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<1>
Accession Number
2010123354
Authors
Berkan O. Katrancioglu N. Ozker E. Ozerdem G. Bakici Z. Yilmaz M.B.
Institution
(Berkan, Katrancioglu) Department of Cardiovascular Surgery, Cumhuriyet
University, School of Medicine, 58140 Sivas, Turkey.
(Ozker) Department of Cardiovascular Surgery, Ordu State Hospital, Ordu,
Turkey.
(Ozerdem) Department of Cardiovascular Surgery, Cag Hospital, Ankara,
Turkey.
(Bakici) Department of Microbiology and Clinical Microbiology, Cumhuriyet
University, School of Medicine, Sivas, Turkey.
(Yilmaz) Department of Cardiology, Cumhuriyet University, School of
Medicine, Sivas, Turkey.
Title
Reduced P-selectin in hearts pretreated with fluvastatin: A novel benefit
for patients undergoing open heart surgery.
Source
Thoracic and Cardiovascular Surgeon. 57(2)(pp 91-95), 2009. Date of
Publication: 2009.
Publisher
Georg Thieme Verlag
Abstract
Objective: P-selectin is an adhesion molecule that plays a role in the
pathogenesis of atherosclerosis. The aim of this study was to assess
whether or not the treatment with fluvastatin for 3 weeks preoperatively
would reduce the levels of circulating P-selectin in patients with
coronary heart disease undergoing coronary artery bypass grafting surgery
(CABG). Materials and Methods: Forty-six patients referred to CABG
operation were included in the study. The patients were randomized into
two groups (1:1): one treated with fluvastatin (80 mg/day, fluvastatin
group, n = 23), and the other one treated with placebo (placebo group, n =
23) for three weeks before surgery. All patients underwent CABG using CPB.
Blood samples were collected at baseline (the day before surgery), before
and after aortic cross-clamping (ACC), at postoperative 0 h (the end of
surgical intervention), and at 4, 12, and 24 hours postoperatively.
Concentrations of soluble P-selectin (sP-selectin) were analyzed. Results:
The sP-selectin values measured in the fluvastatin group were
significantly lower than the values measured in the placebo group. There
was less use of intraoperative inotropic agents in the fluvastatin group
(p < 0.015) and the difference in the length of ICU and hospital stay
showed a significantly shorter stay for the fluvastatin group.
Conclusions: Pretreatment with fluvastatin seemed to reduce P-selectin
levels compared to patients given placebo, and hence, we think that
pretreatment with a statin, fluvastatin in our study, might reduce the
perioperative cardiac injury caused by cardiopulmonary bypass-induced
inflammatory changes. We believe that routine preoperative use of
fluvastatin should be carefully considered. copyright Georg Thieme Verlag
KG Stuttgart New York.
<2>
Accession Number
2010101247
Authors
Calcaterra D. Ricci M. Lombardi P. Katariya K. Panos A. Salerno T.A.
Institution
(Calcaterra) Department of Cardiothoracic Surgery, University of Iowa
Carver College of Medicine, Iowa City, IA, United States.
(Ricci, Lombardi, Katariya, Panos, Salerno) Division of Cardiothoracic
Surgery, Jackson Memorial Hospital, Miami, FL, United States.
(Ricci, Lombardi, Katariya, Panos, Salerno) University of Miami Miller
School of Medicine, Miami, FL, United States.
Title
Reduction of postoperative hypothermia with a new warming device: A
prospective randomized study in off-pump coronary artery surgery.
Source
Journal of Cardiovascular Surgery. 50(6)(pp 813-817), 2009. Date of
Publication: December 2009.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Hypothermia has been used for decades in cardiac surgery to limit the
ischemic insult to the heart. With the diffusion of off-pump coronary
artery surgery, the practice of arresting and cooling the heart has been
abandoned. At University of Miami Miller School of Medicine, we tested a
new warming device by performing a prospective study in which 50 patients
were randomized to either the use of the Kimberly-Clark warming system or
to standard methods of control of body temperature. The two groups were
compared in terms of core body temperature (CBT), intra- and postoperative
blood loss, blood products transfusions, extubation time, intensive care
unit (ICU) and hospital length of stay and incidence of infections. Five
patients in the control group and 0 patients in the study group dropped
their CBT below 35degreesC during the operation (P<0.01). Total blood
loss, measured in terms of cell-saver and chest tube drainage, was 27 %
and 14 % less for the study group (P<0.01). Hospital length of stay was
1.2 day less in the study group (P<0.01). The Kimberly-Clark Patient
Warming System allowed for better control of core body temperature during
off pump coronary artery bypass surgery compared to traditional
techniques. This translated in less intra and postoperative blood loss and
shorter hospital length of stay. Other advantages, such as decreased
blood-products transfusions, decreased incidence of infections, decreased
ICU length of stay and overall reduction of costs might be evident on
larger study groups.
<3>
Accession Number
2010100374
Authors
Orman J. Westerdahl E.
Institution
(Orman) Department of Intensive Care, Linkoping University Hospital,
SE-581 85 Linkoping, Sweden.
(Westerdahl) Department of Medical Sciences, Clinical Physiology, Uppsala
University Hospital, Uppsala, Sweden.
(Westerdahl) Department of Physiotherapy and Centre for Health Care
Sciences, Orebro University Hospital, Orebro, Sweden.
Title
Chest physiotherapy with positive expiratory pressure breathing after
abdominal and thoracic surgery: A systematic review: Review Article.
Source
Acta Anaesthesiologica Scandinavica. 54(3)(pp 261-267), 2010. Date of
Publication: March 2010.
Publisher
Blackwell Munksgaard
Abstract
A variety of chest physiotherapy techniques are used following abdominal
and thoracic surgery to prevent or reduce post-operative complications.
Breathing techniques with a positive expiratory pressure (PEP) are used to
increase airway pressure and improve pulmonary function. No systematic
review of the effects of PEP in surgery patients has been performed
previously. The purpose of this systematic review was to determine the
effect of PEP breathing after an open upper abdominal or thoracic surgery.
A literature search of randomised-controlled trials (RCT) was performed in
five databases. The trials included were systematically reviewed by two
independent observers and critically assessed for methodological quality.
We selected six RCT evaluating the PEP technique performed with a
mechanical device in spontaneously breathing adult patients after
abdominal or thoracic surgery via thoracotomy. The methodological quality
score varied between 4 and 6 on the Physiotherapy Evidence Database score.
The studies were published between 1979 and 1993. Only one of the included
trials showed any positive effects of PEP compared to other breathing
techniques. Today, there is scarce scientific evidence that PEP treatment
is better than other physiotherapy breathing techniques in patients
undergoing abdominal or thoracic surgery. There is a lack of studies
investigating the effect of PEP over placebo or no physiotherapy
treatment. copyright 2009 The Acta Anaesthesiologica Scandinavica
Foundation.
<4>
Accession Number
2010095444
Authors
Rogovik A.L. Vohra S. Goldman R.D.
