optimal revascularization strategies for stable CAD patients with ischemia.
This document summarizes the history of cardiac catheterization and key figures in its development. It describes how William Harvey discovered the circulatory system in the 17th century. A French researcher in 1844 first used catheters in horses to record heart pressures, coining the term "cardiac catheterization." In 1929, Werner Forssmann performed the first human cardiac catheterization by inserting a catheter into his own heart, advancing the field. In 1958, Mason Sones accidentally injected dye into a patient's coronary artery, allowing visualization of coronary arteries and advancement of bypass surgery. Andreas Gruentzig later developed balloon angioplasty to treat coronary artery disease.
Left main disease pci vs cabg excel trial 2016Kunal Mahajan
This randomized controlled trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) for the treatment of left main coronary artery disease. The primary outcome was a composite of death, stroke, or myocardial infarction at 3 years. PCI was found to be non-inferior to CABG for the primary outcome. At 30 days, PCI had fewer adverse events like infections and bleeding, but more deaths, strokes and MIs. Between 30 days and 3 years, ischemia-driven revascularization was more common with PCI. Longer follow-up is still needed given differences in long-term medication use and revascularization between the treatments.
This document discusses PCI (percutaneous coronary intervention) versus CABG (coronary artery bypass grafting) for treating stable coronary artery disease. It provides historical context on the evolution of both procedures and summarizes key randomized controlled trials comparing outcomes of PCI versus CABG. The trials show that CABG provided better long-term outcomes than balloon angioplasty or bare metal stents in multivessel disease. Later trials with drug-eluting stents still found CABG superior for left main or multivessel disease, though the differences were smaller. CABG remains the standard of care for more complex anatomies while PCI is preferred for simpler cases.
The field of cardiology began with William Harvey's discovery of blood circulation in 1628. Key developments include Einthoven's recording of the first electrocardiogram in 1903, Forssman's first cardiac catheterization in 1929, and Gibbon performing the first open-heart surgery using cardiopulmonary bypass in 1953. Modern techniques include balloon angioplasty, drug-eluting stents, echocardiography, pacemakers, implantable cardioverter-defibrillators, and treatments for acute myocardial infarction and heart failure. Continuing subspecialization and preventative measures based on patient characteristics will further improve cardiac care and outcomes.
Historical developments; Trends n issues; Legal n ethical issues in d field o...Ancy Das
The document summarizes the historical development of cardiology from ancient times to the present. Some of the key milestones included William Harvey's discovery of blood circulation in 1628, the development of the stethoscope in 1819, electrocardiography in the early 1900s, and the creation of the first coronary care unit in 1961. Advances in imaging technologies, cardiac surgery, treatments for arrhythmias and heart failure have dramatically improved outcomes for cardiovascular patients over the decades. Prevention through identification and modification of risk factors is now a major focus of cardiology. The future of the field is expected to include greater use of stem cell therapies, gene therapies and implantable devices.
Newer advancements in interventional cardiology by DEEPAK ARJUN, RN,RMDeepak Arjun
after the session, individual can understand the use of interventional cardiology and newer advances in interventional cardiology...
The main aim of this presentation is to improve the knowledge of Bed side Nurse..."He/She can perform better than yesterday and more than today".
A talk about the future of cardiology (also medicine in general) given on the 28th april 2014 in the Medical University of Silesia in Poland to doctors and students. It shows the trends of medicine and medical technology development with the biggest potential.
Devices and technology in interventional cardiologyRamachandra Barik
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
Newer trends in interventional cardiologySuraj Bhorkar
The document discusses newer trends in interventional cardiology, focusing on developments in stent technology, including bare metal stents, drug-eluting stents, and bioabsorbable stents. It describes how stents have evolved from balloon angioplasty to using drugs and biodegradable materials to prevent restenosis. Bioabsorbable stents potentially offer reduced need for long-term blood thinners and restoration of normal vascular function once absorbed. Clinical trials so far show bioabsorbable stents perform similarly to drug-eluting stents with no reported stent thromboses.
