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<1>
Accession Number
2009486640
Authors
Bruchet N.K. Ensom M.H.H.
Institution
(Ensom) University of British Columbia, Children's and Women's Health
Centre of British Columbia, Department of Pharmacy (0B7), 4500 Oak Street,
Vancouver, BC V6H 3N1, Canada.
(Bruchet) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC, Canada.
(Ensom) Faculty of Pharmaceutical Sciences,
(Ensom) University of British Columbia,
(Ensom) Children's and Women's Health Centre of British Columbia,
Department of Pharmacy (0B7), 4500 Oak Street, Vancouver, BC V6H 3N1,
Canada.
Title
Limited sampling strategies for mycophenolic acid in solid organ
transplantation: A systematic review.
Source
Expert Opinion on Drug Metabolism and Toxicology. 5(9)(pp 1079-1097),
2009. Date of Publication: September 2009.
Publisher
Informa Healthcare
Abstract
Background: Mycophenolic acid (MPA) is the active metabolite of
mycophenolate mofetil, a widely used immunosuppressant. Numerous studies
have developed limited sampling strategies (LSSs) to predict MPA AUC in
solid organ transplant recipients. Objectives: To systematically review
and assess quality of literature pertaining to MPA LSSs, evaluate clinical
implications and provide suggestions for future research. Methods:
Literature searches of MEDLINE (1966 - May 2009) and EMBASE (1980 - May
2009) for English articles in solid organ transplantation, along with
manual review of article references were conducted. Included articles were
categorized according to criteria adapted from levels of evidence of the
US Preventative Services Task Force. Results: Of a total of 29 studies
identified, 20 were in kidney, 4 in heart, 4 in liver and 1 in lung
transplantation and 7 were in pediatrics. A total of 14 studies were
deemed to be Level I evidence studies, 3 were Level II-1, 1 was Level II-2
and 11 were Level III. Conclusions: Although various LSSs that are well
correlated to MPA AUC while being relatively unbiased and precise to
predict MPA AUC have been developed, further research is needed to
determine validity of these LSSs in a variety of patient populations and
to determine if these LSSs improve patient outcomes. copyright 2009
Informa UK Ltd All rights reserved.
<2>
Accession Number
2009532264
Authors
Abidov A. Gallagher M.J. Chinnaiyan K.M. Mehta L.S. Wegner J.H. Raff G.L.
Institution
(Abidov) Sarver Heart Center, University of Arizona, Tucson, AZ 85721,
United States.
(Abidov, Gallagher, Chinnaiyan, Wegner, Raff) Cardiology Division, William
Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073, United
States.
(Mehta) Division of Cardiology, Ohio State University, Columbus, OH,
United States.
Title
Clinical effectiveness of coronary computed tomographic angiography in the
triage of patients to cardiac catheterization and revascularization after
inconclusive stress testing: Results of a 2-year prospective trial.
Source
Journal of Nuclear Cardiology. 16(5)(pp 701-713), 2009. Date of
Publication: 2009.
Publisher
Springer New York
Abstract
Background: Management of patients with suspected coronary artery disease
(CAD) and inconclusive stress imaging test findings may result in invasive
coronary angiography (ICA). Coronary computed tomographic angiography
(CCTA) may be useful in defining the risk of CAD and adverse outcomes in
this patient population, as well as in reducing the need for ICA. Methods:
We prospectively enrolled 199 sequential patients referred by
cardiologists for CCTA after either inconclusive or nondiagnostic stress
imaging tests. Before CCTA, physicians identified a "planned
catheterization" group of patients who would undergo invasive angiography
if CCTA were not available. After CCTA testing, patients were followed for
-2 years. We established the added diagnostic value of the CCTA and its
prognostic power in prediction of intermediate-term follow-up events in
this patient population as compared to available historical and clinical
predictors of CAD, stress ECG, and stress imaging test results using a
multivariable Cox proportional hazards survival analysis. Results: Both
observed data and results of the multivariable model for the prediction of
obstructive CAD (>50% stenosis), or major cardiac events (death MI or
revascularization), demonstrated that clinical, stress ECG, and imaging
results were weakly predictive, whereas CCTA was found to be a strong
independent and incremental predictor of the absence of either significant
CAD or MACE in this population. None of the 93 patients with normal CCTA
scans had MACE events, whereas 18 patients with evidence of CAD on the
CCTA results underwent revascularization. Overall, physicians planned ICA
in 125 patients (63.0%); after CCTA, ICA was performed in only 32 (16.0%)
cases over 2 years. In this population with no other highly effective
noninvasive clinical tools for diagnostic and prognostic estimation, the
overall negative predictive value of CCTA for either CAD > 50% or MACE for
2 years was 99%. Conclusion: Observations from this prospective study
demonstrate the significant added diagnostic value and prognostic
potential of CCTA in patients with suspected CAD and either inconclusive
or nondiagnostic stress test results in real-world settings. Normal CCTA
results are associated with excellent intermediate-term prognosis in this
clinical subset, and invasive angiography can be safely avoided in the
majority of these patients when the results of CCTA are available.
