ID

13737

Descripción

Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis. A randomized controlled clinical trial. Short title: "CABACS" DRKS Number:DRKS00000521 IRSCTN Number:ISRCTN13486906 Phase:Therapeutic confirmatory(Phase III) Head of clinical trial: Prof. Dr. med. Christian Weimar University Duisburg-Essen Phone: 0201/723-6503 Fax: 0201/723-6948 e-mail: christian.weimar@uk-essen.de University Hospital Essen Hospital for Neurology Hufelandstr. 55 45122 Essen Trial coordinator: Dr. med. Stephan Knipp Phone: 0201/723-4915 Fax: 0201/723-5451 e-mail: stephan.knipp@uk-essen.de University Duisburg-Essen University Hospital Essen Hospital for thoracic- and cardiovascular surgery Hufelandstr. 55 45122 Essen Data Management: Anja Marr Phone: 0201/92239-257 Fax: 0201/92239-333 o. 0201/723-5933 e-mail: anja.marr@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen Monitoring: Dipl.-Biol. Konstantinos Bilbilis Phone: 0201/92239-252 Fax: 0201/92239-310 e-mail: konstantinos.bilbilis@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen

Palabras clave

Versiones (3)
  1. 1/3/16 1/3/16 -
  2. 2/3/16 2/3/16 -
  3. 20/9/21 20/9/21 -
Subido en

1 de marzo de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis

Inglés

CABACS Case Report Form [Day 30 post-Op]

1 formularios  
Doppler Ultrasonography
Descripción

Doppler Ultrasonography

Right common carotid artery % stenosis according to ECST
Descripción

Common carotid artery stenosis

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0751635
%
Left common carotid artery % stenosis according to ECST
Descripción

Common carotid artery stenosis

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0751635
%
Right internal Carotid Artery % stenosis according to ECST
Descripción

Internal Carotid Artery Stenosis

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0340569
%
Left internal Carotid Artery % stenosis according to ECST
Descripción

Internal Carotid Artery Stenosis

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0340569
%
ECG
Descripción

ECG

Date ECG was performed
Descripción

ECG Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0013798
UMLS CUI [1,2]
C0011008
Any pathologic findings in ECG?
Descripción

ECG findings

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0438154
Please specify any pathologic ECG findings
Descripción

ECG findings

Tipo de datos

text

Alias
UMLS CUI [1]
C0438154
Screening: Outcome events
Descripción

Screening: Outcome events

Did the patient experience any (transient) visual impairment (since surgery)?
Descripción

Visual impairment

Tipo de datos

boolean

Alias
UMLS CUI [1]
C3665347
Did the patient experience paresthesia or weakness on one side of the body (since surgery)?
Descripción

Paresthesia or hemiplegia

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0030554
UMLS CUI [1,2]
C0018991
Did the patient experience speech disorder (since surgery)?
Descripción

Speech disorder

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0037822
Did the patient experience any new signs or symptoms (since surgery)?
Descripción

New signs or symptoms

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0037088
Is at least one of the following adverse events present: cerebrovascular stroke, myocardial infaction,technical failure, death? If `yes` please fill in Adverse event form and send to study coordinator within 7 days.
Descripción

If you suspect cerebrovascular stroke, please initiate cerebral imaging

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0877248
Complications
Descripción

Complications

Deep wound infection
Descripción

Wound infection

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0043241
Sepsis
Descripción

Sepsis

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0243026
Deep vein thrombosis
Descripción

Venous thrombosis

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0040053
Pulmonary Embolism
Descripción

Pulmonary Embolism

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0034065
Pneumonia
Descripción

Pneumonia

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0032285
Severe hemodynamic instability longer than 24h
Descripción

Hemodynamic instability

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0948268
Carotid dilatation
Descripción

Carotid dilatation

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0012359
UMLS CUI [1,2]
C0007272
Carotid bleeding requiring revision
Descripción

Hemorrhage

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0019080
Deterioration of comorbidity (possibly) because of surgical procedure
Descripción

Deterioration of comorbidity

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0563273
UMLS CUI [1,2]
C0009488
Deterioration of comorbidity:If `yes` please specify
Descripción

Deterioration of comorbidity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0563273
UMLS CUI [1,2]
C0009488
Other relevant complications
Descripción

Other relevant complications

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0009566
UMLS CUI [1,2]
C0205394
Other relevant complications:Please specify
Descripción

Other relevant complications

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0009566
UMLS CUI [1,2]
C0205394
Serious adverse events
Descripción

Serious adverse events

Re-CEA/unplanned CEA
Descripción

Please fill in SAE form and send to study coordinator within 7 days via fax

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0014099
UMLS CUI [1,2]
C1527075
Resuscitation
Descripción

Please fill in SAE form and send to study coordinator within 7 days via fax

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0007203
Did any serious adverse events occur?
Descripción

Please fill in SAE form and send to study coordinator within 7 days via fax

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1519255
Patient is on artificial respiration longer than 30 days after surgery
Descripción

