Results Generated From:
EMBASE <1980 to 2010 Week 10>
EMBASE (updates since 2010-03-04)
<1>
[Use Link to view the full text]
Accession Number
2010124357
Authors
Deibele A.J. Jennings L.K. Tcheng J.E. Neva C. Earhart A.D. Gibson C.M.
Institution
(Deibele, Neva) Duluth Clinic, Division of Cardiology, Duluth, MN, United
States.
(Jennings, Earhart) University of Tennessee, Vascular Biology Center of
Excellence, Memphis, United States.
(Tcheng) Duke University Medical Center, Division of Cardiology, Durham,
NC, United States.
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, MA, United States.
Title
Intracoronary eptifibatide bolus administration during percutaneous
coronary revascularization for acute coronary syndromes with evaluation of
platelet glycoprotein IIb/IIIa receptor occupancy and platelet function:
The intracoronary eptifibatide (ICE) trial.
Source
Circulation. 121(6)(pp 784-791), 2010. Date of Publication: February
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Eptifibatide reduces major adverse cardiac events in patients
with acute coronary syndromes undergoing percutaneous coronary
intervention (PCI). Intracoronary bolus administration of eptifibatide may
result in higher levels of platelet glycoprotein IIb/IIIa receptor
occupancy in the local coronary bed, disaggregate thrombus in the
epicardial artery and microvasculature, and thereby improve coronary flow.
Methods and Results: Patients undergoing PCI for an acute coronary
syndrome were randomized to either intracoronary or intravenous bolus
administration of eptifibatide. The primary end point was the local
glycoprotein IIb/IIIa receptor occupancy measured in the coronary sinus.
There were no angiographic, electrophysiological, or other adverse
findings attributable to intracoronary eptifibatide. Platelet glycoprotein
IIb/IIIa receptor occupancy was significantly greater with intracoronary
versus intravenous administration: first bolus, 94+/-9% versus 51+/-15%
(P<0.001); and second bolus, 99+/-2% versus 91+/-4% (P=0.001),
respectively. Microvascular perfusion was significantly improved as
measured by the corrected thrombolysis in myocardial infarction frame
count (cTFC) with intracoronary versus intravenous administration:
pre-PCI, 36 (median) (25th and 75th percentiles, 16 and 64) versus 31
(25th and 75th percentiles, 23 and 45; P=0.8); and post-PCI, 18 (25th and
75th percentiles, 10 and 22) versus 25 (25th and 75th percentiles, 22 and
35; P=0.007), respectively. The only multivariate predictor associated
with a post-PCI cTFC rank score was the first bolus glycoprotein IIb/IIIa
receptor occupancy (P<0.001). Conclusions: Intracoronary bolus
administration of eptifibatide during PCI in patients with acute coronary
syndromes results in higher local platelet glycoprotein IIb/IIIa receptor
occupancy, which is associated with improved microvascular perfusion
demonstrated by an improved cTFC. Copyright copyright 2010 American Heart
Association. All rights reserved.
<2>
Accession Number
2010105401
Authors
Montalescot G. Ellis S.G. de Belder M.A. Janssens L. Katz O. Pluta W.
Ecollan P. Tendera M. van Boven A.J. Widimsky P. Andersen H.R. Betriu A.
Armstrong P. Brodie B.R. Herrmann H.C. Neumann F.-J. Effron M.B. Lu J.
Barnathan E.S. Topol E.J.
Institution
(Montalescot, Ecollan) Pitie-Salpetriere University Hospital, Paris,
France.
(Ellis) Cleveland Clinic Foundation, Cleveland, OH, United States.
(de Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom.
(Janssens) AZ Imelda Ziekenhuis, Bonheiden, Belgium.
(Katz) Clinique Saint-Joseph, Colmar, France.
(Pluta) Wojewodzkie Centrum Medyczne, Opole, Poland.
(Tendera) Medical University of Silesia, Katowice, Poland.
(van Boven) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
(Widimsky) University Hospital FN Kralovske Vinohrady, Prague, Czech
Republic.
(Andersen) Skejby University Hospital, Aarhus, Denmark.
(Betriu) Hospital Clinic I Provincial, Barcelona, Spain.
(Armstrong) University of Alberta Hospital, Edmonton, Alta., Canada.
(Brodie) LeBauer Cardiovascular Research, Greensboro, NC, United States.
(Herrmann) University of Pennsylvania Medical Center, Philadelphia, PA,
United States.
(Neumann) Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
(Effron) Eli Lilly and Company, Indianapolis, IN, United States.
(Lu, Barnathan) Centocor Research and Development, Inc., Malvern, PA,
United States.
(Topol) The Scripps Research Institute, Scripps Clinic, La Jolla, CA,
United States.
Title
Enoxaparin in Primary and Facilitated Percutaneous Coronary Intervention.
A Formal Prospective Nonrandomized Substudy of the FINESSE Trial
(Facilitated INtervention with Enhanced Reperfusion Speed to Stop Events).
