Results Generated From:
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EMBASE (updates since 2010-04-22)
<1>
Accession Number
0020238333
Authors
Hoenig M.R. Aroney C.N. Scott I.A.
Institution
(Hoenig, Aroney, Scott) Royal Brisbane and Women's Hospital, Herston,
Brisbane, Australia, 4029.
Title
Early invasive versus conservative strategies for unstable angina and
non-ST elevation myocardial infarction in the stent era..
Source
Cochrane database of systematic reviews (Online). 3(pp CD004815), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: In patients with unstable angina and non-ST elevation
myocardial infarction (UA/NSTEMI) two strategies are possible, either a
routine invasive strategy where all patients undergo coronary angiography
shortly after admission and, if indicated, coronary revascularization; or
a conservative strategy where medical therapy alone is used initially,
with selection of patients for angiography based on clinical symptoms or
investigational evidence of persistent myocardial ischemia. OBJECTIVES: To
determine the benefits of an invasive compared to conservative strategy
for treating UA/NSTEMI in the stent era. SEARCH STRATEGY: The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library
2008, Issue 1), MEDLINE and EMBASE were searched (1996 to February 2008)
with no language restrictions. SELECTION CRITERIA: Included studies were
prospective trials comparing invasive with conservative strategies in
UA/NSTEMI. DATA COLLECTION AND ANALYSIS: We identified five studies (7818
participants). Using intention-to-treat analysis with random-effects
models, summary estimates of relative risk (RR) with 95% confidence
interval (CI) were determined for primary end-points of all-cause death,
fatal and non-fatal myocardial infarction, all-cause death or non-fatal
myocardial infarction, and refractory angina. Further analysis of included
studies was undertaken based on whether glycoprotein IIb/IIIa receptor
antagonists were used routinely. Heterogeneity was assessed using Chi(2)
and variance (I(2) statistic) methods. MAIN RESULTS: In the all-study
analysis, mortality during initial hospitalization showed a trend to
hazard with an invasive strategy (RR 1.59, 95% CI 0.96 to 2.64). The
invasive strategy did not reduce death on longer-term follow up.
Myocardial infarction rates assessed at 6 to 12 months (5 trials) and 3 to
5 years (3 trials) were significantly decreased by an invasive strategy
(RR 0.73, 95% CI 0.62 to 0.86; and RR 0.78, 95% CI 0.67 to 0.92
respectively). The incidence of early (< 4 month) and intermediate (6 to
12 month) refractory angina were both significantly decreased by an
invasive strategy (RR 0.47, 95% CI 0.32 to 0.68; and RR 0.67, 95% CI 0.55
to 0.83 respectively), as were early and intermediate rehospitalization
rates (RR 0.60, 95% CI 0.41to 0.88; and RR 0.67, 95% CI 0.61 to 0.74
respectively). The invasive strategy was associated with a two-fold
increase in the RR of peri-procedural myocardial infarction (as variably
defined) and a 1.7-fold increase in the RR of (minor) bleeding with no
hazard of stroke. AUTHORS' CONCLUSIONS: Compared to a conservative
strategy for UA/NSTEMI, an invasive strategy is associated with reduced
rates of refractory angina and rehospitalization in the shorter term and
myocardial infarction in the longer term. However, the invasive strategy
is associated with a doubled risk of procedure-related heart attack and
increased risk of bleeding and procedural biomarker leaks. Available data
suggest that an invasive strategy may be particularly useful in those at
high risk for recurrent events.
<2>
Accession Number
0020238316
Authors
Carless P.A. Henry D.A. Moxey A.J. O'Connell D. Brown T. Fergusson D.A.
Institution
(Carless, Henry, Moxey, O'Connell, Brown, Fergusson) Discipline of
Clinical Pharmacology, Faculty of Health, University of Newcastle, Level
5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street,
Waratah, Newcastle, New South Wales, Australia, 2298.
Title
Cell salvage for minimising perioperative allogeneic blood transfusion..
Source
Cochrane database of systematic reviews (Online). 3(pp CD001888), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Concerns regarding the safety of transfused blood, have
prompted reconsideration of the use of allogeneic (blood from an unrelated
donor) red blood cell (RBC) transfusion, and a range of techniques to
minimise transfusion requirements. OBJECTIVES: To examine the evidence for
the efficacy of cell salvage in reducing allogeneic blood transfusion and
the evidence for any effect on clinical outcomes. SEARCH STRATEGY: We
identified studies by searching CENTRAL (The Cochrane Library 2009, Issue
2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the Internet
(to August 2009) and bibliographies of published articles. SELECTION
CRITERIA: Randomised controlled trials with a concurrent control group in
which adult patients, scheduled for non-urgent surgery, were randomised to
cell salvage (autotransfusion), or to a control group, who did not receive
the intervention. DATA COLLECTION AND ANALYSIS: Data were independently
extracted and the risk of bias assessed. Relative risks (RR) and weighted
mean differences (WMD) with 95% confidence intervals (CIs) were
calculated. Data were pooled using a random effects model. The primary
outcomes were the number of patients exposed to allogeneic red cell
transfusion, and the amount of blood transfused. Other clinical outcomes
are detailed in the review. MAIN RESULTS: A total of 75 trials were
included. Overall, the use of cell salvage reduced the rate of exposure to
allogeneic RBC transfusion by a relative 38% (RR=0.62: 95% CI 0.55 to
0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC
transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR
of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to
0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage
resulted in an average saving of 0.68 units of allogeneic RBC per patient
(WMD=-0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact
adversely on clinical outcomes. AUTHORS' CONCLUSIONS: The results suggest
cell salvage is efficacious in reducing the need for allogeneic red cell
transfusion in adult elective cardiac and orthopaedic surgery. The use of
cell salvage did not appear to impact adversely on clinical outcomes.
However, the methodological quality of trials was poor. As the trials were
unblinded and lacked adequate concealment of treatment allocation,
transfusion practices may have been influenced by knowledge of the
patients' treatment status potentially biasing the results in favour of
cell salvage.
