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<1>
Accession Number
2011006736
Authors
Liu P.-Y. Huang Y.-F. Tang C.-W. Chen Y.-Y. Hsieh K.-S. Ger L.-P. Chen
Y.-S. Liu Y.-C.
Institution
(Liu, Huang, Tang, Chen, Hsieh) Department of Pediatrics, Kaohsiung
Veterans General Hospital, Kaohsiung, Taiwan (Republic of China)
(Ger) Department of Medical Education and Research, Kaohsiung Veterans
General Hospital, Kaohsiung, Taiwan (Republic of China)
(Chen) Section of Infectious Diseases, Department of Medicine, Kaohsiung
Veterans General Hospital, Kaohsiung, Taiwan (Republic of China)
(Liu) Section of Infectious Diseases, Department of Medicine, Taipei
Medical University-Shuang Ho Hospital, Taipei, Taiwan (Republic of China)
Title
Staphylococcus lugdunensis Infective Endocarditis: A Literature Review and
Analysis of Risk Factors.
Source
Journal of Microbiology, Immunology and Infection. 43 (6) (pp 478-484),
2010. Date of Publication: December 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background/Purpose: Infective endocarditis caused by Staphylococcus
lugdunensis is a rare disease. Since its first description in 1988, there
have only been a few reports of this disease and the causative organism.
These publications were primarily case reports and brief case series. We
conducted a literature review to identify the nature of the disease and
its risk factors. Methods: We retrospectively reviewed the cases reported
between 1988 and 2008 by searching the relevant literature using the
keywords "endocarditis" and "Staphylococcus lugdunensis" in the Medline
database. All cases included met the definition of the modified Duke
criteria. Results: For the period 1988-2008, 67 cases from 27 articles
were reviewed. The mean age of individuals was 53.9 years. Left-sided
valvular endocarditis represented 52 (82.5%) of cases and native-valve
endocarditis was evident in 48 (78.7%) of cases. A large proportion (82%)
of 50 S. lugdunensis strains were susceptible to penicillin. Valve
replacement operations were performed in 42 (66.7%) patients and the
mortality rate was 38.8%. Univariate analysis showed a higher mortality
rate in patients aged more than 50 years, those treated before 1995, those
treated with antibiotics alone, and those with growth not detected by
echocar-diography. Medical treatment alone was the independent risk factor
for mortality by multivariate analysis. Conclusion: S. lugdunensis
endocarditis led to substantial morbidity and mortality. Detailed
microbiological identification, echocardiography evaluation, and valve
replacement may improve the clinical outcome of individuals with S.
lugdunensis endocarditis. 2010 Taiwan Society of Microbiology.
<2>
Accession Number
2011020816
Authors
Bakhshandeh A.R. Salehi M. Radmehr H. Sattarzadeh R. Nasr A.R. Sadeghpour
A.H.
Institution
(Bakhshandeh, Salehi, Radmehr, Nasr, Sadeghpour) Department of
Cardiovascular Surgery, Imam Tehran University Hospital, Tehran, Iran,
Islamic Republic of
(Sattarzadeh) Department of Cardiology, Imam Tehran University Hospital,
Tehran, Iran, Islamic Republic of
Title
Postoperative pericardial effusion and posterior pericardiotomy: Related?.
Source
Asian Cardiovascular and Thoracic Annals. 17 (5) (pp 477-479), 2009.
Date of Publication: October 2009.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Large pericardial effusions develop in 30% of patients after cardiac
surgery, and reach their maximum size after 10 days, with tamponade in 1%.
The aim of this prospective randomized case-controlled study was to assess
the effectiveness of a posterior pericardiotomy in preventing early and
late (>30 days) development of pericardial effusion. Between April 2005
and May 2006, 410 patients with a mean age of 68.4 +/- 9.2 years
undergoing coronary artery bypass grafting alone or combined with valve
surgery were divided into 2 groups of 205 each. In the pericardiotomy
group, a 4-cm longitudinal incision was made parallel and posterior to the
phrenic nerve. Echocardiography was performed at discharge and 15 and 30
days after the operation. At 15 and 30 days postoperatively, 90.2% and 97%
of patients in the pericardiotomy group were free of effusion; while none
in the control group were free of effusion. A posterior pericardiotomy is
easy to perform and seems to be a safe and effective means of preventing
postoperative effusion and its adverse consequences. SAGE Publications
2009.
<3>
Accession Number
2011024114
Authors
Ammirati E. Rimoldi O.E. Camici P.G.
Institution
(Ammirati) Vascular and Cardio-thoracic Department, San Raffaele Scientifc
Institute and Vita-Salute University San Raffaele, Milan, Italy
(Rimoldi) CNR Institute of Clinical Physiology, Pisa, Italy
(Camici) Heart Care Foundation, Florence, Italy
Title
Is there evidence supporting coronary revascularization in patients with
left ventricular systolic dysfunction?.
Source
Circulation Journal. 75 (1) (pp 3-10), 2011. Date of Publication: 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
The mid- and long-term outcomes of revascularization procedures in
patients with chronic left ventricular (LV) systolic dysfunction due to
coronary artery disease (CAD) in the presence or absence of heart failure
(HF) symptoms are still uncertain. The identifcation of dysfunctional
myocardial segments with residual viability that can improve after
revascularization is pivotal for further patient management. Hibernating
myocardium (ie, chronically dysfunctional but still viable tissue) can be
identifed by positron emission tomography (PET) and cardiac magnetic
resonance (CMR) and its presence and extent can predict functional
recovery after revascularization. Before /S-blockers were introduced as
routine care for HF, surgical revascularization appeared to improve
survival in these patients. Nowadays, novel medical treatments and
devices, such as cardiac-resynchronization therapy and implantable
cardioverter - defbrillators, have improved the prognosis of HF patients
and their use is supported by a number of clinical trials. To adequately
address the unresolved issue of the prognostic benefts of coronary
revascularization in CAD patients with chronic LV dysfunction on optimal
medical therapy with/without devices a randomized trial is warranted. In
such a trial the presence of viability will be assessed by either PET or
CMR. This is an overview of the pathophysiological mechanisms, as well as
of the main clinical studies and meta-analyses that have addressed this
issue in the past 4 decades.
