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<1>
Accession Number
2011164180
Authors
Chin J-H. Lee E-H. Choi D-K. Choi I.-C.
Institution
(Chin, Lee, Choi, Choi) Department of Anaesthesiology and Pain Medicine,
Asan Medical Centre, University of Ulsan College of Medicine, 388-1
Pungnap 2-dong, Songpa-gu, Seoul 138-736, South Korea
Title
A modification of the trans-oesophageal echocardiography protocol can
reduce post-operative dysphagia following cardiac surgery.
Source
Journal of International Medical Research. 39 (1) (pp 96-104), 2011.
Date of Publication: 2011.
Publisher
Field House Publishing LLP (6 Sompting Avenue, Worthing BN14 8HN, United
States)
Abstract
Use of intra-operative trans-oesophageal echocardiography (TEE) is an
independent risk factor for post-operative dysphagia. This study
investigated whether modifying the TEE probe-placement protocol could
reduce the incidence of post-operative dysphagia. In group I (n = 100),
the TEE probe was inserted after anaesthetic induction and remained in
place until the completion of surgery. In group II (n = 100), the TEE
probe was inserted after anaesthetic induction, the heart was examined,
then the probe was removed. The probe was inserted again before weaning
from cardiopulmonary bypass and then immediately removed after
examination. The incidence of dysphagia was significantly higher in group
I than in group II patients (51.1% versus 28.6%). Multivariate regression
analysis showed that the length of time that the TEE probe was in the
oesophagus was an independent predictor of dysphagia. Modification of the
TEE protocol in this way can reduce the incidence of post-operative
dysphagia in cardiac surgery patients. 2011 Field House Publishing LLP.
<2>
Accession Number
2011164199
Authors
Cihan H.B. Erbas F. Erdil N. Sigirci A. Battaloglu B. Yologlu S.
Institution
(Cihan, Erdil, Battaloglu) Department of Cardiovascular Surgery, Turgut
Ozal Medical Centre, 44310 Malatya, Turkey
(Sigirci) Department of Radiology, Malatya, Turkey
(Yologlu) Department of Biostatistics, Inonu University Faculty of
Medicine, Turgut Ozal Medical Centre, Malatya, Turkey
(Erbas) Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital of
Van, Van, Turkey
Title
Pre-operative trans-thoracic doppler ultrasonography evaluation and intra-
operative manual evaluation of the left internal thoracic artery in
patients with type 2 diabetes with coronary artery disease.
Source
Journal of International Medical Research. 39 (1) (pp 277-283), 2011.
Date of Publication: 2011.
Publisher
Field House Publishing LLP (6 Sompting Avenue, Worthing BN14 8HN, United
States)
Abstract
Patients with coronary artery disease, with (n = 25) and without (n = 59)
type 2 diabetes, who were scheduled to undergo coronary artery bypass
grafting were enrolled in this prospective study. The left internal
thoracic artery (LITA) was assessed for graft suitability before surgery
by trans-thoracic Doppler ultra- sonography and during surgery by manual
measurement. Significant differences were seen between pre- operative and
intra-operative LITA blood flow rates and LITA diameters, and the values
of each at the two time points showed significant correlation, suggesting
that pre-operative measurements largely related to intra-operative
conditions. The pre-operative and intra-operative LITA blood flow rates
and LITA diameters were not significantly different between patients with
and without type 2 diabetes. Pre-operative LITA blood flow was monophasic
in three patients without diabetes and the LITA grafts of these patients
were deemed unsuitable for implantation during surgery. It is concluded
that type 2 diabetes does not seem to have a negative effect on the
suitability of LITA grafts. In addition, trans-thoracic Doppler
ultrasonography is an easy, cost-effective, reproducible and non-invasive
examination method, which may help in the evaluation of LIMA function and
contribute to graft selection. 2011 Field House Publishing LLP.
<3>
Accession Number
2011164889
Authors
Xu B. Dou K.-F. Han Y.-L. Lu S.-Z. Yang Y.-J. Huo H. Wang L.-F. Chen Y.-D.
Wang H.-C. Li W.-M. Chen J.-Y. Wang L. Wang Y. Ge J.-B. Li W. Gao R.-L.
