Results Generated From:
EMBASE <1980 to 2010 Week 23>
EMBASE (updates since 2010-06-03)
<1>
Accession Number
0020463410
Authors
Frederich R. Alexander J.H. Fiedorek F.T. Donovan M. Berglind N. Harris S.
Chen R. Wolf R. Mahaffey K.W.
Institution
(Frederich) Bristol-Myers Squibb, Princeton, NJ 08543, USA.
Title
A systematic assessment of cardiovascular outcomes in the saxagliptin drug
development program for type 2 diabetes..
Source
Postgraduate medicine. 122(3)(pp 16-27), 2010. Date of Publication: May
2010.
Abstract
OBJECTIVE: The objective was to assess the relative risk (RR) for
cardiovascular (CV) events across all 8 randomized phase 2/3 trials
evaluating saxagliptin in patients with type 2 diabetes mellitus. METHODS:
Cardiovascular events (death, myocardial infarction [MI], stroke,
revascularization procedures, and cardiac ischemia) were reported by
investigators through standard adverse event reporting procedures and were
systematically identified. Post hoc blinded adjudication of all deaths,
MIs, and strokes was performed using prespecified endpoint definitions by
an independent clinical events committee (CEC). RESULTS: A total of 4607
randomized and treated patients (n = 3356 treated with saxagliptin
[2.5-100 mg/d]; n = 1251, comparator [n = 656, placebo; n = 328,
metformin; n = 267, uptitrated glyburide]) were included. The median ages
were 54 years (saxagliptin) and 55 years (comparator) (interquartile
range, 47-61 each); 51% were female, 73% were white, 52% were
hypertensive, 44% had hypercholesterolemia, 39% had a smoking history, 20%
had a first-degree family member with premature coronary heart disease,
and 12% had prior CV disease. Cardiovascular events were experienced by 61
patients (38 [1.1%], saxagliptin; 23 [1.8%], comparator), and CV
death/MI/stroke events were reported by investigators in 41 patients: 23
(0.7%), saxagliptin; 18 (1.4%), comparator (relative risk, 95% confidence
interval [CI], 0.44 [0.24-0.82]). The CEC reviewed 147 patients with
potential CV events and identified a total of 40 patients with CV
death/MI/stroke: 22 (0.7%), saxagliptin; 18 (1.4%), comparator (RR, 0.43
[0.23-0.80]). Component proportions for CV death, MI, and stroke were
(saxagliptin vs comparator): 7 (0.2%) vs 10 (0.8%), 8 (0.2%) vs 8 (0.6%),
and 11 (0.3%) vs 5 (0.4%), respectively. CONCLUSION: No increased risk of
CV death/MI/stroke was observed in patients randomly assigned saxagliptin
across a broad drug development program. Although this systematic overview
has inherent and important limitations, the data support a potential
reduction in CV events with saxagliptin. The hypothesis of CV protection
with saxagliptin will be tested prospectively in a large randomized
clinical outcome trial evaluating saxagliptin compared with standard of
care in patients with type 2 diabetes at increased risk for CV events.
<2>
Accession Number
2010290682
Authors
Preisman S. Kogan A. Itzkovsky K. Leikin G. Raanani E.
Institution
(Preisman, Itzkovsky, Leikin) Department of Anesthesiology and Intensive
Care, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
(Kogan, Raanani) Department of Cardiac Surgery, Sheba Medical Center, Tel
Hashomer, Tel Aviv University, Tel Aviv, Israel.
