EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2009603729
Authors
Kushner F.G. Hand M. Smith Jr. S.C. King III S.B. Anderson J.L. Antman
E.M. Bailey S.R. Bates E.R. Blankenship J.C. Casey Jr. D.E. Green L.A.
Hochman J.S. Jacobs A.K. Krumholz H.M. Morrison D.A. Ornato J.P. Pearle
D.L. Peterson E.D. Sloan M.A. Whitlow P.L. Williams D.O.
Title
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients
With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and
2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary
Intervention (Updating the 2005 Guideline and 2007 Focused Update)..
Source
Journal of the American College of Cardiology. 54(23)(pp 2205-2241),
2009. Date of Publication: 01 Dec 2009.
Publisher
Elsevier USA

<2>
Accession Number
2009604923
Authors
Nelson A.L. Cohen J.T. Greenberg D. Kent D.M.
Institution
(Nelson) Novartis Institutes for Biomedical Research, 100 Technology
Square, Cambridge, MA 02139, United States.
(Greenberg) Department of Health Systems Management, Ben-Gurion University
of the Negev, PO Box 653, Beer-Sheva 84105, Israel.
(Cohen, Kent) 800 Washington Street, Box 63, Boston, MA 02111, United
States.
Title
Much cheaper, almost as good: Decrementally cost-effective medical
innovation.
Source
Annals of Internal Medicine. 151(9)(pp 662-667), 2009. Date of
Publication: 03 Nov 2009.
Publisher
American College of Physicians
Abstract
Under conditions of constrained resources, cost-saving innovations may
improve overall outcomes, even when they are slightly less effective than
available options, by permitting more efficient reallocation of resources.
The authors systematically reviewed all MEDLINE-cited cost-utility
analyses written in English from 2002 to 2007 to identify and describe
cost- and quality-decreasing medical innovations that might offer
favorable "decrementally" cost-effective tradeoffs - defined as saving at
least $100 000 per quality-adjusted life-year lost. Of 2128
cost-effectiveness ratios from 887 publications, only 9 comparisons (0.4%
of total) described 8 innovations that were deemed to be decrementally
cost-effective. Examples included percutaneous coronary intervention
(instead of coronary artery bypass graft) for multivessel coronary
disease, repetitive transcranial magnetic stimulation (instead of
electroconvulsive therapy) for drug-resistant major depression, watchful
waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On
a per-patient basis, these innovations yielded savings from $122 to almost
$12 000 but losses of 0.001 to 0.021 quality-adjusted life-years
(approximately 8 hours to 1 week). These findings demonstrate the rarity
of decrementally cost-effective innovations in the medical literature.
copyright 2009 American College of Physicians.

<3>
Accession Number
2009604919
Authors
Sharma M. Ansari M.T. Abou-Setta A.M. Soares-Weiser K. Ooi T.C. Sears M.
Yazdi F. Tsertsvadze A. Moher D.
Institution
(Sharma) Regional Stroke Program, Ottawa Hospital, Civic Campus, C2, 1053
Carling Avenue, Ottawa, ON K1Y 4E9, Canada.
(Ansari, Yazdi, Tsertsvadze) University of Ottawa Evidence-based Practice
Center, CHEO-RI, 401 Smyth Road, Ottawa, ON K1H 8LI, Canada.
(Abou-Setta) University of Alberta Evidence-based Practice Center, Alberta
Research Centre for Health Evidence, Aberhart Centre One, 11402 University
Avenue, Edmonton, AB T6G 2J3, Canada.
(Soares-Weiser) Enhance Reviews, PO Box 137, Kfar-Saba, 44101, Israel.
(Ooi) Division of Endocrinology and Metabolism, University of Ottawa,
Ottawa Hospital, 1967 Riverside Drive, Ottawa, ON K1H 7W9, Canada.
(Sears) RR 1, Box 9012, Dunrobin, ON K0A 1T0, Canada.
(Moher) University of Ottawa Evidence-based Practice Center, University of
Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H
8L6, Canada.
Title
Systematic review: Comparative effectiveness and harms of combination
therapy and monotherapy for dyslipidemia.
Source
Annals of Internal Medicine. 151(9)(pp 622-630), 2009. Date of
Publication: 03 Nov 2009.
