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<1>
Accession Number
2010441948
Authors
Di Sciascio G. Patti G. Pasceri V. Gatto L. Colonna G. Montinaro A.
Institution
(Di Sciascio, Patti, Gatto) Department of Cardiovascular Sciences, Campus
Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
(Pasceri) Interventional Cardiology Unit, San Filippo Neri Hospital, Rome,
Italy
(Colonna, Montinaro) Interventional Cardiology Unit, Vito Fazzi Hospital,
Lecce, Italy
Title
Effectiveness of in-laboratory high-dose clopidogrel loading versus
routine pre-load in patients undergoing percutaneous coronary
intervention: Results of the ARMYDA-5 PRELOAD (Antiplatelet therapy for
Reduction of MYocardial Damage during Angioplasty) randomized trial.
Source
Journal of the American College of Cardiology. 56 (7) (pp 550-557), 2010.
Date of Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to evaluate safety and effectiveness of
in-laboratory (in-lab) 600-mg clopidogrel loading pre-percutaneous
coronary intervention (PCI) versus routine 6-h pre-load. Background:
Clopidogrel pre-treatment significantly improves outcome in patients
undergoing PCI; however, efficacy of an in-lab loading strategy before PCI
after coronary angiography versus routine pre-load has not been fully
characterized. Methods: A total of 409 patients (39% with acute coronary
syndrome) were randomized to receive a 600-mg clopidogrel loading dose 4
to 8 h before PCI (pre-load group, n = 204) or a 600-mg loading dose given
in the catheterization lab after coronary angiography, but prior to PCI
(in-lab group, n = 205). Primary end point was 30-day incidence of major
adverse cardiac events: cardiac death, myocardial infarction (MI), or
unplanned target vessel revascularization. Results: There was no
significant difference in primary end point between the 2 randomization
arms (8.8% in-lab vs. 10.3% pre-load; p = 0.72); this was mainly driven by
periprocedural MI (8.8% vs. 9.3%, p = 0.99). No increased risk of bleeding
or vascular complications was observed in the pre-load arm (5.4% vs. 7.8%;
p = 0.42). As determined by the VerifyNow assay (Accumetrics, San Diego,
California), patients in the in-lab group showed higher platelet
reactivity during PCI and 2 h after intervention versus those in the
pre-load arm (p <= 0.043). Conclusions: ARMYDA-5 PRELOAD (Antiplatelet
therapy for Reduction of MYocardial Damage during Angioplasty) trial
indicates that a strategy of 600-mg in-lab clopidogrel load pre-PCI may
have similar clinical outcomes as routine 4- to 8-h pre-load. Thus, when
indicated, in-lab clopidogrel administration can be a safe alternative to
routine pre-treatment given before knowing patients' coronary anatomy.
2010 American College of Cardiology Foundation.
<2>
[Use Link to view the full text]
Accession Number
2010446976
Authors
Udelson J.E. Feldman A.M. Greenberg B. Pitt B. Mukherjee R. Solomon H.A.
Konstam M.A.
Institution
(Udelson, Konstam) Tufts Medical Center, Box 70, 750 Washington Street,
Boston, MA 02111, United States
(Feldman) Jefferson Medical College, Philadelphia, Pa, United States
(Greenberg) University of California San, Diego Medical Center, San Diego,
Calif, United States
(Pitt) University of Michigan School of Medicine, Ann Arbor, Mich, United
States
(Mukherjee, Solomon) Pfizer Inc, New York, NY., United States
Title
Randomized, double-blind, multicenter, placebo-controlled study evaluating
the effect of aldosterone antagonism with eplerenone on ventricular
remodeling in patients with mild-to-moderate heart failure and left
ventricular systolic dysfunction.
Source
Circulation: Heart Failure. 3 (3) (pp 347-353), 2010. Date of
Publication: May 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Aldosterone: antagonism has been studied in patients with
advanced heart failure (HF) and also in patients with post-myocardial
infarction and left ventricular (LV) dysfunction with HF symptoms. Few
data are available on effects of aldosterone antagonism in patients with
mild-to-moderate HF. Methods and Results-In: a multicenter, randomized,
double-blind, placebo-controlled study in patients with mild-tomoderate HF
and LV systolic dysfunction, patients with New York Heart Association
class II/III HF and LV ejection fraction (EF) <=35% were randomly assigned
to receive eplerenone 50 mg/d versus placebo in addition to contemporary
background therapy. Quantitative radionuclide ventriculograms to assess LV
volumes and ejection fraction were performed at baseline and again after 9
months of double-blind treatment and were analyzed in a central core
laboratory, blinded to treatment. The primary efficacy analysis was the
between-group comparison of the change in LV end-diastolic volume index.
Secondary analyses examined changes in LV end-systolic volume index and
ejection fraction as well as markers of collagen turnover. Of the total
226 patients enrolled, 117 were randomly assigned to receive eplerenone
and 109 to receive placebo. There was high use of contemporary background
therapy at baseline, with >=90% use of angiotensin-converting enzyme
inhibitors and/or angiotensin receptor blockers and >=90% use of
beta-blockers. Over 36 weeks of treatment, there was no apparent
between-group difference in the changes in end-diastolic volume index or
end-systolic volume index. There was a reduction in the collagen turnover
marker procollagen type I N-terminal propeptide and plasma B-type
natriuretic peptide in the eplerenone group compared with placebo (P=0.01
and P=0.04, respectively). There was no change in symptom status or
quality-of-life measures. Conclusions-In a clinically stable, well-treated
population of patients with mild-to-moderate HF symptoms and LV
dysfunction, 36 weeks of treatment of aldosterone antagonism with
eplerenone at a dose of 50 mg daily had no detectable effect on parameters
of LV remodeling. 2010 American Heart Association, Inc.
<3>
Accession Number
2010447342
Authors
Armstrong P.W. Gershlick A. Goldstein P. Wilcox R. Danays T. Bluhmki E.
Van De Werf F.
Institution
(Armstrong) 2-51 Medical Sciences Building, University of Alberta,
Edmonton, AB T6G 2H7, Canada
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Goldstein) Centre Hospitalier Regional, Universitaire de Lille, Lille,
France
(Wilcox) Nottingham University Hospital, Nottingham, United Kingdom
(Danays) Boehringer-Ingelheim, Reims, United Kingdom
(Bluhmki) Boehringer-Ingelheim, Biberach, Germany
(Van De Werf) University Hospital Gasthuisberg, Leuven, Belgium
Title
The Strategic Reperfusion Early after Myocardial Infarction (STREAM)
study.
Source
American Heart Journal. 160 (1) (pp 30-35.e1), 2010. Date of
Publication: July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Primary percutaneous coronary intervention (PCI) has emerged
as the preferred therapy for acute ST-elevation myocardial infarction
(STEMI) provided it is performed in a timely fashion at an expert 24/7
facility. Fibrinolysis is a well-accepted alternative, especially in
patients presenting early after symptom onset. The STREAM study will
provide novel information on whether prompt fibrinolysis at first medical
contact, followed by timely catheterization or rescue coronary
intervention in STEMI patients presenting within 3 hours of symptom onset,
represents an appropriate alternative strategy to primary PCI. Methods:
Acute STEMI patients presenting early after symptom onset are eligible if
PCI is not feasible within 60 minutes of first medical contact. This is an
open-label, prospective, randomized, parallel, comparative, international
multicenter trial. Patients are randomized to fibrinolysis combined with
enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6
to 24 hours or rescue coronary intervention if reperfusion fails within 90
minutes of fibrinolysis versus PCI performed according to local
guidelines. Composite efficacy end points at 30 days include death, shock,
heart failure, and reinfarction. Safety end points include ischemic
stroke, intracranial hemorrhage, and major nonintracranial bleeding.
Follow-up is extended to 1 year and includes all-cause mortality.
Discussion: Continuing delays in achieving timely PCI remain a difficult
issue. Many patients fail to achieve the desired reperfusion times of 90
to 120 minutes after first medical contact. The STREAM results will
provide useful additional data on which to base informed therapeutic
decisions. 2010, Mosby, Inc. All rights reserved.