<4>
Accession Number
2011024738
Authors
Price L.C. Wort S.J. Finney S.J. Marino P.S. Brett S.J.
Institution
(Price, Wort, Finney, Marino) Department of Critical Care, National Heart
and Lung Institute, Imperial College London, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, United Kingdom
(Brett) Centre for Perioperative Medicine and Critical Care Research,
Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road,
London W12 0HS, United Kingdom
Title
Pulmonary vascular and right ventricular dysfunction in adult critical
care: Current and emerging options for management: A systematic literature
review.
Source
Critical Care. 14 (5) , 2010. Article Number: 169. Date of Publication:
21 Sep 2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Introduction: Pulmonary vascular dysfunction, pulmonary hypertension (PH),
and resulting right ventricular (RV) failure occur in many critical
illnesses and may be associated with a worse prognosis. PH and RV failure
may be difficult to manage: principles include maintenance of appropriate
RV preload, augmentation of RV function, and reduction of RV afterload by
lowering pulmonary vascular resistance (PVR). We therefore provide a
detailed update on the management of PH and RV failure in adult critical
care.Methods: A systematic review was performed, based on a search of the
literature from 1980 to 2010, by using prespecified search terms. Relevant
studies were subjected to analysis based on the GRADE method.Results:
Clinical studies of intensive care management of pulmonary vascular
dysfunction were identified, describing volume therapy, vasopressors,
sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators,
and mechanical devices. The following GRADE recommendations (evidence
level) are made in patients with pulmonary vascular dysfunction: 1) A weak
recommendation (very-low-quality evidence) is made that close monitoring
of the RV is advised as volume loading may worsen RV performance; 2) A
weak recommendation (low-quality evidence) is made that low-dose
norepinephrine is an effective pressor in these patients; and that 3)
low-dose vasopressin may be useful to manage patients with resistant
vasodilatory shock. 4) A weak recommendation (low-moderate quality
evidence) is made that low-dose dobutamine improves RV function in
pulmonary vascular dysfunction. 5) A strong recommendation
(moderate-quality evidence) is made that phosphodiesterase type III
inhibitors reduce PVR and improve RV function, although hypotension is
frequent. 6) A weak recommendation (low-quality evidence) is made that
levosimendan may be useful for short-term improvements in RV performance.
7) A strong recommendation (moderate-quality evidence) is made that
pulmonary vasodilators reduce PVR and improve RV function, notably in
pulmonary vascular dysfunction after cardiac surgery, and that the
side-effect profile is reduced by using inhaled rather than systemic
agents. 8) A weak recommendation (very-low-quality evidence) is made that
mechanical therapies may be useful rescue therapies in some settings of
pulmonary vascular dysfunction awaiting definitive therapy.Conclusions:
This systematic review highlights that although some recommendations can
be made to guide the critical care management of pulmonary vascular and
right ventricular dysfunction, within the limitations of this review and
the GRADE methodology, the quality of the evidence base is generally low,
and further high-quality research is needed. 2010 Price et al.; licensee
BioMed Central Ltd.
<5>
Accession Number
2011032456
Authors
Goldman S. Sethi G.K. Holman W. Thai H. McFalls E. Ward H.B. Kelly R.F.
Rhenman B. Tobler G.H. Bakaeen F.G. Huh J. Soltero E. Moursi M. Haime M.
Crittenden M. Kasirajan V. Ratliff M. Pett S. Irimpen A. Gunnar W. Thomas
D. Fremes S. Moritz T. Reda D. Harrison L. Wagner T.H. Wang Y. Planting L.
Miller M. Rodriguez Y. Juneman E. Morrison D. Pierce M.K. Kreamer S. Shih
M.-C. Lee K.
Institution
(Goldman, Sethi, Thai, Rhenman, Rodriguez, Juneman, Pierce, Kreamer)
Cardiology Section (1-111C), Southern Arizona VA Health Care System, 3601
S Sixth Ave, Tucson, AZ 85723, United States
(Goldman, Sethi, Thai, Rhenman, Juneman) University of Arizona Sarver
Heart Center, Tucson, AZ, United States
(Holman) Veterans Affairs Medical Center, Birmingham, AL, United States
(McFalls, Ward, Kelly) Veterans Affairs Medical Center, Minneapolis, MN,
United States
(Tobler, Moursi) Veterans Affairs Health Care System, Little Rock, AR,
United States
(Bakaeen, Huh, Soltero) Veterans Affairs Medical Center, Houston, TX,
United States
(Huh) Baylor College of Medicine, Texas Heart Institute, Tucson, TX,
United States
(Soltero) Hospital Damas, Ponce, Puerto Rico
(Haime) Veterans Affairs Health Care Center, West Roxbury, MA, United
States
(Crittenden) Veterans Affairs Medical Center, St Louis, MI, United States
(Kasirajan) Veterans Affairs Medical Center, Richmond, VA, United States
(Ratliff, Pett) Veterans Affairs Medical Center, Albuquerque, NM, United
States
(Irimpen) Veterans Affairs Medical Center, New Orleans, LA, United States
(Gunnar, Thomas, Moritz, Reda) Hines VA Hospital, Cooperative Studies
Program Coordinating Center, Hines, IL, United States
(Fremes) Sunnybrooke and Women's College Health Sciences Center,
University of Toronto, Toronto, ON, Canada
(Harrison) Baptist Health South Florida, Florida International University,
Miami, FL, United States
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park, CA,
United States
(Wang, Planting, Miller, Shih, Lee) Veterans Affairs Health Care System,
Cooperative Studies Program Coordinating Center, Palo Alto, CA, United
States
(Morrison) Interventional Cardiology, Yakima Heart Center, Yakima, WA,
United States
(Shih) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
Title
Radial artery grafts vs saphenous vein grafts in coronary artery bypass
surgery: A randomized trial.
