Results Generated From:
Embase <1980 to 2011 Week 51>
Embase (updates since 2011-12-15)
<1>
Accession Number
70460233
Authors
Theuns D.A.M.J. Smith T. Hunink M.G.M. Bardy G.H. Jordaens L.
Institution
(Theuns, Smith, Jordaens) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Smith, Hunink) Department of Epidemiology, Erasmus MC, Rotterdam,
Netherlands
(Hunink) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard School of
Public Health, Boston, United States
(Bardy) Seattle Institute for Cardiac Research, Seattle, WA, United States
Title
Effectiveness of prophylactic implantation of cardioverter-defibrillators
without additional function improving interventions in patients with
ischemic or nonischemic cardiomyopathy: A systematic review and
meta-analysis.
Source
Europace. Conference: 17th World Congress in Cardiac Electrophysiology
and Cardiac Techniques, Cardiostim 2010 Nice France. Conference Start:
20100616 Conference End: 20100619. Conference Publication: (var.pagings).
12 (pp i47), 2010. Date of Publication: June 2010.
Publisher
Oxford University Press
Abstract
Objective: The aim was to investigate the efficacy of ICD-only therapy in
primary prevention in patients with ischemic or nonischemic
cardiomyopathy. Background: Much controversy continues to exist concerning
the efficacy for primary prophylactic implantable defibrillators (ICDs) in
patients with low ejection fraction respectively due to coronary artery
disease or dilated cardiomyopathy. This is also related to the potential
bias created by function improving interventions added to ICD therapy.
Methods: Public domain databases, MEDLINE. EMBASE. and Cochrane Register
of Controlled Trials were searched from 1980 to 2009 for randomized
clinical trials of ICD vs. conventional therapy. Two investigators
abstracted data independently. Pooled estimates were calculated using both
fixed-effects and random-effects models. Results: Eight trials were
included in the final analysis (5343 patients). ICDs significantly reduced
arrhythmic mortality (relative risk [RR], 0.40; 95% CI, 0.27 - 0.67) and
all-cause mortality (RR 0.72; 95% CI, 0.64-0.82). Regardless of etiology
of cardiomyopathy, ICD benefit was similar for ischemic cardiomyopathy (RR
0.71; 95% CI, 0.61-0.83) vs. nonischemic cardiomyopathy (RR 0.74; 95% CI,
0.59 - 0.93). Conclusions: The results of this meta-analysis provide
strong evidence for the beneficial effect of ICD-only therapy on the
survival of patients with ischemic or nonischemic cardiomyopathy, with a
left ventricular ejection fraction 35%, if they are 40 days from
myocardial infarction and <sup>3</sup> 3 months from a coronary
revascularization procedure.
<2>
Accession Number
2011670279
Authors
Gong M. Lin X.-Z. Lu G.-T. Zheng L.-J.
Institution
(Gong) Department of Anesthesiology, Second Affiliated Hospital, Zhejiang
University, Hangzhou, China
(Lin, Lu, Zheng) Department of Anesthesiology, Taizhou Central Hospital,
Taizhou, China
Title
Preoperative inhalation of milrinone attenuates inflammation in patients
undergoing cardiac surgery with cardiopulmonary bypass.
Source
Medical Principles and Practice. 21 (1) (pp 30-35), 2012. Date of
Publication: December 2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: The purpose of this study was to evaluate the effect of
preoperative inhalation of milrinone on cardiopulmonary bypass
(CPB)-related inflammation. Subjects and Methods: A total of 30 patients
undergoing cardiac surgery were recruited and randomized for preoperative
inhalation of milrinone (Mil group) or normal saline (NS group),
respectively. Each group had 15 patients. Their hemodynamic parameters
were measured and blood samples were obtained longitudinally. The levels
of serum interleukin (IL-6), tumor necrosis factor-alpha (TNF-alpha), and
matrix metalloproteinase (MMP)-9 were determined by ELISA. Results: The
levels of serum IL-6, TNF-alpha, and MMP-9 significantly increased at the
end of cardiac surgery and remained high for 24 h in both groups of
patients. However, the levels of proinflammatory cytokines at the end of
cardiac surgery in the Mil group of patients were significantly lower than
those of the NS group of patients. Conclusions: Our data indicated that
preoperative inhalation of milrinone significantly mitigated CPB-related
inflammation. Copyright 2011 S. Karger AG, Basel.
<3>
Accession Number
2011686481
Authors
Christensen S.B. Dall C.H. Prescott E. Pedersen S.S. Gustafsson F.
Institution
(Christensen, Gustafsson) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Dall, Prescott) Department of Cardiology, Copenhagen University Hospital,
Bispebjerg Hospital, Copenhagen, Denmark
(Pedersen) Center of Research on Psychology in Somatic Diseases, Tilburg
University, Tilburg, Netherlands
Title
A high-intensity exercise program improves exercise capacity,
self-perceived health, anxiety and depression in heart transplant
recipients: A randomized, controlled trial.
Source
Journal of Heart and Lung Transplantation. 31 (1) (pp 106-107), 2012.
Date of Publication: January 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
<4>
Accession Number
2011676914
Authors
Garwood C.L. Hwang J.M. Moser L.R.
Institution
(Garwood, Moser) Department of Pharmacy Practice, Eugene Applebaum College
of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue,
Detroit, MI 48201, United States
(Garwood, Hwang, Moser) Pharmacy Department, Harper University Hospital,
Detroit Medical Center, Detroit, MI, United States
Title
Striking a balance between the risks and benefits of anticoagulation
bridge therapy in patients with atrial fibrillation: Clinical updates and
remaining controversies.
