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<1>
Accession Number
2010084719
Authors
Meurin P. Tabet J.Y. Thabut G. Cristofini P. Farrokhi T. Fischbach M.
Pierre B. Ben Driss A. Renaud N. Iliou M.C. Weber H.
Institution
(Meurin, Tabet, Ben Driss, Renaud, Weber) Les Grands Pres, 27 rue Sainte
Christine, 77174 Villeneuve Saint Denis, France.
(Thabut) Service de Pneumologie, Hopital Bichat, 46 rue Huchard, 75018
Paris, France.
(Cristofini, Iliou) Hopital Broussais, 96 rue Didot, 75014 Paris, France.
(Farrokhi) Hopital Bligny, 91640 Briis-sous-Forges, France.
(Fischbach) Chateau Lemoine, 70 Rue du Marechal Gallieni, 33150 Cenon,
France.
(Pierre) IRIS, 271 Rue des Sources, 69280, Marcy l'Etoile, France.
Title
Nonsteroidal anti-inflammatory drug treatment for postoperative
pericardial effusion: A multicenter randomized, double-blind trial.
Source
Annals of Internal Medicine. 152(3)(pp 137-143), 2010. Date of
Publication: 02 Feb 2010.
Publisher
American College of Physicians
Abstract
Background: The incidence of asymptomatic pericardial effusion is high
after cardiac surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are
widely prescribed in this setting, but no study has assessed their
efficacy. Objective: To assess whether the NSAID diclofenac is effective
in reducing postoperative pericardial effusion volume. Design: Multicenter
randomized, double-blind, placebo-controlled study. (Clinical trials.gov
registration number: NCT00247052) Setting: 5 postoperative cardiac
rehabilitation centers. Patients: 196 patients at high risk for tamponade
because of moderate to large persistent pericardial effusion (grade 2, 3,
or 4 on a scale of 0 to 4, as measured by echocardiography) more than 7
days after cardiac surgery. Intervention: Random assignment at each site
in blocks of 4 to diclofenac, 50 mg, or placebo twice daily for 14 days.
Measurements: The main end point was change in effusion grade after 14
days of treatment. Secondary end points included frequency of late cardiac
tamponade. Results: The initial mean pericardial effusion grade was 2.58
(SD, 0.73) for the placebo group and 2.75 (SD, 0.81) for the diclofenac
group. The 2 groups showed similar mean decreases from baseline after
treatment (-1.08 grades [SD, 1.20] for the placebo group vs. -1.36 (SD,
1.25) for the diclofenac group). The mean difference between groups was
-0.28 grade (95% CI, -0.63 to 0.06 grade; P = 0.105). Eleven cases of late
cardiac tamponade occurred in the placebo group and 9 in the diclofenac
group (P = 0.64). These differences persisted after adjustment for grade
of pericardial effusion at baseline, treatment site, and type of surgery.
Limitation: The sample was not large enough to find small beneficial
effects of diclofenac or assess the cardiovascular tolerance of
diclofenac. Conclusion: In patients with pericardial effusion after
cardiac surgery, diclofenac neither reduced the size of the effusions nor
prevented late cardiac tamponade. Primary Funding Source: French Society
of Cardiology. copyright 2010 American College of Physicians.

<2>
Accession Number
2010052746
Authors
Kapur A. Hall R.J. Malik I.S. Qureshi A.C. Butts J. de Belder M. Baumbach
A. Angelini G. de Belder A. Oldroyd K.G. Flather M. Roughton M.
Nihoyannopoulos P. Bagger J.P. Morgan K. Beatt K.J.
Institution
(Kapur, Qureshi) London Chest Hospital, Barts and The London NHS Trust,
London, England, United Kingdom.
(Hall, Malik, Butts, Flather, Nihoyannopoulos, Bagger, Morgan) Imperial
College Healthcare NHS Trust, London, England, United Kingdom.
(Hall) Norfolk and Norwich University Hospitals, Norwich, England, United
Kingdom.
(de Belder) James Cook University Hospital, Middlesbrough, England, United
Kingdom.
(Baumbach, Angelini) Bristol Heart Institute, Bristol, England, United
Kingdom.
(de Belder) Royal Sussex County Hospital, Brighton, England, United
Kingdom.
(Oldroyd) Western Infirmary, Glasgow, Scotland, United Kingdom.
(Flather, Roughton) Royal Brompton and Harefield NHS Foundation Trust,
London, England, United Kingdom.
(Beatt) Mayday University Hospital, London, England, United Kingdom.
Title
Randomized Comparison of Percutaneous Coronary Intervention With Coronary
Artery Bypass Grafting in Diabetic Patients. 1-Year Results of the CARDia
(Coronary Artery Revascularization in Diabetes) Trial.
Source
Journal of the American College of Cardiology. 55(5)(pp 432-440), 2010.
Date of Publication: 02 Feb 2010.
Publisher
Elsevier USA
Abstract
Objectives: The purpose of this study was to compare the safety and
efficacy of percutaneous coronary intervention (PCI) with stenting against
coronary artery bypass grafting (CABG) in patients with diabetes and
symptomatic multivessel coronary artery disease. Background: CABG is the
established method of revascularization in patients with diabetes and
multivessel coronary disease, but with advances in PCI, there is
uncertainty whether CABG remains the preferred method of
revascularization. Methods: The primary outcome was a composite of
all-cause mortality, myocardial infarction (MI), and stroke, and the main
secondary outcome included the addition of repeat revascularization to the
primary outcome events. A total of 510 diabetic patients with multivessel
or complex single-vessel coronary disease from 24 centers were randomized
to PCI plus stenting (and routine abciximab) or CABG. The primary
comparison used a noninferiority method with the upper boundary of the 95%
confidence interval (CI) not to exceed 1.3 to declare PCI noninferior.
Bare-metal stents were used initially, but a switch to Cypher (sirolimus
drug-eluting) stents (Cordis, Johnson & Johnson, Bridgewater, New Jersey)
was made when these became available. Results: At 1 year of follow-up, the
composite rate of death, MI, and stroke was 10.5% in the CABG group and
13.0% in the PCI group (hazard ratio [HR]: 1.25, 95% CI: 0.75 to 2.09; p =
0.39), all-cause mortality rates were 3.2% and 3.2%, and the rates of
death, MI, stroke, or repeat revascularization were 11.3% and 19.3% (HR:
1.77, 95% CI: 1.11 to 2.82; p = 0.02), respectively. When the patients who
underwent CABG were compared with the subset of patients who received
drug-eluting stents (69% of patients), the primary outcome rates were
12.4% and 11.6% (HR: 0.93, 95% CI: 0.51 to 1.71; p = 0.82), respectively.
Conclusions: The CARDia (Coronary Artery Revascularization in Diabetes)
trial is the first randomized trial of coronary revascularization in
diabetic patients, but the 1-year results did not show that PCI is
noninferior to CABG. However, the CARDia trial did show that multivessel
PCI is feasible in patients with diabetes, but longer-term follow-up and
data from other trials will be needed to provide a more precise comparison
of the efficacy of these 2 revascularization strategies. (The Coronary
Artery Revascularisation in Diabetes trial; ISRCTN19872154). copyright
2010 American College of Cardiology Foundation.