<4>
Accession Number
2010447343
Authors
Surder D. Schwitter J. Moccetti T. Astori G. Rufibach K. Plein S. Cicero
V.L. Soncin S. Windecker S. Moschovitis A. Wahl A. Erne P. Jamshidi P. Auf
Der Maur C. Manka R. Soldati G. Buhler I. Wyss C. Landmesser U. Luscher
T.F. Corti R.
Institution
(Surder, Schwitter, Buhler, Wyss, Landmesser, Luscher, Corti) Department
of Cardiology, University Hospital Zurich, Zurich, Switzerland
(Surder, Moccetti, Astori, Cicero, Soncin, Soldati) Cardiology and Cell
Therapy Unit, Cardiocentro Ticino, Lugano, Switzerland
(Rufibach) Biostatistics Unit, Institute for Social and Preventive
Medicine, University of Zurich, Zurich, Switzerland
(Plein) Academic Unit of Cardiovascular Medicine, University of Leeds,
Leeds, United Kingdom
(Windecker, Moschovitis, Wahl) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Erne, Jamshidi, Auf Der Maur) Department of Cardiology, Cantonal Hospital
Luzern, Luzern, Switzerland
(Manka) Institute for Biomedical Engineering, University and ETH Zurich,
Zurich, Switzerland
Title
Cell-based therapy for myocardial repair in patients with acute myocardial
infarction: Rationale and study design of the SWiss multicenter
Intracoronary Stem cells Study in Acute Myocardial Infarction (SWISS-AMI).
Source
American Heart Journal. 160 (1) (pp 58-64), 2010. Date of Publication:
July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Recent studies report that intracoronary administration of
autologous bone marrow mononucleated cells (BM-MNCs) may improve
remodeling of the left ventricle after acute myocardial infarction (AMI).
Subgroup analysis suggest that early treatment between days 4 and 7 after
AMI is probably most effective; however, the optimal time point of
intracoronary cell administration has never been addressed in clinical
trials. Furthermore, reliable clinical predictors are lacking for
identifying patients who are thought to have most benefit from cellular
therapy. Study Design: In a multicenter trial, 192 patients with AMI
successfully treated by percutaneous coronary intervention (PCI) of the
infarct-related artery will be randomized in a 1:1:1 pattern to 1 control
and 2 BM-MNC treatment groups. The control group will be treated with
state-of-the-art medical management. The treatment groups will receive
intracoronary administration of autologous BM-MNC at 5 to 7 days or 3 to 4
weeks after the initial event, respectively. Left ventricular function as
well as scar size, transmural extension, and regional wall motion score
will be assessed by cardiac magnetic resonance (CMR) studies at baseline
and after 4 and 12 months. Methods: Fifty milliliters of bone marrow will
be harvested by aspiration from the iliac crest and then carried by
courier to a centralized cell processing facility. The mononucleated cell
fraction will be isolated by density gradient centrifugation, washed, and
resuspended in 10 mL of injection medium. The cells will be characterized
by fluorescence-activated cell sorting analysis and tested for sterility
and potency both "in vitro" and "in vivo." Bone marrow MNC will then be
reinfused directly in the infarct-related coronary artery. End points: The
primary end point is the change in global left ventricular (LV) ejection
fraction by CMR at 4 months as compared to baseline. Comparisons will then
be made between each of the prespecified therapy subgroups (early and late
after AMI) and the control group. Secondary end points include change in
infarct size, change in regional myocardial thickness, and wall motion at
4 and 12 months compared to baseline. Infarct extension (size and
transmural extension), time delay to PCI, and coronary flow
characteristics after PCI will be assessed as potential predictors of LV
remodeling and change after cell therapy. Major adverse cardiac events
(MACE) (death, myocardial infarction, coronary revascularization,
rehospitalization for heart failure) will be assessed at 4, 12, and 24
months and time to MACE will be estimated. Discussion: With the present
study, we aim to determine the optimal time point of intracoronary
administration of autologous BM-MNC after AMI on LV remodeling. 2010,
Mosby, Inc. All rights reserved.
<5>
Accession Number
2010447346
Authors
Mauri L. Garg P. Massaro J.M. Foster E. Glower D. Mehoudar P. Powell F.
Komtebedde J. McDermott E. Feldman T.
Institution
(Mauri, Garg) Brigham and Women's Hospital, Boston, MA, United States
(Mauri, Massaro) Harvard Clinical Research Institute, Boston, MA, United
States
(Mauri) Harvard Medical School, Boston, MA, United States
(Foster) University of California San Francisco, San Francisco, CA, United
States
(Glower) Duke University Medical Center, Durham, NC, United States
(Mehoudar, Powell, Komtebedde, McDermott) Abbott Vascular-Structural
Heart, Inc., Menlo Park, CA, United States
(Feldman) North Shore University Health System, Evanston, IL, United
States
Title
The EVEREST II Trial: Design and rationale for a randomized study of the
evalve mitraclip system compared with mitral valve surgery for mitral
regurgitation.
Source
American Heart Journal. 160 (1) (pp 23-29), 2010. Date of Publication:
July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Mitral valve surgery is the standard of care for patients with
symptomatic mitral regurgitation (MR) or asymptomatic MR with evidence of
left ventricular dysfunction or dilation. Whether an endovascular approach
to repair can offer comparable effectiveness with improved safety remains
to be determined in randomized trials. Study Design: The EVEREST II Trial
is a multicenter, randomized controlled trial to evaluate the benefits and
risks of endovascular mitral valve repair using the MitraClip device
compared with open mitral valve surgery (control) in patients with
moderate or severe MR. Using a 2:1 randomization ratio, the trial is
enrolling up to 186 MitraClip-treated subjects and 93 control subjects.
Trial end points include a primary efficacy end point: the proportion of
patients free from death, surgery for valve dysfunction, and with
moderate-severe (3+) or severe (4+) MR at 12 months; the primary safety
end point includes the proportion of patients with death, myocardial
infarction, reoperation, nonelective cardiovascular surgery, stroke, renal
failure, deep would infection, ventilation >48 hours, gastrointestinal
complication, new permanent atrial fibrillation, septicemia, or
transfusion of >=2 U at 30 days or hospital discharge, whichever is
longer. Conclusions: This randomized controlled trial is designed to
evaluate the performance of endovascular mitral repair in comparison to
open mitral valve surgery in patients with significant MR. 2010, Mosby,
Inc. All rights reserved.
<6>
Accession Number
2010447353
Authors
Joyal D. Afilalo J. Rinfret S.
Institution
(Joyal, Afilalo) Division of Cardiology, Sir Mortimer B. Davis Jewish
General Hospital, McGill University, Montreal, QC, Canada
(Rinfret) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Laval University, Quebec City, QC, Canada
Title
Effectiveness of recanalization of chronic total occlusions: A systematic
review and meta-analysis.
Source
American Heart Journal. 160 (1) (pp 179-187), 2010. Date of Publication:
July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Chronic total occlusion (CTO) recanalizations remain extremely
challenging procedures. With improvements in technology and techniques,
success rates for recanalization of CTO continue to improve. However, the
clinical benefits of this practice remain unclear. The aim of the study
was to determine the effectiveness of CTO recanalization on clinical
outcomes. Methods: We performed a systematic review and meta-analysis of
published studies comparing CTO recanalization to medical management. Data
were extracted in duplicate and analyzed by a random effects model.
Results: We did not identify any randomized controlled trials or
observational studies comparing CTO recanalization to a planned medical
management. We did identify 13 observational studies comparing outcomes
after successful vs failed CTO recanalization attempt. These studies
encompassed 7,288 patients observed over a weighted average follow-up of 6
years. There were 721 (14.3%) deaths of 5,056 patients after successful
CTO recanalization compared to 390 deaths (17.5%) of 2,232 patients after
failed CTO recanalization (odds ratio [OR] 0.56, 95% CI 0.43-0.72).