Institution
(Xu) Cardiac Catheterization Laboratory Cardiovascular Institute and Fuwai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
(Dou, Yang, Gao) Department of Cardiology Cardiovascular Institute and
Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing 100037, China
(Han) Department of Cardiology, Shenyang Northern Hospital, Shenyang,
China
(Lu) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Huo) Department of Cardiology, Peking University First Hospital, Beijing,
China
(Wang) Department of Cardiology, Beijing Chao-Yang Hospital, Capital
Medical University, Beijing 100853, China
(Chen) Department of Cardiology, Chinese People's Liberation Army General
Hospital, Beijing 100853, China
(Wang) Department of Cardiology, Xijing Hospital, Fourth Military Medical
University, Xi'an, Shaanxi 710032, China
(Li) Department of Cardiology, First Affiliated Hospital of Harbin Medical
University, Harbin, Heilongjiang 150001, China
(Chen) Department of Cardiology, Guangdong Provincial Cardiovascular
Institute, Guangzhou, Guangdong 510080, China
(Wang) Department of Cardiology, Beijing Friendship Hospital, Capital
Medical University, Beijing 100050, China
(Wang) Department of Cardiology, China-Japan Friendship Hospital, Beijing
100029, China
(Ge) Department of Cardiology, Zhongshan Hospital, Fudan University,
Shanghai 200032, China
(Li) National Center for Cardiovascular Diseases of China, Beijing 100037,
China
Title
A prospective multicenter parallel-controlled trial of TIVOLI
biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR
zotarolimus-eluting stent for the treatment of coronary artery disease:
8-month angiographic and 2-year clinical follow-up results.
Source
Chinese Medical Journal. 124 (6) (pp 811-816), 2011. Date of
Publication: March 2011.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Available drug-eluting stents (DES) have achieved great success
in reducing restenosis rates. Recently, investigators have demonstrated
that the durable olymer carrier lays a significant role in DES-related hy
ersensitive reaction and delays vessel healing. TIVOLI stent is a novel
sirolimus-eluting coronary stent with biodegradable coating containing
sirolimus and olylactic-co-glycolic acid (LGA) olymer. The resent study
sought to evaluate the effectiveness and safety of the TIVOLI
biodegradable- olymer-based sirolimus-eluting stent in treating atients
with coronary artery disease. Methods A ros ective, multicenter clinical
trial com aring TIVOLI biodegradable coated sirolimus-eluting stent with
ENDEAVOR zotarolimus-eluting stent was conducted in 324 atients (TIVOLI
grou: 168 atients; ENDEAVOR grou: 156 atients) at 12 centers in China to
demonstrate the non-inferiority of in-stent late loss with TIVOLI stent
com ared to ENDEAVOR stent in subjects with a maximum of two de novo
native coronary artery lesions (lesion length <=40 mm, reference vessel
diameter 2.25-4.00 mm). The rimary end oint was angiogra hic in-stent late
loss at 8-month. The secondary end oints were clinical outcomes at 2
years, including major adverse cardiac events (cardiac death, myocardial
infarction, or target-lesion revascularization) and stent thrombosis.
Results Angiogra hic late lumen loss at 8 months in the TIVOLI grou was su
erior to the ENDEAVOR grou (in-stent (0.25+/-0.33) mm vs. (0.57+/-0.55)
mm, diff (95% CI) -0.23 (-0.32, -0.14), <0.0001; in-segment (0.25+/-0.33)
mm vs. (0.42+/-0.55) mm, diff (95% CI) -0.13 (-0.23, -0.02), =0.0083). The
rate of in-stent binary restenosis at 8 months was reduced from 8.6% in
the ENDEAVOR grou to 2.9% in the TIVOLI grou (=0.0229). Com ared to
ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in
target-lesion revascularization (4.2% vs. 9.6%, =0.0495) at 2 years. The
two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI
grou, but not significantly different (6.6% vs. 10.9%, =0.1630).
Conclusions TIVOLI was su erior to ENDEAVOR stent with res ect to late
lumen loss at 8 months, and it yielded both lower rates of angiogra hic
binary restenosis at 8 months and target lesion revascularization (TLR) at
2 years. The MACE rate at 2 years was com arable in both grous.
<4>
Accession Number
2011178157
Authors
Paikin J.S. Wright D.S. Eikelboom J.W.
Institution
(Paikin) Hamilton General Hospital, McMaster University, Hamilton, ON,
Canada
(Wright) McMaster University, Hamilton, ON, Canada
(Eikelboom) Thrombosis Service, Hamilton General Hospital, Hamilton Health
Sciences Corporation and McMaster University, Hamilton, ON, Canada
Title
Effectiveness and safety of combined antiplatelet and anticoagulant
therapy: A critical review of the evidence from randomized controlled
trials.