<3>
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Accession Number
2010043167
Authors
Tandar A. Boden W.E.
Institution
(Tandar, Boden) Division of Cardiovascular Medicine, University at Buffalo
Schools of Medicine and Public Health and Kaleida Health System, Buffalo
General Hospital, Buffalo, NY, United States.
Title
Evolving concepts in selecting optimal strategies for the management of
patients with stable coronary disease: Pharmacologic or revascularization
therapy.
Source
Current Opinion in Cardiology. 24(6)(pp 591-595), 2009. Date of
Publication: November 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review: Initial management of patients with stable ischemic
heart disease (SIHD) continues to be vigorously debated amongst
cardiologists. Despite the lack of robust data to support percutaneous
coronary intervention (PCI) as the initial management of SIHD patients, it
remains one of the most commonly performed procedures. Results of the
Clinical Outcomes Utilizing Revascularization and Aggressive Drug
Evaluation (COURAGE) trial reignited the controversy of the benefit of
routine initial PCI over optimal medical therapy (OMT). Recent findings:
The trial suggested that, as an initial management strategy in patients
with SIHD, PCI did not reduce the risk of death, myocardial infarction, or
any other major cardiovascular events, when added to OMT. A meta-analysis
from Schomig et al. suggests that a PCIbased invasive strategy may improve
long-term survival compared with solely medical treatment in stable
coronary artery disease patients. Conclusion As the ability to
mechanically dilate obstructive coronary arterial stenoses has vastly
improved our approach to managing patients with SIHD, the result has been
a swing from an initial pharmacologic approach. An improved understanding
of the pathophysiology of acute coronary syndrome, increased insight into
plaque and patient vulnerability has led to the more aggressive use of
appropriately targeted pharmacologic agents and an evolution in what
constitutes OMT, based largely on the results of the COURAGE trial. Recent
studies support the concept that, in SIHD patients, OMT alone compares
favorably with a therapeutic strategy combining OMT with mechanical
intervention. Thus, the treatment pendulum may be swinging back to the
understanding that 'best practice' today requires the judicious use of
interventional and medical therapies in the appropriate patient
population. copyright 2009 Wolters Kluwer Health | Lippincott Williams &
Wilkins.

<4>
[Use Link to view the full text]
Accession Number
0019933534
Authors
Mauermann W.J. Nuttall G.A. Cook D.J. Hanson A.C. Schroeder D.R. Oliver
W.C.
Institution
(Mauermann, Nuttall, Cook, Hanson, Schroeder, Oliver) Department of
Anesthesiology and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.

Title
Hemofiltration during cardiopulmonary bypass does not decrease the
incidence of atrial fibrillation after cardiac surgery..
Source
Anesthesia and analgesia. 110(2)(pp 329-334), 2010. Date of Publication:
Feb 2010.
Abstract
BACKGROUND: Atrial fibrillation (AF) occurs in 20%-50% of patients after
cardiac surgery and is associated with increased morbidity and mortality.
Corticosteroids are reported to decrease the incidence of postoperative
AF, presumably by attenuating inflammation caused by surgery and
cardiopulmonary bypass (CPB). We hypothesized that hemofiltration during
CPB, which may attenuate inflammation, might decrease the incidence of AF
after cardiac surgery. METHODS: This was a retrospective review of
patients previously enrolled in a double-blind, placebo-controlled trial
evaluating the effects of perioperative steroid therapy and hemofiltration
during CPB on duration of postoperative mechanical ventilation. In that
study, 192 patients undergoing cardiac surgery were randomized to 1 of 3
groups: controls (placebo), hemofiltration during CPB, or perioperative
steroid therapy. Patient records were reviewed to determine the incidence
of new onset AF defined as any electrocardiogram evidence of AF or AF
diagnosed by the patients' clinicians. RESULTS: Of the 192 enrolled
patients, 3 were excluded for protocol violations and 4 were excluded for
history of chronic AF. Data from 185 patients from the original study were
available for review. Sixty patients (32%) had new onset AF after cardiac
surgery. There was no difference among groups in the incidence of AF
(control group, 21%; steroid group, 41%; hemofiltration group, 36%; P =
0.057 among groups). The only risk factor for the development of AF was
age (mean age of patients with AF, 65.4 +/- 10.1 yr vs patients without
AF, 61.4 +/- 11.5 yr; P = 0.024). When age, procedure type, and presence
or absence of chronic obstructive pulmonary disease were controlled for in
multivariate analysis, the difference among study groups remained
nonsignificant (P = 0.108). CONCLUSIONS: Perioperative corticosteroids or
the use of hemofiltration during CPB did not decrease the incidence of AF
after cardiac surgery. Further studies evaluating the efficacy and safety
of perioperative corticosteroids for prevention of postoperative AF are
warranted before their routine use can be recommended.

