ID

13740

Beschrijving

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

Trefwoorden

Versies (3)
  1. 01-03-16 01-03-16 -
  2. 02-03-16 02-03-16 -
  3. 20-09-21 20-09-21 -
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2 maart 2016

DOI

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Creative Commons BY-NC 3.0
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Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis DRKS00000521

Engels

CABACS Case Report Form [Day 30 post-Op]

1 Formulieren  
Doppler Ultrasonography
Beschrijving

Doppler Ultrasonography

Right common carotid artery % stenosis according to ECST
Beschrijving

Common carotid artery stenosis

Datatype

integer

Maateenheden
  • %
Alias
UMLS CUI [1]
C0751635
%
Left common carotid artery % stenosis according to ECST
Beschrijving

Common carotid artery stenosis

Datatype

integer

Maateenheden
  • %
Alias
UMLS CUI [1]
C0751635
%
Right internal Carotid Artery % stenosis according to ECST
Beschrijving

Internal Carotid Artery Stenosis

Datatype

integer

Maateenheden
  • %
Alias
UMLS CUI [1]
C0340569
%
Left internal Carotid Artery % stenosis according to ECST
Beschrijving

Internal Carotid Artery Stenosis

Datatype

integer

Maateenheden
  • %
Alias
UMLS CUI [1]
C0340569
%
ECG
Beschrijving

ECG

Date ECG was performed
Beschrijving

ECG Date

Datatype

date

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

ECG findings

Datatype

boolean

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

ECG findings

Datatype

text

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

Screening: Outcome events

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

Visual impairment

Datatype

boolean

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

Paresthesia or hemiplegia

Datatype

boolean

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

Speech disorder

Datatype

boolean

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

New signs or symptoms

Datatype

boolean

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

If you suspect cerebrovascular stroke, please initiate cerebral imaging

Datatype

boolean

Alias
UMLS CUI [1]
C0877248
Complications
Beschrijving

Complications

Deep wound infection
Beschrijving

Wound infection

Datatype

boolean

Alias
UMLS CUI [1]
C0043241
Sepsis
Beschrijving

Sepsis

Datatype

boolean

Alias
UMLS CUI [1]
C0243026
Deep vein thrombosis
Beschrijving

Venous thrombosis

Datatype

boolean

Alias
UMLS CUI [1]
C0040053
Pulmonary Embolism
Beschrijving

Pulmonary Embolism

Datatype

boolean

Alias
UMLS CUI [1]
C0034065
Pneumonia
Beschrijving

Pneumonia

Datatype

boolean

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

Hemodynamic instability

Datatype

boolean

Alias
UMLS CUI [1]
C0948268
Carotid dilatation
Beschrijving

Carotid dilatation

Datatype

boolean

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

Hemorrhage

Datatype

boolean

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

Deterioration of comorbidity

Datatype

boolean

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

Deterioration of comorbidity

Datatype

text

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

Other relevant complications

Datatype

boolean

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

Other relevant complications

Datatype

text

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

Serious adverse events

Re-CEA/unplanned CEA
Beschrijving

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

Datatype

boolean

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

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

Datatype

boolean

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

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

Datatype

boolean

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

Artificial ventilation

Datatype

boolean

Alias
UMLS CUI [1]
C0035205
Concomitant medication
Beschrijving

Concomitant medication

Does the patient take antiplatelet agents?
Beschrijving

Concomitant Medication

Datatype

boolean

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

Antiplatelet drugs

Datatype

integer

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

Antiplatelet drugs

Datatype

text

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

Concomitant Medication

Datatype

boolean

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

Anticoagulants

Datatype

integer

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

Anticoagulants

Datatype

text

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

Concomitant Medication

Datatype

boolean

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

Antihypertensive drugs

Datatype

integer

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

antihypertensive agent

Datatype

text

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

Concomitant Medication

Datatype

boolean

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

Antilipemic agent

Datatype

integer

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

antilipemic agent

Datatype

text

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

Concomitant Medication

Datatype

boolean

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

Concomitant Medication

Datatype

text

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

Other surgical procedures

Datatype

boolean

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

Other surgical procedure

Datatype

text

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

Date of completion

Datatype

date

Alias
UMLS CUI [1]
C0011008
Signature by investigator
Beschrijving

Signature

Datatype

text

Alias
UMLS CUI [1]
C1519316
Name of Investigator
Beschrijving

Name of Investigator

Datatype

text

Alias
UMLS CUI [1]
C0008961
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Similar models

CABACS Case Report Form [Day 30 post-Op]

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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,carotid occlusion, recurrent carotid stenosis or 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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