Source
JACC: Cardiovascular Interventions. 3(2)(pp 203-212), 2010. Date of
Publication: February 2010.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the risk-benefit of
enoxaparin (Sanofi-Aventis, Paris, France) in primary percutaneous
coronary intervention (PCI). Background: Randomized studies have
demonstrated the superiority of enoxaparin over unfractionated heparin
(UFH) in acute ST-segment elevation myocardial infarction (STEMI) treated
with fibrinolytics. Methods: In the FINESSE (Facilitated INtervention with
Enhanced Reperfusion Speed to Stop Events) trial-a double-blind,
placebo-controlled study-2,452 patients with STEMI were randomized to
primary PCI or facilitated PCI with abciximab alone or with half-dose
reteplase. In this prospective FINESSE substudy, centers pre-specified use
of either enoxaparin (0.5 mg/kg intravenous [IV], 0.3 mg/kg subcutaneous
[SC]) or UFH (40 U/kg IV, 3,000 U maximum) with PCI. A logistic-regression
model and a propensity multivariate model, both adjusted for baseline
variables, were used to evaluate primary safety and secondary efficacy end
points for enoxaparin versus UFH. Results: Enoxaparin was administered to
759 patients and UFH to 1,693 patients. Nonintracranial Thrombolysis In
Myocardial Infarction (TIMI) major/minor bleeding was not significantly
different, but lower nonintracranial TIMI major bleeding was found with
enoxaparin (2.6% vs. UFH 4.4%, logistic-regression adjusted odds ratio
[OR]: 0.55; 95% confidence interval [CI]: 0.31 to 0.99, p = 0.045),
whereas intracranial hemorrhage was similar (0.27% vs. 0.24%, adjusted OR:
1.03; 95% CI: 0.11 to 9.68, p = 0.980). Lower death, myocardial
infarction, urgent revascularization, or refractory ischemia through 30
days was also associated with enoxaparin (5.3%) versus UFH (8.0%, adjusted
OR: 0.47, 95% CI: 0.31 to 0.72, p = 0.0005) as was all-cause mortality
through 90 days (3.8% vs. 5.6%, respectively, adjusted OR: 0.59, 95% CI:
0.35 to 0.99, p = 0.046). End points evaluating the net clinical benefit
also significantly favored enoxaparin over UFH. Conclusions: Enoxaparin
seems to be associated with a lower risk of cardiovascular outcomes
compared with UFH in patients with STEMI undergoing primary PCI.
Confirmation of these findings in a randomized study is warranted. (A
Study of Abciximab and Reteplase When Administered Prior to
Catheterization After a Myocardial Infarction [Finesse]; NCT00046228).
copyright 2010 American College of Cardiology Foundation.
<3>
Accession Number
0020031900
Authors
Ridker P.M. MacFadyen J.G. Fonseca F.A. Genest J. Gotto A.M. Kastelein
J.J. Koenig W. Libby P. Lorenzatti A.J. Nordestgaard B.G. Shepherd J.
Willerson J.T. Glynn R.J.
Institution
(Ridker, MacFadyen, Fonseca, Genest, Gotto, Kastelein, Koenig, Libby,
Lorenzatti, Nordestgaard, Shepherd, Willerson, Glynn) Center for
Cardiovascular Disease Prevention and the Division of Cardiovascular
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
02215, USA.
Title
Number needed to treat with rosuvastatin to prevent first cardiovascular
events and death among men and women with low low-density lipoprotein
cholesterol and elevated high-sensitivity C-reactive protein:
justification for the use of statins in prevention: an intervention trial
evaluating rosuvastatin (JUPITER)..
Source
Circulation. Cardiovascular quality and outcomes. 2(6)(pp 616-623), 2009.
Date of Publication: Nov 2009.
Abstract
BACKGROUND: As recently demonstrated, random allocation to rosuvastatin
results in large relative risk reductions for first cardiovascular events
among apparently healthy men and women with low levels of low-density
lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive
protein. However, whether the absolute risk reduction among such
individuals justifies wide application of statin therapy in primary
prevention is a controversial issue with broad policy and public health
implications. METHODS AND RESULTS: Absolute risk reductions and consequent
number needed to treat (NNT) values were calculated across a range of end
points, timeframes, and subgroups using data from Justification for the
Use of statins in Prevention: an Intervention Trial Evaluating
Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg
versus placebo conducted among 17 802 apparently healthy men and women
with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity
C-reactive protein >or=2 mg/L. Sensitivity analyses were also performed to
address the potential impact that alternative statin regimens might have
on a similar primary prevention population. For the end point of
myocardial infarction, stroke, revascularization, or death, the 5-year NNT
within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT
values for this end point below 50; as examples, 5-year NNT values were 17
for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those
with body mass index <or=25 kg/m(2) and 21 for those with body mass index
greater than 25 kg/m(2), 9 and 26 for those with and without a family
history of coronary disease, 19 and 22 for those with and without
metabolic syndrome, and 14 and 37 for those with estimated Framingham
risks greater or less than 10%. For the net vascular benefit end point
that additionally included venous thromboembolism, the 5-year NNT was 18
(95% CI, 13 to 29). For the restricted "hard" end point of myocardial
infarction, stroke, or death, the 5-year NNT was 29 (95% CI, 19 to 56). In
sensitivity analyses addressing the theoretical utility of alternative
agents, 5-year NNT values of 38 and 57 were estimated for statin regimens
that deliver 75% and 50% of the relative benefit observed in JUPITER,
respectively. All of these calculations compare favorably to 5-year NNT
values previously reported in primary prevention for the use of statins
among hyperlipidemic men (5-year NNT, 40 to 70), for antihypertensive
therapy (5-year NNT, 80 to 160), or for aspirin (5-year NNT, >300).
CONCLUSIONS: Absolute risk reductions and consequent NNT values associated
with statin therapy among those with elevated high-sensitivity C-reactive
protein and low low-density lipoprotein cholesterol are comparable if not
superior to published NNT values for several widely accepted interventions
for primary cardiovascular prevention, including the use of statin therapy
among those with overt hyperlipidemia. CLINICAL TRIAL REGISTRATION:
clinicaltrials.gov. Identifier NCT00239681.
<4>
Accession Number
2010028012
Authors
Charytan D.M. Wallentin L. Lagerqvist B. Spacek R. De Winter R.J. Stern
N.M. Braunwald E. Cannon C.P. Choudhry N.K.
Institution
(Charytan, Stern) Renal Division and Clinical Biometrics, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States.
(Braunwald, Cannon) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States.
(Choudhry) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States.
(Wallentin) Uppsala Clinical Research Center, University Hospital,
Uppsala, Sweden.
(Lagerqvist) Cardiothoracic Center, University Hospital, Uppsala, Sweden.
(De Winter) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands.
(Spacek) Cardiocenter, University Hospital Kralovske Vinohrady, Third
Medical School of Charles University Prague, Prague, Czech Republic.