Successful recanalization was associated with a significant reduction in
subsequent coronary artery bypass graft surgery (CABG) (OR 0.22, 95% CI
0.17-0.27) but not in myocardial infarction (OR 0.74, 95% CI 0.44-1.25) or
major adverse cardiac events (OR 0.81, 95% CI 0.55-1.21). In the 6 studies
that reported angina status, successful recanalization was associated with
a significant reduction in residual/recurrent angina (OR 0.45, 95% CI
0.30-0.67). Conclusions: In highly selected patients considered for CTO
recanalization, successful attempts appear to be associated with an
improvement in mortality and with a reduction for the need for CABG as
compared to failed recanalization. However, given the observational nature
of the reviewed evidence, randomized clinical trials are needed to confirm
these findings. 2010, Mosby, Inc. All rights reserved.
<7>
Accession Number
2010447358
Authors
Chin C.T. Roe M.T. Fox K.A.A. Prabhakaran D. Marshall D.A. Petitjean H.
Lokhnygina Y. Brown E. Armstrong P.W. White H.D. Ohman E.M.
Institution
(Chin, Roe, Lokhnygina, Ohman) Duke Clinical Research Institute, 2400
Pratt St, Durham, NC 27705, United States
(Fox) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control, New Delhi, India
(Marshall, Brown) Eli Lilly and Company, Indianapolis, IN, United States
(Petitjean) Daiichi Sankyo, Inc., Parsippany, NJ, United States
(Armstrong) University of Alberta, Edmonton, AB, Canada
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
Title
Study design and rationale of a comparison of prasugrel and clopidogrel in
medically managed patients with unstable angina/non-ST-segment elevation
myocardial infarction: The TaRgeted platelet Inhibition to cLarify the
Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY
ACS) trial.
Source
American Heart Journal. 160 (1) (pp 16-22.e1), 2010. Date of
Publication: July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Practice guidelines recommend dual antiplatelet therapy with aspirin and
clopidogrel for patients with non-ST-segment elevation acute coronary
syndromes (NSTE ACS) regardless of in-hospital management strategy.
Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that
provides higher and less variable levels of platelet inhibition than
clopidogrel-has demonstrated benefit when used to treat ACS patients
undergoing percutaneous coronary intervention. However, the optimal
approach to antiplatelet therapy for high-risk, medically managed NSTE ACS
patients remains uncertain, as these patients have not been the focus of
previous clinical trials of these therapies. TRILOGY ACS is a phase 3,
randomized, double-blind trial enrolling approximately 10,300 NSTE ACS
patients within 10 days of presentation with either unstable angina or
NSTE myocardial infarction who are not intended to undergo
revascularization procedures for their index event. Patients will be
randomly allocated to prasugrel + aspirin versus clopidogrel + aspirin for
a median duration of 18 months. A reduction in the maintenance dose of
prasugrel for elderly patients (age >=75 years) and those with body weight
<60 kg is planned. The primary composite efficacy end point will be time
to first occurrence of cardiovascular death, myocardial infarction, or
stroke in patients aged <75 years. If the superiority of prasugrel is
established in patients aged <75 years, the treatment arms will then be
compared for all subjects (including those aged >=75 years). TRILOGY ACS
is the largest randomized clinical trial to date focusing exclusively on
medically managed NSTE ACS patients and will provide important information
regarding the optimal approach to oral antiplatelet therapy for this
high-risk, understudied population. 2010, Mosby, Inc. All rights
reserved.
<8>
Accession Number
2010447364
Authors
Torella M. Torella D. Chiodini P. Franciulli M. Romano G. De Santo L. De
Feo M. Amarelli C. Sasso F.C. Salvatore T. Ellison G.M. Indolfi C. Cotrufo
M. Nappi G.
Institution
(Torella, Franciulli, Romano, De Feo, Amarelli, Cotrufo, Nappi) Department
of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, Second
University of Naples, Via Leonardo Bianchi, 80100 Naples, Italy
(Torella, Indolfi) Division of Cardiology, Magna Graecia University,
Catanzaro, Italy
(Torella, Ellison) RISES, Liverpool John Moores University, Liverpool,
United Kingdom
(Chiodini) Department of Medicine and Public Health, Second University of
Naples, Naples, Italy
(De Santo) Department of Cardiac Surgery, University of Foggia, Foggia,
Italy
(Sasso, Salvatore) Department of Internal Medicine, Second University of
Naples, Naples, Italy
Title
LOWERing the INtensity of oral anticoaGulant Therapy in patients with
bileaflet mechanical aortic valve replacement: Results from the
"lOWERING-IT" Trial.
Source
American Heart Journal. 160 (1) (pp 171-178), 2010. Date of Publication:
July 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Moderate anticoagulation after mechanical heart valve
replacement has been proposed to reduce the risk of bleeding related to
lifelong anticoagulation. However, the efficacy of such reduced
antithrombotic regimens is still unknown. The present prospective
open-label, single-center, randomized controlled trial aimed to evaluate
the safety and feasibility of reduced oral anticoagulation after isolated
mechanical aortic valve replacement. Methods: Low-risk patients undergoing
bileaflet mechanical aortic valve replacement were randomized to a low
International normalized ratio (INR) target (1.5-2.5; LOW-INR group) or to
the standard currently recommended INR (2.0-3.0; CONVENTIONAL-INR group)
through daily coumarine oral therapy. No aspirin was added. Median
follow-up was 5.6 years. The primary outcome was assessment of
noninferiority of the low over the standard anticoagulation regimen on
thromboembolic events. Secondary end point was the superiority of the
reduced INR target strategy on bleeding events. Results: We analyzed 396
patients (197 in the LOW-INR group and 199 in the CONVENTIONAL-INR group).
The mean of INR was 1.94 +/- 0.21 and 2.61 +/- 0.25 in the LOW-INR and
CONVENTIONAL-INR groups, respectively (P < .001). One versus three
thromboembolic events occurred in the LOW-INR and CONVENTIONAL-INR,
respectively, meeting the noninferiority criterion (P = .62). Total
hemorrhagic events occurred in 6 patients in the LOW-INR group and in 16
patients in the CONVENTIONAL-INR group (P = .04). Conclusions: LOWERING-IT
trial established that the proposed LOW-INR target is safe and feasible in
low-risk patients after bileaflet aortic mechanical valve replacement. It
results in similar thrombotic events and in a significant reduction of
bleeding occurrence when compared to the conventional anticoagulation
regimen. 2010, Mosby, Inc. All rights reserved.
<9>
Accession Number
2010447529
Authors
Kramer D.G. Trikalinos T.A. Kent D.M. Antonopoulos G.V. Konstam M.A.
Udelson J.E.
Institution
(Kramer, Antonopoulos, Konstam, Udelson) Division of Cardiology,
CardioVascular Center, Tufts Medical Center, Boston, MA, United States
(Trikalinos, Kent) Center for Clinical Evidence Synthesis, Institute for
Clinical Research and Health Policy Studies, Tufts Medical Center, Boston,
MA, United States
Title
Quantitative evaluation of drug or device effects on ventricular
remodeling as predictors of therapeutic effects on mortality in patients
with heart failure and reduced ejection fraction: A meta-analytic
approach.
Source
Journal of the American College of Cardiology. 56 (5) (pp 392-406), 2010.
Date of Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to quantitatively assess the
relationship between therapy-induced changes in left ventricular (LV)
remodeling and longer-term outcomes in patients with left ventricular
dysfunction (LVD). Background: Whether therapy-induced changes in left
ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and
end-systolic volume (ESV) are predictors of mortality in patients with LVD
is not established. Methods: Searches for randomized controlled trials
(RCTs) were conducted to identify drug or device therapies for which an
effect on mortality in patients with LVD was studied in at least 1 RCT of
<500 patients (mortality trials). Then, all RCTs involving those therapies
were identified in patients with LVD that described changes in LVEF and/or
volumes over time (remodeling trials). We examined whether the magnitude
of remodeling effects is associated with the odds ratios for death across
all therapies or associated with whether the odds ratio for mortality was
favorable, neutral, or adverse (i.e., statistically significantly
decreased, nonsignificant, or statistically significantly increased odds
for mortality, respectively). Results: Included were 30 mortality trials
of 25 drug/device therapies (n = 69,766 patients; median follow-up 17
months) and 88 remodeling trials of the same therapies (n = 19,921
patients; median follow-up 6 months). The odds ratio for death in the
mortality trials was correlated with drug/device effects on LVEF (r =
-0.51, p < 0.001), EDV (r = 0.44, p = 0.002), and ESV (r = 0.48, p =
0.002). In (ordinal) logistic regressions, the odds for neutral or
favorable effects in the mortality RCTs increased with mean increases in
LVEF and with mean decreases in EDV and ESV in the remodeling trials.
