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<1>
Accession Number
2011435221
Authors
Vlaar P.J. Mahmoud K.D. Holmes Jr. D.R. Van Valkenhoef G. Hillege H.L. Van
Der Horst I.C.C. Zijlstra F. De Smet B.J.G.L.
Institution
(Vlaar, Mahmoud, Hillege, Van Der Horst, De Smet) Department of
Cardiology, Thorax Center, University Medical Center Groningen, Groningen,
Netherlands
(Holmes Jr.) Department of Cardiology, Mayo Clinic, Rochester, MN, United
States
(Van Valkenhoef, Hillege) Department of Epidemiology, University Medical
Center Groningen, Groningen, Netherlands
(Zijlstra) Department of Cardiology, Thorax Center, Erasmus Medical
Center, Rotterdam, Netherlands
Title
Culprit vessel only versus multivessel and staged percutaneous coronary
intervention for multivessel disease in patients presenting with
ST-segment elevation myocardial infarction: A pairwise and network
meta-analysis.
Source
Journal of the American College of Cardiology. 58 (7) (pp 692-703), 2011.
Date of Publication: 09 Aug 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purposes of this study were to investigate whether, in
patients with ST-segment elevation myocardial infarction (STEMI) and
multivessel disease (MVD), percutaneous coronary intervention (PCI) should
be confined to the culprit or also nonculprit vessels and, when performing
PCI for nonculprit vessels, whether it should take place during primary
PCI or staged procedures. Background: A significant percentage of STEMI
patients have MVD. However, the best PCI strategy for nonculprit vessel
lesions is unknown. Methods: Pairwise and network meta-analyses were
performed on 3 PCI strategies for MVD in STEMI patients: 1) culprit vessel
only PCI strategy (culprit PCI), defined as PCI confined to culprit vessel
lesions only; 2) multivessel PCI strategy (MV-PCI), defined as PCI of
culprit vessel as well as <1 nonculprit vessel lesions; and 3) staged PCI
strategy (staged PCI), defined as PCI confined to culprit vessel, after
which <1 nonculprit vessel lesions are treated during staged procedures.
Prospective and retrospective studies were included when research subjects
were patients with STEMI and MVD undergoing PCI. The primary endpoint was
short-term mortality. Results: Four prospective and 14 retrospective
studies involving 40,280 patients were included. Pairwise meta-analyses
demonstrated that staged PCI was associated with lower short- and
long-term mortality as compared with culprit PCI and MV-PCI and that
MV-PCI was associated with highest mortality rates at both short- and
long-term follow-up. In network analyses, staged PCI was also consistently
associated with lower mortality. Conclusions: This meta-analysis supports
current guidelines discouraging performance of multivessel primary PCI for
STEMI. When significant nonculprit vessel lesions are suitable for PCI,
they should only be treated during staged procedures. 2011 American
College of Cardiology Foundation.

<2>
Accession Number
2011419774
Authors
Jacobson T.A.
Institution
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
Title
Opening a new lipid "Apo-thecary": Incorporating apolipoproteins as
potential risk factors and treatment targets to reduce cardiovascular
risk.
Source
Mayo Clinic Proceedings. 86 (8) (pp 762-780), 2011. Date of Publication:
August 2011.
Publisher
Mayo Medical Ventures (200 First Street Southwest, Rochester MN 55905,
United States)
Abstract
Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors)
represent the cornerstone of drug therapy to reduce lowdensity lipoprotein
(LDL) cholesterol and cardiovascular risk. However, even optimal statin
management of LDL cholesterol leaves many patients with residual
cardiovascular risk, in part because statins are more effective in
reducing LDL cholesterol than apolipoprotein B (Apo B). Apo B may be a
better marker of atherogenic risk than LDL cholesterol because Apo B
measures the total number of all atherogenic particles (total
atherosclerotic burden), including LDL, very low-density lipoprotein,
intermediate-density lipoprotein, remnant lipoproteins, and
lipoprotein(a). To determine whether Apo B is a better indicator of
baseline cardiovascular risk and residual risk after lipid therapy
compared with LDL cholesterol, a MEDLINE search of the literature
published in English from January 1, 1975, through December 1, 2010, was
conducted. On the basis of data from most population studies, elevated Apo
B was more strongly associated with incident coronary heart disease than
similarly elevated LDL cholesterol. Apo B was also a superior benchmark
(vs LDL cholesterol) of statins' cardioprotective efficacy in both
primary-prevention and secondary-prevention trials. To minimize
cardiovascular risk among persons with hypercholesterolemia or
dyslipidemia, the best available evidence suggests that intensive therapy
with statins should be initiated to achieve the lowest possible Apo B
level (with adequate drug toleration) and then other therapies (eg,
niacin, bile acid resins, ezetimibe) added to potentiate these Apo B -
lowering effects. In future consensus lipid-lowering treatment guidelines,
Apo B should be considered as an index of residual risk, a potential
parameter of treatment efficacy, and a treatment target to minimize risk
of coronary heart disease. 2011 Mayo Foundation for Medical Education and
Research.

<3>
Accession Number
2011441137
Authors
Hong S.J. Choi S.C. Ahn C.M. Park J.H. Kim J.S. Lim D.-S.
Institution
(Hong, Choi, Ahn, Park, Kim, Lim) Department of Cardiology, Cardiovascular
Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku,
Seoul 136-705, South Korea
Title
Telmisartan reduces neointima volume and pulse wave velocity 8 months
after zotarolimus-eluting stent implantation in hypertensive type 2
diabetic patients.
Source
Heart. 97 (17) (pp 1425-1432), 2011. Date of Publication: September
2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: Telmisartan is a peroxisome proliferator-activated receptor-
activator with potent anti-inflammatory and antiatherogenic effects. The
authors compared the effects of telmisartan and valsartan on neointima
volume, atherosclerosis progression and brachial-ankle pulse wave velocity
(baPWV) after stenting in hypertensive type 2 diabetes. Design: This was a
prospective, randomised, 8-month follow-up study that included patients
with significant coronary stenosis who received telmisartan (n=36) or
valsartan (n=37). Setting: University hospital. Main outcome measures:
Neointima volume and atherosclerosis progression 10 mm proximal and distal
to the stented segment were analysed using repeat intravascular
ultrasonography. baPWV and inflammatory markers such as interleukin 6,
tumour necrosis factor alpha, C-reactive protein and adiponectin were
compared. Results: Neointima volume at 8 months was significantly lower in
the telmisartan group than the valsartan group (1.9+/-1.0 vs 2.6+/-1.4
mm3/1 mm, p=0.007, respectively). Total plaque volumes 10 mm proximal
(7.1+/-1.5 vs 7.8+/-1.6 mm3/1 mm, p=0.032, respectively) and distal
(3.5+/-1.4 vs 4.1+/-1.3 mm3/1 mm, p=0.028, respectively) to the stent were
significantly lower in the telmisartan group than the valsartan group at 8
months. The decrease from baseline in baPWV was significantly greater in
the telmisartan group than the valsartan group (-52+/-104 vs 30+/-113
cm/s, p=0.002, respectively). The increase from baseline in adiponectin
levels and the decreases from baseline in interleukin 6 and tumour
necrosis factor alpha levels were significantly greater in the telmisartan
group at 8 months. Retinol-binding protein-4, homeostasis model of
assessment index, hemoglobin A1c and low-density lipoprotein cholesterol
levels decreased significantly in both groups without differences in
changes from baseline between the two groups. Conclusions: Telmisartan
reduced neointima volume; atherosclerosis progression 10 mm proximal and
distal to the stented segment and baPWV independent of blood pressure,
glucose and lipid control in hypertensive type 2 diabetes. Clinical trial
no: NCT00599885 (clinicaltrials.gov.).

<4>
Accession Number
2011443698
Authors
Caputo M. Santo K.C. Angelini G.D. Fino C. Agostini M. Grossi C. Suleiman
M.-S. Reeves B.C.
Institution
(Caputo, Santo, Angelini, Suleiman, Reeves) Bristol Heart Institute,
University of Bristol, Bristol Royal Infirmary, Bristol, BS2 8HW, United
Kingdom
(Fino, Agostini, Grossi) Cardiovascular Department, S. Croce and Carle
Hospital, Cuneo, Italy
Title
Warm-blood cardioplegia with low or high magnesium for coronary bypass
surgery: A randomised controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 40 (3) (pp 722-729), 2011.
Date of Publication: September 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Magnesium (Mg²⁺) is cardioprotective and has been
routinely used to supplement cardioplegic solutions during coronary artery
bypass graft (CABG) surgery. However, there is no consensus about the
Mg²⁺ concentration that should be used. The aim of this study
was to compare the effects of intermittent antegrade warm-blood
cardioplegia supplemented with either low- or high-concentration
Mg²⁺. Methods: This study was a randomised controlled trial
carried out in two cardiac surgery centres, Bristol, UK and Cuneo, Italy.
Patients undergoing isolated CABG with cardiopulmonary bypass were
eligible. Patients were randomised to receive warm-blood cardioplegia
supplemented with 5 or 16mmoll^-1 Mg²⁺. The primary
outcome was postoperative atrial fibrillation. Secondary outcomes were
serum biochemical markers (troponin I, Mg²⁺, potassium, lactate
and creatinine) and time-to-plegia arrest. Intra-operative and
postoperative clinical outcomes were also recorded. Results: Data from two
centres for 691 patients (342 low and 349 high Mg²⁺) were
analysed. Baseline characteristics were similar for both groups. There was
no significant difference in the frequency of postoperative atrial
fibrillation in the high (32.8%) and low (32.0%) groups (risk ratio 1.03,
95% confidence interval, CI, 0.82-1.28). However, compared with the low
group, troponin I release was 28% less (95% CI 55-94%, p=0.02) in the
high-Mg²⁺ group. The 30-day mortality was 0.72% (n=5); all
deaths occurred in the high-Mg²⁺ group but there was no
significant difference between the groups (p=0.06). Frequencies of other
major complications were similar in the two groups. Conclusions:
Warm-blood cardioplegia supplemented with 16mmoll^-1
Mg²⁺, compared with 5mmoll^-1 Mg²⁺, does
not reduce the frequency of postoperative atrial fibrillation in patients
undergoing CABG but may reduce cardiac injury. (This trial was registered
as ISRCTN95530505.). 2011 European Association for Cardio-Thoracic
Surgery.