copyright American Society of Nuclear Cardiology 2009.
<3>
Accession Number
2009547630
Authors
Martinez-Dolz L. Almenar L. Reganon E. Vila V. Sanchez-Soriano R.
Martinez-Sales V. Moro J. Aguero J. Sanchez-Lazaro I. Salvador A.
Institution
(Martinez-Dolz, Almenar, Sanchez-Soriano, Moro, Aguero, Sanchez-Lazaro,
Salvador) Heart Failure and Transplant Unit, Department of Cardiology,
Valencia, Spain.
(Reganon, Vila, Martinez-Sales) Research Center, La Fe University
Hospital, Valencia, Spain.
Title
What is the best biomarker for diagnosis of rejection in heart
transplantation?.
Source
Clinical Transplantation. 23(5)(pp 672-680), 2009. Date of Publication:
September/October 2009.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Acute cellular rejection is a major cause of graft loss in
heart transplantation (HT). Endomyocardial biopsy remains the gold
standard for its diagnosis, but it is an invasive procedure not without
risk. A proinflammatory state exists in rejection that could be assessed
by determining plasma levels of inflammatory biomarkers. Objective: To
analyze the utility of various inflammatory markers, which is most
important and what values best classify patients to diagnose rejection.
Materials and methods: A prospective study in 123 consecutive cardiac
transplant recipients was conducted from January 2002 to December 2006.
Fibrinogen protein (Fgp) and function (Fgf), C-reactive protein (CRP),
tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and sialic
acid (SA) determinations were performed at one, two, four, six, nine, and
12 months post-HT at the same time as biopsies. Coronary arteriography and
intravascular ultrasound were performed on the first and last follow-up
visits. Heart-lung transplants, retransplants, pediatric transplants,
patients who died in the first month, and patients who refused consent
were excluded. Also excluded were determinations that coincided with renal
dysfunction, active infection, hemodynamic instability, or a non-evaluable
biopsy. The final analysis included 79 patients and 294 determinations.
The correlation between the levels of these biomarkers and the presence of
rejection in the biopsy ([greater-than or equal to]ISHLT grade 3) was
studied. Results: We did not find significant differences in the values of
any of the markers analyzed on the six follow-up visits. Only CRP showed
significant and sustained differences between the two groups (with and
without rejection) from the second follow-up visit (month 2). The area
under the curve showed significant differences in Fgp (0.614, p = 0.013),
Fgf (0.585, p = 0.05), TNF-alpha (0.605, p = 0.02), SA (0.637, p = 0.002)
and mainly CRP (0.765, p = 0.0001). CRP levels below 0.87 mg/dL ruled out
rejection with a specificity of 90%. Conclusions: Among the inflammatory
markers analyzed, CRP was the most useful parameter for non-invasive
screening of acute cellular rejection in the first year post-HT. copyright
2009 John Wiley & Sons A/S.
<4>
Accession Number
2009543769
Title
Little benefit to revascularization over intensive medical treatment in
diabetes mellitus with coronary artery disease.
Source
Journal of the National Medical Association. 101(9)(pp 975-976), 2009.
Date of Publication: September 2009.