<3>
Accession Number
2010207022
Authors
Serebruany V.L. Atar D.
Institution
(Serebruany) HeartDrugTM Research Laboratories, Johns Hopkins University,
Towson, MD 21204, United States.
(Atar) Division of Cardiology, Oslo University Hospital Aker, Faculty of
Medicine, Norway.
Title
The PLATO trial: Do you believe in magic?.
Source
European Heart Journal. 31(7)(pp 764-767), 2010. Date of Publication:
April 2010.
Publisher
Oxford University Press
Abstract
The recently published and presented PLATelet Inhibition and Clinical
Outcomes (PLATO) trial was a pivotal Phase III, randomized, double-blind,
parallel-group, multinational, clinical study.1 The trial compared
head-to-head the efficacy of the experimental antiplatelet agent
ticagrelor (formerly known as AZD6140, to be marketed as Brilintaw) vs.
standard care with clopidogrel. Patients (n = 18 624) with moderate to
high risk acute coronary syndromes undergoing coronary intervention were
randomized to ticagrelor 180 mg loading dose followed by 90 mg twice daily
thereafter, or clopidogrel 300-600 mg loading dose followed by 75 mg once
daily for 6-12 months. The primary endpoint was the time of the first
event of death from vascular causes, myocardial infarction (MI), or
stroke, and occurred in 11.7% of patients treated with clopidogrel vs.
9.8% of patients randomized to ticagrelor, representing a highly
significant benefit [hazard ratio (HR)=0.84; confidence interval (CI)
=0.77-0.92; P<0.001] of the experimental drug.1 Triaging these three
components of the combined endpoint suggests that the difference in favour
of ticagrelor was driven by the reduction of vascular death (P<0.001) and
MI (P<0.005), but not stroke (P=0.22). There were significantly more fatal
intracranial bleedings (11 vs. 1, P=0.02), but numerically less overall
fatal bleeding (20 vs. 23) after ticagrelor. Among side effects associated
with ticagrelor, dyspnoea (already recognized in the earlier studies with
AZD6140, and probably caused by transitory bronchoconstriction) was the
most prominent one (HR=1.84; CI=1.68-2.02; P<0.001), followed by
ventricular pauses (P,0.01), and laboratory findings of increased uric
acid as well as elevated creatinine (P<0.001 for both). Obviously the
PLATO data will undergo detailed scrutiny and verification during the
assessment by regulatory authorities; however, some considerations already
seem appropriate.
<4>
Accession Number
2010207978
Authors
Conte J.
Institution
(Conte) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, MD, United States.
Title
An indictment of the STICH trial: "True, true, and unrelated".
Source
Journal of Heart and Lung Transplantation. 29(5)(pp 491-496), 2010. Date
of Publication: May 2010.
Publisher
Elsevier USA
<5>
Accession Number
2010222827
Authors
Weir R.A.P. Murphy C.A. Petrie C.J. Martin T.N. Clements S. Steedman T.
Wagner G.S. McMurray J.J.V. Dargie H.J.
Institution
(Weir, Murphy, Petrie, Martin, Clements, Steedman, McMurray, Dargie)
Cardiology Department, Western Infirmary, Glasgow G11 6NT, Scotland,
United Kingdom.
(Wagner) Duke University Medical Center, Durham, NC, United States.
Title
Monocyte chemoattractant protein-1: A dichotomous role in cardiac
remodeling following acute myocardial infarction in man?.
Source
Cytokine. 50(2)(pp 158-162), 2010. Date of Publication: May 2010.
Publisher
Academic Press
Abstract
Introduction: Monocyte chemoattractant protein-1 (MCP-1) is elevated after
acute myocardial infarction (AMI), and potentiates left ventricular (LV)
remodeling in murine models of AMI. We examined the relationships between
serum MCP-1, change in LV function and biomarkers related to remodeling in
a cohort of AMI patients. Methods: Serum MCP-1 concentrations were
measured in 100 patients (age 58.9 +/- 12.0. years, 77% male) admitted
with AMI and LV dysfunction, at baseline (mean 46. h), 12 and 24. weeks;
cardiac magnetic resonance imaging and measurement of matrix
metalloproteinase-2 (MMP-2), MMP-3 and MMP-9 occurred at each time-point.
Results: MCP-1 increased significantly from 697 [483, 997]. pg/mL at
baseline to 878 [678, 1130]. pg/mL at 24. weeks (p<0.001). MMP-3
concentration increased while MMP-9 decreased significantly over time;
MMP-2 concentration did not change significantly. Baseline MCP-1
correlated with change in (Delta) LV end-systolic volume index
(DeltaLVESVI; r=-0.48, p=0.01) and with DeltaLV ejection fraction
(DeltaLVEF; r=0.50, p=0.02). However, DeltaMCP-1 correlated positively
with DeltaLVESVI (r=0.40, p=0.006) and negatively with DeltaLVEF (r=-0.36,
p=0.004). MCP-1 had no relationship with any MMP. Conclusions: MCP-1 may
have a dichotomous role following AMI, aiding early infarct healing but
potentiating later remodeling, which merits further study before any
therapeutic trials of MCP-1 modulation in humans. copyright 2010 Elsevier
Ltd.
<6>
Accession Number
2010217444
Authors
van de Gevel D.F.D. Soliman Hamad M.A. Elenbaas T.W.O. Ostertag J.U.
Schonberger J.P.A.M.
Institution
(van de Gevel, Soliman Hamad, Elenbaas, Schonberger) Department of
Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, Michelangelolaan
2, 5623 EJ Eindhoven, Netherlands.
(Ostertag) Department of Dermatology, Catharina Hospital, Eindhoven,
Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands.
Title
Is the use of Steri-Strip[trademark] S for wound closure after coronary
artery bypass grafting better than intracuticular suture?.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 561-564), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Several methods have been used in wound closure after coronary artery
bypass grafting (CABG). In this study, the safety and efficacy of one of
these methods, Steri-Strip[trademark] S is compared with the traditional
intracuticular suture method. Eighty-one patients undergoing CABG were
prospectively randomized into two groups according to the method of skin
closure: Steri-Strip[trademark] S group and traditional suture group.