<5>
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Accession Number
2011439224
Authors
Massberg S. Byrne R.A. Kastrati A. Schulz S. Pache J. Hausleiter J.
Ibrahim T. Fusaro M. Ott I. Schomig A. Laugwitz K.-L. Mehilli J.
Institution
(Massberg, Byrne, Kastrati, Schulz, Pache, Hausleiter, Fusaro, Ott,
Schomig, Mehilli) ISARESEARCH Center, Deutsches Herzzentrum,
Lazarettstrasse 36, 80636 Munich, Germany
(Ibrahim, Laugwitz) Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat, Munich, Germany
Title
Polymer-free sirolimus- and probucol-eluting versus new generation
zotarolimus-eluting stents in coronary artery disease: The Intracoronary
stenting and angiographic results: Test efficacy of sirolimus- and
probucol-eluting versus zotarolimus-eluting stents (ISAR-TEST 5) Trial.
Source
Circulation. 124 (5) (pp 624-632), 2011. Date of Publication: 02 Aug
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Durable polymer coatings have been implicated in mid- and
long-term adverse events after drug-eluting stent implantation. A
polymer-free dual-drug sirolimus- and probucol-eluting stent and a new
generation permanent polymer zotarolimus-eluting stent are recently
developed technologies demonstrating encouraging results. Methods and
Results-In a clinical trial with minimal exclusion criteria, we randomly
assigned 3002 patients to treatment with sirolimus- and probucol-eluting
stents versus zotarolimus-eluting stents. The trial was designed to
demonstrate noninferiority of the sirolimus- and probucol-eluting stents.
The primary end point was the combined incidence of cardiac death,
target-vessel-related myocardial infarction, or target-lesion
revascularization at 1-year follow-up. Follow-up angiography was scheduled
at 6 to 8 months. The sirolimus- and probucol-eluting stent was
noninferior to the zotarolimus-eluting stent in terms of occurrence of the
primary end point (13.1% versus 13.5%, respectively,
P_{noninferiority}=0.006; hazard ratio=0.97, 95% confidence
interval, 0.78 to 1.19; P_superiority=0.74) . The incidence of
definite/probable stent thrombosis was low in both groups (1.1% versus
1.2%, respectively; hazard ratio=0.91 [95% confidence interval, 0.45 to
1.84], P=0.80). With regard to angiographic efficacy, there were no
differences between the sirolimus- and probucol-eluting stent and the
zotarolimus-eluting stent in terms of either in-segment binary
angiographic restenosis (13.3% versus 13.4% respectively; P=0.95) or
in-stent late luminal loss (0.31+/-0.58 mm versus 0.29+/-0.56 mm,
respectively; P=0.46). Conclusion-In this large-scale study powered for
clinical end points, a polymer-free sirolimus- and probucol-eluting stent
was noninferior to a new generation durable polymer-based
zotarolimus-eluting stent out to 12 months. Clinical Trial
Registration-http://www.clinicaltrials.gov. Unique identifier NCT
00598533. 2011 American Heart Association, Inc.

<6>
Accession Number
2011447638
Authors
Boules N.S. Ghobrial H.Z.
Institution
(Boules, Ghobrial) Department of Anesthesiology and Pain Management,
National Cancer Institute, Cairo University, Cairo, Egypt
Title
Efficiency of the newly introduced ventilatory mode "pressure controlled
ventilation-volume guaranteed" in thoracic surgery with one lung
ventilation.
Source
Egyptian Journal of Anaesthesia. 27 (2) (pp 113-119), 2011. Date of
Publication: April 2011.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: Anesthesia for thoracic surgery routinely involves one lung
ventilation (OLV). Volume controlled ventilation (VCV) was and still the
most common method of performing OLV. We assumed that pressure controlled
ventilation-volume guaranteed (PCV-VG) is a better ventilation strategy
for OLV than VCV as regard the inspiratory pressures, oxygenation
parameters and post-operative ventilatory outcome. Methods: Forty patients
undergoing elective thoracic surgery in the lateral position requiring at
least 1 h of OLV were randomly assigned into two groups. Group VCV: VCV
was performed throughout the operation. Group PCV-VG: PCV-VG was performed
throughout the operation. Blood gas analysis, peak inspiratory pressure
(Ppeak), mean inspiratory pressure (Pmean), plateau inspiratory pressure
(Pplateau) were measured: (1) During two lung ventilation (TLV1) 30 min
after turning the patient to the lateral decubitus prior the beginning of
OLV; (2) 30 min after initiation of OLV(OLV); (3) End of surgery: 30 min
after reestablishing TLV (TLV2). Results: The Ppeak and the Pplateau were
significantly lower in PCV-VG compared with VCV in all stages of the study
(P value < 0.05). There was significant increase in all pressure values in
OLV compared with TLV1 in the two groups (P value < 0.05). There were
significant decrease in the mean Pao2 values during OLV and TLV2 compared
with TLV1 in the two groups (P value < 0.05). Yet the Pao2 was
significantly higher in the PCV-VG group at OLV and TLV2 compared to the
OLV and TLV2 in VCV group. Also Pao2 was significantly lower in TLV2
compared with TLV1 in both groups (P value <0.05). Conclusion: In patients
undergoing thoracic surgery with OLV, pressure controlled volume
guaranteed mode of ventilation decreases inspiratory pressure parameters
and improve arterial oxygenation better than volume controlled
ventilation. 2011 Egyptian Society of Anesthesiologists. Production and
hosting by Elsevier B.V. All rights reserved.

<7>
Accession Number
2011454724
Authors
Takagi H. Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan
Title
Remote ischemic preconditioning for cardiovascular surgery: An updated
meta-analysis of randomized trials.
Source
Vascular and Endovascular Surgery. 45 (6) (pp 511-513), 2011. Date of
Publication: August 2011.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)

<8>
Accession Number
2011454202
Authors
Goehler A. Geisler B.P. Manne J.M. Jahn B. Conrads-Frank A.
Schnell-Inderst P. Gazelle G.S. Siebert U.
Institution
(Goehler, Geisler, Gazelle, Siebert) Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, 165 Cambridge
Street, Boston, MA 02214, United States
(Goehler) Cardiac MR, PET, CT Program, Massachusetts General Hospital,
Harvard Medical School, 165 Cambridge Street, Boston, MA 02214, United
States
(Goehler, Geisler, Jahn, Conrads-Frank, Schnell-Inderst, Siebert)
Department of Public Health, Institute of Public Health, UMIT University
for Health Sciences, Medical Informatics and Technology, Hall i.T.,
Austria
(Goehler) Alfried Krupp von Bohlen und Halbach Foundation, Institute for
Health Systems Management, University of Duisburg-Essen, Essen, Germany
(Manne) Department of Population and International Health, Harvard School
of Public Health, Boston, MA, United States
(Gazelle, Siebert) Center for Health Decision Science, Department of
Health Policy and Management, Harvard School of Public Health, Boston, MA,
United States
Title
Decision-analytic models to simulate health outcomes and costs in heart
failure: A systematic review.
Source
PharmacoEconomics. 29 (9) (pp 753-769), 2011. Date of Publication: 2011.
Publisher
Adis International Ltd (41 Centorian Drive, Private Bag 65901, Mairangi
Bay, Auckland 10 1311, New Zealand)
Abstract
Chronic heart failure (CHF) is a critical public health issue with
increasing effect on the healthcare budgets of developed countries.
Various decision-analytic modelling approaches exist to estimate the cost
effectiveness of health technologies for CHF. We sought to systematically
identify these models and describe their structures.We performed a
systematic literature review in MEDLINEPreMEDLINE, EMBASE, EconLit and the
Cost-Effectiveness Analysis Registry using a combination of search terms
for CHF and decision-analytic models. The inclusion criterion required
'use of a mathematical model evaluating both costs and health consequences
for CHF management strategies'. Studies that were only economic
evaluations alongside a clinical trial or that were purely descriptive
studies were excluded.We identified 34 modelling studies investigating
different interventions including screening (n1), diagnostics (n1),
pharmaceuticals (n15), devices (n13), disease management programmes (n3)
and cardiac transplantation (n1) in CHF. The identified models primarily
focused on middle-aged to elderly patients with stable but progressed
heart failure with systolic left ventricular dysfunction. Modelling
approaches varied substantially and included 27 Markov models, three
discrete-event simulation models and four mathematical equation sets
models; 19 studies reported QALYs. Three models were externally validated.
In addition to a detailed description of study characteristics, the model
structure and output, the manuscript also contains a synthesis and
critical appraisal for each of the modelling approaches.Well designed
decision models are available for the evaluation of different CHF health
technologies. Most models depend on New York Heart Association (NYHA)
classes or number of hospitalizations as proxy for disease severity and
progression. As the diagnostics and biomarkers evolve, there is the hope
for better intermediate endpoints for modelling disease progression as
those that are currently in use all have limitations. 2011 Adis Data
Information BV. All rights reserved.

<9>
[Use Link to view the full text]
Accession Number
2011454508
Authors
Reid R.D. Mullen K.A. Pipe A.L.
Institution
(Reid, Mullen, Pipe) Division of Prevention and Rehabilitation, University
of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
Title
Systematic approaches to smoking cessation in the cardiac setting.
Source
Current Opinion in Cardiology. 26 (5) (pp 443-448), 2011. Date of
Publication: September 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Purpose of Review: Constituents of tobacco smoke are prothrombotic and
atherogenic and causative factors in the development of coronary heart
disease (CHD). Smoking cessation is the single most important intervention
to reduce morbidity and mortality in smokers with CHD. This review
presents contemporary information regarding treatments for smoking
cessation in the setting of CHD. Recent Findings: The beneficial effects
of smoking cessation may be mediated by improvements in endothelial
function. Failure to quit smoking in those with CHD is a typical
consequence of nicotine addiction. Practical counseling and
pharmacotherapy [nicotine replacement therapy (NRT), bupropion, and
varenicline] are well tolerated and effective treatments for CHD patients
attempting to quit smoking. Treatments initiated in hospital following a
CHD-related event or procedure are more effective than those initiated
outside the hospital setting. Extending medication use beyond the initial
treatment phase is the most promising means of preventing relapse.
Financial coverage for smoking cessation pharmacotherapy improves quit
rates. The routine provision of pharmacotherapy and practical counseling
in the CHD setting can be assured by implementing proven, systematic
approaches to smoking cessation treatment. Summary: Smoking cessation is a
fundamental priority in smokers with CHD. Systematic approaches to ensure
that cessation assistance is provided by clinicians and to improve
cessation outcomes for smokers are effective and available. 2011 Wolters
Kluwer Health | Lippincott Williams & Wilkins.