Source
Pharmacotherapy. 31 (12) (pp 1208-1220), 2011. Date of Publication:
December 2011.
Publisher
Pharmacotherapy Publications Inc. (750 Washington Street, Boston MA 02111,
United States)
Abstract
Long-term anticoagulation with a vitamin K antagonist (VKA) or the new
agent dabigatran is recommended to decrease stroke risk in patients with
atrial fibrillation. When patients with atrial fibrillation undergo
initiation or interruption of VKA therapy, or experience an isolated
subtherapeutic international normalized ratio (INR), bridge therapy with a
parenteral anticoagulant may be considered. To describe the literature for
anticoagulation bridge therapy in patients with atrial fibrillation, we
conducted a MEDLINE search (1966-February 2011) of the English-language
literature to identify related studies. Ongoing clinical trials were
identified through a search of the ClinicalTrials.gov registry. Major
national and international guidelines were gathered and evaluated.
Additional literature was obtained through review of relevant references
of the identified articles. Bridging is not supported by guidelines or
clinical trials for patients starting VKA therapy for atrial fibrillation.
A subtherapeutic INR value during long-term VKA therapy may be associated
with increased thromboembolic events, but the benefit of bridging has not
been demonstrated. When VKA therapy is interrupted for procedures,
retrospective and cohort data suggest that the decision to bridge should
be based on a patient's thromboembolic and bleeding risks associated with
the procedure. Typically, it is recommended to use bridge therapy in
patients with atrial fibrillation at high risk for thromboembolism, but
the benefit of bridging is less clear in patients at low risk. Not all
procedures necessitate anticoagulation interruption. Recent trials suggest
that VKAs can be continued when patients are undergoing cardiac device
procedures and some types of radiofrequency ablation. Several clinical
trials are ongoing that will provide more definitive guidance for
perioperative anticoagulation management of patients with atrial
fibrillation. Patients taking dabigatran are unlikely to require bridge
therapy because of a predictable anticoagulant effect and rapid onset of
action. However, evidence for optimal perioperative management of
dabigatran is needed.
<5>
[Use Link to view the full text]
Accession Number
2011679398
Authors
Levine G.N. Bates E.R. Blankenship J.C. Bailey S.R. Bittl J.A. Cercek B.
Chambers C.E. Ellis S.G. Guyton R.A. Hollenberg S.M. Khot U.N. Lange R.A.
Mauri L. Mehran R. Moussa I.D. Mukherjee D. Nallamothu B.K. Ting H.H.
Jacobs A.K. Albert N. Creager M.A. Ettinger S.M. Halperin J.L. Hochman
J.S. Kushner F.G. Magnus Ohman E. Stevenson W. Yancy C.W.
Title
2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention a
report of the American College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines and the Society for
Cardiovascular Angiography and Interventions.
Source
Circulation. 124 (23) (pp e574-e651), 2011. Date of Publication: 06 Dec
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
<6>
Accession Number
2011669416
Authors
Spegar J. Vanek T. Snircova J. Fajt R. Straka Z. Pazderkova P. Maly M.
Institution
(Spegar, Vanek, Snircova, Fajt, Straka, Pazderkova) Department of Cardiac
Surgery, Charles University Prague, University Hospital Kralovske,
Vinohrady, Srobarova 50, 100 34 Prague, Czech Republic
(Maly) Department of Scientific Information and Biostatistics, National
Institute of Public Health, Prague, Czech Republic
Title
Local and systemic application of tranexamic acid in heart valve surgery:
A prospective, randomized, double blind LOST study.
Source
Journal of Thrombosis and Thrombolysis. 32 (3) (pp 303-310), 2011. Date
of Publication: October 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
The study was performed to examine a possible augmentation of systemic
administration of tranexamic acid by the additional topical application
during heart valve surgery in the post-aprotinin era. One-hundred patients
were enrolled in the study and all the patients were given tranexamic acid
intravenously. The participants were randomized into two groups (A, n =49;
B, n =51), and before commencing the sternal suturing, the study solution
(group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group
B: 250 ml of normal saline) was poured into the pericardial cavity. The
cumulative blood loss (geometric means [95%confidence intervals]) 4 h
after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3,
194.4] in group B, test for equality of geometric means P =0.107, test for
equality of variances P =0.059. Eight hours after the surgery, the blood
loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in
group B, P =0.130 and P =0.050, respectively. Twentyfour hours
postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A,
569.7 [476.0, 681.7] ml in group B, P =0.293 and P =0.014, respectively.
The proportion of patients transfused postoperatively by fresh frozen
plasma differed significantly between the two study groups (group A: n
=21, group B: n =36, P =0.008). Our hypothesis is supported by a
significant difference in the inter-group variance of blood loss and the
proportion of patients requiring fresh frozen plasma; however evident
differences in mean postoperative blood loss were not statistically
significant. Springer Science+Business Media, LLC 2011.
<7>
Accession Number
2011686924
Authors
Hsieh P.-L. Wu Y.-T. Chao W.-J.
Institution
(Hsieh, Wu, Chao) School and Graduate Institute of Physical Therapy,
College of Medicine, National Taiwan University, No. 17, Xuzhou Road,
Zhongzheng District Taipei City 10055, Taiwan (Republic of China)
(Wu) Department of Physical Medicine and Rehabilitation, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
Title
Effects of exercise training in heart transplant recipients: A
meta-analysis.