Comparison between the two methods was done with regards to the length of
the wound and the time needed to close it. The median closure time with
Steri-Strip[trademark] S was 5.45+/-3.35 min vs. 7.53+/-3.41 min in the
suture group. A pain score of [greater-than or equal to]6 at the first
postoperative day was found in 30% of the patients in the suture group vs.
14% of the patients in the Steri-Strip[trademark] S group (P=0.07).
Cosmetic evaluation showed a non-significant difference in the linear
visual analogue score in favor of Steri-Strip[trademark] S group compared
to the intracuticular suture group (73.1 vs. 70.1) (P=0.07).
Steri-Strip[trademark] S is a fast, safe alternative for wound closure of
the sternotomy incision and graft harvesting site. A larger study is
needed to establish the potential beneficial effect of
Steri-Strip[trademark] S on wound infection prevention. copyright 2010
Published by European Association for Cardio-thoracic Surgery.
<7>
Accession Number
2010217433
Authors
Hoffmann M. Bruch H.-P. Kujath P. Limmer S.
Institution
(Hoffmann, Bruch, Kujath, Limmer) Surgical Clinic, University Clinic
Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck,
Germany.
Title
Cold-plasma coagulation in the treatment of malignant pleural
mesothelioma: Results of a combined approach.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 502-505), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Malignant pleural mesothelioma is on a continuous rise throughout the
Western countries. It is associated with asbestos fibre exposition in the
past. Surgical approaches include extrapleural pneumonectomy and
pleurectomy/decortication (PyD). We investigated the feasability of the
implementation of cold-plasma coagulation (CPC) on the pleura, pericardium
and diaphragm into an established therapeutic algorithm consisting of PyD
and hyperthermic intrathoracal chemoperfusion (HITHOC) therapy. The
underlying rationale was the prevention of cardiotoxic effects during
HITHOC as well as accidental translocation of malignant cells to the
abdomen. CPC was done as part of a multimodal therapy in stage III
mesothelioma patients. Histologic examinations of pleural excisates after
CPC were done. The patients were followed up in three-month intervals.
Neither parenchymal fistulas, nor cardiotoxic effects were observed. The
histologic examination of the pleural excisates showed complete
predictable necrosis. Moreover, until now (median time after operation 1
year) no relapse of the disease was observed. CPC proved to be a safe
technique when used on the pleura, pericardium and diaphragm. We consider
our trial as a pilot-study. To evaluate potential survival benefits using
this technique larger trials are mandatory. copyright 2010 Published by
European Association for Cardio-Thoracic Surgery.
<8>
Accession Number
2010217102
Authors
Crowe E. Lovibond K. Gray H. Henderson R. Krause T. Camm J.
Institution
(Crowe, Lovibond, Krause) National Clinical Guideline Centre, Royal
College of Physicians of London, London NW1 4LE, United Kingdom.
(Gray) Southampton University Hospital, Southampton SO16 6YD, United
Kingdom.
(Henderson) Nottingham University Hospitals, Nottingham NG5 1PB, United
Kingdom.
(Camm) St. George's, University of London, London SW17 0RE, United
Kingdom.
Title
Early management of unstable angina and non-ST segment elevation
myocardial infarction: Summary of NICE guidance.
Source
BMJ. 340(7750)(pp 805-807), 2010. Date of Publication: 10 Apr 2010.
Publisher
BMJ Publishing Group
<9>
Accession Number
2010211230
Authors
Chong E. Poh K.K. Liang S. Lee R.C.-H. Low A. Teo S.-G. Tan H.C.
Institution
(Chong) Cardiac Department, Alexandra Hospital, National University,
Singapore.
(Poh, Lee, Low, Teo, Tan) National University, Heart Center, National
University Hospital, Singapore.
(Poh, Lee, Low, Teo, Tan) Yong Loo Lin School of Medicine, National
University of Singapore, Singapore.
(Liang) Biostatistics Unit, National University of Singapore, Yong Loo Lin
School of Medicine, Singapore.
Title
Two-year clinical registry follow-up of endothelial progenitor cell
capture stent versus sirolimus-eluting bioabsorbable polymer-coated stent
versus bare metal stents in patients undergoing primary percutaneous
coronary intervention for ST elevation myocardial infarction: ACUTE
CORONARY SYNDROME.
Source
Journal of Interventional Cardiology. 23(2)(pp 101-108), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Endothelial progenitor cell (EPC) capture stent is designed to
promote rapid endothelization and healing and is potentially useful in
patients undergoing primary percutaneous coronary intervention (PCI) for
acute myocardial infarction (AMI). We studied the intermediate-term
efficacy and safety of EPC stent and compared that with sirolimus-eluting
bioabsorbable polymer stent (CURA) and bare metal stent (BMS) in AMI
patients. Methodology: Patients presenting with AMI who underwent primary
PCI with the respective stents between January 2004 and June 2006 were
enrolled in the single-center clinical registry. The study end-points were
major adverse cardiac events (MACE) and stent thrombosis. Results: A total
of 366 patients (EPC = 95, CURA = 53, BMS 218) were enrolled. Baseline
demographics including age, gender, diabetes, renal impairment,
predischarge left ventricular ejection fraction, and creatinine kinase
level were comparable among the groups. Procedural success rate was 99.5%.
Post-procedural thrombolysis in myocardial infarction (TIMI) 3 flow was
achieved in EPC 91.6%, CURA 96.2%, and BMS 88.5% (P = 0.209). At 2 years,
the MACE rate was EPC 13.7%, CURA 15.1%, and BMS 19.7% (P = 0.383). Target
vessel revascularizations (TVR) were EPC 4.2%, CURA 9.4%, and BMS 6.0% (P
= 0.439). Nonfatal myocardial infarctions were EPC 1.1%, CURA 3.8%, and
BMS 4.1% (P = 0.364). One patient in the EPC group had acute stent
thrombosis. There was no late stent thrombosis in the EPC group.