Source
JAMA - Journal of the American Medical Association. 305 (2) (pp 167-174),
2011. Date of Publication: 12 Jan 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Arterial grafts are thought to be better conduits than saphenous
vein grafts for coronary artery bypass grafting (CABG) based on experience
with using the left internal mammary artery to bypass the left anterior
descending coronary artery. The efficacy of the radial artery graft is
less clear. Objective: To compare 1-year angiographic patency of radial
artery grafts vs saphenous vein grafts in patients undergoing elective
CABG. Design, Setting, and Participants: Multicenter, randomized
controlled trial conducted from February 2003 to February 2009 at 11
Veterans Affairs medical centers among 757 participants (99% men)
undergoing first-time elective CABG. Interventions: The left internal
mammary artery was used to preferentially graft the left anterior
descending coronary artery whenever possible; the best remaining recipient
vessel was randomized to radial artery vs saphenous vein graft. Main
Outcome Measures: The primary end point was angiographic graft patency at
1 year after CABG. Secondary end points included angiographic graft
patency at 1 week after CABG, myocardial infarction, stroke, repeat
revascularization, and death. Results: Analysis included 733 patients (366
in the radial artery group, 367 in the saphenous vein group). There was no
significant difference in study graft patency at 1 year after CABG (radial
artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous
vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74;
P=.98). There were no significant differences in the secondary end points.
Conclusion: Among Veterans Affairs patients undergoing first-time elective
CABG, the use of a radial artery graft compared with saphenous vein graft
did not result in greater 1-year patency. Trial Registration:
clinicaltrials.gov Identifier: NCT00054847 2011 American Medical
Association. All rights reserved.
<6>
Accession Number
2011032649
Authors
Zhang F. Dong L. Qian J. Ge J.
Institution
(Zhang, Dong, Qian, Ge) Shanghai Institute of Cardiovascular Diseases,
Zhongshan Hospital, Fudan University, Shanghai 200032, China
Title
Clinical safety and efficacy of everolimus-eluting stents compared to
paclitaxel-eluting stents in patients with coronary artery disease.
Source
Annals of Medicine. 43 (1) (pp 75-79), 2011. Date of Publication:
February 2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background. The everolimus-eluting stent (EES) is a second-generation
drug-eluting stent (DES) which is designed to provide better stent
deliverability, deployment, safety, and efficacy. We performed a
meta-analysis to evaluate the relative safety and efficacy of the EES
compared with the paclitaxel-eluting stent (PES). Methods. The published
literature was scanned by formal searches of electronic databases from
January 2001 to August 2010. All randomized trials comparing EES versus
PES and reporting the clinical outcomes were examined for analysis.
Results. A total of four randomized trials were included, involving 6,788
patients. EES were superior to PES with respect to the major adverse
cardiac events (cardiac death, myocardial infarction (MI), and
ischemia-driven target lesion revascularization (TLR)) within 1-year
follow-up (OR 0.57; P < 0.001). The 1-year rates of MI, ischemia-driven
TLR, and definite or probable stent thrombosis (ST) were also lower with
EES than with PES (OR 0.57, P < 0.001 for MI; OR 0.48, P < 0.001 for TLR;
OR 0.34, P < 0.001 for ST). There was no significant difference between
EES and PES with respect to cardiac mortality (OR 0.93; P 0.81).
Conclusion. The EES is superior to the PES in terms of 1-year safety and
efficacy. 2011 Informa UK, Ltd.
<7>
Accession Number
2011032650
Authors
Dong L. Zhang F. Shu X.
Institution
(Dong, Zhang, Shu) Department of Cardiology, Shanghai Institute of
Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai
200032, China
Title
Usefulness of statins pretreatment for the prevention of postoperative
atrial fibrillation in patients undergoing cardiac surgery.
Source
Annals of Medicine. 43 (1) (pp 69-74), 2011. Date of Publication:
February 2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background. Postoperative atrial fibrillation (AF) remains the most common
arrhythmic complication following cardiac surgery. We performed a
meta-analysis based on all currently available randomized controlled
trials (RCTs) to confirm the hypothesis that statins pretreatment may
lower the risk of postoperative AF in patients undergoing cardiac surgery.
Methods and results. The published literature was scanned by formal
searches of electronic databases up through August 2010. RCTs were
eligible for inclusion if they compared preoperative statins treatment
versus control in patients scheduled for cardiac surgery and had the data
of postoperative AF reported. Pre-specified criteria were met by eight
RCTs involving 841 patients. During the follow-up period, 80 of 422
patients (19.0%) in the statins pretreatment group developed postoperative
AF, significantly less than 149 of 419 (35.6%) patients assigned to the
control group (P < 0.001). Postoperative hospital stay was significantly
shortened in patients pretreated with statins compared with the control (P
< 0.01). Conclusions. This meta-analysis supports the effectiveness of
statins pretreatment on reducing the incidence of postoperative AF in
patients undergoing cardiac surgery. 2011 Informa UK, Ltd.
<8>
Accession Number
2011033196
Authors
Huang T.-M. Wu V.-C. Young G.-H. Lin Y.-F. Shiao C.-C. Wu P.-C. Li W.-Y.
Yu H.-Y. Hu F.-C. Lin J.-W. Chen Y.-S. Lin Y.-H. Wang S.-S. Hsu R.-B.
Chang F.-C. Chou N.-K. Chu T.-S. Yeh Y.-C. Tsai P.-R. Huang J.-W. Lin
S.-L. Chen Y.-M. Ko W.-J. Wu K.-D.
Institution
(Huang, Li, Lin, Lin, Chang, Chu) Department of Internal Medicine,
National Taiwan University Hospital, Yun-Lin Branch, Douliou City, Taiwan
(Republic of China)
(Wu, Lin, Wu, Lin, Huang, Lin, Chen, Wu) Department of Internal Medicine,
National Taiwan University Hospital and College of Medicine, National
Taiwan University, Taipei, Taiwan (Republic of China)
(Young, Yu, Chen, Wang, Hsu, Chou, Yeh, Tsai, Ko) Department of Surgery,
National Taiwan University Hospital and College of Medicine, National
Taiwan University, Taipei, Taiwan (Republic of China)
(Shiao) Division of Nephrology, Department of Internal Medicine, Saint
Mary's Hospital, Lotung, I-Lan County, Taiwan (Republic of China)
(Hu) Department of Medical Research, Graduate Institutes of Clinical
Medicine and Nursing, National Taiwan University, Taipei, Taiwan (Republic
of China)
Title
Preoperative proteinuria predicts adverse renal outcomes after coronary
artery bypass grafting.