<5>
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Accession Number
0019933530
Authors
Weng H. Xu Z.Y. Liu J. Ma D. Liu D.S.
Institution
(Weng, Xu, Liu, Ma, Liu) Department of Anaesthesiology, West China
Hospital, Sichuan University, State Key Laboratory of Biotherapy of
Cancer, Chengdu, Sichuan, People's Republic of China.
Title
Placement of the Univent tube without fiberoptic bronchoscope assistance..
Source
Anesthesia and analgesia. 110(2)(pp 508-514), 2010. Date of Publication:
Feb 2010.
Abstract
BACKGROUND: In this study, we evaluated the feasibility and accuracy of
Univent tube (Fuji Systems, Tokyo, Japan) placement with the aid of
auscultation (AUS) or as guided by a lighted stylet (LS) compared with
placement guided by the fiberoptic bronchoscope (FOB) or the blind
intubation technique as recommended by the manufacturer's guidelines.
METHODS: Eighty ASA physical status I-II adult patients requiring
single-lung ventilation for elective thoracic surgery were randomly
allocated into 4 groups according to the method used for Univent tube
positioning: manufacturer-recommended (MR) group (n = 20); FOB group (n =
20); AUS group (n = 20); and LS group (n = 20). Tracheal placement of the
Univent tube was accomplished with direct rigid laryngoscopy after
anesthetic induction and was positioned by the same anesthesiologist using
1 of the above-described methods. Its position was then checked by another
anesthesiologist with an FOB. The number of attempts required for
successful tube positioning, the volume of air needed for blocker cuff
inflation, and intubation times were recorded, as were the times for
single-lung ventilation and the potential for bronchial injury. RESULTS:
The intubation time was 182 +/- 42 s in the AUS group and 176 +/- 50 s in
the LS group, shorter than that in the FOB (278 +/- 111 s) and MR (266 +/-
127 s) (P < 0.05) groups. The success rate of bronchial blocker insertion
into the left bronchus on the first attempt was 100% in the AUS group, 79%
in the LS group, and 25% in the MR group. The number of blocker insertion
attempts and the volume of air in the blocker cuff in the MR group were
significantly higher than those in the AUS and LS (P < 0.05) groups. In
the supine position, the number of acceptable bronchial blocker placements
was 14 of 20 attempts (70%) in the MR group, significantly fewer than that
in the FOB group (18 of 20, 90%) (P < 0.05). In the AUS and LS groups, the
number of acceptable bronchial blocker placements was 19 of 20 (95%) and
16 of 20 (80%), respectively. After patients were turned to the lateral
decubitus position, the number of acceptable bronchial blocker placements
was 10 of 18 (56%) in the MR group, significantly fewer than that in the
FOB group (17 of 19, 89.5%) (P < 0.05). In the AUS and LS groups, the
number of acceptable bronchial blocker placements was 15 of 20 (75%) and
15 of 19 (79%), respectively. CONCLUSIONS: The placement of the Univent
tube with the aid of AUS or an LS is feasible, and both techniques require
less time than placement aided by an FOB or as recommended by the
manufacturer.

<6>
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Accession Number
2010046471
Authors
Beaulieu Y. Denault A.Y. Couture P. Roy D. Talajic M. O'Meara E. Carrier
M. Page P. Levesque S. Lambert J. Tardif J.-C.
Institution
(Beaulieu, Denault, Couture, Roy, Talajic, O'Meara, Tardif) Department of
Anesthesiology, Montreal Heart Institute, 5000 Belanger Street, Montreal,
QC H1T 1C8, Canada.
(Denault) Division of Critical Care, Centre Hospitalier de l'Universite de
Montreal, Montreal, QC, Canada.
(Carrier, Page) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada.
(Levesque) Montreal Heart Institute Coordinating Center, Montreal, QC,
Canada.
(Lambert) Department of Preventive and Social Medicine, Universite de
Montreal,
Title
Perioperative intravenous amiodarone does not reduce the burden of atrial
fibrillation in patients undergoing cardiac valvular surgery.
Source
Anesthesiology. 112(1)(pp 128-137), 2010. Date of Publication: January
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Atrial fibrillation is a common complication after cardiac
surgery. Postoperative atrial fibrillation is associated with increased
risks of morbidity and mortality, and, therefore, preventive strategies
using oral amiodarone have been developed but are often unpractical.
Intravenous amiodarone administered after the induction of anesthesia and
continued postoperatively for 48 h could represent an effective strategy
to prevent postoperative atrial fibrillation in patients undergoing
cardiac valvular surgery. Methods: Single-center, double-blinded,
double-dummy, randomized controlled trial in patients undergoing valvular
surgery. Patients received either an intravenous loading dose of 300 mg of
amiodarone or placebo in the operating room, followed by a perfusion of 15
mg * kg * 24 h for 2 days. The primary endpoint was the development of
atrial fibrillation occurring at any time within the postoperative period.
Results: One hundred twenty patients were randomly assigned (mean age was
65 +/- 11 yr). Overall atrial fibrillation occurred more frequently in the
perioperative intravenous amiodarone group compared with the placebo group
(59.3 vs. 40.0%; P = 0.035). Four preoperative factors were found to be
independently associated with a higher risk of developing postoperative
atrial fibrillation: older age (P = 0.0003), recent myocardial infarction
(<6 months; P = 0.026), preoperative angina (P = 0.0326), and use of a
calcium channel blocker preoperatively (P = 0.0078) when controlling for
groups. CONCLUSION: In patients undergoing cardiac valvular surgery, a
strategy using intravenous amiodarone for 48 h is not efficacious in
reducing the risk of atrial fibrillation during cardiac valvular surgery.
copyright 2010 American Society of Anesthesiologists, Inc.

