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<1>
Accession Number
2009638348
Authors
Harrington R.A. Stone G.W. McNulty S. White H.D. Lincoff A.M. Gibson C.M.
Pollack Jr. C.V. Montalescot G. Mahaffey K.W. Kleiman N.S. Goodman S.G.
Amine M. Angiolillo D.J. Becker R.C. Chew D.P. French W.J. Leisch F.
Parikh K.H. Skerjanec S. Bhatt D.L.
Institution
(Harrington, McNulty, Mahaffey, Becker) Duke Clinical Research Institute,
Duke University Medical Center, Durham, NC, United States.
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States.
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand.
(Lincoff) Cleveland Clinic, Cleveland, United States.
(Gibson) Beth Israel Deaconess Medical Center, Boston, United States.
(Bhatt) VA Boston Healthcare System and Brigham and Women's Hospital,
Boston, United States.
(Pollack Jr.) Pennsylvania Hospital, University of Pennsylvania,
Philadelphia, PA, United States.
(Montalescot) Institut de Cardiologie, Pitie-Salpetriere Hospital, Paris,
France.
(Kleiman) Methodist DeBakey Heart and Vascular Center, Methodist Hospital,
Houston, TX, United States.
(Amine) Northwest Heart Center, Tomball, TX, United States.
(Goodman) Division of Cardiology, St. Michael's Hospital and, Canadian
Heart Research Centre, Toronto, ON, Canada.
(Angiolillo) University of Florida College of Medicine, Jacksonville, FL,
United States.
(Chew) Flinders University, Flinders Medical Centre, Adelaide, SA,
Australia.
(French) Harbor-UCLA Medical Center, Torrance, CA, United States.
(Leisch) Cardiovascular Division, City Hospital Linz, Linz, Austria.
(Parikh) Heart Care Clinic, Ahmedabad, India.
(Skerjanec) Medicines Company, Parsippany, NJ, United States.
Title
Platelet inhibition with cangrelor in patients undergoing PCI.
Source
New England Journal of Medicine. 361(24)(pp 2318-2329), 2009. Date of
Publication: 10 Dec 2009.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Cangrelor, a nonthienopyridine adenosine triphosphate
analogue, is an intravenous blocker of the adenosine diphosphate receptor
P2Y 12. This agent might have a role in the treatment of patients who
require rapid, predictable, and profound but reversible platelet
inhibition. METHODS: We performed a large-scale international trial
comparing cangrelor with 600 mg of oral clopidogrel administered before
percutaneous coronary intervention (PCI) in patients with acute coronary
syndromes. The primary efficacy end point was a composite of death from
any cause, myocardial infarction, or ischemia-driven revascularization at
48 hours. RESULTS: We enrolled 8877 patients, and 8716 underwent PCI. At
48 hours, cangrelor was not superior to clopidogrel with respect to the
primary composite end point, which occurred in 7.5% of patients in the
cangrelor group and 7.1% of patients in the clopidogrel group (odds ratio,
1.05; 95% confidence interval [CI], 0.88 to 1.24; P = 0.59). Likewise,
cangrelor was not superior at 30 days. The rate of major bleeding
(according to Acute Catheterization and Urgent Intervention Triage
Strategy criteria) was higher with cangrelor, a difference that approached
statistical significance (3.6% vs. 2.9%; odds ratio, 1.26; 95% CI, 0.99 to
1.60; P = 0.06), but this was not the case with major bleeding (according
to the Thrombolysis in Myocardial Infarction criteria) or severe or
life-threatening bleeding (according to Global Utilization of
Streptokinase and Tissue Plasminogen Activator for Occluded Coronary
Arteries criteria). A secondary exploratory end point of death from any
cause, Q-wave myocardial infarction, or ischemia-driven revascularization
showed a trend toward a reduction with cangrelor, but it was not
significant (0.6% vs. 0.9%; odds ratio, 0.67; 95% CI, 0.39 to 1.14; P =
0.14). CONCLUSIONS: Cangrelor, when administered intravenously 30 minutes
before PCI and continued for 2 hours after PCI, was not superior to an
oral loading dose of 600 mg of clo pidogrel, administered 30 minutes
before PCI, in reducing the composite end point of death from any cause,
myocardial infarction, or ischemia-driven revascularization at 48 hours.
