Results Generated From:
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EMBASE (updates since 2010-09-30)
<1>
Accession Number
20156053
Authors
Mendes R.G. Simoes R.P. De Souza Melo Costa F. Pantoni C.B. Di Thommazo L.
Luzzi S. Catai A.M. Arena R. Borghi-Silva A.
Institution
(Mendes) Department of Physiotherapy, Federal University of Sao Carlos,
Sao Carlos, SP, Brazil.
Title
Short-term supervised inpatient physiotherapy exercise protocol improves
cardiac autonomic function after coronary artery bypass graft surgery--a
randomised controlled trial.
Source
Disability and rehabilitation. 32 (16) (pp 1320-1327), 2010. Date of
Publication: 2010.
Abstract
OBJECTIVE: Coronary artery bypass grafting (CABG) is accompanied by severe
impairment of cardiac autonomous regulation (CAR). This study aimed to
determine whether a short-term physiotherapy exercise protocol post-CABG,
during inpatient cardiac rehabilitation (CR), might improve CAR. DESIGN:
Seventy-four patients eligible for CABG were recruited and randomised into
physiotherapy exercise group (EG) or physiotherapy usual care group (UCG).
EG patients underwent a short-term supervised inpatient physiotherapy
exercise protocol consisting of an early mobilisation with progressive
exercises plus usual care (respiratory exercises). UCG only received
respiratory exercises. Forty-seven patients (24 EG and 23 UGC) completed
the study. Outcome measures of CAR included linear and non-linear measures
of heart rate variability (HRV) assessed before discharge. RESULTS: By
hospital discharge, EG presented significantly higher parasympathetic HRV
values [rMSSD, high frequency (HF), SD1)], global power (STD RR, SD2),
non-linear HRV indexes [detrended fluctuation analysis (DFA)alpha1,
DFAalpha2, approximate entropy (ApEn)] and mean RR compared to UCG
(p<0.05). Conversely, higher values of mean HR, low frequency (LF)
(sympathetic activity) and the LF/HF (global sympatho-vagal balance) were
found in the UCG. CONCLUSIONS: A short-term supervised physiotherapy
exercise protocol during inpatient CR improves CAR at the time of
discharge. Thus, exercise-based inpatient CR might be an effective
non-pharmacological tool to improve autonomic cardiac tone in patient's
post-CABG.
<2>
Accession Number
20542811
Authors
Sanchez-Recalde A. Jimenez Valero S. Moreno R. Barreales L. Lozano I.
Galeote G. Martin Reyes R. Calvo L. Lopez-Sendon J.L.
Institution
(Sanchez-Recalde) Interventional Cardiology Unit, Hospital Universitario
La Paz, Madrid, Spain.
Title
Safety and efficacy of drug-eluting stents versus bare-metal stents in
saphenous vein grafts lesions: a meta-analysis.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
6 (1) (pp 149-160), 2010. Date of Publication: May 2010.
Abstract
AIMS: Controversy exists about the safety and efficacy of drug-eluting
stents (DES) in saphenous vein bypass grafts (SVGs). The aim of this study
was to perform a meta-analysis of all published studies comparing DES and
bare-metal stents (BMS) in patients with SVGs disease. METHODS AND
RESULTS: We included 22 studies comparing DES versus BMS in 5,543 patients
with SVGs disease. The primary efficacy endpoint was target vessel
revascularisation (TVR). The primary safety endpoint was mortality. Other
outcomes of interest were cardiac mortality, myocardial infarction, target
lesion revascularisation (TLR), stent thrombosis and a combined of major
adverse cardiac events (MACE). DES significantly reduced the risk of TVR,
OR=0.56 (95% CI, 0.41-0.76, p=0.0003) and TLR, OR=0.58 (95% CI, 0.41-0.81;
p=0.001). Total mortality and cardiac mortality were significantly lower
in DES versus BMS, OR=0.69 (95% CI, 0.49-0.98, p=0.04) and OR=0.71 (95%
CI, 0.51-0.99; p=0.04), respectively. The overall risk of stent
thrombosis, and myocardial infarction were not significantly different for
patients receiving DES vs. BMS. Total MACE were significantly lower in
patients receiving DES, OR=0.55 (95% CI, 0.42-0.71; p<0.00001).
CONCLUSIONS: This meta-analysis suggests that the use of DES in patients
with SVG lesions is associated with a reduction of the need of
reintervention and mortality compared with BMS.
<3>
[Use Link to view the full text]
Accession Number
20733097
Authors
Solomon S.D. Foster E. Bourgoun M. Shah A. Viloria E. Brown M.W. Hall W.J.
Pfeffer M.A. Moss A.J. MADIT-CRT Investigators
Institution
(Solomon) Cardiovascular Division, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, USA.