<7>
Accession Number
2010038668
Authors
Patel J.V. Tracey I. Hughes E.A. Lip G.Y.H.
Institution
(Patel, Tracey, Hughes, Lip) Haemostasis, Thrombosis and Vascular Biology
Unit, University of Birmingham Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom.
Title
Omega-3 polyunsaturated fatty acids: A necessity for a comprehensive
secondary prevention strategy.
Source
Vascular Health and Risk Management. 5(pp 801-810), 2009. Date of
Publication: 2009.
Publisher
DOVE Medical Press Ltd.
Abstract
Long-chain omega-3 polyunsaturated fatty acid (PUFA) supplementation has
been used for the secondary prevention of fatal and nonfatal myocardial
infarction (MI). However, the benefit of this therapy is frequently
confused with other established treatments in the therapeutic strategy
among such patients. We review the data on omega-3 PUFA use in secondary
care and consider indications for its use which include post-MI and raised
triglycerides. We suggest that the available evidence supports the use of
omega-3 supplementation as part of the comprehensive secondary care
package for post-MI patients. copyright 2009 Patel et al, publisher and
licensee Dove Medical Press Ltd.

<8>
Accession Number
2010038635
Authors
Nouri-Majalan N. Ardakani E.F. Forouzannia K. Moshtaghian H.
Institution
(Nouri-Majalan) Department of Nephrology, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of.
(Ardakani) Ali Bin Abu Taleb Medical College, Yazd Azad University, Yazd,
Iran, Islamic Republic of.
(Forouzannia) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of.
(Moshtaghian) Department of Anesthesiology, Afshar Hospital, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of.

Title
Effects of allopurinol and vitamin E on renal function in patients with
cardiac coronary artery bypass grafts.
Source
Vascular Health and Risk Management. 5(pp 489-494), 2009. Date of
Publication: 2009.
Publisher
DOVE Medical Press Ltd.
Abstract
Background: Acute renal failure is a common complication of cardiac
surgery, with oxidants found to play an important role in renal injury. We
therefore assessed whether the supplemental antioxidant vitamin E and the
inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction
after coronary artery bypass graft (CABG) surgery. Methods: Of 60 patients
with glomerular filtration rate (GFR) < 60 mL/min scheduled to undergo
CABG surgery, 30 were randomized to treatment with vitamin E and
allopurinol for 3-5 days before surgery and 30 to no treatment. Serum
creatinine levels and potassium and creatinine clearances were measured
preoperatively and daily until day 5 after surgery. Results: The patients
consisted of 31 males and 29 females, with a mean age of 63 +/- 9 years.
After surgery, there were no significant differences in mean serum
creatinine (1.2 +/- 0.33 vs 1.2 +/- 0.4 mg/dL; p = 0.43) concentrations,
or creatinine clearance (52 +/- 12.8 vs 52 +/- 12.8 mL/min; p = 0.9). The
frequency of acute renal failure did not differ in treatment group
compared with control (16% vs 13%; p = 0.5). Length of stay in the
intensive care unit (ICU) was significantly longer in the control than in
the treated group (3.9 +/- 1.5 vs 2.6 +/- 0.7 days; p < 0.001).
Conclusion: Prophylactic treatment with vitamin E and allopurinol had no
renoprotective effects in patients with pre-existing renal failure
undergoing CABG surgery. Treatment with these agents, however, reduces the
duration of ICU stay. copyright 2009 Nouri-Majalan et al, publisher and
licensee Dove Medical Press Ltd.

<9>
Accession Number
2010038614
Authors
Dasgupta A. Mukherjee D.
Institution
(Dasgupta, Mukherjee) Gill Heart Institute, Division of Cardiovascular
Medicine, University of Kentucky, 900 S. Limestone Street, Lexington, KY
40536-0200, United States.
Title
Use of clopidogrel in the reduction of myocardial damage during
percutaneous coronary intervention.
Source
Vascular Health and Risk Management. 5(pp 275-286), 2009. Date of
Publication: 2009.
Publisher
DOVE Medical Press Ltd.
Abstract
It is estimated that approximately a quarter of patients undergoing
coronary intervention may have significant post-procedural creatinine
(CK)/creatinine kinase myocardial band (CK-MB) elevations and
approximately half may have post-procedural troponin elevations. Current
data suggest that periprocedural infarction is associated with short-,
intermediate-, and long-term adverse outcomes, most notably mortality.
This review examines the role of clopidogrel in decreasing periprocedural
myonecrosis following percutaneous coronary intervention (PCI).
Clopidogrel is an important pharmacologic agent used to reduce myocardial
infarction post-coronary intervention as assessed directly by the
evaluation of cardiac biomarkers and indirectly by the evaluation of
short-term ischemic events. The optimal dose of clopidogrel is considered
to be at least 300 mg given 6 to 15 hours prior to PCI but there is
considerable evidence to suggest that a loading dose of 600 mg given 2 to
6 hours prior to PCI may be more efficacious in limiting post-coronary
intervention events. The benefit obtained from clopidogrel appears
independent of and incremental to that of other antiplatelet and
antithrombotic agents used during and after coronary intervention.
copyright 2009 Dasgupta and Mukherjee, publisher and licensee Dove Medical
Press Ltd.

<10>
Accession Number
2010038611
Authors
Baguet J.-P. Barone-Rochette G. Neuder Y.
Institution
(Baguet, Barone-Rochette, Neuder) Department of Cardiology, University
Hospital, 38043 Grenoble, France.
Title
Candesartan cilexetil in the treatment of chronic heart failure.
Source
Vascular Health and Risk Management. 5(pp 257-264), 2009. Date of
Publication: 2009.
Publisher
DOVE Medical Press Ltd.
Abstract
The prevalence of heart failure is ever increasing around the world,
particularly due to aging populations. Despite improvements in treatment
over the last 20 years, the prognosis for heart failure remains poor.
Among the treatments recommended for chronic heart failure,
angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are
crucial, provided of course that they are not contraindicated. However,
angiotensin II receptor blockers (ARBs) can also be a beneficial treatment
option. Candesartan is a particular ARB, characterized by a strong binding
affinity to the angiotensin II type 1 receptor and slow dissociation. The
benefits of candesartan have been demonstrated by the CHARM programme,
which showed that candesartan significantly reduces the incidence of
cardiovascular death, hospital admissions for decompensated heart failure,
and all-cause mortality in chronic heart failure patients with altered
left ventricular systolic function, when added to standard therapies or as
an alternative to ACE inhibitors when these are poorly tolerated.
Furthermore, candesartan can protect against myocardial infarction, atrial
fibrillation and diabetes. Tolerance to candesartan is good, but blood
pressure and serum potassium and creatinine levels must be monitored.
copyright 2009 Baguet et al, publisher and licensee Dove Medical Press
Ltd.