(ClinicalTrials.gov number, NCT00305162.) Copyright copyright 2009
Massachusetts Medical Society.
<2>
Accession Number
2009638073
Authors
Mehta R.H. Lopes R.D. Ballotta A. Frigiola A. Sketch Jr. M.H. Bossone E.
Bates E.R.
Institution
(Mehta, Lopes, Sketch Jr.) The Duke University Medical Center, Duke
Clinical Research Institute, Durham, NC, United States.
(Ballotta, Frigiola) IRCCS Policlinico S. Donato, Milan, Italy.
(Bossone) Cava de' Tirreni and Amalfi Coast Hospital, Salerno, Italy.
(Bates) University of Michigan, Ann Arbor, MI, United States.
Title
Percutaneous coronary intervention or coronary artery bypass surgery for
cardiogenic shock and multivessel coronary artery disease?.
Source
American Heart Journal. 159(1)(pp 141-147), 2010. Date of Publication:
January 2010.
Publisher
Mosby Inc.
Abstract
Background: Despite advances in treatment of cardiogenic shock (CS), the
incidence of this serious complication of acute ST-elevation myocardial
infarction (STEMI) has stayed relatively constant, and rates of mortality,
although somewhat improved in recent decades, remain dauntingly high.
Although both percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) are used in patients with CS with multivessel
coronary disease, the optimal revascularization strategy in this setting
remains unknown. Methods: We conducted a literature search and review of
English language publications on CS in multiple online medical databases.
Studies were included if they were (1) randomized controlled trials or
observational cohort studies, (2) single-center or multicenter reports,
(3) prospective or retrospective studies, and (4) contained information on
PCI and CABG. Non-English language studies were excluded. Results: Our
search retrieved no published findings from randomized clinical trials,
and only 4 observational reports evaluating PCI versus CABG. Our review of
the limited available data suggests similar mortality rates with CABG and
PCI in patients with STEMI and multivessel coronary disease complicated by
CS. Conclusions: Limited data from observational studies in patients with
CS and multivessel disease suggest that CABG should be considered a
complementary reperfusion strategy to PCI and may be preferred, especially
when complete revascularization with PCI is not possible. Our data
highlight the need for large randomized trials to further evaluate the
relative benefit of PCI versus CABG in patients with multivessel coronary
disease and CS using contemporary surgical and percutaneous techniques.
copyright 2010 Mosby, Inc. All rights reserved.
<3>
Accession Number
2009638070
Authors
Issa V.S. Amaral A.F. Cruz F.D. Ayub-Ferreira S.M. Guimaraes G.V. Chizzola
P.R. Souza G.E.C. Bocchi E.A.
Institution
(Issa, Amaral, Cruz, Ayub-Ferreira, Guimaraes, Chizzola, Souza, Bocchi)
Heart Failure Institute (InCor), Hospital das Clinicas, Faculdade de
Medicina, Brazil.
Title
Glycemia and prognosis of patients with chronic heart failure-Subanalysis
of the Long-term Prospective Randomized Controlled Study Using Repetitive
Education at Six-Month Intervals and Monitoring for Adherence in Heart
Failure Outpatients (REMADHE) trial.
Source
American Heart Journal. 159(1)(pp 90-97), 2010. Date of Publication:
January 2010.
Publisher
Mosby Inc.
Abstract
Background: Heart failure and diabetes often occur simultaneously in
patients, but the prognostic value of glycemia in chronic heart failure is
debatable. We evaluated the role of glycemia on prognosis of heart
failure. Methods: Outpatients with chronic heart failure from the
Long-term Prospective Randomized Controlled Study Using Repetitive
Education at Six-Month Intervals and Monitoring for Adherence in Heart
Failure Outpatients (REMADHE) trial were grouped according to the presence
of diabetes and level of glycemia. All-cause mortality/heart
transplantation and unplanned hospital admission were evaluated. Results:
Four hundred fifty-six patients were included (135 [29.5%] female, 124
[27.2%] with diabetes mellitus, age of 50.2 +/- 11.4 years, and
left-ventricle ejection fraction of 34.7% +/- 10.5%). During follow-up
(3.6 +/- 2.2 years), 27 (5.9%) patients were submitted to heart
transplantation and 202 (44.2%) died; survival was similar in patients
with and without diabetes mellitus. When patients with and without
diabetes were categorized according to glucose range (glycemia [less-than
or equal to] 100 mg/dL [5.5 mmol/L]), as well as when distributed in
quintiles of glucose, the survival was significantly worse among patients
with lower levels of glycemia. This finding persisted in Cox proportional
hazards regression model that included gender, etiology, left ventricle
ejection fraction, left ventricle diastolic diameter, creatinine level and
beta-blocker therapy, and functional status (hazard ratio 1.45, 95% CI
1.09-1.69, P = .039). No difference regarding unplanned hospital admission
was found. Conclusion: We report on an inverse association between
glycemia and mortality in outpatients with chronic heart failure. These
results point to a new pathophysiologic understanding of the interactions
between diabetes mellitus, hyperglycemia, and heart disease. copyright
2010 Mosby, Inc. All rights reserved.
<4>
Accession Number
2009637330
Authors
Bhatt D.L. Lincoff A.M. Gibson C.M. Stone G.W. McNulty S. Montalescot G.
Kleiman N.S. Goodman S.G. White H.D. Mahaffey K.W. Pollack Jr. C.V.
Manoukian S.V. Widimsky P. Chew D.P. Cura F. Manukov I. Tousek F. Jafar
M.Z. Arneja J. Skerjanec S. Harrington R.A.
Institution
(Bhatt) VA (Veterans Affairs) Boston Healthcare System, Brigham and
Women's Hospital, Boston, MA, United States.
(Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United States.
(Lincoff) Cleveland Clinic, Cleveland, United States.
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States.
(Jafar) Interventional Cardiology and Cardiac Research, Hudson Valley
Heart Center, Poughkeepsie, NY, United States.
(McNulty, Mahaffey, Harrington) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States.
(Montalescot) Institut de Cardiologie, Pitie-Salpetriere Hospital, Paris,
France.
(Kleiman) Methodist DeBakey Heart Center, Methodist Hospital, Houston,
United States.
(Goodman) Division of Cardiology, St. Michael's Hospital, Canadian Heart
Research Centre, Toronto, ON, Canada.
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand.
(Pollack Jr.) Pennsylvania Hospital, University of Pennsylvania,
Philadelphia, PA, United States.
(Manoukian) Sarah Cannon Research Institute, Hospital Corporation of
America, Nashville, United States.
(Widimsky) Third Faculty of Medicine, Charles University, Prague, Czech
Republic.
(Chew) Flinders University/Flinders Medical Centre, Adelaide, SA,
Australia.
(Cura) Department of Interventional Cardiology, Instituto Cardiovascular
de Buenos Aires, Buenos Aires, Argentina.
(Manukov) Clinic of Invasive Cardiology, St. George's University Hospital,
Plovdiv, Bulgaria.
(Tousek) Regional Hospital, Ceske Budejovice, Czech Republic.
(Arneja) Arneja Heart Institute, Nagpur, Maharashtra, India.
(Skerjanec) Medicines Company, Parsippany, NJ, United States.
Title
Intravenous platelet blockade with cangrelor during PCI.
Source
New England Journal of Medicine. 361(24)(pp 2330-2341), 2009. Date of
Publication: 10 Dec 2009.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Intravenous cangrelor, a rapid-acting, reversible adenosine
diphosphate (ADP) receptor antagonist, might reduce ischemic events during
percutaneous coronary intervention (PCI). METHODS: In this double-blind,
placebo-controlled study, we randomly assigned 5362 patients who had not
been treated with clopidogrel to receive either cangrelor or placebo at
the time of PCI, followed by 600 mg of clopidogrel. The primary end point
was a composite of death, myocardial infarction, or ischemia-driven
revascularization at 48 hours. Enrollment was stopped when an interim
analysis concluded that the trial would be unlikely to show superiority
for the primary end point. RESULTS: The primary end point occurred in 185
of 2654 patients receiving cangrelor (7.0%) and in 210 of 2641 patients
receiving placebo (8.0%) (odds ratio in the cangrelor group, 0.87; 95%
confidence interval [CI], 0.71 to 1.07; P = 0.17) (modified
intentionto-treat population adjusted for missing data). In the cangrelor
group, as compared with the placebo group, two prespecified secondary end
points were significantly reduced at 48 hours: the rate of stent
thrombosis, from 0.6% to 0.2% (odds ratio, 0.31; 95% CI, 0.11 to 0.85; P =
0.02), and the rate of death from any cause, from 0.7% to 0.2% (odds
ratio, 0.33; 95% CI, 0.13 to 0.83; P = 0.02). There was no significant
difference in the rate of blood transfusion (1.0% in the cangrelor group
and 0.6% in the placebo group, P = 0.13), though major bleeding on one
scale was increased in the cangrelor group, from 3.5% to 5.5% (P<0.001),
because of more groin hematomas. CONCLUSIONS: The use of periprocedural
cangrelor during PCI was not superior to placebo in reducing the primary
end point. The prespecified secondary end points of stent thrombosis and
death were lower in the cangrelor group, with no significant increase in
the rate of transfusion. Further study of intravenous ADP blockade with
cangrelor may be warranted. (ClinicalTrials.gov number, NCT00385138.).
