Results Generated From:
EMBASE <1980 to 2010 Week 25>
EMBASE (updates since 2010-06-17)
<1>
Accession Number
0020464762
Authors
Biancari F. Tiozzo V.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Kajaanintie
52, Oulu, Finland, 90029.
Title
Staples versus sutures for closing leg wounds after vein graft harvesting
for coronary artery bypass surgery..
Source
Cochrane database of systematic reviews (Online). 5(pp CD008057), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Surgical site infection (SSI) after saphenous vein graft
harvesting is a complication occurring in up to 18% of patients who
undergo coronary artery bypass surgery (CABG). It is not known whether the
method of skin closure influences the infection rate. OBJECTIVES: To
compare the rates of SSI and wound dehiscence of staples and sutures for
skin closure after saphenous vein graft harvesting for CABG. SEARCH
STRATEGY: We searched the following electronic databases: The Cochrane
Wounds Group Specialised Register (searched 11/3/10); The Cochrane Central
Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010 Issue
1; Ovid MEDLINE - 1950 to March Week 1 2010; Ovid MEDLINE - In-Process &
Other Non-Indexed Citations (Searched 11/3/10); Ovid EMBASE - 1980 to 2010
Week 09 and EBSCO CINAHL - 1982 to March 11 2010. No date or language
restrictions were applied. SELECTION CRITERIA: Trials comparing staples
and sutures for closing leg wounds after vein graft harvesting in patients
undergoing CABG were eligible for inclusion in this review. DATA
COLLECTION AND ANALYSIS: Two review authors independently assessed the
titles and abstracts of references identified by the search strategy
against the selection criteria and extracted data from eligible trials.
Included trials were assessed for the following risks of bias: generation
of random allocation sequence, allocation concealment, blinding,
incomplete outcome data, selective reporting and freedom from other
biases. For dichotomous variables, we calculated the relative risk with
95% confidence intervals (CI). MAIN RESULTS: We included three
prospective, randomised studies reporting on a total of 148 leg wounds
closed with staples and 175 with sutures after vein graft harvesting in
patients undergoing CABG. All trials were of sub-optimal methodological
quality and all trials were at risk of bias. Leg wound infection rate was
10.8% (16/148) after leg wound closure with staples compared with 8%
(14/174) with sutures (relative risk 1.20, 95% CI 0.60 to 2.39). Leg wound
dehiscence occurred in 9.3% (10/108) of patients after leg wound closure
with staples compared with 8.8% (12/137) with sutures (relative risk 1.05,
95%CI 0.43 to 2.53). AUTHORS' CONCLUSIONS: These results suggest that
there is no evidence of a difference in the risk of SSI and wound
dehiscence when staples rather than sutures are used to close leg wounds
after vein graft harvesting during CABG, however more research is needed.
<2>
Accession Number
2010316107
Authors
Sun L. Zhang T. Lan X. Du G.
Institution
(Sun, Zhang, Lan, Du) National Center for Pharmaceutical Screening,
Chinese Academy of Medical Sciences, Peking Union Medical College, 1 Xian
Nong Tan Street, Beijing 100050, China.
Title
Effects of stem cell therapy on left ventricular remodeling after acute
myocardial infarction: A meta-analysis.
Source
Clinical Cardiology. 33(5)(pp 296-302), 2010. Date of Publication: May
2010.
Publisher
John Wiley and Sons Inc.
Abstract
Objectives: The objective was to perform a meta-analysis of clinical
trials that investigated the effects of stem cell therapy on left
ventricular remodeling in patients after acutemyocardial infarction (AMI).
Background: Intracoronary injection of stem cells in the acute phase of
myocardial infarction has been proposed to replace the cardiomyocytes lost
and to prevent deleterious pathological remodeling after myocardial
infarction. Previously published trials have investigated the effects of
cell therapy on left ventricular (LV) remodeling in AMI patients. However,
the sample size of these studies is small and the conclusions are
inconsistent. Methods: Trials were identified in the Cochrane Library,
EMBASE, and Pub Med databases, reviews, and reference lists of relevant
articles. The weighted mean difference (WMD) was calculated for net
changes in LV end-diastolic and end-systolic volumes (LVEDV and LVESV) by
using fixed-effect models. Results: A total of 11 trials (13 comparisons)
with 832 participants evaluated the association between stem cell therapy
and changes in LVEDV. Compared with the control group, stemcell therapy
did not influence the LVEDV changes from baseline to follow-up (WMD: -1.76
mL, 95% confidence interval [CI]: -4.61 to 1.08 mL, P = 0.233). A total of
9 trials (11 comparisons) with 797 participants evaluated the association
between stem cell therapy and changes in LVESV. Compared with the control
group, patients in the cell therapy group had a significantly greater
reduction in LVESV from baseline to follow-up (WMD: -5.08 mL, 95% CI:
-7.80 to -2.37 mL, P < 0.001). Conclusion: This meta-analysis suggests
that cell therapy improves left ventricular contractility, but has no
effect on LV remodeling. copyright 2010 Wiley Periodicals, Inc.
<3>
Accession Number
2010316104
Authors
Naccarelli G.V. Johnston S.S. Lin J. Patel P.P. Schulman K.L.