Source
Blood Reviews. 25 (3) (pp 123-129), 2011. Date of Publication: May 2011.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Antiplatelet and anticoagulant drugs are effective for the prevention of
arterial and venous thrombosis but patients continue to experience major
cardiovascular events despite their use. Strategies to improve the
effectiveness of antithrombotic therapies include selecting the optimal
drug and dosing regimen, the use of combinations of antiplatelet and
anticoagulant drugs and the development of new more effective drugs to
replace existing therapies. Evidence from randomized controlled trials
indicates that the combination of aspirin and an anticoagulant is more
effective than aspirin alone for the prevention of recurrent
cardiovascular events in patients with acute coronary syndrome and is more
effective than anticoagulation alone for the prevention of thromboembolic
events in patients with mechanical heart valves, but at a cost of
increased bleeding. Randomized controlled trials provide no evidence for
improved effectiveness of combination therapy compared with antiplatelet
therapy alone for the prevention of recurrent cardiovascular events in
patients with non-cardioembolic stroke or peripheral artery disease, or
compared with anticoagulant therapy alone for the prevention of stroke in
patients with atrial fibrillation. Despite lack of evaluation in
randomized controlled trials, combination therapy is commonly used in
patients with separate indications for antiplatelet therapy (e.g., acute
coronary syndrome, recent coronary artery stent) and anticoagulant therapy
(e.g., atrial fibrillation with at least one additional risk factor for
stroke). Randomized trials are urgently required to evaluate the
effectiveness and safety of combining antiplatelet and anticoagulant
therapy in these settings. 2011 Elsevier Ltd.
<5>
Accession Number
2011181225
Authors
Ishy A. de Campos J.R.M. Wolosker N. Kauffman P. Tedde M.L. Chiavoni C.R.
Jatene F.B.
Institution
(Ishy, de Campos, Tedde, Jatene) Department of Thoracic Surgery,
University of Sao Paulo, 388 Peixoto Gomide Street, Sao Paulo, SP
01409-000, Brazil
(Wolosker, Kauffman) Department of Vascular Surgery, University of Sao
Paulo, Sao Paulo, SP, Brazil
(Chiavoni) Medical Resident, Faculty of Medicine, University of Sao Paulo,
Sao Paulo, SP, Brazil
Title
Objective evaluation of patients with palmar hyperhidrosis submitted to
two levels of sympathectomy: T3 and T4.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (4) (pp 545-548),
2011. Date of Publication: April 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
This study compares the results obtained of video-assisted sympathectomy
performed on two distinct ganglion levels (third vs. fourth thoracic
ganglion) in the treatment of palmar hyperhidrosis (PH), through a blind
randomized clinical trial. All participants were randomized into two
groups of 20 patients (G3 and G4) and underwent the operation, and were
followed for 12 months. We used an objective method for measuring sweat,
checking the transepidermal water loss (TEWL), and evaluated the
quality-of-life (QoL) before and after the operation. All patients (n=40)
ceased suffering from PH after surgery, with statistical difference when
we compared the values of TEWL palmar preoperatively with their respective
values at one week, one month, six months and 12 months. The main side
effect observed was compensatory hyperhidrosis (CH), which was most
frequent in G3 after 12 months of follow-up. There was an improvement in
QoL since the first evaluation of the postoperative period with no
difference between groups. Both techniques were effective in the treatment
of PH, generating objective reduction of TEWL regardless of the ganglion
operated. Sympathectomy G3 had a higher incidence of CH, yet the
improvement in QoL was similar in both groups. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.
<6>
Accession Number
2011187405
Authors
Johnson J.N. Ansong A.K. Li J.S. Xu M. Gorentz J. Hehir D.A. Del Castillo
S.L. Lai W.W. Uzark K. Pasquali S.K.
Institution
(Johnson, Ansong, Li, Xu, Pasquali) Division of Pediatric Cardiology,
Department of Pediatrics, Duke University Medical Center, Durham, NC,
United States
(Li, Pasquali) Duke Clinical Research Institute, Durham, NC, United States
(Gorentz, Hehir) Division of Pediatric Cardiology and Pediatric Critical
Care Medicine, Department of Pediatrics, Children's Hospital of Wisconsin,
Milwaukee, WI, United States
(Del Castillo) Division of Critical Care Medicine, Departments of
Anesthesiology Critical Care Medicine and Pediatrics, Children's Hospital
Los Angeles, Los Angeles, CA, United States
(Lai) Division of Pediatric Cardiology, Columbia College of Physicians and
Surgeons, New York, NY, United States
(Uzark) Division of Pediatric Cardiology, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
Title
Celiac artery flow pattern in infants with single right ventricle
following the Norwood procedure with a modified Blalock-Taussig or right
ventricle to pulmonary artery shunt.