Heart disease is the number one cause of death worldwide. It is caused by a buildup of fatty deposits called plaque in the coronary arteries that supply blood to the heart. This buildup is known as atherosclerosis and can lead to coronary artery disease. Risk factors include age, family history, high cholesterol, smoking, high blood pressure, diabetes, obesity, and physical inactivity. To prevent heart disease, one should eat a healthy diet low in fat and cholesterol, exercise regularly, maintain a healthy weight, not smoke, control blood pressure and cholesterol levels, and see a doctor to monitor risk factors. Making lifestyle changes can significantly reduce risk and help live a longer, healthier life.
The document summarizes several interesting ECG cases presented by Dr. Pradeep Katwal. It includes cases showing sinus exit block type II, anteroseptal myocardial infarction, SVT with aberrant conduction, WPW syndrome, inferior MI with right ventricular extension, Brugada syndrome, acute pericarditis, Takasubo cardiomyopathy, and hypothermia presenting initially with complete heart block and later with SVT. The document provides details of the patients' histories, initial ECG readings, diagnoses, and key features of each condition identified on ECG.
Alcohol is a major public health concern, contributing to over 2.5 million deaths per year globally. It has a long history of use dating back thousands of years. Alcohol dependence is characterized by impaired control over drinking and continued use despite consequences. Treatment involves managing withdrawal, brief interventions, rehabilitation programs, medications, and counseling. Physicians play an important role in identifying alcoholism and guiding treatment.
This document discusses the case of a 35-year-old female patient presenting with fever, fatigue, and shortness of breath. Her medical history includes a hysterectomy for menorrhagia and treatment for genitourinary tuberculosis. On examination, she has pallor and tachycardia. Laboratory tests show pancytopenia and blasts in her peripheral blood smear. A bone marrow biopsy confirms the diagnosis of acute myeloid leukemia. The discussion reviews the epidemiology, etiology, classification, clinical presentation, diagnostic workup, and initial treatment evaluation for AML.
This document summarizes a case discussion and review on enteric fever. It describes a clinical case of a 36-year-old male presenting with fever, chills, vomiting and headache. Examination found splenomegaly and bicytopenia. The patient was diagnosed with acute febrile illness and treated with ceftriaxone and paracetamol. The document then reviews enteric fever, including Salmonella transmission, pathogenesis, epidemiology in developing countries, clinical features, complications, diagnosis, and treatment options. It discusses the increasing prevalence of drug-resistant Salmonella Paratyphi A and the need for cautious antibiotic use.
The document discusses adult immunization and summarizes recommendations for various vaccines. It provides an overview of the history and pioneers of immunization like Jenner and Pasteur. Data is presented showing the success of vaccines in reducing cases of diseases like smallpox, diphtheria, and invasive pneumococcal disease. Recommendations are outlined for vaccines including influenza, pneumococcal, hepatitis A/B, meningococcal, MMR, HPV, Tdap, herpes zoster and others. Contraindications and special populations are also mentioned.
This case discusses a 67-year-old female who presented with fever, vomiting, and loose stool for several days. On examination, she was found to be hypotensive and dehydrated. Initial tests showed hyponatremia, hypokalemia, and metabolic acidosis. She was diagnosed with acute infectious gastroenteritis complicated by hypovolumic shock and electrolyte imbalances. She was treated with IV fluids and antibiotics. Her condition improved over three days with correction of her volume status and electrolytes. The discussion then reviews hyponatremia, its causes, assessment of volume status, and treatment approaches depending on the underlying condition.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This document discusses PCI (percutaneous coronary intervention) versus CABG (coronary artery bypass grafting) for treating stable coronary artery disease. It provides historical context on the evolution of both procedures and summarizes key randomized controlled trials comparing outcomes of PCI versus CABG. The trials show that CABG provided better long-term outcomes than balloon angioplasty or bare metal stents in multivessel disease. Later trials with drug-eluting stents still found CABG superior for left main or multivessel disease, though the differences were smaller. CABG remains the standard of care for more complex anatomies while PCI is preferred for simpler cases.