Institution
(Naccarelli, Patel) Penn State Heart and Vascular Institute, Milton S.
Hershey Medical Center, Penn State University, Hershey, PA, United States.
(Johnston, Schulman) Health Care Divisions, Thomson Reuters, Cambridge,
MA, United States.
(Lin) Sanofi-aventis, Bridgewater, NJ, United States.
Title
Cost burden of cardiovascular hospitalization and mortality in ATHENA-like
patients with atrial fibrillation/atrial flutter in the United States.
Source
Clinical Cardiology. 33(5)(pp 270-279), 2010. Date of Publication: May
2010.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The ATHENA trial (A placebo-controlled, double-blind, parallel
arm Trial to assess the efficacy of dronedarone 400 mg bid for the
prevention of cardiovascular Hospitalization or death from any cause in
patiENts with Atrial fibrillation/atrial flutter) demonstrated that
dronedarone reduced the risk of cardiovascular (CV) hospitalization/death
by 24% (P < 0.001) in patients with atrial fibrillation (AF) and atrial
flutter (AFL). Hypothesis: In order to estimate the cost savings
associated with dronedarone use, we estimated the costs associated with CV
hospitalizations and in patient mortality in a large cohort of ATHENA-like
patients. Methods: In this retrospective analysis, we evaluated the cost
of CV hospitalization/mortality in real-world ATHENA-like patients without
heart failure and with employer-sponsored Medicare supplemental insurance
in the United States. Patients similar to those in ATHENA (age
[greater-than or equal to]70 years with AF/AFL and [greater-than or equal
to]1 stroke risk factor, without heart failure) who were hospitalized
between January 2, 2005, and January 1, 2007, were identified from the
MarketScan databases from Thomson Reuters. Health care costs were
evaluated during the 12 months following the index hospitalization.
Results: The analysis included 10 200 ATHENA-like patients.
Hospitalization for CV causes occurred in 53.9% of patients, with a total
of 6700 CV hospitalizations for fatal/nonfatal causes. Themost common
nonfatal causes of CV hospitalizations were AF/other supraventricular
rhythm disorders (20.2%of all CV hospitalizations), congestive heart
failure (CHF; 14.3%), and transient ischemic attack (TIA)/stroke
(10.7%).Mean costs per CV hospitalization for nonfatal causes were $10908.
Inpatient deaths from CV causes occurred in 264(2.6%) patients; the most
common causes of CV in patient death were intracranial/gastrointestinal
hemorrhage (24.2% of CV deaths), TIA/stroke (17.0%), and CHF (15.9%).Mean
hospitalization costsper CV in patient death were $18 565. Conclusions:
Health care costs associated with CV hospitalizations and inpatient deaths
among ATHENA-like patients in the US are high. Novel antiarrhythmic
therapies such as dronedarone, with the potential to reduce CV
hospitalizations/mortality in similar patients, could decrease health care
costs if adopted in clinical practice. copyright 2010 Wiley Periodicals,
Inc.
<4>
Accession Number
2010313720
Authors
McCarthy G.C. Megalla S.A. Habib A.S.
Institution
(McCarthy, Megalla, Habib) Department of Anesthesiology, Duke University
Medical Center, Box 3094, Durham, NC 27710, United States.
Title
Impact of intravenous lidocaine infusion on postoperative analgesia and
recovery from surgery: A systematic review of randomized controlled
trials.
Source
Drugs. 70(9)(pp 1149-1163), 2010. Date of Publication: 2010.
Publisher
Adis International Ltd
Abstract
Postoperative pain continues to be inadequately managed. While opioids
remain the mainstay for postoperative analgesia, their use can be
associated with adverse effects, including ileus, which can prolong
hospital stay. A number of studies have investigated the use of
perioperative intravenous lidocaine infusion for improving postoperative
analgesia and enhancing recovery of bowel function.This systematic review
was performed to determine the overall efficacy of intravenous lidocaine
infusion on postoperative analgesia and recovery from surgery in patients
undergoing various surgical procedures. We searched the databases of
MEDLINE, CINAHL and the Cochrane Library from 1966 to December 2009. We
searched for randomized controlled comparisons of lidocaine infusion with
placebo in the surgical setting and reporting on postoperative analgesia
and other aspects of patient recovery from surgery. The quality of all
included studies was assessed using the Modified Oxford Scale. Information
on postoperative pain intensity and analgesic requirements was extracted
from the trials and compared qualitatively. Other relevant data such as
return of bowel function, length of hospital stay, intraoperative
anaesthetic requirement and adverse effects were also compared.Sixteen
trials were included. A total of 395 patients received intravenous
lidocaine with 369 controls. In open and laparoscopic abdominal surgery,
as well as in ambulatory surgery patients, intravenous perioperative
infusion of lidocaine resulted in significant reductions in postoperative
pain intensity and opioid consumption. Pain scores were reduced at rest
and with cough or movement for up to 48 hours postoperatively. Opioid
consumption was reduced by up to 85 in lidocaine-treated patients when
compared with controls. Infusion of lidocaine also resulted in earlier
return of bowel function, allowing for earlier rehabilitation and shorter
duration of hospital stay. First flatus occurred up to 23 hours earlier,
while first bowel movement occurred up to 28 hours earlier in the
lidocaine-treated patients. Duration of hospital stay was reduced by an
average of 1.1 days in the lidocaine-treated patients. Administration of
intravenous lidocaine infusion did not result in toxicity or clinically
significant adverse events. Lidocaine had no impact on postoperative
analgesia in patients undergoing tonsillectomy, total hip arthroplasty or
coronary artery bypass surgery.In conclusion, intravenous lidocaine
infusion in the perioperative period is safe and has clear advantages in
patients undergoing abdominal surgery. Patients receiving lidocaine
infusion had lower pain scores, reduced postoperative analgesic
requirements and decreased intraoperative anaesthetic requirements, as
well as faster return of bowel function and decreased length of hospital
stay. Further studies are needed to assess whether lidocaine has a
beneficial effect in patients undergoing other types of surgery and to
determine the optimum dose, timing and duration of infusion of lidocaine
in this setting. copyright 2010 Adis Data Information BV. All rights
reserved.
