Results Generated From:
EMBASE <1980 to 2011 Week 08>
EMBASE (updates since 2011-02-17)
<1>
Accession Number
2011079181
Authors
Singh P.P. Singh M. Bedi U. Molnar J. Arora R. Khosla S.
Institution
(Singh, Singh, Bedi, Molnar, Arora, Khosla) Division of Cardiology, Mount
Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608, United
States
Title
Safety and efficacy of triple antithrombotic therapy after percutaneous
coronary intervention in patients needing long-term anticoagulation.
Source
Therapeutic Advances in Cardiovascular Disease. 5 (1) (pp 23-31), 2011.
Date of Publication: February 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Optimal antithrombotic therapy after percutaneous coronary
intervention (PCI) is currently undefined in patients requiring long-term
anticoagulation. Previous studies comparing triple therapy (TT) of
warfarin, aspirin and clopidogrel with standard dual therapy (DT) of
aspirin and clopidogrel have yielded conflicting results. Meta-analysis of
these studies was performed to evaluate safety and efficacy of TT.
Methods: A total of 1482 patients from 6 studies were analyzed using the
Mantel-Haenszel random effect model to extract incidence of major
bleeding. The secondary end point assessed by three of these studies was
major adverse cardiac events (MACEs: cardiovascular death, myocardial
infarction and thromboembolic complications). The incidence of MACEs was
computed using the Mantel-Haenszel fixed effect model. Combined relative
risks (RRs) across all of the studies and the 95% confidence intervals
(CIs) were determined. A two-sided alpha error <0.05 was considered
statistically significant. Results: Baseline characteristics were similar
in both groups. Compared with patients receiving DT, the risk of major
bleeding was significantly higher in the TT group (RR: 2.74, CI:
1.08-6.98; p = 0.034). However, risk of MACE was significantly lower in
the TT group (RR: 0.72, CI: 0.56-0.98; p = 0.014). Conclusion: In patients
requiring long-term anticoagulation after PCI, TT may be superior to DT in
reducing the incidence of MACEs, however risk of major bleeding
complications is increased significantly. 2011 The Author(s).
<2>
Accession Number
2011082271
Authors
Zhang L. Zhang S. Jiang H. Sun A. Zou Y. Ge J.
Institution
(Zhang, Zhang, Jiang, Sun, Zou, Ge) Shanghai Institute of Cardiovascular
Diseases, Zhongshan Hospital, Shanghai Medical College of Fudan
University, 180 Fenglin Road, Shanghai 200032, China
(Zou, Ge) Institutes of Biomedical Sciences, Shanghai Medical College,
Fudan University, Shanghai, China
Title
Effects of statin treatment on cardiac function in patients with chronic
heart failure: A meta-analysis of randomized controlled trials.
Source
Clinical Cardiology. 34 (2) (pp 117-123), 2011. Date of Publication:
February 2011.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background Whether additional benefit can be achieved with the use of
statin treatment in patients with chronic heart failure (CHF) remains
undetermined. Hypothesis Statin treatment may be effective in improving
cardiac function and ameliorating ventricular remodeling in CHF patients.
Methods The PubMed, MEDLINE, EMBASE, and EBM Reviews databases were
searched for randomized controlled trials comparing statin treatment with
nonstatin treatment in patients with CHF. Two reviews independently
assessed studies and extracted data. Weighted mean differences (WMD) with
95% confidence intervals (CI) were calculated using random effects models.
Results Eleven trials with 590 patients were included. Pooled analysis
showed that statin treatment was associated with a significant increase in
left ventricular ejection fraction (WMD: 3.35%, 95% CI: 0.80 to 5.91%, P =
0.01). The beneficial effects of statin treatment were also demonstrated
by the reduction of left ventricular end-diastolic diameter (WMD: -3.77
mm, 95% CI: -6.24 to -1.31 mm, P = 0.003), left ventricular end-systolic
diameter (WMD: -3.57 mm, 95% CI: -6.37 to -0.76 mm, P = 0.01), B-type
natriuretic peptide (WMD: -83.17 pg/mL, 95% CI: -121.29 to -45.05 pg/mL, P
< 0.0001), and New York Heart Association functional class (WMD: -0.30,
95% CI: -0.37 to -0.23, P < 0.00001). Meta-regression showed a
statistically significant association between left ventricular ejection
fraction improvement and follow-up duration (P = 0.03). Conclusions The
current cumulative evidence suggests that use of statin treatment in CHF
patients may result in the improvement of cardiac function and clinical
symptoms, as well as the amelioration of left ventricular remodeling.
Copyright 2011 Wiley Periodicals, Inc.
<3>
Accession Number
2011083979
Authors
Fransoo R.R. Martens P.J. Prior H.J. Burland E. Chateau D. Katz A.
Institution
(Fransoo, Martens, Prior, Burland, Chateau, Katz) Manitoba Centre for
Health Policy, 408 - 727 McDermot Avenue, Winnipeg, MB R3E 3P5, Canada
(Fransoo, Martens) Community Health Sciences, Faculty of Medicine,
University of Manitoba, Winnipeg, MB, Canada
(Chateau) Biostatistical Consulting Unit, Community Health Sciences,
Winnipeg, MB, Canada
(Katz) Family Medicine and Community Health Sciences, Faculty of Medicine,
University of Manitoba, Winnipeg, MB, Canada
Title
Age difference explains gender difference in cardiac intervention rates
after acute myocardial infarction.
Source
Healthcare Policy. 6 (1) (pp 88-103), 2010. Date of Publication: August
2010.
Publisher
Longwoods Publishing Corp. (260 Adelaide Street East, No. 8, Toronto ON
M5A 1N1, Canada)
Abstract
Many investigators have reported higher rates of cardiac procedures for
males than females after acute myocardial infarction (AMI), suggesting
that men are treated more aggressively than women. However, others have
reported no significant differences after controlling for age, resulting
in uncertainty about the existence of a true gender bias in cardiac care.