Conclusion: EPC stent appeared to be safe and had comparable clinical
efficacy with a BMS when used in the AMI setting. At 2-year follow-up, the
EPC group showed favorable, single-digit TVR rate and stent thrombosis
remained a low-event occurrence. copyright 2010, Wiley Periodicals, Inc.
<10>
Accession Number
2010211223
Authors
Galassi A.R. Tomasello S.D. Costanzo L. Campisano M.B. MarzA F. Tamburino
C.
Institution
(Galassi, Tomasello, Costanzo, Campisano, MarzA, Tamburino) Department of
Internal Medicine and Systemic Disease, Ferrarotto Hospital, University of
Catania, Catania, Italy.
Title
Recanalization of complex coronary chronic total occlusions using
high-frequency vibrational energy CROSSER catheter as first-line therapy:
A single center experience.
Source
Journal of Interventional Cardiology. 23(2)(pp 130-138), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Several studies have illustrated the safety and the procedural
outcome of high-frequency vibrational energy in guidewire refractory
chronic total occlusions (CTOs). Aim: To evaluate the advantage of
high-frequency vibrational energy device (CROSSER Catheter) use in
coronary complex CTO revascularization as primary strategy. Methods:
CROSSER was used as a primary approach if four or more unfavorable
angiographic features were observed in the CTO lesions. Results: From May
2007 to February 2009, a CTO percutaneous intervention attempt was
performed in 178 lesions of 171 patients (60.1 +/- 8.9 age with 49.4 +/-
7.2% in ejection fraction). Among these, the CROSSER was used in 46
complex CTO lesions of 45 patients (25.8% of cases) and in the remaining
cases, typical CTO percutaneous coronary intervention techniques were
employed. Clinical success was 84.8% in CROSSER group. Moreover, in the
CROSSER group, no periprocedural myocardial infarction, perforation, or 30
days MACE was observed. In addition, the use of CROSSER was associated
with lower time of procedure, time of fluoroscopy, and contrast load
administration as compared with conventional techniques [88 +/- 27 minutes
vs 109 +/- 38 minutes (P = 0.045), 39 +/- 12 minutes vs 50 +/- 27 minutes
(P = 0.032), and 334 +/- 122cc vs 408 +/- 198cc (P = 0.05), respectively].
Conclusion: In the present study, the CROSSER System was safe and obtained
a high rate of success in complex CTO similar to conventional dedicated
guidewire techniques for noncomplex CTO; however, the CROSSER Catheter
obtained CTO recanalization with lower contrast load administration, less
time of procedure, and lower fluoroscopy exposure. copyright 2010, Wiley
Periodicals, Inc.
<11>
Accession Number
2010211219
Authors
Fernandez-Guerrero J.C. Herrador-Fuentes J. Sanchez-Gila J. Guzman-Herrera
M. Lozano C.
Institution
(Fernandez-Guerrero, Herrador-Fuentes, Sanchez-Gila, Guzman-Herrera,
Lozano) Unidad de Hemodinamica, Servicio de Cardiologia, Complejo
Hospitalario de Jaen, C/Avenida Ejercito Espanol, 10, 23007 Jaen, Spain.
Title
In-hospital and 12-month postprocedural clinical outcome of coronary
bifurcational lesion treatment with the endeavor stent.
Source
Journal of Interventional Cardiology. 23(2)(pp 188-194), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: The zotarolimus-eluting stent (ZES) has been documented as
significantly reducing restenosis and target lesion revascularization
(TLR) requirement compared to bare metal stents (BMS). Methods: In this
single-centered, prospective study we sought to evaluate the short- and
medium-term outcomes of ZES placement in bifurcated coronary artery
lesions. Between August 2006 and December 2007, 107 consecutive patients
(110 bifurcations) were recruited to have ZES placement in the lesion. The
provisional T stenting (PTS) technique was used in 96.3%. Angiographic
success was 100% in main vessel (MV) cases and 97.2% in that of side
branch (SB). Results: With a mean follow-up of 12.4 +/- 1.77 (mean +/- SD)
months there were four deaths, three from cardiac cause (2.85%). There
were 18 patients (19 bifurcations) requiring TLR (17.59%) for clinical
reasons. The only predictor of TLR was the use diameter of ZES [less-than
or equal to]3 mm. Conclusion: ZES can be used for bifurcation lesions
using the PTS technique with a high rate of intraprocedural success;
however, frequency of TLR is high, especially for stents with a diameter
[less-than or equal to]3 mm. copyright 2010, Wiley Periodicals, Inc.
<12>
Accession Number
2010207451
Authors
Angeli F. Verdecchia P. Karthikeyan G. Mazzotta G. Repaci S. Del Pinto M.
Gentile G. Cavallini C. Reboldi G.
Institution
(Angeli, Verdecchia, Mazzotta, Repaci, Del Pinto, Cavallini) Department of
Cardiology, Hospital 'Santa Maria della Misericordia', Perugia, Italy.
(Angeli, Verdecchia) Fondazione Umbra Cuore e Ipertensione, AUCI-ONLUS,
06126 Perugia, Italy.
(Karthikeyan) Departement of Cardiology, All India Institute of Medical
Sciences, New Delhi, India.
(Gentile, Reboldi) Department of Internal Medicine, University of Perugia,
Perugia, Italy.
Title
beta-blockers and risk of all-cause mortality in non-cardiac surgery.
Source
Therapeutic Advances in Cardiovascular Disease. 4(2)(pp 109-118), 2010.
Date of Publication: April 2010.