Title
Early angiography in patients with chronic kidney disease: A collaborative
systematic review.
Source
Clinical Journal of the American Society of Nephrology. 4(6)(pp
1032-1043), 2009. Date of Publication: 2009.
Publisher
American Society of Nephrology
Abstract
Background and objectives: In the general population, an early invasive
strategy of routine coronary angiography is superior to a conservative
strategy of selective angiography in patients who are admitted with
unstable angina or non-ST segment elevation myocardial infarction (MI),
but the effectiveness of this strategy in individuals with chronic kidney
disease (CKD) is uncertain. Design, setting, participants, & measurements:
We conducted a collaborative meta-analysis with data provided by the main
authors of identified trials to estimate the effectiveness of early
angiography in patients with CKD. The Cochrane, Medline, and EMBASE
databases were searched to identify randomized trials that compared
invasive and conservative strategies in patients with unstable angina or
non-ST MI. Pooled risks ratios were estimated using data from enrolled
patients with estimated GFR <60 ml/min per 1.73 m2. Results: Five
randomized trials that enrolled 1453 patients with CKD were included. An
early invasive strategy was associated with nonsignificant reductions in
all-cause mortality, nonfatal MI, and a composite of death or nonfatal MI.
The invasive strategy significantly reduced rehospitalization.
Conclusions: This collaborative study suggests that the benefits of an
early invasive strategy are preserved in patients with CKD and that an
early invasive approach reduces the risk for rehospitalization and is
associated with trends of reduction in the risk for death and nonfatal
re-infarction in patients with CKD. Coronary angiography should be
considered for patients who have CKD and are admitted with non-ST
elevation acute coronary syndromes. Copyright copyright 2009 by the
American Society of Nephrology.
<5>
[Use Link to view the full text]
Accession Number
2010081247
Authors
Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E.
Chello M.
Institution
(Spadaccio, Pollari, Casacalenda, Genovese, Covino, Chello) Department of
Cardiovascular Sciences, University Campus Bio-Medico of Rome, via Alvaro
del Portillo, 200 00128 Roma, Italy.
(Alfano) Department of Cardiovascular Science, Medical School of Naples,
Second University of Naples,
Title
Atorvastatin increases the number of endothelial progenitor cells after
cardiac surgery: A randomized control study.
Source
Journal of Cardiovascular Pharmacology. 55(1)(pp 30-38), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Endothelial progenitor cells (EPCs) are a subtype of hematopoietic stem
cells, which contribute to the repair of injured endothelium. Treatment
with atorvastatin has been shown to increase EPC count in patients with
coronary artery disease. Therefore, we investigated whether atorvastatin
augments the number of EPCs after cardiopulmonary bypass (CPB) surgery. We
conducted a randomized double-blind, placebo-controlled, 2-way crossover
trial in 50 patients undergoing elective coronary surgery. Patients
received either 3-week treatment with atorvastatin or placebo. EPCs were
quantitated by flow cytometric phenotyping on blood samples. Levels of
interleukin, IL-6 and IL-8; tumor necrosis factor alpha; SDF-1alpha;
granulocyte colony-stimulating factor; and vascular endothelial growth
factor were determined at recruitment, preoperatively, post-CPB, and 6,
12, and 24 hours postoperatively. The atorvastatin group showed a
significantly higher amount of EPCs both pre- and postoperatively compared
with the placebo, with a >4-fold increase compared with the baseline
values. CPB induced an increase in all cytokines, but the levels of
proinflammatory cytokines were significantly lower in the atorvastatin
group (P < 0.05). Statin did not affect levels of SDF-1alpha, granulocyte
colony-stimulating factor, and vascular endothelial growth factor.
However, no correlation was found between plasma levels of any cytokine
and number of EPCs, with the exception of SDF-1alpha. Pretreatment with
atorvastatin significantly increases the amount of EPCs after CPB, by a
mechanism independent of plasma levels of cytokines and cholesterol.
Copyright copyright 2010 by Lippincott Williams & Wilkins.
<6>
Accession Number
2010059544
Authors
Giglio M.T. Marucci M. Testini M. Brienza N.
Institution
(Giglio, Marucci, Brienza) Anaesthesia and Intensive Care Unit, Department
of Emergency and Organ Transplantation, University of Bari, Piazza G.
Cesare 11, BARI 70124, Italy.
(Testini) Department of Application in Surgery of Innovative Technologies,
Policlinico, University of Bari, Piazza G. Cesare 11, BARI 70124, Italy.
Title
Goal-directed haemodynamic therapy and gastrointestinal complications in
major surgery: A meta-analysis of randomized controlled trials.
Source
British Journal of Anaesthesia. 103(5)(pp 637-646), 2009. Date of
Publication: November 2009.
Publisher
Oxford University Press
Abstract
Postoperative gastrointestinal (GI) dysfunction is one of the most
frequent complications in surgical patients. Most cases are associated
with episodes of splanchnic hypoperfusion due to hypovolaemia or cardiac
dysfunction. It has been suggested that perioperative haemodynamic
goal-directed therapy (GDT) may reduce the incidence of these
complications in cardiac surgery, and other surgery, but clear evidence is
lacking. We have undertaken a meta-analysis of the effects of GDT on
postoperative GI and liver complications. A systematic search, using
MEDLINE, EMBASE, and The Cochrane Library databases, was performed.
Sixteen randomized controlled trials (3410 participants) met the inclusion
criteria. Data synthesis was obtained using odds ratio (OR) with 95%
confidence interval (CI) by random-effects model. Statistical
heterogeneity was assessed by Q and I2 statistics. GI complications were
ranked as major (required radiological or surgical intervention or
life-threatening condition) or minor (no or only pharmacological treatment
required). Major GI complications were significantly reduced by GDT when
compared with a control group (OR, 0.42; 95% CI, 0.27-0.65). Minor GI
complications were also significantly decreased in the GDT group (OR,
0.29; 95% CI, 0.17-0.50). Treatment did not reduce hepatic injury rate
(OR, 0.54; 95% CI, 0.19-1.55). Quality sensitive analyses confirmed the
main overall results. In patients undergoing major surgery, GDT, by
maintaining an adequate systemic oxygenation, can protect organs
particularly at risk of perioperative hypoperfusion and is effective in
reducing GI complications.