Institution
(Rogovik) Pediatric Research in Emergency Therapeutics (PRETx) Program,
Toronto, ON, Canada.
(Rogovik) Clinical Nutrition and Risk Factor Modification Center, St.
Michael's Hospital, Toronto, ON, Canada.
(Vohra) Complementary and Alternative Research and Education (CARE)
Program, Department of Pediatrics, Stollery Children's Hospital, Edmonton,
AB, Canada.
(Vohra) Faculty of Medicine and Dentistry, School of Public Health,
University of Alberta, Edmonton, AB, Canada.
(Goldman) Pediatric Research in Emergency Therapeutics (PRETx) Program,
Vancouver, BC, Canada.
(Goldman) Division of Pediatric Emergency Medicine, BC Children's
Hospital, Ambulatory Care Building, 4480 Oak St., Vancouver, BC V6H3V4,
Canada.
(Goldman) Department of Pediatrics, University of British Columbia,
Vancouver, BC, Canada.
(Goldman) Child and Family Research Institute (CFRI), Vancouver, BC,
Canada.
Title
Safety considerations and potential interactions of vitamins: Should
vitamins be considered drugs?.
Source
Annals of Pharmacotherapy. 44(2)(pp 311-324), 2010. Date of Publication:
February 2010.
Publisher
Harvey Whitney Books Company
Abstract
OBJECTIVE: To examine adverse effects, adverse events, and potential
interactions of vitamins in light of their current prevalence of use, and
to discuss whether vitamins should be considered over-the-counter drugs or
natural health products/dietary supplements. DATA SOURCES : We performed a
MEDLINE/PubMed search, explored 4 online databases (Medline Plus, Drug
Digest, Natural Medicine Comprehensive Database, and the database of the
University of Maryland), and examined reference lists of included studies
published from 1966 through October 2009. STUDY SELECTION AND DATA
EXTRACTION: The studies were reviewed, with an emphasis on randomized
controlled clinical trials. We included articles with the most clinically
important information with regard to adverse events and interactions. DATA
SYNTHESIS: Vitamins are used by over one third of the North American
population. Vitamins have documented adverse effects and toxicities, and
most have documented interactions with drugs. While some vitamins (biotin,
pantothenic acid, riboflavin, thiamine, vitamin B12, vitamin K) have minor
and reversible adverse effects, others, such as fat-soluble vitamins (A,
E, D), can cause serious adverse events. Two water-soluble vitamins, folic
acid and niacin, can also have significant toxicities and adverse events.
CONCLUSIONS: Our recommendation is that vitamins A, E, D, folic acid, and
niacin should be categorized as over-the-counter medications. Labeling of
vitamins, especially those intended for children and other vulnerable
groups, should include information on possible toxicities, dosing,
recommended upper intake limits, and concurrent use with other products.
Vitamin A should be excluded from multivitamin supplements and food
fortificants.
<5>
Accession Number
2010117498
Authors
Ranasinghe A.M. Bonser R.S.
Institution
(Ranasinghe, Bonser) University of Birmingham, Cardiovascular Medicine,
School of Clinical and Experimental Medicine, Birmingham, B15 2TT, United
Kingdom.
(Ranasinghe, Bonser) UHB NHS FT, Department of Cardiothoracic Surgery,
Edgbaston, Birmingham, B15 2TH, United Kingdom.
Title
Thyroid hormone in cardiac surgery.
Source
Vascular Pharmacology. 52(3-4)(pp 131-137), 2010. Date of Publication:
March 2010/April 2010.
Publisher
Elsevier Inc.
Abstract
Thyroid hormone has a wide range of cardiovascular effects which are
mediated at both genomic and non-genomic levels. As a stress response to
surgery, the non-thyroidal illness syndrome or euthyroid sick syndrome
occurs in the post-operative period following cardiac surgery. There
remains debate about the potential benefits of the treatment of the
non-thyroidal illness syndrome in this setting with acute thyroid hormone
supplementation. This review article sets out to discuss the potential
benefits of thyroid hormone supplementation and the results from trials
relating to both adult and paediatric cardiac surgical population as well
as in the setting of brain stem death to optimise the potential cardiac
donor. copyright 2009.
<6>
Accession Number
2010151484
Authors
Zhang Z.-J. Cheng Q. Jiang G.-X. Marroquin O.C.
Institution
(Zhang, Cheng, Jiang) Department of Epidemiology, School of Public Health,
Shanghai Jiao Tong University, Shanghai, China.
(Jiang) Department of Public Health Sciences, Karolinska Institute,
Stockholm, Sweden.
(Marroquin) Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, United States.
(Marroquin) Division of Cardiology, University of Pittsburgh, Pittsburgh,
PA, United States.
Title
Statins in prevention of repeat revascularization after percutaneous
coronary intervention-A meta-analysis of randomized clinical trials.
Source
Pharmacological Research. 61(4)(pp 316-320), 2010. Date of Publication:
April 2010.
Publisher
Academic Press
Abstract
Recent prospective cohort studies have shown that patients discharged on
statins after percutaneous coronary intervention (PCI) are at lower risks
of repeat revascularization and mortality when compared to those not on
statins after discharge. However, few randomized clinical trials among
post-PCI patients confirmed these beneficial effects. It is needed to
evaluate the effects of post-procedural statin therapy on individual
clinical outcomes to facilitate the further investigation on identifying
the underlying mechanism(s). A meta-analysis of randomized clinical trials
was conducted to examine the effects of statin therapy initiated after
coronary angioplasty on repeat revascularization, all-cause mortality and
myocardial infarction (MI). From relevant reports on Medline (from
inception to October 2009), six randomized clinical trials comprising 2979
patients were included. Relative risks were evaluated for pooled data via
random effect models. Compared with controls, post-PCI statin therapy was
associated with a significantly decreased risk of repeat revascularization
(risk ratio (RR) = 0.73, 95% confidence interval (CI), 0.55-0.98, p =
0.04), nonsignificantly decreased risks of all-cause mortality (RR = 0.88,
95% CI, 0.35-2.21, p = 0.79), MI (RR = 0.76, 95% CI, 0.49-1.18, p = 0.23),
and target lesion or target vessel revascularization (RR = 0.58, 95% CI,
0.24-1.39, p = 0.22). In conclusion, statin therapy after PCI can reduce
the risk of repeat revascularization. Further investigation is needed to
identify the underlying mechanism(s). copyright 2009 Elsevier Ltd. All
rights reserved.
<7>
Accession Number
2010103113
Authors
Saritas A. Kervan U. Vural K.M. Kucuker S.A. Yavas S. Birincioglu L.C.
Institution
(Saritas, Kervan, Vural, Kucuker, Yavas, Birincioglu) Cardiovascular
Surgery Department, Yuksek Ihtisas Hospital of Turkey, Ankara, Turkey.
Title
Visceral protection during moderately hypothermic selective antegrade
cerebral perfusion through right brachial artery.
Source
European Journal of Cardio-thoracic Surgery. 37(3)(pp 669-676), 2010.
