EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010685108
Authors
Sun J.C.J. Teoh K.H.T. Lamy A. Sheth T. Ellins M.L. Jung H. Yusuf S. Anand
S. Connolly S. Whitlock R.P. Eikelboom J.W.
Institution
(Sun, Teoh, Lamy, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Canada
(Sheth, Connolly) Division of Cardiology, McMaster University, Hamilton,
Canada
(Ellins) Department of Radiology, McMaster University, Hamilton, Canada
(Jung) Population Health Research Institute, McMaster University,
Hamilton, Canada
(Yusuf, Anand, Eikelboom) Department of Medicine, McMaster University,
Hamilton, Canada
Title
Randomized trial of aspirin and clopidogrel versus aspirin alone for the
prevention of coronary artery bypass graft occlusion: The preoperative
aspirin and postoperative antiplatelets in coronary artery bypass grafting
study.
Source
American Heart Journal. 160 (6) (pp 1178-1184), 2010. Date of
Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Routine use of postoperative aspirin after coronary artery
bypass grafting (CABG) reduces graft failure and cardiovascular events.
The efficacy and safety of adding clopidogrel to aspirin for the
prevention of graft failure and cardiovascular events after CABG are
unknown. We performed a pilot study measuring safety and efficacy outcomes
of aspirin and clopidogrel therapy after CABG. Methods: We randomized 100
patients undergoing CABG to receive placebo or clopidogrel started after
surgery and for 30 days. All patients received aspirin 81 mg daily. Graft
patency was measured by cardiac computed tomography angiography at 30
days. Results: Clinical follow-up was complete for 99 patients, and 79
(80%) underwent computed tomography angiography. The proportion of
patients with >=1 occluded graft was not significantly different between
placebo and clopidogrel groups (9/39 [23.1%] vs 7/40 [17.5%], relative
risk 0.95, 95% CI 0.80-1.14, P = .54). Among radial artery grafts, the
placebo group had a significantly higher number of occlusions or "string
signs" compared with the clopidogrel group (7/16 [43.8%] vs 2/19 [10.5%],
relative risk 0.24, 95% CI 0.06-1.00, P = .05). There was no difference
between placebo and clopidogrel groups in the safety outcomes of total
postoperative bleeding, transfusions, bleeding events, and reexploration
and in the efficacy outcomes of nonfatal myocardial infarction, stroke,
and death. Conclusions: This pilot study confirms a high rate of graft
occlusion after CABG surgery and suggests that the addition of clopidogrel
to aspirin is feasible and safe and may be superior for prevention of
graft failure in radial artery grafts. 2010 Mosby, Inc.

<2>
Accession Number
2010685109
Authors
Steg P.G. Mehta S. Jolly S. Xavier D. Rupprecht H.-J. Lopez-Sendon J.L.
Chrolavicius S. Rao S.V. Granger C.B. Pogue J. Laing S. Yusuf S.
Institution
(Steg) INSERM U-698, Recherche Clinique en Atherothrombose, Paris, France
(Steg) Universite Paris 7, Denis Diderot, Paris, France
(Steg) Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris,
France
(Mehta, Jolly, Chrolavicius, Yusuf) Population Health Research Institute,
Hamilton Health Sciences, McMaster University Hamilton, ON, Canada
(Xavier) St. John's Medical College, Research Institute, Bangalore, India
(Rupprecht) Medizinische Klinik, Klinikum Russelsheim, Russelsheim,
Germany
(Lopez-Sendon) Hospital Universitario la Paz, 28036 Madrid, Spain
(Rao, Granger) Duke Clinical Research Institute, United States
(Pogue) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Faculty of Health Sciences, Hamilton, ON, Canada
(Laing) GlaxoSmithKline, Uxbridge, United Kingdom
Title
Fondaparinux with unfractionated heparin during revascularization in acute
coronary syndromes (FUTURA/OASIS 8): A randomized trial of intravenous
unfractionated heparin during percutaneous coronary intervention in
patients with non-ST-segment elevation acute coronary syndromes initially
treated with fondaparinux.