<10>
[Use Link to view the full text]
Accession Number
2011454505
Authors
Frey P. Waters D.D.
Institution
(Frey) Division of Cardiology, Brigham and Women's Hospital, Boston, MA,
United States
(Waters) Division of Cardiology, San Francisco General Hospital, San
Francisco, CA, United States
Title
Tobacco smoke and cardiovascular risk: A call for continued efforts to
reduce exposure.
Source
Current Opinion in Cardiology. 26 (5) (pp 424-428), 2011. Date of
Publication: September 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Purpose of Review: This review will summarize contemporary data regarding
the cardiovascular effects of tobacco exposure. In particular, this review
will highlight recent data that focuses on the magnitude of continued
exposure both in the United States and abroad, the cardiovascular risks of
tobacco exposure despite improvements in medical therapy, and the
important effects of low levels of exposure including secondhand smoke
(SHS). Recent Findings: Recent data demonstrates that the current burden
of tobacco exposure both in the United States and worldwide remains large.
Despite improvements in medical therapy for cardiovascular disease the
cardiovascular effects of tobacco exposure are substantial. Recent data
also demonstrates that even intermittent smoking and exposure to SHS have
important cardiovascular effects. Summary: The cardiovascular effects of
tobacco exposure, including even low levels from SHS, remain important.
Continued efforts to reduce exposure to our patients are critical for
improved cardiovascular health. 2011 Wolters Kluwer Health | Lippincott
Williams & Wilkins.

<11>
Accession Number
2011454775
Authors
Morris C. Rogerson D.
Institution
(Morris, Rogerson) Department of Anaesthesia and Intensive Care Medicine,
Royal Derby Hospital, Derby, United Kingdom
Title
What is the optimal type of fluid to be used for peri-operative fluid
optimisation directed by oesophageal Doppler monitoring?.
Source
Anaesthesia. 66 (9) (pp 819-827), 2011. Date of Publication: September
2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
The objective of this review was to determine the optimal type or class of
intravenous fluid to be used during peri-operative patient optimisation
guided by oesophageal Doppler monitoring and to identify future directions
for research. We undertook a literature review of patients undergoing
major (general, colorectal, orthopaedic and urological) surgery, whose
fluid therapy was managed using peri-operative oesophageal Doppler
monitoring. We identified 10 studies that included 891 randomised
patients. A variety of regimens and types of fluid were used in
association with oesophageal Doppler monitoring, including crystalloid,
gelatin and hydroxyethyl starch. A wide variety of hydroxyethyl starch
preparations were used, including high molecular weight and highly
substituted hetastarches, and lower molecular weight tetrastarches. Most
studies were of high quality, associated with reduced hospital stay, but
underpowered to evaluate other outcomes. In units with established
enhanced recovery facilities, the benefits of colloid based on oesophageal
Doppler monitoring were not reproduced. There is little evidence to
support preferential use of any particular type of fluid during
oesophageal Doppler guided optimisation; however, routine use of colloids
is associated with significantly higher costs and may increase hospital
stay. Furthermore, many of these fluids have not been evaluated in patient
populations in whom optimisation is being applied or proposed, and the
potential for harm cannot be excluded. Recommendations for future studies
are provided, including adequate power for primary end points beyond
hospital stay and adequate follow-up, and inclusion of a crystalloid
comparison group. 2011 The Authors. Anaesthesia 2011 The Association of
Anaesthetists of Great Britain and Ireland.

<12>
Accession Number
2011456960
Authors
Dao T.K. Youssef N.A. Armsworth M. Wear E. Papathopoulos K.N. Gopaldas R.
Institution
(Dao, Armsworth, Wear, Papathopoulos) University of Houston, Baylor
College of Medicine, Houston, TX 77204, United States
(Dao) Baylor College of Medicine, Department of Psychiatry and Behavioral
Sciences, Houston, TX, United States
(Youssef) Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, NC, United States
(Youssef) Mid-Atlantic Mental Illness Research, Education and Clinical
Center, Durham Veterans Affairs Medical Center, Durham, NC, United States
(Youssef) University of South Alabama, College of Medicine, Mobile, AL,
United States
(Gopaldas) Division of Cardiothoracic Surgery, University of
Missouri-Columbia, School of Medicine, Columbia, MO, United States
(Gopaldas) Harry S. Truman Veterans Affairs Medical Center, Columbia, MO,
United States
Title
Randomized controlled trial of brief cognitive behavioral intervention for
depression and anxiety symptoms preoperatively in patients undergoing
coronary artery bypass graft surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (3) (pp e109-e115),
2011. Date of Publication: September 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The goal of this study was to examine the feasibility,
acceptability, and efficacy of a brief, tailored cognitive-behavioral
intervention for patients with symptoms of preoperative depression or
anxiety before undergoing a coronary artery bypass graft (CABG) operation.
Methods: Patients were recruited from a university teaching hospital
between February 2007 and May 2009. Patients were randomly assigned to
receive treatment as usual (TAU) or a cognitive behavioral therapy (CBT)
intervention called Managing Anxiety and Depression using Education and
Skills (MADES). A total of 100 subjects were randomized into the study.
Length of hospital stay was assessed with a 1-way analysis of variance.
Depression, anxiety, and quality of life were assessed with mixed-model
repeated measures analyses. Results: Overall, the intervention was
feasible, and patients had a positive impression of the MADES. Patients in
the TAU group stayed longer in the hospital than did those in the MADES
group (7.9 days +/- 2.6 vs 9.2 days +/- 3.5; P = .049). Depressive
symptoms increased at time of hospital discharge for the TAU group,
whereas the MADES group had a decrease in depressive symptoms at the time
of discharge. Quality of life and anxiety symptoms improved in both groups
at 3 to 4 weeks of follow-up. However, the MADES group had greater
improvements than did the TAU group. Conclusions: This study demonstrated
that brief, tailored CBT targeting preoperative depression and anxiety is
both feasible and acceptable for patients undergoing CABG surgery. Most
important, this intervention improved depressive and anxiety symptoms, as
well as quality of life. Moreover, it reduced in-hospital length of stay.
This study found that a cognitive-behavioral intervention for patients
undergoing CABG surgery for symptoms of preoperative depression/anxiety is
both feasible and acceptable. Most important, this intervention improved
depressive and anxiety symptoms, as well as quality of life. It also
reduced in-hospital length of stay. Copyright 2011 by The American
Association for Thoracic Surgery.

<13>
Accession Number
2011452707
Authors
Bauer T. Nienaber C.A. Akin I. Kuck K.-H. Hochadel M. Senges J. Fetsch T.
Tebbe U. Willich S.N. Stumpf J. Sabin G.V. Silber S. Richardt G.
Institution
(Bauer) Department of Cardiology, Medizinische Klinik B, Herzzentrum
Ludwigshafen, Bremserstrasse 79, Ludwigshafen 67063, Germany
(Nienaber, Akin) Universitat Rostock, Rostock, Germany
(Kuck) Asklepios-Klinik St. Georg, Hamburg, Germany
(Hochadel, Senges) Institut fur Herzinfarktforschung, Universitat
Heidelberg, Ludwigshafen, Germany
(Fetsch) Institut fur Klinische Kardiovaskulare Forschung, Munich, Germany
(Tebbe) Klinikum Lippe-Detmold, Detmold, Germany
(Willich) Institute of Social Medicine, Epidemiology and Health Economics,
Charite Berlin, Berlin, Germany
(Stumpf) Gemeinschaftspraxis Kardiologie und Angiologie, Dresden, Germany
(Sabin) Elisabeth-Krankenhaus Essen, Essen, Germany
(Silber) Kardiologische Gemeinschaftspraxis und Praxisklinik Munchen,
Munich, Germany
(Richardt) Segeberger Klinikum, Segeberg, Germany
Title
Comparison between on-label versus off-label use of drug-eluting coronary
stents in clinical practice: Results from the German DES.DE-Registry.
Source
Clinical Research in Cardiology. 100 (8) (pp 701-709), 2011. Date of
Publication: August 2011.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background: Observational studies from the USA have demonstrated that
off-label use of drug-eluting stents (DES) is common. Data on off-label
use in Western Europe are limited. Methods: We analyzed the data of
consecutive patients receiving DES prospectively enrolled in the
multicenter German DES.DE registry (Deutsches Drug-Eluting Stent Register)
between October 2005 and October 2006. Off-label use was defined in the
presence of one of the following criteria: ST-elevation myocardial
infarction, in-stent stenosis, chronic total occlusion, lesions in a
bypass graft, in bifurcation or left main stem, stent length per lesion
>=32 mm, and vessel diameter <2.5 or >3.5 mm. Results: Overall, 4,295
patients were included in this analysis and divided into two groups: 2,366
(55.1%) received DES for off-label and 1,929 (44.9%) for on-label
indications. There were substantial differences in the rates of off-label
use at the participating hospitals. Patients with off-label DES more often
presented with high-risk features such as acute coronary syndrome,
cardiogenic shock, congestive heart failure, and more complex coronary
anatomy. Among hospital survivors, the incidence of the composite endpoint
of death, myocardial infarction and stroke (MACCE) (9.2 vs. 7.4%, p <
0.05), and target vessel revascularization (TVR) (11.3 vs. 9.1%, p < 0.05)
was increased in the off-label group at the 1-year follow-up. However, in
the multivariate analysis off-label use was not linked with an elevated
risk for MACCE (hazard ratio 0.86, 95% confidence interval 0.62-1.18) and
TVR (hazard ratio 1.05, 95% confidence interval 0.78-1.42). Conclusions:
In clinical practice, DES was very frequently used off-label. After
adjustment for confounding variables, off-label use was not associated
with an increase of adverse events. 2011 Springer-Verlag.