Publisher
National Medical Association
Abstract
This large clinical trial used a Latin square, or 2x2 design, to attempt
to answer 2 important questions simultaneously. A total of 2368 patients
with type 2 diabetes and coronary artery disease who were candidates for
elective PCI or CABG were enrolled in the study. Their cardiologist was
asked to recommend a preferred intervention: either PCI or CABG. The 763
patients selected for CABG were then randomly assigned to undergo
revascularization with CABG plus intensive medical therapy or intensive
medical therapy alone. Similarly, the 1605 patients selected for PCI were
randomized to undergo either PCI plus intensive medical therapy or
intensive medical therapy alone. Then, each of these 4 groups was
randomized to receive either insulin provision or insulin sensitization
therapy for their diabetes, both with a goal of a hemoglobin A1C level of
less than 7.0%. Patients in the insulin provision group were primarily
treated with insulin and/or a sulfonylurea, while those in the insulin
sensitization group were largely treated with metformin and/or a
thiazolidinedione. The average age of participants was 62 years, 70% were
men, 17% were black, and 13% were Hispanic (Am Heart J. 2008;156:528-36).
Patients were followed for a mean of 5.3 years. Groups were balanced and
the analysis was by intention to treat. There was some crossover, of
course, as in any such study: 13% assigned to medical therapy only were
revascularized within 6 months; 42% by the end of the study. This compares
with 95% of patients in the revascularization arms of the study who were
revascularized within 6 months. Bare metal stents were used by
approximately two-thirds of patients, mostly in the earlier years of the
patient recruitment period. There was no difference in all-cause mortality
between patients receiving revascularization plus medical therapy vs those
receiving intensive medical therapy only, or between patients receiving
insulin sensitization or insulin provision. This was true whether they
received PCI or CABG. There was also no difference between these groups
regarding the likelihood of major cardiovascular events. The only
exception was in the stratum whose physician thought they should consider
CABG: patients who underwent CABG were more likely to remain free of a
cardiovascular event than those receiving intensive medical therapy alone
(77.6% vs 69.5%, P = .01, NNT = 12). However, that was only true for those
assigned to the insulin sensitization group (18.7% vs 32.0%, P = .002, NNT
= 8), not for those assigned to insulin provision (26.0% vs 29.0%, P =
0.58).
<5>
Accession Number
2009519786
Authors
Sleilaty G. Madi-Jebara S. Yazigi A. Haddad F. Hayeck G. Rassi I.E.
Ashoush R. Jebara V.
Institution
(Sleilaty, Rassi, Ashoush, Jebara) Department of Cardiovascular Surgery,
Hotel Dieu de France Hospital, Beirut, Lebanon.
(Madi-Jebara, Yazigi, Haddad, Hayeck) Department of Anesthesiology, Hotel
Dieu de France Hospital, Beirut, Lebanon.
Title
Postoperative oral amiodarone versus oral bisoprolol as prophylaxis
against atrial fibrillation after coronary artery bypass graft surgery: A
prospective randomized trial.
Source
International Journal of Cardiology. 137(2)(pp 116-122), 2009. Date of
Publication: October 2009.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Postoperative atrial fibrillation (AF) occurs in up to 50% of
patients undergoing coronary artery bypass (CABG) surgery and is
associated with complications. Amiodarone and beta blockers are effective
as prophylaxis for AF after CABG. The purpose of this study was to compare
oral amiodarone versus oral bisoprolol for prevention of AF after CABG.
Methods: In this randomized study, 200 patients admitted for elective CABG
were given oral amiodarone (n = 98 patients) or oral bisoprolol (n = 102
patients) beginning 6 h after surgery. Amiodarone patients received 15
mg/Kg then 7 mg/Kg/day for one month. Bisoprolol patients received 2.5 mg
then 2.5 mg bid indefinitely. Results: Postoperative AF occurred in 15.3%
of the patients in the amiodarone group and 12.7% of the patients in the
bisoprolol group (p = 0.60). Maximal ventricular rate tended to be lower
in the bisoprolol group (125 +/- 6 beats/min) compared with the amiodarone
group (144 +/- 7 beats/min, p = .06). Preoperative beta blockage did not
affect AF incidence in either study group. There was no difference between
the 2 groups for the onset time of AF episodes, total AF duration, AF
recurrence and postoperative length of hospital stay. No serious
postoperative complications occurred in the two study groups. Two
reversible low cardiac output cases occurred with bisoprolol. Conclusions:
Postoperative oral bisoprolol and amiodarone are equally effective for
prophylaxis of AF after CABG. Treatment with bisoprolol resulted in a
trend to lower ventricular response rate in AF cases. Both regimens were
well tolerated. copyright 2008 Elsevier Ireland Ltd. All rights reserved.
<6>
Accession Number
2009551737
Authors
Al-Khatib S.M. Hafley G. Harrington R.A. Mack M.J. Ferguson T.B. Peterson
E.D. Califf R.M. Kouchoukos N.T. Alexander J.H.