In this study, a population-based cohort approach was used to calculate
age-specific procedure rates by sex from administrative data. Chi-square
tests and generalized linear modelling were used to assess gender
differences and interactions. for all four procedures studied, rates were
significantly higher for males than females (p<0.01). However,
age-specific rates revealed few significant differences by gender and a
sharp decrease in intervention rates with age for both males and females.
generalized linear modelling confirmed that patient age was a significant
predictor of intervention rates, whereas sex was not. The significant
gender difference in overall rates was completely confounded by the older
age profile of female AmI patients compared to their male counterparts.
<4>
Accession Number
2011086993
Authors
Singh R. Choudhury M. Kapoor P.M. Kiran U.
Institution
(Singh, Choudhury, Kapoor, Kiran) Department of Cardiac Anesthesia, C N
Center, All India Institute of Medical Sciences, New Delhi, India
Title
A randomized trial of anesthetic induction agents in patients with
coronary artery disease and left ventricular dysfunction.
Source
Annals of Cardiac Anaesthesia. 13 (3) (pp 217-223), 2010. Date of
Publication: September-December 2010.
Publisher
Medknow Publications and Media Pvt. Ltd (A-109, Kanara Business Centre,
off Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The deleterious effects of anesthetic agents in patients suffering from
coronary artery disease are well known. The risk increases when a patient
has compromised ventricular function. There is a paucity of literature
regarding the choice of the suitable agent to avoid deleterious effects in
such patients. The use of etomidate and propofol has been considered
superior to other intravenous anesthetic agents in these groups of
patients. The aim of the present study is to compare the hemodynamic
effects of anesthesia induction with etomidate, thiopentone, propofol, and
midazolam in patients with coronary artery disease and left ventricular
dysfunction. This randomized clinical trail was conducted at the All
Indian Institute of Medical Sciences, New Delhi, India. Sixty patients
with coronary artery disease and left ventricular dysfunction (ejection
fraction < 45%) scheduled for elective coronary artery bypass surgery
participated in this study. After stabilization baseline hemodynamic data
stroke volume variation and systemic vascular resistance index were
recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output
monitor used for hemodynamic monitoring). The patients were randomly
alloted to one of the four groups and the intravenous induction agent was
administered for over 60 - 90 seconds (Group E - Etomidate 0.2 mg/Kg;
Group M - Midazolam 0.15 mg/Kg; Group T - Thiopentone 5 mg/Kg; Group P -
Propofol 1.5 mg/Kg). Hemodynamic data were recorded at one minute
intervals starting from induction till seven minutes after intubation, -
the end point of the present study. There was a significant decrease in
the heart rate in comparison to the baseline(-7 to -15%, P = 0.001), mean
arterial pressure (-27 to -32%, P = 0.001), cardiac index (-36 to -38%, P
= 0.001), and stroke volume index (-27 to -34%, P = 0.001) after induction
in all four groups. The hemodynamic response was similar in all the four
groups. There was no significant change in central venous pressure and
stroke volume variation (SVV) during induction and intubation, while the
effects on the systemic vascular resistance index (SVRI) were variable.
The midazolam group was the most effective in preventing intubation stress
(tachycardia,hypertension). The change from baseline values in heart rate
(+ 4%, P = 0.12) and mean arterial pressure (-1%, P = 0.77) after
intubation were not statistically significant in the midazolam group. The
etomidate group was the least effective of all the four groups in
minimizing stress response, with statistically significant increase from
baseline in both heart rate (P = 0.001) and mean arterial pressure (P =
0.001) at 1 minute after intubation. All the four anesthetic agents were
acceptable for induction in patients with coronary artery disease and left
ventricular dysfunction despite a 30 - 40% decrease in the cardiac index.
Clinician experience along with knowledge of the potential interactions
(e.g., premedication, concurrent opioid use) is needed to determine
hemodynamic stability during anesthetic induction in these patients with
ventricular dysfunction.
<5>
Accession Number
2011086996
Authors
Mehta Y. Vats M. Sharma M. Arora R. Trehan N.
Institution
(Mehta, Vats, Sharma, Arora, Trehan) Department of Cardiac Anesthesia and
Critical Care, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi - 110
076, India
Title
Thoracic epidural analgesia for off-pump coronary artery bypass surgery in
patients with chronic obstructive pulmonary disease.
Source
Annals of Cardiac Anaesthesia. 13 (3) (pp 224-230), 2010. Date of
Publication: September-December 2010.
Publisher
Medknow Publications and Media Pvt. Ltd (A-109, Kanara Business Centre,
off Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The benefits of thoracic epidural analgesia in patients undergoing
coronary artery bypass grafting are well documented. However, the
literature available on the role of high thoracic epidural analgesia
(HTEA) in patients with chronic obstructive pulmonary disease undergoing
off-pump coronary artery bypass graft (OPCAB) surgery is scarce. We
conducted a randomized clinical trial to establish whether HTEA is
beneficial in patients with chronic obstructive pulmonary disease
undergoing elective OPCAB surgery. After institutional ethics board
approval and informed consent, 62 chronic obstructive pulmonary disease
patients undergoing elective OPCAB were randomly grouped into two (n = 31
each). Both groups received general anesthesia (GA), but in the HTEA group
patients, TEA was also administered. Standardized surgical and anesthetic
techniques were used for both the groups. Pulmonary function tests were
performed pre-operatively, 6 h and 24 h post-extubation and on days 2, 3,
4 and 5 along with arterial blood gas analysis (ABG) analysis. Time for
extubation (h) and time for oxygen withdrawal (h) were recorded. Pain
score was assessed by the 10-cm visual analogue scale. All
hemodynamic/oxygenation parameters were noted. Any complications related
to the TEA were also recorded. Patients in the HTEA group were extubated
earlier (10.8 h vs. 13.5 h, P < 0.01) and their oxygen withdrawal time was
also significantly lower (26.26 h vs. 29.87 h, P < 0.01). The VAS score,
both at rest and on coughing, was significantly lower in the HTEA group at
all times, post-operatively (P < 0.01). The forced vital capacity improved
significantly at 6 h post-operatively in the HTEA group (P = 0.026) and
remained significantly higher thereafter. A similar trend was observed in
forced expiratory volume in the first second on day 2 in the HTEA group (P
= 0.024). We did not observe any significant side-effects/mortality in
either group. In chronic obstructive pulmonary disease patients undergoing
elective OPCAB surgery, HTEA is a good adjunct to GA for early extubation,
faster recovery of pulmonary function and better analgesia.