<5>
Accession Number
2010198050
Authors
Rasmussen K. Maeng M. Kaltoft A. Thayssen P. Kelbaek H. Tilsted H.H.
Abildgaard U. Christiansen E.H. Engstrom T. Krusell L.R. Ravkilde J.
Hansen P.R. Hansen K.N. Abildstrom S.Z. Aaroe J. Jensen J.S. Kristensen
S.D. Botker H.E. Madsen M. Johnsen S.P. Jensen L.O. Sorensen H.T. Thuesen
L. Lassen J.F.
Institution
(Rasmussen, Tilsted, Ravkilde, Aaroe) Department of Cardiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark.
(Madsen, Johnsen, Sorensen) Department of Clinical Epidemiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark.
(Johnsen) Centre for Cardiovascular Research, Aarhus University Hospital,
Aalborg Hospital, Aalborg, Denmark.
(Maeng, Kaltoft, Christiansen, Krusell, Kristensen, Botker, Jensen,
Thuesen, Lassen) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark.
(Thayssen, Hansen, Jensen) Department of Cardiology, Odense University
Hospital, Odense, Denmark.
(Kelbaek, Engstrom) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Abildgaard, Hansen, Jensen) Department of Cardiology, Gentofte University
Hospital, Copenhagen, Denmark.
(Abildstrom) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark.
Title
Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary
stents in routine clinical care (SORT OUT III): a randomised controlled
superiority trial.
Source
The Lancet. 375(9720)(pp 1090-1099), 2010. Date of Publication:
20100327/0402.
Publisher
Elsevier Limited
Abstract
Background: In low-risk patients, the zotarolimus-eluting stent has been
shown to reduce rates of restenosis without increasing the risk of stent
thrombosis. We compared the efficacy and safety of the zotarolimus-eluting
stent versus the sirolimus-eluting stent in patients with coronary artery
disease who were receiving routine clinical care with no direct follow-up.
Methods: We did a single-blind, all-comer superiority trial in adult
patients with chronic stable coronary artery disease or acute coronary
syndromes, and at least one target lesion. Patients were treated at one of
five percutaneous coronary intervention centres between January, 2006, and
August, 2007. Computer-generated block randomisation and a telephone
allocation service were used to randomly assign patients to receive the
zotarolimus-eluting or the sirolimus-eluting stent. Data for follow-up
were obtained from national Danish administrative and health-care
registries. The primary endpoint was a composite of major adverse cardiac
events within 9 months: cardiac death, myocardial infarction, and target
vessel revascularisation. Intention-to-treat analyses were done at 9-month
and 18-month follow-up. This trial is registered with ClinicalTrials.gov,
number NCT00660478. Findings: 1162 patients (1619 lesions) were assigned
to receive the zotarolimus-eluting stent, and 1170 patients (1611 lesions)
to receive the sirolimus-eluting stent. 67 patients (72 lesions) had stent
failure, and six patients were lost to follow-up. All randomly assigned
patients were included in analyses at 9-month follow-up; 2200 patients
(94%) had completed 18-month follow-up by the time of our assessment. At 9
months, the primary endpoint had occurred in a higher proportion of
patients treated with the zotarolimus-eluting stent than in those treated
with the sirolimus-eluting stent (72 [6%] vs 34 [3%]; HR 2.15, 95% CI
1.43-3.23; p=0.0002). At 18-month follow-up, this difference was sustained
(113 [10%] vs 53 [5%]; 2.19, 1.58-3.04; p<0.0001). For patients receiving
the zotarolimus-eluting stent and those receiving the sirolimus-eluting
stent, all cause-mortality was similar at 9-month follow-up (25 [2%] vs 18
[2%]; 1.40, 0.76-2.56; p=0.28), but was significantly different at
18-month follow-up (51 [4%] vs 32 [3%]; 1.61, 1.03-2.50; p=0.035).
Interpretation: The sirolimus-eluting stent is superior to the
zotarolimus-eluting stent for patients receiving routine clinical care.
Funding: Cordis and Medtronic. copyright 2010 Elsevier Ltd. All rights
reserved.
<6>
Accession Number
2010202255
Authors
Lee M.S. Yang T. Dhoot J. Liao H.