Source
Journal of the American Society of Nephrology. 22 (1) (pp 156-163), 2011.
Date of Publication: January 2011.
Publisher
American Society of Nephrology (1725 I Street NW, Suite 510, Washington DC
20006, United States)
Abstract
Whether preoperative proteinuria associates with adverse renal outcomes
after cardiac surgery is unknown. Here, we performed a secondary analysis
of a prospectively enrolled cohort of adult patients undergoing coronary
artery bypass grafting (CABG) at a medical center and its two affiliate
hospitals between 2003 and 2007. We excluded patients with stage 5 CKD or
those who received dialysis previously. We defined proteinuria, measured
with a dipstick, as mild (trace to 1+) or heavy (2+ to 4+). Among a total
of 1052 patients, cardiac surgery-associated acute kidney injury (CSA-AKI)
developed in 183 (17.4%) patients and required renal replacement therapy
(RRT) in 50 (4.8%) patients. In a multiple logistic regression model, mild
and heavy proteinuria each associated with an increased odds of CSA-AKI,
independent of CKD stage and the presence of diabetes mellitus (mild: OR
1.66, 95% CI 1.09 to 2.52; heavy: OR 2.30, 95% CI 1.35 to 3.90). Heavy
proteinuria also associated with increased odds of postoperative RRT (OR
7.29, 95% CI 3.00 to 17.73). In summary, these data suggest that
preoperative proteinuria is a predictor of CSA-AKI among patients
undergoing CABG. Copyright 2011 by the American Society of Nephrology.
<9>
Accession Number
2011027036
Authors
Katritsis D.G. Siontis G.C.M. Kastrati A. Vant Hof A.W.J. Neumann F.-J.
Siontis K.C.M. Ioannidis J.P.A.
Institution
(Katritsis) Department of Cardiology, Athens Euroclinic, 9 Athanassiadou
Str., 115 21 Athens, Greece
(Siontis, Siontis, Ioannidis) Clinical Trials and Evidence-Based Medicine
Unit, Department of Hygiene and Epidemiology, University of Ioannina
School of Medicine, Ioannina, Greece
(Kastrati, Neumann) Deutsches Herzzentrum, Technische Universitt Mnchen,
Munich, Germany
(Vant Hof) Isala Klinieken, Locatie Weezenlanden, Department of
Cardiology, Zwolle, Netherlands
(Ioannidis) Tufts Medical Center, Department of Medicine, Tufts University
School of Medicine, Boston, United States
(Ioannidis) Department of Epidemiology, Harvard School of Public Health,
Boston, United States
Title
Optimal timing of coronary angiography and potential intervention in
non-ST-elevation acute coronary syndromes.
Source
European Heart Journal. 32 (1) (pp 32-40), 2011. Date of Publication:
January 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims An invasive approach is superior to medical management for the
treatment of patients with acute coronary syndromes without ST-segment
elevation (NSTE-ACS), but the optimal timing of coronary angiography and
subsequent intervention, if indicated, has not been settled. Methods and
resultsWe conducted a meta-analysis of randomized trials addressing the
optimal timing (early vs. delayed) of coronary angiography in NSTE-ACS.
Four trials with 4013 patients were eligible (ABOARD, ELISA, ISAR-COOL,
TIMACS), and data for longer follow-up periods than those published became
available for this meta-analysis by the ELISA and ISAR-COOL investigators.
The median time from admission or randomization to coronary angiography
ranged from 1.16 to 14 h in the early and 20.886 h in the delayed strategy
group. No statistically significant difference of risk of death [random
effects risk ratio (RR) 0.85, 95 confidence interval (CI) 0.641.11] or
myocardial infarction (MI) (RR 0.94, 95 CI 0.611.45) was detected between
the two strategies. Early intervention significantly reduced the risk for
recurrent ischaemia (RR 0.59, 95 CI 0.380.92, P 0.02) and the duration of
hospital stay (by 28, 95 CI 2235, P < 0.001). Furthermore, decreased major
bleeding events (RR 0.78, 95 CI 0.571.07, P 0.13), and less major events
(death, MI, or stroke) (RR 0.91, 95 CI 0.821.01, P 0.09) were observed
with the early strategy but these differences were not nominally
significant. Conclusion Early coronary angiography and potential
intervention reduces the risk of recurrent ischaemia, and shortens
hospital stay in patients with NSTE-ACS. Published on behalf of the
European Society of Cardiology. All rights reserved. 2010 The Author.
<10>
Accession Number
2011027044
Authors
Boccara F. Mary-Krause M. Teiger E. Lang S. Lim P. Wahbi K. Beygui F.
Milleron O. Gabriel Steg P. Funck-Brentano C. Slama M. Girard P.-M.
Costagliola D. Cohen A.
Institution
(Boccara, Lang, Cohen) Department of Cardiology, Saint Antoine Hospital,
AP-HP, Univ-Paris 6, Paris, France
(Boccara) INSERM, UMR S 938, Facult de Mdecine Saint Antoine, F-75012
Paris, France
(Mary-Krause, Costagliola) INSERM U943, Paris F75013, France
(Mary-Krause, Costagliola) UPMC Univ-Paris 6, UMR S943, Paris F75013,
France
(Teiger) Department of Physiology Henri Mondor Hospital, EA 4393, AP-HP,
Paris 12, Crteil, France
(Lim) Department of Cardiology, Henri Mondor Hospital, AP-HP, Univ-Paris
12, Creteil, France
(Wahbi) Department of Cardiology, Cochin Hospital, Univ-Paris 5, Paris,
France
(Beygui) Institut de Cardiologie, Piti-Salpetrire University Hospital,
APHP, Paris, France
(Milleron) Department of Cardiology, CHI Le-Raincy-Montfermeil,
Montfermeil, France
(Gabriel Steg) INSERM U698, Paris, France
(Gabriel Steg) Universit Paris 7, Paris, France
(Gabriel Steg) Hopital Bichat Claude Bernard, AP-HP, Paris, France
(Funck-Brentano) INSERM, CIC-9304, UMRS-956, F-75013 Paris, France
(Funck-Brentano) AP-HP, Piti-Salpetrire Hospital, Department of
Pharmacology, F-75013 Paris, France
(Funck-Brentano) Univ Paris 06, Faculty of Medicine, Department of
Pharmacology, F-75013 Paris, France
(Slama) Department of Cardiology, Antoine Beclere Hospital, Univ-Paris 11,
Clamart, France
(Girard) Department of Infectious Disease, Saint Antoine Hospital, UPMC,
Paris, France
(Costagliola) Department of Infectious Disease Piti-Salpetrire Hospital,
AP-HP, Paris, France
Title
Acute coronary syndrome in human immunodeficiency virus-infected patients:
Characteristics and 1 year prognosis.
