Journal and News Scan

Takagi H, et al. – A 12–year–ago landmark meta–analysis of bilateral versus single internal thoracic artery (bilateral ITA [BITA] versus single ITA [SITA]) coronary artery bypass grafting for long–term survival included 7 observational studies (only 3 of which reported adjusted hazard ratios [HRs]) enrolling approximately 16,000 patients. Updating the previous meta–analysis to determine whether BITA grafting reduces long–term mortality over SITA grafting, the authors exclusively abstracted (then combined in a meta–analysis) adjusted (not unadjusted) HRs from observational studies. Based on an updated meta–analysis of exclusive adjusted HRs from 20 observational studies enrolling >70,000 patients, BITA grafting appears to significantly reduce long–term mortality. As the proportion of men increases, BITA grafting is more beneficial in reducing the mortality.

Methods

• MEDLINE and EMBASE were searched through September 2013.
• Eligible studies were observational studies of BITA versus SITA grafting and reporting adjusted HRs for long-term (≥4-year) mortality as an outcome.
• Meta-regression analyses were performed to determine whether the effects of BITA grafting were modulated by the pre-specified factors.

 

Results

• Twenty observational studies enrolling 70,897 patients were identified and included.
• A pooled analysis suggested a significant reduction in long-term mortality with BITA relative to SITA grafting (HR, 0.80; 95% confidence interval, 0.77 to 0.84).
• When data from 6 pedicled and 6 skeletonized ITA studies were separately pooled, BITA grafting was associates with a statistically significant 26% and 16% reduction in mortality relative to SITA grafting, respectively (P for subgroup differences = .04).
• A meta-regression coefficient was significantly negative for proportion of men (–0.00960; -0.01806 to -0.00114).

 

The authors evaluated the impact of small (<10mm) pleural effusion on outcomes in patients with NSCLC.  Of over 2000 pts, minimal PE was present in 13%.  It was more common in patients with more advanced stages.  Minimal PE was associated with decreased median survival (7.7 vs 17.7 mos) after adjustment for other prognostic variables.  The impact on outcomes was greater for earlier stages of disease.

There have been some concerns about outcomes of TAVI in patients with bicuspid aortic valves (BAV). In this retrospective study, outcomes after TAVI in 21 patients with BAVs were compared with those in 447 patients with tricuspid aortic valves (TAV). Device success was lower and 30-day mortality was higher in BAV patients. There was no significant difference between groups in terms of 30-day composite safety end point, postprocedural aortic regurgitation or in 12-month cardiovascular mortality.

In an effort to provide diagnostic information complementary to radiographic screening for lung cancer, the authors evaluated the diagnostic performance of plasma mRNA.  The mRNA signature classifier demonstrated 87% sensitivity and 81% specificity, with a negative predictive value of 99%.  In contrast, low dose CT had a sensitivity of 79% and a specificity of 81%.  Combining the mRNA signature classifier and low dose CT resulted in a 5-fold decrease in false positive findings based on CT alone.