Publisher
American College of Physicians
Abstract
Background: Statin therapy effectively prevents vascular disease, but
treatment targets are often not achieved. Purpose: To compare the benefits
and harms of high-dose statin monotherapy with those of combination
therapy in adults at high risk for coronary disease. Data Sources:
English-language records from MEDLINE (1966 to 2009), EMBASE (1980 to
2009), and the Cochrane Library (third quarter of 2008). Study Selection:
A reviewer screened records, and a second reviewer verified selection of
randomized, controlled trials in adult patients that compared combinations
of statins and bile-acid sequestrants, fibrates, ezetimibe, niacin, or
omega-3 fatty acids with statin monotherapy, as well as nonrandomized
comparative studies that were longer than 24 weeks and reported clinical
and harms outcomes. Data Extraction: Data were abstracted for studies by
using standardized forms, and study quality was rated with a standardized
scale and strength of evidence by using the Grading of Recommendations
Assessment, Development, and Evaluation approach. Data Synthesis: 102
studies met eligibility criteria. The main analysis compared combination
therapy with high-dose statin monotherapy in high-risk patients.
Very-low-strength evidence showed that statin-ezetimibe (2 trials; n =
439) and statin-fibrate (1 trial; n = 166) combinations did not reduce
mortality more than highdose statin monotherapy. No trials compared the
effect of combination therapy versus high-dose statin monotherapy on the
incidence of myocardial infarction, stroke, or revascularization
procedures. Two statin-ezetimibe trials (n = 295) demonstrated higher
low-density lipoprotein cholesterol goal attainment with combination
therapy (odds ratio, 7.21 [95% CI, 4.30 to 12.08]). Trials in lower-risk
patients did not show a difference in mortality. Limitations: Studies were
generally short, focused on surrogate outcomes, and were heterogeneous in
the sample's risk for coronary disease. Few studies examined treatment
combinations other than statin-ezetimibe. Conclusion: Limited evidence
suggests that combinations of lipidlowering agents do not improve clinical
outcomes more than highdose statin monotherapy. Very-low-quality evidence
favors statin-ezetimibe treatment for attainment of low-density
lipoprotein cholesterol goals. Primary Funding Source: Agency for
Healthcare Research and Quality. copyright 2009 American College of
Physicians.

<4>
Accession Number
2009585878
Authors
Veglia F. Werba J.P. Tremoli E. Squellerio I. Sisillo E. Parolari A.
Minardi F. Cavalca V.
Institution
(Veglia, Werba, Tremoli, Squellerio, Sisillo, Parolari, Minardi, Cavalca)
Unit of Biostatistics, Centro Cardiologico Monzino IRCCS, Via Parea, 4,
20138 Milano, Italy.
(Tremoli) Department of Pharmacological Sciences, University of Milan,
Milan, Italy.
(Parolari, Cavalca) Institute of Cardiology, University of Milan, Milan,
Italy.
Title
Assessment of oxidative stress in coronary artery bypass surgery:
Comparison between the global index OXY-SCORE and individual biomarkers.
Source
Biomarkers. 14(7)(pp 465-472), 2009. Date of Publication: 2009.
Publisher
Informa Healthcare
Abstract
The performances of the OXY-SCORE, a summary index of oxidative stress,
and of its individual components (plasma malondialdehyde (MDA), oxidized
and reduced glutathione, individual antioxidant capacity, alpha- and
gamma-tocopherol and urinary isoprostanes) were assessed in 47 patients
undergoing coronary surgery, randomly assigned to cardiopulmonary bypass
(CPB) or off-pump procedure (OPCAB) associated with less oxidative stress.
The ability of the OXY-SCORE to classify correctly the patients was high
(area under the ROC curve 0.90). Only free MDA showed a similar
performance, but it was insensitive to the minor variations of the
oxidative balance in the OPCAB group. copyright 2009 Informa UK Ltd.

<5>
Accession Number
2009579039
Authors
Kats S. Brands R. Seinen W. de Jager W. Bekker M.W.A. Hamad M.A.S. Tan
M.E.S.H. Schonberger J.P.A.M.
Institution
(Kats, Bekker, Hamad, Tan, Schonberger) Catharina Hospital, Department of
Cardiothoracic Surgery, Michelangelolaan 2, 5602 ZA Eindhoven,
Netherlands.