Publisher
SAGE Publications Ltd
Abstract
Myocardial ischemia is a frequent complication in patients undergoing
non-cardiac surgery and beta-blockers may exert a protective effect. The
main benefit of beta-blockers in perioperative cardiovascular morbidity
and mortality is believed to be linked to specific effects on myocardial
oxygen supply and demand. beta-blockers may exert anti-inflammatory and
anti-arrhythmic effects. Randomized clinical trials which evaluated the
effects of beta-blockers on all-cause mortality in patients undergoing
non-cardiac surgery have yielded conflicting results. In 9 trials, 10,544
patients with non-cardiac surgery were randomized to beta-blockers (n =
5274) or placebo (n = 5270) and there were a total of 304 deaths. Patients
randomized to beta-blockers group showed a 19% increased risk of all-cause
mortality (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.95-1.50; p
= 0.135). However, trials included in the meta-analysis differed in
several aspects, and a significant degree of heterogeneity (I2 = 46.5%)
was noted. A recent analysis showed that the surgical risk category had a
substantial influence on the overall estimate of the effect of
beta-blockers. Compared with patients in the
intermediate-high-surgical-risk category, those in the high-risk category
showed a 73% reduction in the risk of total mortality with beta-blockers
compared with placebo (OR 0.27, 95% CI 0.10-0.71, p = 0.016). These data
suggest that perioperative beta-blockers confer a benefit which is mostly
limited to patients undergoing high-risk surgery. copyright The Author(s),
2010.
<13>
Accession Number
2010173773
Authors
Onorati F. Rubino A.S. Nucera S. Foti D. Sica V. Santini F. Gulletta E.
Renzulli A.
Institution
(Onorati, Rubino, Nucera, Renzulli) Cardiac Surgery Unit, Magna Graecia
University of Catanzaro, Catanzaro, Italy.
(Foti, Gulletta) Pathology Unit, Magna Graecia University of Catanzaro,
Catanzaro, Italy.
(Santini) Cardiac Surgery Unit, University of Verona, Verona, Italy.
(Sica) Institute of Pathology, Second University of Naples, Naples, Italy.
Title
Off-pump coronary artery bypass surgery versus standard linear or
pulsatile cardiopulmonary bypass: endothelial activation and inflammatory
response.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 897-904), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objective: Poor outcomes after coronary artery bypass grafting (CABG) have
been linked to perioperative endothelial activation and systemic
inflammatory responses. The use of pulsatile cardiopulmonary bypass (PCPB)
or off-pump CABG (OPCABG) may minimise these phenomena. We compared
biochemical and clinical outcomes among patients who underwent CABG with
PCPB, CABG with linear CPB (LCPB) or OPCABG. Methods: Sixty consecutive
patients undergoing isolated elective CABG were prospectively randomised
trial to receive pulsatile CPB (group A, 20 patients), linear CPB (group
B, 20 patients) or OPCABG (group C, 20 patients). Levels of
proinflammatory cytokines (interleukins-2, -6, and -8), anti-inflammatory
cytokines (interleukin-10) and endothelial markers (vascular endothelial
growth factor (VEGF), monocyte chemo-attractant protein (MCP)-1) were
measured before, during and after surgery. Results: VEGF and MCP-1 levels
increased significantly during surgery in all groups, but they increased
the least and were the lowest overall with OPCABG. They rose most and
peaked overall with LCPB. Interleukin-2 levels remained stable during
OPCABG but decreased equally during PCPB and LCPB. Interleukin-6 and -8
levels rose significantly during both types of CPB versus OPCABG.
Interleukin-10 levels increased significantly in all groups during
surgery, but they rose least and were the lowest overall with OPCABG and
rose most and were the highest overall with PCPB. Intubation times,
intensive care unit (ICU) stay and hospital stay were significantly longer
in the LCPB group than the other two groups. Conclusions: LCPB appears to
promote endothelial activation and cytokine secretion, which may delay
recovery. OPCABG was associated with slight endothelial activation and
cytokine response. PCPB significantly attenuates endothelial/cytokine
leakage, resulting in hospital outcomes comparable with those after
OPCABG. copyright 2009 European Association for Cardio-Thoracic Surgery.
<14>
Accession Number
2010177833
Authors
Wu N. Yan S. Wang X. Lv C. Wang J. Zheng Q. Feng Y. Yang Y.
Institution
(Wu, Yan, Wang, Lv, Wang, Zheng, Feng, Yang) Key laboratory of
Carcinogenesis and Translational Research (Ministry of Education),
Department of Thoracic Surgery II, Peking University School of Oncology,
No. 52, Fucheng Avenue, Haidian District, Beijing 100142, China.
Title
A prospective, single-blind randomised study on the effect of intercostal
nerve protection on early post-thoracotomy pain relief.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 840-845), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objectives: Intracostal suture or intercostal muscle flap can reduce
post-thoracotomy pain through the preservation of intercostal nerves below
or above the incision. This study aims to test whether combining
intracostal suture with intercostal muscle flap might achieve better pain
relief than intracostal suture alone. Methods: This study included 144
consecutive patients who underwent pulmonary resection. Eighty patients
entered the trial but eight were excluded. Seventy-two patients were
randomly assigned to a muscle flap group, in which the fifth intercostal
muscle and neurovascular bundle were raised and intracostal suture on the
sixth rib was applied. For the control group, only intracostal suturing on
the sixth rib was done. All patients had a functional epidural placed,
which were removed 24 h after surgery. Differences on average numeric
rating scale (aNRS) scores were assessed in an early post-operative period
from day 1 to day 7 and a later period from week 2 to week 12, when
patients were resting or coughing. The doses of oxycodone demand and
hyperalgesia-related intercostal dermatomes (HIDs) were recorded for
analysis. Results: No differences were noted between the two groups in
terms of length and width of the incision, or duration of rib retraction.
Neither in different time periods (early or late) nor the activity status
(while resting or coughing) yielded a statistical difference on aNRS
scores between the muscle flap group and the control group (muscle flap
group vs control group: mean (95% confidence intervals) from d ay 1 to day
7, 4.42 (1.56-7.28) vs 4.79 (2.03-7.55) on coughing (p = 0.282); median
(inter-quartile range, IQR) from day 1 to day 7, 1.71 (0.86-3) vs 2.50
(1.16-3.12) while resting (p = 0.279); median (IQR) from week 2 to week
12, 0.43 (0-0.86) vs 0.48 (0.06-1.20) on coughing (p = 0.595); median
(IQR) from week 2 to week 12, 0 (0-0.14) vs 0.05 (0-0.14) while resting (p
= 0.856)). No differences were found in total oxycodone consumption from
day 1 to day 7 between the two groups (Z = -1.821, p = 0.069). The rate of
HIDs in each intercostal space and median number of HIDs were similar
between the two groups on day 1 (p > 0.05) and day 7 (p > 0.05).