Date of Publication: March 2010.
Publisher
Elsevier
Abstract
Objective: This study investigates distal organ protection during
moderately hypothermic right brachial artery selective antegrade cerebral
perfusion (MHSACP) in patients undergoing aortic arch repair. Methods:
Fifty patients undergoing ascending aorta/aortic arch repair using the
MHSACP technique (study group) were compared with another 50 patients
randomly selected amongst those undergoing moderately hypothermic open
heart procedures (control group). The data from successive clinical
examinations and blood samplings were then compared to detect any sign of
distal organ damage attributable to the MHSACP technique. Results: The
mortality rate did not differ between the two groups (2%). The average
cardiopulmonary bypass and aortic cross-clamping durations were 154 +/- 53
min versus 102 +/- 25 min and 101 +/- 41 min versus 70 +/- 31 min for the
study and control groups, respectively. The mean MHSACP period was 32 +/-
14 min (11-81 min) in the study group. The average discharge time was 6.4
+/- 1.4 days (5-12 days). Repeated clinical examinations revealed no organ
dysfunction and there was no difference between the two groups (with the
exception of lactate dehydrogenase) with regard to compared biochemical
markers, which might be suggestive of a visceral damaging effect of the
MHSACP technique. Conclusions: The present data show that with the use of
MHSACP, distal organs are relatively well protected during aortic arch
repairs. copyright 2009.
<8>
Accession Number
2010103098
Authors
Schindler E. Photiadis J. Lagudka S. Fink C. Hraska V. Asfour B.
Institution
(Schindler, Lagudka) Department of Pediatric Cardiac Anesthesiology,
Congenital Cardiac Center, Asklepios Klinik Sankt Augustin, Sankt
Augustin, Germany.
(Photiadis, Hraska, Asfour) Department of Pediatric Cardio-Thoracic
Surgery, Congenital Cardiac Center, Asklepios Klinik Sankt Augustin, Sankt
Augustin, Germany.
(Fink) Pediatric Critical Care Medicine, Congenital Cardiac Center,
Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany.
Title
Influence of two perfusion strategies on oxygen metabolism in paediatric
cardiac surgery. Evaluation of the high-flow, low-resistance technique.
Source
European Journal of Cardio-thoracic Surgery. 37(3)(pp 651-657), 2010.
Date of Publication: March 2010.
Publisher
Elsevier
Abstract
Objective: Paediatric cardiac surgery is often performed under hypothermic
conditions, that is, with a reduced core body temperature. Certain
interventions even require the circulation to be stopped. This can only be
done at a body temperature of 18 degreesC, with no risk of neurological
damage and harm to the brain and other organs. Vasoconstriction is a
natural reaction of the body to cold, causing the blood vessels to
contract. Such a reaction would lead to a clear rise in blood pressure on
cardiopulmonary bypass (CPB). Since the blood pressure is regulated in the
arteriolar loop of the capillary system, there is a marked increase in
blood pressure and a suppression of free water into the surrounding
tissue, which, in turn, may lead to the intra-operative development of
oedemas. This study aimed to investigate whether the high-flow,
low-resistance (HFLR) technique offers any benefits over conventional
methods. Method: This open, prospective, randomised study was to recruit
48 children scheduled to undergo surgery for congenital heart disease. To
investigate the two different perfusion strategies, we have measured
intestinal perfusion as well as skin perfusion with laser Doppler
spectroscopy. To identify the effects on the immune system, selected
immunologic parameters of systemic inflammation were additionally
measured. Laser Doppler spectroscopy is a method that uses a glass fibre
probe to determine the parameters of oxygen saturation of haemoglobin and
relative haemoglobin quantity in an illuminated tissue volume, as well as
the perfusion parameters of relative blood flow and blood flow velocity in
the sample volume of the probe. Results: During the study period, the
change in oxygen saturation over time was comparable in both groups. At
the end of surgery, the patients of the high-flow group had significantly
higher saturation levels in the intestinal mucosa (p < 0.05). Over the
course of intensive care, the groups did not differ in terms of fluid
supply, administration of packed red blood cells, platelet concentrates or
fresh frozen plasma. Analysis of urinary output revealed significant group
differences. It was higher in the patients of the high-flow group than the
normal-flow group (p < 0.03), without differences in diuretic
administration. Conclusion: Laser Doppler spectroscopy is highly suited to
the detection even of the slightest changes in flow characteristics and
oxygenation of the skin, musculature and intestinal mucosa during surgery
with extracorporeal circulation using CPB. At the same time, the technique
of HFLR perfusion was found to have benefits over conventional bypass
methods. copyright 2009 European Association for Cardio-Thoracic Surgery.
<9>
Accession Number
2010103090
Authors
Fiorelli A. Vicidomini G. Laperuta P. Busiello L. Perrone A. Napolitano F.
Messina G. Santini M.
Institution
(Fiorelli, Vicidomini, Laperuta, Busiello, Perrone, Napolitano, Messina,
Santini) Thoracic Surgery Unit, Second University of Naples, Naples,
Italy.
Title
Pre-emptive local analgesia in video-assisted thoracic surgery
sympathectomy.
Source
European Journal of Cardio-thoracic Surgery. 37(3)(pp 588-593), 2010.
Date of Publication: March 2010.
Publisher
Elsevier
Abstract
Objective: Our goal is to determine whether infiltration with a
short-acting local anaesthetic such as lidocaine before the surgical
incision has a pre-emptive effect on postoperative pain intensity and on
incidence of paraesthesia in patients undergoing standard thoracoscopic
sympathectomy for palmar hyperhidrosis. Material and methods: This
prospective study includes a consecutive series of 18 patients undergoing
bilateral standard thoracoscopic sympathectomy for palmar hyperhidrosis
during January 2005-December 2007. Each patient enrolled in the study was
randomised to receive pre-incisional lidocaine with epinephrine
infiltration of the wounds on the one side, and normal saline solution on
the other. The identical surgery was performed on each side to allow
patients to act as their own controls. Then, the side which received local
analgesia was compared with the control side with regard to pain control
and paraesthesia after 4, 24 and 168 h postoperatively. The patients and
investigators were both blinded concerning the side randomised to receive
pre-emptive local analgesia (PLA). Results: We found that patients
reported significantly less pain on the side treated with pre-emptive
local anaesthesia in contrast to the control side 4 and 24 h after surgery
(p = 0.001 and p = 0.004, respectively). However, that difference
decreased with time and was no longer significant 168 h following surgery
(p = 0.156). Regarding the paraesthesia, the incidence was higher in the
control side than the PLA side at 4, 24 and 168 h postoperatively, but the
difference was not statistically significant. A total of 17 of 18 (94%)
patients noted a change in palmar hyperhidrosis status after surgery.
Conclusion: Our study shows that the pre-injection of local anaesthetic
before standard thoracoscopic sympathectomy suppresses the local pain
mediators, hence resulting in significantly less pain in the first
postoperative 24 h but not thereafter. The clinical impact of the
procedure is the possibility of early discharge to home and early return
to work with potential economical benefits. However, because of the small
number of patients, further studies are needed to corroborate our results.
copyright 2009.