The field of cardiology began with William Harvey's discovery of blood circulation in 1628. Key developments include Einthoven's recording of the first electrocardiogram in 1903, Forssman's first cardiac catheterization in 1929, and Gibbon performing the first open-heart surgery using cardiopulmonary bypass in 1953. Modern techniques include balloon angioplasty, drug-eluting stents, echocardiography, pacemakers, implantable cardioverter-defibrillators, and treatments for acute myocardial infarction and heart failure. Continuing subspecialization and preventative measures based on patient characteristics will further improve cardiac care and outcomes.
Historical developments; Trends n issues; Legal n ethical issues in d field o...Ancy Das
The document summarizes the historical development of cardiology from ancient times to the present. Some of the key milestones included William Harvey's discovery of blood circulation in 1628, the development of the stethoscope in 1819, electrocardiography in the early 1900s, and the creation of the first coronary care unit in 1961. Advances in imaging technologies, cardiac surgery, treatments for arrhythmias and heart failure have dramatically improved outcomes for cardiovascular patients over the decades. Prevention through identification and modification of risk factors is now a major focus of cardiology. The future of the field is expected to include greater use of stem cell therapies, gene therapies and implantable devices.
Newer advancements in interventional cardiology by DEEPAK ARJUN, RN,RMDeepak Arjun
after the session, individual can understand the use of interventional cardiology and newer advances in interventional cardiology...
The main aim of this presentation is to improve the knowledge of Bed side Nurse..."He/She can perform better than yesterday and more than today".
A talk about the future of cardiology (also medicine in general) given on the 28th april 2014 in the Medical University of Silesia in Poland to doctors and students. It shows the trends of medicine and medical technology development with the biggest potential.
Devices and technology in interventional cardiologyRamachandra Barik
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
Newer trends in interventional cardiologySuraj Bhorkar
The document discusses newer trends in interventional cardiology, focusing on developments in stent technology, including bare metal stents, drug-eluting stents, and bioabsorbable stents. It describes how stents have evolved from balloon angioplasty to using drugs and biodegradable materials to prevent restenosis. Bioabsorbable stents potentially offer reduced need for long-term blood thinners and restoration of normal vascular function once absorbed. Clinical trials so far show bioabsorbable stents perform similarly to drug-eluting stents with no reported stent thromboses.
Heart disease is the number one cause of death worldwide. It is caused by a buildup of fatty deposits called plaque in the coronary arteries that supply blood to the heart. This buildup is known as atherosclerosis and can lead to coronary artery disease. Risk factors include age, family history, high cholesterol, smoking, high blood pressure, diabetes, obesity, and physical inactivity. To prevent heart disease, one should eat a healthy diet low in fat and cholesterol, exercise regularly, maintain a healthy weight, not smoke, control blood pressure and cholesterol levels, and see a doctor to monitor risk factors. Making lifestyle changes can significantly reduce risk and help live a longer, healthier life.
The document summarizes several interesting ECG cases presented by Dr. Pradeep Katwal. It includes cases showing sinus exit block type II, anteroseptal myocardial infarction, SVT with aberrant conduction, WPW syndrome, inferior MI with right ventricular extension, Brugada syndrome, acute pericarditis, Takasubo cardiomyopathy, and hypothermia presenting initially with complete heart block and later with SVT. The document provides details of the patients' histories, initial ECG readings, diagnoses, and key features of each condition identified on ECG.
Alcohol is a major public health concern, contributing to over 2.5 million deaths per year globally. It has a long history of use dating back thousands of years. Alcohol dependence is characterized by impaired control over drinking and continued use despite consequences. Treatment involves managing withdrawal, brief interventions, rehabilitation programs, medications, and counseling. Physicians play an important role in identifying alcoholism and guiding treatment.
This document discusses the case of a 35-year-old female patient presenting with fever, fatigue, and shortness of breath. Her medical history includes a hysterectomy for menorrhagia and treatment for genitourinary tuberculosis. On examination, she has pallor and tachycardia. Laboratory tests show pancytopenia and blasts in her peripheral blood smear. A bone marrow biopsy confirms the diagnosis of acute myeloid leukemia. The discussion reviews the epidemiology, etiology, classification, clinical presentation, diagnostic workup, and initial treatment evaluation for AML.
