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<1>
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Accession Number
2012014641
Authors
Heusch G. Musiolik J. Kottenberg E. Peters J. Jakob H. Thielmann M.
Institution
(Heusch, Musiolik) Institut fur Pathophysiologie, Universitatsklinikum
Essen, Hufelandstr 55, 45122 Essen, Germany
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Jakob, Thielmann) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Essen, Germany
Title
STAT5 activation and cardioprotection by remote ischemic preconditioning
in humans.
Source
Circulation Research. 110 (1) (pp 111-115), 2012. Date of Publication:
06 Jan 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Rationale: The heart can be protected from infarction by brief episodes of
ischemia/reperfusion of a remote organ. Remote ischemic preconditioning
(RIPC) by brief arm ischemia/reperfusion has been recruited in patients
undergoing coronary artery bypass surgery or percutaneous coronary
interventions and during transport to the hospital for acute myocardial
infarction. Cardioprotective signaling has been extensively characterized
in animal experiments. Objective: To identify cardioprotective signaling
by RIPC in humans. Methods and Results: RIPC was induced by 3 cycles of 5
minutes of arm ischemia/5 minutes of reperfusion in patients undergoing
coronary artery bypass surgery. Twelve patients each were randomly
assigned to undergo RIPC or a sham control procedure. Protection was
confirmed by reduced serum troponin I concentrations in patients with RIPC
versus control patients. In myocardial biopsies, an array of established
cardioprotective proteins was analyzed by Western immunoblotting. The
phosphorylation of signal transducer and activator of transcription 5
(STAT5) increased from baseline before ischemic cardioplegic arrest to 10
minutes of reperfusion with RIPC, and STAT5 phosphorylation during
reperfusion was greater in patients with RIPC than in control patients.
Conclusions: The identification of this unique signaling signature of RIPC
will facilitate the development of pharmacological cardioprotection. 2011
American Heart Association, Inc.
<2>
Accession Number
2012022454
Authors
Robinson J.L. Doucette K.
Institution
(Robinson) Department of Pediatrics, University of Alberta, Edmonton,
Canada
(Doucette) Department of Medicine, University of Alberta, Edmonton, Canada
Title
The natural history of hepatitis C virus infection acquired during
childhood.
Source
Liver International. 32 (2) (pp 258-270), 2012. Date of Publication:
February 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: The outcome of patients with hepatitis C virus (HCV) infection
acquired during childhood in the absence of antiviral therapy is not
clear. Aims: The purpose of this study was to review the outcome of
untreated HCV acquired in childhood. Only population-based studies were
included, as referred cases would be predicted to have more severe
disease. Methods: A systematic review of the literature was completed up
to October 2010 to identify studies where a population was screened for
HCV infection that was presumably acquired during childhood. Demographical
and clinical data were collected on infected patients who had not been
treated with an antiviral. Primary outcome was development of a severe
adverse outcome (cirrhosis, hepatoma, need for a liver transplant or
liver-related death). Results: There were 25 studies reporting a total of
733 infected patients. Liver biopsy results were provided for 180 patients
(25%), revealing cirrhosis in eight (1.0% of the total and 4.0% of those
who had a biopsy). None of the other patients developed a severe adverse
outcome. As a result of the small number of patients with a severe adverse
outcome, risk factors for HCV progression could not be identified.
Conclusion: Although HCV can lead to liver transplantation and death
during childhood, the vast majority of patients with disease acquired
during childhood have slowly progressive disease. There is no clear
indication for antiviral therapy in the majority of children with HCV
infection. 2011 John Wiley & Sons A/S.
<3>
Accession Number
2012003354
Authors
Damman P. Clayton T. Wallentin L. Lagerqvist B. Fox K.A.A. Hirsch A.
Windhausen F. Swahn E. Pocock S.J. Tijssen J.G.P. De Winter R.J.
Institution
(Damman, Hirsch, Windhausen, Tijssen, De Winter) Department of Cardiology,
Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ
Amsterdam, Netherlands
(Clayton, Pocock) London School of Hygiene and Tropical Medicine, Keppel
Street, London, United Kingdom
(Wallentin, Lagerqvist) Department of Cardiology, Cardiothoracic Center,
University Hospital, Uppsala, Sweden
(Fox) Cardiovascular Research, Department of Medical and Radiological
Sciences, Royal Infirmary, Edinburgh, United Kingdom
(Swahn) Department of Cardiology, Heart Centre, University Hospital,
Linkoping, Sweden
Title
Effects of age on long-term outcomes after a routine invasive or selective
invasive strategy in patients presenting with non-ST segment elevation
acute coronary syndromes: A collaborative analysis of individual data from
the FRISC II - ICTUS - RITA-3 (FIR) trials.