<6>
Accession Number
2011088936
Authors
Vassileva C.M. Boley T. Markwell S. Hazelrigg S.
Institution
(Vassileva, Boley, Markwell, Hazelrigg) SIU School of Medicine, Division
of Cardiothoracic Surgery, Springfield, IL, United States
Title
Meta-analysis of short-term and long-term survival following repair versus
replacement for ischemic mitral regurgitation.
Source
European Journal of Cardio-thoracic Surgery. 39 (3) (pp 295-303), 2011.
Date of Publication: March 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
The optimal surgical strategy for the management of ischemic mitral
regurgitation (IMR) is still debated. The purpose of this study was to
perform a meta-analysis summarizing the evidence favoring one technique
over another (repair vs replacement). A search of the English literature
in PubMed was performed using 'ischemic mitral regurgitation' and 'repair
or replacement or annuloplasty' in the title/abstract field. Articles were
excluded if they lacked a direct comparison of repair versus replacement,
or used Teflon/pericardial strip or suture annuloplasty in >10% of the
repairs. Nine articles were selected for the final analysis. All studies
except one were relatively recent (2004-2009). The patient characteristics
between treatment groups were similar across studies. All studies excluded
patients with degenerative etiology and used a rigorous definition of IMR.
Most patients had concomitant coronary artery bypass graft. In the
patients with mitral valve replacement, at least the posterior and, in
many cases, the entire subvalvular apparatus were preserved. Mean ejection
fraction and proportion of patients with severe ventricular dysfunction
were similar between the repair and replacement groups. The odds ratios
for the studies, comparing replacement to repair, ranged from 0.884 to
17.241 for short-term mortality and the hazard ratios ranged from 0.677 to
3.205 for long-term mortality. There was a significantly increased
likelihood of both short-term mortality (summary odds ratio 2.667 (95%
confidence interval (CI) 1.859-3.817)) and long-term mortality (summary
hazard ratio 1.352 (95% CI 1.131-1.618)) for the replacement group
compared to the repair group. Based on the meta-analysis of the current
relevant literature, mitral valve repair for IMR is associated with better
short-term and long-term survival compared to mitral valve replacement.
Our conclusion should be interpreted in the context of the inherent
limitations of a meta-analysis of retrospective studies including
heterogeneity of patient characteristics, which may have influenced the
physician's decision to perform mitral valve repair or replacement. In the
absence of any published randomized studies, mitral procedure selection
should be individualized. 2010 European Association for Cardio-Thoracic
Surgery.
<7>
Accession Number
2011054565
Authors
McLintock C.
Institution
(McLintock) Department of Obstetrics and Gynecology, National Women's
Health, Auckland City Hospital, Auckland, New Zealand
Title
Anticoagulant therapy in pregnant women with mechanical prosthetic heart
valves: No easy option.
Source
Thrombosis Research. 127 (SUPPL. 3) (pp S56-S60), 2011. Date of
Publication: February 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
The choice of anticoagulant agent for pregnant women with mechanical
prosthetic heart valves introduces a clinical dilemma for women and the
clinicians caring for them. Options include continuing oral anticoagulants
(OAC) such as warfarin throughout pregnancy, switching from warfarin to
unfractionated heparin or low molecular weight heparin (LMWH) in the first
trimester then back to warfarin until close to delivery or taking
unfractionated heparin or LMWH throughout pregnancy. The dilemma is that
warfarin is the most effective a preventing maternal thromboembolic
complications but causes significant fetal morbidity and mortality;
unfractionated heparin and in particular LMWH have good fetal outcomes but
the risk of thromboembolic complications is high. What is considered to be
an "acceptable level" of risk to mother and infant may differ from one
clinician to another and of equal importance, it may also differ from one
woman to the next. An unbiased discussion of the pros and cons of each
option is required to allow women to make and informed and confident
choice in this very difficult clinical situation. 2010 Elsevier B.V. All
rights reserved.
<8>
Accession Number
2011068195
Authors
Ernst E.
Institution
(Ernst) Complementary Medicine, Peninsula Medical School, University of
Exeter, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom
Title
Serious adverse effects after acupuncture - A systematic review
(2000-2009).
Source
Perfusion. 23 (6) (pp 214-225), 2010. Date of Publication: December
2010.
Publisher
Verlag Perfusion GmbH (Storchenweg 20, Puschendorf 90617, Germany)
Abstract
Background: Acupuncture is usually deemed to be as a safe intervention.
Yet serious complications continue to be reported. The aim of this article
is to systematically review all serious adverse effects recently reported
in the medical literature. Method: Electronic literature searches were
conducted to identify case reports, case series, epidemiological studies
and other investigations reporting adverse effects published between 2000
and 2009. Data were extracted and categorized according to pre-defined
criteria. Results: Numerous reports of severe adverse effects, including
those involving the cardiovascular system were found. Many lacked
important detail. The adverse effects fall into two major categories:
infections and trauma. In most cases, patients made a full recovery but at
least 9 patients died and many more suffered permanent problems. Most
adverse effects were preventable. Conclusions: Serious adverse effects of
acupuncture continue to be reported with some regularity. The majority
would seem to be avoidable, and acupuncturists across the world should
receive adequate training to minimize the risk. Verlag PERFUSION GmbH.
<9>
Accession Number
2011074174
Authors
Pego-Fernandes P.M. Moreira L.F.P. Souza G.E.C. Bacal F. Bocchi E.A. Stolf
N.A.G. Jatene F.B.