This document summarizes a case discussion and review on enteric fever. It describes a clinical case of a 36-year-old male presenting with fever, chills, vomiting and headache. Examination found splenomegaly and bicytopenia. The patient was diagnosed with acute febrile illness and treated with ceftriaxone and paracetamol. The document then reviews enteric fever, including Salmonella transmission, pathogenesis, epidemiology in developing countries, clinical features, complications, diagnosis, and treatment options. It discusses the increasing prevalence of drug-resistant Salmonella Paratyphi A and the need for cautious antibiotic use.
The document discusses adult immunization and summarizes recommendations for various vaccines. It provides an overview of the history and pioneers of immunization like Jenner and Pasteur. Data is presented showing the success of vaccines in reducing cases of diseases like smallpox, diphtheria, and invasive pneumococcal disease. Recommendations are outlined for vaccines including influenza, pneumococcal, hepatitis A/B, meningococcal, MMR, HPV, Tdap, herpes zoster and others. Contraindications and special populations are also mentioned.
This case discusses a 67-year-old female who presented with fever, vomiting, and loose stool for several days. On examination, she was found to be hypotensive and dehydrated. Initial tests showed hyponatremia, hypokalemia, and metabolic acidosis. She was diagnosed with acute infectious gastroenteritis complicated by hypovolumic shock and electrolyte imbalances. She was treated with IV fluids and antibiotics. Her condition improved over three days with correction of her volume status and electrolytes. The discussion then reviews hyponatremia, its causes, assessment of volume status, and treatment approaches depending on the underlying condition.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
2. BACKGROUND
• ROLE OF PERCUTANEOUS CORONARY
INTERVENTION
– ST SEGMENT ELEVATION MI
– UNSTABLE ANGINA
– NSTEMI
• FOR STABLE CORONARY ARTERY DISEASE
– OPTIMAL TREATMENT STRATEGY?
• PCI(PERCUTANEOUS CORONARY INTERVENTION)
• OMT(OPTIMAL MEDICAL THERAPY)
3. PERCUTANEOUS CORONARY
CLINICAL TRAILS INTERVENTION VERSUS
OPTIMAL MEDICAL THERAPY
Clinical outcomes utilizing No significant difference in outcomes
Revascularization and aggressive drug
evaluation (COURAGE)
Bypass Angioplasty Revascularization No significant difference in outcomes
Investigation 2 Diabetes (BARI 2D)
Schömig et al ( 2008)Swiss Interventional Improvement in all-cause mortality in the
Study on Silent revascularized group
Ischemia Type II (SWISS-II) and
COURAGE trials
5. METHODS
• PUBMED, EMBASE And CENTRAL Searchs
• Using medical subject heading or keywords
– Diagnosis of stable CAD
– Intervention of PCI
– Comparision with medical therapy
6. Eligible trails
• Cohort enrolled- Stable Coronary Artery
Disease patients
• Comparision of PCI to optimal medical therapy
• Reporting outcomes
– All-cause mortality
– Cardiovascular death
– Nonfatal MI
– Revascularization
– Freedom from angina
7. Selection and quality assesment
Compilation of searches
Duplicates removed
Study screened by title and abstract (by two independent
reviewer)
Qualified study(full text review by(by two independent reviewer)
DATA ABSTRACTION AND ASSESMENT FOR SOURCES OF SYSTEMATIC
BIAS
8. Data extraction
• Two independent reviewer extracted data
• Data abstracted measured
– study characteristics
– patient characteristics
– details regarding the intervention
– comparison group
– outcome measures
10. Sensitivity Analyses
• POTENTIAL IMPACT OF INDUSTRY FUNDING
• EVOLUTION OF PCI
– potential differential effect of stenting as opposed
to balloon angioplasty alone.
13. • 12 randomized clinical trials
• participants enrolled from all over the world
• 7182 patients
• followed-up - 4.9 years (range 1.5–10.2 years).