Title
Effect of cardiac resynchronization therapy on reverse remodeling and
relation to outcome: multicenter automatic defibrillator implantation
trial: cardiac resynchronization therapy.
Source
Circulation. 122 (10) (pp 985-992), 2010. Date of Publication: 7 Sep
2010.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) plus implantation of
an implantable cardioverter defibrillator (ICD) reduced the risk of death
or heart failure event in patients with mildly symptomatic heart failure,
left ventricular dysfunction, and wide QRS complex compared with an ICD
only. We assessed echocardiographic changes in patients enrolled in the
MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial:
Cardiac Resynchronization Therapy) to evaluate whether the improvement in
outcomes with CRT plus an ICD was associated with favorable alterations in
cardiac size and function. METHODS AND RESULTS: A total of 1,820 patients
were randomly assigned to CRT plus an ICD or to an ICD only in a 3:2
ratio. Echocardiographic studies were obtained at baseline and 12 months
later in 1,372 patients. We compared changes in cardiac size and
performance between treatment groups and assessed the relationship between
these changes over the first year, as well as subsequent outcomes.
Compared with the ICD-only group, the CRT-plus-ICD group had greater
improvement in left ventricular end-diastolic volume index (-26.2 versus
-7.4 mL/m(2)), left ventricular end-systolic volume index (-28.7 versus
-9.1 mL/m(2)), left ventricular ejection fraction (11% versus 3%), left
atrial volume index (-11.9 versus -4.7 mL/m(2)), and right ventricular
fractional area change (8% versus 5%; P<0.001 for all). Improvement in
end-diastolic volume at 1 year was predictive of subsequent death or heart
failure, with adjustment for baseline covariates and treatment group; each
10% decrease in end-diastolic volume was associated with a 40% reduction
in risk (P<0.001). CONCLUSIONS: CRT resulted in significant improvement in
cardiac size and performance compared with an ICD-only strategy in
patients with mildly symptomatic heart failure. Improvement in these
measures accounted for the outcomes benefit. Clinical Trial Registration
Information- URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00180271.
<4>
[Use Link to view the full text]
Accession Number
20733102
Authors
Hueb W. Lopes N. Gersh B.J. Soares P.R. Ribeiro E.E. Pereira A.C. Favarato
D. Rocha A.S. Hueb A.C. Ramires J.A.
Institution
(Hueb) Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil.
Title
Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study
(MASS II): a randomized controlled clinical trial of 3 therapeutic
strategies for multivessel coronary artery disease.
Source
Circulation. 122 (10) (pp 949-957), 2010. Date of Publication: 7 Sep
2010.
Abstract
BACKGROUND: This study compared the 10-year follow-up of percutaneous
coronary intervention (PCI), coronary artery surgery (CABG), and medical
treatment (MT) in patients with multivessel coronary artery disease,
stable angina, and preserved ventricular function. METHODS AND RESULTS:
The primary end points were overall mortality, Q-wave myocardial
infarction, or refractory angina that required revascularization. All data
were analyzed according to the intention-to-treat principle. At a single
institution, 611 patients were randomly assigned to CABG (n=203), PCI
(n=205), or MT (n=203). The 10-year survival rates were 74.9% with CABG,
75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial
infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT
(P<0.010). The 10-year rates of additional revascularizations were 7.4%
with CABG, 41.9% with PCI, and 39.4% with MT (P<0.001). Relative to the
composite end point, Cox regression analysis showed a higher incidence of
primary events in MT than in CABG (hazard ratio 2.35, 95% confidence
interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95%
confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom
from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001).
CONCLUSIONS: Compared with CABG, MT was associated with a significantly
higher incidence of subsequent myocardial infarction, a higher rate of
additional revascularization, a higher incidence of cardiac death, and
consequently a 2.29-fold increased risk of combined events. PCI was
associated with an increased need for further revascularization, a higher
incidence of myocardial infarction, and a 1.46-fold increased risk of
combined events compared with CABG. Additionally, CABG was better than MT
at eliminating anginal symptoms. Clinical Trial Registration Information-
URL: http://www.controlled-trials.com. Registration number:
ISRCTN66068876.
<5>
[Use Link to view the full text]
Accession Number
2010509021
Authors
Solanki A. Puri G.D. Mathew P.J.
Institution
(Solanki, Puri, Mathew) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh 160
012, India
Title
Bispectral index-controlled postoperative sedation in cardiac surgery
patients: A comparative trial between closed loop and manual
administration of propofol.
Source
European Journal of Anaesthesiology. 27 (8) (pp 708-713), 2010. Date of
Publication: August 2010.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background and objective Postoperative cardiac surgery patients are
usually sedated according to clinical sedation scores.