Source
Heart. 98 (3) (pp 207-213), 2012. Date of Publication: February 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To perform a patient-pooled analysis of a routine invasive
versus a selective invasive strategy in elderly patients with non-ST
segment elevation acute coronary syndrome. Methods: A meta-analysis was
performed of patientpooled data from the FRISC IIeICTUSeRITA-3 (FIR)
studies. (Un)adjusted HRs were calculated by Cox regression, with
adjustments for variables associated with age and outcomes. The main
outcome was 5-year cardiovascular death or myocardial infarction (MI)
following routine invasive versus selective invasive management. Results:
Regarding the 5-year composite of cardiovascular death or MI, the routine
invasive strategy was associated with a lower hazard in patients aged
65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged >=75 years (HR
0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95%
CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and
age. The interaction was driven by an excess of early MIs in patients <65
years of age; there was no heterogeneity between age groups concerning
cardiovascular death. The benefits were smaller for women than for men
(p=0.009 for interaction). After adjustment for other clinical risk
factors the HRs remained similar. Conclusion: The current analysis of the
FIR dataset shows that the long-term benefit of the routine invasive
strategy over the selective invasive strategy is attenuated in younger
patients aged <65 years and in women by the increased risk of early events
which seem to have no consequences for long-term cardiovascular mortality.
No other clinical risk factors were able to identify patients with
differential responses to a routine invasive strategy. Trial registration:
http://www.controlled-trials.com/ISRCTN82153174 (ICTUS),
http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).
<4>
Accession Number
2012014182
Authors
Shehata N. Burns L.A. Nathan H. Hebert P. Hare G.M.T. Fergusson D. Mazer
C.D.
Institution
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Departments of
Medicine, Anesthesia and Physiology, University of Toronto, St. Michael's
Hospital, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Central Ontario
Region, Canadian Blood Services, Toronto, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, St Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, University of Ottawa, Ottawa, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Critical Care, General Campus, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Clinical Epidemiology, Ottawa Hospital Research Institute, CMAJ, Ottawa,
ON, Canada
Title
A randomized controlled pilot study of adherence to transfusion strategies
in cardiac surgery.
Source
Transfusion. 52 (1) (pp 91-99), 2012. Date of Publication: January 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
BACKGROUND: It is important to determine the optimal hemoglobin (Hb)
concentration for red blood cell (RBC) transfusion for patients undergoing
cardiac surgery because increased mortality has been associated with the
severity of anemia and exposure to RBCs. Because a definitive trial will
require thousands of patients, and because there is variability in
transfusion practices, a pilot study was undertaken to determine adherence
to proposed strategies. STUDY DESIGN AND METHODS: A single-center parallel
randomized controlled pilot trial was conducted in high-risk cardiac
patients to assess adherence to two transfusion strategies. Fifty patients
were randomly assigned either to a "restrictive" transfusion strategy
(RBCs if their Hb concentration was 70 g/L or less intraoperatively during
cardiopulmonary bypass [CPB] and 75 g/L or less postoperatively) or a
"liberal" transfusion strategy (RBCs if their Hb concentration was 95 g/L
or less during CPB and less than 100 g/L postoperatively). RESULTS: The
percentage of adherence overall was 84% in the restrictive arm and 41% in
the liberal arm. Twenty-two (88%) patients were transfused 99 units of
RBCs in the liberal group compared to 13 patients who were transfused 50
units in the restrictive group (p < 0.01). There were no significant
differences in individual adverse outcomes; however, more adverse events
occurred in the restrictive group (38 vs. 15, p < 0.01). CONCLUSION:
Adherence to the evaluated interventions is vital to all randomized
controlled trials as it has the potential to affect outcomes. Further
pilot studies are required to optimize enrollment and transfusion
adherence before a definitive study is conducted. 2011 American
Association of Blood Banks.
<5>
Accession Number
22077816
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van de Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W. TRACER
Investigators
Institution
(Tricoci) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC 27705, USA.
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
The New England journal of medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 5 Jan 2012.
Abstract
Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist
that inhibits thrombin-induced platelet activation. In this multinational,
double-blind, randomized trial, we compared vorapaxar with placebo in
12,944 patients who had acute coronary syndromes without ST-segment
elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. Follow-up in
the trial was terminated early after a safety review. After a median
follow-up of 502 days (interquartile range, 349 to 667), the primary end
point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of
6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs.