Source
Cardiology. 120 (1) (pp 27-35), 2011. Date of Publication: December
2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: Muscle wasting and exercise intolerance are common in heart
transplant recipients. Most studies on the effects of exercise training
have used relatively small sample sizes and are heterogeneous in nature.
The purpose of this meta-analysis was to systematically review the
relevant studies and investigate the effects of exercise training on
exercise capacity and muscle strength in heart transplant recipients.
Methods: A systematic search was adopted from electronic databases and
relevant references, using medical subject heading key words related to
heart transplantation and exercise. Only randomized controlled trials with
exercise intervention versus usual care were included. The data were
expressed as the weighted mean differences with 95% confidence intervals
(CIs). Results: Altogether 6 studies were included. Peak oxygen
consumption (VO<sub>2</sub>) was reported in 4 trials (117 patients), and
muscle strength was reported in 3 trials (67 patients). Peak
VO<sub>2</sub> was significantly increased by 2.34 ml/kg/min (95% CI
0.63-4.05). One-repetition maxima of the chest press (23.28 kg, 95% CI
0.64-45.91) and leg press (28.84 kg, 95% CI 5.70-51.98) were significantly
improved by exercise training. Conclusion: Exercise training is
recommended for heart transplant recipients to improve peak VO<sub>2</sub>
and muscle strength despite the small number of trials included in this
meta-analysis. 2011 S. Karger AG, Basel.
<8>
Accession Number
2011680541
Authors
Mitaka C. Kudo T. Haraguchi G. Tomita M.
Institution
(Mitaka) Department of Critical Care Medicine, Tokyo Medical and Dental
University Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
(Kudo, Haraguchi) Intensive Care Unit, Tokyo Medical and Dental University
Hospital Faculty of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital Faculty of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
Title
Cardiovascular and renal effects of carperitide and nesiritide in
cardiovascular surgery patients: A systematic review and meta-analysis.
Source
Critical Care. 15 (5) , 2011. Article Number: R258. Date of
Publication: 27 Oct 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Acute kidney injury (AKI) following cardiovascular surgery
is a common disease process and is associated with both morbidity and
mortality. The aim of our study was to evaluate the cardiovascular and
renal effects of an atrial natriuretic peptide (ANP, carperitide) and a
B-type (or brain) natriuretic peptide (BNP, nesiritide) for preventing and
treating AKI in cardiovascular surgery patients.Methods: Electronic
databases, including PubMed, EMBASE and references from identified
articles were used for a literature search.Results: Data on the infusion
of ANP or BNP in cardiovascular surgery patients was collected from
fifteen randomized controlled trials and combined. The infusion of ANP or
BNP increased the urine output and creatinine clearance or glomerular
filtration rate, and reduced the use of diuretics and the serum creatinine
levels. A meta-analysis showed that ANP infusion significantly decreased
peak serum creatinine levels, incidence of arrhythmia and renal
replacement therapy. The meta-analysis also showed that ANP or BNP
infusion significantly decreased the length of ICU stay and hospital stay
compared with controls. However, the combined data were insufficient to
determine how ANP or BNP infusion during the perioperative period
influences long-term outcome in cardiovascular surgery
patients.Conclusions: The infusion of ANP or BNP may preserve
postoperative renal function in cardiovascular surgery patients. A large,
multicenter, prospective, randomized controlled trial will have to be
performed to assess the therapeutic potential of ANP or BNP in preventing
and treating AKI in the cardiovascular surgical setting. 2011 Mitaka et
al.; licensee BioMed Central Ltd.
<9>
Accession Number
2011673292
Authors
Asaad O.M.
Institution
(Asaad) Department of Anesthesia, Faculty of Medicine, Cairo University,
Egypt
Title
Bilateral Bispectral Index (BIS)-VISTA monitoring of cerebral
hypoperfusion in patients with carotid artery stenosis undergoing coronary
artery bypass surgery.
Source
Egyptian Journal of Anaesthesia. 27 (4) (pp 233-240), 2011. Date of
Publication: October 2011.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: Carotid stenosis is a frequent coexisting condition in
patients undergoing Coronary Artery Bypass Graft (CABG) surgery. During
cardiac surgery, acute hemodynamic changes can cause cerebral ischemia.
When acute slowing of the Electroencephalography (EEG) develops because of
cerebral ischemia, a profound reduction in Bispectral Index (BIS) is seen,
although the depth of anesthesia does not change. We investigated the
diagnostic value of bilateral BIS as an indicator of cerebral
hypoperfusion during CABG surgery in patients with carotid artery stenosis
and the incidence of left-right BIS differences. Methods: Forty patients
scheduled for elective CABG surgery were randomized into two groups
according to preoperative Duplex carotid ultrasound; Group with Carotid
Artery stenosis (CA-stenosis) (n = 23) and Group without stenosis
(CA-normal) (n = 17). All patients underwent monitoring using bilateral
BIS system. We analyzed BIS data at eight stages of the CABG procedure.
Results: Mean BIS values recorded from left and right hemispheres declined
significantly in comparison to steady state of anesthesia in both groups
(T2), (p < 0.0001 for both). In CA-stenosis group only, there were
significant interhemispheric differences during AXC apply (p < 0.01).
Average BIS values of right and left hemispheres and parallel to it, SEF
data decreased significantly in both groups during initiation of CPB-T3,
during AXC application-T4 and during AXC removal-T6 (p < 0.001).