Electrophysiological data derived from electroencephalography, such as the
bispectral index (BIS), have been reported to assess and quantify the
level of sedation, although experience in these patients is limited. In
the current study, we evaluated a closed-loop system - closed-loop
anaesthesia delivery system (CLADS) - for postoperative sedation after
open heart surgery using BIS. Methods Forty-one postoperative cardiac
surgery patients in the age group 18-65 years were included. In the
postanaesthesia care unit, they were randomly allocated to two groups: a
CLADS group, which received a continuous infusion of propofol using CLADS,
and a manual group, which received propofol at a rate manually adjusted by
the clinician. Propofol was administered in both groups to maintain the
BIS at a target of 70 for adequate sedation. Patients were weaned from
mechanical ventilation and the trachea extubated after confirmation of
haemodynamic stability, haemostasis, normothermia and mental orientation.
Results The percentage of total sedation time during which BIS remained
within +/-10 of the target value (BIS of 70 during sedation) was
significantly higher in the CLADS group than in the manual group
(P=0.002). The assessment of performance parameters using median
performance error and median absolute performance error indicated better
performance in the CLADS group. Manual control required the propofol
infusion rate to be changed frequently, taking up considerable time and
attention of the clinician. Conclusion Closed-loop delivery of propofol to
control BIS for postoperative sedation is feasible and efficient after
cardiac surgery. 2010 Copyright European Society of Anaesthesiology.
<6>
[Use Link to view the full text]
Accession Number
2010509242
Authors
Van Gulik L. Ahlers S.J. Brkic Z. Belitser S.V. Van Boven W.J. Van Dongen
E.P. Knibbe C.A. Bruins P.
Institution
(Van Gulik, Van Dongen, Bruins) Department of Anaesthesiology, Intensive
Care and Pain Management, St Antonius Hospital, PO Box 3430, 3440 EM
Nieuwegein, Netherlands
(Ahlers, Knibbe) Department of Clinical Pharmacy, St Antonius Hospital,
Nieuwegein, Netherlands
(Brkic, Belitser) Department of Pharmaco-epidemiology, Faculty of
Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
(Van Boven) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
Title
Improved analgesia after the realisation of a pain management programme in
ICU patients after cardiac surgery.
Source
European Journal of Anaesthesiology. 27 (10) (pp 900-905), 2010. Date of
Publication: October 2010.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background and objective Although clinical guidelines recommend systematic
evaluation of pain in ICU patients, we know little about the effects from
such systematic pain evaluation. This study aims to quantify the effect of
a pain management programme in the ICU. Methods In this prospective
two-phase study, pain levels scored by ICU patients after cardiac surgery
through sternotomy were compared before and after the implementation of a
pain management programme. The pain management programme consisted of a
three-fold strategy; all staff was trained in assessing pain and in
providing adequate analgesia, a new patient data management system obliged
nurses to ask patients for their pain score three times a day and the
preferred analgesic treatment was optimised. The numeric rating scale (NRS
0-10) was used by 190 patients. A NRS at least 4 was considered
unacceptable. A generalised linear mixed-effects model was used for
analysing repeated measurements data. Results The occurrence of
unacceptable pain (NRS >=4) was significantly lower in the intervention
group [odds ratio 2.54 (95% confidence interval 1.22-5.65; P = 0.01) for
the control group]. Patients in the intervention group received
significantly more morphine (29.3 vs. 22.6 mg a day, P< 0.01), with higher
morphine amounts administered to patients with higher NRS scores (P =
0.01). In the control group, no such relationship was observed (P = 0.66).
There was no difference in length of stay in the ICU or in ventilation
time. Conclusion The intervention programme successfully reduced the
occurrence of unacceptable pain. Further improvement of pain management
should focus on the prevention of pain. 2010 Copyright European Society
of Anaesthesiology.
<7>
Accession Number
2010509409
Authors
Klamt J.G. Vicente W.V.D.A. Garcia L.V. Ferreira C.A.
Institution
(Klamt, Garcia) Department of Biomechanics, Medicine and Rehabilitation of
the Locomotors System, Faculty of Medicine of Ribeiro Preto-USP,
University of Sao Paulo, 14049-9005 Ribeiro Preto, SP, Brazil
(Klamt) Hospital das Clinicas da FMRP-USP, Servico de Anestesia, Av. dos
Bandeirantes 3900-Monte Alegre, 14048-900 Ribeiro Preto, SP, Brazil
(Vicente, Ferreira) Department of Surgery and Anatomy, Faculty of Medicine
of Ribeiro Preto-USP, University of Sao Paulo, 14049-9005 Ribeiro Preto,
SP, Brazil
Title
Effects of dexmedetomidine-fentanyl infusion on blood pressure and heart
rate during cardiac surgery in children.
