Publications (2)2.69 Total impact
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ABSTRACT: We sought to assess the feasibility of comparing the efficacy and safety of fondaparinux versus heparin for prevention of graft failure and major CV events in patients undergoing coronary artery bypass grafting (CABG). Patients undergoing CABG were randomized to receive postoperative injections of fondaparinux or heparin in-hospital. After discharge, the fondaparinux group received fondaparinux and the heparin group received placebo injections for 30 days post surgery. Efficacy outcomes were graft failure, death, MI, and stroke at 30 days. Safety outcomes were bleeding, transfusion, and reoperation. 100 patients were recruited, 99 were randomized, 49 received fondaparinux and 50 received heparin. CT angiography was performed in 97% of patients. 188 grafts in the treatment group and 189 grafts in the heparin group were imaged. A similar proportion of patients treated with fondaparinux compared with heparin had at least one occluded graft (18.8% fondaparinux vs. 14.9% heparin, P = 0.62) and a similar number of grafts were occluded in each treatment group (all grafts: 4.8% vs. 4.8%, P = 0.99; saphenous vein grafts 4.2% vs. 4.2%, P = 0.98). There was no difference between treatment groups in death, MI, stroke, bleeding events, or reoperation. One in 10 patients undergoing CABG had at least one occluded graft at 30 days and one in 20 grafts is occluded by 30 days. Fondaparinux appears to be a safe alternative to heparin after CABG and it is feasible to conduct a definitive RCT using CT angiography to evaluate the effect of fondaparinux treatment on graft patency.
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ABSTRACT: To evaluate the prevalence, clinical significance, interobserver agreement, and follow-up of extracardiac findings on coronary computed tomographic angiography (CTA). A prospectively recruited cohort of 80 patients at low to intermediate risk of having coronary artery disease underwent CTA with field of view imaging from lung apices to upper abdomen. Two staff radiologists read each scan independently. Scans read by reader no. 1 were read as part of routine clinical practice, and the findings were subsequently reclassified to potentially significant, as defined by requiring clinical or radiologic follow-up, and insignificant by a separate observer, whereas reader no. 2 retrospectively read and autonomously classified the findings as potentially significant or insignificant. Reader no. 1 found 7 potentially significant findings in 7 patients and 33 insignificant findings in 29 patients. Reader no. 2 found 10 potentially significant findings in 10 patients and 59 insignificant findings in 42 patients. Inter-rater agreement was moderate (kappa = 0.49; 95% confidence interval, 0.31-0.67) for the presence vs the absence of extracardiac findings and moderate (kappa = 0.52; 95% confidence interval, 0.15-0.89) for the presence of potentially significant extracardiac findings. The most common potentially significant finding was possibly malignant lung nodule (n = 6 [reader 1], 4 [reader 2]). Four patients with potentially significant findings received follow-up imaging, and 1 patient underwent biopsy, which was complicated by pneumothorax. No diagnoses of malignancy were made. Extracardiac findings are frequent and moderately reproducible, however, in this study, not associated with clinical benefit. Large prospective studies are required to establish whether reporting of extracardiac findings is associated with improved patient outcomes.
Hamilton, Ontario, Canada
- Department of Radiology