19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01;
P=0.07). A composite of death from cardiovascular causes, myocardial
infarction, or stroke occurred in 822 patients in the vorapaxar group
versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard
ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe
bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group
(hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. In patients with acute coronary syndromes, the
addition of vorapaxar to standard therapy did not significantly reduce the
primary composite end point but significantly increased the risk of major
bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER
ClinicalTrials.gov number, NCT00527943.).
<6>
Accession Number
2012019313
Authors
Hassan Murad M. Coburn J.A. Coto-Yglesias F. Dzyubak S. Hazem A. Lane M.A.
Prokop L.J. Montori V.M.
Institution
(Hassan Murad, Coburn, Coto-Yglesias, Dzyubak, Hazem, Lane, Prokop,
Montori) Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First
Street SW, Rochester, MN 55905, United States
(Hassan Murad, Hazem) Division of Preventive Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Hazem) Department of Internal Medicine, University of North Dakota,
Fargo, ND 58103, United States
(Montori) Division of Endocrinology, Diabetes, Metabolism, and Nutrition,
Mayo Clinic, Rochester, MN 55905, United States
Title
Glycemic control in non-critically ill hospitalized patients: A systematic
review and meta-analysis.
Source
Journal of Clinical Endocrinology and Metabolism. 97 (1) (pp 49-58),
2012. Date of Publication: January 2012.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Background: The effect of intensive therapy to achieve tight glycemic
control in patients hospitalized in non-critical care settings is unclear.
Methods:Weconducted a systematic review and meta-analysis to determine the
effect of intensive glycemic control strategies on the outcomes of death,
stroke, myocardial infarction, incidence of infection, and hypoglycemia.
We included randomized and observational studies. Bibliographic databases
were searched through February 2010. Random effects model was used to pool
results across studies. Results: Nineteen studies (nine randomized and 10
observational studies) were included. The risk of bias across studies was
moderate. Meta-analysis demonstrates that intensive glycemic control was
not associated with significant effect on the risk of death, myocardial
infarction, or stroke. There was a trend for increased risk of
hypoglycemia (relative risk, 1.58; 95% confidence interval,0.97-2.57),
particularly in surgical studies and when the planned glycemic target was
achieved. Intensive glycemic control was associated with decreased risk of
infection (relative risk, 0.41; 95% confidence interval, 0.21-0.77) that
was mainly derived from studies in surgical settings. Conclusion:
Intensive control of hyperglycemia in patients hospitalized in
non-critical care settings may reduce the risk of infection. The quality
of evidence is low and mainly driven by studies in surgical settings.
Copyright 2012 by The Endocrine Society.
<7>
Accession Number
2012013932
Authors
Navarese E.P. Kubica J. Castriota F. Gibson C.M. De Luca G. Buffon A.
Bolognese L. Margheri M. Andreotti F. Di Mario C. De Servi S.
Institution
(Navarese, Kubica) Department of Cardiology and Internal Medicine, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University,
Sklodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland
(Castriota) GVM Care and Research, Interventional Cardio-Angiology Unit,
Cotignola, Italy
(Gibson) Cardiovascular Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(De Luca) Department of Cardiology, Maggiore Della Carita Hospital,
Novara, Italy
(Buffon, Andreotti) Department of Cardiovascular Medicine, Catholic
University of the Sacred Heart, Rome, Italy
(Bolognese) Cardiovascular Department, San Donato Hospital, Arezzo, Italy
(Margheri) Division of Cardiology, Azienda Ospedaliera, Ravenna, Italy
(Di Mario) Royal Brompton Hospital, Imperial College, London, United
Kingdom
(De Servi) Department of Cardiovascular Diseases, Civic Hospital, Legnano,
Italy
Title
Safety and efficacy of biodegradable vs. durable polymer drug-eluting
stents: Evidence from a meta-analysis of randomised trials.
Source
EuroIntervention. 7 (8) (pp 985-994), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Drug-eluting stents (DES) are a major advance in interventional
cardiology; however concerns have been raised regarding their long-term
safety due to the permanent nature of the polymer. New generation stents
with biodegradable polymers (BDS) have recently been developed. The aim of
this study was to perform a meta-analysis of randomised controlled trials
(RCTs) comparing the safety and efficacy profile of BDS vs. durable
polymer DES. Methods and results: The MEDLINE/CENTRAL and Google Scholar
databases were searched for RCTs comparing safety and efficacy of BDS vs.