Source
Anesthesiology Research and Practice. 2010 , 2010. Article Number:
869049. Date of Publication: 2010.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. The purpose of this study was to access the effects of
dexmedetomidine-fentanyl infusion on blood pressure (BP) and heart rate
(HR) before surgical stimulation, on their changes to skin incision, and
on isoflurane requirement during cardiac surgery in children. Methods.
This study had a prospective, randomized, and open-label design.
Thirty-two children aged 1 month to 10 years undergoing surgery for repair
congenital heart disease (CHD) with CPB were randomly allocated into two
groups: group MDZ received midazolam 0.2mgkg(1)h(1) and group DEX received
dexmedetomidine 1 gkg(1)h(1) during the first hour followed by half of
these rates of infusions thereafter. Both group received fentanyl 10
gkg(1), midazolam 0.2mgkg(1) and vecuronium 0.2mgkg(1) for induction.
These same doses of fentanyl and vecuronium were infused during the first
hour then reduced to half. The infusions started after induction and
maintained until the end of surgery. Isoflurane was given briefly to
control hyperdynamic response to skin incision and sternotomy. Results. In
both groups, systolic blood pressure (sBP) and heart rate (HR) decreased
significantly after one hour of infusion of the anesthetic solutions, but
there were significantly less increase in diastolic blood pressure, sBP,
and HR, and less patients required isoflurane supplementation to skin
incision in the patients of the DEX group. Discussion. Dexmedetomidine
infusion without a bolus appears to be an effective adjunct to fentanyl
anesthesia in control of hemodynamic responses to surgery for repair of
CHD in children. 2010 Jyrson Guilherme Klamt et al.
<8>
Accession Number
2010515773
Authors
Li Y.-L. Wan Z. Lu W.-L. Wang J.-H.
Institution
(Li, Wan) Department of Cardiology, Tianjin Medical University General
Hospital, 154 Anshan Road, Tianjin 300052, China
(Lu, Wang) School of Public Health, Tianjin Medial University, Tianjin,
China
Title
Comparison of sirolimus- and paclitaxel-eluting stents in patients
undergoing primary percutaneous coronary intervention for ST-elevation
myocardial infarction: A meta-analysis of randomized trials.
Source
Clinical Cardiology. 33 (9) (pp 583-590), 2010. Date of Publication:
September 2010.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: It has been reported that sirolimus-eluting stents (SES) and
paclitaxel-eluting stents (PES) have been more effective than bare-metal
stents in reducing restenosis and cardiac events in a broad range of
patients with coronary artery disease. However, it is unknown whether
there might be differences between these two drug-eluting stents in terms
of efficacy and safety in the setting of acute ST-segment elevation
myocardial infarction (STEMI). Hypothesis: The aim of the present study
was to compare SES with PES in patients with acute STEMI undergoing
primary percutaneous coronary intervention (PCI). Methods: The published
research was scanned by formal searches of electronic databases(PubMed,
EMBASE, and the Cochrane Central Register of Controlled Trials) from
January 2001 to February 2010. Internet-based sources of information on
the results of clinical trials in cardiology were also searched. Results:
A total of 4 randomized trials were included in the present meta-analysis,
involving 1105 patients (550 in the SES group, 555 in the PES group). SES
were significantly more effective in the reduction of angiographic binary
(>=50%) restenosis (4.0% vs 9.6%, odds ratio 0.38, 95% confidence interval
0.19 to 0.74, P = 0.004) compared to PES. The differences between SES and
PES were not statistically significant with respect to target vessel
revascularization (TVR), stent thrombosis, cardiac death, and myocardial
infarction. Conclusions: SES are superior to PES in reducing the incidence
of restenosis in patients undergoing primary PCI for STEMI, with
nonsignificant differences in terms of TVR, cardiac death, myocardial
infarction, and stent thrombosis. 2010 Wiley Periodicals, Inc.
<9>
Accession Number
2010503404
Authors
Grube E. Schofer J. Hauptmann K.E. Nickenig D. Curzen N. Allocco D.J.
Dawkins K.D.
Institution
(Grube) HELIOS Heart Center, Siegburg, Germany
(Schofer) Cardiovascular Medical Care Center, Hamburg, Germany
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Nickenig) Medizinische Klinik, Poliklinik II Universittsklinikum Bonn,
Bonn, Germany
(Curzen) Southampton University Hospital, Southampton, United Kingdom
(Allocco, Dawkins) Boston Scientific Corporation, Natick, MA, United
States
Title
A novel paclitaxel-eluting stent with an ultrathin abluminal biodegradable
polymer: 9-month outcomes with the jactax hd stent.