<10>
Accession Number
2010103087
Authors
Balci A.E. Ozyurtkan M.O.
Institution
(Balci, Ozyurtkan) Euphrates University Hospital, Thoracic Surgery
Department, 23119 Elazig, Turkey.
Title
Clinical and surgical specifications of adult unilateral diaphragmatic
eventration according to their aetiology in 28 patients. Importance of
using diaphragmatic patch and minimal thoracotomy incision.
Source
European Journal of Cardio-thoracic Surgery. 37(3)(pp 606-612), 2010.
Date of Publication: March 2010.
Publisher
Elsevier
Abstract
Objective: This study aims to determine the differences among various
diaphragmatic eventration (DE) aetiologies and to compare the outcomes of
the operation relative to the use of a diaphragmatic patch. Methods:
Between 2003 and 2009, 28 patients with a DE who underwent surgery were
classified according to the following aetiology: (a) previous operation or
disease, (b) congenital/idiopathic and (c) trauma. Patients who received
diaphragmatic patches during their operations (plication + patch, P/P, 19
cases) were compared with the patients receiving sole plication during the
operation (P, 9 cases). The operations had been performed through a
minimal length lateral thoracotomy incision (12-14 cm). Results: The mean
age of the patients was 53.3 +/- 9.8 years. A high hemi-diaphragm (alone
or associated with a blunt sinus or a wide mediastinum) was the most
prominent chest X-ray (CXR) finding in 19 patients (68%). The
postoperative mean forced expiratory volume in 1 s (FEV1) value (2.1 +/-
0.7) and the dyspnoea score (1.8 +/- 0.7) were better than the
preoperative values (1.7 +/- 0.6; 3.4 +/- 0.9, respectively). The average
height of the diaphragm (7.8 +/- 3.1 cm) was not correlated with the
dyspnoea score and the FEV1 value. Postoperative complications (4/28 or
14.3%) were minimal, excluding one respiratory insufficiency. The mean
follow-up time was 23.4 +/- 17.8 months. Patients with congenital
aetiology were younger, had higher diaphragms, had earlier operations
after symptoms started and had better preoperative FEV1 values. P/P
operations were done later than P operations. The P/P method patients had
shorter postoperative hospital stays than the P method patients. Two
diaphragmatic events (recurrence and herniation) occurred after the
operations were performed with the P method. Conclusions: Buttressing the
diaphragm by patch after the plication can protect from recurrence of a DE
or any diaphragmatic insufficiency. Previous abdominal interventions may
increase the complication rate after a DE operation. copyright 2009
European Association for Cardio-Thoracic Surgery.
<11>
Accession Number
0020031818
Authors
Garcia S. Moritz T.E. Goldman S. Littooy F. Pierpont G. Larsen G.C. Reda
D.J. Ward H.B. McFalls E.O.
Institution
(Garcia, Moritz, Goldman, Littooy, Pierpont, Larsen, Reda, Ward, McFalls)
Division of Cardiology, Minneapolis VA Medical Center and the University
of Minnesota, Minneapolis, Minn., USA.
Title
Perioperative complications after vascular surgery are predicted by the
revised cardiac risk index but are not reduced in high-risk subsets with
preoperative revascularization..
Source
Circulation. Cardiovascular quality and outcomes. 2(2)(pp 73-77), 2009.
Date of Publication: Mar 2009.
Abstract
BACKGROUND: The Revised Cardiac Risk Index (RCRI) is useful for risk
stratifying patients before noncardiac operations. Among patients with
documented coronary artery disease who undergo vascular surgery, it is
unclear whether preoperative revascularization reduces postoperative
cardiac complications in high-risk subsets defined by the RCRI. METHODS
AND RESULTS: The Coronary Artery Revascularization Prophylaxis Trial was a
randomized, controlled trial that tested the long-term benefit of a
preoperative coronary artery revascularization before elective vascular
surgery. Using preoperative baseline characteristics to determine the
RCRI, we tested the benefit of preoperative revascularization on death and
nonfatal myocardial infarction in patients with multiple risks. Among 462
patients undergoing vascular surgery, there were 72 complications (15.6%)
within 30 days postsurgery, including 15 deaths (3.2%) and 57 nonfatal
myocardial infarctions (12.3%). The postoperative risk of death and
nonfatal myocardial infarction after surgery increased according to the
RCRI (odds ratio, 1.73; 95% CI, 1.26 to 2.38; P<0.001), with a rate of
1.6% in patients with no risk that increased to 23.4% in patients with >
or =3 risks. Preoperative revascularization had no influence on the
incidence of complications in any risk subset (odds ratio, 0.86; 95% CI,
0.50 to 1.49; P=0.60). Among those individuals with > or =2 risks who also
demonstrated ischemia on a preoperative stress-imaging test (N=146), the
incidence of events was 23% in patients with and without preoperative
revascularization (P=0.95). CONCLUSIONS: The risk of death and nonfatal
myocardial infarction is accurately predicted by the RCRI in patients
undergoing vascular surgery but is not reduced in any high-risk subset of
the RCRI with preoperative coronary artery revascularization.
<12>
Accession Number
2010165307
Authors
Welsh R.C. Granger C.B. Westerhout C.M. Blankenship J.C. Holmes Jr. D.R.
O'Neill W.W. Hamm C.W. Van de Werf F. Armstrong P.W.
Institution
(Welsh, Westerhout, Armstrong) University of Alberta, Edmonton, Alta.,
Canada.
(Granger) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States.
(Blankenship) Geisinger Medical Center, Danville, PA, United States.
(Holmes Jr.) Mayo Clinic, Rochester, MN, United States.
(O'Neill) University of Miami, Miami, FL, United States.
(Hamm) Kerckhoff Heart Centre, Bad Nauheim, Germany.
(Van de Werf) Department of Cardiology, University Hospital Gasthuisberg,
Leuven Coordinating Center, Leuven, Belgium.
Title
Prior Coronary Artery Bypass Graft Patients With ST-Segment Elevation
Myocardial Infarction Treated With Primary Percutaneous Coronary
Intervention.
Source
JACC: Cardiovascular Interventions. 3(3)(pp 343-351), 2010. Date of
Publication: March 2010.
Publisher
Elsevier Inc.