DES. Safety endpoints were mortality, myocardial infarction (MI), and
stent thrombosis (ST). Efficacy endpoints were target vessel
revascularisation (TVR), target lesion revascularisation (TLR) and
six-month in-stent late loss (ISLL). The meta-analysis included eight RCTs
(n=7,481). At a median follow-up of nine months, as compared to DES, BDS
use did not increase mortality (OR [95% CI] = 0.91 [0.69-1.22], p=0.53) or
MI (OR [95% CI] = 1.14 [0.90-1.44], p=0.29). Rate of late/very late ST was
significantly reduced in BDS patients (OR [95% CI] = 0.60 [0.39-0.91],
p=0.02), as was six-month ISLL (mean difference [95% CI] = -0.07 [-0.12;
-0.02] mm, p=0.004) in comparison with DES patients. Rates of TVR and TLR
were comparable between BDS and DES. Conclusions: BDS are at least as safe
as standard DES with regard to survival and MI, and more effective in
reducing late ST, as well as six-month ISLL. Further large RCTs with
long-term follow-up are warranted to definitively confirm the potential
benefits of BDS. Europa Edition 2011. All rights reserved.
<8>
Accession Number
2012013931
Authors
Sabate M. Cequier A. Iniguez A. Serra A. Hernandez-Antolin R. Mainar V.
Valgimigli M. Tespili M. Den Heijer P. Bethencourt A. Vazquez N.
Brugaletta S. Backx B. Serruys P.W.
Institution
(Sabate, Brugaletta) University Hospital Clinic, Barcelona, Spain
(Cequier) University Hospital of Bellvitge, Barcelona, Spain
(Iniguez) Hospital do Meixoeiro, Vigo, Spain
(Serra) University Hospital of Sant Pau, Barcelona, Spain
(Hernandez-Antolin) University Hospital San Carlos, Madrid, Spain
(Mainar) Hospital General of Alicante, Alicante, Spain
(Valgimigli) University Hospital Ferrara, Ferrara, Italy
(Tespili) University Hospital Bolognini Seriate, Bergamo, Italy
(Den Heijer) Amphia Ziekenhuis, Breda, Netherlands
(Bethencourt) Hospital Son Dureta, Palma de Mallorca, Spain
(Vazquez) Hospital Juan Canalejo, A Coruna, Spain
(Backx) Cardialysis, Rotterdam, Netherlands
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
Title
Rationale and design of the EXAMINATION trial: A randomised comparison
between everolimus-eluting stents and cobalt-chromium bare-metal stents in
ST-elevation myocardial infarction.
Source
EuroIntervention. 7 (8) (pp 977-984), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To assess the performance of the everolimus-eluting stent (EES)
versus cobalt chromium bare-metal stent (BMS) in the setting of primary
percutaneous coronary intervention for treatment of patients presenting
with ST-segment elevation myocardial infarction (STEMI). The implantation
of a drug-eluting stent in the setting of an acute myocardial infarction
is still controversial. In several registries this clinical scenario has
been associated with the development of stent thrombosis. The EES has
demonstrated to reduce the stent thrombosis rate as compared to
paclitaxel-eluting stent in randomised controlled trials, mainly performed
in patients in stable clinical conditions. There are however few data
regarding the effectiveness of EES in the context of STEMI. Methods and
results: This is an investigator-driven, prospective, multicentre,
multinational, randomised, single blind, two-arm, controlled trial
(ClinicalTrials.gov number: NCT00828087). This trial, with an all comer
design, randomises approximately 1,500 patients 1:1 to EES or BMS.
Overall, any patient presenting with STEMI up to 48 hours who requires
emergent percutaneous coronary intervention can be included. The primary
endpoint is the patient-oriented combined endpoint of all-cause death, any
myocardial infarction and any revascularisation at 1-year according to the
Academic Research Consortium. Clinical follow-up will be scheduled at 30
days, six months, one year and yearly up to five years. No angiographic
follow-up is mandated per protocol. Conclusions: This trial with broad
inclusion and few exclusion criteria will shed light on the performance of
the second generation EES in the complex scenario of STEMI. Europa
Edition 2011. All rights reserved.
<9>
Accession Number
2012013925
Authors
Kang W.C. Ahn T. Lee K. Han S.H. Shin E.K. Jeong M.H. Yoon J.H. Park J.-S.