Institution
(Lee, Yang, Dhoot) Division of Cardiology, David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, CA, United
States.
(Liao) Boston Scientific Corporation, Marlborough, MN, United States.
Title
Meta-Analysis of Clinical Studies Comparing Coronary Artery Bypass
Grafting With Percutaneous Coronary Intervention and Drug-Eluting Stents
in Patients With Unprotected Left Main Coronary Artery Narrowings.
Source
American Journal of Cardiology. 105(8)(pp 1070-1075), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
The aim of this study was to compare the safety and efficacy of coronary
artery bypass grafting (CABG) with percutaneous coronary intervention
(PCI) using drug-eluting stents (DES) in patients with unprotected left
main coronary artery (ULMCA) disease. The current American College of
Cardiology and American Heart Association guidelines recommend CABG for
the treatment of patients with ULMCA disease on the basis of clinical
trials demonstrating a survival benefit with CABG compared to medical
therapy. DES reduce the rate of target vessel revascularization compared
with bare-metal stents in ULMCA PCI and may be a safe alternative to CABG.
A meta-analysis was conducted of clinical studies comparing CABG and PCI
with DES for ULMCA disease with respect to death; the composite of death,
myocardial infarction, or stroke; and target vessel revascularization at 1
year follow-up. The analysis included 2,905 patients from 8 clinical
studies (2 randomized trials and 6 nonrandomized studies). At 1-year
follow-up, there was no significant difference between the CABG and DES
groups in the risk for death (odds ratio [OR] 1.12, 95% confidence
interval [CI] 0.80 to 1.56) or the composite end point of death,
myocardial infarction, or stroke (OR 1.25, 95% CI 0.86 to 1.82). The risk
for target vessel revascularization was significantly lower in the CABG
group compared to the PCI group (OR 0.44, 95% CI 0.32 to 0.59). In
conclusion, PCI with DES is safe and could represent a good alternative to
CABG for selected cases in patients with ULMCA disease. copyright 2010
Elsevier Inc. All rights reserved.
<7>
Accession Number
2010201608
Authors
Lee M.S. Yang T. Kandzari D.E. Tobis J.M. Liao H. Mahmud E.
Institution
(Lee, Yang, Tobis) Division of Cardiology, University of California, Los
Angeles, David Geffen School of Medicine, Los Angeles, CA, United States.
(Kandzari) Division of Cardiology, Scripps Clinic, La Jolla, CA, United
States.
(Liao) Boston Scientific Corporation, Natick, MA, United States.
(Mahmud) Division of Cardiology, University of California, San Diego,
School of Medicine, San Diego, CA, United States.
Title
Comparison by Meta-Analysis of Drug-Eluting Stents and Bare Metal Stents
for Saphenous Vein Graft Intervention.
Source
American Journal of Cardiology. 105(8)(pp 1076-1082), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
This meta-analysis was undertaken to assess the efficacy and safety of
drug-eluting stents (DESs) compared to bare metal stents (BMSs) in
saphenous vein graft (SVG) interventions. DESs decrease the risk of target
vessel revascularization in native coronary arteries compared to BMSs. The
ideal treatment strategy in patients with SVG disease is unknown. A search
of the published reports was conducted to identify studies that compared
DESs and BMSs in SVG intervention with a minimum follow-up of 6 months. A
total of 19 studies (2 randomized trials and 17 registries), including
3,420 patients who had undergone SVG intervention (DESs, n = 1,489 and
BMS, n = 1,931), met the selection criteria. The mean length of follow-up
was 20 +/- 12 months. Using the fixed effect model, target vessel
revascularization was less frequently performed in patients who had
undergone SVG intervention with a DES than with a BMS (odds ratio [OR]
0.59, 95% confidence interval [CI] 0.49 to 0.72). The incidence of
myocardial infarction was lower in patients with a DES than in those with
a BMS (OR 0.69, 95% CI 0.49 to 0.99). No differences were found in the
risk of death (OR 0.78, 95% CI 0.59 to 1.02) or stent thrombosis (OR 0.41,
95% CI 0.15 to 1.11) between the 2 groups. In conclusion, these findings
support the use of DESs in SVG lesions. copyright 2010 Elsevier Inc. All
rights reserved.
<8>
Accession Number
2010201604
Authors
Parodi G. Migliorini A. Valenti R. Bellandi B. Signorini U. Moschi G.
Buonamici P. Cerisano G. Antoniucci D.
Institution
(Parodi, Migliorini, Valenti, Bellandi, Signorini, Moschi, Buonamici,
Cerisano, Antoniucci) Division of Cardiology, Careggi Hospital, Florence,
Italy.
Title
Comparison of Bivalirudin and Unfractionated Heparin Plus Protamine in
Patients With Coronary Heart Disease Undergoing Percutaneous Coronary
Intervention (from the Antithrombotic Regimens aNd Outcome [ARNO] Trial).