(Brands, Seinen) Institute for Risk Assessment, University Utrecht,
Utrecht, Netherlands.
(de Jager) UMCU, Luminex Core Facility, Utrecht, Netherlands.
Title
Anti-inflammatory effects of alkaline phosphatase in coronary artery
bypass surgery with cardiopulmonary bypass.
Source
Recent Patents on Inflammation and Allergy Drug Discovery. 3(3)(pp
214-220), 2009. Date of Publication: 2009.
Publisher
Bentham Science Publishers B.V.
Abstract
Laboratory and clinical data have implicated endotoxin as an important
factor in the inflammatory response to cardiopulmonary bypass. Alkaline
phosphatase prevents endotoxin-induced systemic inflammation in animals
and humans. We assessed the effects of the administration of bovine
intestinal alkaline phosphatase on surgical complications in patients
undergoing coronary artery bypass grafting. In a double blind, randomized,
placebo-controlled study, a total of 63 patients undergoing coronary
artery bypass grafting were enrolled. Bovine intestinal alkaline
phosphatase or placebo was administered as an intravenous bolus followed
by continuous infusion for 36 hours. The primary endpoint was reduction of
post-surgical inflammation. No significant safety concerns were
identified. The overall inflammatory response to coronary artery bypass
grafting with cardiopulmonary bypass was low in both placebo and bovine
intestinal alkaline phosphatase patient group. Five patients in the
placebo group displayed a significant TNFalpha response followed by an
increase in plasma levels of IL-6 and IL-8. Such a TNFalpha response was
not observed in the bovine intestinal alkaline phosphatase group,
suggesting anti-inflammatory activity of bovine intestinal alkaline
phosphatase. Other variables related to systemic inflammation showed no
statistically significant differences. Bovine intestinal alkaline
phosphatase can be administered safely in an attempt to reduce the
inflammatory response in coronary artery bypass grafting patients with a
low to intermediate EuroSCORE. The anti-inflammatory effects might be more
pronounced in patients developing more fulminant postoperative
inflammatory responses. This will be investigated in a further trial with
inclusion of patients undergoing complicated cardiac surgery, demanding
extended cardiopulmonary bypass and aortic cross clamp time. In this
review article some recent patents related to the field are also
discussed. copyright 2009 Bentham Science Publishers Ltd.

<6>
Accession Number
2009549330
Authors
Tcheng J.E. Lim I.H. Srinivasan S. Jozic J. Gibson C.M. O'Shea J.C. Puma
J.A. Simon D.I.
Institution
(Tcheng) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States.
(Lim) Tan Tock Seng Hospital, Singapore, Singapore, Singapore.
(Srinivasan) Schering-Plough Research Institute, Kenilworth, NJ, United
States.
(Jozic, Simon) University Hospitals Case Medical Center, Case Western
Reserve University School of Medicine, Cleveland, Ohio, United States.
(Gibson) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, Mass, United States.
(O'Shea) Bon Secours Hospital, Cork, Ireland, Ireland.
(Puma) Lenox Hill Hospital, New York City, NY, United States.
Title
Stent parameters predict major adverse clinical events and the response to
platelet glycoprotein IIb/IIIa blockade findings of the ESPRIT trial.