Abstract
Objectives: We sought to compare outcomes in ST-segment elevation
myocardial infarction (STEMI) patients undergoing primary percutaneous
coronary intervention (PCI) with or without previous coronary artery
bypass grafts (CABG). Background: Limited information exists regarding
procedural success and clinical outcomes of STEMI patients with CABG
undergoing primary PCI. Methods: The APEX-AMI (Assessment of Pexelizumab
in Acute Myocardial Infarction) trial was a randomized, placebo-controlled
trial of pexelizumab in STEMI patients with planned primary PCI: 128 of
5,745 (2.2%) patients had prior CABG. Clinical/procedural characteristics,
culprit vessel (infarct-related artery [IRA]), and 90-day clinical
outcomes were compared. Results: Patients with previous CABG were more
frequently men, older, had a higher incidence of comorbidities and
multivessel disease. In patients with versus without prior CABG, PCI was
performed less frequently, that is, 78.9% versus 93.9%; of those with
prior CABG receiving PCI, Thrombolysis In Myocardial Infarction (TIMI)
flow grade 3 was also restored less often, that is, 82.5% versus 91.6%
(both p < 0.001). In prior CABG, there was a nearly even designation of
the IRA as a bypass graft (n = 63) versus a native vessel (n = 55): IRA
post-PCI TIMI flow grade 3 was achieved in 66.7% versus 88.0%,
respectively (p = 0.043). Prior CABG patients had increased 90-day death
and composite 90-day death/congestive heart failure/shock. Excess death
remained significant after multivariable adjustment (hazard ratio: 1.9,
95% confidence interval: 1.08 to 3.33, p = 0.025). When prior CABG
patients were stratified by the type of IRA, there was further
discrimination of the increased 90-day death, that is, 19% bypass graft (n
= 63) versus 5.7% native vessel (n = 55, p = 0.05), respectively.
Conclusions: Prior CABG patients with STEMI are less likely to undergo
acute reperfusion, have worse angiographic outcomes following primary PCI,
and higher 90-day mortality. These findings are especially applicable when
the IRA was a bypass graft. copyright 2010 American College of Cardiology
Foundation.
<13>
Accession Number
2010165303
Authors
Kim J.-S. Kim J. Choi D. Lee C.J. Lee S.H. Ko Y.-G. Hong M.-K. Kim B.-K.
Oh S.J. Jeon D.W. Yang J.-Y. Cho J.R. Lee N.-H. Cho Y.-H. Cho D.-K. Jang
Y.
Institution
(Kim, Kim, Choi, Lee, Lee, Ko, Hong, Jang) Division of Cardiology, Yonsei
Cardiovascular Center, Severance Hospital, Seoul, South Korea.
(Kim, Oh, Jeon, Yang) Division of Cardiology, Kangnam Sacred Heart
Hospital, Seoul, South Korea.
(Cho, Lee) Division of Cardiology, National Health Insurance Corporation
Ilsan Hospital, Koyang, South Korea.
(Cho, Cho) Division of Cardiology, Department of Internal Medicine,
Myongji Hospital, Goyang, South Korea.
Title
Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous
Coronary Intervention in ST-Segment Elevation Myocardial Infarction. The
STATIN STEMI Trial.
Source
JACC: Cardiovascular Interventions. 3(3)(pp 332-339), 2010. Date of
Publication: March 2010.
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to determine the efficacy of high-dose
atorvastatin in patients with ST-segment elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI).
Background: Previous randomized trials have demonstrated that statin
pre-treatment reduced major adverse cardiac events (MACEs) in patients
with stable angina pectoris and acute coronary syndrome. However, no
randomized studies have been carried out with STEMI patients in a primary
PCI setting. Methods: A total 171 patients with STEMI were randomized to
80-mg atorvastatin (n = 86) or 10-mg atorvastatin (n = 85) arms for
pre-treatment before PCI. All patients were prescribed clopidogrel (600
mg) before PCI. After PCI, both groups were treated with atorvastatin (10
mg). The primary end point was 30-day incidence of MACE including death,
nonfatal MI, and target vessel revascularization. Secondary end points
included corrected thrombolysis in myocardial infarction frame count,
myocardial blush grade, and ST-segment resolution at 90 min after PCI.
Results: MACE occurred in 5 (5.8%) and 9 (10.6%) patients in the 80-mg and
10-mg atorvastatin pre-treatment arms, respectively (p = 0.26). Corrected
thrombolysis in myocardial infarction frame count was lower in the 80-mg
atorvastatin arm (26.9 +/- 12.3 vs. 34.1 +/- 19.0, p = 0.01). Myocardial
blush grade and ST-segment resolution were also higher in the 80-mg
atorvastatin arm (2.2 +/- 0.8 vs. 1.9 +/- 0.8, p = 0.02 and 61.8 +/- 26.2
vs. 50.6 +/- 25.8%, p = 0.01). Conclusions: High-dose atorvastatin
pre-treatment before PCI did not show a significant reduction of MACEs
compared with low-dose atorvastatin but did show improved immediate
coronary flow after primary PCI. High-dose atorvastatin may produce an
optimal result for STEMI patients undergoing PCI by improving
microvascular myocardial perfusion. (Efficacy of High-Dose AtorvaSTATIN
Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation
Myocardial Infarction [STATIN STEMI]; NCT00808717). copyright 2010
American College of Cardiology Foundation.
<14>
Accession Number
2010147848
Authors
Banning A.P. Westaby S. Morice M.-C. Kappetein A.P. Mohr F.W. Berti S.
Glauber M. Kellett M.A. Kramer R.S. Leadley K. Dawkins K.D. Serruys P.W.
Institution
(Banning, Westaby) John Radcliffe Hospital, Oxford, United Kingdom.
(Morice) Institut Hospitalier Jacques Cartier, Massy, France.
(Kappetein, Serruys) Thorax Center, Erasmus University Medical Center,
Rotterdam, Netherlands.
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany.
(Berti, Glauber) Institute of Clinical Physiology, CNR Massa, Massa,
Italy.
(Kellett, Kramer) Maine Medical Center, Portland, ME, United States.
(Leadley, Dawkins) Boston Scientific Corporation, Natick, MA, United
States.
Title
Diabetic and Nondiabetic Patients With Left Main and/or 3-Vessel Coronary
Artery Disease. Comparison of Outcomes With Cardiac Surgery and
Paclitaxel-Eluting Stents.
Source
Journal of the American College of Cardiology. 55(11)(pp 1067-1075),
2010. Date of Publication: 16 Mar 2010.
Publisher
Elsevier USA
Abstract
Objectives: This study was designed to compare contemporary surgical
revascularization (coronary artery bypass graft surgery [CABG]) versus
TAXUS Express (Boston Scientific, Natick, Massachusetts)
paclitaxel-eluting stents (PES) in diabetic and nondiabetic patients with
left main and/or 3-vessel disease. Background: Although the prevalence of
diabetes mellitus is increasing, the optimal coronary revascularization
strategy in diabetic patients with complex multivessel disease remains
controversial. Methods: The SYNTAX (SYNergy between percutaneous coronary
intervention with TAXus and cardiac surgery) study randomly assigned 1,800
patients (452 with medically treated diabetes) to receive PES or CABG.
Results: The overall 1-year major adverse cardiac and cerebrovascular
event rate was higher among diabetic patients treated with PES compared
with CABG, but the revascularization method did not impact the
death/stroke/myocardial infarction rate for nondiabetic patients (6.8%
CABG vs. 6.8% PES, p = 0.97) or for diabetic patients (10.3% CABG vs.