Source
American Journal of Cardiology. 105(8)(pp 1053-1059), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
Previous studies have compared bivalirudin and unfractionated heparin
(UFH) plus the routine use of glycoprotein IIb/IIIa inhibitors. They have
demonstrated that bivalirudin can decrease bleeding complications without
a significant increase in ischemic complications, resulting in a better
net clinical outcome, as defined by the efficacy (ischemic complications)
or safety (bleeding complications) end point. The aim of the present study
was to compare bivalirudin and UFH plus protamine in patients undergoing
elective percutaneous coronary intervention and pretreated with
clopidogrel and aspirin. We randomly assigned 850 patients with stable or
unstable coronary artery disease to bivalirudin or UFH followed by
protamine at the end of the percutaneous coronary intervention. The
primary end point was in-hospital major bleeding. The main secondary end
points were the 1-month composite of death, myocardial infarction,
unplanned target vessel revascularization; and the 1-month net clinical
outcome. The rate of major bleeding (primary end point) was 0.5% in
patients randomized to bivalirudin and 2.1% in patients randomized to UFH
(p = 0.033). At 30 days, the rate of major bleeding was 0.9% in the
bivalirudin arm and 2.8% in the UFH arm (p = 0.043). The composite of
death, myocardial infarction, and target vessel revascularization rate and
the net clinical outcome rate was 2.8% and 6.4% (p = 0.014) and 3.3% and
7.8% (p = 0.004), respectively, in the bivalirudin and UFH arms. In
conclusion, in percutaneous coronary intervention patients pretreated with
clopidogrel and aspirin, bivalirudin was associated with less major
bleeding and fewer ischemic complications and a better net clinical
outcome than UFH. copyright 2010 Elsevier Inc. All rights reserved.
<9>
Accession Number
2010310263
Authors
Gregorini C. Cipriano Jr. G. De Aquino L.M. Rodrigues Branco J.N.
Bernardelli G.F.
Institution
(Gregorini, Cipriano Jr., De Aquino, Rodrigues Branco, Bernardelli)
Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Title
Short-duration transcutaneous electrical nerve stimulation in the
postoperative period of cardiac surgery.
Source
Arquivos Brasileiros de Cardiologia. 94(3)(pp 325-331+345-351), 2010.
Date of Publication: March 2010.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Respiratory muscle strength has been related to the
postoperative outcome of cardiac surgeries. The main documented
therapeutic purpose of transcutaneous electrical nerve stimulation (TENS)
is the reduction of pain, which could bring secondary benefits to the
respiratory muscles and, consequently, to lung capacities and volumes.
Objectives: The objective of the present study was to evaluate the
effectiveness of short-duration transcutaneous electrical nerve
stimulation (TENS) in the reduction of pain and its possible influence on
respiratory muscle strength and lung capacity and volumes of patients in
the postoperative period of cardiac surgery. Methods: Twenty five patients
with mean age of 59.9 +/- 10.3 years, of whom 72% were men, and
homogeneous as regards weight and height, were randomly assigned to two
groups. One group received therapeutic TENS (n = 13) and the other,
placebo TENS (n = 12), for four hours on the third postoperative day of
cardiac surgery. Pain was analyzed by means of a visual analogue scale,
and of respiratory muscle strength as measured by maximum respiratory
pressures and lung capacity and volumes before and after application of
TENS. Results: Short-duration TENS significantly reduced pain of patients
in the postoperative period (p < 0.001). Respiratory muscle strength (p <
0.001), tidal volume (p < 0.001) and vital capacity (p < 0.05)
significantly improved after therapeutic TENS, unlike in the placebo
group. Conclusion: Short-duration TENS proved effective for the reduction
of pain and improvement of respiratory muscle strength, as well as of lung
volumes and capacity.
<10>
Accession Number
2010310262
Authors
Succi J.E. Gerola L.R. Succi G.M. De Almeida R.A.C.F. Rocha Novais L.S.
Rocha B.
Institution
(Succi, Gerola, Succi, De Almeida, Rocha Novais, Rocha) Hospital
Bandeirantes em Sao Paulo, Sao Paulo, SP, Brazil.
Title
Ischemic preconditioning influence ventricular function in off-pump
revascularization surgery.
Source
Arquivos Brasileiros de Cardiologia. 94(3)(pp 319-324+339-344), 2010.
Date of Publication: March 2010.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Ischemic preconditioning is a method that prepares and
protects cells to tolerate a long period of ischemia with the least
possible injury. Objectives: Evaluate the influence of ischemic
preconditioning over left ventricular function during off-pump myocardial
revascularization. Method: Forty patients with clinical indication for
off-pump myocardial revascularization were randomized in two groups, with
or without ischemic preconditioning. Ischemic preconditioning was carried
out by performing coronary occlusion for two minutes and releasing blood
flow for one minute; two cycles were performed. Left ventricular
contractility was evaluated through transesophageal Doppler by measuring
blood flow acceleration in the descending aorta - Hemosonic 100. The
acceleration measurements were performed at the start of the surgery,
after heart positioning and five and ten minutes after coronary occlusion.
Results: There was no significant difference in left ventricular
contractility between the two groups. At the beginning of the procedure
flow acceleration was 9.37 +/- 2.9m/s2 in the preconditioning group and
12.5 +/- 3.1 m/s2 in no-preconditioning group (p = 0.23); after
positioning of heart, it was 8.47 +/- 3.3 and 8.31 +/- 3.6 m/s2 (p =
0.96); after five minutes - 8.7 +/- 4.1 and 7.94 +/- 2.9 m/s 2 (p = 0.80);
and after ten minutes - 9.2 +/- 4.5 and 7.98 +/- 3.4 m/s2 (p = 0.71).