Conclusions: In patients with LVD, short-term trial-level therapeutic
effects of a drug or device on LV remodeling are associated with
longer-term trial-level effects on mortality. 2010 American College of
Cardiology Foundation.
<10>
Accession Number
2010448706
Authors
Amr Y.M. Yassin I.M.
Institution
(Amr, Yassin) Department of Anesthesiology, Faculty of Medicine, Tanta
University, Tanta, 31527, Egypt
Title
Cardiac protection during on-pump coronary artery bypass grafting:
Ischemic versus isoflurane preconditioning.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 14 (3) (pp 205-211),
2010. Date of Publication: September 2010.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objectives. To compare the cardioprotective effects of anesthetic
preconditioning by isoflurane with ischemic preconditioning. Methods. A
total of 45 patients scheduled for elective coronary artery bypass graft
(CABG) surgery were randomized to preconditioning either by 3 episodes of
1-minute aortic cross-clamping followed by 4 minutes of reperfusion after
each episode, a 10-minute exposure to isoflurane 2.5% followed by 5
minutes of washout, or no preconditioning technique (control group).
Hemodynamic data, cardiac troponin I (cTnI), creatine kinase isoenzyme MB
(CK-MB) release, need for inotropic support, hospital stay, and adverse
cardiac events were measured and recorded. Results. Preconditioned
patients showed marked improvement in hemodynamic data, less need for
inotropic support, and less postoperative increase in the serum levels of
CK-MB and cTnI. No significant difference in hospital stay was found.
Also, 4 patients in the control group had adverse cardiac events versus 1
patient in the isoflurane and ischemic groups in 1 year of follow-up.
Conclusions. Based on this very small sample size, these data support a
cardioprotective effect of isoflurane and ischemic preconditioning during
CABG surgery. The Author(s) 2010.
<11>
Accession Number
20347836
Authors
Bauer B.A. Cutshall S.M. Wentworth L.J. Engen D. Messner P.K. Wood C.M.
Brekke K.M. Kelly R.F. Sundt III T.M.
Institution
(Bauer) Division of General Internal Medicine, Mayo Clinic, 200 First
Street SW, Rochester, MN 55905, United States
(Cutshall) Department of Surgery, Mayo Clinic, Rochester, MN, United
States
(Wentworth, Messner) Department of Nursing, Mayo Clinic, Rochester, MN,
United States
(Engen) Department of Physical Medicine and Rehabilitation, Mayo Clinic,
Rochester, MN, United States
(Wood) Division of Biomedical Informatics and Biostatistics, Mayo Clinic,
Rochester, MN, United States
(Brekke) Cardiovascular Research, Mayo Clinic, Rochester, MN, United
States
(Kelly, Sundt III) Division of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, United States
Title
Effect of massage therapy on pain, anxiety, and tension after cardiac
surgery: A randomized study.
Source
Complementary Therapies in Clinical Practice. 16 (2) (pp 70-75), 2010.
Date of Publication: May 2010.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Integrative therapies such as massage have gained support as interventions
that improve the overall patient experience during hospitalization.
Cardiac surgery patients undergo long procedures and commonly have
postoperative back and shoulder pain, anxiety, and tension. Given the
promising effects of massage therapy for alleviation of pain, tension, and
anxiety, we studied the efficacy and feasibility of massage therapy
delivered in the postoperative cardiovascular surgery setting. Patients
were randomized to receive a massage or to have quiet relaxation time
(control). In total, 113 patients completed the study (massage, n = 62;
control, n = 51). Patients receiving massage therapy had significantly
decreased pain, anxiety, and tension. Patients were highly satisfied with
the intervention, and no major barriers to implementing massage therapy
were identified. Massage therapy may be an important component of the
healing experience for patients after cardiovascular surgery. 2009
Elsevier Ltd. All rights reserved.
<12>
Accession Number
20347840
Authors
Cutshall S.M. Wentworth L.J. Engen D. Sundt T.M. Kelly R.F. Bauer B.A.
Institution
(Cutshall) Department of Surgery, Mayo Clinic, Rochester, MN, United
States
(Wentworth) Department of Nursing, Mayo Clinic, Rochester, MN, United
States
(Engen) Department of Physical Medicine and Rehabilitation, Mayo Clinic,
Rochester, MN, United States
(Sundt, Kelly) Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
(Bauer) Division of General Internal Medicine, Mayo Clinic, 200 First
Street SW, Rochester, MN 55905 MN, United States
Title
Effect of massage therapy on pain, anxiety, and tension in cardiac
surgical patients: A pilot study.
Source
Complementary Therapies in Clinical Practice. 16 (2) (pp 92-95), 2010.
Date of Publication: May 2010.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Objectives: To assess the role of massage therapy in the cardiac surgery
postoperative period. Specific aims included determining the difference in
pain, anxiety, tension, and satisfaction scores of patients before and
after massage compared with patients who received standard care. Design: A
randomized controlled trial comparing outcomes before and after
intervention in and across groups. Setting: Saint Marys Hospital, Mayo
Clinic, Rochester, Minnesota. Subjects: Patients undergoing cardiovascular
surgical procedures (coronary artery bypass grafting and/or valvular
repair or replacement) (N = 58). Interventions: Patients in the
intervention group received a 20-minute session of massage therapy
intervention between postoperative days 2 and 5. Patients in the control
group received standard care and a 20-minute quiet time between
postoperative days 2 and 5. Outcome measures: Linear Analogue
Self-assessment scores for pain, anxiety, tension, and satisfaction.
Results: Statistically and clinically significant decreases in pain,
anxiety, and tension scores were observed for patients who received a
20-minute massage compared with those who received standard care. Patient
feedback was markedly positive. Conclusions: This pilot study showed that
massage can be successfully incorporated into a busy cardiac surgical
practice. These results suggest that massage may be an important therapy
to consider for inclusion in the management of postoperative recovery of
cardiovascular surgical patients. 2009 Elsevier Ltd. All rights reserved.
<13>
Accession Number
20387314
Authors
Block P.C.
Institution
(Block) Emory University Hospital, Atlanta, Georgia 30322, USA.
Title
Much ado, but not what to do.
Source
The Journal of invasive cardiology. 22 (4) (pp 167), 2010. Date of
Publication: Apr 2010.
<14>
Accession Number
2010447291
Authors
Harrison P.
Institution
(Harrison) Oxford Haemophilia and Thrombosis Centre, Churchill Hospital,
Oxford, OX3 7LJ, United Kingdom
Title
The influence of citrate concentrations on PFA-100 closure times, platelet
hyper-reactivity and aspirin monitoring.
Source
Thrombosis Research. 126 (2) (pp e137-e138), 2010. Date of Publication:
2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
<15>
Accession Number
2010447327
Authors
Ternstrom L. Radulovic V. Karlsson M. Baghaei F. Hyllner M. Bylock A.
Hansson K.M. Jeppsson A.
Institution
(Ternstrom, Karlsson, Hyllner, Jeppsson) Department of Cardiovascular
Surgery and Anesthesia, Sahlgrenska University Hospital, SE 413 45
Gothenburg, Sweden
(Radulovic, Baghaei) Department of Medicine/Hematology and Coagulation
Disorders, Sahlgrenska University Hospital, Gothenburg, Germany
(Bylock, Hansson) AstraZeneca AB, Molndal, Sweden
(Ternstrom, Karlsson, Jeppsson) Department of Molecular and Clinical
Medicine, Institute of Medicine, University of Gothenburg, Gothenburg,
Sweden
Title
Plasma activity of individual coagulation factors, hemodilution and blood
loss after cardiac surgery: A prospective observational study.