10.1% PES, p = 0.96). The presence of diabetes was associated with
significantly increased mortality after either revascularization
treatment. The incidence of stroke was higher among nondiabetic patients
after CABG (2.2% vs. PES 0.5%, p = 0.006). Compared with CABG, mortality
was higher after PES use for diabetic patients with highly complex lesions
(4.1% vs. 13.5%, p = 0.04). Revascularization with PES resulted in higher
repeat revascularization for nondiabetic patients (5.7% vs. 11.1%, p <
0.001) and diabetic patients (6.4% vs. 20.3%, p < 0.001). Conclusions:
Subgroup analyses suggest that the 1-year major adverse cardiac and
cerebrovascular event rate is higher among diabetic patients with left
main and/or 3-vessel disease treated with PES compared with CABG, driven
by an increase in repeat revascularization. However, the composite safety
end point (death/stroke/myocardial infarction) is comparable between the 2
treatment options for diabetic and nondiabetic patients. Although further
study is needed, these exploratory results may extend the evidence for PES
use in selected patients with less complex left main and/or 3-vessel
lesions. (SYNergy Between PCI With TAXus and Cardiac Surgery [SYNTAX];
NCT00114972). copyright 2010 American College of Cardiology Foundation.
<15>
[Use Link to view the full text]
Accession Number
2010142328
Authors
Forli L. Bollerslev J. Simonsen S. Isaksen G.A. Kvamsdal K.E. Godang K.
Gadeholt G. Pripp A.H. Bjortuft O.
Institution
(Forli, Bollerslev, Isaksen, Kvamsdal, Godang) Medical Department,
Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway.
(Bollerslev) Faculty Division, University of Oslo, Oslo University
Hospital, Oslo, Norway.
(Simonsen) Department of Cardiology, Rikshospitalet, Oslo University
Hospital, Oslo, Norway.
(Gadeholt) Department of Clinical Pharmacology, Rikshospitalet, Oslo
University Hospital, Oslo, Norway.
(Pripp) Section of Biostatistics, Research Services Department, Oslo
University Hospital, Oslo, Norway.
(Bjortuft) Department of Respiratory Medicine, Rikshospitalet, Oslo
University Hospital, Oslo, Norway.
Title
Dietary vitamin K2 supplement improves bone status after lung and heart
transplantation.
Source
Transplantation. 89(4)(pp 458-464), 2010. Date of Publication: February
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Osteoporosis is a problem after transplantation. Studies since
the last year indicate that vitamin K plays a role in optimal bone health.
The aim of this randomized, double blind, prospective longitudinal study
was to investigate the effect of a dietary supplement with vitamin K2 (180
mug menakinon-7) on bone mass, the first year after lung and heart
transplantation. Methods: After preoperative baseline investigation of
bone mass and bone-related biochemistry, 35 lung and 59 heart recipients
were postoperatively randomized to vitamin K2 or placebo and
reinvestigated the following year. Results: In all recipients, 1 year
after solid organ transplantation, the difference between vitamin K2 and
placebo for the lumbar spine (L2-L4) bone mineral density (BMD) was 0.028
(SE 0.014) g/cm, P=0.055 and for L2 to L4 bone mineral content was 1.33
(SE 1.91) g/cm (P=0.5). In lung recipients separately, the difference for
bone mineral content was 3.39 g (SE 1.65), P=0.048 and in heart recipients
0.45 (SE 0.02) g, P=0.9 after controlling for baseline measures. In a
forward stepwise linear regression analysis fitted to model differences in
the L2 to L4 BMD, controlled for possible confounding variables (including
use of bisphosphonate), and the only significant predictors were organ
(B=-0.065 g/cm, P<0.001) and vitamin K2 (B=0.034 g/cm, P=0.019).
Insufficient vitamin D status was common, and the parathyroid hormone was
highest in the K2 group indicating a higher need for vitamin D.
ConclusionS: One year of vitamin K2 supplement suggest a favorable effect
on lumbar spine BMD with different response in lung and heart recipients.
Vitamin D status should receive more attention. Copyright copyright 2010
by Lippincott Williams & Wilkins.
<16>
Accession Number
2010122577
Authors
Solak O. Emmiler M. Ela Y. Dundar U. Kocogullar C.U. Eren N. Gokce I.Y.
Cekirdekci A. Kavuncu V.
Institution
(Solak, Dundar, Gokce, Kavuncu) Department of Physical Medicine and
Rehabilitation, Afyon Kocatepe University, School of Medicine,
Afyonkarahisar, Turkey.
(Emmiler, Kocogullar, Eren, Cekirdekci) Department of Cardiovascular
Surgery, Afyon Kocatepe University, School of Medicine, Afyonkarahisar,
Turkey.
(Ela) Department of Anesthesiology, Afyon Kocatepe University, School of
Medicine, Afyonkarahisar, Turkey.
Title
Comparison of continuous and intermittent transcutaneous electrical nerve
stimulation in postoperative pain management after coronary artery bypass
graft ing: A randomized, placebo-controlled prospective study.
Source
Heart Surgery Forum. 12(5)(pp E266-E271), 2009. Date of Publication:
October 2009.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective: We compared the effectiveness of continuous transcutaneous
electrical nerve stimulation (TENS) and intermittent TENS in the
management of pain after coronary artery bypass grafting (CABG). Methods:
We randomized 100 patients who had undergone median sternotomy for CABG
into 4 groups with 25 patients each: (1) continuous TENS (CTENS) and
pharmacologic analgesia, (2) intermittent TENS (ITENS) and pharmacologic
analgesia, (3) placebo TENS (PTENS) and pharmacologic analgesia, and (4)
pharmacologic analgesia alone (control). We studied these groups with
regard to the relief of postoperative pain during the fi rst 24 hours. For
each patient we recorded the following: demographic characteristics; vital
signs; intensity of pain with a visual analogue scale (VAS) before
treatment (VAS0), at the 12th hour (VAS12), and at the 24th hour (VAS24);
and analgesic intake. Results: The groups were comparable with respect to
age, sex, and body mass index at baseline. Mean VAS scores decreased
within each group; however, the mean VAS12 and VAS24 scores decreased
signifi cantly in the CTENS and ITENS groups, compared with PTENS and
control groups (P < .05). We found no signifi cant difference between the
CTENS and ITENS groups with respect to decreasing VAS12 and VAS24 scores
(P > .05). Narcotic intake was signifi cantly less in the CTENS and ITENS
groups than in the control and PTENS groups (P < .01). Furthermore,
narcotic requirements were signifi cantly lower in the CTENS group than in
the ITENS group (P < .01). Conclusions: CTENS and ITENS after median
sternotomy for CABG decreased pain and reduced narcotic requirements more
than in the PTENS and control treatments during fi rst postoperative 24
hours. Neither CTENS nor ITENS is superior to the other in decreasing
pain; however, CTENS leads to a greater reduction in the narcotic
requirement than ITENS. Objective: We compared the effectiveness of
continuous transcutaneous electrical nerve stimulation (TENS) and
intermittent TENS in the management of pain after coronary artery bypass
grafting (CABG). Methods: We randomized 100 patients who had undergone
median sternotomy for CABG into 4 groups with 25 patients each: (1)
continuous TENS (CTENS) and pharmacologic analgesia, (2) intermittent TENS
(ITENS) and pharmacologic analgesia, (3) placebo TENS (PTENS) and
pharmacologic analgesia, and (4) pharmacologic analgesia alone (control).