Intergroup comparison showed significant decrease in BIS values in
CA-stenosis group when compared to CA-normal group during induction of
anesthesia-T1 and during AXC apply-T4 (both p < 0.001) and during AXC
removal-T6 (p = 0.04). Conclusion: Our findings suggest that an acute
decrease in BIS which represent abrupt slowing of the EEG, reflects acute
cerebral hypoperfusion particularly when it accompanies acute hypotension,
as long as the changes in BIS is not drug induced. 2011 Egyptian Society
of Anesthesiologists. Production and hosting by Elsevier B.V. All rights
reserved.
<10>
Accession Number
2011663794
Authors
Wykrzykowska J. Serruys P. Buszman P. Linke A. Ischinger T. Klauss V.
Eberli F. Corti R. Wijns W. Morice M.-C. Di Mario C. Van Geuns R.-J. Van
Es G.-A. Juni P. Windecker S.
Institution
(Wykrzykowska) Academic Medical Center, Amsterdam, Netherlands
(Serruys, Van Geuns) Thoraxcenter, Ba583a, Erasmus MC, 's-Gravendijkwal
230, 3015 CE Rotterdam, Netherlands
(Buszman) Medical University of Silesia, Katowicze, Poland
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Ischinger) Department of Cardiology, Hospital Bogenhausen, Munich,
Germany
(Klauss) Department of Cardiology, University Hospital Munich, Munich,
Germany
(Eberli, Corti) Department of Cardiology, University Hospital, Zurich,
Switzerland
(Wijns) Department of Cardiology, OLVZ, Aalst, Belgium
(Morice) Institut Cardiovasculaire, Paris-Sud, Massy, France
(Di Mario) Department of Cardiology, Royal Brompton Hospital, London,
United Kingdom
(Van Es) Cardialysis BV, Rotterdam, Netherlands
(Juni) CTU Bern, Bern University Hospital, Bern, Switzerland
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
Title
The three year follow-up of the randomised "all-comers" trial of a
biodegradable polymer biolimus-eluting stent versus permanent polymer
sirolimus-eluting stent (LEADERS).
Source
EuroIntervention. 7 (7) (pp 789-795), 2011. Date of Publication:
November 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The current study reports clinical outcomes at three year follow-up
of the LEADERS clinical trial which was the first all-comers trial
comparing a new generation biodegradable polymer biolimus drug-eluting
stent (BES) with the first generation permanent polymer sirolimus-eluting
stent (SES). Methods and results: One thousand seven hundred and seven
patients were randomised to unrestricted use of BES (n=857) or SES (n=850)
in an all-comers population. Three year follow-up was available in 95% of
the patients, 812 treated with BES and 809 treated with SES. At three
years, BES remains non-inferior to SES for the primary endpoint of major
adverse cardiac events (composite of cardiac death, myocardial infarction
(MI), or clinically-indicated target vessel revascularisation (CI-TVR)
(BES 15.7% versus SES 19%; HR 0.82 CI 0.65-1.03; p=0.09). The MACE Kaplan
Meier event curves increasingly diverge with the difference in events
increasing from 1.4% to 2.4% and 3.3% at 1, 2 and 3 years, respectively in
favour of BES. The rate of cardiac death was non-significantly lower 4.2%
versus 5.2% (HR=0.81 CI 0.52-1.26; p=0.34) and the rate of myocardial
infarction was equivalent 7.2% versus 7.1% (HR 1.01 CI 0.70-1.44; p=0.97)
for BES versus SES, respectively. Thus BES was non-inferior to SES in all
the safety endpoints. Clinically-indicated TVR occurred in 9.4% of BES
treated patients versus 11.1% of SES treated patients (HR 0.84 CI
0.62-1.13; p=0.25). Rates of definite stent thrombosis were 2.2% for BES
and 2.9% for SES (HR 0.78 CI 0.43-1.43; p=0.43), with the event rate
increase of 0.2% from one to three years for BES and 0.9% for SES. For
patients presenting with ST-elevation myocardial infarction BES was
superior to SES in reducing MACE. Conclusions: The findings of the three
year follow-up support the claim that the biodegradable polymer
biolimus-eluting stent has equivalent safety and efficacy to permanent
polymer sirolimus-eluting stent in an all-comers patient population. Its
performance is superior in some subpopulations such as in ST-elevation MI
patients and event rates for BES are overall lower than for SES with a
trend toward increasing divergence of outcomes over three years. Europa
Edition 2011. All rights reserved.
<11>
Accession Number
2011681503
Authors
Bulbulia R. Bowman L. Wallendszus K. Collins R. Meade T. Sleight P.
Armitage J. Parish S. Peto R. Youngman L. Buxton M. De Bono D. George C.
Fuller J. Keech A. Mansfield A. Pentecost B. Simpson D. Warlow C. McNamara
J. O'Toole L. Doll R. Wilhelmsen L. Fox K.M. Hill C. Sandercock P.
Institution
(Bulbulia, Bowman, Wallendszus, Parish, Armitage, Peto, Collins, Collins,
Meade, Sleight, Armitage, Parish, Peto, Youngman, Buxton, De Bono, George,
Fuller, Keech, Mansfield, Pentecost, Simpson, Warlow, McNamara, O'Toole,
Doll, Wilhelmsen, Fox, Hill, Sandercock) Clinical Trial Service Unit,
Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF,
United Kingdom
Title
Effects on 11-year mortality and morbidity of lowering LDL cholesterol
with simvastatin for about 5 years in 20 536 high-risk individuals: A
randomised controlled trial.