Source
European Heart Journal. 32 (1) (pp 41-50), 2011. Date of Publication:
January 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Natural history and prognosis of acute coronary syndrome (ACS) in
HIV-infected patients remain to be determined. We sought to compare
coronary risk factors, angiographic features, acute results of
percutaneous coronary intervention, in-hospital outcomes, and
pre-specified 1 year prognosis of HIV-infected and HIV-uninfected patients
with ACS. Methods and resultsHIV-infected and HIV-uninfected patients with
a first episode of ACS were matched for age (+/-5 years), sex, and type of
ACS. The primary endpoint was the rate of major adverse cardiac and
cerebral events (MACCE), comprising cardiac death, recurrent ACS,
recurrent coronary revascularization, and stroke. Overall, 103
HIV-infected and 195 HIV-uninfected patients were enrolled (mean age 49.0
+/- 9.4 years, 94 men). Coronary risk factors were well balanced, but
HIV-infected patients more frequently used illicit drugs (23 vs. 6, P
0.001) and had higher triglyceride concentrations (246 +/- 189 vs. 170 +/-
139 mg/dL, P 0.002) compared with HIV-uninfected patients. Angiographic
features of coronary artery disease were similar (multivessel disease 41
vs. 39, P 0.96; ACC/AHA type culprit lesion <B2, both 77, P 0.83). At 1
year, the rate of occurrence of first MACCE did not differ between groups
[hazard ratio (HR) 1.4, 95 CI 0.63.0]. Recurrent ACS was more frequent in
HIV-infected patients (HR 6.5, 95 CI 1.723.9) with no difference in the
rate of clinical restenosis. Conclusion sThese results suggest that the
acute management of ACS in HIV-infected patients can routinely be the same
as that of HIV-uninfected patients, but that specific secondary prevention
measures are needed to alleviate the increased risk of recurrent ACS.
2010 The Author.
<11>
Accession Number
2011027045
Authors
Bueno H. Betriu A. Heras M. Alonso J.J. Cequier A. Garcia E.J.
Lopez-Sendon J.L. MacAya C. Hernandez-Antolin R.
Institution
(Bueno) Department of Cardiology, Hospital General Universitario Gregorio
Maran, Dr Esquerdo, 46, 28007 Madrid, Spain
(Betriu, Heras) Departments of Cardiology, Hospital Clnic, Barcelona,
Spain
(Alonso) Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada,
Spain
(Cequier) Department of Cardiology, Hospital Bellvitge, Hospitalet de
Llobregat, Barcelona, Spain
(Garcia, MacAya, Hernandez-Antolin) Department of Cardiology, Hospital
Clnico San Carlos, Madrid, Spain
(Lopez-Sendon) Department of Cardiology, Hospital Universitario la Paz,
Madrid, Spain
Title
Primary angioplasty vs. fibrinolysis in very old patients with acute
myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio
en Ancianos) randomized trial and pooled analysis with previous studies.
Source
European Heart Journal. 32 (1) (pp 51-60), 2011. Date of Publication:
January 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To compare primary percutaneous coronary intervention (pPCI) and
fibrinolysis in very old patients with ST-segment elevation myocardial
infarction (STEMI), in whom head-to-head comparisons between both
strategies are scarce. Methods and resultsPatients <75 years old with
STEMI <6 h were randomized to pPCI or fibrinolysis. The primary endpoint
was a composite of all-cause mortality, re-infarction, or disabling stroke
at 30 days. The trial was prematurely stopped due to slow recruitment
after enroling 266 patients (134 allocated to pPCI and 132 to
fibrinolysis). Both groups were well balanced in baseline characteristics.
Mean age was 81 years. The primary endpoint was reached in 25 patients in
the pPCI group (18.9) and 34 (25.4) in the fibrinolysis arm [odds ratio
(OR), 0.69; 95 confidence interval (CI) 0.381.23; P 0.21]. Similarly,
non-significant reductions were found in death (13.6 vs. 17.2, P 0.43),
re-infarction (5.3 vs. 8.2, P 0.35), or disabling stroke (0.8 vs. 3.0, P
0.18). Recurrent ischaemia was less common in pPCI-treated patients (0.8
vs. 9.7, P< 0.001). No differences were found in major bleeds. A pooled
analysis with the two previous reperfusion trials performed in older
patients showed an advantage of pPCI over fibrinolysis in reducing death,
re-infarction, or stroke at 30 days (OR, 0.64; 95 CI 0.450.91). Conclusion
Primary PCI seems to be the best reperfusion therapy for STEMI even for
the oldest patients. Early contemporary fibrinolytic therapy may be a safe
alternative to pPCI in the elderly when this is not
available.Clinicaltrials.gov NCT00257309. 2010 The Author.
<12>
Accession Number
2011027247
Authors
Persson A. Bollerslev J. Rosen T. Mollerup C.L. Franco C. Isaksen G.A.
Ueland T. Jansson S. Caidahl K.
Institution
(Persson, Caidahl) Department of Clinical Physiology, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Bollerslev, Isaksen, Ueland) Department of Endocrinology, University of
Oslo, Oslo University Hospital, Oslo, Norway
(Rosen, Franco) Department of Endocrinology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Mollerup) Department of Endocrine Surgery, Copenhagen University
Hospital, Rikshospitalet, Denmark
(Ueland) Research Institute for Internal Medicine, University of Oslo,
Oslo, Norway
(Jansson) Department of Surgery, Sahlgrenska Hospital, Gothenburg, Sweden
(Caidahl) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden
Title
Effect of surgery on cardiac structure and function in mild primary
hyperparathyroidism.