Bae J.H. Hur S.H. Rha S.W. Oh S.K. Kim D.I. Jang Y. Choi J.W. Kim B.O.
Institution
(Kang, Ahn, Lee, Han, Shin) Cardiology, Gil Hospital, Gachon University of
Medicine and Science, 1198 Kuwol-dong, Namdong-gu, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Yoon) Wonju Christian Hospital, Wonju, South Korea
(Park) Yeungnam University Hospital, Daegu, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Oh) Wonkwang University Hospital, Iksan, South Korea
(Kim) Inje University Busan Paik Hospital, Busan, South Korea
(Jang) Severance Hospital, Seoul, South Korea
(Choi) Eulji Hospital, Seoul, South Korea
(Kim) Inje University Sanggye Paik Hospital, Seoul, South Korea
Title
Comparison of zotarolimus-eluting stents versus sirolimus-eluting stents
versus paclitaxel-eluting stents for primary percutaneous coronary
intervention in patients with ST-elevation myocardial infarction: Results
from the Korean Multicentre Endeavor (KOMER) acute myocardial infarction
(AMI) trial.
Source
EuroIntervention. 7 (8) (pp 936-943), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The aim of this study was to compare the efficacy and safety of
zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES) and
paclitaxel-eluting stents (PES) in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI).Methods and results: This study was a prospective,
single-blind, multicentre, randomised trial. The primary endpoint was
major adverse cardiac events (MACE) at 12 months post-procedure, defined
as cardiac death, recurrent myocardial infarction (MI), or
ischaemia-driven target lesion revascularisation (TLR). An angiographic
substudy was performed at nine months among 348 patients. From October
2006 to April 2008, 611 patients with STEMI undergoing primary PCI were
randomly assigned to treatment with ZES (n=205), SES (n=204), or PES
(n=202). The cumulative incidence of MACE was 5.9% in the ZES group, 3.4%
in the SES group and 5.7% in the PES group at 12-month follow-up
(p=0.457). There was a trend towards a lower rate of ischaemia-driven TLR
at 12- (p=0.092) and 18-month (p=0.080) follow-up in the SES group
compared to the ZES and PES groups. No difference was observed in rates of
cardiac death, recurrent MI and combined death and/or recurrent MI among
three groups at 12- and 18-month follow-up. The rate of stent thrombosis
was similar among the three groups (2.0% in each group,
p=1.000).Conclusions: As compared with SES and PES, the use of ZES in
patients with STEMI undergoing primary PCI, showed similar rates of MACE,
cardiac death and recurrent MI at 12 and 18 months. There was a trend
towards a higher rate of TLR with ZES or PES compared to SES. Europa
Edition 2011. All rights reserved.
<10>
Accession Number
2012013921
Authors
Genereux P. Mehran R. Palmerini T. Caixeta A. Kirtane A.J. Lansky A.J.
Brodie B.R. Witzenbichler B. Mockel M. Guagliumi G. Peruga J.Z. Dudek D.
Fahy M.P. Dangas G. Stone G.W.
Institution
(Genereux, Mehran, Palmerini, Caixeta, Kirtane, Lansky, Fahy, Dangas,
Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 E. 59th St., New York, NY 10022, United States
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro, NC, United States
(Witzenbichler, Mockel) Charite-Universitatsmediz in Berlin, Campus
Benjamin Franklin, Campus Virchow-Klinikum, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Department of Cardiology Medical University, Lodz Bieganski
Hospital, Lodz, Poland
(Dudek) Jagiellonian University, Krakow, Poland
Title
Radial access in patients with ST-segment elevation myocardial infarction
undergoing primary angioplasty in acute myocardial infarction: The
HORIZONS-AMI trial.
Source
EuroIntervention. 7 (8) (pp 905-916), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We sought to determine whether a transradial (TR) approach compared
with a transfemoral (TF) approach was associated with improved clinical
outcomes in patients with ST-segment elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI) in a
post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data
comparing the TR approach with the TF approach in patients with STEMI
treated with primary PCI and contemporary anticoagulant regimens. Methods
and results: In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340
patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints
included the 30-day and one-year rates of major adverse cardiovascular
events (MACE: death, reinfarction, stroke or target vessel
revascularisation), non CABG-related major bleeding, and net adverse
clinical events (NACE: MACE or major bleeding). TR compared to TF access
was associated with significantly lower 30-day rates of composite death or
reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non
CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95],
p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and
NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year,
the TR group still had significantly reduced rates of death or
reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non
CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89],
p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and
NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By
multivariable analysis, TR access was an independent predictor of freedom
from MACE and NACE at 30 days and one year. Conclusions: In patients with
STEMI undergoing primary PCI with contemporary anticoagulation regimens in
the HORIZONS-AMI trial, a TR compared with a TF approach was associated
with reduced major bleeding and improved event-free survival. Europa
Edition 2011. All rights reserved.