Source
Thrombosis Research. 126 (2) (pp e128-e133), 2010. Date of Publication:
2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Hemodilution and consumption of coagulation factors during
cardiopulmonary bypass has been suggested to contribute to bleeding
complications after cardiac surgery. The aim was to describe the activity
of individual coagulation factors after CABG in relation to hemodilution
and postoperative bleeding. Materials and Methods: Plasma concentrations
of fibrinogen and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI
and FXIII adjusted for hemodilution were analysed in 57 CABG patients
before, and 2 h and 24 h after surgery. Postoperative bleeding was
registered and correlations to coagulation factor activity were
calculated. Results: Adjusted plasma concentration of fibrinogen (-14 +/-
6%), and plasma activity of FII (-9 +/- 6%), FV (-13 +/- 8%), FX (-13 +/-
7%) and FXIII (-9 +/- 14%) were reduced two hours after surgery compared
to baseline (all p < 0.001). FVII (+ 3 +/- 12%, p = 0.34) and FXI (+ 1 +/-
19%, p = 0.50) were unchanged, while FVIII (+ 23 +/- 44%, p = 0.006) and
FIX (+ 23 +/- 17%, p < 0.001) increased. Twenty-four hours after surgery
fibrinogen (+ 45 +/- 27%), FVIII (+ 93 +/- 66%) and FIX (+ 33 +/- 26%)
were all increased (all p < 0.001), while FVII (-37 +/- 14%, p < 0.001),
FXI (-4 +/- 18%, p = 0.02) and FXIII (-6 +/- 15%, p = 0.004) were
decreased. Median postoperative blood loss was 380 ml/12 h. There were
significant inverse correlations between postoperative blood loss and
fibrinogen concentration 2 h after surgery (r = -0.33, p = 0.019) and
between postoperative blood loss and pre- and postoperative FXIII activity
(r = -0.34, p = 0.009 and r = -0.41, p = 0.003, respectively), but not
between blood loss and any of the other factors. Conclusions: There is a
marked dissociation in plasma activity of individual coagulation factors
after CABG. Plasma concentration of fibrinogen and factor XIII activity
correlates inversely to postoperative blood loss after CABG. 2010
Elsevier Ltd. All rights reserved.
<16>
Accession Number
2010447905
Authors
Ridker P.M. Genest J. Boekholdt S.M. Libby P. Gotto A.M. Nordestgaard B.G.
Mora S. MacFadyen J.G. Glynn R.J. Kastelein J.J.P.
Institution
(Ridker, Mora, MacFadyen, Glynn) Center for Cardiovascular Disease,
Prevention Brigham and Women's Hospital, Harvard Medical School, Boston,
MA 02215, United States
(Ridker, Libby, Mora) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Genest) McGill University Health Centre, Montreal, QC, Canada
(Gotto) Weill Cornell Medical College of Cornell University, New York, NY,
United States
(Nordestgaard) Department of Clinical Biochemistry, Herlev Hospital,
Copenhagen University Hospital, Denmark
(Boekholdt, Kastelein) Department of Cardiology and Vascular Medicine,
Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
Title
HDL cholesterol and residual risk of first cardiovascular events after
treatment with potent statin therapy: An analysis from the JUPITER trial.
Source
The Lancet. 376 (9738) (pp 333-339), 2010. Date of Publication: 2010.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Summary Background HDL-cholesterol concentrations are inversely associated
with occurrence of cardiovascular events. We addressed, using the JUPITER
trial cohort, whether this association remains when LDL-cholesterol
concentrations are reduced to the very low ranges with high-dose statin
treatment. Participants in the randomised placebo-controlled JUPITER trial
were adults without diabetes or previous cardiovascular disease, and had
baseline concentrations of LDL cholesterol of less than 337 mmol/L and
high-sensitivity C-reactive protein of 2 mg/L or more. Participants were
randomly allocated by a computer-generated sequence to receive
rosuvastatin 20 mg per day or placebo, with participants and adjudicators
masked to treatment assignment. In the present analysis, we divided the
participants into quartiles of HDL-cholesterol or apolipoprotein A1 and
sought evidence of association between these quartiles and the JUPITER
primary endpoint of first non-fatal myocardial infarction or stroke,
hospitalisation for unstable angina, arterial revascularisation, or
cardiovascular death. This trial is registered with ClinicalTrials.gov,
number NCT00239681. For 17 802 patients in the JUPITER trial, rosuvastatin
20 mg per day reduced the incidence of the primary endpoint by 44
(p<00001). In 8901 (50) patients given placebo (who had a median
on-treatment LDL-cholesterol concentration of 280 mmol/L [IQR 243-324]),
HDL-cholesterol concentrations were inversely related to vascular risk
both at baseline (top quartile vs bottom quartile hazard ratio [HR] 054,
95 CI 035-083, p=00039) and on-treatment (055, 035-087, p=00047). By
contrast, among the 8900 (50) patients given rosuvastatin 20 mg (who had a
median on-treatment LDL-cholesterol concentration of 142 mmol/L [IQR
114-186]), no significant relationships were noted between quartiles of
HDL-cholesterol concentration and vascular risk either at baseline (112,
062-203, p=082) or on-treatment (103, 057-187, p=097). Our analyses for
apolipoprotein A1 showed an equivalent strong relation to frequency of
primary outcomes in the placebo group but little association in the
rosuvastatin group. Although measurement of HDL-cholesterol concentration
is useful as part of initial cardiovascular risk assessment,
HDL-cholesterol concentrations are not predictive of residual vascular
risk among patients treated with potent statin therapy who attain very low
concentrations of LDL cholesterol. AstraZeneca. 2010 Elsevier Ltd.
<17>
Accession Number
2010450878
Authors
Bennett-Guerrero E. Ferguson Jr. T.B. Lin M. Garg J. Mark D.B. Scavo Jr.
V.A. Kouchoukos N. Richardson Jr. J.B. Pridgen R.L. Corey G.R.
Institution
(Bennett-Guerrero) Division of Perioperative Clinical Research, Duke
Clinical Research Institute, Duke University, Durham, NC, United States
(Lin, Garg) Division of Biostatistics and Bioinformatics, Duke Clinical
Research Institute, Duke University, Durham, NC, United States
(Mark) Division of Outcomes Research, Duke Clinical Research Institute,
Duke University, Durham, NC, United States
(Pridgen) Division of Project Leadership, Duke Clinical Research
Institute, Duke University, Durham, NC, United States
(Corey) Division of Infectious Disease, Duke Clinical Research Institute,
Duke University, Durham, NC, United States
(Ferguson Jr.) Department of Cardiovascular Sciences, East Carolina Heart
Institute, Greenville, NC, United States
(Scavo Jr.) Indiana Ohio Heart, Fort Wayne, IN, United States
(Kouchoukos) Missouri Baptist Medical Center, St Louis, MO, United States
(Richardson Jr.) Saint Vincent's Hospital, Birmingham, AL, United States
Title
Effect of an implantable gentamicin-collagen sponge on sternal wound
infections following cardiac surgery: A randomized trial.
Source
JAMA - Journal of the American Medical Association. 304 (7) (pp 755-762),
2010. Date of Publication: 18 Aug 2010.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Despite the routine use of prophylactic systemic antibiotics,
sternal wound infection still occurs in5%or more of cardiac surgical
patients and is associated with significant excess morbidity, mortality,
and cost. The gentamicin-collagen sponge, a surgically implantable topical
antibiotic, is currently approved in 54 countries.Alarge, 2-center,
randomized trial in Sweden reported in 2005 that the sponge reduced
surgical site infection by 50% in cardiac patients. Objective: To test the
hypothesis that the sponge prevents infection in cardiac surgical patients
at increased risk for sternal wound infection. Design, Setting, and
Participants: Phase 3 single-blind, prospective randomized controlled
trial, 1502 cardiac surgical patients at high risk for sternal wound
infection (diabetes, body mass index >30, or both) were enrolled at 48 US
sites between December 21, 2007, and March 11, 2009. Intervention:
Single-blind randomization to insertion of 2 gentamicin-collagen sponges
(total gentamicin of 260 mg) between the sternal halves at surgical
closure (n=753) vs no intervention (control group: n=749). All patients
received standardized care including prophylactic systemic antibiotics and
rigid sternal fixation. Main Outcome Measures: The primary end point was
sternal wound infection occurring through 90 days postoperatively as
adjudicated by a clinical events classification committee blinded to study
treatment group. The primary study comparison was done in the
intent-to-treat population. Secondary outcomes included (1) superficial
wound infection (involving subcutaneous tissue but not extending down to
sternal fixation wires), (2) deep wound infection (involving the sternal
wires, sternal bone, and/or mediastinum), and (3) score for additional
treatment, presence of serous discharge, erythema, purulent exudate,
separation of the deep tissues, isolation of bacteria, and duration of
inpatient stay (ASEPSIS; minimum score of 0 with no theoretical maximum).