<7>
Accession Number
2010041617
Authors
Reiner Z.
Institution
(Reiner) Department of Internal Medicine, University Hospital Center
Zagreb, Zagreb, Croatia.
Title
Combined therapy in the treatment of dyslipidemia.
Source
Fundamental and Clinical Pharmacology. 24(1)(pp 19-28), 2010. Date of
Publication: February 2010.
Publisher
Blackwell Publishing Ltd
Abstract
This systematic review analyses the efficacy, tolerability and safety of
combinations of different medicines used to treat dyslipidemias in
clinical practice. A PubMed search up to January 2009, was conducted to
identify relevant studies. Criteria used to identify studies included (1)
English language, (2) published studies with original data or
meta-analyses in peer-reviewed journals. Although statin treatment is a
mainstay of dyslipidemia management today, complementary effects of other
lipid-lowering and/or HDL-cholesterol-raising therapies might
substantially increase the clinical benefits not only in the small
minority of patients with severe dyslipidemias but in others as well.
These therapies include combinations with bile acid sequestrants
(cholestyramine, colestipol, colesevelam), ezetimibe, niacin, plant
sterols, fibrates (fenofibrate, bezafibrate, gemfibrozil), and
prescription omega-3 fatty acids. Therapeutic approaches which incorporate
the use of multiple drugs combinations for dyslipidemia treatment should
be more widely adopted since combination therapy might offer a means to
increase the number of patients able to meet their lipoprotein goals
according to the guidelines. However, it has to be stated that for most of
these combination therapies data on cardiovascular outcomes are still
lacking. copyright 2009 The Author Journal compilation copyright 2009
Societe Francaise de Pharmacologie et de Therapeutique.
<8>
Accession Number
2010027735
Authors
Duvan I. Durukan B. Gurbuz A. Yorgancioglu C.
Institution
(Duvan) Department of Cardiac Surgery, Guven Hospital, Simsek Sokak No:
29, Kavaklidere, Ankara, Turkey.
(Durukan, Gurbuz, Yorgancioglu) Department of Cardiac Surgery, Faculty of
Medicine, Hacettepe University, Ankara, Turkey.
Title
A comparison of different management techniques for myocardial protection
in acyanotic congenital cardiac patients.
Source
Turkish Journal of Medical Sciences. 39(6)(pp 887-893), 2009. Date of
Publication: December 2009.
Publisher
Turkiye Klinikleri Journal of Medical Sciences
Abstract
Aim: It has already been shown that terminal warm blood cardioplegia
(TWBC) supports myocardial protection in pediatric patients when it is
administered after cold blood cardioplegia. However, the myocardial
protective effects of TWBC applied after cold crystalloid cardioplegia
(CCC) is still a subject of debate. Materials and methods: Twenty
acyanotic congenital cardiac patients were randomly divided into 2 groups
of 10. In the control group (CG), moderate hypothermia, topical cooling,
and cold crystalloid cardioplegia were performed for the protection of the
myocardium. In the other group (TWBCG), the same procedure was supported
using TWBC just before the unclamping of the aorta. Blood samples were
analyzed to discover the progression of anaerobic energy metabolism
potentially causing injury of the myocardium during the ischemic,
reperfusion, and postoperative period. Results: There were no significant
statistical differences in age, body weight, mean pulmonary artery
pressure, operation procedure, cardiopulmonary bypass and aortic cross
clamping time, period of respiratory support, and intensive care unit and
hospital stay. Also measurement of serum cardiac troponin T (TnT),
creatine kinase MB(CK-MB), and lactate levels preoperatively, just after
the release of the cross clamp and at the time of postoperative 4, 12, 24,
and 48 h showed no significant differences either. Conclusion: TWBC was
not able to enhance the myocardial protective effects in acyanotic
congenital cardiac patients when performed in addition to CCC. copyright
TUBI[dot]TAK.
<9>
Accession Number
0020030830
Authors
Turrini F. Messora R. Giovanardi P. Tondi S. Magnavacchi P. Cavani R.
Tosoni G. Cappelli C. Pellegrini E. Romano S. Baldini A. Zennaro R.G.
Bondi M.
Institution
(Turrini, Messora, Giovanardi, Tondi, Magnavacchi, Cavani, Tosoni,
Cappelli, Pellegrini, Romano, Baldini, Zennaro, Bondi) Azienda USL di
Modena, Medicina Cardiovascolare, Nuovo Ospedale Sant Agostino Estense,
41100 Modena, Italy.
Title
Screening asymptomatic patients with diabetes for unknown coronary artery
disease: does it reduce risk? An open-label randomized trial comparing a
strategy based on exercise testing aimed at revascularization with
management based on pharmacological/behavioural treatment of traditional
risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be
Diagnosed and treated early in.
Source
Trials. 10(pp 119), 2009. Date of Publication: 2009.
Abstract
BACKGROUND: Coronary artery disease is the leading cause of morbidity and
mortality in patients with type 2 diabetes. Screening for asymptomatic
coronary artery disease with treatment by means of revascularization seems
to be an appealing option for prevention. The utility of such a strategy
has never been challenged in a randomized trial. METHODS/DESIGN: In the
present study a cohort of diabetic patients without any symptoms and
without known coronary artery disease will be screened at two diabetes
outpatients services. Those with intermediate or high risk (equal or
greater than 10% according to the Italian risk chart) will be asked to
participate and enrolled. They will be seen and followed in order to
provide the best adherence to medical therapy. Half of the patients will
be randomized to undergo an exercise tolerance testing while the other
group will continue to be regularly seen at diabetes outpatients services.