Source
Circulation: Cardiovascular Interventions. 2(1)(pp 43-51), 2009. Date of
Publication: February 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Only limited data describe relationships between stent
parameters (length and diameter), adverse events after percutaneous
coronary intervention, and effects of platelet glycoprotein IIb/IIIa
blockade by stent parameters. Methods and Results-In this post hoc
analysis of the 1983 patients receiving a stent in the Enhanced
Suppression of the Platelet Glycoprotein IIb/IIIa Receptor with Integrilin
Therapy randomized percutaneous coronary intervention trial of
eptifibatide versus placebo, rates of the major adverse cardiac event
(MACE) end point (death, myocardial infarction, urgent target-vessel
revascularization, or thrombotic bailout) at 48 hours and 1 year were
correlated with stent parameters and then analyzed by randomization to
eptifibatide versus placebo. In the placebo group, MACE increased with
number of stents implanted, total stent length (by quartiles of <15, 15 to
<18, 18 to <30, and >30 mm), and total stented vessel area (by quartiles
of area < 141,141 to < 188,188 to <292, and >292 mm2). By stent
parameters, MACE at 48 hours was reduced in the eptifibatide group at
stent lengths of 18 to <30 mm (odds ratio [OR], 0.55; 95% CI, 0.32 to
0.94; P=0.030) and >30 mm (OR, 0.43; 95% CI, 0.25 to 0.75; P=0.003), stent
diameters of >2.5 to <3.5 mm (OR, 0.56; 95% CI, 0.39 to 0.82; P=0.002),
and with 2 stents implanted (OR, 0.39; 95% CI, 0.22 to 0.69; P=0.001). In
the placebo group, near-linear relationships were observed between both
increasing stent length and increasing stented vessel area and MACE at 48
hours and 1 year (all, P<0.001); these gradients were flattened in the
eptifibatide group (P=0.005 for stent length). Conclusions-Stent
parameters predict MACE after percutaneous coronary intervention.
Glycoprotein IIb/IIIa blockade mitigates much of the hazard of increasing
procedural complexity. (Circ Cardiovasc Intervent. 2009;2:43-51.)
copyright 2009 American Heart Association, Inc.

<7>
Accession Number
2009549328
Authors
Erglis A. Kumsars I. Niemela M. Kervinen K. Maeng M. Lassen J.F. Gunnes P.
Stavnes S. Jensen J.S. Galloe A. Narbute I. Sondore D. Makikallio T.
Ylitalo K. Christiansen E.H. Ravkilde J. K. Steigen T. Mannsverk J.
Thayssen P. Norregaard Hansen K. Syvanne M. Helqvist S. Kjell N. Wiseth R.
Aaroe J. Puhakka M. Thuesen L.
Institution
(Erglis, Kumsars, Narbute, Sondore) Centre of Cardiology, Paul Stradins
Clinical University Hospital, Riga, Latvia, Latvia.
(Niemela, Makikallio, Ylitalo, Syvanne) Division of Cardiology,
(Maeng, Lassen, Christiansen, Ravkilde, Thuesen) Department of Internal
Medicine, University of Oulu, Finland.
(Gunnes, Stavnes) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark.
(Jensen, Galloe) Department of Cardiology, Feiring Clinic, Feiring,
Norway.
(K. Steigen, Mannsverk) Department of Cardiology, Gentofte University
Hospital, Gentofte, Denmark.
(Thayssen, Norregaard Hansen) Department of Cardiology, University
Hospital of Tromsoe, Tromsoe, Norway.
(Kjell) Department of Cardiology, Odense University Hospital, Denmark.
(Helqvist) Division of Cardiology, Helsinki University Central Hospital,
Helsinki, Finland.
(Kervinen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
(Wiseth) Department of Cardiology, Tampere University Hospital, Tampere,
Finland.
(Aaroe) Department of Cardiology, Trondheim University Hospital,
Trondheim, Norway.
(Puhakka) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark.
(Puhakka) Division of Cardiology, Kuopio University Central Hospital,
Kuopio, Finland.
(Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Pilsonu 13, Riga, Latvia LV1002, Latvia.
Title
Randomized comparison of coronary bifurcation stenting with the crush
versus the culotte technique using sirolimus eluting stents the nordic
stent technique study.
Source
Circulation: Cardiovascular Interventions. 2(1)(pp 27-34), 2009. Date of
Publication: February 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-In a number of coronary bifurcation lesions, both the main
vessel and the side branch need stent coverage. Using sirolimus eluting
stents, we compared 2 dedicated bifurcation stent techniques, the crush
and the culotte techniques in a randomized trial with separate clinical
and angiographic end-points. Methods and Results-A total of 424 patients
with a bifurcation lesion were randomized to crush (n=209) and culotte
(n=215) stenting. The primary end point was major adverse cardiac events;
cardiac death, myocardial infarction, target vessel revascularization, or
stent thrombosis after 6 months. At 6 months there were no significant
differences in major adverse cardiac event rates between the groups; crush
4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast
volumes were similar in the 2 groups. The rates of procedure-related
increase in biomarkers of myocardial injury were 15.5% in crush versus
8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative
coronary assessment at the index procedure and after 8 months. The
angiographic end-points of in-segment and in-stent restenosis of main
vessel and/or side branch after 8 months were found in 12.1% versus 6.6%
(P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte
groups, respectively. Conclusions-Both the crush and the culotte
bifurcation stenting techniques were associated with similar and excellent
clinical and angiographic results. Angiographically, there was a trend
toward less in-segment restenosis and significantly reduced in-stent
restenosis following culotte stenting. (Circ Cardiovasc Intervent.