Results: Of 1502 patients, 1006 had diabetes (67%) and 1137 were obese
(body mass index >30) (76%). In the primary analysis, there was no
significant difference in sternal wound infection in 63 of 753 patients
randomized to the gentamicin-collagen sponge group (8.4%) compared with 65
of 749 patients randomized to the control group (8.7%) (P=.83). No
significant differences were observed between the gentamicin-collagen
sponge group and the control group, respectively, in superficial sternal
wound infection (49/753 [6.5%] vs46/749[6.1%];P=.77), deep sternal wound
infection (14/753[1.9%]vs19/749[2.5%]; P=.37), ASEPSIS score (mean [SD],
1.9 [6.4] vs 2.0 [7.2]; P=.67), or rehospitalization for sternal wound
infection (23/753 [3.1%] vs 24/749 [3.2%]; P=.87). Conclusion: Among US
patients with diabetes, high body mass index, or both undergoing cardiac
surgery, the use of 2 gentamicin-collagen sponges compared with no
intervention did not reduce the 90-day sternal wound infection rate. Trial
Registration: clinicaltrials.gov Identifier: NCT00600483. 2010 American
Medical Association. All rights reserved.
<18>
Accession Number
20449698
Authors
Aslam S. Gray D.
Institution
(Aslam) Division of Cardiovascular Medicine, University Hospital,
Nottingham, UK.
Title
Ranolazine (Ranexa) in the treatment of chronic stable angina.
Source
Advances in therapy. 27 (4) (pp 193-201), 2010. Date of Publication: Apr
2010.
Abstract
Ischemic heart disease is the major cause of morbidity and mortality in
the Western world. Patients often suffer a reduction in quality of life
due to chronic stable angina, but therapeutic options can be limited due
to concerns for heart rate and blood pressure, as well as side effect
profiles. Even revascularization therapy has its limitations and newer
agents are required to help in this battle for symptomatic relief.
Ranolazine (Ranexa(R), A. Menarini Pharma UK, High Wycombe, UK) is a drug
with a novel mechanism of action that has been shown in several large
trials to be an efficacious adjunctive agent in reducing symptoms of
chronic stable angina. It is thought to work by inhibiting the late sodium
current in cardiac myocytes, thereby reducing sodium and calcium overload
that follows ischemia. This improves myocardial relaxation and reduces
left ventricular diastolic stiffness, which in turn enhances myocardial
contractility and perfusion. The drug is generally well tolerated and the
evidence so far is encouraging, with a clear clinical benefit achieved in
the target groups. Its main strength is that it does not appear to affect
either heart rate or blood pressure. This review provides an insight into
this treatment option, describes the clinical trials evidence, proposed
mechanism of action, and pharmacokinetics, and outlines the indications
for its use in chronic stable angina.
<19>
Accession Number
20736470
Authors
Perera D. Stables R. Thomas M. Booth J. Pitt M. Blackman D. de Belder A.
Redwood S. BCIS-1 Investigators
Institution
(Perera) Cardiovascular Division, King's College London, London SE1 7EH,
UK.
Title
Elective intra-aortic balloon counterpulsation during high-risk
percutaneous coronary intervention: a randomized controlled trial.
Source
JAMA : the journal of the American Medical Association. 304 (8) (pp
867-874), 2010. Date of Publication: 25 Aug 2010.
Abstract
CONTEXT: Observational studies have previously reported that elective
intra-aortic balloon pump (IABP) insertion may improve outcomes following
high-risk percutaneous coronary intervention (PCI). To date, this
assertion has not been tested in a randomized trial. OBJECTIVE: To
determine whether routine intra-aortic balloon counterpulsation before PCI
reduces major adverse cardiac and cardiovascular events (MACCE) in
patients with severe left ventricular dysfunction and extensive coronary
disease. DESIGN, SETTING, AND PATIENTS: The Balloon Pump-Assisted Coronary
Intervention Study, a prospective, open, multicenter, randomized
controlled trial conducted in 17 tertiary referral cardiac centers in the
United Kingdom between December 2005 and January 2009. Patients (n = 301)
had severe left ventricular dysfunction (ejection fraction < or = 30%) and
extensive coronary disease (Jeopardy Score > or = 8/12); those with
contraindications to or class I indications for IABP therapy were
excluded. INTERVENTION: Elective insertion of IABP before PCI. MAIN
OUTCOME MEASURES: Primary end point was MACCE, defined as death, acute
myocardial infarction, cerebrovascular event, or further revascularization
at hospital discharge (capped at 28 days). Secondary end points included
all-cause mortality at 6 months, major procedural complications, bleeding,
and access-site complications. RESULTS: MACCE at hospital discharge
occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the
no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence
interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and
7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]).
Fewer major procedural complications occurred with elective IABP insertion
compared with no planned IABP use (1.3% vs 10.7%, P < .001; OR, 0.11 [95%
CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3% (P =
.06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in 3.3%
and 0% (P = .06) of the elective and no planned IABP groups, respectively.
CONCLUSIONS: Elective IABP insertion did not reduce the incidence of MACCE
following PCI. These results do not support a strategy of routine IABP
placement before PCI in all patients with severe left ventricular
dysfunction and extensive coronary disease. TRIAL REGISTRATION: isrctn.org
Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481.
<20>
Accession Number
20084300
Authors
Gualandro D.M. Calderaro D. Yu P.C. Marques A.C. Caramelli B.
Institution
(Gualandro) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
Title
Beta-blockers and non-cardiac operations what will change after the POISE
study?: ?que cambia despues del estudio POISE?.
Source
Arquivos brasileiros de cardiologia. 93 (5) (pp e82-84), 2009. Date of
Publication: Nov 2009.
<21>
Accession Number
2010409983
Authors
Choi Y.S. Shim J.K. Hong S.W. Kim J.C. Kwak Y.L.
Institution
(Choi, Shim, Kim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 250 Seongsanno, Seodaemun-Ku, Seoul, South Korea
(Hong) Department of Anesthesiology and Pain Medicine, Kyungpook National
University College of Medicine, Daegu, South Korea
Title
Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on
coagulation and inflammatory response when used as priming solutions for
cardiopulmonary bypass.
Source
Minerva Anestesiologica. 76 (8) (pp 584-591), 2010. Date of Publication:
August 2010.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. This prospective, randomized and controlled trial compares the use of
human albumin (HA) and hydroxyethyl starch (HES) 130/0.4 in the priming
solution for a non-biocompatible cardiopulmonary bypass (CPB) circuit. The
effects of each substance on coagulation, postoperative blood loss and
pro-inflammatory activities were examined. Methods. Thirty-six adult
patients undergoing mitral valvular heart surgery were randomly assigned
to either the HA or HES group; 500 mL of 5% HA or 6% HES 130/0.4 were
added to the priming solution of the CPB circuit for each group,
respectively. Coagulation variables were measured perioperatively; these
variables included thromboelastographic (TEG) parameters and
pro-inflammatory markers such as interleukin (IL)-6, IL-8 and tumor
necrotic factor (TNF)-alpha. Postoperative blood loss and transfusion
requirements were also assessed. Results. There were no significant
intergroup differences in the coagulation variables (including TEG
parameters), serum concentrations of IL-6, IL-8 and TNF-alpha, and blood
loss or transfusion requirements. TEG parameters, which indicate the speed
of solid clot formation and the strength of the fibrin clot, decreased up
to 4 hours after CPB in both groups. Serum concentrations of IL-6, IL-8
and TNF-alpha were higher up to 12 hours after surgery compared to
baseline values in both groups. Hemoglobin levels and platelet counts were
lower up to 12 hours after surgery compared to baseline values in both
groups. Conclusion. HES 130/0.4 was comparable to albumin as a component
of the priming solution for a non-biocompatible CPB circuit. The two
substances showed similar effects on coagulation variables, blood loss and
pro-inflammatory activities in adult patients undergoing mitral valvular
heart surgery. 2009 Edizioni Minerva Medica.
