Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Dec 2020
Review Meta AnalysisPartial oral antibiotic therapy is non-inferior to intravenous therapy in non-critically ill patients with infective endocarditis : Review and meta-analysis.
Antimicrobial therapy is a cornerstone in the treatment of infective endocarditis (IE). Typically, intravenous (i.v.) therapy is given for 6 weeks or longer, leading to prolonged hospital stays and high costs. Several trials evaluating the efficacy of partial oral therapy (POT) have been published. This article aimed to review and meta-analyze studies comparing i.v. therapy versus POT in non-critically ill patients suffering from IE. ⋯ Data comparing POT with standard care in IE is limited and to date only one sufficiently powered stand-alone trial exists to support its use. In this meta-analysis POT was non-inferior to i.v. therapy with respect to mortality and IE relapse in non-critically ill patients suffering from both left-sided and right-sided IE. These findings indicate that POT is a feasible treatment strategy in selected patients suffering from IE but further validation in future studies will be required.
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Wien. Klin. Wochenschr. · Dec 2020
Meta AnalysisImpella in cardiogenic shock following acute myocardial infarction: a systematic review and meta-analysis.
Cardiogenic shock (CS) conveys a high mortality risk. A cardiac assist device may serve as bridge to patient recovery. We aimed to provide a pooled estimate on mortality and complications from studies evaluating the use of the left ventricular assist device Impella in CS following acute myocardial infarction. In addition, we evaluated whether mortality risk differed with device placement before or after percutaneous coronary intervention (PCI). ⋯ Pooled estimates of Impella use in myocardial infarction with CS revealed a high 30-day mortality; however, as compared to post-PCI, Impella initiation prior to PCI was associated with a survival benefit.
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Wien. Klin. Wochenschr. · Dec 2020
Predicting the presence of coronary artery disease by transesophageal echocardiography.
The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades. ⋯ With an negative predictive value (NPV) of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If at least mild AS is present, normal coronary arteries are improbable.
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Wien. Klin. Wochenschr. · Dec 2020
ReviewRecommendations for driving after implantable cardioverter defibrillator implantation and the use of a wearable cardioverter defibrillator : Different viewpoints around the world.
The use of implantable cardioverter defibrillators (ICD) has been shown to improve survival in patients at risk of sudden cardiac death; however, due to the continuous risk of sudden loss of consciousness during arrhythmia or ICD intervention, they pose a potential risk to other road users while driving. A large number of opinions and recommendations from authorities and medical societies all over the world exist regarding driving restrictions after ICD implantation. This analysis provides an overview of the recommendations on driving restrictions from several countries. Furthermore, the use of the wearable and the subcutaneous ICD are taken into account.