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3.
Indian Heart J ; 68(2): 213-24, 2016.
Article in English | MEDLINE | ID: mdl-27133344

ABSTRACT

This systematic review with meta-analysis sought to determine the efficacy and safety of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) on clinical outcomes following percutaneous coronary intervention. Medline, Embase, Elsevier, and web of knowledge as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. After screening 445 studies, a total of 23 trials (including a total of 43,912 patients) were identified that reported outcomes. Pooled analysis revealed that LMWH compared to UFH could significantly increase thrombolysis in myocardial infarction grade 3 flow (p<0.001), which was associated with similar target vessel revascularization (p=0.6), similar incidence of stroke (p=0.7), and significantly lower incidence of re-myocardial infarction (p<0.001), major bleeding (p=0.02) and mortality (p<0.001). Overall, LMWH was shown to be a useful type of heparin for patients with MI undergoing PCI, due to its higher efficacy and lower rate of complication compared to UFH. It is also associated with increased myocardial perfusion, decreased major hemorrhage, and mortality.


Subject(s)
Heparin, Low-Molecular-Weight/administration & dosage , Intraoperative Complications/prevention & control , Myocardial Infarction/drug therapy , Myocardial Infarction/surgery , Anticoagulants/administration & dosage , Heparin/administration & dosage , Humans , Injections, Intravenous , Intraoperative Period , Treatment Outcome
4.
Kardiol Pol ; 74(7): 610-26, 2016.
Article in English | MEDLINE | ID: mdl-26779856

ABSTRACT

BACKGROUND AND AIM: This systematic review with meta-analysis sought to determine the strength of evidence for effects of antioxidants (AO) such as N-acetyl cysteine (NAC), vitamin C, vitamin E, and alpha-lipoic acid on the incidence of contrast-in-duced nephropathy (CIN), requirement for haemodialysis, level of serum creatinine, and mortality after coronary angiography. METHODS AND RESULTS: After Medline, Embase, Elsevier, Sciences online database, and Google Scholar literature searches, studies with randomised controlled design were selected for the meta-analysis. The effect sizes measured were odds ratio (OR) for categorical variables and standard mean difference (SMD) with 95% confidence interval (CI) for calculating differences between mean changes of serum creatinine in intervention and control groups. A value of p < 0.1 for Q test or I2 > 50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 2350 studies. After screening, a total of 49 trials were identified that reported outcomes. Pooled treatment effect analysis revealed that NAC (OR of 0.79; 95% CI 0.69-0.9; p = 0.000), vitamin C (0.63; 95% CI 0.45-0.89; p = 0.000), and vitamin E (OR of 0.5; 95% CI 0.27-0.92; p = 0.026) could significantly reduce the incidence of CIN. NAC (SMD of -0.119; 95% CI -0.191 - 0.046; p = 0.000), but not vitamin C (SMD of -0.08; 95% CI -0.22-0.04; p = 0.1) and vitamin E (-0.25; 95% CI -0.46-0.05; p = 0.1), could significantly reduce mean levels of serum creatinine. Nevertheless, AO could not reduce the incidence of mortality, with an OR of 0.94 (95% CI 0.69-1.28; p = 0.7). CONCLUSIONS: Overall, antioxidants such as NAC, vitamin C, and vitamin E can reduce the incidence of CIN, while only NAC might be able to significantly lower serum creatinine levels. There is no impact of AO supplementation on mortality.


Subject(s)
Antioxidants/therapeutic use , Contrast Media/adverse effects , Coronary Angiography/adverse effects , Dietary Supplements , Kidney Diseases/prevention & control , Aged , Antioxidants/pharmacology , Female , Humans , Incidence , Kidney Diseases/chemically induced , Kidney Diseases/epidemiology , Kidney Function Tests , Male , Middle Aged
5.
Cardiol Res Pract ; 2015: 690308, 2015.
Article in English | MEDLINE | ID: mdl-25973282

ABSTRACT

This systematic review with meta-analysis sought to determine comparison of efficacy and safety of hydration with sodium bicarbonate versus sodium chloride on contrast induced nephropathy and clinical outcomes. We searched major electronic databases for studies in randomized controlled trials. A value of P < 0.1 for Q test or I (2) > 50% indicated significant heterogeneity between the studies. Literature search of all databases retrieved 650 studies. 29 studies enrolled in meta-analysis. Pooled analysis indicated about the incidence of CIN (OR of 0.718; 95% CI: 0.60 to 0.85; P = 0.000), requirement of hemodialysis (OR of 1.00; 95% CI: 0.49 to 2.01; P = 0.9), mean changes of serum creatinine (WMD of 2.321; 95% CI: 1.995 to 2.648; P = 0.000), length of hospital stays (WMD of -0.774; 95% CI: -1.65 to 0.10; P = 0.08), major adverse cardiovascular events (OR = 1.075, 95% CI: 0.59 to 1.95; P = 0.8), and mortality (OR of 0.73; 95% CI: 0.42 to 1.26; P = 0.2). Overall, hydration with sodium bicarbonate could significantly reduce CIN and the length of hospital stay compared to sodium chloride. In addition NAC added as a supplement to sodium bicarbonate could increase prophylactic effects against nephropathy.