Conclusions: The combination of intracostal suture with intercostal muscle
flap may not necessarily achieve better post-thoracotomy pain control than
using intracostal suture alone. copyright 2009 European Association for
Cardio-Thoracic Surgery.
<15>
Accession Number
2010177832
Authors
Cardillo G. Carleo F. Giunti R. Lopergolo M.G. Salvadori L. De Massimi
A.R. Petrella L. Martelli M.
Institution
(Cardillo, Carleo, Giunti, Lopergolo, Salvadori, De Massimi, Martelli)
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera
San Camillo-Forlanini, Via Portuense 332, 00149 Rome, Italy.
(Petrella) Department of Studi Geoeconomici, Linguistici, Statistici,
Storici per l'Analisi Regionale, Sapienza University of Rome, Rome, Italy.
Title
Predictors of survival in patients with locally advanced thymoma and
thymic carcinoma (Masaoka stages III and IVa).
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 819-823), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objective: We sought to evaluate factors influencing long-term survival of
patients with locally advanced thymoma/thymic carcinoma (Masaoka stages
III and IVa) treated by immediate surgery or induction therapy plus
surgery. Methods: From January 1991 to April 2007, we surgically treated
61 patients with locally advanced thymoma/thymic carcinoma (Masaoka stages
III and IVa). Staging included total body computed tomography (CT) scan in
all patients, and chest magnetic resonance imaging (MRI) in 27 selected
patients. All patients had histological confirmation before surgery.
Thirty-one patients (group A) underwent induction chemotherapy followed by
surgery. Thirty patients (group B) underwent immediate surgery.
Thirty-four patients (group A: 13; group B: 17) received postoperative
radiation therapy. Results: No intra-operative mortality was reported.
World Health Organization (WHO) histological classification included 19
AB, four B1, seven B2 and 13 B3 thymomas and 18 thymic carcinomas.
Thirty-four patients were Masaoka stage III (group A: 18; group B: 16) and
27 patients were stage IVa (group A: 13; group B: 14). After a median
follow-up of 77 months, six patients of group A and seven patients of
group B died of disease. The overall 10-year survival rate was 50.6%. The
10-year survival rate was 57.9% in group A and 38.1% in group B (p =
0.03). Multivariate analysis showed complete resection (p = 0.02), Masaoka
stage (III vs IVa) (p = 0.02), induction chemotherapy (group A vs group B)
(p = 0.003) and histological WHO subtype (AB vs B1, B2 and B3) (p = 0.01)
to be statistically significant independent predictors of survival. Sex,
age and adjuvant radiation therapy showed no statistically significant
difference. Conclusions: Complete resection, Masaoka stage, induction
chemotherapy and histological WHO classification showed to be independent
predictors of survival in locally advanced thymoma/thymic carcinoma.
copyright 2009 European Association for Cardio-Thoracic Surgery.
<16>
Accession Number
2010173724
Authors
Fan Y. Zhang A.-M. Xiao Y.-B. Weng Y.-G. Hetzer R.
Institution
(Fan, Xiao) Department of Cardiothoracic and Vascular Surgery, Chongqing
Xinqiao Hospital, Third Military Medical University, Chongqing, China.
(Zhang) Department of Oncology, Chongqing Xinqiao Hospital, Third Military
Medical University, Chongqing, China.
(Weng, Hetzer) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum Berlin, Berlin, Germany.
Title
Warm versus cold cardioplegia for heart surgery: a meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 912-919), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Much controversy persists regarding the optimal techniques for myocardial
protection during heart surgery. Numerous studies have compared warm
cardioplegia with cold cardioplegia for myocardial preservation, but the
outcomes were inconclusive. The aim of this meta-analysis of randomised
controlled trials (RCTs) was to compare the beneficial and harmful effects
of warm and cold cardioplegia during heart surgery. Electronic databases
and manual bibliographical searches were conducted. A meta-analysis of all
RCTs comparing warm cardioplegia to cold cardioplegia perfusion during
cardiac surgery was performed. Data for clinical events (in-hospital
death, myocardial infarction (MI), low output syndrome, postoperative use
of intra-aortic balloon pump, stroke and atrial fibrillation),
postoperative cardiac index, postoperative creatine kinase-MB (CK-MB) and
cardiac troponin release were extracted, and we summarised the combined
results of the data of the RCTs as relative risk (RR), with 95% confidence
intervals. A total of 41 RCTs including 5879 patients were assessed in
this study. We found that there was no statistical difference between
patients receiving warm cardioplegia and cold cardioplegia in the
incidences of clinical events. Warm cardioplegia was associated with
improved postoperative cardiac index. CK-MB and cardiac troponin
concentrations after surgery were significantly lower in the warm group as
compared with the cold group. Using warm cardioplegia for myocardial
protection during heart surgery resulted in similar incidences of clinical
events, significant improvement in postoperative cardiac index and
reduction in postoperative enzyme release as compared with cold
cardioplegia. copyright 2009 European Association for Cardio-Thoracic
Surgery.
<17>
Accession Number
2010218092
Authors
Ovrum E. Tangen G. Tollofsrud S. Ringdal M.-A.L. Oystese R. Istad R.
Institution
(Ovrum, Tangen, Tollofsrud, Ringdal, Oystese, Istad) Division of
Cardiovascular and Respiratory Medicine and Surgery, Oslo Heart Center,
Oslo University Hospital, Rikshospitalet, Norway.