Best medical/behavioral therapy will be offered to both groups. Those
patients with a positive exercise tolerance testing will be studied by
coronary angiography and treated according to the severity of coronary
lesions by percutaneous stenting or surgery.The objective of the study is
to evaluate the efficacy of the screening strategy aimed at
revascularization. A cost-effectiveness analysis will be performed at the
end of the follow up. DISCUSSION: The study will provide useful
information about prevention and treatment of diabetic patients at high
risk of coronary events. It will be made clearer if detection of silent
coronary artery disease has to be recommended and followed by treatment.
Given the simplicity of the study protocol, it will be easily transferable
to the real world. TRIAL REGISTRATION: (ClinicalTrials.gov): NCT00547872.
<10>
Accession Number
2010059586
Authors
Berger K. Sander M. Spies C.D. Weymann L. Buhner S. Lochs H. Wernecke
K.-D. Von Heymann C.
Institution
(Berger, Sander, Spies, Weymann, Von Heymann) Department of
Anaesthesiology and Intensive Care Medicine, Charite-Universitatsmedizin
Berlin, Campus Charite Mitte, Augustenburger Platz 1, 13353 Berlin,
Germany.
(Buhner, Lochs) Department of Gastroenterology and Hepatology,
Charite-Universitatsmedizin Berlin, Campus Charite Mitte, Germany.
(Wernecke) SOSTANA (Sophisticated Statistical Analysis) GmbH,
Charite-Universitatsmedizin Berlin, Germany.
Title
Profound haemodilution during normothermic cardiopulmonary bypass
influences neither gastrointestinal permeability nor cytokine release in
coronary artery bypass graft surgery.
Source
British Journal of Anaesthesia. 103(4)(pp 511-517), 2009. Date of
Publication: October 2009.
Publisher
Oxford University Press
Abstract
Background. Cardiopulmonary bypass (CPB) impairs intestinal barrier
function and induces systemic inflammation after cardiac surgery. The
objective of this study was to evaluate the effect of profound
haemodilution (haematocrit 19-21%) during normothermic CPB on
gastrointestinal permeability and cytokine release in comparison with a
standard haemodilution (haematocrit 24-26%). Methods. This was a
prospective, controlled, randomized pilot trial of 60 patients without
gastrointestinal disease undergoing normothermic CPB (35.5-36degreesC) for
coronary artery bypass graft surgery. Gastrointestinal permeability was
measured by the triple-sugar technique (sucrose, lactulose, and mannitol
excretion in urine) before and after CPB. Interleukin (IL)-6, IL-10, and
tumour necrosis factor alpha (TNFalpha) were quantified using
enzyme-linked immunosorbent assays. Results. Data from 59 patients (19-21%
haematocrit, n=28; 24-26% haematocrit, n=31) were analysed. Data on
gastrointestinal permeability were available for 47 patients (19-21%
haematocrit, n=23; 24-26% haematocrit, n=24), blood samples for cytokine
analysis from 59 patients. Mannitol excretion was normal before and after
surgery without significant differences between the groups (after
operation: 5.4% vs 2.9, P=0.193). Lactulose and sucrose excretion was
within a normal range before surgery and increased afterwards without
differences between the groups. IL-6, IL-10, and TNFalpha were elevated
after surgery, but there was no difference between the groups [IL-6
(P=0.78), IL-10 (P=0.74), and TNFalpha (P=0.67)]. Conclusions. Profound
haemodilution during normothermic CPB brought about significant changes
neither in intestinal permeability nor in cytokine release. It may be
concluded that a haematocrit of 19-21% during normothermic CPB does not
impair intestinal barrier function and cytokine response in patients
without gastrointestinal comorbidity.
<11>
Accession Number
2010047291
Authors
Turrini F. Messora R. Giovanardi P. Tondi S. Magnavacchi P. Cavani R.
Tosoni G. Cappelli C. Pellegrini E. Romano S. Baldini A. Zennaro R.G.
Bondi M.
Institution
(Turrini, Messora, Giovanardi, Bondi) Azienda USL di Modena, Medicina
Cardiovascolare, Nuovo Ospedale Sant Agostino Estense, 41100 Modena,
Italy.
(Tondi, Magnavacchi, Tosoni, Cappelli, Zennaro) Azienda USL di Modena,
Cardiologia, Nuovo Ospedale Sant Agostino Estense, 41100 Modena, Italy.
(Cavani, Pellegrini, Romano, Baldini) Azienda USL di Modena, Servizio di
diabetologia, Ospedale Estense, 41100 Modena, Italy.
Title
Screening asymptomatic patients with diabetes for unknown coronary artery
disease: Does it reduce risk? An open-label randomized trial comparing a
strategy based on exercise testing aimed at revascularization with
management based on pharmacological/behavioural treatment of traditional
risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be
Diagnosed and treated early in Diabetics.
Source
Trials. 10, 2009. Article Number: 119. Date of Publication: 23 Dec 2009.
Publisher
BioMed Central Ltd.
Abstract
Background: Coronary artery disease is the leading cause of morbidity and
mortality in patients with type 2 diabetes. Screening for asymptomatic
coronary artery disease with treatment by means of revascularization seems
to be an appealing option for prevention. The utility of such a strategy
has never been challenged in a randomized trial.Methods/Design: In the
present study a cohort of diabetic patients without any symptoms and
without known coronary artery disease will be screened at two diabetes
outpatients services. Those with intermediate or high risk (equal or
greater than 10% according to the Italian risk chart) will be asked to
participate and enrolled. They will be seen and followed in order to
provide the best adherence to medical therapy. Half of the patients will
be randomized to undergo an exercise tolerance testing while the other
group will continue to be regularly seen at diabetes outpatients services.