Title
Modified thromboelastography evaluation of platelet dysfunction in
patients undergoing coronary artery surgery.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1367-1374), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
Objective: Anti-platelet therapy is associated with increased
perioperative bleeding. Although current guidelines call for its
caessation 5-10 days prior to cardiac surgery, this could constitute an
increased risk of preoperative myocardial infarction. The optimal safe
period from discontinuation of anti-platelet therapy to surgery is as yet
unknown for the individual patient. We investigated whether preoperative
thromboelastography (TEG) with platelet mapping could predict bleeding
tendency in patients (on recent anti-platelet therapy) undergoing coronary
artery bypass grafting (CABG). Methods: We prospectively evaluated 59
patients on aspirin and clopidogrel therapy who underwent CABG. Of them,
25 patients received aspirin alone. TEG with platelet mapping was
performed immediately prior to surgery in all 59 patients. Results: During
the first 24 h post-surgery, 9/59 patients bled excessively (1216 +/- 310
ml in excessive bleeding vs 576 +/- 155 ml in non-bleeding patients). Of
the patients bled excessively, eight received clopidogrel treatment prior
to surgery. However, 26 of the remaining 34 patients receiving clopidogrel
did not bleed significantly. Clopidogrel-induced platelet dysfunction
diagnosed by platelet mapping discerned between patients who demonstrated
excessive bleeding and those who did not (78% - sensitivity, 84% -
specificity, p = 0.004). Aspirin-induced platelet dysfunction did not
reflect a bleeding tendency. Of all patients, 85% did not respond to a
standard dose of clopidogrel, whereas 44% did not respond to aspirin.
Conclusions: TEG with platelet mapping is able to predict excessive
postoperative blood loss among patients who underwent CABG and recent
anti-platelet therapy. The prevalence of non-responsiveness to
anti-platelet therapy, including clopidogrel, is higher in patients
undergoing coronary artery bypass grafting than in the general population.
In this study, aspirin-induced platelet dysfunction did not influence
postoperative blood loss. copyright 2010 European Association for
Cardio-Thoracic Surgery.
<3>
Accession Number
0020417770
Authors
Damgaard S. Nielsen C.H. Andersen L.W. Bendtzen K. Tvede M. Steinbruchel
D.A.
Institution
(Damgaard) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark.
Title
Cell saver for on-pump coronary operations reduces systemic inflammatory
markers: a randomized trial..
Source
The Annals of thoracic surgery. 89(5)(pp 1511-1517), 2010. Date of
Publication: May 2010.
Abstract
BACKGROUND: This study investigated whether intraoperative use of a cell
saver reduces the systemic inflammatory response after coronary operations
using cardiopulmonary bypass (CPB). METHODS: The study randomized 29
patients, 15 to cell saving of pericardial suction blood and residual
blood in the CPB circuit after perfusion (cell saver group) vs 14 who
received direct retransfusion of the suction blood and the CPB circuit
blood (control group). Outcome measures were plasma concentrations of the
inflammatory markers interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12,
tumor necrosis factor-alpha, soluble tumor necrosis factor receptors I and
II, and procalcitonin at 6, 24, and 72 hours postoperatively. RESULTS: At
6 hours postoperatively, the cell saver group displayed significantly
reduced plasma levels of IL-6 and IL-8 (p < 0.05). A reduction in IL-10
was also found (p = 0.05), along with nonsignificant reductions in the
remaining markers. At 24 and 72 hours, significant differences between
groups no longer existed. In the cell saver group, the suction blood and
CPB circuit blood were cleared for tumor necrosis factor receptors (p <
0.005), and IL-6, IL-8, IL-10, and procalcitonin were significantly
reduced (p < 0.05). Median intraoperative blood loss was 250 mL in the
cell saver group vs 475 mL (p < 0.02). Immediately postoperatively the
hemoglobin level was higher in the cell saver group (p < 0.03).
Transfusion requirements were similar. CONCLUSIONS: The cell saver reduced
the systemic levels of the proinflammatory markers IL-6 and IL-8 at 6
hours after CPB. The role of the anti-inflammatory molecules IL-10 and
soluble tumor necrosis factor receptors is undefined in this setting.
Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier
Inc. All rights reserved.
<4>
Accession Number
0020184812
Authors
Hemingway H. Henriksson M. Chen R. Damant J. Fitzpatrick N. Abrams K.
Hingorani A. Janzon M. Shipley M. Feder G. Keogh B. Stenestrand U.