However, contractility evolution was different throughout time in each
group. The preconditioning group maintained left ventricular contractility
during the entire procedure, since the beginning (0.52), while the group
without ischemic preconditioning presented reduction in left ventricular
contractility (p = 0.0034). Conclusion: Ischemic preconditioning prevented
the decrease in left ventricular contractility during off-pump myocardial
revascularization surgery.
<11>
Accession Number
2010295816
Authors
Jun M. Foote C. Lv J. Neal B. Patel A. Nicholls S.J. Grobbee D.E. Cass A.
Chalmers J. Perkovic V.
Institution
(Jun, Foote, Lv, Neal, Patel, Cass, Chalmers, Perkovic) The George
Institute for International Health, University of Sydney, Sydney,
Australia.
(Lv) Peking University First Hospital, Beijing, China.
(Nicholls) Departments of Cardiovascular Medicine and Cell Biology,
Cleveland Clinic, Cleveland, OH, United States.
(Grobbee) Julius Centre, University Medical Centre, Utrecht, Netherlands.
Title
Effects of fibrates on cardiovascular outcomes: a systematic review and
meta-analysis.
Source
The Lancet. 375(9729)(pp 1875-1884), 2010. Date of Publication:
20100529/0604.
Publisher
Elsevier Limited
Abstract
Background: Several clinical trials have reported inconsistent findings
for the effect of fibrates on cardiovascular risk. We undertook a
systematic review and meta-analysis to investigate the effects of fibrates
on major clinical outcomes. Methods: We systematically searched Medline,
Embase, and the Cochrane Library for trials published between 1950 and
March, 2010. We included prospective randomised controlled trials
assessing the effects of fibrates on cardiovascular outcomes compared with
placebo. Summary estimates of relative risk (RR) reductions were
calculated with a random effects model. Outcomes analysed were major
cardiovascular events, coronary events, stroke, heart failure, coronary
revascularisation, all-cause mortality, cardiovascular death, non-vascular
death, sudden death, new onset albuminuria, and drug-related adverse
events. Findings: We identified 18 trials providing data for 45 058
participants, including 2870 major cardiovascular events, 4552 coronary
events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95%
CI 0-18) for major cardiovascular events (p=0.048) and a 13% RR reduction
(7-19) for coronary events (p<0.0001), but had no benefit on stroke (-3%,
-16 to 9; p=0.69). We noted no effect of fibrate therapy on the risk of
all-cause mortality (0%, -8 to 7; p=0.92), cardiovascular mortality (3%,
-7 to 12; p=0.59), sudden death (11%, -6 to 26; p=0.19), or non-vascular
mortality (-10%, -21 to 0.5; p=0.063). Fibrates reduced the risk of
albuminuria progression by 14% (2-25; p=0.028). Serious drug-related
adverse events were not significantly increased by fibrates (17 413
participants, 225 events; RR 1.21, 0.91-1.61; p=0.19), although increases
in serum creatinine concentrations were common (1.99, 1.46-2.70;
p<0.0001). Interpretation: Fibrates can reduce the risk of major
cardiovascular events predominantly by prevention of coronary events, and
might have a role in individuals at high risk of cardiovascular events and
in those with combined dyslipidaemia. Funding: National Health and Medical
Research Council of Australia. copyright 2010 Elsevier Ltd. All rights
reserved.
<12>
Accession Number
2010314228
Authors
Mehilli J. Byrne R.A. Tiroch K. Pinieck S. Schulz S. Kufner S. Massberg S.
Laugwitz K.-L. Schomig A. Kastrati A.
Institution
(Mehilli, Byrne, Tiroch, Pinieck, Schulz, Kufner, Massberg, Kastrati)
Deutsches Herzzentrum, Technische Universitat, Munich, Germany.
(Laugwitz, Schomig) 1. Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat, Munich, Germany.
Title
Randomized Trial of Paclitaxel- Versus Sirolimus-Eluting Stents for
Treatment of Coronary Restenosis in Sirolimus-Eluting Stents. The
ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug
Eluting Stents for In-Stent Restenosis 2) Study.
Source
Journal of the American College of Cardiology. 55(24)(pp 2710-2716),
2010. Date of Publication: 15 Jun 2010.
Publisher
Elsevier USA
Abstract
Objectives: For patients with sirolimus-eluting stent (SES) restenosis
requiring reintervention, we compared a strategy of repeat SES (Cypher,
Cordis, Miami Lakes, Florida) implantation with paclitaxel-eluting stent
(PES) (Taxus, Boston Scientific, Natick, Massachusetts) implantation.
Background: Despite their high anti-restenotic efficacy, the widespread
utilization of SES therapy has led to a significant absolute number of
patients presenting with SES treatment failure. The optimal treatment
strategy for such patients remains unclear. Methods: The ISAR-DESIRE 2
(Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for
In-Stent Restenosis 2) study was a randomized, open-label,
active-controlled trial conducted among 450 patients with clinically
significant in-SES restenosis at 2 centers in Munich, Germany. After
pre-treatment with 600 mg clopidogrel, all patients were randomly assigned
to either SES or PES implantation. The primary end point was late lumen
loss, based on in-stent analysis, at 6- to 8-month follow-up angiography.