Source
The Lancet. 378 (9808) (pp 2013-2020), 2011. Date of Publication:
December 10-16, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Findings of large randomised trials have shown that lowering LDL
cholesterol with statins reduces vascular morbidity and mortality rapidly,
but limited evidence exists about the long-term efficacy and safety of
statin treatment. The aim of the extended follow-up of the Heart
Protection Study (HPS) is to assess long-term efficacy and safety of
lowering LDL cholesterol with statins, and here we report cause-specific
mortality and major morbidity in the in-trial and post-trial periods. 20
536 patients at high risk of vascular and non-vascular outcomes were
allocated either 40 mg simvastatin daily or placebo, using minimised
randomisation. Mean in-trial follow-up was 53 years (SD 12), and
post-trial follow-up of surviving patients yielded a mean total duration
of 110 years (SD 06). The primary outcome of the long-term follow-up of
HPS was first post-randomisation major vascular event, and analysis was by
intention to treat. This trial is registered with ISRCTN, number 48489393.
During the in-trial period, allocation to simvastatin yielded an average
reduction in LDL cholesterol of 10 mmol/L and a proportional decrease in
major vascular events of 23 (95 CI 19-28; p<00001), with significant
divergence each year after the first. During the post-trial period (when
statin use and lipid concentrations were similar in both groups), no
further significant reductions were noted in either major vascular events
(risk ratio [RR] 095 [089-102]) or vascular mortality (098 [090-107]).
During the combined in-trial and post-trial periods, no significant
differences were recorded in cancer incidence at all sites (098 [092-105])
or any particular site, or in mortality attributed to cancer (101
[092-111]) or to non-vascular causes (096 [089-103]). More prolonged
LDL-lowering statin treatment produces larger absolute reductions in
vascular events. Moreover, even after study treatment stopped in HPS,
benefits persisted for at least 5 years without any evidence of emerging
hazards. These findings provide further support for the prompt initiation
and long-term continuation of statin treatment. UK Medical Research
Council, British Heart Foundation, Merck & Co, Roche Vitamins. 2011
Elsevier Ltd.
<12>
Accession Number
2011670868
Title
Effect of simvastatin plus ezetimibe on incidence of major atherosclerotic
events in patients with advanced chronic kidney disease.
Source
Australian Journal of Pharmacy. 92 (1098) (pp 92), 2011. Date of
Publication: November 2011.
Publisher
Australian Pharmaceutical Publishing Company Ltd (40 Burwood Road,
Hawthorn VIC 3122, Australia)
<13>
[Use Link to view the full text]
Accession Number
2011671818
Authors
Altinbas A. Van Zandvoort M.J.E. Van Den Berg E. Jongen L.M. Algra A. Moll
F.L. Nederkoorn P.J. Mali W.P.T.M. Bonati L.H. Brown M.M. Kappelle L.J.
Van Der Worp H.B.
Institution
(Altinbas, Van Zandvoort, Van Den Berg, Jongen, Algra, Moll, Nederkoorn,
Mali, Bonati, Brown, Kappelle, Van Der Worp) Department of Neurology,
Rudolf Magnus Institute of Neuroscience, University Medical Center
Utrecht, PO Box 85500, G03.228, 3508 GA Utrecht, Netherlands
Title
Cognition after carotid endarterectomy or stenting: A randomized
comparison.
Source
Neurology. 77 (11) (pp 1084-1090), 2011. Date of Publication: 13 Sep
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: To compare the effect on cognition of carotid artery stenting
(CAS) and carotid endarterectomy (CEA) for symptomatic carotid artery
stenosis. Methods: Patients randomized to CAS or CEA in the International
Carotid Stenting Study (ICSS; ISRCTN25337470) at 2 participating centers
underwent detailed neuropsychological examinations (NPE) before and 6
months after revascularization. Ischemic brain lesions were assessed with
diffusion-weighted imaging before and within 3 days after
revascularization. Cognitive test results were standardized into z scores,
from which a cognitive sumscore was calculated. The primary outcome was
the change in cognitive sumscore between baseline and follow-up. Results:
Of the 1,713 patients included in ICSS, 177 were enrolled in the 2 centers
during the substudy period, of whom 140 had an NPE at baseline and 120 at
follow-up. One patient with an unreliable baseline NPE was excluded. CAS
was associated with a larger decrease in cognition than CEA, but the
between-group difference was not statistically significant: -0.17 (95% CI
-0.38 to 0.03; p = 0.092). Eighty-nine patients had a pretreatment MRI and
64 within 3 days after revascularization. New ischemic lesions were found
twice as often after CAS than after CEA (relative risk 2.1; 95% CI 1.0 to
4.4; p = 0.041). Conclusions: Differences between CAS and CEA in effect on
cognition were not statistically significant, despite a substantially
higher rate of new ischemic lesions after CAS than after CEA.
Classification of Evidence: This study provides Class III evidence that
any difference between the effects of CAS and CEA on cognition at 6 months
after revascularization is small. 2011 by AAN Enterprises, Inc.
<14>
Accession Number
2011665469
Authors
Mizrak A. Kocamer B. Deniz H. Yendi F. Oner U.
Institution
(Mizrak, Kocamer, Yendi, Oner) Department of Anaesthesiology and
Reanimation, Gaziantep University School of Medicine, Gaziantep University
Medical Faculty, 27310 Sahinbey, Gaziantep, Turkey
(Deniz) Department of Cardiovascular Surgery, Gaziantep University School
of Medicine, 27310 Sahinbey, Gaziantep, Turkey
Title
Cardiovasular changes after placement of a classic endotracheal tube,
double-lumen tube, and Laryngeal Mask Airway.