Source
JACC: Cardiovascular Interventions. 3 (4) (pp 431-438), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The JACTAX HD trial ("JACTAX" Trial Drug Eluting Stent Trial)
evaluated the safety and clinical performance of a novel JACTAX HD (Boston
Scientific Corporation, Natick, Massachusetts) paclitaxel-eluting stent
(PES) in de novo coronary lesions. Background: The JACTAX HD (Boston
Scientific) stent consists of a pre-crimped bare-metal Libert (Boston
Scientific) stent coated on its abluminal aspect with an ultrathin (<1
mum) 1/1 mixture of biodegradable polylactide polymer and paclitaxel
applied as discrete microdots (nominal totals of 9.2 mug each of polymer
and paclitaxel per 16-mm stent). Methods: In this prospective, single-arm,
multicenter, first-human-use study (n = 103), the primary end point of
9-month major adverse cardiac events (MACE) (cardiac death, myocardial
infarction, ischemia-related target vessel revascularization) was compared
with an objective performance criterion (OPC) of 17% (11% MACE based on
TAXUS ATLAS [TAXUS Libert-SR Stent for the Treatment of de Novo Coronary
Artery Lesions] trial results plus a pre-specified noninferiority margin
of 6%). Results: The composite primary end point occurred in 7.8% of
JACTAX HD patients with an upper 1-sided 95% confidence limit of 13.6%,
thus meeting the pre-specified criteria for noninferiority. There was no
death, Q-wave myocardial infarction, or stent thrombosis through 9 months.
In-stent late loss was 0.33 +/- 0.45 mm, with an in-stent binary
restenosis of 5.2% and net volume obstruction by intravascular ultrasound
of 11.4 +/- 11.2%. Conclusions: The JACTAX HD stent with an abluminal
biodegradable polymer showed 9-month MACE, in-stent late loss, restenosis,
and net volume obstruction comparable to that observed with the TAXUS
Libert (Boston Scientific) stent coated with a conformal durable polymer.
Further studies are underway to better evaluate the potential of this new
PES design, which might allow for more rapid endothelialization and
improved vessel healing. 2010 American College of Cardiology Foundation.
<10>
Accession Number
2010503413
Authors
Uchida T. Popma J. Stone G.W. Ellis S.G. Turco M.A. Ormiston J.A.
Muramatsu T. Nakamura M. Nanto S. Yokoi H. Baim D.S.
Institution
(Uchida, Baim) Boston Scientific Corporation, Natick, MA, United States
(Popma) Innovations in Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
(Ellis) Department of Cardiology, Cleveland Clinic, Cleveland, OH, United
States
(Turco) Center for Cardiac, Vascular Research, Washington Adventist
Hospital, Takoma Park, MD, United States
(Ormiston) Mercy Angiography Unit, Mercy Hospital, Auckland, NZ, United
States
(Muramatsu) Saiseikai Yokohama City Eastern Hospital, Kanegawa, Japan
(Nakamura) Department of Cardiology, Toho University Ohashi Medical
Center, Toky, Japan
(Nanto) Department of Advanced Cardiovascular Therapeutics, Osaka
University Graduate School of Medicine, Osaka, Japan
(Uchida, Yokoi) Department of Cardiology, Kokura Memorial Hospital,
FGBRuoka, Japan
Title
The clinical impact of routine angiographic follow-up in randomized trials
of drug-eluting stents: A critical assessment of "oculostenotic"
reintervention in patients with intermediate lesions.
Source
JACC: Cardiovascular Interventions. 3 (4) (pp 403-411), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The aim of this study was to study the long-term clinical
effects of routine angiographic follow-up and related reintervention after
drug-eluting stenting. Background: Prior stent trials have shown that
protocol-mandated angiographic follow-up increases repeat interventions
compared with clinical follow-up alone. The long-term clinical impact of
this practice is unknown. Methods: Long-term outcomes of patients assigned
to routine angiographic follow-up in 3 large-scale TAXUS (Boston
Scientific, Natick, Massachusetts) trials were compared with patients
assigned to clinical follow-up alone, in a propensity score-adjusted
patient-level meta-analysis. Outcomes were also compared in patients with
treated versus untreated nonischemic intermediate lesions (quantitative
angiographic stenosis between <40% and <70%) detected at angiographic
follow-up. Results: Target lesion revascularization (TLR) rates at 5 years
were significantly higher in the angiographic compared with clinical
follow-up cohort (18.3% vs. 11.1%, p < 0.001). This was due to more
frequent treatment of intermediate lesions, but there was no associated
reduction in rates of cardiac death or myocardial infarction (8.9% vs.