Source
Clinical Endocrinology. 74 (2) (pp 174-180), 2011. Date of Publication:
February 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Context The cardiovascular (CV) risk profile is worsened in primary
hyperparathyroidism (PHPT), and CV mortality is related to serum calcium
levels. It is unknown whether CV mortality is increased in the most common
form of PHPT and whether the increased CV risk is reversible after
surgery. Objective To investigate reversibility of echocardiographic
variables in patients with mild PHPT who were randomized to observation
without surgery or operation, and followed for 2 years.
Design/Setting/Patients Forty-nine patients (mean age 63 +/- 7 years, 8
men) who had performed the 2-year visit in a randomized study on mild PHPT
(serum calcium at baseline 265 +/- 009 mm) (observation) vs 267 +/- 006 mm
(surgery) and where echocardiography had been performed, participated in
the study. Results Calcium and parathyroid hormone (PTH) levels were
normalized following surgery and were stable in the observation group. PTH
levels at baseline were highly correlated with ventricular mass. Detailed
echocardiography revealed a minor and borderline significant treatment
effect of surgery on left ventricular mass index (LVMI) compared to
observation (P = 0066) and a significant 11% reduction in diastolic
dimension of the interventricular septum (IVSd-mean) in the surgery group
(P < 001), with no alterations in the observation group. Conclusions Based
on detailed echocardiographic measures over a 2-year observation period,
we found only minor differences between the two groups. However, the
potential treatment effect on LVMI and the within-group differences in
IVSd-mean suggest that longer follow-up may yield larger and clinically
important differences. 2011 Blackwell Publishing Ltd.
<13>
Accession Number
2011027679
Authors
Suh J.-W. Lee S.-P. Park K.-W. Lee H.-Y. Kang H.-J. Koo B.-K. Cho Y.-S.
Youn T.-J. Chae I.-H. Choi D.-J. Rha S.-W. Bae J.-H. Kwon T.-G. Bae J.-W.
Cho M.-C. Kim H.-S.
Institution
(Suh, Lee, Park, Lee, Kang, Koo, Kim) Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Suh, Cho, Youn, Chae, Choi) Cardiovascular Center, Seoul National
University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
(Rha) Cardiovascular Center, Korea University Guro Hospital, Seoul, South
Korea
(Bae, Kwon) Heart Center, Konyang University Hospital, Daejon, South Korea
(Bae, Cho) Chungbuk National University Hospital, Cheongju, South Korea
Title
Multicenter randomized trial evaluating the efficacy of cilostazol on
ischemic vascular complications after drug-eluting stent implantation for
coronary heart disease: Results of the CILON-T (influence of
cilostazol-based triple antiplatelet therapy on ischemic complication
after drug-eluting stent implantation) trial.
Source
Journal of the American College of Cardiology. 57 (3) (pp 280-289), 2011.
Date of Publication: 18 Jan 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives We aimed to test whether cilostazol has beneficial effects in
the real-world patients treated with intracoronary drug-eluting stents
(DES). Background The addition of cilostazol on the conventional dual
antiplatelet therapy has been reported to reduce platelet reactivity and
to improve clinical outcomes after percutaneous coronary intervention in
previous studies. Methods In a randomized multicenter trial, we enrolled
960 patients who received DES. They were randomized to receive either dual
antiplatelet therapy (DAT) (aspirin and clopidogrel) or triple
antiplatelet therapy (TAT) (aspirin, clopidogrel, and cilostazol) for 6
months. Primary end point was the composite of cardiac death, nonfatal
myocardial infarction, ischemic stroke, or target lesion revascularization
(TLR). Secondary end points were P2Y<sub>12</sub> reaction unit (PRU)
measured with the VerifyNow P2Y12 assay (Accumetrics, San Diego,
California) at discharge and at 6 months after the index procedure.
All-cause death, stent thrombosis, and each component of the primary end
point at 6 months were other secondary end points. Analysis was done on an
intention-to-treat basis. Results At 6 months' follow-up, there was no
difference in the primary end point between the 2 groups (8.5% in TAT vs.
9.2% in DAT, p = 0.74). In secondary end point analysis, the TAT group
achieved lower PRU levels than the DAT group both at discharge (206.6 +/-
90.3 PRU vs. 232.2 +/- 80.3 PRU, p < 0.001) and at 6 months (210.7 +/-
87.9 PRU vs. 255.7 +/- 73.7 PRU, p < 0.001). In the Cox proportional
hazards analysis, lesion length (<28 mm, hazard ratio [HR]: 2.10, 95%
confidence interval [CI]: 1.25 to 3.52), and PRU level at discharge (every
increase in tertile, HR: 1.61, 95% CI: 1.16 to 2.25) were predictors of
the primary end point, but not the use of cilostazol (HR: 0.90, 95% CI:
0.54 to 1.52). Conclusions Despite the greater reduction of platelet
reactivity by addition of cilostazol to conventional DAT, TAT did not show
superiority in reducing the composite of adverse cardiovascular outcomes
after DES implantation. (The Efficacy of CILostazol ON Ischemic
Complications After DES Implantation [CILON-T]; NCT00776828) 2011
American College of Cardiology Foundation.
<14>
Accession Number
2011018395
Authors
Salhiyyah K. Taggart D.
Institution
(Salhiyyah) Department of Cardiothoracic Surgery, Royal Brompton and
Harefield NHS Trust, London, United Kingdom
(Taggart) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford, United Kingdom
Title
Beating-heart valve surgery: A systematic review.
Source
Asian Cardiovascular and Thoracic Annals. 17 (6) (pp 650-658), 2009.
Date of Publication: December 2009.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Beating-heart continuous coronary perfusion (BHCCP) has been promoted as
an alternative to the technique of cardioplegic arrest in valve surgery.