Artificial ventilation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0035205
Concomitant medication
Descripción

Concomitant medication

Does the patient take antiplatelet agents?
Descripción

Concomitant Medication

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2347852
Please choose from the list below, which antiplatelet drug the patient takes
Descripción

Antiplatelet drugs

Tipo de datos

integer

Alias
UMLS CUI [1]
C0085826
Please specify which antiplatelet drugs the patient took, if you chose `other`
Descripción

Antiplatelet drugs

Tipo de datos

text

Alias
UMLS CUI [1]
C0085826
Does the patient take any anticoagulants?
Descripción

Concomitant Medication

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2347852
Please choose which one of the anticoagulants listed below the patient takes.
Descripción

Anticoagulants

Tipo de datos

integer

Alias
UMLS CUI [1]
C0003280
Please specify which anticoagulant the patient takes, if you chose `other`.
Descripción

Anticoagulants

Tipo de datos

text

Alias
UMLS CUI [1]
C0003280
Does the patient take any antihypertensive drugs?
Descripción

Concomitant Medication

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2347852
Please choose which one of the antihypertensive drugs listed below the patient takes.
Descripción

Antihypertensive drugs

Tipo de datos

integer

Alias
UMLS CUI [1]
C0003364
Please specify which antihypertensive agent the patient takes, if you chose `other`.
Descripción

antihypertensive agent

Tipo de datos

text

Alias
UMLS CUI [1]
C0003364
Does the patient take any lipid lowering agents?
Descripción

Concomitant Medication

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2347852
Please choose which one of the antilipemic agents listed below the patient takes
Descripción

Antilipemic agent

Tipo de datos

integer

Alias
UMLS CUI [1]
C0003367
Please specify which antilipemic agent the patient takes, if you chose `other`.
Descripción

antilipemic agent

Tipo de datos

text

Alias
UMLS CUI [1]
C0003367
Any other relevant concomitant medication the patient takes?
Descripción

Concomitant Medication

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2347852
Please specify what other concomitant medication the patient takes
Descripción

Concomitant Medication

Tipo de datos

text

Alias
UMLS CUI [1]
C2347852
Has Subject undergone any other relevant surgical procedures other than recorded on this form
Descripción

Other surgical procedures

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0543467
Please specify the nature of the other surgical procedure
Descripción

Other surgical procedure

Tipo de datos

text

Alias
UMLS CUI [1]
C0543467
Date of completion of this form
Descripción

Date of completion

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Signature by investigator
Descripción

Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316
Name of Investigator
Descripción

Name of Investigator

Tipo de datos

text

Alias
UMLS CUI [1]
C0008961
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Similar models

CABACS Case Report Form [Day 30 post-Op]