8.8%, p = 0.93). Of patients with nonischemic intermediate lesions, 17%
who were not revascularized at the time of angiographic follow-up had a
subsequent TLR, whereas 7% of patients who had TLR at this follow-up
angiogram required additional revascularization during long-term
follow-up. Conclusions: A strategy of routine angiographic follow-up
increases oculostenotic revascularization of nonischemic intermediate
lesions without affecting subsequent rates of cardiac death or myocardial
infarction, and TLR was not required in 83% of those lesions. A
conservative approach, in which repeat angiography is limited to patients
with recurrent ischemia or progressive symptoms, minimizes repeat
revascularization of nonischemic intermediate lesions and optimizes
long-term event-free survival after drug-eluting stent implantation. 2010
American College of Cardiology Foundation.
<11>
Accession Number
2010504878
Authors
Jo H.R. Lee W.K. Kim Y.H. Min J.H. Chae Y.K. Choi I.G. Kim Y.S. Lee Y.K.
Institution
(Jo, Lee, Kim, Min, Chae, Choi, Kim, Lee) Department of Anesthesiology and
Pain Medicine, Kwandong University College of Medicine, 697-24,
Hwajeong-dong, Deogyang-gu, Goyang 412-270, South Korea
Title
The effect of milrinone infusion on right ventricular function during
coronary anastomosis and early outcomes in patients undergoing off-pump
coronary artery bypass surgery.
Source
Korean Journal of Anesthesiology. 59 (2) (pp 92-98), 2010. Date of
Publication: August 2010.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: During coronary anastomosis in off-pump coronary artery bypass
surgery (OPCAB), hemodynamic alternations can be induced by impaired
diastolic function of the right ventricle. This study was designed to
examine the effect of milrinone on right ventricular function and early
outcomes in patients undergoing OPCAB. Methods: Forty patients undergoing
OPCAB were randomly assigned in a double-blind manner to receive either
milrinone (milrinone group, n = 20) or normal saline (control group, n =
20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min
after stabilizer application for anastomosis of the left anterior
descending coronary artery (LAD, T2), the obtuse marginalis branch (OM,
T3), the right coronary artery (RCA, T4), 5 min after sternal closure
(T5), and after ICU arrival. The right ventricular ejection fraction
(RVEF) and right ventricular volumetric parameters were also measured
using the thermodilution technique. For evaluation of early outcomes, the
30-day operative mortality and morbidity risk models were used. Results:
There was no significant difference in hemodynamic variables, including
mean arterial pressure, between the 2 groups, except for the cardiac index
and RVEF. The cardiac index and RVEF were significantly greater at T3 in
the milrinone group than in the control group. Conclusions: Continuous
infusion of milrinone demonstrated a beneficial effect on cardiac output
and right ventricular function in patients undergoing OPCAB, especially
during anastomosis of the graft to the OM artery, and it had no adverse
effect on early outcomes. Copyright Korean Society of Anesthesiologists,
2010.
<12>
Accession Number
2010508763
Authors
Percival V.G. Riddell J. Corcoran T.B.
Institution
(Percival, Riddell, Corcoran) Department of Anaesthesia and Pain Medicine,
Royal Perth Hospital, North Block, Wellington Street, Perth, WA 6000,
Australia
(Corcoran) School of Medicine and Pharmacology, University of Western
Australia, Australia
(Corcoran) Royal Perth Hospital, Australia
Title
Single dose dexamethasone for postoperative nausea and vomiting - A
matched case-control study of postoperative infection risk.
Source
Anaesthesia and Intensive Care. 38 (4) (pp 661-666), 2010. Date of
Publication: July 2010.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
Dexamethasone is an effective prophylaxis against postoperative nausea and
vomiting but is immunosuppressive and may predispose patients to an
increased postoperative infection risk. This matched case-control study
examined the association between the administration of a single
intraoperative anti-emetic dose of dexamethasone (4 to 8 mg) and
postoperative infection in patients undergoing non-emergency surgery in a
university trauma centre. Cases were defined as patients who developed
infection between one day and one month following an operative procedure
under general anaesthesia. Controls who did not develop infection were
matched for procedure, age and gender. Exclusion criteria included
immunosuppressive medications, chronic glucocorticoid therapy, cardiac
surgical and solid-organ transplantation procedures. Sixty-three cases and
172 controls were identified. Cases were more likely to have received
dexamethasone intraoperatively (25.4 vs 11%, P=0.006), and less likely to
have received perioperative antibiotic prophylaxis (60.3 vs 84.3%,
P=0.001). Stepwise, multivariate conditional logistic regression confirmed
these associations, with adjusted odds ratios of 3.03 (1.06 to 19.3,
P=0.035) and 0.12 (0.02 to 0.7, P=0.004) respectively for the associations
between dexamethasone and perioperative antibiotic prophylaxis, with
postoperative infection. We conclude that intraoperative administration of
dexamethasone for anti-emetic purposes may confer an increased risk of
postoperative infection.
<13>
Accession Number
2010508888
Authors
Ribeiro E.E. Ribeiro H.B.