Title
Low postoperative dose of aprotinin reduces bleeding and is safe in
patients receiving clopidogrel before coronary artery bypass surgery. A
prospective randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 545-548), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Clopidogrel (Plavix) given before the operation increases bleeding
complications following coronary artery bypass grafting (CABG). High
perioperative doses of aprotinin (Trasylol) are known to reduce bleeding
and transfusions after cardiac surgery, but may increase the risk of
thrombosis, renal impairment, and mortality. The aim of the study was to
evaluate the clinical effects of aprotinin given in high doses intra- and
postoperatively vs. a low postoperative dose in patients on clopidogrel.
Patients admitted for first-time CABG and receiving clopidogrel with or
without aspirin, were prospectively randomized either to receive a total
of 75,000 kallikrein inhibitor unit (KIU)/kg aprotinin given intra- and
postoperatively or 25,000 KIU/kg aprotinin after the operation. Three
hundred and ninety-nine patients aged 32-87 years (median 67 years) were
included. Postoperative bleeding was slightly different, but moderate in
both groups. The transfusion rate was similar, as were the incidences of
postoperative neurological disturbances and myocardial infarction. Renal
impairment and need for inotropic drugs were more frequent in the high
dose group. Thirty-day mortality was similar (high dose 2%, low dose 0.5%,
P=0.22). A low postoperative dose of aprotinin in patients receiving
clopidogrel is safe and has comparable effects regarding postoperative
bleeding complications as a high dose. copyright 2010 Published by
European Association for Cardio-Thoracic Surgery.
<18>
Accession Number
2010210919
Authors
Piscione F. Piccolo R. Cassese S. Galasso G. D'Andrea C. De Rosa R.
Chiariello M.
Institution
(Piscione, Piccolo, Cassese, Galasso, D'Andrea, De Rosa, Chiariello)
Department of Clinical Medicine, Cardiovascular Sciences and Immunology,
Federico II University, Naples, Italy.
Title
Is direct stenting superior to stenting with predilation in patients
treated with percutaneous coronary intervention? Results from a
meta-analysis of 24 randomised controlled trials.
Source
Heart. 96(8)(pp 588-594), 2010. Date of Publication: April 2010.
Publisher
BMJ Publishing Group
Abstract
Background: In the last decade, direct stenting has been proposed as an
alternative strategy to conventional stenting with balloon predilation.
The aim of this study was to perform a meta-analysis of randomised trials
comparing a direct stenting strategy versus a conventional one. Methods: A
literature search was performed using Medline, EMBASE, the Cochrane
Central Register of Controlled Trials, scientific session abstracts and
relevant websites, from inception of each database to June 2009. Included
studies comprised randomised controlled trials evaluating direct versus
conventional stenting in patients undergoing percutaneous coronary
intervention. Primary endpoint was the composite of death or myocardial
infarction and secondary endpoints were myocardial infarction and
target-vessel revascularisation occurrence. Results: 24 trials met
inclusion criteria, with 6803 patients enrolled (3412 or 50.15% randomised
to direct stenting and 3391 or 49.85% randomised to conventional
stenting). Up to 6-month follow-up, the composite of death or myocardial
infarction was significantly reduced with direct stenting compared with
conventional stenting (3.95% versus 5.10% respectively, OR=0.76 (95% CI
0.60 to 0.96), p=0.02). This reduction was primarily driven by a lower
myocardial infarction occurrence (3.16% versus 4.04%, respectively,
OR=0.77 (0.59 to 0.99), p=0.04). Furthermore, direct stenting was not
associated with a reduction in target-vessel revascularisation (6.50%
versus 6.96%, respectively, OR=0.92 (0.76 to 1.12), p=0.42). Conclusion:
This meta-analysis demonstrates that, in selected coronary lesions, direct
stenting improves outcome in patients undergoing percutaneous coronary
intervention, primarily reducing myocardial infarction incidence.
<19>
Accession Number
2010210670
Authors
Flores G.
Title
Racial and ethnic disparities in the health and health care of children.
Source
Pediatrics. 125(4)(pp e979-e1020), 2010. Date of Publication: April 2010.
Publisher
American Academy of Pediatrics
Abstract
OBJECTIVE: This technical report reviews and synthesizes the published
literature on racial/ethnic disparities in children's health and health
care. METHODS: A systematic review of the literature was conducted for
articles published between 1950 and March 2007. Inclusion criteria were
peer-reviewed, original research articles in English on racial/ ethnic
disparities in the health and health care of US children. Search terms
used included "child," "disparities," and the Index Medicus terms for each
racial/ethnic minority group. RESULTS: Of 781 articles initially reviewed,
111 met inclusion criteria and constituted the final database. Review of
the literature revealed that racial/ethnic disparities in children's
health and health care are quite extensive, pervasive, and persistent.
Disparities were noted across the spectrum of health and health care,
including in mortality rates, access to care and use of services,
prevention and population health, health status, adolescent health,
chronic diseases, special health care needs, quality of care, and organ
transplantation. Mortality-rate disparities were noted for children in all
4 major US racial/ethnic minority groups, including substantially greater
risks than white children of all-cause mortality; death from drowning,
from acute lymphoblastic leukemia, and after congenital heart defect
surgery; and an earlier median age at death for those with Down syndrome
and congenital heart defects. Certain methodologic flaws were commonly
observed among excluded studies, including failure to evaluate children
separately from adults (22%), combining all nonwhite children into 1 group
(9%), and failure to provide a white comparison group (8%). Among studies
in the final database, 22% did not perform multivariable or stratified
analyses to ensure that disparities persisted after adjustment for
potential confounders. CONCLUSIONS: Racial/ethnic disparities in
children's health and health care are extensive, pervasive, and
persistent, and occur across the spectrum of health and health care.
Methodologie flaws were identified in how such disparities are sometimes
documented and analyzed. Optimal health and health care for all children
will require recognition of disparities as pervasive problems,
methodologically sound disparities studies, and rigorous evaluation of
disparities interventions.
<20>
Accession Number
2010210628
Authors
Snookes S.H. Gunn J.K. Eldridge B.J. Donath S.M. Hunt R.W. Galea M.P.