<22>
Accession Number
2010428749
Authors
Filosso P.L. Ruffini E. Solidoro P. Molinatti M. Bruna M.C. Oliaro A.
Institution
(Filosso, Ruffini, Molinatti, Bruna, Oliaro) Department of Thoracic
Surgery, University of Turin, San Giovanni Battista Hospital, Via Genova
3, 10126 Turin, Italy
(Solidoro) Service of Pneumology, San Giovanni Battista Hospital,
University of Turin, Turin, Italy
Title
Digital air leak monitoring after lobectomy for primary lung cancer in
patients with moderate COPD: Can a fast-tracking algorithm reduce
postoperative costs and complications?.
Source
Journal of Cardiovascular Surgery. 51 (3) (pp 429-433), 2010. Date of
Publication: June 2010.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Prolonged air leaks remain one of the most important complication
after pulmonary resection. The aim of this study was to test a new
fast-track chest tube removal protocol using a new drainage system, which
digitally records postoperative air leaks, compared to the traditional
one, with subjective visual air leak assessment. Methods. Patients with
moderate COPD undergoing lobectomy for primary lung cancer at the
Department of Thoracic Surgery of the University of Torino were randomised
in two groups with different chest drainage systems and different removal
protocols: in Group A the drainage was removed after digitally recordered
measurement of air leaks; in Group B the tube was removed according to the
air leaks visualization by bubbling in the water column. The following
variables were evaluated: first and second drainage removal day; overall
hospital length of stay; overall hospitalization costs. Results. First and
second drainages were removed sooner in those patients with the digital
drainage system. An earlier drainage removal is associated with
significative reduction in hospital length of stay and overall
hospitalization costs. Conclusion. The digital and continuous air leak
measurement reduces the hospital length of stay by a more accurate and
reproductive air leaks measurement. Further studies are mandatory to
corroborate our preliminary results.
<23>
Accession Number
20440039
Authors
Shamloo B.K. Chintala R.S. Nasur A. Ghazvini M. Shariat P. Diggs J.A.
Singh S.N.
Institution
(Shamloo) Department of Internal Medicine, Division of Cardiovascular
Diseases, Howard University Hospital, Washington, DC, USA.
Title
Spontaneous coronary artery dissection: aggressive vs. conservative
therapy.
Source
The Journal of invasive cardiology. 22 (5) (pp 222-228), 2010. Date of
Publication: May 2010.
Abstract
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare
condition that commonly presents as an acute coronary event in the younger
population, especially in females of childbearing age. Generally, there is
no consensus on the etiology, prognosis, and treatment of SCAD. METHODS:
The Medline database was searched for "spontaneous coronary artery
dissection" between 1931 and 2008. A total of 440 cases of SCAD were
identified. Demographic data were analyzed with either the Student's
t-test or the chi-square test for categorical and nominal variables,
respectively. Kaplan-Meier outcome analysis was used to assess the outcome
of a given treatment for all patients after 1990. RESULTS: SCAD was found
more commonly in females with 308 (70%) cases. Pregnancy was associated
with SCAD in 80 (26.1%) cases. Among pregnant patients, 67 (83.8%)
developed SCAD in the postpartum period and 13 (16.2%) patients in the
prepartum period. Analysis of treatment modalities showed that 21.2% of
the patients who were conservatively managed after the initial diagnosis
eventually required surgical or catheter-based intervention compared to
2.5% of patients who were initially treated with an aggressive strategy.
Kaplan-Meier analysis showed that patients with an isolated single lesion
in left or right coronary artery had a statistically significant better
outcome when treated with an early aggressive strategy, including coronary
artery bypass grafting (CABG) or stent placement as compared to a
conservative strategy (p = 0.023, p = 0.006, respectively). CONCLUSION:
Early intervention with either CABG or percutaneous coronary intervention
following the diagnosis of SCAD leads to a better outcome and less need
for further intervention.
<24>
Accession Number
2010432197
Authors
Cheung E.W.-Y. Wong W.H.-S. Cheung Y.-F.
Institution
(Cheung, Wong, Cheung) Department of Paediatrics and Adolescent Medicine,
Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
Title
Meta-analysis of pulmonary valve replacement after operative repair of
tetralogy of fallot.
Source
American Journal of Cardiology. 106 (4) (pp 552-557), 2010. Date of
Publication: August 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The present meta-analysis aimed to determine the outcomes and effect on
right ventricular (RV) function of surgical pulmonary valve replacement
(PVR) in patients after repair of tetralogy of Fallot. The reported
outcomes of surgical PVR in children and adults after tetralogy of Fallot
repair were from relatively small observational studies. The PubMed
database was searched from its inception to April 2009. Observational
studies reporting on the following outcomes measures after surgical PVR
were reviewed: early and late all-cause mortalities, the redo-PVR rate,
and changes in the indexed RV volumes, ejection fraction, and QRS duration
after PVR. Of the 305 citations screened, 15 met the criteria and were
analyzed. The pooled early mortality rate (n = 595) was 2.1% (95%
confidence interval [CI] 1.1% to 4.0%). The late mortality rate was
0.5%/patient-year (95% CI 0.2% to 0.8%/patient-year), and the redo-PVR
rate was 1.9%/patient-year (95% CI 1.3% to 2.5%/patient-year). Data on RV
volumes and ejection fractions were available from 5 studies (n = 141).
The pooled mean difference in the indexed RV end-diastolic and
end-systolic volume was -63 ml/m<sup>2</sup> (95% CI -55 to -72) and -37
ml/m<sup>2</sup> (95% CI -30 to -45), respectively. No significant changes
in the pooled mean difference of the RV ejection fraction (95% CI -1% to
3%) or QRS duration (95% CI -10 to 1 ms) were observed. In conclusion,
surgical PVR in patients after tetralogy of Fallot repair has been
associated with low early and late mortality and significant decreases in
RV volumes but no changes in the RV ejection fraction or QRS duration.
2010 Elsevier Inc. All rights reserved.
<25>
Accession Number
2010433869
Authors
Chen W.T. Krishnan G.M. Sood N. Kluger J. Coleman C.I.
Institution
(Chen, Coleman) University of Connecticut School of Pharmacy, Storrs, CT,
United States
(Krishnan) University of Connecticut School of Medicine, Farmington, CT,
United States
(Chen, Coleman) Department of Drug Information, Hartford Hospital,
Hartford, CT, United States
(Sood, Kluger) Department of Cardiology, Hartford Hospital, Hartford, CT,
United States
Title
Effect of statins on atrial fibrillation after cardiac surgery: A
duration- and dose-response meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (2) (pp 364-372),
2010. Date of Publication: 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: This meta-analysis of randomized, controlled trials evaluated
effects of statins on postoperative atrial fibrillation risk after cardiac
surgery. Methods: Randomized, controlled trials evaluating statins in
cardiac surgery were selected from MEDLINE (1996-August 2009), Cochrane
CENTRAL Register, and manual review of references without any language
restrictions. End points examined included postoperative atrial
fibrillation, intensive care unit stay, and total hospital stay.