Source
Pediatric Cardiology. 32 (4) (pp 479-486), 2011. Date of Publication:
April 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
A potential advantage of the right ventricle to pulmonary artery versus
modified Blalock-Taussig shunt in patients undergoing the Norwood
procedure is limitation of diastolic runoff from the systemic to pulmonary
circulation. We evaluated mesenteric flow patterns and gastrointestinal
outcomes following the Norwood procedure associated with either shunt
type. Patients randomized to a right ventricle to pulmonary artery versus
modified Blalock-Taussig shunt in the Pediatric Heart Network Single
Ventricle Reconstruction Trial at centers participating in this ancillary
study were eligible for inclusion; those with active necrotizing
enterocolitis, sepsis, or end-organ dysfunction were excluded. Celiac
artery flow characteristics and gastrointestinal outcomes were collected
at discharge. Forty-four patients (five centers) were included. Median age
at surgery was 5 days [interquartile range (IQR) = 4-8 days]. Median
celiac artery resistive index (an indicator of resistance to perfusion)
was higher in the modified Blalock-Taussig shunt group (n = 19) versus the
right ventricle to pulmonary artery shunt group (n = 25) [1.00 (IQR =
0.84-1.14) vs. 0.82 (IQR = 0.74-1.00), p = 0.02]. There was no difference
in interstage weight gain, necrotizing enterocolitis, or feeding
intolerance episodes between the groups. The celiac artery resistive index
was higher in patients with the modified Blalock-Taussig shunt versus the
right ventricle to pulmonary artery shunt but was not associated with
measured gastrointestinal outcomes. 2011 Springer Science+Business Media,
LLC.
<7>
Accession Number
2011187406
Authors
Golbus J.R. Wojcik B.M. Charpie J.R. Hirsch J.C.
Institution
(Golbus, Wojcik) University of Michigan Medical School, 1301 Catherine
Road, Ann Arbor, MI 48109-5864, United States
(Charpie) Department of Pediatrics, SPC 5204, C.S. Mott Children's
Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5864, United
States
Title
Feeding complications in hypoplastic left heart syndrome after the Norwood
procedure: A systematic review of the literature.
Source
Pediatric Cardiology. 32 (4) (pp 539-552), 2011. Date of Publication:
April 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Gastrointestinal and feeding complications after the Norwood procedure in
infants with hypoplastic left heart syndrome increases morbidity and
mortality. These problems are the result of intraoperative challenges,
shunt-dependent physiology, and the absence of best-practice guidelines.
In response, a systematic review of feeding-related complications and
management strategies was performed. A literature search from 1950 to
March 2010 identified 21 primary research articles and 4 reviews.
Dysphagia, necrotizing enterocolitis (NEC), and poor nutritional status
are significant feeding-related complications. Three studies directly
compared the modified Blalock-Taussig shunt with the right
ventricle-to-pulmonary artery conduit (RV-PA). Patients palliated with
either shunt had impaired mesenteric blood flow. Mortality did not differ
between shunt types. Three studies demonstrated improved outcomes, e.g.,
increased survival, decreased incidence of NEC, and decreased median time
to recommended daily allowance of calories, with a postoperative feeding
algorithm. Two studies showed increased survival between stage I and II
surgical palliation after implementation of a home-monitoring system
consisting of daily weight and systemic oxygen saturation measurements.
The RV-PA shunt does not significantly alter mortality or increase
mesenteric blood flow. A postoperative feeding algorithm and a
home-monitoring system may improve outcomes and decrease average hospital
length of stay (LOS). Additional studies are needed to determine which
interventions, as part of a standardized protocol, improve survival and
decrease complications. 2011 Springer Science+Business Media, LLC.
<8>
Accession Number
2011191096
Authors
Mamas M.A. Foley J. Nair S. Wiper A. Clarke B. El-Omar M. Fraser D.G.
Khattar R. Neyses L. Fath-Ordoubadi F.
Institution
(Mamas, Foley, Nair, Wiper, Clarke, El-Omar, Fraser, Khattar, Neyses,
Fath-Ordoubadi) Manchester Heart Centre, Manchester Royal Infirmary,
Biomedical Research Centre, Oxford Road, Manchester, United Kingdom
(Mamas, Neyses) Manchester Academic Health Science Centre, University of
Manchester, Oxford Road, Manchester, United Kingdom
Title
A comparison of drug-eluting stents versus bare metal stents in saphenous
vein graft PCI outcomes: A meta-analysis.