<14>
Accession Number
2011456952
Authors
Virzi L. Pemberton V. Ohye R.G. Tabbutt S. Lu M. Atz T.C. Barnard T.
Dunbar-Masterson C. Ghanayem N.S. Jacobs J.P. Lambert L.M. Lewis A. Pike
N. Pizarro C. Radojewski E. Teitel D. Xu M. Pearson G.D.
Institution
(Virzi, Lu) New England Research Institutes, Watertown, MA, United States
(Pemberton, Pearson) National Heart Lung, Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Ohye) University of Michigan Medical School, Ann Arbor, MI, United States
(Tabbutt) University of Pennsylvania School of Medicine, Philadelphia, PA,
United States
(Atz) Medical University of South Carolina, Charleston, SC, United States
(Barnard) Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,
United States
(Dunbar-Masterson) Children's Hospital Boston, Boston, MA, United States
(Ghanayem) Medical College of Wisconsin, Children's Hospital of Wisconsin,
Milwaukee, WI, United States
(Jacobs) University of South Florida College of Medicine, Tampa, FL,
United States
(Lambert) Primary Children's Hospital, Salt Lake City, UT, United States
(Lewis) University of Southern California, Los Angeles, CA, United States
(Pike) Children's Hospital Los Angeles, Los Angeles, CA, United States
(Pizarro) Jefferson Medical College, Philadelphia, PA, United States
(Radojewski) Hospital for Sick Children, Toronto, ON, Canada
(Teitel) University of California San Francisco, San Francisco, CA, United
States
(Xu) Duke University Medical Center, Durham, NC, United States
Title
Reporting adverse events in a surgical trial for complex congenital heart
disease: The Pediatric Heart Network experience.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (3) (pp 531-537),
2011. Date of Publication: September 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of this analysis was to evaluate a novel strategy
for reporting adverse events in the Pediatric Heart Network's randomized
surgical trial of systemic-pulmonary artery shunt versus right
ventricle-pulmonary artery conduit in infants with hypoplastic left heart
syndrome. The strategy was developed to align the reporting process with
the needs of a surgical trial while maintaining participant safety.
Methods: Adverse event reporting was analyzed for 2 groups of study
subjects: those randomized to a trial arm during a period in which a
standard adverse event reporting system was used (period 1) and those
randomized after institution of a system that focused serious adverse
event reporting on 6 sentinel events (period 2). The analysis encompassed
the period from randomization (Norwood surgery) to hospital discharge from
stage II surgery. Adverse event rates were compared using a Poisson
regression model for the number of events per subject. Results: From
period 1 to period 2, the rate of serious adverse events requiring
expedited reporting decreased as expected (0.42 vs 0.14/subject/month of
follow-up; P < .001). Subjects with a serious (sentinel) adverse event in
period 2 had a significantly higher rate of death and cardiac
transplantation. Conclusions: The new adverse event reporting system
successfully targeted subjects at highest risk, while decreasing the
administrative burden associated with adverse event reports. This
methodology may be of benefit in trials evaluating surgical or
device-based interventions and in critically ill populations where many
common clinical events would qualify as serious adverse events in the
context of a drug trial. Copyright 2011 by The American Association for
Thoracic Surgery.

<15>
Accession Number
2011452706
Authors
Schulz S. Mehilli J. Ndrepepa G. Dotzer F. Dommasch M. Kufner S. Birkmeier
K.A. Tiroch K. Byrne R.A. Schomig A. Kastrati A.
Institution
(Schulz, Mehilli, Ndrepepa, Dommasch, Kufner, Birkmeier, Tiroch, Byrne,
Schomig, Kastrati) Deutsches Herzzentrum, Technische Universitat,
Lazarettstr. 36, Munich 80636, Germany
(Schomig) 1. Medizinische Klinik, Klinikum Rechts der Isar, Technische
Universitat, Ismaninger Str. 22, Munich 81675, Germany
(Dotzer) Klinikum Garmisch-Partenkirchen, Zentrum fur Innere
Medizin/Kardiologie, Auenstrae 6, 82467 Garmisch-Partenkirchen, Germany
Title
Influence of abciximab on evolution of left ventricular function in
patients with non-ST-segment elevation acute coronary syndromes undergoing
PCI after clopidogrel pretreatment: Lessons from the ISAR-REACT 2 trial.
Source
Clinical Research in Cardiology. 100 (8) (pp 691-699), 2011. Date of
Publication: August 2011.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background: Abciximab reduced the combined endpoint of death, myocardial
infarction (MI) and target vessel revascularization in patients with
non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing
percutaneous coronary intervention (PCI) with stent implantation after a
600-mg loading dose of clopidogrel. The aim of the present study was to
investigate the impact of abciximab on the evolution of left ventricular
ejection fraction (LVEF) in these patients. Methods: The current study
included 1,158 patients enrolled in the randomized, double-blind
ISAR-REACT 2 (the Intracoronary Stenting and Antithrombotic Regimen: Rapid
Early Action for Coronary Treatment) trial who had paired angiograms
obtained at baseline and 6-8 months after randomization. Of them, 586
patients received abciximab and 572 patients received placebo. The primary
outcome analysis was LVEF at 6-8-month follow-up. Results: Baseline LVEF
was comparable in patients assigned to abciximab or placebo (53.2 +/- 12.6
vs. 53.7 +/- 12.1%; P = 0.393). At 6-8-month follow-up angiography, there
was no difference in LVEF between the abciximab and placebo groups (55.4
+/- 11.5 vs. 55.8 +/- 11.2%; P = 0.743). Subgroup analysis of patients
with elevated baseline troponin (>0.03 mug/L) also revealed comparable
LVEF at follow-up in both treatment groups (P = 0.527). The multivariate
analysis identified age, arterial hypertension, prior MI, prior coronary
artery bypass graft surgery, baseline LVEF, MI at 30 days and repeat PCI
as independent correlates of follow-up LVEF. Conclusion: Although
abciximab reduced the 30-day and 1-year incidence of major adverse cardiac
events in patients with NSTE-ACS undergoing primary PCI after
pre-treatment with a 600-mg loading dose of clopidogrel, the agent did not
improve or impact on the evolution of LVEF over 6-8 months of follow-up.
2011 Springer-Verlag.

<16>
Accession Number
2011456948
Authors
Dahl J.S. Videbaek L. Poulsen M.K. Pellikka P.A. Veien K. Andersen L.I.
Haghfelt T. Moller J.E.
Institution
(Dahl, Videbaek, Poulsen, Veien, Haghfelt) Department of Cardiology,
Odense University Hospital, Sdr Boulevard, 5000 Odense C, Denmark
(Pellikka) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Andersen) Department of Thoracic Surgery, Odense University Hospital,
Odense, Denmark
(Moller) Department of Cardiology, Heart Center, Copenhagen University
Hospital Rigshospitalet, Copenhagen, Denmark
Title
Noninvasive assessment of filling pressure and left atrial pressure
overload in severe aortic valve stenosis: Relation to ventricular
remodeling and clinical outcome after aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (3) (pp e77-e83),
2011. Date of Publication: September 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: One of the hemodynamic consequences of aortic valve stenosis is
pressure overload leading to left atrial dilatation. Left atrial size is a
known risk factor providing prognostic information in several cardiac
conditions. It is not known if this is also the case in patients with
aortic valve stenosis after aortic valve replacement. Methods: A total of
119 patients with severe aortic valve stenosis scheduled for aortic valve
replacement were evaluated preoperatively and divided into 2 groups
according to left atrial volume index (>=40 mL/m²).
Echocardiography was repeated 12 months after surgery. Patients were
followed up for 24 months. The primary end point was the composite end
point overall mortality and hospitalization due to congestive heart
failure. Results: Preoperative left atrial dilation was associated with
left ventricular hypertrophy and increased filling pressure. Preoperative
left atrial volume index was associated with persistent abnormalities in
left ventricular filling pressure and left ventricular mass index at 1
year after surgery. Event-free survival in patients with left atrial
volume index of 40 mL/m² or more at 1 year was 71% compared
with 88% in patients with left atrial volume index less than 40
mL/m² (P =.002). Patients with preoperative increased E/e'
ratio and left ventricular hypertrophy were at increased risk. In Cox
regression analysis after correcting for standard risk factors, left
atrial volume index was found to be the only significant predictor of the
composite end point. In a forward conditional multivariable model, left
atrial volume index 40 mL/m² or greater (hazard ratio, 4.2
[1.6-10.7]; P =.003) remained an independent predictor, whereas E/e' was
borderline significant (P =.06). Conclusions: In patients with symptomatic
severe aortic valve stenosis undergoing aortic valve replacement, left
atrial volume provides important prognostic information beyond standard
risk factors. Copyright 2011 by The American Association for Thoracic
Surgery.

<17>
Accession Number
2011456932
Authors
Acker M.A. Jessup M. Bolling S.F. Oh J. Starling R.C. Mann D.L. Sabbah
H.N. Shemin R. Kirklin J. Kubo S.H.
Institution
(Acker, Jessup) University of Pennsylvania, Philadelphia, PA, United
States
(Bolling) University of Michigan, Ann Arbor, MI, United States
(Oh) Mayo Clinic, Rochester, MI, United States
(Starling) Cleveland Clinic Foundation, Cleveland, OH, United States
(Mann) Baylor College of Medicine, Houston, TX, United States
(Sabbah) Henry Ford Hospital, Detroit, MI, United States
(Shemin) University of California, Los Angeles, Los Angeles, CA, United
States
(Kirklin) University of Alabama at Birmingham, Birmingham, AL, United
States
(Kubo) Acorn Cardiovascular, St Paul, MI, United States
Title
Mitral valve repair in heart failure: Five-year follow-up from the mitral
valve replacement stratum of the Acorn randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (3) (pp 569-574.e1),
2011. Date of Publication: September 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The study objective was to evaluate the long-term (5-year)
safety and efficacy of mitral valve surgery with and without the CorCap
cardiac support device (Acorn Cardiovascular, St Paul, Minn) in patients
with dilated cardiomyopathy and New York Heart Association class II-IV
heart failure. Background: The Acorn trial provided a unique opportunity
to assess the long-term safety and efficacy of mitral valve surgery
because clinical visits and echocardiograms (read by a core laboratory)
were completed for 5 years of follow-up. Further, this study provided
follow-up data on the long-term effect of the CorCap cardiac support
device as an adjunct to mitral valve surgery. Methods: From the original
Acorn trial (n = 300 patients), 193 patients were enrolled in the mitral
valve repair/replacement stratum. A total of 102 were randomized to mitral
valve surgery alone (control group) and 91 were randomized to mitral valve
surgery with implantation of the CorCap cardiac support device (treatment
group). Patients were followed up for 5 years. Results: As previously
reported, 30-day operative mortality was only 1.6%. At 5 years, the total
mortality was 30% with an average annual mortality rate of approximately
6% per year. The effects of mitral valve surgery led to a progressive
decrease in left ventricular end-diastolic and end-systolic volumes, which
were highly significant at all time points. At the end of 5 years, there
was an average reduction in left ventricular end-diastolic volume of 75
mL, which represents a 28% reduction from baseline. During 5 years of
follow-up, 29 patients had recurrent mitral regurgitation and 5 patients
underwent repeat mitral valve surgery. The addition of the CorCap device
led to greater decreases in left ventricular end-diastolic volume (average
difference of 16.5 mL; P = .05), indicating that the CorCap device had an
additive effect to the mitral valve operation. Conclusions: This study
demonstrates long-term improvement in left ventricular structure and
function after mitral valve surgery for up to 5 years. These data provide
evidence supporting mitral valve repair in combination with the Acorn
CorCap device for patients with nonischemic heart failure with severe left
ventricular dysfunction who have been medically optimized yet remain
symptomatic with significant mitral regurgitation. Copyright 2011 by The
American Association for Thoracic Surgery.