Shekerdemian L.
Institution
(Snookes, Eldridge) Physiotherapy Department, Melbourne, VIC, Australia.
(Gunn, Hunt) Department of Neonatal Medicine, Melbourne, VIC, Australia.
(Donath) Clinical Epidemiology and Biostatistics Unit, Melbourne, VIC,
Australia.
(Shekerdemian) Paediatric Intensive Care Unit, Royal Children's Hospital,
Melbourne, VIC, Australia.
(Snookes, Galea) School of Physiotherapy, Melbourne, VIC, Australia.
(Gunn, Donath, Hunt, Shekerdemian) Department of Paediatrics, University
of Melbourne, Melbourne, VIC, Australia.
(Gunn, Hunt, Shekerdemian) Critical Care and Neurosciences, Melbourne,
VIC, Australia.
(Donath) Clinical Epidemiology and Biostatistics Unit, Murdoch Children's
Research Institute, Melbourne, VIC, Australia.
Title
A systematic review of motor and cognitive outcomes after early surgery
for congenital heart disease.
Source
Pediatrics. 125(4)(pp e818-e827), 2010. Date of Publication: April 2010.
Publisher
American Academy of Pediatrics
Abstract
CONTEXT: Brain injury is the most common long-term complication of
congenital heart disease requiring surgery during infancy. It is clear
that the youngest patients undergoing cardiac surgery, primarily neo-nates
and young infants, are at the greatest risk for brain injury.
Develop-mental anomalies sustained early in life have lifelong
repercussions. OBJECTIVE: We conducted a systematic reviewto examine
longitudinal studies of cognitive and/or motor outcome after cardiac
surgery dur-ing early infancy. METHODS: Electronic searches were performed
in Medline, the Cumu-lative Index to Nursing and Allied Health Literature
(Cinahl), and Em-base (1998-2008). The search strategy yielded 327
articles, of which 65 were reviewed. Eight cohorts provided prospective
data regarding the cognitive and/or motor outcome of infants who had
undergone surgery for congenital heart disease before 6 months of age. Two
authors, Ms Snookes and Dr Gunn, independently extracted data and
presented results according to 3 subgroups for age of follow-up: early
develop-ment (1 to <3 years); preschool age (3-5 years); and school age
(>5 to 17 years). Weighted analysis was undertaken to pool the results of
studies when appropriate. RESULTS: All of the identified studies reported
results of the Bayley Scales of Infant Development for children younger
than the age of 3. Outcome data as reported by the Bayley Scales were
combined for infants assessed at 1 year of age, revealing a weighted mean
Mental Development Index of 90.3 (95% confidence interval: 88.9-91.6) and
Psychomotor Development Index of 78.1 (95% confidence interval:
76.4-79.7). Additional analysis was limited by a lack of data at
pre-school and school age. CONCLUSIONS: With this review we identified a
limited number of pro-spective studies that systematically addressed
outcome in patients at the highest risk. These studies consistently
revealed cognitive and mo-tor delay in children after cardiac surgery
during early infancy. Addi-tional investigation is required to ascertain
the consequences of such impairment during later childhood and into adult
life.
<21>
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Accession Number
2010172125
Authors
Eder B. Hofmann P. Von Duvillard S.P. Brandt D. Schmid J.-P. Pokan R.
Wonisch M.
Institution
(Eder, Brandt, Wonisch) Center for Cardiac Rehabilitation, PVA SKA,
Quellenstr.1, Graz, A-8061 St Radegund, Austria.
(Hofmann) Institute of Sports Sciences, Human Performance Research,
Karl-Franzens University Graz, Austria.
(Von Duvillard) Department of Sport Science and Kinesiology, University of
Salzburg, Austria.
(Schmid) Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and
Rehabilitation, University Hospital, Switzerland.
(Pokan) Institute of Sports Science, University of Vienna, Austria.
Title
Early 4-week cardiac rehabilitation exercise training in elderly patients
after heart surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 30(2)(pp
85-92), 2010. Date of Publication: March-April 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: The aim of this study was to assess the effects on exercise
performance of supplementing a standard cardiac rehabilitation program
with additional exercise programming compared to the standard cardiac
rehabilitation program alone in elderly patients after heart surgery.
Methods: In this prospective, randomized controlled trial, 60 patients (32
men and 28 women, mean age 73.1 +/- 4.7 years) completed cardiac
rehabilitation (initiated 12.2 +/- 4.9 days postsurgery). Subjects were
assigned to either a control group (CG, standard cardiac rehabilitation
program [n = 19]), or an intervention group (IG, additional walking [n =
19], or cycle ergometry training [n = 22]). A symptom limited
cardiopulmonary exercise test and 6-minute walk test (6MWT) were performed
before and after 4 weeks of cardiac rehabilitation. The MacNew
questionnaire was used to assess quality of life (QOL). Results: At
baseline, no significant differences for peak oxygen uptake (V[dot]2),
maximal power output, or the 6MWT were detected between IG and CG. Global
QOL was significantly higher in IG. After 4 weeks of cardiac
rehabilitation, patients significantly improved in absolute values of the
cardiopulmonary exercise test, 6MWT, and QOL scores. Significant
differences between groups were found for peak V[dot]2 (IG: 18.2 +/- 3.1
mL*kg-1*min -1 vs. CG: 16.5 +/- 2.2 mL*kg*min, P < .05); maximal power
output (IG: 72.2 +/- 16 W vs. CG: 60.7 +/- 15 W, P < .05); 6MWT (IG: 454.8
+/- 76.3 m vs. CG: 400.5 +/- 75.5 m, P < .05); and QOL global (IG: 6.5 +/-
0.5 vs. CG: 6.3 +/- 0.6, P < .05). Conclusion: The supplementation of
additional walking or cycle exercise training to standard cardiac
rehabilitation programming compared to standard cardiac rehabilitation
alone in elderly patients after heart surgery leads to significantly
better exercise tolerance.
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