Copyright copyright 2009 Massachusetts Medical Society.
<5>
Accession Number
2009618486
Authors
Sedlis S.P. Jurkovitz C.T. Hartigan P.M. Goldfarb D.S. Lorin J.D. Dada M.
Maron D.J. Spertus J.A. Mancini G.B.J. Teo K.K. O'Rourke R.A. Boden W.E.
Weintraub W.S.
Institution
(Sedlis, Goldfarb, Lorin) Veterans Affairs New York Harbor Health Care
System, New York University School of Medicine, New York, NY, United
States.
(Jurkovitz, Weintraub) Christiana Care Health System, Newark, DE, United
States.
(Hartigan) Veterans Affairs Coop. Studies Program Coordinating Center and
Veterans Affairs Connecticut Health C, West Haven, CT, United States.
(Dada) Hartford Hospital, Hartford, CT, United States.
(Maron) Vanderbilt University Medical Center, Nashville, TN, United
States.
(Spertus) Mid America Heart Institute, Kansas City, MO, United States.
(Mancini) Vancouver Hospital, Cardiovascular Imaging Research Core
Laboratory, University of British Columbia, Vancouver, BC, Canada.
(Teo) McMaster University Medical Centre, Hamilton, Ont., Canada.
(O'Rourke) Veterans Affairs South Texas Health Care System, San Antonio,
TX, United States.
(Boden) Veterans Affairs Western New York Health Care System and Kaleida
Health, Buffalo, NY, United States.
Title
Optimal Medical Therapy With or Without Percutaneous Coronary Intervention
for Patients With Stable Coronary Artery Disease and Chronic Kidney
Disease.
Source
American Journal of Cardiology. 104(12)(pp 1647-1653), 2009. Date of
Publication: 15 Dec 2009.
Publisher
Elsevier Inc.
Abstract
Chronic kidney disease (CKD) is a risk factor for poor outcomes in
patients with coronary artery disease (CAD), but it is unknown whether CKD
influences the efficacy of alternative CAD treatment strategies. Thus, we
compared outcomes in stable CAD patients with and without CKD randomized
to percutaneous coronary intervention (PCI) and optimal medical therapy
(OMT) or OMT alone in a post hoc analysis of the 2,287 patient COURAGE
study. At baseline, 320 patients (14%) had CKD defined as a glomerular
filtration rate of <60 mL/min/1.73 m2, as estimated by the abbreviated
4-variable Modification of Diet in Renal Disease equation. The patients
with CKD were older (68 +/- 9 vs 61 +/- 10 years; p <0.001) and more often
had diabetes mellitus (42% vs 33%; p = 0.002), hypertension (81% vs 65%; p
<0.03), heart failure (13% vs 3.4%; p <001), and three-vessel CAD (37% vs
29%, p = 0.01). After adjustment for these differences, CKD remained an
independent predictor of death or nonfatal myocardial infarction (hazard
ratio 1.48, 95% confidence interval 1.15 to 1.90). PCI had no effect on
these outcomes. Furthermore, at 36 months, a similar percentage of
patients with CKD treated with OMT (70%) and PCI plus OMT (76%) were
angina free compared to patients without CKD. In conclusion, CKD is an
important determinant of clinical outcomes in patients with stable CAD,
regardless of the treatment strategy. Although PCI did not reduce the risk
of death or myocardial infarction when added to OMT for patients with CKD,
it also was not associated with worse outcomes in this high-risk group.