Source
Journal of Clinical Anesthesia. 23 (8) (pp 616-620), 2011. Date of
Publication: December 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Study Objective: To compare hemodynamic responses, P wave dispersion (Pd),
and QT dispersion (QTd) after placement of a classic endotracheal tube
(ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA). Design:
Prospective study. Setting: Outpatient surgery center. Patients: 75 adult,
ASA physical status 1 and 2 patients undergoing cystoscopy and
thoracoscopic surgery. Interventions: Patients were randomized to undergo
placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA
(Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and
fentanyl 1.0 mug/kg, and maintained with nitrous oxide, oxygen, 2% to 3%
sevoflurane, and rocuronium 0.5 mg/kg. Measurements: Mean arterial
pressure (MAP) and heart rate (HR) were recorded immediately before
intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30
minutes after intubation/airway insertion. Results: QT dispersion after
tube placement was significantly higher than before tube placement in
Group D (P = 0.0001) and Group L (P = 0.03). Mean arterial pressure and HR
in Group T were significantly higher than in Group L at the first minute
after tube placement (P = 0.02). Heart rate and MAP at baseline were
significantly higher than the other measurement times in Groups T and D (P
< 0.01). Conclusions: The LMA caused no change in Pd, HR, or MAP values
during or after airway placement, but caused QTd after airway insertion.
The ETT caused a sudden increase at the first minute after tube placement,
without any Pd or QTd. In addition, DLT caused QTd without any serious
change in hemodynamics. 2011 Elsevier Inc. All rights reserved.
<15>
Accession Number
2011669426
Authors
Sun J.C.J. Teoh K.H.T. Sheth T. Landry D. Jung H. Warkentin T.E. Yusuf S.
Lamy A. Eikelboom J.W.
Institution
(Teoh, Lamy) Division of Cardiac Surgery, McMaster University, Hamilton,
Canada
(Sheth, Yusuf) Division of Cardiology, McMaster University, Hamilton,
Canada
(Landry) Department of Radiology, McMaster University, Hamilton, Canada
(Jung, Yusuf, Lamy, Eikelboom) Population Health Research Institute,
McMaster University, Hamilton, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Canada
(Warkentin, Yusuf, Eikelboom) Department of Medicine, McMaster University,
Hamilton, Canada
Title
Randomized trial of fondaparinux versus heparin to prevent graft failure
after coronary artery bypass grafting: The Fonda CABG study.
Source
Journal of Thrombosis and Thrombolysis. 32 (3) (pp 378-385), 2011. Date
of Publication: October 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
We sought to assess the feasibility of comparing the efficacy and safety
of fondaparinux versus heparin for prevention of graft failure and major
CV events in patients undergoing coronary artery bypass grafting (CABG).
Patients undergoing CABG were randomized to receive postoperative
injections of fondaparinux or heparin in-hospital. After discharge, the
fondaparinux group received fondaparinux and the heparin group received
placebo injections for 30 days post surgery. Efficacy outcomes were graft
failure, death, MI, and stroke at 30 days. Safety outcomes were bleeding,
transfusion, and reoperation. 100 patients were recruited, 99 were
randomized, 49 received fondaparinux and 50 received heparin. CT
angiography was performed in 97%of patients. 188 grafts in the treatment
group and 189 grafts in the heparin group were imaged. A similar
proportion of patients treated with fondaparinux compared with heparin had
at least one occluded graft (18.8%fondaparinux vs. 14.9%heparin, P =0.62)
and a similar number of grafts were occluded in each treatment group (all
grafts: 4.8%vs. 4.8%, P =0.99; saphenous vein grafts 4.2%vs. 4.2%, P
=0.98). There was no difference between treatment groups in death, MI,
stroke, bleeding events, or reoperation. One in 10 patients undergoing
CABG had at least one occluded graft at 30 days and one in 20 grafts is
occluded by 30 days. Fondaparinux appears to be a safe alternative to
heparin after CABG and it is feasible to conduct a definitive RCT using CT
angiography to evaluate the effect of fondaparinux treatment on graft
patency. Springer Science+Business Media, LLC 2011.
<16>
Accession Number
70608625
Authors
Keeping-Burke L. Purden M. Frasure-Smith N. Cossette S. McCarthy F. Amsel
R.
Institution
(Keeping-Burke) University of New Brunswick, Saint John, NB, Canada
(Purden, Frasure-Smith, Amsel) McGill University, Saint John, NB, Canada
(Cossette) Universite de Montreal, Saint John, NB, Canada
(McCarthy) Dalhousie University, Saint John, NB, Canada
Title
Recovery outcomes in coronary artery bypass graft (CABG) surgery patients
following a randomized controlled trial of a telehealth nursing
intervention.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S343), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
Few randomized trials have evaluated clinical outcomes of patients who
receive telehealth. In this study, CABG surgery patients and their
caregivers (n=182) were randomized on the day prior to surgery to receive
either one week of daily home audio-video nursing visits post-discharge or
routine discharge education in hospital. The purpose was to determine
whether a nurse-led telehealth program post-discharge resulted in greater
decreases in anxiety (S-STAI), depression (CESD-10), uncertainty (MUIS),
conflict (IPRI), and health care use, and greater perceptions of personal
and treatment control (IPQ-r) and support (IPRI) for patients who received
the program compared to those who received usual care. Telephone
interviews were conducted the day before surgery and 3 weeks
post-discharge. The data were analyzed using 2x2 analyses of covariance
that assessed main effects of telehealth and patient sex and their
interaction on changes in the outcome variables including baseline scores
as covariates. The findings demonstrated no difference between changes in
anxiety for patients in telehealth versus usual care. However, patients
who received telehealth showed significantly greater reductions in
uncertainty (p=.03), marginally greater improvements in perceived
treatment control (p=.09), and were less likely to contact a physician
(p=.04) compared to the standard care group. This randomized control study
is one of few to assess the benefits of telehealth programs for CABG
surgery patients. Future evaluations of multi-component telehealth
interventions should consider component analyses in order to disentangle
the relationships between the different elements of an intervention and
the effects on patients' recovery outcomes.