Institution
(Pego-Fernandes, Moreira, Souza, Bacal, Bocchi, Stolf, Jatene) Inst. do
Coracao (Incor), Hosp. Das Clinicas, Universidade de Sao Paulo, Sao Paulo,
SP, Brazil
Title
Endoscopic left sympathetic blockade in the treatment for dilated
cardiomyopathy.
Source
Arquivos Brasileiros de Cardiologia. 95 (6) (pp 685-690), 2010. Date of
Publication: December 2010.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: The level of sympathetic nervous activity is a major
determinant of prognosis in patients with heart failure. Objective: The
purpose of this investigation was to perform a proof-of-principle trial of
therapeutic endoscopic left thoracic sympathetic blockade in heart failure
patients to assess safety and immediate effects. Methods: Fifteen patients
with dilated cardiomyopathy and left ventricular ejection fraction (LVEF)
< 40%, New York Heart Association functional class II or III, and heart
rate > 65 bpm, despite either adequate betablocker use or intolerant to
it, were enrolled. Ten patients underwent left infra-stellate ganglion
plus T3-T4 interspinal space clipping through videothoracoscopy, while the
other five patients were randomized to a control group. Results: None of
the treated patients had any procedure-related adverse cardiovascular
events at the perioperative period. Two patients from the surgical group
died due to pulmonary thromboembolism or myocardial infarction within 6
months of the initial follow-up, while three patients from the control
group had heart failure progression and died or developed cardiogenic
shock during the same period. Treated patients presented improvement in
quality of life, level of physical activity and LVEF (from 25 +/- 9% to 32
+/- 8%, p=0.024) at 6 months of follow-up, whereas these parameters did
not change in control patients. Conclusion: Endoscopic left thoracic
sympathetic blockade is feasible and appears to be safe in severe heart
failure patients. This initial study suggests that this procedure might be
an effective alternative approach to sympathetic blockade in the treatment
of dilated cardiomyopathies.
<10>
Accession Number
2011085228
Authors
Li J.S. Colan S.D. Sleeper L.A. Newburger J.W. Pemberton V.L. Atz A.M.
Cohen M.S. Golding F. Klein G.L. Lacro R.V. Radojewski E. Richmond M.E.
Minich L.L.
Institution
(Li) Department of Pediatrics, Duke Clinical Research Institute, Duke
University Medical Center, PO Box 17969, Durham, NC 27715, United States
(Colan, Sleeper, Klein) New England Research Institute, Watertown, MA,
United States
(Newburger, Lacro) Children's Hospital, Boston, MA, United States
(Pemberton) National Heart, Lung and Blood Institute, NIH, Bethesda, MD,
United States
(Atz) Medical University of South Carolina, Charleston, SC, United States
(Cohen) Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Golding, Radojewski) Hospital for Sick Children, Toronto, ON, Canada
(Richmond) Columbia University, New York, NY, United States
(Minich) University of Utah, Salt Lake City, UT, United States
Title
Lessons learned from a pediatric clinical trial: The Pediatric Heart
Network angiotensin-converting enzyme inhibition in mitral regurgitation
study.
Source
American Heart Journal. 161 (2) (pp 233-240), 2011. Date of Publication:
February 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Mitral regurgitation is the most common indication for
reoperation in children following repair of atrioventricular septal defect
(AVSD). We hypothesized that angiotensin-converting enzyme inhibitor
therapy would decrease the severity of mitral regurgitation and limit left
ventricular volume overload in children following AVSD repair. Methods:
The Pediatric Heart Network designed a placebo-controlled randomized trial
of enalapril in this population. The primary aim was to test the effect of
enalapril on the change in left ventricular end-diastolic dimension body
surface area-adjusted z score. Before the launch of the trial, a
feasibility study was performed to estimate the number of patients with at
least moderate mitral regurgitation following AVSD repair. Trial
experience: Seventeen months after the start of the study, 349 patients
were screened, 8 were trial eligible, and only 5 were enrolled. The study
was subsequently terminated because of low patient accrual. Several
factors led to the problems with patient accrual, including (1) the use of
criteria to assess disease severity in the feasibility study that were not
identical to those used in the trial, (2) failure to achieve equipoise for
the study among clinicians and referring physicians, (3) reliance on
methodology developed in adult populations with different disease
mechanisms, and (4) absence of adequate data to define the natural history
of the disease process under study. Progress in the treatment of children
with cardiovascular disease will depend on the future of multicenter
collaborative clinical trials. The lessons learned from this study may
contribute to improvements in this research. 2011 Mosby, Inc.
<11>
Accession Number
2011085244
Authors
Jolly S.S. Niemela K. Xavier D. Widimsky P. Budaj A. Valentin V. Lewis
B.S. Avezum A. Steg P.G. Rao S.V. Cairns J. Chrolavicius S. Yusuf S. Mehta
S.R.
Institution
(Jolly, Chrolavicius, Yusuf, Mehta) McMaster University, Population Health
Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
(Niemela) Tampere University Hospital, Tampere, Finland
(Xavier) St John's Medical College and Research Institute, Bangalore,
India
(Widimsky) Charles University, Hospital Kralovske Vinohrady, Prague, Czech
Republic
(Budaj) Postgraduate Medical School, Department of Cardiology, Grochowski
Hospital, Warsaw, Poland
(Valentin) Hospital Universitari Dr Peset, Valencia, Spain
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Steg) INSERM U-698, Recherche Clinique en Atherothrombose, Assistance
Publique-Hopitaux de Paris, Paris, France
(Rao) Duke Clinical Research Institute, Duke University, Durham, NC,
United States
(Cairns) University of British Columbia, Vancouver, Canada
Title
Design and rationale of the RadIal Vs. femorAL access for coronary
intervention (RIVAL) trial: A randomized comparison of radial versus
femoral access for coronary angiography or intervention in patients with
acute coronary syndromes.