<11>
Accession Number
2012022817
Authors
Santangeli P. Di Biase L. Pelargonio G. Dello Russo A. Casella M.
Bartoletti S. David Burkhardt J. Mohanty P. Santarelli P. Natale A.
Institution
(Santangeli, Di Biase, David Burkhardt, Mohanty, Natale) Texas Cardiac
Arrhythmia Institute, St. David's Medical Center, 1015 East 32nd Street,
Austin, TX, United States
(Pelargonio, Santarelli) Institute of Cardiology, Catholic University of
the Sacred Heart, Rome, Italy
(Dello Russo, Casella, Bartoletti) Arrhythmia Department, Institute of
Cardiology, IRCCS-Centro Cardiologico Monzino, Milan, Italy
(Di Biase, Natale) Department of Biomedical Engineering, University of
Texas, Austin, TX, United States
(Di Biase) Department of Cardiology, University of Foggia, Foggia, Italy
Title
Cardiac resynchronization therapy in patients with mild heart failure: A
systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. 32 (2) (pp 125-135),
2011. Date of Publication: November 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Purpose: Cardiac resynchronization therapy (CRT) reduces symptoms and
improves survival in patients with advanced heart failure (New York Heart
Association (NYHA) functional class III-IV), reduced ejection fraction,
and wide QRS complex. Whether CRT has the same benefit also in
asymptomatic or mildly symptomatic heart failure patients is
controversial. Our objective is to summarize the available evidence on the
effects of CRT in asymptomatic or mildly symptomatic (NYHA I-II) heart
failure patients. Methods: We searched major web databases for randomized
controlled trials of CRT in patients with mild heart failure (NYHA
functional class I-II). Data regarding all-cause mortality, heart failure
events, left ventricular (LV) volumes and ejection fraction, and worsening
of NYHA functional class were extracted. Results: We identified five
trials (CONTAK-CD, MIRACLE ICD-II, REVERSE, MADIT-CRT, and RAFT) that
enrolled 4,213 patients (91% with NYHA II functional class). Primary
analysis excluded the CONTAK-CD, which was not specifically conducted on
patients with mild heart failure. At pooled analysis, CRT decreased
mortality (odds ratio (OR), 0.78 [95% confidence interval (CI)], 0.63 to
0.97; p=0.024) and heart failure events (OR, 0.63 [95% CI, 0.52 to 0.76],
p<0.001), induced a significant LV reverse remodeling (weighted mean
difference (WMD) of LV ejection fraction =+4.8%[95% CI, + 0.9 to+ 8.7%],
p=0.015 and WMD of LV end-systolic volume index =
-19.4mL/m<sup>2</sup>[95%CI, - 18.2 to - 20.7mL/m<sup>2</sup>], p<0.001)
and prevented the progression of heart failure symptoms (OR for worsening
of NYHA functional class= 0.54 [95% CI, 0.31 to 0.93], p=0.026). Inclusion
of the CONTAK-CD did not change the results. Conclusions: Among patients
with mild (NYHA II) heart failure, CRT reduces mortality and the risk of
heart failure events, induces a favorable LV reverse remodeling and slows
the progression of heart failure symptoms. Springer Science+Business
Media, LLC 2011.
<12>
Accession Number
70639618
Authors
Haase-Fielitz A. Mertens P.R. Plas M. Kuppe H. Hetzer R. Westerman M.
Ostland V. Prowle J.R. Bellomo R. Haase M.
