metcardio.org
 Meta-analysis and Evidence-based Medicine Training in Cardiology
The metcardio.org website is dedicated to meta-analysis and evidence-based medicine training in cardiology. It is sponsored by the Meta-analysis and Evidence-based medicine Training in Cardiology (METCARDIO) Group, currently headquartered in Turin, Italy, and formerly known as the Center for Overview, Meta-analysis, and Evidence-based Medicine Training (COMET). The focus of the metcardio.org website is on clinical research methods and evidence-based cardiovascular medicine with a specific interest in interventional cardiology and peripheral cardiovascular interventions. Nonetheless, there is plenty of training and research opportunities for other evidence-based endeavors, eg in anesthesiology, critical care medicine, and psychiatry.


Title: A systematic review on clinical predictors of anthracycline cardiotoxicity
Highlights: Clinical studies reporting on the incidence and predictors of anthracycline cardiotoxicity will be systematically searched, appraised and pooled with meta-analytic methods
Search strategy: PubMed will be searched for pertinent articles according to the following highly sensitive strategy: doxorubicin OR anthracycline* OR epirubicin OR adriamycin) AND (cardiotoxic* OR (cardiac AND toxicit*)) AND (predict* OR independent* OR Prognosis/Broad[filter] OR Therapy/Broad[filter]) NOT (animal [mh] NOT human [mh]) NOT (comment[pt] OR editorial[pt] OR meta-analysis[pt] OR practice-guideline[pt] OR review[pt])
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy
Online only supplement: 89 Kb Doc file, August 2013

Title: A network meta-analysis of preventive means for anthracycline cardiotoxicity
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy

Title: A network meta-analysis of beta-blockers for heart failure
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy

Title: A systematic review and meta-analysis on drug-eluting balloons for peripheral artery disease
Search strategy: PubMed will be searched for pertinent articles according to the following highly sensitive strategy: ((paclitaxel-eluting OR paclitaxel-coated OR (drug AND (eluting OR coated))) AND ((peripheral AND artery AND disease) OR popliteal OR femoral OR tibial OR infra-inguinal OR infrainguinal)) AND (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (clinical trial[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind[tw])) OR (latin square[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh]) NOT (comment[pt] OR editorial[pt] OR meta-analysis[pt] OR practice-guideline[pt] OR review[pt]))
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy

Title: A meta-regression on the benefits of radial access in patients with ST-elevation myocardial infarction
Search strategy: PubMed will be searched for pertinent articles according to the following highly sensitive strategy: (radial OR transradial OR trans-radial) AND coronary AND access* AND (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (clinical trial[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind[tw])) OR (latin square[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh]) NOT (comment[pt] OR editorial[pt] OR meta-analysis[pt] OR practice-guideline[pt] OR review[pt]))
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy

Title: A network meta-analysis on the renal safety of iodinated contrast agents
Principal investigator: Giuseppe Biondi-Zoccai, Sapienza University of Rome, Latina, Italy
Methods: This review will be conducted in keeping with ongoing guidelines. All reviewing activities will be conducted independently by two skilled systematic reviewers, with divergences resolved after consensus.
MEDLINE/PubMed will be searched according to Biondi-Zoccai et al, combining a dedicated string for randomized trials as follows: (iodixanol OR iomeprol OR ioxaglate OR iopamidol OR iopromide OR iohexol OR iopamidol OR iopental OR iopentol OR iopramide OR ioversol) AND (nephropathy OR ((kidney OR renal) AND (insufficiency OR damage OR injury OR failure))) AND (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (clinical trial[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind[tw])) OR (latin square[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh]) NOT (comment[pt] OR editorial[pt] OR meta-analysis[pt] OR practice-guideline[pt] OR review[pt])). Google Scholar and Scopus were also searched for additional citations. No language restriction was enforced.
Citations will be initially screened at the title and abstract level, and discarded if clearly not pertinent. Potentially suitable citations will be retrieved as full reports. They will then be included if reporting a randomized trial, on low-osmolar or iso-osmolar radiographic contrast agents, and reporting data on renal safety. Studies including high-osmolar contrast agents as comparators will conversely be excluded a priori to minimize their confounding effect on the evidence network.
Major design, patient, and procedural features will be abstracted from the shortlisted studies. Outcomes of interest will be the short-term (within 30 days) rate of CIN, defined as an absolute increase of at least 0.5 mg/dL or a relative increase of at least 25% in serum creatinine. In addition, the risk of at least 25% increase in serum creatinine will be separately abstracted as secondary endpoint. In case such outcomes are not reported, CIN will be abstracted in keeping with the specific study definition. Additional endpoints will be short-term (within 30 days) rates of dialysis and all cause death. Study validity will be appraised in keeping with the Cochrane Collaboration recommendations.
Descriptive analyses will rely on median values or percentages. Inferential analyses will rely on the computation of odds ratios (OR) and absolute rates (AR), both with 95% credibility intervals (CI), by means of network meta-analysis with a binomial likelihood model and logit link. The probability that each agent has the lowest rate of events (Pbest) will also be computed. Each analysis will be based on non-informative priors for effect sizes and precision. Convergence and lack of auto-correlation will be checked and confirmed after a 50,000-simulation burn-in phase, and, finally, direct probability statements will be based on an additional 100,000-simulation phase. Model fit and choice between random and fixed-effect models will be based on computing and comparing estimates for deviance and deviance information criterion (DIC). Sensitivity analyses will be conducted for the primary endpoint limiting the scope to intravenous contrast administration only, intra-arterial contrast administration only, and studies published after 2003. Pairwise inconsistency and inconsistency between direct and indirect effect estimates will be assessed with the I2 statistic. Extent of small study effects/publication bias will be assessed by visual inspection of funnel plots. Computations will be performed with WinBUGS 1.4.3 (MRC Biostatistics Unit, Cambridge, UK).