McAllister K. Kaski J.C. Timmis A. Palmer S. Sculpher M.
Institution
(Hemingway, Henriksson, Chen, Damant, Fitzpatrick, Abrams, Hingorani,
Janzon, Shipley, Feder, Keogh, Stenestrand, McAllister, Kaski, Timmis,
Palmer, Sculpher) Department of Epidemiology and Public Health, University
College London, UK.
Title
The effectiveness and cost-effectiveness of biomarkers for the
prioritisation of patients awaiting coronary revascularisation: a
systematic review and decision model..
Source
Health technology assessment (Winchester, England). 14(9)(pp 1-151,
iii-iv), 2010. Date of Publication: Feb 2010.
Abstract
OBJECTIVE: To determine the effectiveness and cost-effectiveness of a
range of strategies based on conventional clinical information and novel
circulating biomarkers for prioritising patients with stable angina
awaiting coronary artery bypass grafting (CABG). DATA SOURCES: MEDLINE and
EMBASE were searched from 1966 until 30 November 2008. REVIEW METHODS: We
carried out systematic reviews and meta-analyses of literature-based
estimates of the prognostic effects of circulating biomarkers in stable
coronary disease. We assessed five routinely measured biomarkers and the
eight emerging (i.e. not currently routinely measured) biomarkers
recommended by the European Society of Cardiology Angina guidelines. The
cost-effectiveness of prioritising patients on the waiting list for CABG
using circulating biomarkers was compared against a range of alternative
formal approaches to prioritisation as well as no formal prioritisation. A
decision-analytic model was developed to synthesise data on a range of
effectiveness, resource use and value parameters necessary to determine
cost-effectiveness. A total of seven strategies was evaluated in the final
model. RESULTS: We included 390 reports of biomarker effects in our
review. The quality of individual study reports was variable, with
evidence of small study (publication) bias and incomplete adjustment for
simple clinical information such as age, sex, smoking, diabetes and
obesity. The risk of cardiovascular events while on the waiting list for
CABG was 3 per 10,000 patients per day within the first 90 days (184
events in 9935 patients with a mean of 59 days at risk). Risk factors
associated with an increased risk, and included in the basic risk
equation, were age, diabetes, heart failure, previous myocardial
infarction and involvement of the left main coronary artery or
three-vessel disease. The optimal strategy in terms of cost-effectiveness
considerations was a prioritisation strategy employing biomarker
information. Evaluating shorter maximum waiting times did not alter the
conclusion that a prioritisation strategy with a risk score using
estimated glomerular filtration rate (eGFR) was cost-effective. These
results were robust to most alternative scenarios investigating other
sources of uncertainty. However, the cost-effectiveness of the strategy
using a risk score with both eGFR and C-reactive protein (CRP) was
potentially sensitive to the cost of the CRP test itself (assumed to be 6
pounds in the base-case scenario). CONCLUSIONS: Formally employing more
information in the prioritisation of patients awaiting CABG appears to be
a cost-effective approach and may result in improved health outcomes. The
most robust results relate to a strategy employing a risk score using
conventional clinical information together with a single biomarker (eGFR).
The additional prognostic information conferred by collecting the more
costly novel circulating biomarker CRP, singly or in combination with
other biomarkers, in terms of waiting list prioritisation is unlikely to
be cost-effective.
<5>
Accession Number
2010293469
Authors
Hsin H.-T. Li A.-H. Yeih D.-F. Lai C.-L. Chiu Y.-W. Liao P.-C. Chen K.-C.
Lo H.-J. Yang C.-Y. Chu S.-H.
Institution
(Hsin) Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital,
Taipei, Taiwan (Republic of China).
(Hsin) National Tainan Institute of Nursing, Tainan City, Taiwan (Republic
of China).
(Li, Yeih, Lai, Chiu, Liao, Chen, Lo, Yang, Chu) Cardiovascular Center,
Far-Eastern Memorial Hospital, 13F, No. 21, Sec. 2, Nan-Ya South Rd.,
Banciao City, Taipei County 220, Taiwan (Republic of China).
