On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the outcome of coronary stenting in the elderly?

1     exp Angioplasty, transluminal, percutaneous coronary/    results= 7897   
2     limit 1 to (human and english language)    results= 6033   
3     limit 2 to "aged, 80 and over"    results= 492   
4     3 and stent$.mp. [mp=title, abstract, registry number word,    results= 115   
mesh subject heading]
5     exp Coronary disease/    results= 37208   
6     limit 5 to (human and english language and "aged, 80 and    results= 1957   
over")
7     6 and stent$.mp. [mp=title, abstract, registry number word,    results= 133   
mesh subject heading]
8     from 7 keep 5,13    results= 2   
9     7 and (elderly or octagenarian or aged).ti.    results= 6   
10     from 9 keep 2-6    results= 5   
11     4 and (elderly or octagenarian or aged).ti.    results= 2   

Reference Librarian comments

I find that this question is a bit tricky. I followed what you were trying to do (in your strategy above...). I hope the references you got were helpful.

Just for fun, I tried the search also -- and I benefited from what you had already tried, so I intentionally took a slightly different tack.

I thought like this:

"I'll make a big set with stents. And then I'll make a couple of big sets of coronary diseases or the procedure angioplasty. And then I'll "and" the stent set with those. That set is pretty big (set #4) so I'll "and" to some "outcomes" subject headings. And set #6 is still mighty big. So maybe it's time to limit to the elderly, with set #7. After that I just "played..."

Are there any "EBM" reviews (evidence-based medicine). Yes.
Are there review articles. Yes.
How many would there be if I limited my results to the 200 biggest clinical journals and also limited to just the last year. (43).

Anyway, here's my strategy. Thanks for participating in the exercise.

Medline 1991 to January 2000

#
Search History
Results
1
exp *Stents/
5848
2
exp coronary disease/
37208
3
exp angioplasty/
12310
4
1 and (2 or 3)
2244
5
exp fatal outcome/ or exp "outcome and process assessment (health care)"/ or exp "outcome
assessment (health care)"/ or exp treatment outcome/ or "outcome".mp.
176243
6
4 and 5
688
7
limit 6 to ("aged < 65 and over >" or "aged, 80 and over")
384
8
limit 7 to ebm reviews
2
9
limit 7 to (human and english language and review articles)
4
10
limit 7 to (aim journals and yr=1999-2000)
43

°°° Here are the two from set #8 ...

<1>
AN 98240845
AU Antoniucci D. Santoro GM. Bolognese L. Valenti R. Trapani M. Fazzini
PF.
IN Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
TI A clinical trial comparing primary stenting of the infarct-related artery
with optimal primary angioplasty for acute myocardial
infarction: results from the Florence Randomized Elective
Stenting in Acute Coronary Occlusions (FRESCO) trial.
SO Journal of the American College of Cardiology. 31(6):1234-9, 1998 May.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB OBJECTIVES: This study sought to compare stenting of the primary
infarct-related artery (IRA) with optimal primary percutaneous transluminal
coronary angioplasty (PTCA) with respect to
clinical and angiographic outcomes of
patients with an acute myocardial infarction. BACKGROUND: Early
and late restenosis or reocclusion of the IRA after
successful primary PTCA significantly contributes to increased patient
morbidity and mortality. Coronary stenting
results in a lower rate of angiographic and clinical
restenosis than standard PTCA in patients with angina
and with previously untreated, noncomplex lesions. METHODS:
After successful primary PTCA, 150 patients were randomly
assigned to elective stenting or no further intervention. The primary end
point of the trial was a composite end point, defined as death, reinfarction
or repeat target vessel revascularization as a consequence of recurrent
ischemia within 6 months of randomization. The secondary end
point was angiographic evidence of restenosis or reocclusion at 6 months
after randomization. RESULTS: Stenting of the IRA was
successful in all patients randomized to stent
treatment. At 6 months, the incidence of the primary end
point was 9% in the stent group and 28% in the PTCA group
(p=0.003); the incidence of restenosis or reocclusion was 17% in the stent
group and 43% in the PTCA group (p=0.001). CONCLUSIONS:
Primary stenting of the IRA, compared with optimal primary
angioplasty, results in a lower rate of major adverse events
related to recurrent ischemia and a lower rate of
angiographically detected restenosis or reocclusion of the IRA.

<2>
AN 97212607
AU Versaci F. Gaspardone A. Tomai F. Crea F. Chiariello L. Gioffre PA.
IN Servizio Speciale di Diagnosi e Cura di Emodinamica, Universita di Roma Tor
Vergata, Italy.
TI A comparison of coronary-artery stenting with
angioplasty for isolated stenosis of the proximal left
anterior descending coronary artery [see comments].
CM Comment in: N Engl J Med 1997 Jul 24;337(4):277-8, Comment in: ACP J Club
1997 Sep-Oct;127(2):32
SO New England Journal of Medicine. 336(12):817-22, 1997 Mar
20.
LM Dana(complete) &MFHSL(1990-date);also Web,check catalog .
AB BACKGROUND: Randomized studies have shown that the use of
coronary-artery stenting as the initial
treatment for coronary stenosis is
associated with a lower risk of restenosis than is standard
coronary angioplasty. We prospectively
investigated the efficacy of these two approaches in selected patients with
isolated stenosis of the proximal left anterior descending
coronary artery. METHODS: A total of 120 patients with
isolated stenosis of the proximal left anterior descending
coronary artery were randomly assigned to
stent implantation or standard coronary
angioplasty. The primary clinical end points were the rate
of procedural success (defined as residual stenosis of less than 50 percent
and the absence of death, myocardial infarction,
and the need for coronary-artery bypass
surgery during the hospital stay) and the rate of event-free
survival (defined as freedom from death, myocardial infarction,
and the recurrence of angina) at 12 months. The angiographic
end point was the rate of restenosis 12 months after the procedure. RESULTS:
The two treatment groups did not differ significantly with
respect to demographic, clinical, or angiographic characteristics. The rates
of procedural success were similar in the two groups of patients (95 percent
in the stenting group vs. 93 percent in the angioplasty
group, P = 0.98). The 12-month rates of event-free survival were 87 percent
after stenting and 70 percent after
angioplasty (P = 0.04). The rates of restenosis were 19
percent after stent implantation and 40 percent after
angioplasty (P = 0.02). CONCLUSIONS: In patients with
symptomatic isolated stenosis of the proximal left anterior descending
coronary artery, stenting had advantages over
standard coronary
angioplasty in that it was associated with both a lower rate
of restenosis and a better clinical
outcome.