Best medical/behavioral therapy will be offered to both groups. Those
patients with a positive exercise tolerance testing will be studied by
coronary angiography and treated according to the severity of coronary
lesions by percutaneous stenting or surgery.The objective of the study is
to evaluate the efficacy of the screening strategy aimed at
revascularization. A cost-effectiveness analysis will be performed at the
end of the follow up.Discussion: The study will provide useful information
about prevention and treatment of diabetic patients at high risk of
coronary events. It will be made clearer if detection of silent coronary
artery disease has to be recommended and followed by treatment. Given the
simplicity of the study protocol, it will be easily transferable to the
real world. copyright 2009 Turrini et al; licensee BioMed Central Ltd.
<12>
Accession Number
0019914571
Authors
Zohreh K. Farah A.E. Mehrab M. Abbas S.O. Alireza H. Soraya M. Soheil S.
Institution
(Zohreh, Farah, Mehrab, Abbas, Alireza, Soraya, Soheil) Tehran Heart
Center, Medical Science Department, University of Tehran, Tehran, Iran,
Islamic Republic of.
Title
Comparison of compression stocking with elastic bandage in reducing
postoperative edema in coronary artery bypass graft patient.
Source
Journal of Vascular Nursing. 27(4)(pp 103-106), 2009. Date of
Publication: December 2009.
Publisher
Mosby Inc.
Abstract
The removal of the saphenous veins in coronary artery bypass graft (CABG)
surgery may cause leg edema. Compression therapy is often used to prevent
postoperative edema. The objective of this study was to compare the
efficacy of medical compression stocking (TED) and elastic bandage-type on
donor limbs after CABG. The peripheries of lower limbs were measured at
four regions (A: end of tarsal bones, H: heel, B: immediately above the
ankle, C: largest circumference of the calf) at admission in 295 patients
how CABG candidates and differences in these measurement points at
discharge compared to measurements at admission time were calculated. The
difference was considered as a measure of the effectiveness of two types
of compression to prevent postoperative edema in donor limbs after CABG.
The alterations of 396 donor limbs of 295 patients were examined after
CABG at admission and discharge time. In 101 patients veins for graft were
taken from both lower limbs. After analysis, if subjects had worn TED
stockings, the peripheries of donor limbs at discharge were less than at
admission time in the A and H regions compared to elastic bandage group
(PA = 0/009), (PH = 0/012). The conclusion reached was that using the kind
of knee length compression stocking (TED stocking, Kendall Co.) is more
effective edema at foot and heel regions in donor limbs after CABG than
elastic bandages. copyright 2009 Society for Vascular Nursing, Inc.
<13>
Accession Number
2010047559
Authors
Abdel-Salam Z. Nammas W.
Institution
(Abdel-Salam, Nammas) Cardiology Department, Faculty of Medicine, Ain
Shams University, Cairo, Egypt.
Title
The Combined Pharmacological Stress Echocardiography Protocol for
Predicting Improvement of Global Left Ventricular Systolic Function After
Revascularisation.
Source
Heart Lung and Circulation. 19(2)(pp 81-89), 2010. Date of Publication:
February 2010.
Publisher
Elsevier Ltd
Abstract
Background: We compared the prognostic power of three pharmacological
stress echocardiography protocols for predicting improvement of global
left ventricular systolic function following revascularisation. Methods:
We enrolled 100 consecutive patients with significant coronary
stenosis/occlusion and regional dys-synergy in the affected artery
territory. Patients underwent assessment of regional and global left
ventricular systolic function. They underwent then three pharmacological
stress echocardiography protocols: low dose dobutamine, infra-low dose
dipyridamole, combined protocol. All patients underwent coronary
revascularisation. Echocardiography was repeated 8 weeks later. Predicted
function improvement by the three protocols was compared with actual
improvement. Results: The combined protocol was more sensitive to predict
systolic function improvement after revascularisation, but less specific,
the diagnostic accuracy was similar among the three protocols. A cutoff
value of 6 viable segments best predicted global function improvement with
the combined protocol. Conclusions: The combined protocol has a higher
sensitivity but lower specificity to predict global left ventricular
systolic function improvement after revascularisation, as compared to the
other two protocols. copyright 2009 Australasian Society of Cardiac and
Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.
<14>
Accession Number
0019171056
Authors
Taniguchi C. Eid R.C. Saghabi C. Souza R. Silva E. Knobel E. Paes A.T.
Barbas C.S.
Institution
(Taniguchi, Eid, Saghabi, Souza, Silva, Knobel, Paes, Barbas) Adult - ICU
- Albert Einstein Hospital, Brazil.
Title
Automatic versus manual pressure support reduction in the weaning of
post-operative patients: a randomised controlled trial..
Source
Critical care (London, England). 13(1)(pp R6), 2009. Date of Publication:
2009.
Abstract
INTRODUCTION: Reduction of automatic pressure support based on a target
respiratory frequency or mandatory rate ventilation (MRV) is available in
the Taema-Horus ventilator for the weaning process in the intensive care
unit (ICU) setting. We hypothesised that MRV is as effective as manual
weaning in post-operative ICU patients. METHODS: There were 106 patients
selected in the post-operative period in a prospective, randomised,
controlled protocol. When the patients arrived at the ICU after surgery,
they were randomly assigned to either: traditional weaning, consisting of
the manual reduction of pressure support every 30 minutes, keeping the
respiratory rate/tidal volume (RR/TV) below 80 L until 5 to 7 cmH2O of
pressure support ventilation (PSV); or automatic weaning, referring to MRV
set with a respiratory frequency target of 15 breaths per minute (the
ventilator automatically decreased the PSV level by 1 cmH2O every four
respiratory cycles, if the patient's RR was less than 15 per minute). The
primary endpoint of the study was the duration of the weaning process.