<6>
Accession Number
2009580462
Authors
Medford A.R.L. Agrawal S. Free C.M. Bennett J.A.
Institution
(Medford, Agrawal, Free, Bennett) Department of Respiratory Medicine,
Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield
Hospital, Leicester LE3 9QP, Leicestershire, United Kingdom.
Title
A local anaesthetic video-assisted thoracoscopy service: Prospective
performance analysis in a UK tertiary respiratory centre.
Source
Lung Cancer. 66(3)(pp 355-358), 2009. Date of Publication: December 2009.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Local anaesthetic video-assisted thoracoscopy (LAVAT) is a
safe, reliable and therapeutic procedure used by respiratory physicians in
the management of pleural disease, especially pleural malignancy. We
describe a prospective analysis of a UK LAVAT service set up in a tertiary
respiratory centre to complement an existing large surgical video-assisted
thoracic surgery (VATS) service. Methods: A prospective analysis of 125
LAVAT procedures over a 34-month period was performed looking at a variety
of quality control endpoints comparing them to national thoracic surgical
VATS standards. Results: Talc pleurodesis was effective in over 86% of
cases and this did not significantly lengthen bed stay (median 4.5 days).
Bed stay was also unchanged between the ages of 60-89 years. Over 77% of
the 48 patients with proven metastatic pleural lung malignancy or
mesothelioma received either surgical decortication or oncological
treatment (palliative chemotherapy in 57%). In only 6% were biopsies not
possible because of technical factors. LAVAT biopsies had a diagnostic
accuracy of 97.4%, sensitivity 95.4%, specificity 100%, positive
predictive value 100%, and negative predictive value 94.7%. Our
complication rate was 4% and mortality rate 0.8%. Discussion: Our LAVAT
service meets surgical VATS standards for diagnosis and safety with a good
pleurodesis efficacy rate. It complements our surgical VATS service,
offering a pleural diagnostic service for patients with non-complex
pleural exudates or too frail for VATS. Our data demonstrate there is a
demand and potential for respiratory physicians dealing with pleural
malignancy to develop LAVAT and enhance their local lung cancer and
pleural diagnostic pathway. copyright 2009 Elsevier Ireland Ltd. All
rights reserved.
<7>
Accession Number
2009607483
Authors
Santarpino G. Caroleo S. Onorati F. Rubino A.S. Dardano A. Gulletta E.
Santangelo E. Amantea B. Renzulli A.
Institution
(Santarpino, Onorati, Rubino, Renzulli) Cardiac Surgery Unit, Magna
Graecia University of Catanzaro, Catanzaro, Italy.
(Caroleo, Santangelo, Amantea) Anesthesiology Unit, Magna Graecia
University of Catanzaro, Catanzaro, Italy.
(Dardano, Gulletta) Clinical Pathology, Magna Graecia University of
Catanzaro, Catanzaro, Italy.
Title
Inflammatory response after cardiopulmonary bypass: A randomized
comparison between conventional hemofiltration and steroids.
Source
Journal of Cardiovascular Surgery. 50(4)(pp 555-564), 2009. Date of
Publication: August 2009.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. Recent reports have shown anti-inflammatory effects with conventional
hemofiltration (CUF) in patients undergoing cardiopulmonary bypass (CPB).
The aim of this study was to evaluate the immunological and the
hemodynamic response to CUF or metilprednisolone in patients undergoing
coronary artery bypass grafting. Methods. Twenty-four consecutive patients
were prospectively randomized to receive CUF (12 patients, Group A) or
metilprednisolone (12 patients, Group B). Hemodynamic response was
evaluated by Swan-Ganz catheter, immunological response was analyzed by
IL-2, EL-4, IL-6, TNF-alpha, IFN-gamma, IL-10 before anesthetic induction
(T0), at aortic-declamping (T1), at the end of surgery (T2), LTU admission
(T3) and 24 hours (T4). Troponin I was measured at the same time-points.