Secondary end points were binary angiographic restenosis (diameter
stenosis >50%) at 6- to 8-month follow-up, target lesion
revascularization, the composite of death or myocardial infarction, and
definite stent thrombosis at 12 months. Results: Regarding anti-restenotic
efficacy, there were no differences between SES and PES in late loss (0.40
+/- 0.65 mm vs. 0.38 +/- 0.59 mm; p = 0.85), binary restenosis (19.6% vs.
20.6%; p = 0.69), or target lesion revascularization (16.6% vs. 14.6%; p =
0.52). In terms of safety outcomes, the rates of death/myocardial
infarction (6.1% vs. 5.8%; p = 0.86) and stent thrombosis (0.4% vs. 0.4%;
p > 0.99) were also similar. Conclusions: In cases of SES restenosis,
treatment with either repeat SES or switch to PES was associated with a
comparable degree of efficacy and safety. Drug resistance at an individual
patient level may play a contributory role to the somewhat higher than
expected late loss observed with the SES in the current study.
(Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for
In-Stent Restenosis 2 [ISAR-DESIRE 2]; NCT00598715). copyright 2010
American College of Cardiology Foundation.
<13>
Accession Number
2010311586
Authors
Simes R.J. O'Connell R.L. Aylward P.E. Varshavsky S. Diaz R. Wilcox R.G.
Armstrong P.W. Granger C.B. French J.K. Van de Werf F. Marschner I.C.
Califf R. White H.D.
Institution
(Simes, O'Connell, Marschner) NHMRC Clinical Trials Center, University of
Sydney, Sydney, Australia.
(Aylward) Flinders Medical Center, Adelaide, Australia.
(Varshavsky) Evidence Clinical and Pharmaceutical Research, Los Altos, CA,
United States.
(Diaz) Estudios Clinicos Latino America (ECLA) Collaborative Group,
Rosario, Argentina.
(Wilcox) University Hospital, Nottingham, United Kingdom.
(Armstrong) University of Alberta, Edmonton, Alta., Canada.
(Granger, Califf) Duke Clinical Research Institute, Durham, NC, United
States.
(French, White) Auckland City Hospital, Auckland, New Zealand.
(Van de Werf) Gasthuisberg University Hospital, Leuven, Belgium.
(Marschner) Department of Statistics, Macquarie University, Sydney,
Australia.
Title
Unexplained international differences in clinical outcomes after acute
myocardial infarction and fibrinolytic therapy: Lessons from the Hirulog
and Early Reperfusion or Occlusion (HERO)-2 trial.
Source
American Heart Journal. 159(6)(pp 988-997), 2010. Date of Publication:
June 2010.
Publisher
Mosby Inc.
Abstract
Background: Despite advances in therapy, global mortality due to acute
myocardial infarction remains high. The international Hirulog and Early
Reperfusion or Occlusion (HERO-2) trial of 17,073 patients with ST-segment
elevation myocardial infarction provided the opportunity to explore
international differences in outcomes. Methods: Patient characteristics,
treatment, and outcomes were compared across 5 diverse regions: Western
countries, Latin America, Eastern Europe, Russia, and Asia. In addition, a
representative sample of 1,743 screened patients was compared with
enrolled patients. Results: Larger percentages of eligible patients were
randomized in Eastern Europe, Russia, and Asia than Western countries.
These regions enrolled more patients with anterior myocardial infarction,
Killip class III or IV, and late presentation (>4 hours). More patients
aged >75 years were enrolled from Western countries. Overall risk levels
were similar. Eastern Europe and Russia had lower rates than Western
countries of coronary revascularization (2% vs 18%) and longer hospital
stays (median 18 vs 7 days). Thirty-day mortality was lower in Western
countries; 6.7% versus 10.2% to 13.2% elsewhere, whereas reinfarction was
more frequent (3.2% vs 1.5% to 3.0%; each, P < .001). Regional mortality
differences persisted after adjustment for baseline risk factors,
treatments, or national health and economic statistics (each P < .001).
Conclusions: The variation in mortality and other clinical outcomes across
geographic regions was not adequately explained by risk factors, patterns
of care, or national health statistics. Nevertheless, large international
trials are a better way to assess potential new treatments across many
countries than the alternative of separate smaller trials in each region.
copyright 2010 Mosby, Inc. All rights reserved.
<14>
[Use Link to view the full text]
Accession Number
2010301994
Authors
Joly P. Bastuji-Garin S. Frances C. Lebbe C. Aubin F. Penso-Assathiany D.
D'Incan M. Avril M.-F. Lair G. Barete S. Euvrard S.
Institution
(Joly, Lair) Department of Dermatology, University of Rouen, Rouen
University Hospital, Rouen, France.
(Bastuji-Garin) Department of Clinical Research and Public Health, AP-HP,
Groupe H. Mondor, Albert Chenevier, Universite Paris 12, Creteil, France.
(Frances, Barete) Department of Dermatology, Paris VI University Hospital,
Paris, France.
(Lebbe) Department of Dermatology, APHP, Paris Diderot University
Hospital, Paris, France.