Institution
(Ribeiro, Ribeiro) Instituto do Coracao (InCor), Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Title
Real-world use of drug-eluting stents: The importance of registries.
Source
Arquivos Brasileiros de Cardiologia. 95 (1) (pp 131-134), 2010. Date of
Publication: July 2010.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
over the last decades the efficacy and safety of bare metal (BMS) and drug
eluting stents (DES) have been demonstrated in many different clinical
scenarios, leading to their use in more than 75% of the procedures
worldwide. Compared to BMS, DES have shown lower rates of angiographic
restenosis and target-vessel revascularization. This benefit was initially
demonstrated in trials that excluded patients with more complex lesions,
such as those with larger or smaller vessels, chronic total occlusions,
bifurcation lesions, stent restenosis, long lesions and left main coronary
artery disease. This real-world population has been recently evaluated in
many registries and meta-analyses that are reviewed herein.
<14>
Accession Number
2010509810
Authors
Kuss O. Von Salviati B. Borgermann J.
Institution
(Kuss, Von Salviati) Institute of Medical Epidemiology, Biostatistics and
Informatics, Faculty of Medicine, University of Halle-Wittenberg,
Magdeburger Str 8, 06097 Halle (Saale), Germany
(Borgermann) Heart and Diabetes Center North Rhine-Westphalia, Department
of Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad
Oeynhausen, Germany
Title
Off-pump versus on-pump coronary artery bypass grafting: A systematic
review and meta-analysis of propensity score analyses.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (4) (pp 829-835.e13),
2010. Date of Publication: October 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Despite numerous randomized and nonrandomized trials on off-
and on-pump coronary artery bypass grafting, it remains open which method
is superior. Patient selection and small sample sizes limit the evidence
from randomized trials; lack of randomization limits the evidence from
nonrandomized trials. Propensity score analyses are expected to improve on
at least some of these problems. We aimed to systematically review all
propensity score analyses comparing off- and on-pump coronary artery
bypass grafting. Methods: Propensity score analyses comparing off- and
on-pump surgery were identified from 8 bibliographic databases, citation
tracking, and a free web search. Two independent reviewers abstracted data
on 11 binary short-term outcomes. Results: A total of 35 of 58 initially
retrieved propensity score analyses were included, accounting for a total
of 123,137 patients. The estimated overall odds ratio was less than 1 for
all outcomes, favoring off-pump surgery. This benefit was statistically
significant for mortality (odds ratio, 0.69; 95% confidence interval,
0.60-0.75), stroke, renal failure, red blood cell transfusion (P < .0001),
wound infection (P < .001), prolonged ventilation (P < .01), inotropic
support (P = .02), and intraaortic balloon pump support (P = .05). The
odds ratios for myocardial infarction, atrial fibrillation, and
reoperation for bleeding were not significant. Conclusions: Our systematic
review and meta-analysis of propensity score analyses finds off-pump
surgery superior to on-pump surgery in all of the assessed short-term
outcomes. This advantage was statistically significant and clinically
relevant for most outcomes, especially for mortality, the most valid
criterion. These results agree with previous systematic reviews of
randomized and nonrandomized trials. Copyright 2010 by The American
Association for Thoracic Surgery.
<15>
Accession Number
2010475166
Authors
Siragy H.M.
Institution
(Siragy) Department of Medicine, Hypertension Center, University of
Virginia, PO Box 801409, Charlottesville, VA 22908, United States
Title
Comparing angiotensin II receptor blockers on benefits beyond blood
pressure.
Source
Advances in Therapy. 27 (5) (pp 257-284), 2010. Date of Publication: May
2010.
Publisher
Health Communications Inc. (292 Fernwood Avenue, Edison, New Jersey NJ
08837, United States)
Abstract
The renin-angiotensin-aldosterone system (RAAS) is one of the main
regulators of blood pressure, renal hemodynamics, and volume homeostasis
in normal physiology, and contributes to the development of renal and
cardiovascular (CV) diseases. Therefore, pharmacologic blockade of RAAS
constitutes an attractive strategy in preventing the progression of renal
and CV diseases. This concept has been supported by clinical trials
involving patients with hypertension, diabetic nephropathy, and heart
failure, and those after myocardial infarction. The use of angiotensin II
receptor blockers (ARBs) in clinical practice has increased over the last
decade. Since their introduction in 1995, seven ARBs have been made
available, with approved indications for hypertension and some with
additional indications beyond blood pressure reduction. Considering that
ARBs share a similar mechanism of action and exhibit similar tolerability
profiles, it is assumed that a class effect exists and that they can be
used interchangeably. However, pharmacologic and dosing differences exist
among the various ARBs, and these differences can potentially influence
their individual effectiveness. Understanding these differences has
important implications when choosing an ARB for any particular condition
in an individual patient, such as heart failure, stroke, and CV risk
reduction (prevention of myocardial infarction). A review of the
literature for existing randomized controlled trials across various ARBs
clearly indicates differences within this class of agents. Ongoing
clinical trials are evaluating the role of ARBs in the prevention and
reduction of CV rates of morbidity and mortality in highrisk patients.