Title
Two-year follow-up of tirofiban-based management of non-ST-elevation acute
coronary syndrome - A single center study.
Source
Acta Cardiologica Sinica. 26(1)(pp 19-27), 2010. Date of Publication:
March 2010.
Publisher
Republic of China Society of Cardiology
Abstract
Background: The current practice guidelines suggest early and invasive
strategies in treating patients of non-ST-elevation acute coronary
syndrome (NSTEACS) with high-risk profiles. However, the definite benefit
and treatment protocols are still under debate. We conducted a
tirofiban-based follow-up study to assess the effects of early-invasive
strategy in NSTEACS. Methods: This was a prospective, open-label
randomized trial. The study had a two-by-two factorial design, combining
enoxaparin/unfractionated heparin and early-invasive/early- conservative
strategies. The early-invasive arm mandated coronary angiography within 12
hours after randomization, while the counterpart took more than 48 hours.
All enrolled patients received tirofiban at admission. The primary
endpoint was composed of cardiovascular death, re-hospitalization due to
recurrent angina, target vessel revascularization and unscheduled coronary
bypass surgery in follow-up. The secondary endpoint concerned the bleeding
complications. Results: After a 2-year follow-up of 61 eligible patients,
the early-invasive arm did not show benefit over the early-conservative
arm (RR = 0.522, P = 0.318; Kaplan Meier (KM) log-rank P = 0.36) and
enoxaparin was not superior to unfractionated heparin (RR = 0.319, P =
0.079; KM log-rank P = 0.15). From another viewpoint, updated strategies
utilizing either enoxaparin or early catheterization were better than the
conventional one, which adopted unfractionated heparin and delayed
angiography (RR = 0.276, 95% CI 0.101-0.752, P = 0.026; KM log-rank P =
0.0026). There was no difference in bleeding complications. Conclusion:
The updated treatment should be superior to the most conventional protocol
in treating NSTEACS. But, we cannot conclude that the early-invasive
strategy benefits all NSTEACS patients more, especially when optimal
adjunctive pharmacologic therapies are applied.
<6>
Accession Number
2010268631
Authors
Nault I. Miyazaki S. Forclaz A. Wright M. Jadidi A. Jais P. Hocini M.
Haissaguerre M.
Institution
(Nault, Miyazaki, Forclaz, Wright, Jadidi, Jais, Hocini, Haissaguerre)
Hopital Cardiologique Haut-Leveque, Universite Victor Segalen, Avenue de
Magellan, 33 604, Bordeaux-Pessac cedex, France.
Title
Drugs vs. ablation for the treatment of atrial fibrillation: The evidence
supporting catheter ablation.
Source
European Heart Journal. 31(9)(pp 1046-1054), 2010. Date of Publication:
May 2010.
Publisher
Oxford University Press
Abstract
Treatment strategy for atrial fibrillation (AF) is a controversial matter.
Catheter ablation is increasingly being used to treat patients with AF,
and recent studies have reported success rates >80 for paroxysmal AF and
>70 for persistent AF. The purpose of this work is to review the evidence
supporting catheter ablation and compare it with pharmacological treatment
in the management of AF. copyright The Author 2010.
<7>
Accession Number
2010292076
Authors
Pham M.X. Teuteberg J.J. Kfoury A.G. Starling R.C. Deng M.C. Cappola T.P.
Kao A. Anderson A.S. Cotts W.G. Ewald G.A. Baran D.A. Bogaev R.C. Elashoff
B. Baron H. Yee J. Valantine H.A.
Institution
(Pham, Valantine) Stanford University Medical Center, Stanford, CA, United
States.
(Pham) VA Palo Alto Health Care System, Palo Alto, CA, United States.
(Teuteberg) University of Pittsburgh Medical Center, Pittsburgh, United
States.