Source
Journal of Interventional Cardiology. 24 (2) (pp 172-180), 2011. Date of
Publication: April 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Aims: Studies demonstrate that percutaneous coronary intervention (PCI)
with drug-eluting stents (DES) is associated with reduced
revascularization and major adverse cardiac events (MACE) rates compared
to bare metal stents (BMS) in native coronary vessels. Optimal PCI
treatment of saphenous vein graft (SVG) lesions remains unclear despite
SVG procedures representing up to 10% of PCI cases. We therefore performed
a metaanalysis to compare outcomes between BMS and DES in SVG PCI. Methods
and Results: A search (2004-2009) of MEDLINE and conference proceedings
for all relevant studies comparing mortality and MACE outcomes in DES
versus BMS in SVG PCI and meta-analysis of the data was performed. Twenty
studies were identified from 2005 to 2009 enrolling a total of 5,296
patients. Meta-analysis revealed a decrease in mortality associated with
DES use, odds ratio (OR) 0.68; 95% confidence interval (CI) 0.53-0.88; P =
0.004. Similarly, MACE (OR 0.64; 95% CI 0.51-0.82; P < 0.001), total
lesion revascularization (OR 0.60; 95% CI 0.43-0.83; P = 0.002), and total
vessel revascularization (OR 0.57; 95% CI 0.41-0.80; P = 0.001) were
significantly decreased in the patients in which DES were used compared to
BMS. This reduction in mortality and MACE events associated with DES use
appears to be limited to registry studies and not randomized controlled
studies. Conclusions: Our meta-analysis suggests DES use to be safe in SVG
PCI and associated with reduced mortality and MACE rates with reductions
in revascularization also observed. 2011, Wiley Periodicals, Inc.
<9>
Accession Number
2011191681
Authors
Silber S. Windecker S. Vranckx P. Serruys P.W.
Institution
(Silber) Heart Centre at the Isar, Am Isarkanal 36, D-81379 Munich,
Germany
(Windecker) Bern University Hospital, Bern, Switzerland
(Serruys) Department of Interventional Cardiology, Thoraxcentre,
University Medical Centre Rotterdam, Rotterdam, Netherlands
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Hasselt, Belgium
Title
Unrestricted randomised use of two new generation drug-eluting coronary
stents: 2-year patient-related versus stent-related outcomes from the
RESOLUTE All Comers trial.
Source
The Lancet. 377 (9773) (pp 1241-1247), 2011. Date of Publication: April
9-15, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
In the RESOLUTE All Comers trial, the Resolute zotarolimus-eluting stent
was non-inferior to the Xience V everolimus-eluting stent for the primary
stent-related endpoint of target lesion failure (cardiac death, target
vessel myocardial infarction, and ischaemia-driven target lesion
revascularisation) at 1 year. However, data for long-term safety and
efficacy from randomised studies of new generation drug-eluting coronary
stents in patients treated in routine clinical practice are scarce. We
report the prespecified 2-year clinical outcomes from the RESOLUTE All
Comers trial. In 2008, patients with at least one coronary lesion 225-40
mm in diameter, with greater than 50 stenosis, were randomly assigned to a
Resolute zotarolimus-eluting stent or a Xience V everolimus-eluting stent
at 17 centres in Europe and Israel. Randomisation was by an interactive
voice response system stratified by centre. Study investigators were not
masked to treatment allocation; but those who did data management and
analysis, and patients were masked. There were no restrictions as to the
number of vessels or lesions treated, or the number of stents implanted.
We assessed prespecified safety and efficacy outcomes at 2 years with
specific focus on patient-related composite (all death, all myocardial
infarction, all revascularisation) and stent-related composite outcomes.
Analyses were by intention to treat. This study is registered with
ClinicalTrials.gov, number NCT00617084. 1140 patients were assigned to the
zotarolimus-eluting stent and 1152 to the everolimus-eluting stent; 1121
and 1128 patients, respectively, completed 2-year follow-up. The
patient-related outcome (231 [206] zotarolimus vs 231 [205] everolimus;
difference 01, 95 CI -32 to 35; p=0958) and stent-related outcome (126
[112] vs 121 [107]; difference 05, -21 to 31; p=0736) did not differ
between groups, although rates of the stent-related outcome were
substantially lower than were those for the patient-related outcome. Three
patients in each group (03) had very late (after 1 year) stent thrombosis.
Similar safety and efficacy outcomes were sustained between two new
generation drug-eluting stents at 2-year follow-up. The greater number of
patient-related than stent-related events in patients with complex
clinical and lesion characteristics emphasises that during long-term
follow-up, the optimisation of secondary prevention is at least as
important as the selection of which new generation drug-eluting stent to
implant in a specific lesion. Medtronic (USA). 2011 Elsevier Ltd.
<10>
Accession Number
2011192923
Authors
Iversen A. Abildgaard U. Galloe A. Hansen P.R. Galatius S. Madsen J.K.
Engstroem T. Pedersen S. Jensen K.S. Jensen J.S.
