Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity Meta-Analysis of Randomized and Observational Studies

ObjectivesThe purpose of this study was to assess the effects of off-pump coronary bypass surgery (OPCAB) on mortality and morbidity.BackgroundDespite its potential for reducing morbidity and mortality, OPCAB’s role in clinical practice remains controversial.MethodsA meta-analysis of 37 randomized controlled trials (RCTs) (n=3,449) and 22 risk-adjusted (logistic regression or propensity-score) observational studies (n=293,617) was performed. Two reviewers performed literature searches (MEDLINE, EMBASE, PubMed, reference lists), quality assessment, and data extraction. Treatment effects were calculated as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsIn RCTs, OPCAB was associated with reduced atrial fibrillation (OR 0.59; 95% CI 0.46 to 0.77) and trends toward reduced 30-day mortality (OR 0.91 95% CI 0.45 to 1.83), stroke (OR 0.52; 95% CI 0.25 to 1.05), and myocardial infarction (OR 0.79; 95% CI 0.50 to 1.25). Observational studies showed OPCAB to be associated with reduced 30-day mortality (OR 0.72; 95% CI 0.66 to 0.78), stroke (OR 0.62; 95% CI 0.55 to 0.69), infarction (OR 0.66; 95% CI 0.50 to 0.88), and atrial fibrillation (OR 0.78; 95% CI 0.74 to 0.82). At one to two years, OPCAB was associated with trends toward reduced mortality, but also increased repeat revascularization (RCT: OR 1.75, 95% CI 0.78 to 3.94; Observational: OR 1.35, 95% CI 0.76 to 2.39).ConclusionsRandomized controlled trials did not find, aside from atrial fibrillation, the statistically significant reductions in short-term mortality and morbidity demonstrated by observational studies. These discrepancies might be due to differing patient-selection and study methodology. Future studies must focus on improving research methodology, recruiting high-risk patients, and collecting long-term data

OPTIMAL CHOICE OF THE DRUG COMBINATION IN ARTERIAL HYPERTENSION THERAPY. FOCUS AT COMBINATION OF ANTIOTENSIN-CONVERTING ENZYME AND CALCIUM ANTAGONIST COMBINATION

Currently cardiovascular diseases (CVD) are an urgent problem of national and international practice. The arterial hypertension takes the leading place due to the fact that the disease has acquired the character of epidemics. The medical and social importance of AH is preconditioned by the fact that this pathology is an important risk factors of major CVD – myocardium infarction and brain stroke that predetermine the high mortality rates [1]