Institution
(Al-Khatib, Hafley, Harrington, Peterson, Califf, Alexander) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States.
(Al-Khatib, Harrington, Peterson, Califf, Alexander) Division of
Cardiology, Duke University Medical Center, Durham, NC, United States.
(Mack) Cardiopulmonary Research Science and Technology Institute, Dallas,
TX, United States.
(Ferguson) East Carolina University, Greenville, NC, United States.
(Kouchoukos) Missouri Baptist Medical Center, St. Louis, MO, United
States.
Title
Patterns of management of atrial fibrillation complicating coronary artery
bypass grafting: Results from the PRoject of Ex-vivo Vein graft
ENgineering via Transfection IV (PREVENT-IV) Trial.
Source
American Heart Journal. 158(5)(pp 792-798), 2009. Date of Publication:
November 2009.
Publisher
Mosby Inc.
Abstract
Background: Current practice related to the management of atrial
fibrillation (AF) complicating coronary artery bypass grafting (CABG) is
uncertain. Methods: We examined management of post-CABG AF in the
PREVENT-IV trial, and we explored patterns of use of postoperative rhythm
versus rate control and anticoagulation for AF by geographic region and
type of site. We also compared outcomes of patients who developed
post-CABG AF (663) with those who did not (2,131). Results: The incidence
of AF was 24%. Post-CABG AF was treated with a rhythm control strategy in
81% of patients and with warfarin in 23% of patients. Although there were
significant variations across sites in the management of post-CABG AF,
patterns of use of postoperative rhythm versus rate control and
anticoagulation did not differ by geographic region or by whether or not
the enrolling site was an academic institution. Mortality was higher in
patients with post-CABG AF than patients without AF at 30 days (1.5% vs
0.7%, P = .01) but not at 3 years (6.9% vs 4.9%, P = .41). There was a
trend toward a higher risk of mortality or stroke at 30 days in patients
with AF (2.4% vs 1.9%, P = .08). Conclusion: Although a rhythm control
strategy was used in most of the patients in this trial and the overall
rate of use of warfarin was low, the significance of these findings is
uncertain because of the lack of data from randomized clinical trials. The
substantial variations in the management of post-CABG AF across sites are
likely because of definitive data on the most effective therapies,
highlighting the need for clinical trials on rate versus rhythm control
and on anticoagulation for AF in this setting. copyright 2009 Mosby, Inc.
All rights reserved.
<7>
Accession Number
2009541233
Authors
Kirtane A.J. Patel R. O'Shaughnessy C. Overlie P. McLaurin B. Solomon S.
Mauri L. Fitzgerald P. Popma J.J. Kandzari D.E. Leon M.B.
Institution
(Kirtane, Patel, Leon) Columbia University Medical Center, the
Cardiovascular Research Foundation, New York, NY, United States.
(O'Shaughnessy) Elyria Memorial Hospital, Elyria, OH, United States.
(Overlie) Lubbock Heart Hospital, Lubbock, TX, United States.
(McLaurin) Anderson Medical Center, Anderson, SC, United States.
(Solomon) Methodist Hospital, Houston, TX, United States.
(Mauri) Harvard Clinical Research Institute, Boston, MA, United States.
(Fitzgerald) Stanford University, Stanford, CA, United States.
(Popma) Caritas Cardiovascular Center, St. Elizabeth's Medical Center,
Boston, MA, United States.
(Kandzari) Scripps Clinic, La Jolla, CA, United States.
Title
Clinical and Angiographic Outcomes in Diabetics From the ENDEAVOR IV
Trial. Randomized Comparison of Zotarolimus- and Paclitaxel-Eluting Stents
in Patients With Coronary Artery Disease.
Source
JACC: Cardiovascular Interventions. 2(10)(pp 967-976), 2009. Date of
Publication: October 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to examine outcomes related to the
use of the Endeavor zotarolimus-eluting stent (ZES) (Medtronic
CardioVascular, Santa Rosa, California) compared with the TAXUS
paclitaxel-eluting stent (PES) (Boston Scientific Corp., Natick,
Massachusetts) in the 477 patients with diabetes mellitus (DM) enrolled in
the randomized ENDEAVOR IV (Randomized Comparison of Zotarolimus- and
Paclitaxel-Eluting Stents in Patients with Coronary Artery Disease) trial.
