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  • 1
    Online Resource
    Online Resource
    Predicting Acute Kidney Injury following Transcatheter Aortic Valve Replacement
    University of Toronto Libraries - UOTL ; 2017
    In:  Clinical & Investigative Medicine Vol. 40, No. 6 ( 2017-12-17), p. 243-
    Details
    In: Clinical & Investigative Medicine, University of Toronto Libraries - UOTL, Vol. 40, No. 6 ( 2017-12-17), p. 243-
    Abstract: Purpose: Acute kidney injury occurs in up to a quarter of patients following transcatheter aortic valve replacement (TAVR) and has been associated with increased short and long-term mortality rates. A variety of patient characteristics predictive of post-TAVR acute kidney injury (AKI) have been identified, however discrepancies among studies exist almost uniformly. We investigated the hypothesis that the change in glomerular filtration rate (ΔGFR) in response to contrast administered during pre-TAVR coronary angiography is predictive of ΔGFR post-TAVR. Methods: The study comprised 195 patients who underwent TAVR at a single center between August 2008 and June 2015 and were prospectively included in the CAPITAL TAVR registry. Multiple linear regression analysis was conducted to estimate the effect of independent variables on the change in renal function post-TAVR. Results: There was no relationship identified between the ΔGFR post-angiogram and the ΔGFR post-TAVR (r=0.043, P=0.582). Multiple linear regression analysis revealed that a significant amount of the change in renal function post-TAVR can be explained by the patient’s baseline creatinine (beta coefficient, -0.310, P
    Type of Medium: Online Resource
    ISSN: 1488-2353
    URL: Article
    DOI: 10.25011/cim.v40i6.29125
    Language: Unknown
    Publisher: University of Toronto Libraries - UOTL
    Publication Date: 2017
    detail.hit.zdb_id: 2067562-8
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  • 2
    Online Resource
    Online Resource
    Does stent strut design impact clinical outcomes: comparative safety and efficacy of Endeavor Resolute versus Resolute Integrity zotarolimus-eluting stents
    University of Toronto Libraries - UOTL ; 2015
    In:  Clinical & Investigative Medicine Vol. 38, No. 5 ( 2015-10-07), p. 296-
    Details
    In: Clinical & Investigative Medicine, University of Toronto Libraries - UOTL, Vol. 38, No. 5 ( 2015-10-07), p. 296-
    Abstract: Percutaneous coronary intervention is the most commonly performed method of revascularizing obstructive coronary artery disease. The impact of stent strut design on clinical outcomes remains unclear. The Endeavour Resolute (ER-ZES) and the Resolute Integrity (RI-ZES) zotarolimus-eluting stents utilize identical polymers and anti-proliferative agents, differing only in their respective strut design. This study assessed the comparative safety and efficacy of these two stents in unrestricted contemporary real-world practice. Methods: A total of 542 patients were identified, corresponding to 340 ER-ZES and 480 RI-ZES. The primary endpoint was major adverse cardiac events (MACE) defined by a composite of death, nonfatal myocardial infarction and stroke. Secondary endpoints included post-procedural length of stay, in-stent restenosis, target lesion revascularization, target vessel revascularization, coronary artery bypass grafting and stent thrombosis. Results: MACE occurred in 3.2% of the ER-ZES cohort and 5.0% of the RI-ZES cohort (p= 0.43). Adjusted analysis utilizing propensity score-adjusted odds ratio for MACE, was 1.37 (95% CI 0.46-4.07, p=0.57). The mortality rate (0.9% ER-ZES vs. 1.9% RI-ZES, p=0.59), non-fatal MI (2.3% ER-ZES vs. 3.1% RI-ZES, p=0.75) and stroke (0.0% ER-ZES vs. 0.3% RI-ZES, p=0.85) were not different. Additionally, there was no difference in any of secondary outcomes. Conclusions: The clinical performance and safety of both ER-ZES and RI-ZES were not statistically different, despite differences in stent strut design.