<17>
Accession Number
70608382
Authors
Simard T. Hibbert B. Pourdjabbar A. Wilson K. Hawken S. O'Brien E.
Institution
(Simard, Hibbert, Pourdjabbar, Wilson, Hawken, O'Brien) OttawaONCanada
Title
Percutaneous coronary intervention with or without on-site coronary artery
bypass surgery: A meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S222), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Current ACC/AHA guidelines recommend against the performance
of elective or primary PCI without surgical backup (ie. a class III and
IIb recommendation respectively). However, advances in percutaneous
coronary intervention (PCI) have markedly reduced complication rates such
that the need for cardiac surgery on-site (SOS) is unclear. Numerous
centers have already implemented PCI programs with noonsite surgery backup
(NSOS). To evaluate the necessity for SOS, we performed a systematic
review and meta-analysis of studies to determine if SOS conferred clinical
benefit in patients undergoing PCI. METHODS/RESULTS: English-language
articles published from 1966 through December 2010 were retrieved using
keyword searches of Medline and Scopus supplemented by letters to authors
and reviews of all bibliographies. Article inclusion and data extraction
was performed by two independent reviewers. We identified 18 articles (3
case control, 13 cohort, and 2 randomized control studies) published
between 1992 and 2009 which contained reported events on 1,150,200
patients. The combined odds ratio calculated using a random effects model
for death with NSOS was 0.93 (95% CI, 0.80-1.09). In studies with data
reported for primary PCI and elective PCI the OR for death was 0.91 (95%
CI, 0.84-1.00) and 1.04 (95% CI, 0.67-1.63). A lack of significant effect
of SOS was maintained when analysis was performed by study type or when
adjusted for study quality. No differences in rates of emergency coronary
artery bypass grafting or post procedural myocardial infarction were
observed between SOS and NSOS centers. CONCLUSION: Surgical backup on-site
does not confer a mortality benefit in either elective or primary PCI.
Currently available evidence does not support the ACC/AHA recommendations.
Performance of PCI in a NSOS setting appears both feasible and safe.
(Table Presented).
<18>
Accession Number
70608366
Authors
Sawatzky J.V. Christie S. Singal R.K.
Institution
(Sawatzky, Christie, Singal) WinnipegMBCanada
Title
An np managed cardiac surgery follow-up clinic: A randomized controlled
trial demonstrating improved patient outcomes.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S213-S214), 2011. Date of
Publication: September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Advances in technology and peri-operative care have led to
rapid recovery and earlier discharge following cardiac surgery. However,
the limited time for discharge teaching to patients who may not be
cognitively or emotionally able to comprehend and retain the information
can have negative consequences. Furthermore, cardiac surgery patients
experience a variety of health-related issues following discharge.
Nevertheless, the shortened length of stay has generally not been
accompanied by an increased focus on follow-up care. OBJECTIVE: The aim of
this study was to describe and compare the outcomes of a Nurse
Practitioner (NP) managed early post-operative cardiac surgery follow-up
clinic with the standard model of post-discharge follow-up. METHODS: Two
hundred post-operative coronary artery bypass graft (CABG) patients in a
large tertiary centre were randomized to either: 1: an NP initiated
telephone assessment 3 days post-discharge, with additional NP follow-up
clinic visits, teaching, care, and referrals as required; or 2: the
standard model of post-discharge follow-up. RESULTS: The findings, based
on data collected at baseline (prior to discharge) and at 2 additional
intervals post-discharge, revealed that at 2 weeks post-discharge the
intervention group had significantly higher SF-36 physical functioning
scores and lower symptom inventory scores than the control group (P >
0.05). Although baseline differences were non-significant, at 2 and 6
weeks post-discharge the intervention group was more satisfied with the
quality of service compared to the control group. CONCLUSIONS: Early
post-discharge NP managed follow-up care in patients undergoing CABG is
associated with improved physical functioning, decreased symptoms and
increased patient satisfaction. Further development of this concept is
warranted as a potentially significant tool in the ever streamlined
management of these patients. The ongoing development and refinement of
this clinic, including planned clinical and research strategies to improve
health services and quality of life for these patients will be highlighted
in this presentation.
<19>
Accession Number
70608335
Authors
Price J. Naik V. Boodhwani M. Brandys T. Hendry P. Lam B.
Institution
(Price, Naik, Boodhwani, Brandys, Hendry, Lam) BrusselsBelgium
Title
The impact of after-hours simulator practice on performance of vascular
anastomosis during surgical training: A randomized trial.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S197), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
OBJECTIVES: Evidence supporting the benefit of surgical skills practice in
a simulated environment is increasing. However, the use of simulation in
cardiac surgical training has been limited. The purpose of the current
trial was to examine the effect of independent and deliberate simulator
practice, during nonclinical time, on the performance of an end-to-side
microvascular anastomosis in an in-vivo model. METHODS: This
single-blinded, randomized controlled trial received IRB approval.