Hematological and coagulative controls were performed. Results. Morbidity
and mortality were comparable between the two groups. Group A demonstrated
lower cardiac index at T1 (2.1+/-0.69 L/min m2 vs. 3.917+/-1.28, P=0.034)
without significantly higher indexed-systemic-vascular-resistances at the
end of surgery (1101+/-434.3 dyne s cm-5 m-2 vs. 797.7+/-316.67, P=0.233).
When proinflammatory and anti-inflammatory cytokines were considered, all
improved during the postoperative time course, without differences between
the 2 Groups (P=NS). Hematological and coagulative data were similar in
the two groups, in terms of white blood cells, platelets, prothrombin
time, and activated partial thromboplastin time (P=NS). Conclusion.
Anti-inflammatory action of CUF was comparable to steroids, thus
determining a similar proinflammatory response to CPB. However,
hemodynamics was slightly impaired by CUF. Therefore, there is no reason
to prefer CUF to steroids in patients undergoing elective CABG.
<8>
Accession Number
2009603546
Authors
Zangrillo A. Bignami E. Biondi-Zoccai G.G.L. Covello R.D. Monti G. D'Arpa
M.C. Messina M. Turi S. Landoni G.
Institution
(Zangrillo, Bignami, Covello, Monti, D'Arpa, Messina, Turi, Landoni)
Department of Anesthesia and Intensive Care, Universita Vita-Salute San
Raffaele, Milan, Italy.
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
Universita di Torino, Torino, Italy.
Title
Spinal Analgesia in Cardiac Surgery: A Meta-analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 23(6)(pp 813-821),
2009. Date of Publication: December 2009.
Publisher
W.B. Saunders
Abstract
Objective: Controversial results exist on the effects of spinal analgesia
in cardiac surgery. The authors conducted a review of randomized studies
to show whether there are any advantages in clinically relevant outcomes
using spinal analgesia in patients undergoing cardiac surgery. Design:
Meta-analysis. Setting: Multiple hospitals. Participants: A total of 1,106
patients from 25 randomized trials. Interventions: None. Measurements and
Main Result: PubMed, BioMedCentral, CENTRAL, EMBASE, Cochrane Central
Register of Controlled Trials, and conference proceedings were searched
(updated January 2009) for randomized trials that compared general
anesthesia with an anesthetic plan including spinal analgesia in cardiac
surgery. Four independent reviewers performed data extraction, with
divergences resolved by consensus. A total of 1,106 patients from 25
randomized studies were included in the analysis. Overall analysis showed
that there were no differences in terms of mortality (2/562 [0.4%] in the
spinal group v 2/514 [0.4%] in the control arm [risk difference (RD) =
0.00 [-0.02, +0.02], p = 1.0), perioperative myocardial infarction (9/421
[2.1%] in the spinal group v 11/407 [2.7%] in the control arm [RD = 0.00,
-(0.03, +0.02), p = 0.77), and the length of hospital stay (WMD = -0.28
days [-0.68, -0.13], p = 0.18, with 419 included patients). Conclusions:
This analysis indicated that spinal analgesia does not improve clinically
relevant outcomes in patients undergoing cardiac surgery, discouraging
further randomized controlled trials on this topic even if changes in
techniques, devices, and drugs could modify the outlook of the comparison
between spinal and standard anesthesia in this setting. copyright 2009
Elsevier Inc. All rights reserved.
<9>
Accession Number
2009603545
Authors
Cruz Pardos P. Garutti I. Pineiro P. Olmedilla L. de la Gala F.
Institution
(Cruz Pardos, Garutti, Pineiro, Olmedilla, de la Gala) Department of
Anesthesiology and Reanimation, Hospital General Universitario Gregorio
Maranon, Madrid, Spain.
Title
Effects of Ventilatory Mode During One-Lung Ventilation on Intraoperative
and Postoperative Arterial Oxygenation in Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 23(6)(pp 770-774),
2009. Date of Publication: December 2009.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to investigate the relationship
between the ventilatory mode used during one-lung ventilation (OLV) and
intraoperative and early postoperative arterial oxygenation in patients
undergoing thoracic surgery. Methods: A prospective, randomized clinical
trial. Setting: A tertiary care university hospital single institution.