Source
American Heart Journal. 160 (6) (pp 1029-1034.e1), 2010. Date of
Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: There is uncertainty regarding the optimal adjunctive
unfractionated heparin (UFH) regimen for percutaneous coronary
intervention (PCI) in patients with non-ST-segment elevation acute
coronary syndrome (NSTE-ACS) treated with fondaparinux. Objective: The aim
of this study is to evaluate the safety of 2 dose regimens of adjunctive
intravenous UFH during PCI in high-risk patients with NSTE-ACS initially
treated with fondaparinux and referred for early coronary angiography.
Design: This is an international prospective cohort study of approximately
4,000 high-risk patients presenting to hospital with unstable angina or
non-ST-segment elevation myocardial infarction, treated with fondaparinux
as initial medical therapy, and referred for early coronary angiography
with a view to revascularization. Within this cohort, 2,000 patients
undergoing PCI will be eligible for enrollment into a double-blind
international randomized parallel-group trial evaluating standard
activated clotting time (ACT)-guided doses of intravenous UFH versus a
non-ACT-guided weight-adjusted low dose. The standard regimen uses an
85-U/kg bolus of UFH if there is no platelet glycoprotein IIb/IIIa
(GpIIb-IIIa) inhibitor or 60 U/kg if GpIIb-IIIa inhibitor use is planned,
with additional bolus guided by blinded ACT measurements. The low-dose
regimen uses a 50 U/kg UFH bolus, irrespective of planned GpIIb-IIIa use.
The primary outcome is the composite of peri-PCI major bleeding, minor
bleeding, or major vascular access site complications. The assessment of
net clinical benefit is a key secondary outcome: it addresses the
composite of peri-PCI major bleeding with death, myocardial infarction, or
target vessel revascularization at day 30. Conclusion: FUTURA/OASIS 8 will
help define the optimal UFH regimen as adjunct to PCI in high-risk
NSTE-ACS patients treated with fondaparinux. 2010 Mosby, Inc.

<3>
Accession Number
2010685120
Authors
Poggio R. Arazi H.C. Giorgi M. Miriuka S.G.
Institution
(Poggio, Arazi, Giorgi, Miriuka) Departamento de Cardiologia, Fundacion
FLENI, Buenos Aires, Argentina
(Poggio) Instituto de Efectividad Clinica y Sanitaria (IECS), Buenos
Aires, Argentina
(Giorgi) Instituto de Investigaciones Epidemiologicas, Academia Nacional
de Medicina, Buenos Aires, Argentina
(Miriuka) CONICET, Buenos Aires, Argentina
Title
Prediction of severe cardiovascular events by VE/Vco2 slope versus peak
Vo2 in systolic heart failure: A meta-analysis of the published
literature.
Source
American Heart Journal. 160 (6) (pp 1004-1014), 2010. Date of
Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Peak Vo₂ has traditionally been used for prognostic
evaluation in systolic heart failure. However, in the past years, VE/Vco
₂ slope has been shown to be similar or even superior in many
studies. We performed a systematic review and a meta-analysis of
diagnostic studies of VE/Vco₂ slope to assess its ability to
predict cardiovascular events in systolic heart failure. Methods: We
searched the published literature in PubMed and ISI Web of Science for
VE/Vco₂ slope in heart failure, and performed a systematic
review and a meta-analysis of diagnostic studies in articles fulfilling
previously established selection criteria. End points were serious
cardiovascular events defined as death or the combined end point of death,
ventricular assist device implantation, or heart transplant. A
sub-analysis was also performed with those articles providing enough data
to compare VE/Vco₂ slope prognostic ability to that of peak
Vo₂. Results: Four hundred ninety-one articles that are
potentially relevant were identified, and 12 studies were selected based
on our predefined criteria. No heterogeneity or evidence of publication
bias was found. The 12 studies included a total of 2,628 patients with a
mean follow-up of 31 months (95% CI 16-46 months). The combined event rate
at 1 year was 11.2% (95% CI 7.8%-14.6%). Diagnostic odds ratio and area
under the curve for serious cardiovascular events were 5.02 (95% CI
4.06-6.21) and 0.75 (95% CI 0.72-0.78), respectively. Six studies provided
sufficient data for VE/Vco₂ slope and peak Vo₂
comparison. Both variables showed similar performance, although
VE/Vco₂ did present a trend to superiority. Conclusions: In
this meta-analysis, VE/Vco₂ slope represents a reasonable
ability to predict serious cardiovascular events in systolic heart
failure, and is at least as effective as peak Vo₂. 2010 Mosby,
Inc.