Background: Percutaneous coronary intervention (PCI) in diabetic patients
is associated with increased rates of restenosis-related end points
compared with PCI in nondiabetic patients. Although ZES has been
associated with similar clinical efficacy compared with PES in the overall
trial population of the ENDEAVOR IV trial, whether these results are
maintained in the higher-risk restenosis subgroup of patients with DM has
not been determined. Methods: Clinical and angiographic outcomes were
compared according to randomized treatment assignment to either ZES or
PES. Results: Baseline characteristics were similar among ZES (n = 241)
and PES (n = 236) diabetic patients, with slightly longer lesion lengths
in PES-treated patients (12.9 mm vs. 14.0 mm, p = 0.041). Among the 86 DM
patients assigned to routine angiographic follow-up (18% of the overall DM
cohort), in-stent percent diameter stenosis at 8 months was greater among
ZES-treated patients (32.9 vs. 21.1, p = 0.023), with a trend toward
higher in-stent late loss. One-year clinical outcomes were similar among
DM patients treated with either ZES or PES (target vessel failure: 8.6%
vs. 10.8%, p = 0.53; target lesion revascularization: 6.9% vs. 5.8%, p =
0.70; target vessel revascularization: 8.6% vs. 9.4%, p = 0.87). There
were no significant interactions between DM status and stent type with
respect to the outcomes measured, and the relative efficacy/safety of ZES
and PES were similar among insulin- and noninsulin-requiring subgroups.
Conclusions: One-year clinical outcomes were similar among DM patients
treated with ZES and PES in the ENDEAVOR IV trial. These findings parallel
the overall trial results, which demonstrated similar efficacy and safety
of ZES and PES for single de novo coronary lesions. copyright 2009
American College of Cardiology Foundation.
<8>
Accession Number
2009529422
Authors
Doll J.A. Nikolsky E. Stone G.W. Mehran R. Lincoff A.M. Caixeta A.
McLaurin B. Cristea E. Fahy M. Kesanakurthy V. Lansky A.J.
Institution
(Doll, Nikolsky, Stone, Mehran, Caixeta, McLaurin, Cristea, Fahy,
Kesanakurthy, Lansky) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, United States.
(Lincoff) Cleveland Clinic, Cleveland, OH, United States.
(McLaurin) AnMed Health, Anderson, SC, United States.
(Nikolsky) Clinical Trial Center, Cardiovascular Research Foundation, 111
East 59 Street, New York, NY 10022, United States.
Title
Outcomes of patients with coronary artery perforation complicating
percutaneous coronary intervention and correlations with the type of
adjunctive antithrombotic therapy: Pooled analysis from REPLACE-2, ACUITY,
and HORIZONS-AMI trials: COMPLICATIONS.
Source
Journal of Interventional Cardiology. 22(5)(pp 453-459), 2009. Date of
Publication: October 2009.
Publisher
Blackwell Publishing Inc.
Abstract
Background: The lack of a specific counteragent to bivalirudin may
complicate the management of patients with coronary artery (CA)
perforation during percutaneous coronary intervention (PCI). Aim: Assess
outcomes of patients with CA perforation from three PCI trials comparing
intravenous bivalirudin with provisional glycoprotein (GP) IIb/IIIa
inhibition versus unfractionated heparin (UFH) plus GP IIb/IIIa. Methods:
A pooled analysis of patients treated with PCI in three randomized trials
including REPLACE-2, ACUITY, and HORIZONS-AMI. Results: Among a total of
12,921 patients, CA perforation occurred in 35 patients (0.27%). By
multivariable analysis, baseline creatinine clearance was the only
independent predictor of CA perforation (per 10 mL/min decrease, odds
ratio [95% confidence interval] = 1.28 [1.11, 1.47], P = 0.0007). At 30
days, patients with versus without CA perforation had significantly (all P
values [less-than or equal to]0.001) higher rates of 30-day mortality
(11.4% vs. 1.0%), myocardial infarction (MI) [Q wave: 22.9% vs. 5.7%;
non-Q wave: 17.1% vs. 4.9%], target vessel revascularization (TVR) [20.1%
vs. 1.8%], and composite end-point of death/MI/TVR (31.4% vs. 7.8%).