14. STUDY YEARS
Characteristics of Included Trials Descrip Secondary
Exclusion Description Primary Follo
OF INCLUSION Criteria
tion of
of Medical Outcome
Outcomes w Up, y
ENROLMENT, Interve
COUNTRY CRITERIA ntion Therapy
70%–99% stenosis in 6 mo exercise Change in
ACME- Not reported PTCA 325 mg
11987–
proximal two thirds of 1
major coronary artery,
Aspirin,
nitrates, β-
stress testing:
length of time
to onset of 1
degree of
stenosis in
index lesion,
3
physical well
1990 stress test with ≥1 mm ST blockers, mm ST
depression, being
depression in at least 1 lead calcium questionnaire,
USA or filling defect on thallium channel
maximal ST
segment employment
status
scan, or MI in past 3 mo blockers depression,
maximal work
product
History of angina, MI Unstable angina PTCA Aspirin plus Primary/seco change in
ACME-2 refractory to ndary exercise 5
within 3 mo, or ≥3 mm individualiz
1987– medical therapy,
ed therapy outcomes duration,
horizontal ST depression prior PCI, primary not time to onset
1990 on exercise testing; cardiac diagnosis of Nitrates, individually of angina,
other than CAD, β-blockers, described maximal
USA ≥70% stenosis in ≥50% left main and Angina rate-pressure
proximal two thirds of 1 stenosis, 3 vessel Calcium frequency, 6 product,
or 2 coronary arteries CAD, LVEF≤30% channel mo exercise percent
tolerance diameter
(data for 1 vessel CAD blockers
testing and stenosis of
previously presented as angiography: index lesions
ACME-1)
32. All Cause Mortality
PCI VS OMT RESULT
longest follow-up duration risk ratio [RR], 0.85; 95% CI, 0.71–
1.01
the ≤1 year RR, 1.34; 95% CI, 0.87–2.08
1 to 5 years RR, 0.97; 95% CI, 0.56–1.69
≥5 years RR, 0.82; 95% CI, 0.65–1.02
• Overall, there was no statistically significant difference in mortality
between the PCI and OMT groups; the point estimate at the longest
follow-up duration notably did favor the PCI group SWISS-2 and
ALKK individually showed the most favorable effects of PCI over
OMT; of note, these 2 trials included those with prior recent MIs.
33. CARDIVASCULAR DEATH
PCI VS OMT CARDIVASCULAR DEATH
longest follow-up duration RR, 0.71; 95% CI, 0.47–1.06
PCI group (RR, 0.71; 95% CI, 0.47– RR, 0.70; 95% CI, 0.46–1.08
1.06)
<5 YEARS RR, 1.53; 95% CI, 0.69–3.38
• The point estimate in the longest follow-up duration
analysis favored the PCI group and this difference was
most apparent in those trials with ≥5 years follow-up
although these were not statistically significant.
34. NONFATAL MI
PCI vs OMT result
overall analysis (RR, 0.93; 95% CI, 0.70–1.24)
≤1 year RR, 0.82; (95% CI, 0.37–1.80)
1 to 5 years RR 1.11(95% CI, 0.47–2.59),
≥5 year RR O.92(95% CI, 0.67–1.27)
35. Revascularization
PCI VS OMT RESULT
overall analysis (RR, 0.93; 95% CI, 0.76–
1.14)
≤1 year RR, 1.49; 95% CI
1–5 years RR 0.98; 95% CI, 0.74–1.30;
≥5 year RR 0.99; 95% CI, 0.75–1.30
time points
36. Freedom From Angina
PCI VS OMT RESULT
OVERALL (RR, 1.20; 95% CI, 1.06–1.37
≤1 year RR, 1.32; 95% CI, 1.13–1.54
1–5 years 1.57; 95% CI, 1.06–2.32
≥5 year 1.06–2.32; RR, 1.17; 95% CI, 1.00–1.38)
37. Study limitations
• Analysis of symptoms driven
revascularization
• Freedom from angina
• Dosage of medication administered
• Evolution of therapy
• Variation in target level
38. Discussion
BUT
Most
updated
analysis to All-cause
date mortality
Greater
No and cardiac
freedom
significant death in trial
from angina-
difference in with longer
PCI
outcome follow up-
PCI