<18>
Accession Number
21518677
Authors
Garg S. Sarno G. Gutierrez-Chico J.L. Garcia-Garcia H.M. Gomez-Lara J.
Serruys P.W. ARTS-II investigators
Institution
(Garg) Department of Interventional Cardiology, Erasmus MC, Rotterdam, The
Netherlands.
Title
Five-year outcomes of percutaneous coronary intervention compared to
bypass surgery in patients with multivessel disease involving the proximal
left anterior descending artery: an ARTS-II sub-study.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
6 (9) (pp 1060-1067), 2011. Date of Publication: Apr 2011.
Abstract
The aim of this study was to compare the 5-year outcomes of patients with
multivessel disease (MVD) involving the proximal left anterior descending
(LAD) artery who were treated with sirolimus drug-eluting stents (SES),
bare metal stents (BMS) and coronary artery bypass surgery (CABG).
Clinical outcomes were compared between the 682 patients enrolled in the
ARTS-I and ARTS-II study who had MVD involving the proximal LAD, and were
treated with BMS (27.4%), CABG (30.2%), and SES (42.4%). At 5-year
follow-up the primary endpoint of major adverse cardiovascular and
cerebrovascular events (MACCE) occurred in 33.7%, 18.0% and 24.9% of
patients treated with BMS, CABG and SES, respectively (BMS vs. SES p=0.04,
CABG vs. SES p=0.07). Unadjusted and adjusted rates of mortality and
death/stroke/myocardial infarction (safety) were comparable between all
three treatments. Repeat revascularisation was significantly lower
following CABG irrespective of adjustment. The absolute difference in
MACCE between patients with a logistic EuroSCORE above and below the mean
(i.e., 2.09%) was 18.8% (p=0.001), and 1.9% (p=0.28) for CABG and SES,
respectively. In patients with a high EuroSCORE, SES was a significantly
safer treatment (p=0.04) whilst repeat revascularisation remained lower
with CABG irrespective of the EuroSCORE. At 5-year follow-up CABG has
comparable safety, and superior efficacy in terms of reducing repeat
revascularisation compared to BMS and SES in the treatment of patients
with MVD involving the proximal LAD however, appropriate patient selection
remains imperative.

<19>
Accession Number
2011441821
Authors
Dzierwa K. Pieniazek P. Musialek P. Piatek J. Tekieli L. Podolec P. Drwila
R. Hlawaty M. Trystula M. Motyl R. Sadowski J.
Institution
(Dzierwa, Pieniazek, Musialek, Piatek, Tekieli, Podolec, Drwila, Hlawaty,
Motyl, Sadowski) Department of Cardiac and Vascular Diseases, Jagiellonian
University, Cracow, Poland
(Dzierwa, Pieniazek, Musialek, Tekieli, Podolec, Hlawaty, Motyl) John Paul
II Hospital, Cracow, Poland
(Piatek, Drwila, Trystula) Department of Cardiovascular Surgery and
Transplantation, Division of Endovascular Surgery, Jagiellonian
University, Cracow, Poland
(Trystula) Center of Clinical Neurology, Crakow, Poland
Title
Treatment strategies in severe symptomatic carotid and coronary artery
disease.
Source
Medical Science Monitor. 17 (8) (pp RA191-RA197), 2011. Date of
Publication: 2011.
Publisher
International Scientific Literature Inc. (1125 Willis Ave., Albertson NY
11507, United States)
Abstract
Coexistent carotid artery stenosis (CS) and multivessel coronary artery
disease (CAD) is not infrequent. One in 5 patients with multivessel CAD
has a severe CS, and CAD incidence reaches 80% in those referred for
carotid revascularization. We reviewed treatment strategies for
concomitant severe CS and CAD. We performed a literature search (MEDLINE)
with terms including carotid artery stenting (CAS), coronary artery bypass
grafting (CABG), carotid endarterectomy (CEA), stroke, and myocardial
infarction (MI). The main therapeutic option for CS-CAD has been
(simultaneous or staged) CEA-CABG. This, however, is associated with a
high risk of MI (in those with CEA prior to CABG) or stroke (CABG prior to
CEA), and the cumulative major adverse event rate (MAE - death, stroke or
MI) reaches 10-12%. With increasing adoption of CAS, a sequential strategy
of CAS followed by CABG has emerged. Registries (usually single-centre)
indicate an MAE rate of 7% for CAS followed by CABG (frequently after >30
days, due to double antiplatelet therapy). Recently, 1-stage CAS-CABG has
been introduced. This involves different antiplatelet regimens and, in
some centers, preferred offpump CABG, with a cumulative MAE of 1.4-4.5%.
No randomized trial comparing different treatment strategies in CS-CAD has
been conducted, and thus far reported series are prone to
selection/reporting bias. In addition to the established surgical
treatment (CEA-CABG, sequential/simultaneous), hybrid revascularization
(CAS-CABG) is emerging as a viable therapeutic option. Larger, preferably
multi-centre, studies are required before this can become widely applied.
Med Sci Monit.

<20>
Accession Number
2011447124
Authors
Miller C.D. Hwang W. Case D. Hoekstra J.W. Lefebvre C. Blumstein H.
Hamilton C.A. Harper E.N. Hundley W.G.
Institution
(Miller, Hoekstra, Lefebvre, Blumstein, Harper) Department of Emergency
Medicine, Wake Forest School of Medicine, Medical Center Boulevard,
Winston-Salem, NC 27357, United States
(Hwang) Department of Social Sciences and Health Policy, Division of
Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC,
United States
(Case) Department of Biostatistical Sciences, Division of Public Health
Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
(Hamilton) Department of Biomedical Engineering, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Hundley) Department of Internal Medicine, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Hundley) Departments of Cardiology and Radiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Title
Stress CMR imaging observation unit in the emergency department reduces
1-year medical care costs in patients with acute chest pain: A randomized
study for comparison with inpatient care.
Source
JACC: Cardiovascular Imaging. 4 (8) (pp 862-870), 2011. Date of
Publication: August 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to compare the direct cost of medical care
and clinical events during the first year after patients with intermediate
risk acute chest pain were randomized to stress cardiac magnetic resonance
(CMR) observation unit (OU) testing versus inpatient care. Background: In
a recent study, randomization to OU-CMR reduced median index
hospitalization cost compared with the cost of inpatient care in patients
presenting to the emergency department with intermediate risk acute chest
pain. Methods: Emergency department patients with intermediate risk chest
pain were randomized to OU-CMR (OU care, cardiac markers, stress CMR) or
inpatient care (admission, care per admitting provider). This analysis
reports the direct cost of cardiac-related care and clinical outcomes
(myocardial infarction, revascularization, cardiovascular death) during
the first year of follow-up subsequent to discharge. Consistent with
health economics literature, provider cost was calculated from
work-related relative value units using the Medicare conversion factor;
facility charges were converted to cost using departmental-specific
cost-to-charge ratios. Linear models were used to compare cost
accumulation among study groups. Results: We included 109 randomized
subjects in this analysis (52 OU-CMR, 57 inpatient care). The median age
was 56 years; baseline characteristics were similar in both groups. At 1
year, 6% of OU-CMR and 9% of inpatient care participants experienced a
major cardiac event (p = 0.72) with 1 patient in each group experiencing a
cardiac event after discharge. First-year cardiac-related costs were
significantly lower for participants randomized to OU-CMR than for
participants receiving inpatient care (geometric mean = $3,101 vs. $4,742
including the index visit [p = 0.004] and $29 vs. $152 following discharge
[p = 0.012]). During the year following randomization, 6% of OU-CMR and 9%
of inpatient care participants experienced a major cardiac event (p =
0.72). Conclusions: An OU-CMR strategy reduces cardiac-related costs of
medical care during the index visit and over the first year subsequent to
discharge, without an observed increase in major cardiac events. (Cost
Comparison of Cardiac Magnetic Resonance Imaging [MRI] Use in Emergency
Department [ED] Patients With Chest Pain; NCT00678639) 2011 American
College of Cardiology Foundation.

<21>
Accession Number
21550906
Authors
Kereiakes D.J. Smits P.C. Kedhi E. Parise H. Fahy M. Serruys P.W. Stone
G.W.
Institution
(Kereiakes) The Christ Hospital Heart and Vascular Center/The Lindner
Research Center, Cincinnati, Ohio 45219, USA.
Title
Predictors of death or myocardial infarction, ischaemic-driven
revascularisation, and major adverse cardiovascular events following
everolimus-eluting or paclitaxel-eluting stent deployment: pooled analysis
from the SPIRIT II, III, IV and COMPARE trials.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
7 (1) (pp 74-83), 2011. Date of Publication: May 2011.
Abstract
Although clinical trials have demonstrated superior clinical efficacy and
improved safety of the everolimus-eluting stent (EES) compared with
paclitaxel-eluting stents (PES) the clinical, angiographic and procedural
factors associated with adverse clinical outcomes following drug-eluting
stent (DES) deployment have not been carefully analysed. We performed a
patient-level pooled database analysis from the SPIRIT II, III, IV and
COMPARE prospective randomised (EES versus PES) trials which enrolled
6,789 patients undergoing coronary stenting with follow-up through two
years. To determine independent predictors of death, myocardial infarction
(MI), ischaemia-driven revascularisation (target lesion [ID-TLR] or target
vessel [ID-TVR]), and major adverse cardiovascular events ([MACE];
composite occurrence of cardiovascular death, MI, ID-TLR), we analysed
clinical, angiographic and procedural variables using Cox proportional
hazard stepwise regression analysis. Treatment with EES (versus PES) was a
powerful, independent predictor of relative freedom from MI (HR [95% CI]=
0.54 [0.41, 0.71]; p<0.0001), cardiac death or MI (0.63 [0.49, 0.80];
p=0.0002), ID-TLR (0.59 [0.47, 0.74]; p<0.0001), ID-TVR (0.70 [0.58,0.84];
p=0.0002) and MACE (0.64 [0.54, 0.77]; p<0.0001). Both diabetes and the
extent of coronary artery disease as reflected by the number of lesions
treated were predictive of cardiac death, ID-TLR, ID-TVR, MI and MACE.
This multivariate analysis identified independent predictors of adverse
outcomes to two years following DES deployment. Treatment with EES (versus
PES) is an independent predictor of freedom from MI, cardiac death or MI,
ID-TLR, ID-TVR and MACE.