    Type of Medium: Online Resource
    ISSN: 1488-2353
    URL: Article
    DOI: 10.25011/cim.v38i5.25686
    Language: Unknown
    Publisher: University of Toronto Libraries - UOTL
    Publication Date: 2015
    detail.hit.zdb_id: 2067562-8
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  • 3
    Online Resource
    Online Resource
    Efficacy of milrinone and dobutamine in low cardiac output states: Systematic review and meta-analysis
    University of Toronto Libraries - UOTL ; 2019
    In:  Clinical and Investigative Medicine Vol. 42, No. 2 ( 2019-06-23), p. E26-32
    Details
    In: Clinical and Investigative Medicine, University of Toronto Libraries - UOTL, Vol. 42, No. 2 ( 2019-06-23), p. E26-32
    Abstract: Purpose: Patients in cardiac intensive care units (ICU) are admitted with increasingly higher disease acuity and a larger burden of non-cardiac critical illness. Accordingly, positive inotropes are being used with increased frequency and little comparative data to support drug selection. We compared the effectiveness and safety of dobutamine and milrinone in low cardiac output states (LCOS) and/or cardiogenic shock (CS). Methods: We performed a systematic review comparing dobutamine to milrinone on all-cause mortality, length of stay in the ICU (LOS-ICU), length of stay in hospital (LOS-H) and significant arrhythmias in hospitalized patients with LCOS and/or CS. Results: We identified 11 studies that meet eligibility requirements and which were published between 2001 and 2016 and included 23,056 patients. Only one randomized clinical trial was identified, with the remaining studies comprising observational cohort studies. The primary outcome, all-cause mortality, trended towards a benefit with milrinone but did not meet pre-specified significance (OR 1.13, 95% CI 1.00-1.29, p=0.06). While LOS-ICU (mean difference -0.72, 95% CI -1.10- -0.34, p=0.0002) was shorter with dobutamine, there was no difference in LOS-H (mean difference -1.22, 95% CI -4.68 – 2.24, p=0.49). Significant arrhythmias, specifically symptomatic and/or requiring antiarrhythmic therapy, were no different between the groups (OR 1.78, 95% CI 0.85-3.76, p=0.13). Conclusions: Currently available data comparing milrinone to dobutamine in patients requiring inotropic support is limited. Dobutamine may be associated with a shorter LOS in the ICU, with a worrisome signal of increased risk of allcause mortality. Randomized data are needed to guide inotrope selection in patients with LCOS and/or CS.
    Type of Medium: Online Resource
    ISSN: 1488-2353
    URL: Article
    DOI: 10.25011/cim.v42i2.32813
    Language: Unknown
    Publisher: University of Toronto Libraries - UOTL
    Publication Date: 2019
    detail.hit.zdb_id: 2067562-8
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  • 4
    Online Resource
    Online Resource
    Impact of trainee involvement on patient radiation exposure and contrast volumes during invasive cardiac procedures
    University of Toronto Libraries - UOTL ; 2020
    In:  Clinical and Investigative Medicine Vol. 43, No. 1 ( 2020-04-05), p. E18-E21
    Details
    In: Clinical and Investigative Medicine, University of Toronto Libraries - UOTL, Vol. 43, No. 1 ( 2020-04-05), p. E18-E21
    Abstract: Purpose: The impact of cardiology fellows (CFs) and interventional cardiology fellows (ICFs) on patient radiation and contrast exposure during diagnostic coronary angiography and percutaneous coronary intervention is unknown. Methods: Between 2011 and 2014, 16,175 cases were retrospectively assessed involving 27 CFs, 22 ICFs and 24 staff as primary operators. Results: During diagnostic coronary angiography, ICFs administered the lowest radiation dose (5,648±5,523 cGy*cm2; 1.30 ± 1.27 mSv)—achieving 22% less radiation than the staff (6,889±4,294 cGy*cm2; 1.58 ± 0.99 mSv) and 36% less than CFs (7,700±6,751 cGy*cm2; 1.77 ± 1.55 mSv) (p 〈 0.01). When adjusted for access site, CFs administered more radiation than either the ICFs or staff. However, differences between ICFs and staff were exclusively observed during transradial procedures (p 〈 0.01). With regards to contrast administration, ICFs administered less contrast (126.3 ± 57.6 mL) than either CFs (130±52.4 mL) or staff (132.7±47.6 mL) (p 〈 0.01)—again, a finding isolated to the transradial cohort. Of the 6,751 percutaneous coronary intervention cases, no significant differences existed between the ICFs or staff cardiologists in patient radiation exposure—but a CF as the primary operator resulted in an 18% increase in radiation exposure. Notably, contrast use was not different amongst the types of operators (p 〈 0.05). Conclusion: In conclusion, having a cardiology fellow as primary operator during invasive cardiac procedures increases patient radiation exposure and minimally increases contrast administration. Strategies to minimize patient radiation exposure while maintaining trainee involvement should be evaluated.
    Type of Medium: Online Resource
    ISSN: 1488-2353
    URL: Article
    DOI: 10.25011/cim.v43i1.33565
    Language: Unknown
    Publisher: University of Toronto Libraries - UOTL
    Publication Date: 2020
    detail.hit.zdb_id: 2067562-8
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