(Aubin) Department of Dermatology, Besancon University Hospital, Besancon,
France.
(Penso-Assathiany) Department of Dermatology, Paris 12 University
Hospital, Creteil, France.
(D'Incan) Department of Dermatology, Clermont-Ferrand University Hospital,
Clermont-Ferrand, France.
(Avril) Department of Dermatology, Paris v University Hospital, Paris,
France.
(Euvrard) Department of Dermatology, Lyon University Edouard Herriot
Hospital, Hospices Civils de Lyon, Lyon, France.
Title
Squamous cell carcinomas are associated with verrucokeratotic cutaneous
lesions but not with common warts in organ-transplant patients. a
case-control study.
Source
Transplantation. 89(10)(pp 1224-1230), 2010. Date of Publication: 27 May
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Warts are thought to be associated with the development of
squamous cell carcinoma (SCC) in organ transplant patients. We
investigated the association between the different types of warts and SCC
in organ transplant patients. Methods: A prospective multicenter
case-control study was conducted. Cases were patients with a kidney or
heart transplant who were referred for a SCC. Controls were organ
transplant patients without SCC, individually matched for age, gender,
type of organ transplant (heart or kidney), skin phototype, time from
transplantation, and center. Four types of warts: flat warts, verrucae
vulgares (including palmo-plantar warts and common warts), verrucous
papilloma, and verrucokeratotic lesions were compared between cases and
controls using conditional logistic regression. Results: Ninety-nine cases
and 169 controls were included. In multivariate analysis, number of
rejections, azathioprine, prednisolone and anti-lymphocyte anti-serum or
anti-CD3 monoclonal antibodies use, cumulative sun exposure, actinic
keratosis, and verrucokeratic lesions (odds ratio [OR] 16.50; 95%
confidence interval [CI] 2.82-96.80) were independently associated with
SCC, whereas the association with verrucous papilloma was borderline
significant (OR 2.21; 95% CI 0.97-8.15). The association between the
presence of at least one of these two types of warts (verruco-keratotic
lesions and verrucous papilloma) and the occurrence of SCC was highly
significant (OR 18.36; 95% CI 3.03-111) when these warts were located in
the same area than SCC, whereas no significant association was evidenced
when these warts were located in another area (OR 1.02; 95% CI 0.13-5.79).
Conclusion: Verrucous papilloma and mainly verrucokeratotic lesions are
strongly associated with the risk of SCC in organ transplant patients,
whereas the most typical types of warts: verrucae vulgares and flat warts,
are not. Copyright copyright 2010 by Lippincott Williams & Wilkins.
<15>
Accession Number
2010295817
Authors
Staels B.
Institution
(Staels) Universite Lille Nord de France, Lille, France.
(Staels) U1011 Inserm, Lille, France.
(Staels) Universite Droit et Sante de Lille, Lille, France.
(Staels) Institut Pasteur de Lille, 59019 Lille cedex, France.
Title
Fibrates in CVD: a step towards personalised medicine.
Source
The Lancet. 375(9729)(pp 1847-1848), 2010. Date of Publication:
20100529/0604.
Publisher
Elsevier Limited
<16>
Accession Number
2010291688
Authors
Kruis R.W.J. Vlasveld F.A.E. Van Dijk D.
Institution
(Kruis, Vlasveld, Van Dijk) Departments of Anesthesiology and Intensive
Care, University Medical Center Utrecht, Mail Stop F06.149, PO Box 85500,
3508 GA Utrecht, Netherlands.
Title
The (Un)importance of cerebral microemboli.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 14(2)(pp 111-118),
2010. Date of Publication: June 2010.
Publisher
SAGE Publications Inc.
Abstract
Background: The use of cardiopulmonary bypass (CPB) is associated with
cerebral microemboli. Cognitive decline after cardiac surgery has
therefore always been attributed to the use of CPB. However, randomized
studies comparing coronary bypass surgery with and without CPB failed to
establish a clear cognitive benefit of avoiding CPB. The aim of this
analysis was to systematically review the studies that directly assessed
the association between cerebral microemboli and cognitive decline after
cardiac surgery. Methods: The electronic database of PubMed of the
National Library of Medicine from 1980 until 2009 was searched to identify
relevant literature. Search terms related to "cardiac surgery,"
"microemboli," and "cognitive decline" were used. Studies were reviewed
independently by 2 reviewers and relevant articles were included
completely if they matched the selection criteria. This review included
studies in adult cardiac surgical patients reporting both a measure of
cerebral embolic load and cognitive outcomes. Results: The literature
search yielded 423 different titles, of which 22 met the selection
criteria. All 22 studies used neuropsychological tests to determine
cognitive outcome. Seven studies used postoperative (diffusion-weighted)
magnetic resonance imaging (MRI) to detect cerebral emboli and 15 studies
used intraoperative transcranial Doppler imaging. In 1 MRI study and 5
Doppler studies, an association was found between the number of cerebral
emboli and the risk of postoperative cognitive decline. In 15 studies,
such an association could not be established. One study did not assess the
direct relation between microemboli and cognitive decline. Conclusion:
This systematic review could neither confirm nor rule out a causal link
between emboli from CPB and postoperative cognitive decline. copyright
2010 The Author(s).