<22>
Accession Number
2011445877
Authors
Bilotta F. Doronzio A. Stazi E. Titi L. Zeppa I.O. Cianchi A. Rosa G.
Paoloni F.P. Bergese S. Asouhidou I. Ioannou P. Abramowicz A.E. Spinelli
A. Delphin E. Ayrian E. Zelman V. Lumb P.
Institution
(Bilotta, Doronzio, Stazi, Titi, Zeppa, Cianchi, Rosa) Department of
Anaesthesiology, Critical Care and Pain Medicine, Sapienza University of
Rome, Policlinico Umberto I, Rome, Italy
(Paoloni) GIMEMA, Data Center, Rome, Italy
(Bergese) Departments of Anesthesiology and Neurological Surgery, The Ohio
State University, Columbus, OH, United States
(Asouhidou, Ioannou) Second Department of Anesthesiology G.Papanikolaou
General Hospital, Exohi Thessaloniki, Greece
(Abramowicz, Spinelli, Delphin) Department of Anesthesiology, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, The Bronx,
NY, United States
(Ayrian, Zelman, Lumb) Department of Anesthesiology, University of
Southern California, Los Angeles, CA, United States
Title
Early postoperative cognitive dysfunction and postoperative delirium after
anaesthesia with various hypnotics: Study protocol for a randomised
controlled trial - The PINOCCHIO trial.
Source
Trials. 12 , 2011. Article Number: 170. Date of Publication: 06 Jul
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Postoperative delirium can result in increased postoperative
morbidity and mortality, major demand for postoperative care and higher
hospital costs. Hypnotics serve to induce and maintain anaesthesia and to
abolish patients' consciousness. Their persisting clinical action can
delay postoperative cognitive recovery and favour postoperative delirium.
Some evidence suggests that these unwanted effects vary according to each
hypnotic's specific pharmacodynamic and pharmacokinetic characteristics
and its interaction with the individual patient.We designed this study to
evaluate postoperative delirium rate after general anaesthesia with
various hypnotics in patients undergoing surgical procedures other than
cardiac or brain surgery. We also aimed to test whether delayed
postoperative cognitive recovery increases the risk of postoperative
delirium.Methods/Design: After local ethics committee approval, enrolled
patients will be randomly assigned to one of three treatment groups. In
all patients anaesthesia will be induced with propofol and fentanyl, and
maintained with the anaesthetics desflurane, or sevoflurane, or propofol
and the analgesic opioid fentanyl.The onset of postoperative delirium will
be monitored with the Nursing Delirium Scale every three hours up to 72
hours post anaesthesia. Cognitive function will be evaluated with two
cognitive test batteries (the Short Memory Orientation Memory
Concentration Test and the Rancho Los Amigos Scale) preoperatively, at
baseline, and postoperatively at 20, 40 and 60 min after
extubation.Statistical analysis will investigate differences in the
hypnotics used to maintain anaesthesia and the odds ratios for
postoperative delirium, the relation of early postoperative cognitive
recovery and postoperative delirium rate. A subgroup analysis will be used
to categorize patients according to demographic variables relevant to the
risk of postoperative delirium (age, sex, body weight) and to the
preoperative score index for delirium.Discussion: The results of this
comparative anaesthesiological trial should whether each the three
hypnotics tested is related to a significantly different postoperative
delirium rate. This information could ultimately allow us to select the
most appropriate hypnotic to maintain anaesthesia for specific subgroups
of patients and especially for those at high risk of postoperative
delirium.Registered at Trial.gov Number: ClinicalTrials.gov: NCT00507195.
2011 Bilotta et al; licensee BioMed Central Ltd.

<23>
Accession Number
2011444005
Authors
Singh J.A.
Institution
(Singh) Medicine Service, Birmingham VA Medical Center and Department of
Medicine, University of Alabama, Birmingham, AL 35294, United States
(Singh) Center for Surgical Medical acute Care Research and Transitions,
Birmingham VA Medical Center, Birmingham, AL 35205, United States
(Singh) Division of Epidemiology, School of Public Health, University of
Alabama, Birmingham, AL 35294, United States
(Singh) Departments of Health Sciences Research and Orthopedic Surgery,
Mayo Clinic School of Medicine, Rochester, MN 55905, United States
Title
Advances in gout: Some answers, more questions.
Source
Arthritis Research and Therapy. 12 (5) , 2010. Article Number: 136.
Date of Publication: 24 Sep 2010.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
In a previous issue of the journal, Becker and colleagues present efficacy
and safety data from a large study comparing febuxostat to allopurinol.
The study showed non-inferiority of febuxostat 40 mg/day in lowering serum
urate compared to allopurinol 200 to 300 mg/day. More importantly, the
study showed a similar frequency of important cardiovascular adverse
events (cardiovascular death, nonfatal myocardial infarction and nonfatal
stroke) for febuxostat 40 mg/day (0%), febuxostat 80 mg/day (0.4%) and
allopurinol groups (0.4%). Other cardiac adverse event rates (unstable
angina, coronary revascularization, cerebral revascularization, transient
ischemic attack, venous and peripheral arterial vascular thrombotic event,
congestive heart failure, and arrhythmia) were also similar for febuxostat
40 mg/day (1.3%), febuxostat 80 mg/day (1.2%) and allopurinol groups
(0.9%). A meta-analysis of safety data from published studies is
presented. 2010 BioMed Central Ltd.

<24>
Accession Number
70504823
Authors
Miceli A. Concistre G. Gilmanov D. Chiaramonti F. Murzi M. Varone E.
Caputo M. Angelini G.D. Glauber M.
Institution
(Miceli, Concistre, Gilmanov, Chiaramonti, Murzi, Varone, Glauber)
Fondazione G. Monasterio, CNR-Regione Toscana, Cardiothoracic, Massa,
Italy
(Miceli, Caputo, Angelini) Bristol Heart Institute, Bristol, United
Kingdom
Title
Renin-angiotensin antagonism systems and acute kidney injury after cardiac
surgery. A meta analysis of over 20,000 patients.
Source
Heart Surgery Forum. Conference: 21st World Congress World Society of
Cardio-Thoracic Surgeons Berlin Germany. Conference Start: 20110612
Conference End: 20110615. Conference Publication: (var.pagings). 14 (pp
S107), 2011. Date of Publication: June 2011.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objectives: Acute kidney injury (AKI) after cardiac surgery is associated
with an increased risk of mortality. Several studies report controversial
results with regard to the effect of angiotensin converting enzyme
inhibitors (ACEI) and angiotensin receptor blockers (ARB) on postoperative
renal function. The aim of the study was to estimate the risk of
preoperative angiotensin antagonism on AKI in patients undergoing cardiac
surgery. Methods: A systematic review of all studies reporting the impact
of preoperative ACEI/ARB therapy on the incidence of AKI after cardiac
surgery was performed. Results: Six observational studies were identified
reporting the incidence of postoperative AKI in 22,304 patients having
cardiac surgery with (n = 8216, 36.8%) or without (n = 14,088; 63.2%)
preoperative ACEI/ARB use. Postoperative AKI was significantly higher
(8.6% versus 6%, P < .0001) in patients undergoing cardiac surgery who
received preoperative ACEI/ARB treatment compared with controls. Pooled
analysis showed a 41% of increased in the risk of AKI (OR 1.41, 95%CI 1.07
to 1.87; P = .01 for overall effect) in patients receiving ACEI/ARB
therapy before cardiac surgery. Conclusions: Cumulative analysis of
studies currently available in literature documents that preoperative
angiotensin antagonism therapy is associated with increased in the risk of
postoperative acute kidney injury. Randomized trials need to confirm these
data.

<25>
Accession Number
70504705
Authors
Dawson A.G. Buchan K.G.
Institution
(Dawson, Buchan) Aberdeen Royal Infirmary, Department of Cardiothoracic
Surgery, Aberdeen, United Kingdom
Title
Is colorectal pulmonary metastatectomy worthwhile?.
Source
Heart Surgery Forum. Conference: 21st World Congress World Society of
Cardio-Thoracic Surgeons Berlin Germany. Conference Start: 20110612
Conference End: 20110615. Conference Publication: (var.pagings). 14 (pp
S63), 2011. Date of Publication: June 2011.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objectives: It has recently been suggested by a leading UK thoracic
surgeon that colorectal pulmonary metastatectomy should only be offered in
the context of a randomised controlled trial (Treasure T, et al. When
professional opinion is not enough. BMJ. 2007;334:831). We believe that
this is not a majority view amongst thoracic surgeons and reviewed a
single surgeon's experience with pulmonary metastatectomy over a 7-year
period in order to demonstrate the effectiveness of the procedure.
Methods: A retrospective case note review of 18 patients undergoing
colorectal pulmonary metastatectomy was performed. Demographic details
along with the number of thoracic operations required and history of
hepatectomy were recorded. Survival data were calculated from the date of
the initial thoracic operation to the date of death or date of censoring
(18 February 2011), whichever came first. Descriptive statistics were
employed to analyse outcomes and the Kaplan-Meier method was used to
report survival in the cohort. Results: Between the years 2003 and 2010,
18 patients underwent colorectal pulmonary metastatectomy. In 13 patients
(72%), the procedure involved resecting a single isolated deposit, whilst
5 (28%) required bilateral pulmonary resections for disease control. Eight
patients (44%) underwent hepatic metastatectomy prior to pulmonary
resection. The operative procedures comprised wedge resection (14),
lobectomy (3), and pneumonectomy (1). There were no perioperative deaths.
Data for 3- and 5-year survival were available for 14 and 5 patients,
respectively, culminating in 3- and 5-year survival rates of 71% (10/14)
and 60% (3/5), respectively. All 14 survivors remain disease free at
follow-up. Conclusion: Although these numbers are small they do indicate a
highly satisfactory outcome for what is usually a minor thoracic surgical
operation. We believe patients should be given the option of pulmonary
metastatectomy when operable colorectal metastases are present whether
within a randomised controlled trial or not.