Institution
(Iversen, Abildgaard, Galloe, Hansen, Galatius, Madsen, Engstroem,
Pedersen, Jensen, Jensen) Department of Cardiology P, Gentofte University
Hospital, Post 4210, Niels Andersensvej 65, DK-2900 Hellerup, Denmark
(Jensen) Clinical Institute of Surgery and Internal Medicine, Faculty of
Health Sciences, University of Copenhagen, Copenhagen, Denmark
Title
Intracoronary compared to intravenous bolus abciximab during primary
percutaneous coronary intervention in ST-segment Elevation Myocardial
Infarction (STEMI) patients reduces 30-day mortality and target vessel
revascularization: A randomized trial.
Source
Journal of Interventional Cardiology. 24 (2) (pp 105-111), 2011. Date of
Publication: April 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Abciximab is beneficial in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (pPCI). However, the optimal administration route of the
initial bolus of abciximab, that is, intravenous (IV) versus intracoronary
(IC), has been questioned. Preliminary studies suggest that IC-bolus is
superior, probably due to high local concentration. In this study, we
assess the short-term efficacy and safety of IC compared to IV bolus of
abciximab in patients with STEMI during pPCI. Methods: In 2006-2008, we
randomized 355 STEMI patients who underwent pPCI and had indication for
abciximab to either IV or IC bolus followed by a 12-hour IV infusion.
Primary end-points at 30 days were target vessel revascularization (TVR),
recurrent myocardial infarction (MI) or death, and the composite of the
three. Secondary end-points were bleeding complications. Results: The two
groups (IV n = 170;IC n = 185) were similar with respect to baseline
characteristics. Mortality at 30 days was 5.3% in the IV group compared to
only 1.1% in the IC group (P = 0.02). TVR was performed in 9.4% in the IV
group compared to 3.8% in the IC group (P = 0.03). No significant
difference in MI rates was seen (IV 4.7% vs. IC 2.7%; P = 0.32). We found
a significant reduction in the composite end-point (IV 19.4% vs. IC 7.6%;
P = 0.001) in favor of IC use. Major bleeding complications were similar
(IV 2.4% vs. IC 1.6%; P = 0.62). Neither difference was observed in minor
bleedings (IV 14.1% vs. IC 9.7%; P = 0.20). Conclusion: IC administration
of bolus abciximab in STEMI patients undergoing pPCI reduces 30-day
mortality and TVR and tends to reduce MI, compared to IV-bolus. 2010,
Wiley Periodicals, Inc.
<11>
[Use Link to view the full text]
Accession Number
2011185424
Authors
Colombo A. Castellani M. Piccaluga E. Pusineri E. Palatresi S. Longari V.
Canzi C. Sacchi E. Rossi E. Rech R. Gerundini P. Viecca M. Deliliers G.L.
Rebulla P. Soligo D. Giordano R.
Institution
(Colombo, Piccaluga, Viecca) Catheterization Laboratory, Cardiology
Department, 'Luigi Sacco' Hospital, via GB Grassi 74, 20157 Milan, Italy
(Rebulla, Giordano) Cell Factory 'F. Calori', Center of Transfusion
Medicine, Cellular Therapy and Cryobiology, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Castellani, Longari, Canzi, Gerundini) Nuclear Medicine Department,
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Pusineri, Palatresi) Clinical Cardiology Unit, IRCCS Policlinico San
Donato, San Donato, Italy
(Sacchi, Rossi) Immunohematology and Transfusion Medicine, 'Luigi Sacco'
Hospital, Milan, Italy
(Rech) Emergency Medicine Unit, 'Luigi Sacco' Hospital, Milan, Italy
(Deliliers, Soligo) Hematology and Bone Marrow Transplantation Centre,
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of
Milan, Milan, Italy
Title
Myocardial blood flow and infarct size after CD133+ cell injection in
large myocardial infarction with good recanalization and poor reperfusion:
Results from a randomized controlled trial.
Source
Journal of Cardiovascular Medicine. 12 (4) (pp 239-248), 2011. Date of
Publication: April 2011.