Its potential advantage is the elimination of cardioplegia and the
corollary risk of ischemic reperfusion injury. The use of CCP has been
recommended especially when performing more complex operations, such as
mitral valve repair, and particularly as surgeons become more familiar
with beating-heart coronary surgery. We conducted a systematic review to
assess the strength of the evidence supporting the efficacy of BHCCP
compared to cardioplegia in valve surgery. Thirty nine reports were
identified. Of these, only two were randomized control trials. Overall the
studies were generally of poor quality and had a low evidence level. In
those studies, mortality and major morbidity from BHCCP were within
acceptable levels, nevertheless, there was no advantage over cardioplegic
arrest. On the other hand there is weak evidence that it may reduce
functional and biochemical markers of myocardial injury. In conclusion,
BHCCP is an operative strategy in valve surgery with some potential
benefits. There is, however a need for a high quality, prospective,
randomized control trial to establish the exact role for BHCCP in complex
valve surgery. 2009 SAGE Publications.
<15>
Accession Number
2011018396
Authors
Ramzisham A.-R.M. Raflis A.R. Khairulasri M.G. Ooi Su Min J. Fikri A.M.
Zamrin M.D.
Institution
(Ramzisham, Raflis, Khairulasri, Fikri, Zamrin) Department of Surgery,
Heart and Lung Centre, Universiti Kebangsaan Malaysia Medical Centre,
Kuala Lumpur, Malaysia
(Ooi Su Min) Division of Cardiothoracic Anaesthesia, Medical Centre Kuala
Lumpur, Universiti Kebangsaan Malaysia, Malaysia
Title
Figure-of-eight vs. Interrupted sternal wire closure of median sternotomy.
Source
Asian Cardiovascular and Thoracic Annals. 17 (6) (pp 587-591), 2009.
Date of Publication: December 2009.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Sternal dehiscence is a rare but devastating complication following median
sternotomy for cardiac surgery. The optimal technique for sternal closure
is unclear. We conducted this prospective randomized trial to compare the
incidence of sternal dehiscence after figure-of-8 and simple interrupted
suturing in patients undergoing coronary artery bypass grafting. Between
January 2007 and June 2008, 98 patients had figure-of-8 suturing and 97
had interrupted sutures. The mean age of the patients was 60.9 +/- 7.6
years. The overall sternal dehiscence rate was 8%; 7 cases in the in
figure-of-8 group and 9 in the interrupted group. Thirteen patients had no
wound infection and healed with conservative treatment. Only 3 patients
had sternal dehiscence with infection: 2 with simple interrupted closure
and 1 with figure-of-8 sternal closure. There was no significant
difference in rates of sternal dehiscence between the 2 groups. It was
concluded that figure-of-8 sternal suturing is equally effective as simple
interrupted suturing in preventing sternal dehiscence. 2009 SAGE
Publications.
<16>
Accession Number
2011018401
Authors
Gualis J. Florez S. Tamayo E. Alvarez F.J. Castrodeza J. Castano M.
Institution
(Gualis, Florez, Tamayo, Alvarez, Castrodeza, Castano) Department of
Cardiac Surgery, Valladolid University Hospital, Valladolid, Spain
Title
Risk factors for mediastinitis and endocarditis after cardiac surgery.
Source
Asian Cardiovascular and Thoracic Annals. 17 (6) (pp 612-616), 2009.
Date of Publication: December 2009.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
A prospective open-cohort study was performed in 838 adults undergoing
coronary revascularization or valve surgery to define the risk factors for
development of surgical site infections. Patients diagnosed with
mediastinitis or endocarditis during follow-up were compared with patients
with no such infection. After 1 year of follow-up, 22 (2.6%) patients had
developed mediastinitis or endocarditis. No preoperative or intraoperative
variables were identified as risk factors. By multivariate analysis of
postoperative variables, respiratory insufficiency, microorganisms in
blood cultures, and intensive care unit stay were independent risk factors
for the development of these complications. The type of antibiotic
prophylaxis had no influence on the incidence of organ or space infections
after cardiac surgery. 2009 SAGE Publications.
<17>
Accession Number
2011022580
Authors
Morgan C. Zappitelli M. Gill P.
Institution
(Morgan) Division of Nephrology, Department of Pediatrics, University of
Alberta, Canada
(Zappitelli) Montreal Children's Hospital, McGill University Health
Centre, 2300 Tupper Street, Montreal, QC, H3H 1P3, Canada
(Gill) Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC
Mackenzie Health Sciences Centre, Edmonton, AB, T6G 2R7, Canada
(Morgan) 2B2-42 WC Mackenzie Health Sciences Centre, Edmonton, AB, T6G
2R7, Canada
Title
Statin prophylaxis and inflammatory mediators following cardiopulmonary
bypass: A systematic review.
Source
Critical Care. 13 (5) , 2009. Article Number: R165. Date of
Publication: 20 Oct 2009.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Introduction: Induction of an inflammatory response is thought to have a
significant role in the complications that follow cardiopulmonary bypass
(CPB). The statin drugs are increasingly being recognized as having potent
anti-inflammatory effects and hence have potential to influence an
important mechanism of injury in CPB, although there is no current
confirmation that this is indeed the case. Our objective was to
systematically review if pre-operative prophylactic statin therapy,
compared with placebo or standard of care, can decrease the inflammatory
response in people undergoing heart surgery with CPB.Methods: We performed
a systematic and comprehensive literature search for all randomized
controlled trials (RCTs) of open heart surgery with CPB in adults or
children who received prophylactic statin treatment prior to CPB, with
reported outcomes which included markers of inflammation. Two authors
independently identified eligible studies, extracted data, and assessed
study quality using standardized instruments. Weighted mean difference
(WMD) was the primary summary statistic with data pooled using a random
effects model. Descriptive analysis was used when data could not be
pooled.Results: Eight RCTs were included in the review, with the number of
trials for each inflammatory outcome being even more limited. Pooled data
demonstrated benefit with the use of statin to attenuate the post-CPB
increase in interleukins 6 and 8 (IL-6, IL-8), peak high sensitivity
C-reactive protein (hsCRP), and tumor necrosis factor-alpha (TNF-alpha)
post-CPB (WMD [95% confidence interval (CI)] -23.5 pg/ml [-36.6 to -10.5];
-23.4 pg/ml [-35.8 to -11.0]; -15.3 mg/L [CI -26.9 to -3.7]; -2.10 pg/ml
[-3.83 to -0.37] respectively). Very limited RCT evidence suggests that
prophylactic statin therapy may also decrease adhesion molecules following
CPB including neutrophil CD11b and soluble P (sP)-selectin.Conclusions:
Although the RCT evidence may suggest a reduction in post-CPB inflammation
by statin therapy, the evidence is not definitive due to significant
limitations. Several of the trials were not methodologically rigorous and
statin intervention was highly variable in this small number of studies.