<26>
Accession Number
70504700
Authors
Sivaraman A.
Institution
(Sivaraman) Madras Medical College, Department of Cardiothoracic Surgery,
Chennai, India
Title
Efficacy of intrapleural instillation of tranexamic acid for the control
of postoperative bleeding following pulmonary resections for chronic
inflammatory pulmonary diseases. A randomized clinical trial.
Source
Heart Surgery Forum. Conference: 21st World Congress World Society of
Cardio-Thoracic Surgeons Berlin Germany. Conference Start: 20110612
Conference End: 20110615. Conference Publication: (var.pagings). 14 (pp
S61), 2011. Date of Publication: June 2011.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Introduction: Postoperative micro vascular bleeding following pulmonary
resections is adding considerable morbidity and increases the need for
more blood transfusion. We aim to study the effectiveness of intrapleural
instillation of tranexamic acid (TA) to control postoperative bleeding in
patients undergoing various types of pulmonary resections for chronic
inflammatory pulmonary diseases (CIPD). Methods: Forty consecutive adult
patients with CIPD (patients with bleeding diathesis excluded) scheduled
for various types of pulmonary resection ranging from wedge resection to
pneumonectomy were assigned randomly to receive either intrapleural
instillation of TA (1 g of drug mixed with 100 mL of normal saline
[Group1]) or 100 mL of normal saline alone (Group 2) on closure of
thoracotomy wound after adequate control of obvious bleeding cut vessels.
A minimum contact time of 1 hour kept before allowing for chest drainage.
Complete blood counts and bleeding and clotting times were done pre- and
postoperatively. Postoperative blood loss and blood transfusion
requirements were compared. Results: Significant postoperative bleeding
was noted in group 2 when compared with group 1. The mean total blood loss
was 226 mL +/- 168 mL in group 1 and 538 mL +/- 292 mL in group 2 (P <
.001). Blood transfusion requirement was lower in group 1 (20%) when
compared to group 2 (60%) (Odds ratio = 0.1667). No thrombotic events
noted. Limitations of our study: 1. Only a small volume of patients was
studied, and a large volume for meta-analysis is needed. 2. Lack of
multicenter study in CIPD patients for comparison. Conclusion: Our
short-term study results showed intrapleural instillation of TA is
beneficial to reduce the postoperative bleeding and blood transfusion
requirements in patients undergoing pulmonary resections for CIPD.
Moreover, the use of TA didn't increase thrombotic complications.

<27>
Accession Number
70504574
Authors
Milanez A.M. Dallan L.A. Lisboa L.F. Vianna C.B. Cabeda E. Parga J.R.
Stolf N.G.
Institution
(Milanez, Dallan, Lisboa, Stolf) Heart Institute (InCor), University of
Sao Paulo Medical School, Coronary Surgery, Sao Paulo, Brazil
(Vianna) Heart Institute (InCor), University of Sao Paulo Medical School,
Chronic Coronary Disease, Sao Paulo, Brazil
(Cabeda, Parga) Heart Institute (InCor), University of Sao Paulo Medical
School, Tomography, Sao Paulo, Brazil
Title
Robotic left internal mammary artery harvesting for single vessel
minimally invasive coronary bypass: A randomized controlled trial.
Source
Heart Surgery Forum. Conference: 21st World Congress World Society of
Cardio-Thoracic Surgeons Berlin Germany. Conference Start: 20110612
Conference End: 20110615. Conference Publication: (var.pagings). 14 (pp
S13), 2011. Date of Publication: June 2011.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective: The aim of this study is to compare the patency of left
internal mammary artery (LIMA) robotically harvested to left anterior
descendent (LAD) artery minimally invasive bypass with conventional LIMA
to LAD off-pump bypass. Method: From 2007 to 2010, 36 patients were
randomized to either LIMA robotically harvested to LAD artery minimally
invasive bypass or standard LIMA to LAD off-pump bypass. Patients assigned
to robotic group underwent robotic endoscopic harvesting of LIMA with the
AESOP system followed by a small left thoracotomy in the 4th intercostal
space for off-pump LAD bypass. Patients assigned to standard group
underwent full median sternotomy, open LIMA harvesting followed by
off-pump LAD bypass. Transit time flow measurement (Medi-Stim Butterfl y
Medtronic Inc., Minneapolis, MN) was used for intraoperative evaluation of
LIMA to LAD patency. After a mean 24-month follow-up, Multislice Computed
Tomography (Aquilion ONE 320, Toshiba America Medical Systems, Inc.,
Tustin, CA) was used to evaluate LIMA to LAD midterm patency. Results: The
mean LIMA harvesting time in robotic group was 50.8 +/- 11.2 minutes
versus 22.7 +/- 3.4 minutes in conventional group. There was no
significant difference in intraoperative LIMA to LAD flow between robotic
and conventional groups (46.18 +/- 20.73 mL/min versus 48.65 +/- 24.15
mL/min, P = .84). There were no significant differences in incidence of
wound infection (0 versus 2, P = .484) and reoperation for bleeding (0
versus 1, P = 1.00) between robotic and conventional groups respectively.
In robotic group, Multislice CT revealed patent LIMA graft in 18 (100%)
patients versus 17 (94.4%) patients in conventional group (P = 1.00).
There was no mortality in the study group. Conclusions: Minimally invasive
LAD bypass using LIMA graft robotically harvested was safe and feasible.
Early and mid-term LIMA patency was similar between both techniques.

<28>
Accession Number
70504306
Authors
Appleby C. Kemp I. Stables R.H.
Institution
(Appleby, Kemp, Stables) Liverpool Heart and Chest Hospital, Liverpool,
United Kingdom
Title
Patient vs physician reported angina before and after revascularisation of
coronary artery disease: Evidence from a large randomised controlled trial
(the SOS trial).
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2011
Manchester United Kingdom. Conference Start: 20110613 Conference End:
20110615. Conference Publication: (var.pagings). 97 (pp A27-A28), 2011.
Date of Publication: June 2011.
Publisher
BMJ Publishing Group
Abstract
Introduction: The success of revascularisation therapies for coronary
artery disease (CAD) must be measured by both an improvement in hard
clinical endpointsdmortality, repeat revascularisation procedures and
myocardial infarction, the traditional focus of clinical trialsdand,
critically for patients, the relief of angina symptoms. Interest in
patient reported outcomes (PROMs) has increased, although their use in
cardiovascular trials is far from universal. In particular the differences
between physician and patient reported outcomes has not been analysed.
High quality data from the Stent or Surgery (SOS) trial allows such an
analysis. Methods: The SoS trial was a large RCT (n=988) comparing
stentassisted percutaneous coronary intervention (PCI) with coronary
artery bypass grafting (CABG) in patients with multivessel CAD.
Participation in the SoS trial included an appraisal of angina symptoms by
both patient and physician according to the Canadian Cardiovascular
Society (CCS) Classification System prior to, and subsequently at 6 and 12
months following coronary intervention. In this study patient and doctor
reported outcomes were compared systematically. Results: Paired CCS scores
at baseline, 6 months and 12 months were available for 919, 886 and 888
cases respectively. At baseline the overall level of agreementwas good
with>75%paired data sets demonstrating a difference of<=+/-1 CCS class.
Patterns of discordance change however between baseline and follow-up
timepoints.Abstract 40 figure 1 shows the paired scores at baseline,
charting the patient score and, for each CCS grade, the observed
differenceddoctor (D) minus patient (P). Doctors are reluctant to record
scores of 0 or 4, preferring CCS grades 2 and 3. Thus there is little
overall difference inmean CCS score (P 2.2 vs D 2.5, p<0.001). Yet at
follow-up, doctors record freedomfromangina (CCS=0) in a more substantial
proportion of the population, considerably more so than patients
self-report (p<0.0001) (Abstract 40 figure 2). The published results of
the SOS trial used doctor gradings to report freedom from angina at 1 year
in 79% of CABG patients vs 66% of PCI patients (p<0.0001). If patient
gradings are used instead these figures are reduced to 57% in CABG and 44
% in PCI (p<0.0001), rendering both treatment strategies significantly
less effective at relieving angina from a patients perspective (p<0.0001),
Abstract 40 table 1. (Figure presented) Conclusions This is the first
randomised study to compare the improvement in angina status reported by
patients and clinicians following revascularisation therapy for coronary
artery disease. The observed trend for doctors to insist that all patients
must have some symptoms at baseline, and more importantly, to suggest that
a greater proportion of patients have been rendered symptom free at
follow-up (than is suggested by self-reported estimates) has important
implications and may call into question our current understanding of the
impact of revascularisation.

<29>
Accession Number
70504305
Authors
Alahmar A. A Perry R. Stables R.H.
Institution
(Alahmar) Leicester University Hospital Glenfield, Leicester, United
Kingdom
(A Perry, Stables) Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Title
A randomised controlled trial comparing conventional coronary artery
bypass graft surgery with a composite arterial graft technique.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2011
Manchester United Kingdom. Conference Start: 20110613 Conference End:
20110615. Conference Publication: (var.pagings). 97 (pp A27), 2011.
Date of Publication: June 2011.
Publisher
BMJ Publishing Group
Abstract
Background: Composite (Y/T) coronary artery bypass graft surgery (CABG)
confers full arterial revascularisation, and "hands off " aorta compared
to conventional bypass graft surgery. However, the composite surgical
configuration could lead to preferential blood flow down one armthan the
other (left internal mammary artery LIMA or radial artery RA) with its
potential impact on graft patency. Aim To investigate the impact of bypass
graft configuration on short-term grafts patency and cardiac related
quality of life. Methods: and Results: This is a single centre randomised,
controlled trial Between March 2006 and July 2007, 322 patients undergoing
isolated bypass graft surgery at our institution were screened and 89
(27%) met the inclusion criteria and were randomised. Patients were
allocated to conventional (conv n=46) or composite (comp n=43). The two
primary end points were graft patency defined as (Thrombolysis In
Myocardial Infarction) TIMI III flow in distal anastomosis at angiography
12e24 months after surgery, and cardiac-related health status assesses by
Seattle angina questionnaire (SAQ). Baseline characteristics were similar
between the two groups apart fromdiabetes where there were more diabetic
patients in the composite arm than the conventional one (15(35%) vs 5(11%)
p<0.01 respectively). Trial was stopped prematurely following 18 months
interim analysis which showed significant graft failure in the composite
arm (40%). Final Analysis was performed on intention to treat basis.
Sixty-five (73%) had follow-up angiography(34 conv, 31 comp), with total
of 116 graft in conventional arm and 100 grafts in composite arm. All
patients in both groups had LIMAgraft to left anterior descending artery
(LAD). Graft patency rate was significantly higher in the conventional
compared to composite arm (95(82%) vs 59(59%) p<0.001 respectively). Three
main domains of the SAQs there was significant improvement between before
and 6 months after surgery in both groups. There were no significant
differences between the two groups in the percentage of improvement in
these four domains (Physical limitation, Angina stability, Angina
frequency, Quality of life). Conclusions In our randomised trial,
composite bypass graft surgery was associated with higher graft failure
rate at 12-24 months after surgery compared to conventional type. This
difference may be due to the composite conduit configuration. Further
blood flow characteristics study in this configuration can help understand
such an important finding and its implication on our clinical practice.
Despite the difference in graft patency there were no differences in
physical limitation, angina stability, angina frequency, or quality of
life between the two groups.