6.
Cardiovasc Revasc Med ; 16(3): 179-89, 2015.
Article in English | MEDLINE | ID: mdl-25704158

ABSTRACT

This systematic review with meta-analysis sought to determine protective effects of erythropoietin on clinical outcomes following percutaneous coronary intervention (PCI). Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference (WMD) with 95% confidence interval for calculating differences between mean values of duration of hospitalization in intervention and control groups. Values of P<0.1 for Q test or I(2)>50% indicated significant heterogeneity between the studies. The literature searches of all major databases retrieved 973 studies. After screening, a total of 15 trials that reported outcomes were identified. Pooled analysis was performed on left ventricular ejection fraction (WMD of -0.047; 95% CI: -0.912 to 0.819; P=0.9), left ventricular end diastolic volume (WMD of -0.363; 95% CI: -3.902 to 3.175; P=0.8), left ventricular end systolic volume (WMD of 0.346; 95% CI: -2.533 to 3.226; P=0.8), infarct size (WMD of -0.446; 95% CI: -2.352 to -1.460; P=0.6), stroke (OR of 2.1; 95% CI: 0.58 to 7.54; P=0.2), re-myocardial infarction (OR of 1.06; 95% CI: 0.52 to 2.185; P=0.8), heart failure (OR of 0.53; 95% CI: 0.259 to 1.105; P=0.09), mortality (OR of 0.56; 95% CI: 0.27 to 1.19; P=0.13), thrombosis (OR of 0.774; 95% CI: 0.41 to 1.45; P=0.4), major adverse cardiovascular events (OR of 0.926; 95% CI: 0.63 to 1.35; P=0.6). Short-term administration of EPO in patients with myocardial infarction (MI) undergoing PCI does not result in improvement in cardiac function, reduction of infarct size and all-cause mortality. Low dose EPO therapy may not be the choice of treatment for the patients with MI, while higher doses might be more effective.


Subject(s)
Erythropoietin/administration & dosage , Erythropoietin/therapeutic use , Myocardial Infarction/therapy , Animals , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Myocardial Infarction/diagnosis , Percutaneous Coronary Intervention/methods , Stroke/diagnosis , Stroke/therapy , Thrombosis/diagnosis , Thrombosis/therapy
7.
Asian Cardiovasc Thorac Ann ; 23(3): 363-74, 2015 03.
Article in English | MEDLINE | ID: mdl-25281762

ABSTRACT

BACKGROUND: This systematic review with meta-analysis sought to determine the efficacy and safety of intramyocardial transplantation of bone marrow stem cells during coronary artery bypass graft surgery on postoperative cardiac functional parameters such as left ventricular ejection fraction and left ventricular end-diastolic volume. METHODS: Medline/PubMed, Embase, Elsevier, Sciences online database, and Google Scholar literature search were searched. The effect sizes measured were risk ratio for categorical variables and weighted mean difference with 95% confidence interval for calculating differences between mean values of baseline and follow-up cardiac functional parameters. A value of p < 0.1 for Q test, or I(2 )> 50%, indicated significant heterogeneity among studies. The literature search retrieved 2900 studies from screened databases, of which 2866 (98.6%) were excluded and 34 (619 patients) were included for scoping review. The final analysis included 9 studies (335 patients). RESULTS: Pooled effects estimates of left ventricular ejection fraction and left ventricular end-diastolic volume showed that bone marrow stem cell transplantation had a weighted mean difference of 4.06 (95% confidence interval: 0.41-7.72; p = 0.02) and 7.06 (95% confidence interval: -8.58-22.7; p = 0.3), respectively. CONCLUSIONS: Intramyocardial transplantation of bone marrow stem cells improves cardiac functional parameters, significantly increasing left ventricular ejection fraction with a nonsignificant reduction in left ventricular end-diastolic volume. Also, this therapeutic method has no life-threatening complications and was therefore found to be an effective and safe method.


Subject(s)
Bone Marrow Cells/cytology , Bone Marrow Transplantation/methods , Cardiac Surgical Procedures/methods , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Transplantation, Autologous/methods , Humans , Myocardial Ischemia/physiopathology , Odds Ratio , Recovery of Function , Stroke Volume , Treatment Outcome , Ventricular Function, Left
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