<4>
Accession Number
2010678431
Authors
Lee Y.H. Lee B.K. Choi Y.J. Yoon I.K. Chang B.C. Gwak H.S.
Institution
(Lee, Lee, Choi, Yoon, Chang, Gwak) College of Pharmacy, Division of Life
and Pharmaceutical Sciences, Ewha Womans University, 11-1 Daehyun-Dong,
Seodaemun-Gu, Seoul 120-750, South Korea
Title
Interaction between warfarin and Korean red ginseng in patients with
cardiac valve replacement.
Source
International Journal of Cardiology. 145 (2) (pp 275-276), 2010. Date of
Publication: 19 Nov 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<5>
Accession Number
70316166
Authors
Monk-Hanse T. Have Dal C. Bisgaard Christense S. Snoe M. Gustafsso F.
Rasmuse H. Prescot E.
Institution
(Monk-Hanse, Have Dal, Bisgaard Christense, Snoe, Rasmuse, Prescot)
Bispebjerg Hospital, Copenhagen University Hospital, Department of
Cardiology, Copenhagen, Denmark
(Gustafsso) Rigshospitalet, Copenhagen University Hospital, Heart Centre,
Copenhagen, Denmark
Source
European Journal of Echocardiography. Conference: 14th Annual Meeting of
the European Association of Echocardiography Copenhagen Denmark.
Conference Start: 20101208 Conference End: 20101211. Conference
Publication: (var.pagings). 11 (pp ii60), 2010. Date of Publication:
December 2010.
Publisher
Oxford University Press
Abstract
Purpose: Despite normal left ventricular ejection fraction (LVEF), heart
transplant (htx) recipients have limited physical performance, mainly due
to chronotropic incompetence and diastolic dysfunction. We studied
diastolic function at rest and during exercise, before and after 8 weeks
of aerobic interval training in a randomized controlled trial in stable
htx patients. Methods: 23 stable htx patients (mean age 50.9+/-14.2) were
randomized to 8 weeks of high-intensity aerobic interval training (n=13)
or control (n=10). Patients underwent maximum bicycle exercise test and
semi supine exercise stressechocardiography before and after training.
Standard resting echocardiography using Philips IE33 included pulsed
Doppler LV inflow at apical 4 chamber (E,A, dec. time) and pulsed TDI (e)
at the lateral corner of mitral annulus. Acquisitions were repeated at 30%
and 60% of maximum workload. Recordings were analyzed by two experienced
echocardiographers blinded to allocation. Results: All patients had normal
LVEF and none fulfilled ESC criteria for diastolic dysfunction. Baseline
measures of diastolic function E, A, E/A and E/e increased and dec. time
decreased with increasing workload (table). VO2peak was not correlated
with E/A, E/e or dec.time during rest or exercise. The intervention group
improved VO2peak while the control group did not (p<0.001). However, all
measures of diastolic function remained similar in the two groups.
Conclusion: In contrast to previous studies we found no association
between exercise capacity and measures of diastolic function in htx
recipients. E/e increased with workload indicating stress induced
diastolic dysfunction. 8 weeks of high-intensity aerobic training improved
Vo2peak but did not alter diastolic parameters at rest or during
exercise.(Table presented).

<6>
Accession Number
2010685931
Authors
Biondi-Zoccai G. Lotrionte M. Sheiban I.
Institution
(Biondi-Zoccai, Sheiban) Division of Cardiology, University of Turin,
Turin, Italy
(Lotrionte) Unit for Heart Failure and Cardiac Rehabilitation, Catholic
University, Rome, Italy
Title
Management of multivessel coronary disease after ST-elevation myocardial
infarction treated by primary coronary angioplasty.