Secondary endpoints were levels of pressure support, RR, TV (mL), RR/TV,
positive end expiratory pressure levels, FiO2 and SpO2 required during the
weaning process, the need for reintubation and the need for non-invasive
ventilation in the 48 hours after extubation. RESULTS: In the intention to
treat analysis there were no statistically significant differences between
the 53 patients selected for each group regarding gender (p = 0.541), age
(p = 0.585) and type of surgery (p = 0.172). Nineteen patients presented
complications during the trial (4 in the PSV manual group and 15 in the
MRV automatic group, p < 0.05). Nine patients in the automatic group did
not adapt to the MRV mode. The mean +/- sd (standard deviation) duration
of the weaning process was 221 +/- 192 for the manual group, and 271 +/-
369 minutes for the automatic group (p = 0.375). PSV levels were
significantly higher in MRV compared with that of the PSV manual reduction
(p < 0.05). Reintubation was not required in either group. Non-invasive
ventilation was necessary for two patients, in the manual group after
cardiac surgery (p = 0.51). CONCLUSIONS: The duration of the automatic
reduction of pressure support was similar to the manual one in the
post-operative period in the ICU, but presented more complications,
especially no adaptation to the MRV algorithm. TRIAL REGISTRATION: Trial
registration number: ISRCTN37456640.
<15>
Accession Number
0020026538
Authors
Gualis J. Florez S. Tamayo E. Alvarez F.J. Castrodeza J. Castano M.
Institution
(Gualis, Florez, Tamayo, Alvarez, Castrodeza, Castano) Department of
Cardiac Surgery, Valladolid University Hospital, Valladolid, Spain.
Title
Risk factors for mediastinitis and endocarditis after cardiac surgery..
Source
Asian cardiovascular & thoracic annals. 17(6)(pp 612-616), 2009. Date of
Publication: Dec 2009.
Abstract
A prospective open-cohort study was performed in 838 adults undergoing
coronary revascularization or valve surgery to define the risk factors for
development of surgical site infections. Patients diagnosed with
mediastinitis or endocarditis during follow-up were compared with patients
with no such infection. After 1 year of follow-up, 22 (2.6%) patients had
developed mediastinitis or endocarditis. No preoperative or intraoperative
variables were identified as risk factors. By multivariate analysis of
postoperative variables, respiratory insufficiency, microorganisms in
blood cultures, and intensive care unit stay were independent risk factors
for the development of these complications. The type of antibiotic
prophylaxis had no influence on the incidence of organ or space infections
after cardiac surgery.
<16>
Accession Number
0020026533
Authors
Ramzisham A.R. Raflis A.R. Khairulasri M.G. Ooi Su Min J. Fikri A.M.
Zamrin M.D.
Institution
(Ramzisham, Raflis, Khairulasri, Ooi Su Min, Fikri, Zamrin) Division of
Cardiothoracic Surgery, Heart and Lung Centre, Universiti Kebangsaan
Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Title
Figure-of-eight vs. interrupted sternal wire closure of median
sternotomy..
Source
Asian cardiovascular & thoracic annals. 17(6)(pp 587-591), 2009. Date of
Publication: Dec 2009.
Abstract
Sternal dehiscence is a rare but devastating complication following median
sternotomy for cardiac surgery. The optimal technique for sternal closure
is unclear. We conducted this prospective randomized trial to compare the
incidence of sternal dehiscence after figure-of-8 and simple interrupted
suturing in patients undergoing coronary artery bypass grafting. Between
January 2007 and June 2008, 98 patients had figure-of-8 suturing and 97
had interrupted sutures. The mean age of the patients was 60.9 +/- 7.6
years. The overall sternal dehiscence rate was 8%; 7 cases in the in
figure-of-8 group and 9 in the interrupted group. Thirteen patients had no
wound infection and healed with conservative treatment. Only 3 patients
had sternal dehiscence with infection: 2 with simple interrupted closure
and 1 with figure-of-8 sternal closure. There was no significant
difference in rates of sternal dehiscence between the 2 groups. It was
concluded that figure-of-8 sternal suturing is equally effective as simple
interrupted suturing in preventing sternal dehiscence.
<17>
[Use Link to view the full text]
Accession Number
0019809326
Authors
Ayoub C.M. Sfeir P.M. Bou-Khalil P. Azar M. Haddadin A.S. Harfouch D. Nasr
V.G. El-Khatib M.F.
Institution
(Ayoub, Sfeir, Bou-Khalil, Azar, Haddadin, Harfouch, Nasr, El-Khatib)
Department of Anaesthesiology, American University of Beirut Medical
Center, Beirut, Lebanon, USA.
Title
Prophylactic amiodarone versus lidocaine for prevention of reperfusion
ventricular fibrillation after release of aortic cross-clamp..
Source
European journal of anaesthesiology. 26(12)(pp 1056-1060), 2009. Date of
Publication: Dec 2009.
Abstract
BACKGROUND AND OBJECTIVE: Ventricular fibrillation is common after aortic
cross-clamp release in patients undergoing open-heart surgeries. The aim
of the study was to evaluate the efficacy of the prophylactic
administration of 150 mg amiodarone by way of the pump 2 min before
release of aortic cross-clamp in preventing ventricular fibrillation.
METHODS: The present study is a prospective, randomized, controlled and
blinded study performed at a teaching university hospital where 120
patients undergoing coronary bypass graft surgery were randomly assigned
to three groups. Each group received either 150 mg of amiodarone or 100 mg
lidocaine or isotonic saline by way of pump 2 min before release of the
aortic cross-clamp. The frequency of occurrence of ventricular
fibrillation and the subsequent required defibrillation counter shocks
were determined in all groups. RESULTS: The frequency of occurrence of
ventricular fibrillation was significantly higher in both the amiodarone
(48%) and the control group (45%) as compared with the lidocaine group
(20%) with no statistically significant difference between the amiodarone
and the control groups. Furthermore, when ventricular fibrillation
occurred, the percentage of patients requiring defibrillation counter
shocks was significantly higher in both the amiodarone (58%) and control
(61%) groups as compared with the lidocaine group (13%) with no difference
between the amiodarone and the control groups, despite a significant
decrease in the defibrillation counter shocks energy requirements in the
amiodarone group. CONCLUSION: The present study showed no difference
between amiodarone (150 mg) and placebo in preventing ventricular
fibrillation after release of aortic cross-clamp. In addition, the use of
lidocaine was able to reduce the incidence of ventricular fibrillation as
compared with both amiodarone and placebo.