We studied these groups with regard to the relief of postoperative pain
during the fi rst 24 hours. For each patient we recorded the following:
demographic characteristics; vital signs; intensity of pain with a visual
analogue scale (VAS) before treatment (VAS0), at the 12th hour (VAS12),
and at the 24th hour (VAS24); and analgesic intake. Results: The groups
were comparable with respect to age, sex, and body mass index at baseline.
Mean VAS scores decreased within each group; however, the mean VAS12 and
VAS24 scores decreased signifi cantly in the CTENS and ITENS groups,
compared with PTENS and control groups (P < .05). We found no signifi cant
difference between the CTENS and ITENS groups with respect to decreasing
VAS12 and VAS24 scores (P > .05). Narcotic intake was signifi cantly less
in the CTENS and ITENS groups than in the control and PTENS groups (P <
.01). Furthermore, narcotic requirements were signifi cantly lower in the
CTENS group than in the ITENS group (P < .01). Conclusions: CTENS and
ITENS after median sternotomy for CABG decreased pain and reduced narcotic
requirements more than in the PTENS and control treatments during fi rst
postoperative 24 hours. Neither CTENS nor ITENS is superior to the other
in decreasing pain; however, CTENS leads to a greater reduction in the
narcotic requirement than ITENS. copyright 2009 Forum Multimedia
Publishing, LLC.
<17>
Accession Number
2010122576
Authors
Ela Y. Emmiler M. Kocogullari C.U. Terzi Y. Sivaci R.G. Cekirdekci A.
Institution
(Ela, Sivaci) Department of Anesthesiology, Faculty of Medicine, Kocatepe
University, Afyonkarahisar, Turkey.
(Emmiler, Kocogullari, Cekirdekci) Department of Cardiovascular Surgery,
Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey.
(Terzi) Department of Statistics, Kocatepe University, Afyonkarahisar,
Turkey.
Title
Advantages of autologous blood transfusion in off-pump coronary artery
bypass.
Source
Heart Surgery Forum. 12(5)(pp E261-E265), 2009. Date of Publication:
October 2009.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: In this randomized controlled study, we investigated the
effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood
transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery.
Methods: Sixty patients who underwent surgery between February 2008 and
August 2008 were randomized into 2 groups. The AHBT group (n = 30)
consisted of patients who received autologous Hemobag blood transfusion,
and the ABT group (n = 30) consisted of patients who received allogenic
blood transfusion. All patients underwent OPCAB via sternotomy. The time
to extubation, chest tube drainage volume, postoperative white blood cell
counts, amount of blood transfusion, sedimentation rate, C-reactive
protein concentration, postoperative temperature, and the presence of
atelectasis were recorded in the intensive care unit. Results:
Intraoperative bleeding and fluid resuscitation were similar in the 2
groups (P > .05); however, there were significant decreases in
postoperative blood loss, extubation period, postoperative white cell
counts, sedimentation rate, incidence of atelectasis, C-reactive protein,
and fever in the AHBT group compared with the ABT group (P < .05). The
rate of atrial fibrillation in the AHBT group tended to be lower than in
the ABT group. Conclusion: Autologous blood transfusion in OPCAB may be
beneficial in certain cardiac surgery patients; however, these beneficial
effects require further study to be proved. copyright 2009 Forum
Multimedia Publishing, LLC.
<18>
Accession Number
2010122575
Authors
Yakut N. Tulukoglu E. Emrecan B. Bayrak S. Yilik L. Goktogan T. Gurbuz A.
Institution
(Yakut, Tulukoglu, Bayrak) Department of Cardiovascular Surgery, Gazi
Hospital, Izmir, Turkey.
(Emrecan) Department of Cardiovascular Surgery, Pamukkale University,
Denizli, Turkey.
(Yilik, Goktogan, Gurbuz) Ataturk Training and Research Hospital,
Department of Cardiovascular Surgery, Izmir, Turkey.
Title
Which is first: Left anterior descending artery anastomosis or right
coronary artery anastomosis in off-pump coronary artery bypass grafting?.
Source
Heart Surgery Forum. 12(5)(pp E256-E260), 2009. Date of Publication:
October 2009.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objectives: The sequence of the distal anastomosis for revascularization
in off-pump coronary artery bypass grafting (OPCABG) surgery is under
debate. The hypothesis in this study was that an analysis of cardiac
markers would reveal that anastomosing the left anterior descending
coronary artery (LAD) before the right coronary artery (RCA) would
decrease myocardial damage in OPCABG surgery for 2-vessel disease.
Methods: Forty patients with stable angina who underwent OPCABG surgery
and who had LAD and RCA lesions were randomized into 2 groups of 20
patients each. The LAD was revascularized first in group 1, and the RCA
was revascularized first in group 2. Cardiac troponin I, creatine kinase
(CK), and CK myocardial band (CK-MB) were measured in the 2 groups before
surgery and at 8, 24, and 48 hours after surgery. Results: No mortality
occurred in the 2 groups. The groups were similar with respect to sex,
age, durations of anastomosis of the left internal thoracic artery to the
LAD and of the saphenous vein graft to the RCA, and preoperative CK,
CK-MB, and troponin I levels. Postoperative CK-MB levels were
significantly higher in group 2 in the eighth and 24th postoperative hours
than in group 1 (P = .009 and .041, respectively). Similarly, troponin I
levels were significantly higher in group 2 in the eighth, 24th, and 48th
hours than in group 1 (P = .003, .003, and .006, respectively).
Conclusions: Anastomosis to the LAD first in OPCABG surgery led to a
slight reduction in myocardial enzyme release against the occlusion of the
target vessels during anastomoses in patients with RCA and LAD stenoses.
<19>
Accession Number
2010147849
Authors
Serruys P.W. Onuma Y. Garg S. Vranckx P. De Bruyne B. Morice M.-C. Colombo
A. Macaya C. Richardt G. Fajadet J. Hamm C. Schuijer M. Rademaker T.
Wittebols K. Stoll H.P.
Institution
(Serruys, Onuma, Garg) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands.
(Vranckx) Hartcentrum, Hasselt, Belgium.
(De Bruyne) Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium.
(Morice) Cardiovascular Institute, Paris, France.
(Colombo) San Raffaele Hospital, Milan, Italy.
(Macaya) Hospital Clinico San Carlos, Madrid, Spain.
(Richardt) Segeberger Kliniken GmbH, Bad Segeberg, Germany.
(Fajadet) Clinique Pasteur, Toulouse, France.
(Hamm) Kerckhof-Klinik, Bad Nauheim, Germany.