Publisher
Lippincott Williams and Wilkins (345 Hudson St., 16th Fl., New York NY
10014-4502, United States)
Abstract
OBJECTIVE: Large acute ST-elevation myocardial infarction (STEMI)
sometimes leaves extensive ischemic damage despite timely and successful
primary angioplasty. This clinical picture of good recanalization with
incomplete reperfusion represents a good model to assess the reparative
potential of locally administered cell therapy. Thus, we conducted a
randomized controlled trial aimed at evaluating the effect of
intracoronary administration of CD133 stem cells on myocardial blood flow
and function in this setting. METHODS: Fifteen patients with large
anterior STEMI, myocardial blush grade 0-1 and more than 50% ST-elevation
recovery after optimal coronary recanalization (TIMI 3 flow) with stenting
were randomly assigned to receive CD133 cells from either bone marrow
(group A) or peripheral blood (group B), or to stay on drug therapy alone
(group C). The cells were intracoronary injected within 10-14 days of
STEMI. Infarct-related myocardial blood flow (MBF) was evaluated by NH
positron emission tomography 2-5 days before cell administration and after
1 year. RESULTS: MBF increased in the infarct area from 0.419
(0.390-0.623) to 0.544 (0.371-0.729) ml/min per g in group A, decreased
from 0.547 (0.505-0.683) to 0.295 (0.237-0.472) ml/min per g in group B
and only slightly changed from 0.554 (0.413-0.662) to 0.491 (0.453-0.717)
ml/min per g in group C (A vs. C: P = 0.023; B vs. C: P = 0.066). Left
ventricular volume tended to increase more in groups B and C than in group
A, ejection fraction and wall motion score index remained stable in the
three groups. CONCLUSION: These findings support the hypothesis that
intracoronary administration of bone marrow-derived, but not peripheral
blood-derived CD133 cells 10-14 days after STEMI may improve long-term
perfusion. 2011 Italian Federation of Cardiology.
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Accession Number
2011186436
Authors
Lian C.-W. Li H. Li Q. Liu B.
Institution
(Lian, Li, Li, Liu) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu 610041, China
Title
Tranexamic acid for coronary artery bypass grafting with on-pump: A
systematic review.
Source
Chinese Journal of Evidence-Based Medicine. 11 (2) (pp 150-160), 2011.
Date of Publication: 2011.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To assess the efficacy and safety of tranexamic acid in coronary
artery bypass grafting (CABG) with on-pump. Methods Randomized controlled
trials (RCTs) of CABG were searched in The Cochrane Library, MEDLINE,
CNKI, VIP, CBM from the date of their establishment to December 2010. The
quality of the included studies was evaluated, and meta-analyses were
performed with The Cochrane Collaboration's RevMan 5.0 software. Results A
total of 22 studies involving 2 424 patients were included. The results of
meta-analyses showed: a) blood loss: although there was no superiority
compared to the placebo in reducing intraoperative blood loss (P=0.18),
tranexamic acid was effective in reducing postoperative blood loss (6 h:
WMD= -218.66, 95%CI -362.84 to -74.47, P=0.003; 24 h: WMD= -213.50, 95%CI
-339.78 to -87.21, P=0.000 9; total:WMD= -314.11, 95%CI -396.24 to
-231.98, P<0.000 01); and it was significantly better than e-aminocaproic
acid (6 h: WMD= -209.00, 95%CI -362.24 to -55.76, P<0.000 01; 24 h: WMD=
-361.00, 95%CI -666.56 to -55.44, P=0.02) and acute nomovolemic
hemodilution (total: WMD= -532.00, 95%CI -646.18 to -417.82, P<0.000 01),
and high dose aprotinin (6h: WMD=108.77, 95% CI 43.43 to 174.10, P=0.001;
24h: WMD=121.76, 95%CI 39.34 to 204.18, P=0.004; total: WMD=458.00, 95%CI
189.09 to 726.91, P=0.000 8); but there was no significant difference
compared with low dose aprotinin (P>0.05); b) perioperative transfusion
rate: tranexamic acid was effective in reducing postoperative transfusion
rates of FFP and PLT (RR=0.25, 95%CI 0.08 to 0.79, P=0.02; RR=0.20, 95%CI
0.04 to 0.99, P=0.05), similar to e-aminocaproic acid (P>0.05), however,
less effective than high dose aprotinin in terms of reducing postoperative
RBC transfusion (RR=2.65, 95%CI 1.43 to 4.89, P=0.002); and c)
perioperative adverse events: there were no significant differences in
perioperative complications between any comparisons (P>0.05). Conclusion
Tranexamic acid is a safe and effective antifibrinolitic drug in CABG with
on-pump, for it can reduce postoperative hemorrhage and transfusion of FFP
and PLT. However, due to the limited quality of the included studies,
further verification with more high quality trials is needed.
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Accession Number
2011186977
Authors
Schiariti M. Saladini A. Cuturello D. Missiroli B. Puddu P.E.
Institution
(Schiariti, Saladini, Missiroli) S. Anna Hospital, Catanzaro, Italy
(Schiariti, Cuturello, Puddu) Department of the Heart and Great Vessels
'A. Reale', University 'La Sapienza', Rome, Italy
Title
Long-term efficacy of high-dose tirofiban versus double-bolus eptifibatide
in patients undergoing percutaneous coronary intervention.