Springer Healthcare 2010.
<16>
Accession Number
20542783
Authors
Dambrink J.H. Debrauwere J.P. van 't Hof A.W. Ottervanger J.P. Gosselink
A.T. Hoorntje J.C. de Boer M.J. Suryapranata H.
Institution
(Dambrink) Department of Cardiology, Isala klinieken, Zwolle, The
Netherlands. <v.r.c.derks@isala.nl>
Title
Non-culprit lesions detected during primary PCI: treat invasively or
follow the guidelines?.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
5 (8) (pp 968-975), 2010. Date of Publication: Apr 2010.
Abstract
AIMS: Evidence regarding the optimal treatment of non-culprit lesions
detected during primary PCI is lacking. Our aim was to investigate whether
early invasive treatment improves left ventricular ejection fraction (EF)
and prevents major adverse cardiac events (MACE). METHODS AND RESULTS: Of
121 patients with at least one non-culprit lesion, 80 were randomised to
early FFRguided PCI (invasive group), and 41 to medical treatment
(conservative group). Primary endpoint was EF at six months, secondary
endpoints included MACE. In the invasive group, early angiography was
performed 7.5 days (5-20) after primary PCI. Forty percent of the
non-culprit lesions did not show haemodynamic significance (FFR > 0.75).
Subsequent PCI of at least one non-culprit lesion was performed in 52%,
PCI without preceding FFR was performed in 8% and elective CABG was done
in 4%. No in-hospital events occurred in the conservative group. After six
months, EF was comparable (59+/-9% vs. 57+/-9%, p=0.362), and there was no
difference in MACE between invasively and conservatively treated patients
(21 vs. 22%, p=0.929). CONCLUSIONS: An invasive strategy towards
non-culprit lesions does not lead to an increase in EF or a reduction in
MACE. The functional stenosis severity of non-culprit lesions is
frequently overestimated.
<17>
Accession Number
70271943
Authors
Ye J.
Institution
(Ye) Division of Cardiovascular Surgery, St. Paul's Hospital, University
of British Columbia, Canada
Source
Cardiology. Conference: International Heart Forum Beijing China.
Conference Start: 20100811 Conference End: 20100813. Conference
Publication: (var.pagings). 117 (pp 8), 2010. Date of Publication:
September 2010.
Publisher
S. Karger AG
Abstract
Aortic valve replacement (AVR) with cardiopulmonary bypass has been the
only treatment that offers both symptomatic relief and the potential for
improved long-term survival, and hence has been the treatment of choice
for patients with symptomatic severe degenerative aortic stenosis for
decades. Its mortality and morbidity rates have been extremely low in the
majority of patients with isolated aortic stenosis, and most experienced
surgeons can perform AVR with single digit mortality even in
octogenarians. However, since a considerable number of elderly patients
with symptomatic severe aortic stenosis have significant co-morbidities,
open-heart AVR can be associated with an unacceptable perioperative
mortality and morbidity rates. Therapeutic options for these patients are
limited, and neither medical therapy nor balloon valvuloplasty offers any
survival benefit. Minimally invasive transcatheter aortic valve
implantation (AVI) was developed and the first successful transcatheter
AVI performed in 2002. This procedure has rapidly evolved particularly
since 2005 when more sophisticated delivery systems facilitated
transarterial and transapical accesses, which are more reproducible and
favoured procedures. The clinical feasibility and encouraging
early/mid-term clinical outcomes of both transfemoral and transapical
transcatheter AVI have been well documented by us and many other groups.
Although uncertainty remains particularly about long-term outcome, valve
durability, and the appropriate role for this new therapy, it appears
likely that transcatheter valve implantation will become a more widely
available and accepted therapeutic option for aortic valve stenosis.
Transcatheter AVI has now been performed in many hospitals worldwide, and
in a few centers up to 50% of patients with aortic stenosis now receives
this procedure. However, extremely cautions have to be taken in expanding
the procedure into low risk or young patients with aortic stenosis since
its long-term outcome and valve durability remain undetermined,
conventional AVR offers excellent clinical outcome with extremely low
operative mortality and morbidity in low risk or young patients that
probably cannot be matched by the transcatheter procedure, and mechanical
valves provides a better long-term survival benefit than bioprostheses in
young patients. Multi-center randomized controlled clinical trials will
define the role of transcatheter procedure in the management of aortic
valve disease in the future.
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