(Kfoury) Intermountain Medical Center and Intermountain Healthcare, Salt
Lake City, United States.
(Starling) Cleveland Clinic, Cleveland, United States.
(Deng) Columbia University Medical Center, New York, United States.
(Cappola) Hospital of the University of Pennsylvania, Philadelphia, United
States.
(Kao) Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO,
United States.
(Anderson) University of Chicago, Medical Center, Chicago, United States.
(Cotts) Northwestern University, Chicago, United States.
(Ewald) Washington University, School of Medicine, St. Louis, United
States.
(Baran) Newark Beth Israel Medical Center, Newark, NJ, United States.
(Bogaev) Texas Heart Institute, Houston, United States.
(Elashoff, Baron, Yee) XDx, Brisbane, CA, United States.
Title
Gene-expression profiling for rejection surveillance after cardiac
transplantation.
Source
New England Journal of Medicine. 362(20)(pp 1890-1900), 2010. Date of
Publication: 20 May 2010.
Publisher
Massachussetts Medical Society
Abstract
Endomyocardial biopsy is the standard method of monitoring for rejection
in recipients of a cardiac transplant. However, this procedure is
uncomfortable, and there are risks associated with it. Gene-expression
profiling of peripheral-blood specimens has been shown to correlate with
the results of an endomyocardial biopsy. Methods: We randomly assigned 602
patients who had undergone cardiac transplantation 6 months to 5 years
previously to be monitored for rejection with the use of gene-expression
profiling or with the use of routine endomyocardial biopsies, in addition
to clinical and echocardiographic assessment of graft function. We
performed a noninferiority comparison of the two approaches with respect
to the composite primary outcome of rejection with hemodynamic compromise,
graft dysfunction due to other causes, death, or retransplantation.
Results: During a median follow-up period of 19 months, patients who were
monitored with gene-expression profiling and those who underwent routine
biopsies had similar 2-year cumulative rates of the composite primary
outcome (14.5% and 15.3%, respectively; hazard ratio with gene-expression
profiling, 1.04; 95% confidence interval, 0.67 to 1.68). The 2-year rates
of death from any cause were also similar in the two groups (6.3% and
5.5%, respectively; P = 0.82). Patients who were monitored with the use of
gene-expression profiling underwent fewer biopsies per person-year of
follow-up than did patients who were monitored with the use of
endomyocardial biopsies (0.5 vs. 3.0, P<0.001). Conclusions: Among
selected patients who had received a cardiac transplant more than 6 months
previously and who were at a low risk for rejection, a strategy of
monitoring for rejection that involved gene-expression profiling, as
compared with routine biopsies, was not associated with an increased risk
of serious adverse outcomes and resulted in the performance of
significantly fewer biopsies. (ClinicalTrials.gov number, NCT00351559.)
Copyright copyright 2010 Massachusetts Medical Society. All rights
reserved.
<8>
Accession Number
2010284707
Authors
Colivicchi F. Tubaro M. Mocini D. Genovesi Ebert A. Strano S. Melina G.
Uguccioni M. Santini M.
Institution
(Colivicchi, Tubaro, Mocini, Santini) Cardiology Division, Cardiovascular
Department, San Filippo Neri Hospital, Rome, Italy.
(Genovesi Ebert) Cardiology Division, Spedali Riuniti Hospital, Livorno,
Italy.
(Strano) Cardiovascular Department, First School of Medicine, Sapienza
University, Rome, Italy.
(Melina) Cardiovascular Surgery, Cardio-Thoracic Department, Second School
of Medicine, Sapienza University, Rome, Italy.
(Uguccioni) Cardiology Division, CTO-Alesini Hospital, Rome, Italy.
Title
Full-dose atorvastatin versus conventional medical therapy after
non-ST-elevation acute myocardial infarction in patients with advanced
non-revascularisable coronary artery disease.
Source
Current Medical Research and Opinion. 26(6)(pp 1277-1284), 2010. Date of
Publication: June 2010.