<18>
[Use Link to view the full text]
Accession Number
0019770662
Authors
Hou X. Yang F. Liu R. Yang J. Zhao Y. Wan C. Ni H. Gong Q. Dong P.
Institution
(Hou, Yang, Liu, Yang, Zhao, Wan, Ni, Gong, Dong) Department of Cardiac
Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing,
China.
Title
Retrograde autologous priming of the cardiopulmonary bypass circuit
reduces blood transfusion in small adults: a prospective, randomized
trial..
Source
European journal of anaesthesiology. 26(12)(pp 1061-1066), 2009. Date of
Publication: Dec 2009.
Abstract
BACKGROUND AND OBJECTIVE: Extreme haemodilution occurring with
cardiopulmonary bypass imposes a primary risk factor for blood transfusion
in small adult cardiac surgical patients. Priming of the cardiopulmonary
bypass circuit with patients' own blood [retrograde autologous priming
(RAP)] is a technique used to limit haemodilution and reduce transfusion
requirements. We designed this study to evaluate the effects of RAP on
reducing perioperative blood transfusion in small adults. METHODS: One
hundred and twenty patients with a body surface area of less than 1.5 m
undergoing first-time, nonemergency cardiac surgery were randomized to
either the standard priming group or the RAP group. All patients followed
strict transfusion criteria. Homologous transfusion, haematocrit, plasma
colloid osmotic pressure and postoperative clinical outcomes were
evaluated perioperatively. RESULTS: Patient characteristics and operative
parameters were equal for patients in both groups. With autologous
priming, a mean volume of 614.8 +/- 138.8 ml of priming solution was
replaced with autologous blood. This allowed a significantly higher
haematocrit value during cardiopulmonary bypass (P < 0.05). Red blood cell
transfusion was necessary in 83.3% of patients of the standard priming
group on pump, whereas only 26.7% of patients of the RAP group required
transfusion (P < 0.01). The overall transfusion rate of the RAP group was
significantly less than that in the standard priming group during the
hospitalization (90.0 vs. 50.0%, P < 0.01). Amongst patients who received
transfusion on pump, the number of homologous units of packed red blood
cells was less in the RAP group than that in the standard priming group
intraoperatively and perioperatively (0.94 +/- 0.32 vs. 1.48 +/- 0.68
units, P = 0.03; 1.24 +/- 0.54 vs. 1.69 +/- 0.69 units, P = 0.15). Ten
minutes after aortic cross-clamp, colloid osmotic pressure was reduced by
39.7 +/- 2.8% in the standard priming group and by 28.6 +/- 3.2% in the
RAP group (P < 0.05). Clinical outcomes were similar with respect to
pulmonary, renal and hepatic function, length of ICU stay and hospital
stay. CONCLUSION: RAP resulted in a significant decrease in intraoperative
haemodilution and conserved the use of blood. This technique should be
considered for patients with a small body surface area (<1.5 m) undergoing
open heart surgery.
<19>
[Use Link to view the full text]
Accession Number
0019478674
Authors
Cui W. Li Y. Li S. Wang R. Li J.
Institution
(Cui, Li, Li, Wang, Li) Department of Anesthesia, Capital Medical
University affiliated Beijing Friendship Hospital, Beijing, PR China.
Title
Systemic administration of lidocaine reduces morphine requirements and
postoperative pain of patients undergoing thoracic surgery after
propofol-remifentanil-based anaesthesia..
Source
European journal of anaesthesiology. 27(1)(pp 41-46), 2010. Date of
Publication: Jan 2010.
Abstract
BACKGROUND AND OBJECTIVE: Remifentanil is being increasingly used as an
analgesic in fast-track surgery, but severe postoperative pain may happen
occasionally. In this study, we evaluated the effects of systemic
administration of lidocaine on postoperative pain and morphine
requirements after propofol-remifentanil-based anaesthesia. METHODS: Forty
patients undergoing thoracic surgery were randomly assigned to lidocaine
(33.0 microg kg(-1) min(-1)) and physiological saline control groups in
propofol-remifentanil-based anaesthesia. The setting of the plasma
concentration (C(p)) of the target-controlled infusion of propofol was
adjusted according to the bispectral index of the electroencephalogram and
blood pressure. The C(p) and effect-site concentration (C(e)) of propofol
were calculated by target-controlled infusion pump during the
intraoperative period. Pain scoring includes a four-point verbal rating
scale, Riker's sedation-agitation scale and a visual analogue scale; the
morphine requirement in the postanaesthesia care unit and the morphine
consumption via a patient-controlled analgesia device on the ward were
recorded during the postoperative period. RESULTS: Morphine requirements
within 30, 30-60 and 0-120 min in the postanaesthesia care unit of the
lidocaine group decreased significantly (P < 0.05, n = 20 per group)
compared with that of the control group. The four-point verbal rating
scale at 30 min in the postanaesthesia care unit, visual analogue scale at
6 h on coughing and patient-controlled analgesia morphine consumption
during 2-6 h postoperative time were also significantly (P < 0.05, n = 20
per group) reduced in the lidocaine group. In addition, the intraoperative
propofol C(e) in the lidocaine group during the periods of intubation,
organ resection, closing of chest cavity and extubation was significantly
lower (P < 0.05, n = 20 per group) than that in the control group under
the same hypnotic depth. CONCLUSION: Systemic administration of lidocaine
could reduce morphine requirements, postoperative pain and intraoperative
propofol C(e) of patients undergoing thoracic surgery after
propofol-remifentanil-based anaesthesia.
No comments:
Post a Comment