Source
American Heart Journal. 161 (2) (pp 254-260.e4), 2011. Date of
Publication: February 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Major bleeding in acute coronary syndromes (ACS) is associated
with an increased risk of subsequent mortality and recurrent ischemic
events. Observational data and small randomized trials suggest that radial
instead of femoral access for coronary angiography/intervention results in
fewer bleeding complications, with preserved and possibly improved
efficacy. Radial access versus femoral access has yet to be formally
evaluated in a randomized trial adequately powered for the comparison of
clinically important outcomes. Objectives: The aim of this study is to
evaluate the efficacy and safety of radial versus femoral access for
coronary angiography/intervention in patients with ACS managed with an
invasive strategy. Design: This was a multicenter international randomized
trial with blinded assessment of outcomes. 7021 patients with ACS (with or
without ST elevation) have been randomized to either radial or femoral
access for coronary angiography/intervention. The primary outcome is the
composite of death, myocardial infarction, stroke, or non-coronary artery
bypass graft-related major bleeding up to day 30. The key secondary
outcomes are (1) death, myocardial infarction, or stroke up to day 30 and
(2) non-coronary artery bypass graft-related major bleeding up to day 30.
Percutaneous coronary intervention (PCI) success rates will also be
compared between the two access sites. Conclusions: The RIVAL trial will
help define the optimal access site for coronary angiography/intervention
in patients with ACS. 2011 Mosby, Inc.
<12>
Accession Number
2011086190
Authors
Chavan C. Karmalkar M. Badani R. Sharada K. Rani U. Rao P. Subramanyam R.
Narasimhan C.
Institution
(Chavan, Karmalkar, Badani, Sharada, Rani, Rao, Subramanyam, Narasimhan)
CARE Hospitals, The Institute of Medical Sciences, Hyderabad, India
Title
Evaluation of Bachmann bundle pacing versus right atrial pacing in
prevention of atrial fibrillation after coronary artery bypass surgery.
Source
Indian Pacing and Electrophysiology Journal. 10 (12) (pp 529-535), 2010.
Date of Publication: December 2010.
Publisher
Indian Pacing and Electrophysiology Group (Pulikkottil Thondayad, Calicut
Kerala 673017, India)
Abstract
Background: In patients undergoing coronary artery bypass surgery (CABGS),
occurrence of atrial fibrillation (AF) is common in the postoperative
period and is associated with increased morbidity with longer intensive
unit care (ICU) and hospital stay. Prevention with antiarrhythmic drugs is
of limited success and associated with significant side effects. Therefore
alternative approaches, such as Bachmann Bundle pacing, are required.
Methods and Results: 154 consecutive patients, mean age 58+/-8.8 years,
including 134 males and 20 females, were randomized to three groups; Group
I: No pacing n= 54, Group II: RA pacing n= 52, Group III: Bachmann Bundle
pacing n= 48. All the groups were well matched with regard to age, left
atrial size, ejection fraction and use of beta blockers. Patients in
Groups II and III were continually paced at a rate of 100 beats per minute
(bpm) or at 10 bpm more than patients' intrinsic heart rate. All the
patients were monitored for 72 hours by telemetry and occurrence of AF was
noted. Incidence of AF was 0% (none of 48 patients) in Group III as
compared to 16.6% in Group I (9 of 54 patients) (p 0.003) and 12.5% in
Group II (5 of 52 patients) (p 0.03). There was a trend towards shorter
ICU stay in Group III (3.9 days) ascompared to Group II (4.5 days) and
Group I (4.1 days). Among the three groups, the reductionin mean P wave
duration also was greater in Bachmann bundle paced group. Conclusion: In
patients undergoing CABGS, Bachmann bundle pacing is superior to right
atrial/ no pacing in the post operative period for preventing occurrence
of AF and reducing ICU stay,commensurate with a reduction in mean P wave
duration on surface ECG.
<13>
Accession Number
2011086963
Authors
Parthasarathi G. Raman S.P. Sinha P.K. Singha S.K. Karunakaran J.
Institution
(Parthasarathi, Raman, Sinha, Singha) Department of Anesthesiology, Sree
Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum -
695 011, Kerala, India
(Karunakaran) Department of Cardiothoracic and Vascular Surgery, Sree
Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum -
695 011, India
Title
Ketamine has no effect on oxygenation indices following elective coronary
artery bypass grafting under cardiopulmonary bypass.
Source
Annals of Cardiac Anaesthesia. 14 (1) (pp 13-18), 2011. Date of
Publication: January-April 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (A-109, Kanara Business Centre,
off Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Cardiopulmonary bypass is known to elicit systemic inflammatory response
syndrome and organ dysfunction. This can result in pulmonary dysfunction
and deterioration of oxygenation after cardiac surgery and cardiopulmonary
bypass. Previous studies have reported varying results on
anti-inflammatory strategies and oxygenation after cardiopulmonary bypass.
Ketamine administered as a single dose at induction has been shown to
reduce the pro-inflammatory serum markers in patients undergoing
cardiopulmonary bypass. Therefore we investigated if ketamine can result
in better oxygenation in these patients. This was a prospective randomized
blinded study. Eighty consecutive adult patients undergoing elective
coronary artery bypass grafting under cardiopulmonary bypass were included
in the study. Patients were divided into two groups. Patients in ketamine
group received 1mg/kg of ketamine intravenously at induction of
anesthesia. Control group patients received an equal volume of saline. All
patients received standard anesthesia, operative and postoperative
care.Paired t test and independent sample t test were used to compare the
inter-group and between group oxygenation indices respectively.
Oxygenation index and duration of ventilation were analyzed. Deterioration
of oxygenation index was noted in both the groups after cardiopulmonary
bypass. However, there was no significant difference in the oxygenation
index at various time points after cardiopulmonary bypass or the duration
of ventilation between the two groups. This study shows that the
administered as a single dose at induction does not result in better
oxygenation after cardiopulmonary bypass.
<14>
Accession Number
2011086966
Authors
El-Tahan M.R.
Institution
(El-Tahan) Department of Anaesthesia and Surgical ICU, King Fahd Hospital
of the University, Al Khubar, Saudi Arabia
Title
Preoperative ephedrine counters hypotension with propofol anesthesia
during valve surgery: A dose dependent study.