Institution
(Haase-Fielitz, Mertens, Haase) Otto von Guericke University, Nephrology,
Magdeburg, Germany
(Plas, Kuppe) German Heart Center Berlin, Institute of Anesthesiology,
Berlin, Germany
(Hetzer) German Heart Center Berlin, Department of Cardiothoracic Surgery,
Berlin, Germany
(Westerman, Ostland) Intrinsic LifeSciences LLC, San Diego, United States
(Prowle, Bellomo) Austin Health, Melbourne, Australia
Title
Urine hepcidin is an early predictor of protection from cardiopulmonary
bypass-associated acute kidney injury-an observational cohort study.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S208), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Conventional markers of acute kidney injury (AKI) lack
diagnosticaccuracy and are expressed only late after cardiac surgery with
cardiopulmonary bypass(CPB). Recently, interest has focused on hepcidin, a
regulator of iron homeostasis, as a uniquerenal biomarker.OBJECTIVES. We
aimed to (1) assess the predictive value of early postoperative
urinehepcidin and plasma hepcidin for protection from AKI (2) investigate
the role of chronickidney disease on the predictive value of hepcidin and
(3) explore whether changes in urinehepcidin reflect changes in plasma
hepcidin.METHODS. We studied 100 adult patients in the control arm of a
randomized controlled trial(clinicaltrials.gov NCT00672334) that were
identified to be at increased risk of AKI aftercardiac surgery with CPB.
AKI was defined according to the RIFLE classification. Samples ofplasma
and urine were obtained simultaneously (1) before CPB (2) 6 h after the
start of CPBand (3) at 24 h after CPB. Plasma and urine hepcidin
25-isoforms were quantified by competitiveenzyme-linked
immunoassay.RESULTS. At 6 and 24 h after CPB, AKI-free patients (N = 91)
had largely increased andwere 3-7 times higher urine hepcidin
concentrations compared to patients with subsequentAKI (N = 9) in whom
postoperative urine hepcidin remained at preoperative levels(P = 0.004, P
= 0.002). Furthermore, higher urine hepcidin and, even more so, urine
hepcidinadjusted to urine creatinine at 6 h after CPB discriminated
patients who did not developAKI [AUC-ROC 0.80 (95% CI 0.71-0.87); 0.88
(95% CI 0.78-0.97)] or did not need renalreplacement therapy initiation
[AUC 0.81 (95% CI 0.72-0.88); 0.88 (95% CI 0.70-0.99)] fromthose who did.
At 6 h, urine hepcidin adjusted to urine creatinine was an independent
predictorof protection from AKI (P = 0.011). Plasma hepcidin did not
predict protection from AKI.The study findings remained essentially
unchanged after excluding patients with preoperativechronic kidney
disease.CONCLUSIONS. Our findings suggest that urine hepcidin is an early
predictive biomarker ofprotection from AKI after CPB thereby contributing
to early patients risk stratification.
<13>
Accession Number
70639315
Authors
Goepfert M.S. Richter H.P. Kubitz J.C. Von Sandersleben A. Gruetzmacher J.
Rafflenbeul E. Roeher K. Zu Eulenburg C. Reichenspurner H. Goetz A.E.
Reuter D.A.
Institution
(Goepfert, Richter, Kubitz, Von Sandersleben, Gruetzmacher, Rafflenbeul,
Roeher, Goetz, Reuter) University Medical Center Hamburg-Eppendorf,
Anaesthesiolgy and Intensive Care Medicine, Hamburg, Germany
(Zu Eulenburg) University Medical Center Hamburg-Eppendorf, Department of
Medical Biometry and Epidemiology, Hamburg, Germany
(Reichenspurner) University Heart Center Hamburg, Department of
Cardiovascular Surgery, Hamburg, Germany
Title
Does early perioperative goal directed therapy using functional and
volumetric hemodynamic parameters improve therapy in cardiac surgery? A
prospective, Randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S132), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. There is growing evidence that an early and algorithm guided
hemodynamic therapy primarily increasing cardiac output by preload
optimization improves outcome in high risk surgical patients. Preload
optimization was so far guided either by the filling pressures CVP or
PAOP, cardiac output (CO), or functional parameters based on heart lung
interactions, i.e. stroke volume variations (SVV). In particular the
latter one, having shown to be useful intraoperatively under
controlledmechanical ventilation, but becomes invalid in patients under
assisted mechanical ventilation or during spontaneous breathing.