<11>
Accession Number
2010038609
Authors
De Vita M. Burzotta F. Biondi-Zoccai G.G.L. Lefevre T. Dudek D. Antoniucci
D. Orrego P.S. De Luca L. Kaltoft A. Sardella G. Zijlstra F. Isshiki T.
Crea F.
Institution
(De Vita, Burzotta, Crea) Catholic University of Sacred Heart, Cardiology
Institute, Largo F Vito, 1, 00168 Rome, Italy.
(Biondi-Zoccai) Interventional Cardiology, University of Turin, Italy.
(Lefevre) ICPS, Massy, France.
(Dudek) Department of Cardiology, Jagiellonian University, Kracow, Poland.
(Antoniucci) Division of Cardiology, Careggi Hospital, Florence, Italy.
(Orrego) Interventional Cardiology, A. De Gasperis Department, Niguarda
Hospital, Milan, Italy.
(De Luca) Department of Cardiovascular Sciences, European Hospital, Rome,
Italy.
(Kaltoft) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark.
(Sardella) Department of Cardiovascular and Respiratory Sciences, La
Sapienza University, Rome, Italy.
(Zijlstra) University Medical Center Groningen, Groningen, Netherlands.
(Isshiki) Department of Cardiology, Teykio University School of Medicine,
Tokyo, Japan.
Title
Individual patient-data meta-analysis comparing clinical outcome in
patients with ST-elevation myocardial infarction treated with percutaneous
coronary intervention with or without prior thrombectomy. ATTEMPT study: A
pooled Analysis of Trials on ThrombEctomy in acute Myocardial infarction
based on individual PatienT data.
Source
Vascular Health and Risk Management. 5(pp 243-247), 2009. Date of
Publication: 2009.
Publisher
DOVE Medical Press Ltd.
Abstract
Background: Available data from randomized trials on thrombectomy in
patients with ST-elevation myocardial infarction (STEMI) have shown
favorable trends in myocardial reper-fusion. However, few data are
available on the effect of thrombectomy on clinical outcome. Thus we have
designed a collaborative individual patient-data meta-analysis which aimed
to assess the long-term clinical outcome in STEMI patients randomized to
percutaneous coronary intervention (PCI) with or without thrombectomy.
Method: After a thorough database search, the principal investigators of
randomized trials comparing thrombectomy with standard PCI in patients
with STEMI were contacted. Principal investigators as authors of 11
randomized studies agreed to participate and were asked to complete a
structured database by providing a series of key pre-PCI clinical and
angiographic data as well as the longest available clinical outcome of the
patients enrolled in the corresponding trial. The primary end-point of
this pooled analysis is the comparison of overall survival rates between
patients randomized to PCI with thrombectomy or PCI without thrombectomy.
The secondary end-points are survival free from myocardial infarction
(MI), target lesion revascularization (TLR), major adverse coronary events
(MACE: death + MI + TLR) and death + MI between patients randomized to PCI
with thrombectomy or PCI without thrombectomy. A pre-defined subgroup
analysis is planned considering the following variables: type of
thrombectomy device used, diabetes, rescue PCI, IIb/IIIa-inhibitors use,
time-to-reperfusion, infarct-related artery, and pre-PCI TIMI flow.
Implications: This study will provide useful data on the effect of the
reported improved myocardial perfusion associated with thrombectomy on the
long-term clinical outcome in patients with STEMI. copyright 2009 De Vita
et al, publisher and licensee Dove Medical Press Ltd.

<12>
Accession Number
0019488583
Authors
dos Santos L.M. Santos V.C.J. Santos S.R.C.J. Malbouisson L.M.S. Carmona
M.J.C.
Institution
(dos Santos, Carmona) Department of Anesthesia, Heart Institute, Faculdade
de Medicina da Universidade de Sao Paulo, Sao Paulo/SP, Brazil.
(Santos, Santos, Malbouisson) Department of Clinical Pharmacology,
Pharmaceutical Sciences School, Universidade de Sao Paulo, Sao Paulo/SP,
Brazil.
Title
Intrathecal morphine plus general anesthesia in cardiac surgery: Effects
on pulmonary function, postoperative analgesia, and plasma morphine
concentration.
Source
Clinics. 64(4)(pp 279-285), 2009. Date of Publication: 2009.
Publisher
Universidade de Sao Paulo
Abstract
OBJECTIVES: To evaluate the effects of intrathecal morphine on pulmonary
function, analgesia, and morphine plasma concentrations after cardiac
surgery. INTRODUCTION: Lung dysfunction increases morbidity and mortality
after cardiac surgery. Regional analgesia may improve pulmonary outcomes
by reducing pain, but the occurrence of this benefit remains
controversial. METHODS: Forty-two patients were randomized for general
anesthesia (control group n=22) or 400 mug of intrathecal morphine
followed by general anesthesia (morphine group n=20). Postoperative
analgesia was accomplished with an intravenous, patient-controlled
morphine pump. Blood gas measurements, forced vital capacity (FVC), forced
expiratory volume (FEV), and FVC/FEV ratio were obtained preoperatively,
as well as on the first and second postoperative days. Pain at rest,
profound inspiration, amount of coughing, morphine solicitation,
consumption, and plasma morphine concentration were evaluated for 36 hours
postoperatively. Statistical analyses were performed using the repeated
measures ANOVA or Mann-Whiney tests (*p<0.05). RESULTS: Both groups
experienced reduced FVC postoperatively (3.24 L to 1.38 L in control
group; 2.72 L to 1.18 L in morphine group), with no significant decreases
observed between groups. The two groups also exhibited similar results for
FEV1 (p=0.085), FEV1/FVC (p=0.68) and PaO2/FiO2 ratio (p=0.08). The
morphine group reported less pain intensity (evaluated using a visual
numeric scale), especially when coughing (18 hours postoperatively:
control group=4.73 and morphine group=1.80, p=0.001). Cumulative morphine
consumption was reduced after 18 hours in the morphine group (control
group=20.14 and morphine group=14.20 mg, p=0.037). The plasma morphine
concentration was also reduced in the morphine group 24 hours after
surgery (control group=15.87 ng.mL-1 and morphine group=4.08 ng.mL-1,
p=0.029). CONCLUSIONS: Intrathecal morphine administration did not
significantly alter pulmonary function; however, it improved patient
analgesia and reduced morphine consumption and morphine plasma
concentration.