Meta-regression analyses were conducted to determine whether statins'
effects were duration or dose dependent. A random-effects model was used
in all instances. Results: Eight trials (n = 774) were identified and
subjected to meta-analysis. Statins reduced postoperative atrial
fibrillation risk (relative risk 0.57, 95% confidence interval 0.45-0.72,
P < .0001, risk difference -0.14, 95% confidence interval -0.20 to -0.08,
P < .0001, number needed to treat 8) and total hospital stay (weighted
mean difference -0.66 days, 95% confidence interval -1.01 to -0.30 days, P
= .0004) relative to placebo. Intensive care unit stay was also reduced
(weighted mean difference -0.17 days, 95% confidence interval -0.37 to
0.03 days, P = .09) but did not meet prespecified criteria for statistical
significance. Metaregression analysis revealed association between
duration of preoperative statin prophylaxis and postoperative atrial
fibrillation risk reduction (3% reduction per day, P = .008). No
association was found between statin dose used and risk reduction (P =
.47). Conclusions: Evidence suggests that statins are associated with
reduced risk of postoperative atrial fibrillation and shorter hospital
stay after cardiac surgery and that earlier therapy results in more
profound benefit. Copyright 2010 by The American Association for Thoracic
Surgery.
<26>
Accession Number
2010438107
Authors
Cicek D. Pekdemir H. Kalay N. Binici S. Altay H. Muderrisoglu H.
Institution
(Cicek) Baskent University School of Medicine, Department of Cardiology,
Antalya, Turkey
(Pekdemir) Inonu University School of Medicine, Department of Cardiology,
Malatya, Turkey
(Kalay) Erciyes University School of Medicine, Department of Cardiology,
Kayseri, Turkey
(Binici, Altay) Baskent University School of Medicine, Department of
Cardiology, Adana, Turkey
(Muderrisoglu) Baskent University School of Medicine, Department of
Cardiology, Ankara, Turkey
Title
Efficacy of sirolimus-eluting stents compared with paclitaxel-eluting
stents in an unselected population with coronary artery disease: 24-month
outcomes of patients in a prospective non-randomized registry in southern
Turkey.
Source
International Journal of Medical Sciences. 7 (4) (pp 191-196), 2010.
Date of Publication: 2010.
Publisher
Ivyspring International Publisher (P.O. Box 4546, Lake Haven NSW 2263,
Australia)
Abstract
Background: The efficacy of drug-eluting stents has been shown in
randomized trials, but some controversy exists regarding which stent
sirolimus-eluting or paclitaxel-eluting is more effective in unselected
Turkish patients. Therefore, we investigated the clinical outcomes of
patients who were treated with one type of these drug-eluting stents in
the real world. Methods: We created a registry and prospectively analyzed
data on a consecutive series of all patients who presented to our
institution with symptomatic coronary artery disease between February 2005
and March 2007 and who were treated with the sirolimus- or the
paclitaxel-eluting stent. The follow-up period after stent implantation
was approximately 24 months. The primary end point was a major cardiac
event, and the secondary end point was stent thrombosis. Informed consent
was obtained from all subjects, and the study protocol was approved by the
local ethical committee. Results: In total, 204 patients were treated with
either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting
stent (n = 101). The lesions in the 2 arms of the study were treated
similarly by conventional technique. At 24-month follow-up, patients who
received the paclitaxel- eluting stent showed significantly higher rates
of non-Q-wave myocardial infarction (1.9% vs 5.9%; P:.002), target vessel
revascularization (1.9% vs 4.9%; P:.002), coronary artery bypass graft
surgery (1.9% vs 6.9%; P:.001), and late stent thrombosis (1.9% vs 3.9%,
P:.002). Conclusions: Patients who received the sirolimus-eluting stent
showed better clinical outcomes compared with those who had the
paclitaxel-eluting-stent. Key words: coronary artery disease, drug-eluting
stent, major adverse cardiac event, stent thrombosis. Ivyspring
International Publisher.
<27>
Accession Number
2010438528
Authors
Matsushita K. Muramatsu T. Kondo T. Maeda K. Shintani S. Murohara T.
Institution
(Matsushita, Muramatsu, Kondo, Maeda, Shintani, Murohara) Department of
Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai,
Showa-ku, Nagoya 466-8550, Japan
Title
Rationale and design of the NAGOYA HEART Study: Comparison between
valsartan and amlodipine regarding morbidity and mortality in patients
with hypertension and glucose intolerance.
Source
Journal of Cardiology. 56 (1) (pp 111-117), 2010. Date of Publication:
July 2010.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) (Hongo 4-9-22,
Bunkyo-ku, Tokyo 113, Japan)
Abstract
Background: Inhibitors of the renin angiotensin system are recommended as
the first-line medications for diabetic hypertensive patients. However,
there is less evidence supporting this recommendation especially among
East Asians, a population with a unique distribution of cardiovascular
disease compared to the Western population. Methods and results: The
NAGOYA HEART Study is a prospective randomized open-label blinded-endpoint
study to compare an angiotensin II receptor blocker, valsartan, and a
calcium channel blocker, amlodipine, regarding their efficacies on
cardiovascular morbidity and mortality in Japanese hypertensive patients
with glucose intolerance. Of 1168 eligible patients, we enrolled 1150
patients from October 2004 to January 2009. The participants will be
followed for more than a median follow-up period of 3 years. The primary
composite endpoint includes myocardial infarction, stroke, coronary
revascularization, and admission due to congestive heart failure or sudden
cardiac death. Any of these events are adjudicated by an independent
committee under blinded information regarding the treatment arm. Secondary
endpoints include all-cause mortality, changes in glucose tolerance
status, kidney function, left ventricular structure measured by
echocardiogram, and incident atrial fibrillation/flutter. The study was
registered at ClinicalTrials.gov NCT00129233. Conclusion: The NAGOYA HEART
Study will provide us with a relevant insight for appropriate treatment of
hypertension with glucose intolerance. 2010 Japanese College of
Cardiology.
<28>
Accession Number
2010443798
Authors
Ge J. Zhu J. Hong B.-K. Boonbaichaiyapruck S. Goh Y.S. Hou C.J.-Y. Pinton
P.
Institution
(Ge, Zhu) Zhong Shan Hospital, Fudan University, Shanghai, China
(Hong) Gangnam Severance Hospital, Yonsei University College of Medicine,
Seoul, South Korea
(Boonbaichaiyapruck) Ramathibodi Hospital, Bangkok, Thailand
(Goh) Changi General Hospital, Singapore, Singapore
(Hou) Mackay Memorial Hospital and Mackay Medicine, Nursing and Management
College, Taiwan (Republic of China)
(Pinton) Lilly Corporate Center, Indianapolis, IN 46285, United States
Title
Prasugrel versus clopidogrel in Asian patients with acute coronary
syndromes: Design and rationale of a multi-dose, pharmacodynamic, phase 3
clinical trial.
Source
Current Medical Research and Opinion. 26 (9) (pp 2077-2085), 2010. Date
of Publication: September 2010.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background: Prasugrel is a third generation thienopyridine that is more
potent, rapid in onset, and consistent in inhibition of platelets than
clopidogrel. However, early prasugrel dose-ranging studies and the
subsequent phase 3 TRITON-TIMI 38 trial were conducted primarily in
Caucasian populations. Objectives: The current clinical study is designed
to confirm superior inhibition of platelet aggregation with prasugrel
versus clopidogrel in the treatment of Asian subjects with acute coronary
syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
Research design and methods: This is a phase 3, randomized, double-blind,
multi-dose, four-arm parallel, multinational clinical trial. East and
Southeast Asian patients (N=715) with moderate-to high-risk ACS undergoing
PCI will be randomized to one of three prasugrel dosing regimens (60mg
LD/10mg MD; 30mg LD/7.5mg MD; 30mg LD/5mg MD) or clopidogrel (300mg
LD/75mg MD) for 90 days. Main outcome measures: The primary endpoint is
inhibition of platelet aggregation measured by the point-of-care
Accumetrics VerifyNow P2Y12 device, and the primary analysis will be
performed in a hierarchical manner for descending doses of prasugrel.
Additional key endpoints include major adverse cardiovascular events,
non-coronary artery bypass-graft (CABG) surgery-related TIMI bleeding, and
genetic analyses of cytochrome P450 polymorphisms. Conclusions: This study
is a phase 3, multi-dose, pharmacodynamic comparison of prasugrel versus
clopidogrel in Asian patients with ACS undergoing PCI. It is the first
study designed to investigate prasugrel therapy specifically in Asian ACS
subjects, and will inform which doses of prasugrel are effective and safe
for patients of Asian ethnicity. 2010 Informa UK Ltd. All rights
reserved.
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