Publisher
Informa Healthcare
Abstract
Aims: This study tested the hypothesis that the addition of full-dose
atorvastatin (80mg/day) to conventional medical treatment could reduce
ischaemic recurrences after non-ST-elevation acute myocardial infarction
(NSTE-AMI) in patients with severe and diffuse coronary artery disease
(CAD) not amenable to any form of mechanical revascularisation. Methods
and results: The study was an open-label, randomised, controlled, blinded
end-point classification trial, employing the PROBE (Prospective Open
Treatment and Blinded End Point Evaluation) design. A total of 290
patients (mean age 74.6+/-9.6 years) with NSTE-AMI and angiographic
evidence of severe and diffuse CAD, not amenable to revascularisation by
either coronary surgery or angioplasty, were randomised to atorvastatin
80mg/day (n=144) or conventional medical treatment (n=146). A primary end
point event (combination of cardiovascular death, non-fatal acute
myocardial reinfarction and disabling stroke within 12 months of
randomisation) occurred in 16.0 of patients treated with atorvastatin
80mg/day and in 26.7 of patients receiving conventional treatment (HR
0.56; 95 CI 0.330.93, p=0.027). The study was not blinded. Consequently, a
bias in the assessment of clinical outcome cannot be completely excluded.
Conclusions: In conclusion, when compared with a conventional treatment
strategy, full-dose therapy with atorvastatin 80mg/day provides greater
protection against ischaemic recurrences after NSTE-AMI in patients with
severe, diffuse, non-revascularisable CAD. copyright 2010 Informa UK Ltd
All rights reserved.
<9>
Accession Number
2010274405
Authors
Nicholls S.J. Hsu A. Wolski K. Hu B. Bayturan O. Lavoie A. Uno K. Tuzcu
E.M. Nissen S.E.
Institution
(Nicholls, Hsu, Wolski, Bayturan, Lavoie, Uno, Tuzcu, Nissen) Department
of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United
States.
(Nicholls) Department of Cell Biology, Cleveland Clinic, Cleveland, OH,
United States.
(Nicholls) Center for Cardiovascular Diagnostics and Prevention, Cleveland
Clinic, Cleveland, OH, United States.
(Hu) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States.
Title
Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic
Plaque Burden and Clinical Outcome.
Source
Journal of the American College of Cardiology. 55(21)(pp 2399-2407),
2010. Date of Publication: 25 May 2010.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to investigate the relationship
between intravascular ultrasound (IVUS)-derived measures of
atherosclerosis and cardiovascular outcomes. Background: IVUS has been
used in clinical trials to evaluate the effect of medical therapies on
coronary atheroma progression. Methods: Coronary plaque progression was
evaluated in 4,137 patients in 6 clinical trials that used serial IVUS.
The relationship between baseline and change in percent atheroma volume
(PAV) and total atheroma volume with incident major adverse cardiovascular
events (MACE) was investigated. Results: PAV increased by 0.3% (p <
0.001), and 19.9% of subjects experienced MACE (0.9% death, 1.8%
myocardial infarction, 18.9% coronary revascularization). Greater baseline
PAVs were observed in patients who experienced myocardial infarctions
(42.2 +/- 9.6% vs. 38.6 +/- 9.1%, p = 0.001), coronary revascularization
(41.2 +/- 9.3% vs. 38.1 +/- 9.0%, p < 0.001), or MACE (41.3 +/- 9.2% vs.