<13>
Accession Number
0019565135
Authors
Ferreira P.E. Rodrigues A.J. Evora P.R.
Institution
(Ferreira, Rodrigues, Evora) Hospital das Clinicas, Faculdade de Medicina
de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, Brazil.

Title
Effects of an inspiratory muscle rehabilitation program in the
postoperative period of cardiac surgery..
Source
Arquivos brasileiros de cardiologia. 92(4)(pp 275-282), 2009. Date of
Publication: Apr 2009.
Abstract
BACKGROUND: Respiratory muscles are affected after cardiac surgeries.
OBJECTIVE: To verify whether the preoperative conditioning of the
inspiratory muscles might help to decrease postoperative respiratory
dysfunction. METHODS: Thirty volunteers of both genders and with a minimum
age of 50 years, while waiting for myocardial revascularization and/or
cardiac valve surgery, were randomly assigned to two groups. Fifteen
patients were included in a domiciliary program of at least 2 weeks of
preoperative training of the inspiratory muscles, using a device with a
load corresponding to 40% of the maximum inspiratory pressure. The other
15 patients received general advice and did not train the inspiratory
muscle. Spirometry, before and after the training program, as well as the
evolution of the arterial blood gases and of the maximum inspiratory and
expiratory pressure, before and after the operation were evaluated in both
group. The clinical outcomes of the two groups were also compared.
RESULTS: We observed that inspiratory muscle training increased the forced
vital capacity, the maximum voluntary ventilation and the ratio between
the forced expired volume during the first second and the forced vital
capacity. The evolution of the arterial blood gases and of the maximum
inspiratory and expiratory pressures before and after the operation was
similar in both groups, with the outcomes also being similar. CONCLUSION:
We concluded that our domiciliary program of inspiratory muscle training
was safe and improved the forced vital capacity and the maximum voluntary
ventilation, although the clinical benefits of this program were not
clearly demonstrable in the present study.

<14>
Accession Number
2010071002
Authors
Joyal D. Filion K.B. Eisenberg M.J.
Institution
(Joyal, Eisenberg) Division of Cardiology, Jewish General Hospital,
Montreal, Que., Canada.
(Filion, Eisenberg) Department of Epidemiology, Biostatistics, and
Occupational Health, McGill University, Montreal, Que., Canada.
(Filion) Division of Clinical Epidemiology, McGill University Health
Center, Montreal, Que., Canada.
(Filion, Eisenberg) Division of Clinical Epidemiology, Jewish General
Hospital, Montreal, Que., Canada.
Title
Effectiveness and safety of drug-eluting stents in vein grafts: A
meta-analysis.
Source
American Heart Journal. 159(2)(pp 159-169.e4), 2010. Date of Publication:
February 2010.
Publisher
Mosby Inc.
Abstract
Background: The use of drug-eluting stents (DES) in degenerative vein
grafts is currently an off-label indication. Recent studies have had
conflicting results regarding the effectiveness and safety of this
practice. The objective of this meta-analysis was to compare DES to
bare-metal stents for the treatment of vein graft stenosis. Methods:
PubMed and the Cochrane clinical trials database were systematically
searched to identify all randomized controlled trials (RCTs) and
observational studies examining DES for vein graft stenosis published in
English between 2003 and 2009. Inclusion criteria included follow-up
duration [greater-than or equal to]6 months. Data were stratified by study
design and pooled using random effects models. Results: Twenty studies
were found to meet our inclusion criteria. Eighteen studies were
observational and 2 were RCTs. In observational studies, DES were
associated with a reduction in major adverse cardiac events (MACE) (odds
ratio [OR] 0.50, 95% CI 0.35-0.72), death (OR 0.69, 95% CI 0.53-0.91),
target vessel revascularization (TVR) (OR 0.54, 95% CI 0.37-0.79), and
target lesion revascularization (TLR) (OR 0.54, 95% CI 0.37-0.78). The
incidence of myocardial infarction was similar between groups. In the
RCTs, pooled results were inconclusive because of small sample sizes.
Conclusions: Although data from observational studies suggest that the use
of DES for vein graft stenosis has favorable effects on MACE, death, TVR,
and TLR, these data should be interpreted with caution due to their
observational nature. Corresponding RCT data are inconclusive. There
remains a need for large multicenter RCTs to address the effectiveness and
safety of DES for vein graft stenosis. copyright 2010 Mosby, Inc. All
rights reserved.