Source
American Heart Journal. 160 (6 SUPPL.) (pp S28-S35), 2010. Date of
Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Primary percutaneous coronary intervention of the infarct-related artery
is now considered the gold standard for patients with acute ST-elevation
myocardial infarction. However, a sizable portion of patients with
ST-elevation myocardial infarction have concomitant multivessel disease,
which raises important therapeutic and prognostic issues. Indeed, it is
still unclear whether percutaneous coronary intervention of the culprit
vessel alone is superior, equivalent, or inferior in terms of risk-benefit
balance in comparison to a strategy of complete revascularization, with
percutaneous coronary intervention of nonculprit vessels as well. The
present systematic review provides an updated prospective on the
rationale, background, and outcomes of culprit-only versus multivessel
percutaneous revascularization in subjects undergoing primary percutaneous
coronary intervention. Our findings clearly demonstrate that multivessel
coronary disease significantly and adversely impacts on patient prognosis,
yet a culprit-only revascularization strategy should be sought after in
most cases, unless patient instability or symptoms/signs of residual
myocardial ischemia support nonculprit vessel intervention. 2010 Mosby,
Inc. All rights reserved.

<7>
Accession Number
2010679056
Authors
Kereiakes D.J. Cutlip D.E. Applegate R.J. Wang J. Yaqub M. Sood P. Su X.
Su G. Farhat N. Rizvi A. Simonton C.A. Sudhir K. Stone G.W.
Institution
(Kereiakes) Christ Hospital Heart, Vascular Center, Carl and Edyth Lindner
Center for Research and Education, Cincinnati, OH, United States
(Cutlip) Harvard Clinical Research Institute, Boston, MA, United States
(Applegate) Wake Forest University Health Sciences, Winston-Salem, NC,
United States
(Wang) Union Memorial Hospital, Baltimore, MD, United States
(Yaqub, Sood, Su, Su, Simonton, Sudhir) Abbott Vascular, Santa Clara, CA,
United States
(Farhat) EMH Regional Medical Center, Elyria, OH, United States
(Rizvi) Cardiovascular Specialists of North Houston, Houston, TX, United
States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Outcomes in diabetic and nondiabetic patients treated with everolimus- or
paclitaxel-eluting stents: Results from the SPIRIT IV clinical trial
(Clinical Evaluation of the XIENCE v Everolimus Eluting Coronary Stent
System).
Source
Journal of the American College of Cardiology. 56 (25) (pp 2084-2089),
2010. Date of Publication: December 14-21, 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives We compared the safety and efficacy of the XIENCE V (Abbott
Vascular, Santa Clara, California) everolimus-eluting stent (EES) with the
TAXUS Express (Boston Scientific, Natick, Massachusetts)
paclitaxel-eluting stent (PES) among the large cohort of randomized
diabetic patients enrolled in the SPIRIT IV (Clinical Evaluation of the
XIENCE V Everolimus Eluting Coronary Stent System) trial. Background
Diabetes mellitus remains a significant predictor of adverse clinical
outcomes after percutaneous coronary intervention with drug-eluting
stents, and the comparative outcomes of different drug-eluting stents in
diabetic patients remains ill-defined. Methods In the SPIRIT IV trial,
3,687 patients with up to 3 de novo native coronary artery lesions were
prospectively randomized 2:1 to receive EES or PES. Randomization was
stratified by the presence of diabetes and lesion complexity. The primary
end point was the occurrence of target lesion failure (TLF) (cardiac
death, target-vessel myocardial infarction, or ischemia-driven target
lesion revascularization) at 1 year. Clinical outcomes were evaluated in
randomized diabetic (n = 1,185 [786 EES; 399 PES]) and nondiabetic
patients (n = 2,498 [1,669 EES; 829 PES]). Results The EES compared with
PES reduced TLF in nondiabetic patients (3.1% vs. 6.7%, p < 0.0001), with
significant reductions in myocardial infarction, stent thrombosis, and
target lesion revascularization. In contrast, no difference in TLF (6.4%
vs. 6.9%, respectively, p = 0.80) or any of its components was present
among diabetic patients, regardless of insulin use. A significant
interaction between the presence of diabetes and stent type on TLF
(p_interaction = 0.02) was observed. Conclusions In the SPIRIT
IV randomized trial, EES compared with PES provided similar clinical
outcomes in diabetic patients and superior clinical outcomes in
nondiabetic patients at 1 year. (SPIRIT IV Clinical Trial: Clinical
Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the
Treatment of Subjects With de Novo Native Coronary Artery Lesions;
NCT00307047) 2010 American College of Cardiology Foundation.