2009;2:27-34.) copyright 2009 American Heart Association, Inc.

<8>
Accession Number
2009549315
Authors
Russo R.J. Silva P.D. Teirstein P.S. Attubato M.J. Davidson C.J. DeFranco
A.C. Fitzgerald P.J. Goldberg S.L. Hermiller J.B. Leon M.B. Ling F.S.
Lucisano J.E. Schatz R.A. Wong S.C. Weissman N.J. Zientek D.M.
Institution
(Russo, Silva, Teirstein, Lucisano, Schatz) Division of Cardiovascular
Diseases, Scripps Clinic, La Jolla, Calif,
(Attubato) New York University Medical Center, New York, NY,
(Davidson) Northwestern University Feinberg School of Medicine, Chicago,
Ill,
(DeFranco) Comprehensive Cardiovascular Care Group, Milwaukee, Wis,
(Fitzgerald) Stanford University, Palo Alto, Calif,
(Goldberg) University of Washington Medical Center, Seattle, Wash,
(Hermiller) St. Vincent Hospital, Indianapolis, Ind,
(Leon) Columbia University, New York, NY,
(Ling) Strong Memorial Hospital of the University of Rochester, Rochester,
NY,
(Wong) Weill Medical College of Cornell University, New York, NY,
(Weissman) Cardiovascular Research Institute, Washington,
(Zientek) Hospital Center, Wash, DC,
(Zientek) Austin Heart Hospital, Austin, TX,
(Russo) Division of Cardiovascular Diseases, Scripps Clinic, SW206, 10666
North Torrey Pines Road, San Diego, CA 92037,
Title
A randomized controlled trial of angiography versus intravascular
ultrasound-directed bare-metal coronary stent placement (the AVID trial).
Source
Circulation: Cardiovascular Interventions. 2(2)(pp 113-123), 2009. Date
of Publication: April 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-AVID (Angiography Versus Intravascular ultrasound-Directed
stent placement) is a multicenter, randomized controlled trial designed to
assess the effect of intravascular ultrasound (IVUS)-directed stent
placement on the 12-month rate of target lesion revascularization (TLR).
Methods and Results-After elective coronary stent placement and an optimal
angiographic result (< 10% stenosis), 800 patients were randomized to
Angiography-or IVUS-directed therapy. Blinded IVUS was performed in the
Angiography group without further therapy. In the IVUS group, IVUS
criteria for optimal stent placement (<10% area stenosis, apposition, and
absence of dissection) were applied. Final minimum stent area was 6.90
+/-2.43 mm2 in the Angiography group and 7.55+/-2.82 mm2 in the IVUS group
(P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%)
received further therapy. The 12-month TLR rate was 12.0% in the
Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level
[CI], [-8.3% to 0.5%]). When vessels with a distal reference diameter <2.5
mm by core laboratory angiography measurement were excluded from analysis,
the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the
IVUS group (P=0.01, 95% CI, [- 10.6% to -1.2%]). With a prestent
angiographic stenosis of >70%, the TLR rate was lower in the IVUS group
compared with the Angiography group (3.1% versus 14.2%; P=0.002; 95% CI,
[- 18.4% to -4.2%]). Conclusions-IVUS-directed bare-metal stent placement
results in larger acute stent dimensions without an increase in
complications and a significantly lower 12-month TLR rate for vessels >2.5
mm by angiography and for vessels with high-grade prestent stenosis.
However, for the entire sample analyzed on an intention-to-treat basis,
IVUS-directed bare-metal stent placement does not significantly reduce the
12-month TLR rate when compared with stent placement guided by angiography
alone. In addition, IVUS evaluation of adequate stent expansion is
underutilized by experienced operators. (Circ Cardiovasc Intervent.
2009;2:113-123.) copyright 2009 American Heart Association, Inc.