Source
Annals of Cardiac Anaesthesia. 14 (1) (pp 30-40), 2011. Date of
Publication: January-April 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (A-109, Kanara Business Centre,
off Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The prophylactic use of small doses of ephedrine may counter the
hypotension response to propofol anesthesia with minimal hemodynamic
changes. One hundred-fifty patients scheduled for valve surgery were
randomly assigned into five groups (n = 30 for each) to receive saline,
0.07, 0.1, or 0.15 mg/kg of ephedrine, or phenylephrine 1.5 g/kg before
induction of propofol-fentanyl anesthesia. After induction, patient
receiving ephedrine had higher mean arterial pressure, systemic vascular
resistance (SVRI), cardiac (CI), stroke volume (SVI), and left ventricular
stroke work (LVSWI) indices. Patients received 0.15 mg/kg of ephedrine
showed additional increased heart rate and frequent ischemic episodes (P <
0.001). However, those who received phenylephrine showed greater rise in
SVRI, reduced CI, SVI, and LVSWI and more frequent ischemic episodes. We
conclude that the prophylactic use of small doses of ephedrine (0.070.1
mg/kg) is safe and effective in the counteracting propofol-induced
hypotension during anesthesia for valve surgery.
<15>
Accession Number
2011088405
Authors
Kurian G.A. Paddikkala J.
Institution
(Kurian) MMM Academy of Medical Sciences, Institute of Cardiovascular
Diseases, Madras Medical Mission, 4A Jayalalithanagar, Mogappair, Chennai
600037, India
(Paddikkala) Department of Biotechnology, Amala Cancer Research Centre,
Amalanagar, Trichur, Kerala 680553, India
Title
N-acetylcysteine and magnesium improve biochemical abnormalities
associated with myocardial ischaemic reperfusion in South Indian patients
undergoing coronary artery bypass grafting: A comparative analysis.
Source
Singapore Medical Journal. 51 (5) (pp 381-388), 2010. Date of
Publication: MAY 2010.
Publisher
Singapore Medical Association (2 College Road, Level 2, Singapore 0316,
Singapore)
Abstract
Introduction: The clinical presentation of ischaemic reperfusion in
postoperative patients correlates with oxidative stress. The limited
clinical success of anti-ischaemic reperfusion agents has prompted a
comparison of the efficacy of N-acetylcysteine (NAC) and magnesium (Mg) in
South Indian patients undergoing coronary artery bypass grafting (CABG).
Methods: In Clinical Trial I, 52 South Indian patients who had undergone
CABG surgery (with intraoperative Mg supplementation) and 40 controls
(without Mg supplementation) were selected and matched. The control
patients underwent the same protocol without Mg. In Clinical Trial II, the
study population consisted of 50 patients, where 25 patients received NAC
just before the release of the aortic cross clamp. In the NAC untreated
group, dextrose solution was administered at the same time as the placebo.
Six blood samples were taken at different times during the cardiac surgery
and the antioxidant enzymes, ATPase and cardiac markers from the coronary
sinus blood samples were analysed. Results: Increased blood lipid
peroxidation was observed in patients who were not treated with Mg/NAC.
The administration of Mg/NAC just before the release of the aortic cross
clamp reduced the lipid peroxidation significantly (p-value is less than
0.05). The above observations were supported by the antioxidant enzyme
levels. Significant improvements to the erythrocyte ATPase and cardiac
markers in patients treated with Mg/NAC correlated with a reduction in
postoperative abnormalities. Based on the biochemical status of the
patients, Mg was shown to mediate better recovery from postoperative
changes. Conclusion: NAC and Mg decreased pump- induced oxidative stress
during cardiopulmonary bypass (CPB), suggesting that it could be a novel
therapy for assisting in the prevention of CPB-induced oxidative stress.
<16>
Accession Number
2011067413
Authors
Derosa G.
Institution
(Derosa) Department of Internal Medicine and Therapeutics, University of
Pavia, Fondazione IRCCS Policlinico S. Matteo, P.le C. Golgi, 2, 27100
Pavia, Italy
Title
Nateglinide does not reduce the incidence of diabetes or cardiovascular
outcomes in people with impaired glucose tolerance and cardiovascular
disease or risk factors.
Source
Evidence-Based Medicine. 16 (1) (pp 7-8), 2011. Date of Publication:
February 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<17>
Accession Number
2011067417
Authors
Pezzini A.
Institution
(Pezzini) Dipartimento di Scienze Mediche e Chirurgiche, Clinica
Neurologica, Universita degli Studi di Brescia, Brescia, Italy
Title
Large placebo-controlled RCT in myocardial infarction survivors finds that
daily folic acid and vitamin B12 have no effect on risk of major vascular
event.
Source
Evidence-Based Medicine. 16 (1) (pp 12-13), 2011. Date of Publication:
February 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<18>
Accession Number
2011067419
Authors
Bhalla V.
Institution
(Bhalla) Division of Nephrology, Department of Medicine, Stanford
University School of Medicine, 780 Welch Road, Palo Alto, CA 94304, United
States
Title
In diabetic nephropathy, high doses of vitamin B decrease glomerular
filtration rate and increase risk of the composite outcome of a vascular
event or all-cause mortality compared with placebo.
Source
Evidence-Based Medicine. 16 (1) (pp 14-15), 2011. Date of Publication:
February 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<19>
Accession Number
2011067425
Authors
Perkovic V. Huxley R.
Institution
(Perkovic, Huxley) George Institute for Global Health, Camperdown, NSW,
Australia
Title
Prognostic value of CRP in stable coronary artery disease unclear due to a
variety of biases in existing studies, therefore no clinical practice
recommendations can be made.
Source
Evidence-Based Medicine. 16 (1) (pp 23-24), 2011. Date of Publication:
February 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<20>
Accession Number
2011067430
Authors
Pearce E.N.
Institution
(Pearce) Boston University School of Medicine, Boston, MA, United States
Title
In people with subclinical hypothyroidism, TSH level >10 mIU/l may predict
increased risk of coronary heart disease and related mortality.