38.0 +/- 9.0%, p < 0.001). Each standard deviation increase in PAV was
associated with a 1.32-fold (95% confidence interval: 1.22 to 1.42; p <
0.001) greater likelihood of experiencing a MACE. During follow-up (21.1
+/- 3.7 months), greater increases in PAV, but not total atheroma volume,
were observed in subjects who experienced MACE compared with those who did
not (0.95 +/- 0.19% vs. 0.46 +/- 0.16%, p < 0.001). Each standard
deviation increase in PAV was associated with a 1.20-fold (95% confidence
interval: 1.10 to 1.31; p < 0.001) greater risk for MACE. Multivariate
analysis revealed that factors associated with MACE included baseline PAV
(p < 0.0001), change in PAV (p = 0.002), smoking (p = 0.0002) and
hypertension (p = 0.01). Conclusions: A direct relationship was observed
between the burden of coronary atherosclerosis, its progression, and
adverse cardiovascular events. The relationship between disease
progression and outcomes largely reflected the need for coronary
revascularization. These data support the use of atherosclerosis imaging
with IVUS in the evaluation of novel antiatherosclerotic therapies.
copyright 2010 American College of Cardiology Foundation.
<10>
Accession Number
2010261474
Authors
Duggal J.K. Singh M. Attri N. Singh P.P. Ahmed N. Pahwa S. Molnar J. Singh
S. Khosla S. Arora R.
Institution
(Duggal, Singh, Attri, Singh, Ahmed, Pahwa, Molnar, Singh, Khosla, Arora)
Chicago Medical School, Affiliated Hospitals, Rosalind Franklin University
of Medicine and Science, North Chicago, IL, United States.
Title
Effect of niacin therapy on cardiovascular outcomes in patients with
coronary artery disease.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 15(2)(pp
158-166), 2010. Date of Publication: June 2010.
Publisher
SAGE Publications Ltd
Abstract
Background: Niacin or nicotinic acid (vitamin B3) raises the levels of
high-density lipoprotein cholesterol (HDL) by about 30% to 35%. In
patients with prior coronary disease, 7 trials have been published on
clinical cardiovascular disease outcomes and the results, not
surprisingly, are inconsistent. Hence, we performed this meta-analysis of
randomized placebo-controlled trials (RCTs) to evaluate the effect of
niacin on cardiovascular outcomes in patients with coronary artery
disease. Methods: A systematic search using PubMed, EMBASE, and Cochrane
library databases was performed. Seven studies with a total of 5137
patients met our inclusion criteria. Heterogeneity of the studies was
analyzed by the Cochran Q statistics. The significance of common treatment
effect was assessed by computing the combined relative risks using the
Mantel-Haenszel fixed-effect model. A 2-sided alpha error of less than.05
was considered statistically significant (P <.05). Results: Compared to
placebo group, niacin therapy significantly reduced coronary artery
revascularization (RR [relative risk]: 0.307 with 95% CI: 0.150-0.628; P
=.001), nonfatal myocardial infarction ([MI]; RR: 0.719; 95% CI:
0.603-0.856; P =.000), stroke, and TIA ([transient ischemic attack] RR:
0.759; 95%CI: 0.613-0.940; P =.012), as well as a possible but
nonsignificant decrease in cardiac mortality (RR: 0.883: 95% CI:
0.773-1.008; p= 0.066). Conclusions: In a meta-analysis of seven trials of
secondary prevention, niacin was associated with a significant reduction
in cardiovascular events and possible small but non-significant decreases
in coronary and cardiovascular mortality.
<11>
Accession Number
2010255630
Authors
Jeremias A. Vasu S. Gruberg L. Kastrati A. Stone G.W. Brown D.L.
Institution
(Jeremias, Vasu, Gruberg, Brown) Division of Cardiovascular Medicine,
Department of Medicine, Stony Brook University Medical Center, Stony
Brook, NY, United States.
(Kastrati) Department of Medicine, Deutsches Herzzentrum, Technische
Universitat, Munich, Germany.
(Stone) Department of Medicine, Columbia University Medical Center, New
York, NY, United States.
(Stone) Cardiovascular Research Foundation, New York, NY, United States.
Title
Impact of abciximab on mortality and reinfarction in patients with acute
ST-segment elevation myocardial infarction treated with primary stenting.
Source
Catheterization and Cardiovascular Interventions. 75(6)(pp 895-902),
2010. Date of Publication: 01 May 2010.
Publisher
Wiley-Liss Inc.
