Annals of internal medicine
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Meta Analysis Comparative Study
Evidence for use of coronary stents. A hierarchical bayesian meta-analysis.
Coronary stents are widely used in interventional cardiology, but a current quantitative systematic overview comparing routine coronary stenting with standard percutaneous transluminal coronary angioplasty (PTCA) and restricted stenting (provisional stenting) has not been published. ⋯ In the controlled environment of randomized clinical trials, routine coronary stenting is safe but probably not associated with important reductions in rates of mortality, acute myocardial infarction, or coronary artery bypass surgery compared with standard PTCA with provisional stenting. Coronary stenting is associated with substantial reductions in angiographic restenosis rates and the subsequent need for repeated PTCA, although this benefit may be overestimated because of trial designs. The incremental benefit of routine stenting for reducing repeated angioplasty diminishes as the crossover rate of stenting with conventional PTCA increases.
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Meta Analysis
Suboptimal monitoring and dosing of unfractionated heparin in comparative studies with low-molecular-weight heparin.
Site-specific validation of the activated partial thromboplastin time (aPTT) therapeutic range is required to ensure administration of the optimal dose of unfractionated heparin. Therapeutic ranges of 1.5 to 2.5 times the control value are subtherapeutic for most modern aPTT reagents. ⋯ Most studies monitored unfractionated heparin inappropriately. This shortcoming could be responsible for the reduced efficacy of unfractionated heparin in clinical trials.
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Review Meta Analysis
Implantable cardioverter defibrillators in primary and secondary prevention: a systematic review of randomized, controlled trials.
Sudden cardiac death is common in persons with cardiovascular disease. ⋯ Implantable cardioverter defibrillators prevent sudden cardiac death regardless of baseline risk. However, their impact on total mortality is sensitive to baseline risk for arrhythmic death. Decisions about resource allocation for ICDs depend on accurate stratification of patients according to risk.
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Meta Analysis
Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis.
To assess the effect of cardioselective beta-blockers on respiratory function of patients with reactive airway disease. ⋯ Cardioselective beta-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. The results were similar for patients with concomitant chronic airways obstruction. Given their demonstrated benefit in such conditions as heart failure, cardiac arrhythmias, and hypertension, cardioselective beta-blockers should not be withheld from patients with mild to moderate reactive airway disease.
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Meta Analysis
Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.
To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force. ⋯ In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.