Source
Journal of Cardiovascular Medicine. 12 (1) (pp 29-36), 2011. Date of
Publication: January 2011.
Publisher
Lippincott Williams and Wilkins (345 Hudson St., 16th Fl., New York NY
10014-4502, United States)
Abstract
Background: There is no head-to-head comparison between tirofiban versus
eptifibatide in patients undergoing percutaneous coronary intervention
(PCI) when added to standard antiaggregating drugs (AAD) to prevent
ischemic events within 1 year. Methods: We compared real-world patients
undergoing PCI who were on oral single AAD and were block randomized to
receive, immediately preintervention, high-dose tirofiban (n = 519) or
double-bolus eptifibatide (n = 147) and a second oral antiplatelet agent.
The incidence of composite ischemic events within 1 year, including death,
acute myocardial infarction, angina, stent thrombosis or repeat PCI or
coronary bypass surgery (primary end-point) was modelled by forced Cox's
regression. Results: There were overall 65 composite ischemic events: 47
(9.1%) in the tirofiban group and 18 (12.2%) in the eptifibatide group
(univariate log-rank test: P = 0.22). On the basis of 21 potential
covariates fitted simultaneously, multivariable adjusted hazard ratios
showed that age [hazard ratio 1.03, 95% confidence interval (CI)
1.01-1.07, P = 0.01], chronic renal failure (hazard ratio 3.21, 95% CI
1.02-10.10, P = 0.05), pre-PCI values of creatine kinase-myocardial band
(CK-MB) (hazard ratio 1.002, 95% CI 1.0002-1.0054, P = 0.04), intra-aortic
balloon pump (hazard ratio 5.88, 95% CI 12.33-14.85, P = 0.0002) and the
presence of eptifibatide (hazard ratio 1.85, 95% CI 1.04-3.29, P = 0.04)
were significant risk factors whereas thrombolysis by tenecteplase (hazard
ratio 0.19, 95% CI 0.05-0.69, P = 0.01) was a significant protector.
Interestingly, eptifibatide versus tirofiban efficacy was explained based
on pre-PCI values of CK-MB. Conclusion: Head-to-head comparison between
eptifibatide and tirofiban in patients undergoing PCI while on double AAD
showed that eptifibatide had a lower efficacy on the incidence of
composite ischemic events within 1 year, which might be explained by a
reduced action on CK-MB pre-PCI. 2010 Italian Federation of Cardiology.
<14>
Accession Number
2011189975
Authors
Poortaghi S. Atri S.B. Safayian A. Baghernia A.
Institution
(Poortaghi) Nursing Education, Tabriz Emam Reza Educational Treatment
Center, Tabriz, Iran, Islamic Republic of
(Atri) Nursing Management, Tabriz Emam Reza Educational Treatment Center,
Tabriz, Iran, Islamic Republic of
(Safayian) Nursing and Midwifery Faculty, Health and Nutrition Faculty,
Tabriz Emam Reza Educational Treatment Center, Tabriz, Iran, Islamic
Republic of
(Baghernia) Tabriz University of Medical Sciences, Anesthesiology and
Intensive Care Department, Tabriz Emam Reza Educational Treatment Center,
Tabriz, Iran, Islamic Republic of
Title
General health improves with home-based cardiac rehabilitation program.
Source
Saudi Medical Journal. 32 (4) (pp 407-411), 2011. Date of Publication:
2011.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To determine whether continuing cardiac rehabilitation
programs at home has positive effects on psychological and general health
of the participants' in comparison with the control group. Method: This
randomized controlled trial was conducted in Tabriz Shahid Madani
rehabilitation center, Tabriz, Iran between February 2009 and January
2010. Eighty patients referred to the rehabilitation center were randomly
divided into case and control groups. Both groups received routine cardiac
rehabilitation program in the rehabilitation center. In addition, the case
group received education and practical training in various rehabilitation
measures along with home visits of a community health nurse in follow-up
period. General Health Questionnaire (GHQ-28) was used to assess
psychological and general health between the 2 groups at baseline and on
follow-up period. Collected data from the GHQ-28 were analyzed using
Minitab software and repeated measurement analysis model. Results: In this
study, 75% (n=60) of participants were male and 25% (n=20) were female
with an age range of 57.41+/-1.01 years (mean+/-SE). The results showed
statistical significant difference in general health (p=0.000) between the
2 groups and in different measurements (p=0.000). Conclusion: Home-based
cardiac rehabilitation has a positive effect on patients' general health,
thus referring patients who suffer from heart diseases is recommended.
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