Patients assigned to bivalirudin versus UFH plus a GP IIb/IIIa inhibitor
had nonsignificantly lower rates of death (0% vs. 18.8%, P = 0.08),
similar rates of MI (26.7% vs. 25.0%, P = 0.92), significantly lower rates
of TVR (6.7% vs. 37.5%, P = 0.04), and similar rates of the composite
end-point of death/MI/TVR (35.5% vs. 26.7%, P = 0.54). Conclusion: In
three PCI trials, treatment of patients experiencing CA perforation with
adjunctive antithrombotic therapy of bivalirudin monotherapy was not
associated with worse outcomes compared to treatment with UFH plus GP
IIb/IIIa inhibitors. (J Interven Cardiol 2009;22:453-459) copyright 2009,
Wiley Periodicals, Inc.
<9>
Accession Number
2009529409
Authors
Engel J.M. MUhling J. Kwapisz M. Heidt M.
Institution
(Engel, MUhling) Department of Anaesthesiology and Intensive Care
Medicine, Hospital of Wetzlar-Braunfels, Forsthausstr. 1, D-35578 Wetzlar,
Germany.
(Kwapisz) Department of Anesthesia, Dalhousie University, Halifax, NS,
Canada.
(Heidt) Department of Cardiology, University Hospital Giessen and Marburg
GmbH, Marburg, Germany.
Title
Glutamine administration in patients undergoing cardiac surgery and the
influence on blood glutathione levels.
Source
Acta Anaesthesiologica Scandinavica. 53(10)(pp 1317-1323), 2009. Date of
Publication: November 2009.
Publisher
Blackwell Munksgaard
Abstract
Background: Cardiac surgery with an extracorporeal circulation
cardiopulmonary bypass (CPB) is characterized by an oxidative stress
response. Glutathione (GSH) belongs to the major antioxidative defense. In
metabolic stress, glutamine (GLN) may be the rate-limiting factor of GSH
synthesis. Decreased GLN plasma levels were observed after various
critical states. We evaluated, in patients undergoing open heart surgery
with CPB, the effects of a peri-operative GLN supplementation on GSH in
whole blood and assessed their influence on the Sequential Organ Failure
Assessment score and the intensive care unit length of stay. Methods: In
this prospective, randomized, double-blinded study, we included 60
patients (age older than 70 years, ejection fraction <40% or mitral valve
replacement) undergoing an elective cardiac surgery with CPB. We randomly
assigned each subject to receive an infusion with either GLN (0.5
g/kg/day, group 1) or an isonitrogeneous, isocaloric, isovolemic amino
acids solution (group 2) or saline (group 3). Results: From the first
post-operative day GLN plasma levels in group 1 were significantly
increased compared with the other groups. With saline GSH the levels
decreased significantly post-operatively compared with GLN. We observed a
significant correlation between GLN delivery and GSH levels. Conclusions:
A peri-operative high-dose GLN infusion increased plasma GLN
concentrations and maintained the GSH levels after cardiac surgery with
CPB. copyright 2009 The Acta Anaesthesiologica Scandinavica Foundation.
<10>
[Use Link to view the full text]
Accession Number
2009361299
Authors
Ho K.M. Tan J.A.
Institution
(Ho, Tan) Department of Intensive Care Medicine, Royal Perth Hospital,
Perth, Australia.
(Ho) School of Population Health, University of Western Australia, Perth,
Australia.
(Ho) Department of Intensive Care Medicine, Royal Perth Hospital, Perth,
WA 6000, Australia.
Title
Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery
a dose-response meta-analysis.