(Schuijer, Rademaker) Cardialysis BV, Rotterdam, Netherlands.
(Wittebols, Stoll) Cordis Clinical Research EMEA, a Johnson and Johnson
Company, Waterloo, Belgium.
Title
5-Year Clinical Outcomes of the ARTS II (Arterial Revascularization
Therapies Study II) of the Sirolimus-Eluting Stent in the Treatment of
Patients With Multivessel De Novo Coronary Artery Lesions.
Source
Journal of the American College of Cardiology. 55(11)(pp 1093-1101),
2010. Date of Publication: 16 Mar 2010.
Publisher
Elsevier USA
Abstract
Objectives: The purpose of this study is to compare the 5-year clinical
outcomes, safety, and efficacy of sirolimus-eluting stents (SES) in the
ARTS II (Arterial Revascularization Therapies Study II) with the outcomes
of coronary artery bypass graft (CABG) and bare-metal stenting (BMS) from
the ARTS I. Background: The long-term outcomes after SES implantation in
patients with multivessel disease remains to be established. Methods: The
ARTS I was a randomized trial of 1,205 patients with multivessel disease
comparing CABG and BMS. The ARTS II study was a nonrandomized trial with
the Cypher sirolimus-eluting stent (Cordis, a Johnson & Johnson Company,
Warren, New Jersey), applying the same inclusion and exclusion criteria,
end points, and protocol definitions. The ARTS II trial enrolled 607
patients, with an attempt to enroll at least one-third of patients with
3-vessel disease. Results: At 5-year, the death/stroke/myocardial
infarction event-free survival rate was 87.1% in ARTS II SES, versus 86.0%
(p = 0.1) and 81.9% (p = 0.007) in ARTS I CABG and BMS cohorts,
respectively. The 5-year major adverse cardiac and cerebrovascular event
(MACCE) rate in ARTS II (27.5%) was significantly higher than ARTS I CABG
(21.1%, p = 0.02), and lower than in ARTS I BMS (41.5%, p < 0.001). The
cumulative incidence of definite stent thrombosis was 3.8%. Thirty-two
percent (56 of 176) of major adverse cardiac events (MACE) at 5 years were
related to possible, probable, or definite stent thrombosis. Conclusions:
At 5 years, SES had a safety record comparable to CABG and superior to
BMS, and a MACCE rate that was higher than in patients treated with CABG,
and lower than in those treated with BMS. Approximately one-third of the
events seen with SES could be prevented through the elimination of early,
late, and very late stent thrombosis. copyright 2010 American College of
Cardiology Foundation.
<20>
Accession Number
2010111701
Authors
Ovbiagele B. Campbell S. Faiz A. Chambless L.E.
Institution
(Ovbiagele) Stroke Center and Department of Neurology, UCLA School of
Medicine, Los Angeles, CA, United States.
(Campbell, Faiz, Chambless) Department of Biostatistics, School of Public
Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
United States.
Title
Relationship between non-specific prescription pill adherence and Ischemic
stroke outcomes.
Source
Cerebrovascular Diseases. 29(2)(pp 146-153), 2010. Date of Publication:
January 2010.
Publisher
S. Karger AG
Abstract
Background: Adherence to non-specific prescription therapy may be
associated with clinical outcomes beyond a given treatment effect. We
assessed the association of blinded randomized pill prescription adherence
with vascular outcomes after ischemic stroke. Methods: We analyzed the
Vitamin Intervention for Stroke Prevention (VISP) study database. VISP was
a double-blind randomized trial, designed to determine whether high doses
of vitamins (vs. low doses) would reduce recurrent stroke risk in 3,680
participants over a 2-year period. We examined the independent association
of adherence with a composite endpoint (stroke, myocardial infarction,
death). Results: Among 3,357 (91%) subjects with complete data, women,
non-White persons, current smokers, those not on statins and those without
a history of coronary artery bypass surgery were significantly less likely
to be optimally adherent. Over the trial, persons who adhered well to
treatment were less likely to experience the combined outcome than those
who adhered poorly (13.4 vs. 20.6%, p < 0.0001). After multivariable
analysis using various adherence measures, there were no significant
differences between [greater-than or equal to]80% vs. <80% adherence, but
compared to <65% adherence, pill adherence levels of [greater-than or
equal to]90 to <99% (HR 0.56, 95% CI = 0.34-0.91; p = 0.02) and
[greater-than or equal to]99% (HR 0.46, 95% CI = 0.29-0.73; p = 0.001)
were associated with lower occurrence of the combined outcome at 18
months. Conclusions: Long-term excellent adherence to non-specific pill
prescription among ischemic stroke patients is independently associated
with lower vascular risk, and is likely a marker of overall healthy
behavior that may be helpful in targeting stroke patients with unhealthy
practices. Copyright copyright 2009 S. Karger AG, Basel.
<21>
Accession Number
0020002340
Authors
Wentworth L.J. Briese L.J. Timimi F.K. Sanvick C.L. Bartel D.C. Cutshall
S.M. Tilbury R.T. Lennon R. Bauer B.A.
Institution
(Wentworth, Sanvick, Bartel) Department of Nursing Administration, Mayo
Clinic, Rochester, MN, United States.
(Briese) Department of Nursing, Mayo Clinic, Rochester, MN, United States.
(Timimi, Tilbury) Division of Cardiovascular Disease, Mayo Clinic,
Rochester, MN, United States.
(Cutshall) Department of Surgery, Mayo Clinic, Rochester, MN, United
States.
(Lennon) Biomedical Statistics and Informatics, Mayo Clinic, Rochester,
MN, United States.
(Bauer) Division of General Internal Medicine, Mayo Clinic, Rochester, MN,
United States.
Title
Massage therapy reduces tension, anxiety, and pain in patients awaiting
invasive cardiovascular procedures.
Source
Progress in Cardiovascular Nursing. 24(4)(pp 155-161), 2009. Date of
Publication: 2009.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: (1) To assess the efficacy of a 20 minute massage therapy
session on pain, anxiety, and tension in patients before an invasive
cardiovascular procedure. (2) To assess overall patient satisfaction with
the massage therapy. (3) To evaluate the feasibility of integrating
massage therapy into preprocedural practices. Experimental
pretest-posttest design using random assignment. Medical cardiology
progressive care units at a Midwestern Academic Medical Center. Patients
(N=130) undergoing invasive cardiovascular procedures. The intervention
group received 20 minutes of hands on massage at least 30 minutes before
an invasive cardiovascular procedure. Control group patients received
standard preprocedural care. Visual analogue scales were used to collect
verbal numeric responses measuring pain, anxiety, and tension pre- and
postprocedure. The differences between pre- and postprocedure scores were
compared between the massage and standard therapy groups using the
Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores
were identified along with an increase in satisfaction for patients who
received a 20-minute massage before procedure compared with those
receiving standard care. This pilot study showed that massage can be
incorporated into medical cardiovascular units' preprocedural practice and
adds validity to prior massage studies. copyright 2009 Wiley Periodicals,
Inc.
