Difference between revisions of "Sharifi"
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| − | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:">Addition of HBOT to percutaneous coronary intervention for MI or angina reduces re-stenosis.</span></span>'''</span> |
| − | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical bottom line:</span></span>'''</span> |
<span style="font-family: Arial, sans-serif; font-size: 14pt;">1. The addition of HBOT to acute MI or unstable angina patients having undergone percutaneous coronary intervention reduces the rate of the clinical restenosis.</span> | <span style="font-family: Arial, sans-serif; font-size: 14pt;">1. The addition of HBOT to acute MI or unstable angina patients having undergone percutaneous coronary intervention reduces the rate of the clinical restenosis.</span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Citation/s:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">1.Sharifi M., Fares W., Abdel-Karim I., Koch M.J., Sopdo J., Adler D. Usefulness of Hyperbaric Oxygen Therapy to Inhibit Restenosis After Percutaneous Coronary Intervention for Acute Myocardial Infarction or Unstable Angina Pectoris. Am J Cardiol 2004;93:1533-1535.</span></span></span> | ||
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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Lead author's name and fax:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Mohsen Sharifi, [[mailto:mohsen.sharifi@ttuhsc.edu| <span style="color:blue">mohsen.sharifi@ttuhsc.edu</span>]]</span></span></span> |
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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Among patients with an acute coronary syndrome who have undergone percutaneous coronary intervention (PCI), does the addition of hyperbaric oxygen therapy (HBOT) reduce the rate of coronary vessel re-stenosis?</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">myocardial infarction AND angina pectoris AND restenosis.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Non-blinded randomised controlled trial without intention-to-treat.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Patients with unstable ACS stabilized on medical therapy with the resolution of chest pain and normalization of ST-segment changes.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">(N = 37; 37 analysed): Standard PCI in de novo native or saphenous vein grafts receiving >/=1stent. Received aspirin 325mg/day and heparin during PCI and 1 month of therapy with clopidogrel 75mg/day. No additional treatments were given.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">(N = 33; 24 analysed): As above, plus two HBOT sessions involving 100% oxygen at 2ATA for 90minutes with a total chamber dwell time of 120minutes. The first HBOT commenced 2hours before or immediately after PCI while the second HBOT was given another 18 hours later.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Evidence:</span></span>'''</span> |
{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Outcome</span>'''</span></p> |
| − | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Time to Outcome</span>'''</span></p> |
| − | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Control group</span>'''</span></p> |
| − | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">HBO group</span>'''</span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Relative risk reduction</span>'''</span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Absolute risk reduction</span>'''</span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">NNT</span>'''</span></p> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-family: | + | <span style="line-height:normal">'''<span style="font-family:">Death</span>'''</span> |
| − | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">8 months</span></span></p> |
| − | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.08</span></span></p> |
| − | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">100%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.08</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">12</span></span></p> |
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| − | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">95% CI:</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">45% to 100%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">-0.01 to 0.17</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">NNT 6 to INF</span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">NNH</span>'''<span style="font-family:">145 to INF</span>'''</span></p> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-family: | + | <span style="line-height:normal">'''<span style="font-family:">MACE</span>'''</span> |
| − | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">8 months</span></span></p> |
| − | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.35</span></span></p> |
| − | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.03</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">91%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.32</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">3</span></span></p> |
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| − | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">95% CIs:</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">45% to 100%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.16 to 0.49</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">2 to 6</span></span></p> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-family: | + | <span style="line-height:normal">'''<span style="font-family:">MI</span>'''</span> |
| − | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:52.15pt; border:solid windowtext 1.0pt" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">8 months</span></span></p> |
| − | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:41.65pt; border:solid windowtext 1.0pt" width="58" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.19</span></span></p> |
| − | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:40.4pt; border:solid windowtext 1.0pt" width="56" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.03</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">84%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.16</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">6</span></span></p> |
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| − | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | colspan="4" style="width:188.9pt; border:solid windowtext 1.0pt" width="256" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">95% CI:</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">11% to 100%</span></span></p> |
| − | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.02 to 0.30</span></span></p> |
| − | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:108.6pt; border:solid windowtext 1.0pt" width="148" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">3 to 50</span></span></p> |
|} | |} | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Comments:</span></span>'''</span> |
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1. 5 patients allocated to HBOT arm were analysed in the control arm, therefore intention to treat not possible.</span></span></span> |
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2. Follow-up angiography on all patients would have been useful to determine the rates of coronary vessel re-occlusion in the two groups.</span></span></span> |
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3. Effectiveness of HBO may be reduced with modern drug eluting stents.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Sven Todd.; [[mailto:sventodd@gmail.com| <span style="color:blue">sventodd@gmail.com</span>]] Wednesday, 8 June 2005</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">1 June 2024</span></span></span> |
<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</span> | <span style="display: block; text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</span> | ||
Latest revision as of 03:59, 22 August 2022
Addition of HBOT to percutaneous coronary intervention for MI or angina reduces re-stenosis.