Source
Evidence-Based Medicine. 16 (1) (pp 31-32), 2011. Date of Publication:
February 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<21>
Accession Number
2011069115
Authors
Schuster A. Tang W.H.W.
Institution
(Schuster, Tang) Heart and Vascular Institute, Cleveland Clinic, 9500
Euclid Avenue, Desk J3-4, Cleveland, OH 44195, United States
Title
Ivabradine in heart failure: To SHIFT or not to SHIFT.
Source
Current Heart Failure Reports. 8 (1) (pp 1-3), 2011. Date of
Publication: March 2011.
Publisher
Current Science, Inc. (400 Market Street, Suite 700, Philadelphia PA
19106, United States)
<22>
Accession Number
2011074366
Authors
Papoulidis P. Ananiadou O. Chalvatzoulis E. Ampatzidou F. Koutsogiannidis
C. Karaiskos T. Madesis A. Drossos G.
Institution
(Papoulidis, Ananiadou, Chalvatzoulis, Koutsogiannidis, Karaiskos,
Madesis, Drossos) Department of Cardiothoracic Surgery, General Hospital
'G. Papanikolaou', Exohi, 57010 Thessaloniki, Greece
(Ampatzidou) 2nd ICU Department, General Hospital 'G. Papanikolaou',
Thessaloniki, Greece
Title
The role of ascorbic acid in the prevention of atrial fibrillation after
elective on-pump myocardial revascularization surgery: A single-center
experience - a pilot study.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (2) (pp 121-124),
2011. Date of Publication: February 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Atrial fibrillation (AF) is a common arrhythmia that occurs
postoperatively in cardiac surgery. There is evidence for the role of
oxidative stress in the etiology of AF. In our study, we examined whether
antioxidant ascorbic acid (vitamin C), could help in the reduction of the
incidence of postoperative AF. Patients who were scheduled to undergo
elective isolated on-pump coronary artery bypass grafting (CABG) were
included in our study. One hundred and seventy patients were randomly
divided in two groups: Group A (n=85) received vitamin C preoperatively
and postoperatively whereas Group B (n=85) did not receive any (control
group). The incidence of AF was 44.7% in the vitamin C group and 61.2% in
the control group (P=0.041). The hospitalization time, the intensive care
unit stay and the time interval for the conversion of AF into sinus rhythm
was significantly shorter in the vitamin C group. Patients that developed
AF also had longer hospital length of stay (9.5+/-2.8 days vs. 6.7+/-1.9,
P=0.034). Supplementation of vitamin C reduces the incidence of postCABG
AF, and decreases the time needed for rhythm restoration and length of
hospital stay. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.
<23>
Accession Number
2011074381
Authors
Muhammad M.I.A.
Institution
(Muhammad) Department of Thoracic Surgery, King Fahad Hospital, Almadinah
Almunawarah, Saudi Arabia
Title
The pericardial window: Is a video-assisted thoracoscopy approach better
than a surgical approach?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (2) (pp 174-178),
2011. Date of Publication: February 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: The approach to the pericardial window in patients with
pericardial effusion (PE) remains undefined as to whether a surgical
(transthoracic or subxiphoid) or a thoracoscopic pericardial window is the
optimal operative approach to PE. We hypothesized that the window into the
pleural space created by the thoracoscopy might improve the outcome.
Methods: We conducted a prospective study between September 2007 and
October 2009. All patients with PE diagnosed by echocardiography who
attended the Cardiothoracic Department in King Fahd Hospital are included
in this study. They were 30 patients (18 males, 12 females aged 44+/-1.22
years). Patients were subdivided into two groups. Group A, 15 patients
underwent the surgical (transthoracic or subxiphoid) procedure and Group
B, 15 patients underwent the video-assisted thoracoscopy procedure.
Preoperative, intraoperative and postoperative variables, morbidity,
recurrence, and survival were compared in both groups. Results:
Preoperative variables were well-matched for age, sex, preoperative
tamponade, echocardiographical characteristics and co-morbidities between
both groups. No recurrence of effusion was observed in the two groups.
Operative time was statistically highly significant (P<0.001); it was
longer in Group B. There was no intraoperative complication in both
groups. There was no postoperative complication in both groups except one
case of superficial wound infection in Group A. There was no significance
difference between both groups as regard duration of chest tube drainage
and length of hospital stay. There was no inhospital mortality in both
groups. Conclusions: Pericardial window by video-assisted thoracoscopy is
an effective technique for pericardial drainage and biopsy. Apart from its
diagnostic value, it allows the physician to fashion a pleuropericardial
window for effective drainage while avoiding the complications of classic
surgical procedures. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.
<24>
Accession Number
2011074401
Authors
Zahid I. Routledge T. Bille A. Scarci M.
Institution
(Zahid) Imperial College London, South Kensington Campus, London SW7 2AZ,
United Kingdom
(Routledge, Bille, Scarci) Department of Thoracic Surgery, Guy's Hospital,
Great Maze Pond, London SE1 9RT, United Kingdom
Title
What is the best treatment of postpneumonectomy empyema?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (2) (pp 260-264),
2011. Date of Publication: February 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether an open surgical
approach is superior to minimally invasive surgery in patients with
postpneumonectomy empyema (PPE). Overall 171 papers were found using the
reported search, of which 12 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results are
tabulated. We conclude that open surgical approaches are superior to
minimally invasive surgery in terms of empyema recurrence rate, mortality
and reintervention rate. Minimally invasive surgery includes chest tube
drainage with or without chemical irrigation and video-assisted
thoracoscopic surgery debridement. Whereas open surgery includes open
debridement, open window thoracostomy (OWT) and thoracomyoplasty. To allow
for an accurate comparison, success of an intervention was defined as
prevention of empyema recurrence. Two studies reported surgical outcomes
of patients treated with minimally invasive treatment options. They found
high mortality rates (17.1%) and low success rates (31%) in patients
treated by chest tube drainage with chemical irrigation. Five studies
treated PPE using a combination of minimally invasive and open surgical
approaches and reported a high reintervention rate of 3.5 (range 3-5) and
an empyema recurrence rate of 13.3%. Higher success rates (6.7 vs. 95%),
lower mortality rates (33 vs. 0%) and shorter hospital stay (47.5 vs. 17.6
days) were all noted with thoracomyoplasty compared to chest tube drainage
therapy. Five studies managed PPE using OWT or thoracomyoplasty. The time
between empyema diagnosis to resolution (3 vs. 38 months) was much shorter
with immediate OWT than with delayed OWT therapy. The Clagett procedure
resulted in a mean hospital stay of 12.9 days, an operative mortality rate
of 7.1% and an overall success rate of 81%. Thoracomyoplasty led to a mean
hospital stay of 34 days with a mortality rate of 6%. The shorter hospital
stay, lower empyema recurrence rates and lower mortality rates may make
open surgical approaches a more effective treatment option to minimally
invasive options. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.