Abstract
Objectives: To combine data from all randomized trials of abciximab versus
placebo or open-label control in patients with STEMI treated with primary
stenting to assess the short-term and long-term mortality, reinfarction,
and bleeding complications. Background: Clinical trials of adjunctive
abciximab therapy in patients with ST-segment elevation myocardial
infarction (STEMI) undergoing primary stenting have produced conflicting
results. Methods: Formal searches of electronic databases (Medline,
Cochrane) from January 1990 to April 2009 were performed. Five trials
randomizing 2,937 patients (1,475 in the abciximab group, 1,462 in the
placebo group) were included in the analysis. Results: When compared with
placebo, abciximab was not associated with a significant reduction in the
odds of 30-day (OR 0.71, 95% CI: 0.45-1.14, P = 0.16) or long-term (OR
0.85, 95% CI: 0.48-1.50, P = 0.57) mortality. Similarly, the rate of
reinfarction was not statistically different at 30 days (OR 0.59, 95% CI:
0.30-1.17, P = 0.13) or at long-term follow-up (OR 0.67; 95% CI:
0.39-1.16, P = 0.16). However, when trials with upstream use of
thienopyridines were excluded, abciximab was associated with a significant
reduction in the composite of death or reinfarction at 30 days (OR 0.45;
95% CI: 0.26-0.77, P = 0.004) but not at long-term follow-up (OR 0.59; 95%
CI: 0.27-1.28, P = 0.18). Conclusion: Routine use of abciximab in patients
with STEMI treated with primary stenting may reduce short-term rates of
death or reinfarction in patients not administered preprocedural
thienopyridine therapy, but does not appear to be beneficial in those who
receive preprocedural thienopyridines. copyright 2010 Wiley-Liss, Inc.
<12>
Accession Number
2010287071
Authors
Schramko A. Suojaranta-Ylinen R. Kuitunen A. Raivio P. Kukkonen S. Niemi
T.
Institution
(Schramko, Suojaranta-Ylinen, Kuitunen, Kukkonen, Niemi) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Meilahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland.
(Raivio) Department of Cardiothoracic Surgery, Helsinki University
Hospital, Meilahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland.
Title
Hydroxyethylstarch and gelatin solutions impair blood coagulation after
cardiac surgery: A prospective randomized trial.
Source
British Journal of Anaesthesia. 104(6)(pp 691-697), 2010. Date of
Publication: June 2010.
Publisher
Oxford University Press
Abstract
Background. Colloids are often used after cardiac surgery as intravascular
volume replacement therapy. Cardiac surgical patients have an increased
risk of bleeding. Both hydroxyethylstarch (HES) and gelatin solutions
impair haemostasis. We examined the impact and dose effect on coagulation
of HES 130/0.4, gelatin, or Ringer's acetate solutions after cardiac
surgery.Methods. Forty-five patients received three boluses (each 7 ml
kg-1) of either 6% HES 130/0.4, 4% gelatin, or Ringer's acetate solution
after elective cardiac surgery. The infusion of study solution was
continued in the dose 7 ml kg -1 over the following 12 h. The total dose
of study solution was 28 ml kg-1. Hypovolaemia was treated with Ringer's
acetate. Modified thromboelastometry was performed to detect coagulation
disorders.Results. Clot formation time was prolonged and clot strength
decreased after infusion of 7, 14, and 21 ml kg-1 of either colloid
compared with the Ringer's acetate group. After infusion of 14 and 21 ml
kg-1 of Ringer's acetate, clot strength was slightly, but significantly,
increased. On the first postoperative morning, clot strength was still
decreased in the gelatin group in comparison with the Ringer's acetate
group. Neither HES nor gelatin induced fibrinolysis. Chest tube drainage
was comparable between all groups.Conclusions. Even a small dose of HES
130/0.4 or gelatin impaired clot strength after cardiac surgery in a
dose-dependent fashion, but neither colloid increased blood loss.
copyright 2010 The Author.
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