Volumetric parameters of cardiac preload, such as global end-diastolic
volume index (GEDI) differ significantly inter-individually in critically
ill patients, but have been proven to be highly accurate to allow tracking
changes in cardiac preload in both, mechanically ventilated patients, and
during spontaneous breathing. OBJECTIVES. We implemented a hemodynamic
treatment algorithmbased on measurements of CO, SVV, and a
patient-individual GEDI for optimizing therapy during and after elective
cardiac surgery.We compared a study group (SG) guided by this
algorithmwith a control group (CG) guided by an algorithm based on CVP and
mean arterial blood pressure (MAP). METHODS.After approval of the ethic
committee and written informed consent one-hundred patients scheduled for
elective coronary artery bypass (CAB) surgery or CAB surgery in
combination with aortic valve replacement (AVR) were randomized either to
the SG (n = 50), or to the CG (n = 50). Algorithm driven hemodynamic
therapy started immediately after induction of anesthesia and was
commenced until discharge from the intensive care unit (ICU). RESULTS. 92
Patients could finally be analyzed. There was no difference in
perioperative mortality. All over complications were less in the SG (42
vs. 63). Time to reach ICU discharge criteria (SG: 15 +/- 6 h vs. CG: 24
+/- 29 (p<0.001), length of stay on the ICU (SG: 42 +/- 19 h vs.CG: 61 +/-
58 (p<0.05), and time to reach criteria for hospital discharge (SG: 5d +/-
3 vs.CG: 6 +/- 3 (p<0.001) were significantly shorter in the SG. The
cumulative use of catecholamines and vasopressors was significantly less
in the SG (1,196 +/- 1,002 mug) compared to the CG (2,523 +/- 2,205mulg;
p<0.001).Areas under the curve for postoperative (36 h) creatinine kinase,
AST, ALT, and gGT all were smaller in the study group, however without
reaching statistical significance. There were no differences in pulmonary
or renal function within the study period. CONCLUSIONS. Goal-directed
hemodynamic therapy based on an algorithm using measurements of CO, SVV
and a patient-individual GEDI minimizes organ damage and reduces length of
ICU stay after elective cardiac surgery. If long-term outcome can be
improved by these treatment strategies needs to be clarified in the
future.
<14>
Accession Number
70639219
Authors
Paulus F. Veelo D.P. De Nijs S.B. Beenen L.F. Bresser P. De Mol B.A.
Binnekade J.M. Schultz M.J.
Institution
(Paulus, Veelo, Binnekade, Schultz) Academic Medical Center, Department of
Intensive Care, Amsterdam, Netherlands
(De Nijs) Academic Medical Center, Department of Respiratory Medicine,
Amsterdam, Netherlands
(Beenen) Academic Medical Center, Department of Radiology, Amsterdam,
Netherlands
(Bresser) Academic Medical Center, Respiratory Medicine, Amsterdam,
Netherlands
(De Mol) Academic Medical Center, Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
Title
Manual hyperinflation partly prevents reductions of functional residual
capacity in cardiac surgical patients: A randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S108), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Cardiac surgical patients are kept in an iatrogenic state of
physical and pharmacologic immobilization for several hours after surgery,
to facilitate intubation and weaning from mechanically ventilation.
Immobilization reduces mucociliary transport, which can lead to retention
of sputum at atelectasis. Manual hyperinflation (MH) aims at preventing
airway plugging by mobilization of airway secretions in mechanical
ventilated patients, and as such could improve functional residual
capacity (FRC) and oxygenation after surgery. OBJECTIVES. We performed a
randomized controlled trial in patients after cardiac surgery with the aim
to compare a strategy using routineMHmaneuvers with a strategy only
usingMH if clinically indicated. METHODS. Patients after elective cardiac
surgery and admitted to the ICU of a university hospital were randomly
allocated to "routine" (MH within 1/2 h after arrival in the ICU and every
6 h until tracheal extubation) or "on demand" MH (MH only in case of
failed endotracheal suctioning while sputum is obviously present, or in
case of oxygen de-saturation not responding to 3 min hyper-oxygenation)
during mechanical ventilation. FRC was measured pre-operatively and 1, 3,
and 5 days after extubation. Chest radiographs were obtained, both
pre-operative and on the third post-operative day. Peripheral hemoglobin
saturation (Spo2) was measured at day 1, 3, and 5 after extubation while
the patient was breathing room air. RESULTS. Hundred patients were
enrolled. Patients in the "routine" group received median [IOR] 2
[2-3]MHprocedures compared to 0 [0-0]MHprocedures in the "on demand"
group. In the "routine" group FRC decreased to 72% of the pre-operative
measurement compared to 57% in the "on demand" (P = 0.002). Post-operative
chest radiographs showed more patients without signs of atelectasis in the
routineMHgroup (17%) compared to patients in the control group (0%) (P =
0.002). There were, however, no differences in oxygenation. CONCLUSIONS.
"Routine" MH attenuates reduction of FRC in the early post-operative days
after cardiac surgery. In accordance, occurrence of atelectasis on
post-operative chest radiographs was significant lower in patients who
received MH.
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