<30>
Accession Number
70504292
Authors
Khawaja M.Z. Haran H. Nadra I. Wilson K. Clack L. Macgillivray K. Hancock
J. Young C. Bapat V. Thomas M. Redwood S.
Institution
(Khawaja, Nadra, Wilson, Clack, Macgillivray, Hancock, Young, Bapat,
Thomas, Redwood) Guy's and St. Thomas' Hospitals NHS Foundation Trust,
London, United Kingdom
(Haran) King's College School Of Medicine and Dentristry, London, United
Kingdom
Title
The effects of pre-existing significant coronary artery disease upon
outcome after transcatheter aortic valve implantation using the edwards
bioprosthesis.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2011
Manchester United Kingdom. Conference Start: 20110613 Conference End:
20110615. Conference Publication: (var.pagings). 97 (pp A19-A20), 2011.
Date of Publication: June 2011.
Publisher
BMJ Publishing Group
Abstract
Introduction: Patients undergoing surgical aortic valve replacement (sAVR)
routinely undergo simultaneous coronary artery bypass grafting (CABG) for
significant coronary artery disease (CAD) due to adverse prognostic
impact. While manufacturers advise percutaneous intervention (PCI) of
significant CAD prior to transcatheter aortic valve implantation (TAVI)
there is considerable variation among operators. Methods: We performed a
retrospective analysis of 168 patients who underwent TAVI using the
Edwards bioprosthesis from March 2008 to October 2010 at St. Thomas
Hospital, London. They were divided into two groups according to the
results of the pre-TAVI coronary angiogram: (Group 1) patients with >=1
coronary stenosis of >=70% severity and those without (Group 2). The
end-point was all-cause mortality. Results: In total, 70 patients (41.7%)
had significant CAD prior to TAVI, with 10 (6.0%) undergoing PCI prior to
their procedure. There were no significant differences in either the
baseline characteristics or access approach between the two groups
(Abstract 26 tables 1 and 2). At a mean follow-up of 335+/-277 days
(mean+/-SD), the overall mortality was 22.6%; Group 1 mortality was 30%
and in group 2 was 17.3% (p=0.124) (see Abstract 26 figure 1) There was no
difference seen in the length of stay in the intensive care unit
(2.7+/-6.2 vs 4.1+/-14.9 days, p=0.462) nor in the number of days to
discharge (12.6+/-10.1 vs 12.8+/-13, p=0.928). Among those patients who
underwent PCI in Group 1, 8 had single vessel intervention and 2 had PCI
to 2 vessels. The target vessels were left main stem (LMS) (n=2), proximal
left anterior descending artery (LAD) (n=5), circumflex (n=1), right
coronary artery (RCA) (n=2), saphenous vein graft (SVG) to LAD (n=1) and
SVG to circumflex (n=1). Mortality in this sub-group was not significantly
different from the CAD patients who did not receive PCI (50% vs 26.7%,
p=0.272). (Table presented) Conclusion: The presence of significant CAD
had no significant impact upon the all-cause mortality of patients after
TAVI in our (Figure presented) study. As yet, the impact of PCI to
significant CAD upon outcome after TAVI is not known and will be assessed
in a prospective, randomised controlled trial currently underway.

<31>
Accession Number
70505720
Authors
Arreola-Ornelas H. Rosado-Buzzo A. Garcia-Mollinedo L. Dorantes-Aguilar J.
Mucino-Ortega E. Mould-Quevedo J.F.
Institution
(Arreola-Ornelas, Rosado-Buzzo, Garcia-Mollinedo, Dorantes-Aguilar) Links
and Links, Mexico City, Mexico
(Mucino-Ortega, Mould-Quevedo) Pfizer S.A. de C.V., Mexico City, Mexico
Title
Cost-effectiveness of dalteparin in the management of unstable
angina/non-st-segment elevation myocardial infarction (UA/NSTEMI) events
in adult patients in Mexico.
Source
Value in Health. Conference: 15th Annual International Meeting of the
International Society for Pharmacoeconomics and Outcomes Research, ISPOR
2010 Atlanta, GA United States. Conference Start: 20100515 Conference End:
20100519. Conference Publication: (var.pagings). 13 (3 SUPPL. 3) (pp
A164), 2010. Date of Publication: May 2010.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: Updated clinical practice guidelines recommend antithrombotic
agents to minimize complications and deaths following UA/NSTEMI events.
The purpose of this study was to estimate the cost-effectiveness of
different antithrombotic agents in the management of UA/NSTEMI, from the
institutional perspective. METHODS: A seven-state Markov model was
performed to estimate health and economic consequences during a time
horizon of five weeks (one-week cycles). Effectiveness measures were
reduction in incidence of acute myocardial infarct (AMI) and recurrence of
angina, as well as avoided events of myocardial revascularization and
deaths associated to acute coronary syndrome. Transition probabilities
were obtained from a meta-analysis employing international published
literature. Doses of comparators were: dalteparin (240 UI/kg/day);
enoxaparin (2 mg/kg/day); fondaparinux(5 mg/ day); nadroparin(172
IU/kg/day) and unfractionated heparin(UFH 15,000 IU/day). Resource use was
obtained from the Social Security Mexican Institute hospital records (n =
5000). Costs were extracted from government and institutional sources and
include hospitalization, drugs, medical procedures, imagenology,
laboratory tests and adverse events management. Probabilistic sensitivity
analyses were performed employing bootstrapping techniques. Acceptability
curves were constructed. RESULTS: Dalteparin, enoxaparin, fondaparinux,
nadroparin and UHF (reference alternative) associated costs per patient
were: US$2501 (+19%), US$2531 (+20%), US$2226 (+6%), US$2556 (+21%) and
US$2179, respectively. Dalteparin is the only alternative that exhibits
better health outcomes than reference in all considered effectiveness
measures (p < 0.05 in AMI and myocardial revascularization). Incremental
costeffectiveness ratios (ICER [CI95%]) for dalteparin compared to UHF
were US$10,916 [US$10,703-US$11,128] and US$3,509 [US$3,440-US$3,577], per
additional AMI reduced and additional myocardial revascularization
avoided, respectively. At a willingness to pay of US$15,800 per additional
AMI avoided, acceptability curves showed that the probability that
dalteparin be cost-effective is close to one, while for enoxaparin is
negligible. CONCLUSIONS: Regarding AMI reduction and avoided myocardial
revascularization, dalteparin represents a cost-effective antithrombotic
therapy in Mexican patients who suffered UA/NSTEMI due its higher efficacy
and reasonable incremental costs.

<32>
Accession Number
70505667
Authors
Chawla A. Siddiqui M.K. Rai M.K.
Institution
(Chawla, Siddiqui, Rai) Heron Health Private Limited, Chandigarh, India
Title
Percutaneous coronary intervention compared with aortocoronary bypass in
diabetic patients with multivascular coronary disease.
Source
Value in Health. Conference: 15th Annual International Meeting of the
International Society for Pharmacoeconomics and Outcomes Research, ISPOR
2010 Atlanta, GA United States. Conference Start: 20100515 Conference End:
20100519. Conference Publication: (var.pagings). 13 (3 SUPPL. 3) (pp
A153), 2010. Date of Publication: May 2010.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: Diabetes patients with coronary artery disease represent a
population with high cardiovascular morbidity and mortality. The objective
of the study was to compare the long-term effectiveness of percutaneous
coronary intervention (PCI) versus coronary artery bypass graft (CABG) in
diabetic patients with multi-vascular coronary artery disease (MVD).
METHODS: Studies were retrieved from PUBMED database using keywords:
angioplasty, coronary, stent, PCI and coronary artery bypass surgery
(August 1992 to December 2009). Randomised controlled trials which
compared PCI and CABG in head to head comparisons were included according
to pre-specified inclusion/exclusion criteria. The outcomes of interest
were mortality, myocardial infarction (MI), stroke, and the use of
additional revascularization procedures. Two reviewers independently
extracted data from the included studies. Data was analyzed using STATA
(v9.0).RESULTS: Of the 416 studies identified, 5 studies met the inclusion
criteria. A total of 813 patients were included in this analysis (208 in
ARTS, 78 in EARCI-II, 115 in MASS-II, 353 in BARI trial, and 59 in EAST).
In total, 409 diabetic patients with MVD were randomized to PCI, and 404
were randomized to CABG. Survival was significantly greater after CABG
than after PCI with a risk ratio of 1.28 (95% CI 1.06, 1.55); p = 0.009
for the five-year mortality rate. The relative risk for revascularization
rate at five year follow-up was 4.11 (95% CI: 2.20, 7.68) for PCI vs.
CABG. Results for myocardial infarction were non-significant with a risk
ratio of 1.10 (95% CI: 0.73, 1.65); p = 0.644. CONCLUSIONS: CABG was
associated with lower incidence of mortality and revascularization at five
years of follow-up compared to PCI. Rate of MI was similar for both the
procedures. Analysis from this review suggests that CABG greatly improves
survival and reintervention rate when compared to PCI, in diabetic
patients with multi-vessel coronary artery disease.