2 Minute Medicine Rewind October 20th – October 27th, 2013

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In this section, we will highlight the key high-impact studies, updates, and analyses published in medicine during the past week.

Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction

Thrombus aspiration is used as an adjunct for managing ST-segment elevation myocardial infarctions (STEMI) and occurs prior to percutaneous coronary intervention (PCI).  Previous research on the effectiveness of thrombus aspiration have not been adequately powered for hard clinical end points, but have suggested that there may be a survival benefit.  In this randomized, controlled registry trial, 7244 patients with STEMI who were undergoing PCI were randomized to thrombus aspiration followed by PCI or PCI only.  Researchers found that there was no significant difference in 30-day mortality rates between the intervention and control groups (2.8% vs. 3.0%, hazard ratio 0.94, 95% CI 0.72 – 1.22, p= 0.63).  Additionally there was no statistically significant difference found in rates of recurrent myocardial infarction, stent thrombosis, stroke, or neurologic complications. This randomized trial utilized a registry to follow-up on patients with the benefit of accruing many patients at relative low cost. In this trial of STEMI patients, thrombus aspiration followed by PCI did not have any clinically significant differences in outcomes from PCI alone.

Effect of Statin Therapy on Mortality in Patients With Ventilator-Associated Pneumonia

Previous observational studies have reported that statins may improve outcomes for various infections due to their anti-inflammatory and immunomodulating effects.  In this randomized controlled trial, which was stopped prematurely for futility, 300 patients with ventilator-associated pneumonia (VAP) were assigned to receive either simvastatin or placebo, starting on the same day as antibiotic therapy and lasting until discharge, death or 28 days, whichever occurred first.  The first interim analysis found that the 28-day mortality was not significantly different between the simvastatin and placebo groups (21.2% vs. 15.2%, hazard ratio 1.45, 95% CI  0.83 – 2.51).  There was additionally no significant difference in day-14, ICU, or hospital mortality rates.  This study therefore showed that there was no significant difference in outcomes in treating VAP patients with statins.

Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients

Previous studies suggest that influenza illness may contribute to an increase in acute thrombotic vascular events in patients with coronary artery or cerebrovascular disease.  Small, randomized control trials (RCT) have suggested that vaccination for influenza may reduce the risk of cardiovascular events but no definitive analysis has been conducted to date.  In this meta-analysis, researchers conducted a systematic search of the literature and included 6 randomized controlled trials that together involved 6725 participants who were randomized to standard intramuscular or intranasal influenza vaccination or to placebo.  Patients who received the influenza vaccine demonstrated a lower risk of composite cardiovascular events (2.9% vs 4.7%, RR, 0.64 (95% CI 0.48-0.86, P = .003)) with the greatest treatment effect seen among high-risk patients who had more active coronary disease.   The findings of this analysis justify a large RCT to assess the effects of influenza vaccination on hard cardiovascular end points.

Risedronate in children with osteogenesis imperfecta: a randomised, double-blind, placebo-controlled trial

Children with osteogenesis imperfecta are at higher risk for fractures, and biphophonates is often used to treat treat or prevent fractures. In this multicenter, randomized, control trial of children 4 – 15 years old with osteogenesis imperfecta, 147 participants were randomized 2:1 to risedronate (2.5mg or 5mg) or placebo for 1 year. Study participants randomized to risedronate had higher increase in lumbar bone mineral density (16.4% increase vs. 7.6% increase in placebo, p < 0.0001) and fewer clinical fractures at 1 year (31% vs. 49%, p = 0.045). The authors concluded oral risedronate is effective at preventing first and recurrent fractures in children with osteogenesis imperfecta.

Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades?

The rate of hospital acquired pressure ulcers have been considered to compare hospitals for public reporting and financial penalties. In this retrospective analysis of California hospitals, investigators compared the rate of recorded hospital acquired pressure ulcers from administrative databases and surveillance data (actually examined patients). Administrative databases underreported the number of hospital acquired pressure ulcers (mean rate 0.15%, 95% CI 0.13 – 0.17%) compared to surveillance data (mean rate 2.0%, 95% CI 1.8 – 2.2%). There was significant discordance in relative performance of hospitals between the quartiles – the worse 25% of hospitals by the rate from administrative database had performance ratings of 6% “superior”, 29% “above average”, 31% “average”, and 35% “below average” from surveillance data. This study suggests administrative records may not be reliable for comparing hospitals. 

By Neal Yuan and David Ouyang

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