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Doppler Ultrasonography
Common carotid artery stenosis
Item
Right common carotid artery % stenosis according to ECST
integer
C0751635 (UMLS CUI [1])
Common carotid artery stenosis
Item
Left common carotid artery % stenosis according to ECST
integer
C0751635 (UMLS CUI [1])
Internal Carotid Artery Stenosis
Item
Right internal Carotid Artery % stenosis according to ECST
integer
C0340569 (UMLS CUI [1])
Internal Carotid Artery Stenosis
Item
Left internal Carotid Artery % stenosis according to ECST
integer
C0340569 (UMLS CUI [1])
Item Group
ECG
ECG Date
Item
Date ECG was performed
date
C0013798 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
ECG findings
Item
Any pathologic findings in ECG?
boolean
C0438154 (UMLS CUI [1])
ECG findings
Item
Please specify any pathologic ECG findings
text
C0438154 (UMLS CUI [1])
Item Group
Screening: Outcome events
Visual impairment
Item
Did the patient experience any (transient) visual impairment (since surgery)?
boolean
C3665347 (UMLS CUI [1])
Paresthesia or hemiplegia
Item
Did the patient experience paresthesia or weakness on one side of the body (since surgery)?
boolean
C0030554 (UMLS CUI [1,1])
C0018991 (UMLS CUI [1,2])
Speech disorder
Item
Did the patient experience speech disorder (since surgery)?
boolean
C0037822 (UMLS CUI [1])
New signs or symptoms
Item
Did the patient experience any new signs or symptoms (since surgery)?
boolean
C0037088 (UMLS CUI [1])
Adverse event
Item
Is at least one of the following adverse events present: cerebrovascular stroke, myocardial infaction,technical failure, death? If `yes` please fill in Adverse event form and send to study coordinator within 7 days.
boolean
C0877248 (UMLS CUI [1])
Item Group
Complications
Wound infection
Item
Deep wound infection
boolean
C0043241 (UMLS CUI [1])
Sepsis
Item
Sepsis
boolean
C0243026 (UMLS CUI [1])
Venous thrombosis
Item
Deep vein thrombosis
boolean
C0040053 (UMLS CUI [1])
Pulmonary Embolism
Item
Pulmonary Embolism
boolean
C0034065 (UMLS CUI [1])
Pneumonia
Item
Pneumonia
boolean
C0032285 (UMLS CUI [1])
Hemodynamic instability
Item
Severe hemodynamic instability longer than 24h
boolean
C0948268 (UMLS CUI [1])
Carotid dilatation
Item
Carotid dilatation
boolean
C0012359 (UMLS CUI [1,1])
C0007272 (UMLS CUI [1,2])
Hemorrhage
Item
Carotid bleeding requiring revision
boolean
C0019080 (UMLS CUI [1])
Deterioration of comorbidity
Item
Deterioration of comorbidity (possibly) because of surgical procedure
boolean
C0563273 (UMLS CUI [1,1])
C0009488 (UMLS CUI [1,2])
Deterioration of comorbidity
Item
Deterioration of comorbidity:If `yes` please specify
text
C0563273 (UMLS CUI [1,1])
C0009488 (UMLS CUI [1,2])
Other relevant complications
Item
Other relevant complications
boolean
C0009566 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Other relevant complications
Item
Other relevant complications:Please specify
text
C0009566 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item Group
Serious adverse events
Re-CEA
Item
Re-CEA/unplanned CEA
boolean
C0014099 (UMLS CUI [1,1])
C1527075 (UMLS CUI [1,2])
Resuscitation
Item
Resuscitation
boolean
C0007203 (UMLS CUI [1])
Serious adverse events
Item
Did any serious adverse events occur?
boolean
C1519255 (UMLS CUI [1])
Artificial ventilation
Item
Patient is on artificial respiration longer than 30 days after surgery
boolean
C0035205 (UMLS CUI [1])
Item Group
Concomitant medication
Concomitant Medication
Item
Does the patient take antiplatelet agents?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose from the list below, which antiplatelet drug the patient takes
integer
C0085826 (UMLS CUI [1])
Antiplatelet drugs
Code List
Please choose from the list below, which antiplatelet drug the patient takes
CL Item
Acetyl salicylic acid (1)
CL Item
Clopidogrel (2)
CL Item
Acetyl salicylic acid plus Dipyridamole (3)
CL Item
More than one of the list (4)
CL Item
Other (5)
Antiplatelet drugs
Item
Please specify which antiplatelet drugs the patient took, if you chose `other`
text
C0085826 (UMLS CUI [1])
Concomitant Medication
Item
Does the patient take any anticoagulants?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the anticoagulants listed below the patient takes.
integer
C0003280 (UMLS CUI [1])
Anticoagulants
Code List
Please choose which one of the anticoagulants listed below the patient takes.
CL Item
Unfractionated heparin IV (1)
CL Item
Full dose LMW heparin (Enoxaparin , Others) (2)
CL Item
Vitamin K Antagonists like Warfarin (Coumadin) (3)
CL Item
Dabigatran (4)
CL Item
Other (5)
CL Item
More than one of the list (6)
Anticoagulants
Item
Please specify which anticoagulant the patient takes, if you chose `other`.
text
C0003280 (UMLS CUI [1])
Concomitant Medication
Item
Does the patient take any antihypertensive drugs?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the antihypertensive drugs listed below the patient takes.
integer
C0003364 (UMLS CUI [1])
Antihypertensive drugs
Code List
Please choose which one of the antihypertensive drugs listed below the patient takes.
CL Item
ACE inhibitor (1)
CL Item
angiotensin receptor blocker (2)
CL Item
Diuretics (3)
CL Item
Calcium Antagonist (4)
CL Item
Beta blocker (5)
CL Item
Other (6)
CL Item
More than one of the list (7)
antihypertensive agent
Item
Please specify which antihypertensive agent the patient takes, if you chose `other`.
text
C0003364 (UMLS CUI [1])
Concomitant Medication
Item
Does the patient take any lipid lowering agents?
boolean
C2347852 (UMLS CUI [1])
Item
Please choose which one of the antilipemic agents listed below the patient takes
integer
C0003367 (UMLS CUI [1])
Antilipemic agent
Code List
Please choose which one of the antilipemic agents listed below the patient takes
CL Item
Statine (1)
CL Item
Other (2)
CL Item
More than one (3)
antilipemic agent
Item
Please specify which antilipemic agent the patient takes, if you chose `other`.
text
C0003367 (UMLS CUI [1])
Concomitant Medication
Item
Any other relevant concomitant medication the patient takes?
boolean
C2347852 (UMLS CUI [1])
Concomitant Medication
Item
Please specify what other concomitant medication the patient takes
text
C2347852 (UMLS CUI [1])
Other surgical procedures
Item
Has Subject undergone any other relevant surgical procedures other than recorded on this form
boolean
C0543467 (UMLS CUI [1])
Other surgical procedure
Item
Please specify the nature of the other surgical procedure
text
C0543467 (UMLS CUI [1])
Date of completion
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature by investigator
text
C1519316 (UMLS CUI [1])
Name of Investigator
Item
Name of Investigator
text
C0008961 (UMLS CUI [1])
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