Thirty-nine first and second year surgical trainees were randomized to an
expert-guided tutorial on a procedural trainer, or the expert-guided
tutorial combined with selfdirected practice on the same procedural
trainer. Self-directed practice consisted of 10 anastomoses performed on
the procedural trainer: a low-fidelity, commercially available bench model
utilizing 4mm PTFE graft as simulated blood vessel. Two weeks after the
tutorial, subjects performed an end-to-side anastomosis in a live porcine
model, under realistic operating room conditions. Assessment of outcomes
was performed by two blinded, expert observers, utilizing validated
measurements of technical skill. The primary outcome was the score on the
Objective Structured Assessment of Technical Skill (OSATS) scale.
Secondary outcomes included an anastomosis-specific end-product evaluation
and time to completion. Statistical analysis was conducted using
non-parametric, univariate techniques. RESULTS: Compared to residents who
received expert-guided simulator training alone, those who in addition
practiced on a simulator independently scored significantly higher on the
OSATS scale (23.7 +/- 4.7 vs. 18.5 +/- 3.9, P = 0.003). Residents who
practiced independently also scored significantly higher on the
end-product evaluation (11.4 +/- 3.2 vs. 8.9 +/- 2.1, P = 0.02) and
performed the anastomosis significantly faster (777 seconds vs. 977
seconds, P = 0.04). These findings were consistent for both first and
second year trainees. Interrater reliability was high between the expert
observers (Intraclass correlation coefficient = 0.8). CONCLUSIONS:
Residents who had the opportunity for self-directed simulator practice
performed an end-to-side anastomosis more adeptly, more quickly and with a
higher quality endproduct. The results of this randomized trial suggest
that independent training on a procedural trainer did transfer to improved
performance in an operating room environment. In an era of increasing work
hour restrictions, simulation represents a valuable alternative
methodology for training surgical skills. Simulator training should be
incorporated into cardiovascular surgical curricula and residents should
have access to this modality after-hours for independent practice to
improve operating room performance.
<20>
Accession Number
70610731
Authors
Nikolaidou V. Petsios K. Matziou V.
Institution
(Nikolaidou, Petsios) Pediatric Cardiosurgical Intensive Care Unit,
Onassis Cardiac Center, Athens, Greece
(Petsios) Faculty of Nursing, National and Kapodistrian University of
Athens, Athens, Greece
(Matziou) Faculty of Nursing, University of Athens, Athens, Greece
Title
Nursing management of postoperative pain in children after cardiac
surgery.
Source
Acta Paediatrica, International Journal of Paediatrics. Conference: 3rd
Excellence in Paediatrics Conference and the 1st PNAE Congress on
Paediatric Nursing Istanbul Turkey. Conference Start: 20111130 Conference
End: 20111203. Conference Publication: (var.pagings). 100 (pp 128-129),
2011. Date of Publication: December 2011.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Postoperative pain management in children is a complex,
multidimensional and subjective phenomenon. During last decades, many
protocols and significant tools have been developed for the management of
pain and a significant number of studies have been published. However,
there are only a limited number of studies for the management of pain in
children after cardiac surgery. Purpose: A systematic review of the
literature concerning the postoperative pain assessment and nursing
management in children after cardiac surgery was performed.
Material-Methods: A systemic review was conducted in international
scientific databases (PUBMED, CINAHL, WEB OF SCIENCE), related to the
management of pain in children after cardiac surgery which were published
after 2000. One hundred and thirty-eight articles were primarily
identified and 38 matched the review criteria and were further analyzed
(19 reviews and 18 studies). Results: Intra and post-operative anaesthesia
and analgesia for children undergoing cardiac surgery are an important
determinant of postoperative recovery. However, limited studies were
focused on postoperative sedation and analgesia within the paediatric
intensive care unit. The postoperative pain management in paediatric
cardiac patients depends from various factors such as the type of surgery,
the incision, the duration of the surgery, the analgesic therapy (type,
dose and frequency) along with the nursing experience and skills. For
example, children with sternal incisions reported significantly more pain
than subjects with submammary incisions and greater amounts of analgesia
were used in children under 3 years of age. Many protocols have been
developed for the administration of systemic and continuous intravenous
analgesic therapy using appropriate pain assessment tools. Morphine and
ketamine are most used for effective and safe analgesia. Conclusions:
There is a clear need for the development of a nursing standard to assess
and manage pain and sedation in this population. The development of
appropriate pain tools can lead to a reliable assessment of postoperative
pain in sedated and intubated children after cardiac surgery.
<21>
Accession Number
70610467
Title
Abstracts from the 2012 Southern Association for Vascular Surgery Annual
Meeting.
Source
Journal of Vascular Surgery. Conference: 2012 Southern Association for
Vascular Surgery Annual Meeting Scottsdale, AZ United States. Conference
Start: 20120118 Conference End: 20120121. Conference Publication:
(var.pagings). 54 (6) , 2011. Date of Publication: December 2011.
Publisher
Mosby Inc.
Abstract
The proceedings contain 54 papers. The topics discussed include:
additional supervised exercise therapy after a percutaneous vascular
intervention for peripheral arterial disease: a randomized clinical trial;
clinical and technical outcomes from a randomized clinical trial of
endovenous laser ablation compared with conventional surgery for great
saphenous varicose veins; staged versus synchronous carotid endarterectomy
and coronary artery bypass grafting: analysis of 10-year nationwide
outcomes; comparative predictors of mortality for endovascular and open
repair of ruptured infrarenal abdominal aortic aneurysms; systematic
review and meta-analysis of growth rates of small abdominal aortic
aneurysms; the von willebrand inhibitor ARC1779 reduces cerebral
embolization after carotid endarterectomy a randomized trial; venous
lower-limb evaluation in patients with acute pulmonary embolism; and iliac
artery recanalization of chronic occlusions to facilitate EVAR - midterm
multicenter results.
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