This systematic review demonstrates that there is a significant gap that
exists in the current literature in regards to the potential
anti-inflammatory effect of statin therapy prior to CPB. 2009 Morgan et
al.; licensee BioMed Central Ltd.
<18>
Accession Number
2011024132
Authors
Hang C.-L. Hsieh B.-T. Wu C.-J. Yip H.-K. Yang C.-H. Chen S.-M. Hsieh
Y.-K. Fu M. Chua S. Guo G.B.-F. Leung S.W.
Institution
(Hang, Wu, Yip, Yang, Chen, Hsieh, Fu, Chua, Guo) Section of Cardiology,
Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung
Medical Center, Kaohsiung Hsien, Taiwan, China
(Hang, Wu, Yip, Yang, Chen, Hsieh, Fu, Chua, Guo) Chang Gung University
College of Medicine, Tao-Yuan, Taiwan, China
(Hsieh) Central Taiwan University of Science and Technology, Taichung,
Taiwan, China
(Leung) Department of Radiation Oncology, Yuan's General Hospital,
Kaohsiung City, China
Title
Six-year clinical follow-up after treatment of diffuse in-stent restenosis
with cutting balloon angioplasty followed by intracoronary brachytherapy
with liquid rhenium-188-filled balloon via transradial approach.
Source
Circulation Journal. 75 (1) (pp 113-120), 2011. Date of Publication:
2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Long-term follow-up studies revealed a signifcant decline in
the benefts of intracoronary radiation for in-stent restenosis. Methods
and Results: A total of 25 study and 25 contemporaneous control patients
with diffuse in-stent restenosis who underwent cutting balloon angioplasty
(CBA) transradially, followed by subsequent intracoronary irradiation with
a liquid /S-emitter Rhenium-188 (<sup>188</sup>Re)-flled balloon were
enrolled in the study. The mean clinical follow-up durations were
64.9+/-13.0 and 66.3+/-13.8 months for the irradiated and control
patients, respectively. Six-month angiographic restenosis was observed in
16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25)
of the patients in the control groups (P=0.03). The 6-month major adverse
cardiac events (MACE) rate was 12% and 44%, respectively (P=0.025). The
3-year follow-up angiography was performed in 16 of 21 (76%) irradiated
patients and in 4 of 13 (31%) control patients who had no signifcant
restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1
of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late
target lesion revascularization was performed in 1 irradiated and 2
control patients. The MACE rate within 6 years was signifcantly reduced in
the irradiated group (20% vs. 56%, P=0.019). Conclusions: Brachytherapy
using <sup>188</sup>Re-flled balloon following CBA for diffuse in-stent
restenotic native coronary arteries is effective in reducing target lesion
restenosis and improving long-term outcomes.
<19>
Accession Number
2011029564
Authors
Bosch M.A. Contreras E. Madoz P. Ortiz P. Pereira A. Pujol M.M.
Institution
(Bosch, Contreras, Madoz, Ortiz, Pereira, Pujol) Banc de Sang i Teixits,
Pg. Vall dHebron, 119-129 Barcelona 08035, Spain
(Bosch, Contreras, Madoz, Ortiz, Pereira, Pujol) Banc de Sang i
Teixits-Joan XXIIi, Tarragona, Spain
(Bosch, Contreras, Madoz, Ortiz, Pereira, Pujol) Banc de Sang i
Teixits-Sant Pau, Barcelona, Spain
(Bosch, Contreras, Madoz, Ortiz, Pereira, Pujol) Service of Hemotherapy
and Hemostasis, Hospital Clinic, Barcelona, Spain
(Bosch, Contreras, Madoz, Ortiz, Pereira, Pujol) Banc de Sang i
Teixits-Mutua de Terrassa, Terrassa, Spain
Title
The epidemiology of blood component transfusion in Catalonia, Northeastern
Spain.
Source
Transfusion. 51 (1) (pp 105-116), 2011. Date of Publication: January
2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Epidemiologic information on blood component usage can help
improve the utilization of transfusion resources. Study design and methods
Crosssectional survey in 2007 that included every hospital in Catalonia.
Clinical data of blood recipients, including the four-digit International
Classification of Diseases, 9th Revision, Clinical Modification codes and
the indication for transfusion, were prospectively collected according to
an established protocol. Results: In total, 19,148 red blood cell (RBC)
units, 1812 platelet (PLT) doses, and 3070 plasma units, transfused into
8019 patients (median age, 71 years; 52% males), were surveyed. Half the
RBC units were used by patients older than 70 years. Specific diagnosis
and procedures with the highest RBC use were lower limb orthopedic surgery
(10.6% of all units) and gastrointestinal hemorrhage (6%). Therapeutic
plasmapheresis (8.1%) and heart valve surgery (7.2%) were the procedures
with the highest plasma use. Oncohematology patients accounted for 73% of
transfused PLTs, more that two-thirds being administered for hemorrhage
prophylaxis. Acute hemorrhage was the most common indication for RBC and
plasma transfusion. Among all blood recipients, 80% received only RBCs and
6.9% received only plasma and/or PLTs, without concomitant RBCs. The
population transfusion incidence rates were 35 RBC units, three PLT doses,
and 6 plasma units per 1000 population-year. Demographic changes
anticipate a 30% increase in RBC transfusion by year 2030. CONCLUSIONS:
These results allow for identification of blood uses that are susceptible
to improvement, help appraise the expected yield of blood safety measures,
and will assist in planning the future blood supply. 2010 American
Association of Blood Banks.