<25>
Accession Number
2011088504
Authors
Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L.
Institution
(Sun, Ji, Mei, Wang, Feng, Cai, Chi) Department of Thoraco-Cardiovascular
Surgery, Shanghai Tongji Hospital, Tongji University, Shanghai, China
Title
Role of preoperative atorvastatin administration in protection against
postoperative atrial fibrillation following conventional coronary artery
bypass grafting.
Source
International Heart Journal. 52 (1) (pp 7-11), 2011. Date of
Publication: 2011.
Publisher
International Heart Journal Association (7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan)
Abstract
Atrial fibrillation (AF) is one of the most common postoperative
arrhythmias in patients who undergo coronary artery bypass grafting
(CABG). The aim of this study was to evaluate the effect of preoperative
atorvastatin on postoperative atrial fibrillation following coronary
artery bypass grafting with cardiopulmonary bypass (CCABG). One hundred
consecutive patients undergoing elective CCABG, without history of AF or
previous statin treatment, were enrolled and randomly assigned to a statin
group (atorvastatin 20 mg/d, n = 49) or a control group (placebo, n = 51)
starting 7 days preoperatively. The primary endpoint was the occurrence of
postoperative AF. C-reactive protein (CRP) levels were assessed in all
selected patients before surgery and every 24 hours postoperatively until
discharge from hospital. Atorvastatin significantly reduced the incidence
of postoperative AF and postoperative peak CRP level versus placebo (18%
versus 41%, P = 0.017; 129.3 +/- 24.3 mg/L versus 149.3 +/- 32.5 mg/L, P <
0.0001). Kaplan-Meier curves confirmed a significantly better
postoperative atrial fibrillation-free survival in the statin group
(chi<sup>2</sup> = 7.466, P = 0.006). Logistic regression analysis showed
preoperative atorvastatin treatment was an independent factor associated
with a significant reduction in postoperative AF (OR = 0.235, P = 0.007),
whereas high postoperative CRP levels were associated with increased risk
(OR = 2.421, P = 0.015). Preoperative atorvastatin administration may
inhibit inflammatory reactions to prevent atrial fibrillation following
coronary artery bypass grafting with cardiopulmonary bypass.
<26>
Accession Number
70341158
Authors
Testa L. Agostoni P. Zoccai G.G.L.B. Latini R.A. Laudisa M.L. Pizzocri S.
Lanotte S. Brambilla N. Banning A.P. Bedogni F.
Institution
(Testa, Latini, Laudisa, Pizzocri, Lanotte, Brambilla, Bedogni) Clinical
Institute S. Ambrogio, Milan, Italy
(Agostoni) University Medical Center Utrecht, Utrecht, Netherlands
(Zoccai) Institute of Cardiology, University of Turin, Turin, Italy
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
Source
American Journal of Cardiology. Conference: Transcatheter Cardiovascular
Therapeutics Symposium San Francisco, CA United States. Conference Start:
20090921 Conference End: 20090925. Conference Publication: (var.pagings).
104 (6 SUPPL. 1) (pp 122D), 2009. Date of Publication: 21 Sep 2009.
Publisher
Elsevier Inc.
Abstract
Aim: Elevation of Troponin after scheduled percutaneous coronary
intervention (PCI) is a recognised consequence. We sought to evaluate the
prognostic significance and impact of the newly published definition of
PCI- related myocardial infarction (MI) according to which any troponin
elevation > 3x the upper reference limit identify a peri-procedural MI.
Methods: Search of BioMedCentral, CENTRAL, mRCT, and PubMed (updated May
2008). Outcomes of interest were: MACE (the composite of all cause death,
MI, repeat target vessel PCI (re-PCI) and coronary artery bypass grafting
(CABG)); single end points were also assessed. Results: Fifteen studies
have been included totalling 7578 patients. Troponin elevation, occurred
in 28.7% of the procedures. The incidence of PCI-related MI according to
the new definition was 14.5%. During the hospitalisation, any level of
raised troponin was associated with an increased risk of MACE [OR 11.29
(3.00-42.48), Number needed to harm (NNH) 5], death [OR 7.16 (1.95-26.27),
NNH=100], MI [OR 30.85 (6.05-157.38), NNH=4], re-PCI [OR 4.13
(1.23-13.88), NNH=50]. Patients with PCI- related MI had an increased risk
ofdeath [OR 17.25 (2.71-109.96), NNH=100] andre-PCI [OR 10.86 (3.2-36.94),
NNH=25]. At follow up of 18 months any troponin elevation was associated
with an increased risk of MACE [OR 1.48 (1.12-1.96), NNH=20], death [OR
2.19 (1.59-3.00), NNH=50], MI [OR 3.29 (2.71-6.31), NNH=33], and re-PCI
[OR 1.47 (1.06-2.03), NNH=25]. In patients with PCI-related MI the risk of
MACE was further increased: OR 2.25 (1.26-4.00), NNH=3. An increase of the
troponin level below the cut-off was not associated with MACE. Conclusion:
A diagnosis of MI according to the new guidelines applies to 15% of
patients undergoing PCI and these patients are at high risk of further
adverse events both during the hospital stay and at 18 months.