Participants: One hundred ten patients scheduled for thoracic surgery with
at least 1 hour of OLV. Interventions: Patients were prospectively
randomized into 2 groups depending on the ventilatory mode used during
OLV: volume-controlled ventilation (VCV) or pressure-controlled
ventilation (PCV). In VCV, the authors used a tidal volume (Vt) of 8 mL/kg
and in the PCV group an inspiratory pressure to provide a tidal volume of
8 mL/kg. Measurements and Main Results: Airway pressures and arterial
blood gases were obtained at 20, 30, and 40 minutes after OLV. The authors
recorded the ratio of arterial oxygen tension to inspired oxygen fraction
(PaO2/FIO2) at 4 hours (RU1) and 24 hours (RU2) after surgery. During OLV,
there were no differences in arterial oxygenation, airway plateau
pressure, and mean pressure between groups, although peak pressure was
higher in the VCV group (p < 0.01). The PaO2/FIO2 ratio at RU1 was 312.6
+/- 106 in the VCV group and 322.1 +/- 104. In the PCV group at RU2, it
was 402.4 +/- 105 and 389.6 +/- 114, respectively, and there were no
significant differences between the groups. Conclusions: In patients
undergoing thoracic surgery, the use of PCV compared with VCV during OLV
with the same Vt of 8 mL/kg does not affect arterial oxygenation during
OLV or early postoperative oxygenation. copyright 2009 Elsevier Inc. All
rights reserved.
<10>
Accession Number
2009632205
Authors
Tikkanen M.J. Szarek M. Fayyad R. Holme I. Cater N.B. Faergeman O.
Kastelein J.J.P. Olsson A.G. Larsen M.L. Lindahl C. Pedersen T.R.
Institution
(Tikkanen) Department of Medicine, Division of Cardiology, Helsinki
University Central Hospital, Helsinki, Finland.
(Szarek, Fayyad, Cater) Pfizer Inc., New York, NY, United States.
(Holme, Pedersen) Centre of Preventive Medicine, Ulleval University
Hospital, Oslo, Norway.
(Faergeman, Larsen) Department of Medicine-Cardiology A, Arhus University
Hospital, Arhus, Denmark.
(Kastelein) Department of Vascular Medicine, Academic Hospital Amsterdam,
Amsterdam, Netherlands.
(Olsson) Department of Internal Medicine, Faculty of Health Sciences,
University Hospital, Linkoping, Sweden.
(Lindahl) Pfizer Sweden, Sollentuna, Sweden.
Title
Total Cardiovascular Disease Burden: Comparing Intensive With Moderate
Statin Therapy. Insights From the IDEAL (Incremental Decrease in End
Points Through Aggressive Lipid Lowering) Trial.
Source
Journal of the American College of Cardiology. 54(25)(pp 2353-2357),
2009. Date of Publication: 20091215/22.
Publisher
Elsevier USA
Abstract
Objectives: This post-hoc analysis of the IDEAL (Incremental Decrease in
End Points Through Aggressive Lipid Lowering) trial was designed to assess
the comparative treatment efficacy of high-dose atorvastatin and
usual-dose simvastatin for the prevention of events subsequent to the
first event, using the Wei, Lin, and Weissfeld method. Background:
Time-to-first-event analysis of data is frequently utilized to provide
efficacy outcome information in coronary heart disease prevention trials.
However, during the course of such long-term trials, a large number of
events occur subsequent to the first event, the analysis of which will be
precluded by this approach. Methods: The Wei, Lin, and Weissfeld method
allows the analysis of repeated occurrence of events of the same type or
of entirely different natures. It regards the recurrence times as
multivariate event (failure) times, and models the marginal (individual)
distribution for each event with the Cox proportional hazards model.
Results: In the IDEAL trial, compared with patients taking simvastatin 20
to 40 mg daily, patients receiving atorvastatin 80 mg daily had their
relative risk of a first cardiovascular event reduced by 17% (p < 0.0001),
of a second by 24% (p < 0.0001), of a third by 19% (p = 0.035), of a
fourth by 24% (p = 0.058), and of a fifth by 28% (p = 0.117). Conclusions:
Our results indicate that intensive statin therapy continues to be more
effective than standard statin therapy, even beyond the first event, and
suggest that clinicians should not hesitate to prescribe high-dose statin
therapy for patients experiencing multiple recurrent cardiovascular
events. copyright 2009 American College of Cardiology Foundation.
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