<15>
Accession Number
2010070995
Authors
Sanchis J. Bosch X. Bodi V. Nunez J. Doltra A. Heras M. Mainar L. Santas
E. Bragulat E. Garcia-Alvarez A. Carratala A. Llacer A.
Institution
(Sanchis, Bodi, Nunez, Mainar, Santas, Llacer) Cardiology Department,
University Clinic Hospital, University of Valencia, Valencia, Spain.
(Bosch, Doltra, Heras, Bragulat, Garcia-Alvarez) Cardiology Department,
Hospital Clinic, University of Barcelona, Barcelona, Spain.
(Carratala) Clinical Biochemistry Department, University Clinic Hospital,
Valencia, Spain.
Title
Randomized comparison between clinical evaluation plus N-terminal
pro-B-type natriuretic peptide versus exercise testing for decision making
in acute chest pain of uncertain origin.
Source
American Heart Journal. 159(2)(pp 176-182), 2010. Date of Publication:
February 2010.
Publisher
Mosby Inc.
Abstract
Background: Exercise testing constitutes the usual tool for decision
making in chest pain units. This policy implies logistical constrains. Our
aim was to evaluate a new strategy, combining a clinical risk score and
N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients
presenting to the emergency department with chest pain, without ischemic
electrocardiogram changes or troponin elevation. Methods: A total of 320
patients were randomized to either usual management, involving exercise
testing, or a new strategy combining a clinical risk score and NT-proBNP
without exercise testing. In the usual management, discharge decision was
guided by the result of exercise test. In the new strategy, those patients
with low clinical risk score and NT-proBNP were directly discharged. The
primary outcome was hospitalization at the index episode. Secondary
outcomes were cardiac events at 1 year. Results: A total of 110 patients
(69%) were hospitalized using usual management in comparison with 90 (56%)
in the new strategy (P = .03). There were no differences in death or
myocardial infarction (n = 11, 6.9% vs n = 6, 3.8%, P = .3) or cardiac
events (n = 38, 24% vs n = 28, 18%, P = .2). Revascularizations at the
index episode were more frequent under usual management (18% vs 8%, P =
.01), although the new strategy was associated with higher rate of planned
postdischarge revascularizations (0.6% vs 5%, P = .04). Conclusions: A
strategy combining clinical history and NT-proBNP is simpler and reduced
initial emergency hospitalizations in patients with chest pain, in
comparison with the usual strategy involving exercise testing. Larger
studies to assess its impact on long-term hard end points are needed.
(ClinicalTrials.gov NCT00493844). copyright 2010 Mosby, Inc. All rights
reserved.

<16>
[Use Link to view the full text]
Accession Number
2010044455
Authors
Plantinga Y. Dogan S. Grobbee D.E. Bots M.L.
Institution
(Plantinga, Dogan, Grobbee, Bots) Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Stratenum 6.131,
Heidelberglaan 100, Utrecht 3584 CX, Netherlands.
Title
Carotid intima-media thickness measurement in cardiovascular screening
programmes.
Source
European Journal of Cardiovascular Prevention and Rehabilitation.
16(6)(pp 639-644), 2009. Date of Publication: December 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Support for the notion that a carotid intima-media thickness (CIMT)
measurement is useful in individual cardiovascular risk prediction in
addition to a risk function may come from studies showing that for an
individual a high or low CIMT measurement leads to a correct shift from
one to another risk category and this shift is followed by different
treatment consequences. We set out to systematically review the published
evidence by performing a PubMed search (2 March 2009). Out of 50
publications on CIMT and future events, 31 reported on the relation in the
correct domain, [i.e. those free from symptomatic vascular disease or
diabetes mellitus in which assessment of risk using a risk function (e.g.
Framingham or SCORE) to base initiation of drug treatment upon is
recommended]. Most studies reported relative risks (or equivalents) for
the entire population only, and no information on relative risks within
certain risk categories that may be of use to reclassify individuals based
on combination of absolute and relative risks. No data on potential shifts
of participants was presented. Eight studies specifically focused on the
added value of CIMT in risk prediction. In seven studies the area under
the curve (AUC) of a receiver operating characteristic was used to assess
improvements in risk prediction. These analyses showed that addition of a
CIMT measurement to established risk factors led to small and sometimes
significant improvements in the AUC. However, change in AUC should not be
the only parameter to rely on to judge the appropriateness of CIMT in risk
stratification. In one study (n = 242), evidence was presented in
participants with an intermediate Framingham risk score, a CIMT
measurement above the 60th (men) and 80th (women) percentile of
age-specific normal CIMT values, shifted participants above the threshold
for initiation of drug therapy. Yet, the study was based on 24 events, and
no information was presented on the proportion of participants correctly
shifted. At present it seems that the published evidence to quantitatively
support the use of a CIMT measurement to help in risk stratification on
top of a risk function is limited. copyright 2009 The European Society of
Cardiology.

<17>
[Use Link to view the full text]
Accession Number
2010044446
Authors
Kapur A. Bartolini D. Finlay M.C. Qureshi A.C. Flather M. Strange J.W.
Hall R.J.
Institution
(Kapur, Finlay, Qureshi) Barts and the London NHS Trust, London, United
Kingdom.
(Bartolini) University of Genoa, Genoa, Italy.
(Flather) Royal Brompton and Harefield NHS Trust, London, United Kingdom.
(Strange) Bristol Heart Institute, University Hospitals Bristol, NHS
Foundation Trust, Bristol, United Kingdom.
(Hall) Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Title
The bypass angioplasty revascularization in type 1 and type 2 diabetes
study: 5-year follow-up of revascularization with percutaneous coronary
intervention versus coronary artery bypass grafting in diabetic patients
with multivessel disease.
Source
Journal of Cardiovascular Medicine. 11(1)(pp 26-33), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: The aim of the Bypass Angioplasty Revascularization in Type 1
and Type 2 Diabetes study was to assess percutaneous coronary intervention
(PCI) and coronary artery bypass grafting (CABG) as treatments for
multivessel coronary artery disease in diabetic patients. Background: CABG
is generally regarded as the treatment of choice for multivessel coronary
artery disease in diabetes. PCI is an alternative therapy. The Bypass
Angioplasty Revascularization in Type 1 and 2 Diabetes study compared
long-term outcomes of CABG with PCI in diabetic patients treated during
the bare-metal stent era.Methods: We collected data prospectively on
consecutive diabetic patients undergoing index angiography in a single
tertiary centre from January 1998 to December 2001. Multivessel coronary
artery disease was defined as more than 50% luminal stenosis in two or
more vessels. Exclusion criteria included left main stem disease and
previous revascularization. Results: Two hundred and thirty-five eligible
patients underwent CABG and 237 PCI. Median follow-up was 5.4 years. There
were 46 (19%) deaths in the CABG group and 43 (18%) deaths in the PCI
group (P = 0.64). Cox regression analysis revealed baseline glomerular
filtration rate (hazard ratio 0.979, P = 0.001), age (hazard ratio 1.034,
P = 0.033), urgent procedure (hazard ratio 1.97, P = 0.008) and myocardial
infarction within 4 weeks (hazard ratio 2.494, P = 0.041) to be important
predictors of outcome. At 5 years, there was no mortality difference
(hazard ratio 1.0) following adjustment for baseline characteristics, and
the Kaplan-Meier survival curves were similar. A subanalysis of patients
with three-vessel disease revealed similar outcomes with both PCI and
CABG. Conclusion: In the Bypass Angioplasty Revascularization in Type 1
and Type 2 Diabetes study, diabetic patients with multivessel coronary
artery disease had similar long-term mortality whether treated with CABG
or PCI, the revascularization determined by the physician's choice. This
was despite the frequent use of a strategy of selective revascularization
in the PCI arm. Randomized trials comparing PCI and CABG specifically in
diabetes, that is, Coronary Artery Revascularization in Diabetes and
Future Revascularization Evaluation in Diabetes Mellitus: Optimal
Management, will show whether drug-eluting stents further enhance PCI
outcomes over the long term. copyright 2010 Italian Federation of
Cardiology.