Source
Circulation. 119(14)(pp 1853-1866), 2009. Date of Publication: 14 Apr
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Cardiopulmonary bypass and cardiac surgery are associated with
a significant systemic inflammatory response that may increase
postoperative complications. This meta-analysis assessed whether the
benefits and risks of corticosteroid use were dose dependent in adult
cardiac surgery. Methods and Results-Randomized controlled trials of the
use of corticosteroid prophylaxis in adult cardiac surgery (>18 years of
age) requiring cardiopulmonary bypass were selected from MEDLINE (1966 to
August 1, 2008), EMBASE (1988 to August 1, 2008), and the Cochrane
controlled trials register without any language restrictions. A total of
3323 patients from 50 randomized controlled trials were identified and
subject to meta-analysis. Corticosteroid prophylaxis reduced the risk of
atrial fibrillation (25.1% versus 35.1%; number needed to treat, 10;
relative risk, 0.74; 95% confidence interval [CI], 0.63 to 0.86; P<0.01)
and length of stay in the intensive care unit (weighted mean difference,
-0.37 days; 95% CI, -0.21 to -0.52; P<0.01) and hospital (weighted mean
difference, -0.66 days; 95% CI, -0.77 to -1.25; P=0.03) compared with
placebo. The use of corticosteroid was not associated with an increased
risk of all-cause infection (relative risk, 0.93; 95% CI, 0.61 to 1.41;
P=0.73), but hyperglycemia requiring insulin infusion after corticosteroid
prophylaxis was common (28.2%; relative risk, 1.49; 95% CI, 1.11 to 2.01;
P<0.01). No additional benefits were found on all outcomes beyond a total
dose of 1000 mg hydrocortisone, and very high doses of corticosteroid were
associated with prolonged mechanical ventilation. Conclusions-Evidence
suggests that low-dose corticosteroid is as effective as high-dose
corticosteroid in reducing the risk of atrial fibrillation and duration of
mechanical ventilation but with fewer potential side effects in adult
cardiac surgery. copyright 2009 American Heart Association, Inc.
<11>
[Use Link to view the full text]
Accession Number
2009293678
Authors
Meyers P.M. Schumacher H.C. Higashida R.T. Barnwell S.L. Creager M.A.
Gupta R. McDougall C.G. Pandey D.K. Sacks D. Wechsler L.R.
Title
Indications for the performance of intracranial endovascular
neurointerventional procedures: A scientific statement from the American
Heart Association Council on Cardiovascular Radiology and Intervention,
Stroke Council, Council on Cardiovascular Surgery and Anesthesia,
Interdisciplinary Council on Peripheral Vascular Disease, and
Interdisciplinary Council on Quality of Care and Outcomes Research.
Source
Circulation. 119(16)(pp 2235-2239), 2009. Date of Publication: 28 Apr
2009.
Publisher
Lippincott Williams and Wilkins
<12>
Accession Number
2009544822
Authors
Rosenbloom J.I. Wellenius G.A. Mukamal K.J. Mittleman M.A.
Institution
(Rosenbloom, Wellenius, Mukamal, Mittleman) Cardiovascular Epidemiology
Research Unit, Division of General Medicine and Primary Care, Department
of Medicine, Boston, MA, United States.
(Mittleman) Department of Epidemiology, Harvard School of Public Health,
Boston, MA, United States.
Title
Self-reported anxiety and the risk of clinical events and atherosclerotic
progression among patients with Coronary Artery Bypass Grafts (CABG).
Source
American Heart Journal. 158(5)(pp 867-873), 2009. Date of Publication:
November 2009.
Publisher
Mosby Inc.
Abstract
Background: Symptoms of anxiety are associated with increased risk of
coronary artery disease and potentially poor prognosis among patients with
existing coronary artery disease, but whether symptoms of anxiety
influence atherosclerotic progression among such patients is uncertain.
Accordingly, we evaluated the hypotheses that symptoms of anxiety are
associated with adverse clinical outcomes and progression of
atherosclerosis among individuals with previous coronary artery bypass
graft (CABG) surgery and saphenous vein grafts enrolled in the Post-CABG
Trial. Methods: The Post-CABG Trial randomized patients with a history of
CABG surgery to either aggressive or moderate lipid lowering and to either
warfarin or placebo. Patients were followed up for clinical end points and
coronary angiography was conducted at enrollment and after a median
follow-up of 4.3 years. Anxiety symptoms were assessed at enrollment using
the state portion of the Spielberger State-Trait Anxiety Inventory (STAI)
in 1317 patients. Results: In models adjusting for age, sex, race,
treatment assignment and years since CABG surgery, a STAI score
[greater-than or equal to]40 was positively associated with risk of death
or myocardial infarction (MI) (OR 1.55, 95% CI 1.01-2.36, P = .044). This
association was attenuated slightly when depressive symptoms were included
in the model, but lost statistical significance (P = .11). There was a
dose-response relationship between STAI score and risk of death or MI.
There was no association between self-reported anxiety and atherosclerotic
progression of grafts. Conclusions: Anxiety symptoms are associated with
increased risk of death or MI among patients with saphenous vein grafts,
but this risk does not appear to be mediated by more extensive
atherosclerotic progression. copyright 2009 Mosby, Inc. All rights
reserved.
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