Clinical bottom line:
1. The addition of HBOT to acute MI or unstable angina patients having undergone percutaneous coronary intervention reduces the rate of the clinical restenosis.
Citation/s:1.Sharifi M., Fares W., Abdel-Karim I., Koch M.J., Sopdo J., Adler D. Usefulness of Hyperbaric Oxygen Therapy to Inhibit Restenosis After Percutaneous Coronary Intervention for Acute Myocardial Infarction or Unstable Angina Pectoris. Am J Cardiol 2004;93:1533-1535.
Lead author's name and fax:Mohsen Sharifi, [mohsen.sharifi@ttuhsc.edu]
Three-part Clinical Question:Among patients with an acute coronary syndrome who have undergone percutaneous coronary intervention (PCI), does the addition of hyperbaric oxygen therapy (HBOT) reduce the rate of coronary vessel re-stenosis?
Search Terms:myocardial infarction AND angina pectoris AND restenosis.
The Study:Non-blinded randomised controlled trial without intention-to-treat.
The Study Patients:Patients with unstable ACS stabilized on medical therapy with the resolution of chest pain and normalization of ST-segment changes.
Control group(N = 37; 37 analysed): Standard PCI in de novo native or saphenous vein grafts receiving >/=1stent. Received aspirin 325mg/day and heparin during PCI and 1 month of therapy with clopidogrel 75mg/day. No additional treatments were given.
Experimental group(N = 33; 24 analysed): As above, plus two HBOT sessions involving 100% oxygen at 2ATA for 90minutes with a total chamber dwell time of 120minutes. The first HBOT commenced 2hours before or immediately after PCI while the second HBOT was given another 18 hours later.
The Evidence:
Outcome |
Time to Outcome |
Control group |
HBO group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Death |
8 months |
0.08 |
0 |
100% |
0.08 |
12 |
95% CI: |
45% to 100% |
-0.01 to 0.17 |
NNT 6 to INF NNH145 to INF | |||
|
MACE |
8 months |
0.35 |
0.03 |
91% |
0.32 |
3 |
95% CIs: |
45% to 100% |
0.16 to 0.49 |
2 to 6 | |||
|
MI |
8 months |
0.19 |
0.03 |
84% |
0.16 |
6 |
95% CI: |
11% to 100% |
0.02 to 0.30 |
3 to 50 | |||
Comments:
1. 5 patients allocated to HBOT arm were analysed in the control arm, therefore intention to treat not possible.
2. Follow-up angiography on all patients would have been useful to determine the rates of coronary vessel re-occlusion in the two groups.
3. Effectiveness of HBO may be reduced with modern drug eluting stents.
Appraised by:Sven Todd.; [sventodd@gmail.com] Wednesday, 8 June 2005
Kill or Update By:1 June 2024