<18>
Accession Number
2010037431
Authors
Gunaydin S. McCusker K. Vijay V.
Institution
(Gunaydin) Department of Cardiovascular Surgery, University of Kirikkale,
Kirikkale, Turkey.
(McCusker) Portsmouth Regional Hospital, Portsmouth, NH, United States.
(Vijay) State University of New York, Brooklyn, NY, United States.
(Gunaydin) Department of CV Surgery, University of K. Kale, Angora Evleri
G-8 Bl. No: 1, Beysukent-Ankara 06800, Turkey.
Title
Clinical and biomaterial evaluation of a new condensed dual-function
extracorporeal circuit in reoperation for coronary artery bypass surgery.
Source
International Journal of Artificial Organs. 32(11)(pp 802-810), 2009.
Date of Publication: 2009.
Publisher
Wichtig Editore s.r.l.
Abstract
Purpose: This prospective, randomized study compared the clinical
performance of three types of circuits: a newly introduced, fully-coated,
interchangeable open-closed circuit with a dual configuration (hard shell
with a bypass shunt), reduced length, and reduced prime of less than 800
cc (CondECC); a completely coated circuit (ECC); and a similar uncoated,
open circuit with standard length and prime (CONT). Methods: 75 patients
undergoing reoperation for coronary revascularization were randomly
allocated into three groups (n=25): Group 1: CondECC with shortened
tubing, components and an open-closed configuration of low priming volume
with a centrifugal pump and a shunt which bypassed the reservoir for
closed configuration; Group 2: ECC with a roller pump and hard-shell
reservoir; Group 3: CONT. Blood samples for CBC, inflammatory mediators
[interleukin-2 (IL-2), complement-3a (C3a)] and flow cytometry
(CD11b/CD18) were collected after induction (T1) and heparin
administration (T2), 15 min after cardiopulmonary bypass (CPB) (T3),
before cessation of CPB (T4), 15 min after reversal (T5), and the first
postoperative day (T6). Results: Leukocyte counts demonstrated significant
increases at T4, T5 in CONT but remained stable in ECC and CondECC
(p<0.05). Platelets were preserved better at T4, T5 in both ECC and
CondECC study groups (p<0.05). IL-2 and C3a levels were significantly
lower at T3, T4, T5 in CondECC and T4, T5 in ECC (p<0.05). Blood protein
adsorption analysis demonstrated increased amount of microalbumin on CONT
fibers (p<0.05). Conclusions: The CondECC is a flexible, dual-function,
open/closed configuration system that was easy to use, safe and achieved
better biocompatibility when compared to coated and uncoated conventional
circuits. copyright Wichtig Editore, 2009.

<19>
Accession Number
2010007777
Authors
Khoynezhad A. Celis R. Hashemzadeh M. Movahed M.R. Jalali Z.
Institution
(Khoynezhad) Creighton University Medical Center, Division of
Cardiothoracic and Vascular Surgery, 601 N 30th Street, Omaha, NE 68131,
United States.
(Celis, Hashemzadeh, Movahed) University of Arizona, Sarver Heart Center,
1501 N. Campbell Ave., Tucson, AZ 85724, United States.
(Jalali) University of Nebraska Medical Center, Department of Internal
Medicine, 804 S. 52nd Street, Omaha, NE 68106, United States.
Title
Current status of thoracic endografting and its adjunctive pharmacology.
Source
Expert Opinion on Pharmacotherapy. 10(17)(pp 2871-2881), 2009. Date of
Publication: December 2009.
Publisher
Informa Healthcare
Abstract
Background: Thoracic endovascular aortic repair is a promising treatment
modality. The advantages in the short term include shorter hospital stay,
avoidance of lengthy invasive procedures, and decreased anesthesia time.
It has made possible the treatment of elderly patients with coexisting
comorbidities who otherwise would be difficult candidates for open
surgery. Objective: Although the technical aspects of thoracic
endovascular procedures have been described in the literature, the adjunct
pharmacology has not been discussed. The aim of this study is therefore to
review the clinical pharmacology necessary for procedural details in
repair of patients with aortic aneurysms and aortic dissection. Methods: A
literature search was performed using PUBMED by combining relevant Medical
Subject Heading key words. The query was subsequently limited to English
language, and involving "human". The articles were assessed for their
validity, importance, and applicability. The publications were analyzed
and clinically important data were collected and incorporated.
Results/conclusion: Thoracic endovascular aortic repair is a complex
procedure on a morbid cohort of patients with aortic pathologies. The
pharmacotherapy is a crucial component of the procedure: It is aimed at
facilitating the endovascular procedure and improving outcomes. copyright
2009 Informa UK Ltd.