Results Generated From:
Embase <1980 to 2012 Week 04>
Embase (updates since 2012-01-19)
<1>
Accession Number
2012013528
Authors
Whitlow P.L. Feldman T. Pedersen W.R. Lim D.S. Kipperman R. Smalling R.
Bajwa T. Herrmann H.C. Lasala J. Maddux J.T. Tuzcu M. Kapadia S. Trento A.
Siegel R.J. Foster E. Glower D. Mauri L. Kar S.
Institution
(Whitlow, Tuzcu, Kapadia) Department of Cardiovascular Medicine, J2-3,
Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
(Feldman) Northshore University Health System, Chicago, IL, United States
(Pedersen) Minneapolis Heart Institute and Foundation, Minneapolis, MN,
United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Kipperman) Oklahoma Heart Hospital, Oklahoma City, OK, United States
(Smalling) Memorial Hermann Heart and Vascular Institute, Houston, TX,
United States
(Bajwa) Aurora Health Center, West Bend, WI, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Lasala) Washington University, St. Louis, MO, United States
(Maddux) International Heart Institute of Montana, Missoula, MT, United
States
(Trento, Siegel, Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Foster) University of California, San Francisco, San Francisco, CA,
United States
(Glower) Duke University Medical Center, Durham, NC, United States
(Mauri) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
Title
Acute and 12-month results with catheter-based mitral valve leaflet
repair: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk
Study.
Source
Journal of the American College of Cardiology. 59 (2) (pp 130-139), 2012.
Date of Publication: 10 Jan 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High
Risk Study (HRS) assessed the safety and effectiveness of the MitraClip
device (Abbott Vascular, Santa Clara, California) in patients with
significant mitral regurgitation (MR) at high risk of surgical mortality
rate. Background: Patients with severe MR (3 to 4+) at high risk of
surgery may benefit from percutaneous mitral leaflet repair, a potentially
safer approach to reduce MR. Methods: Patients with severe symptomatic MR
and an estimated surgical mortality rate of >=12% were enrolled. A
comparator group of patients screened concurrently but not enrolled were
identified retrospectively and consented to compare survival in patients
treated by standard care. Results: Seventy-eight patients underwent the
MitraClip procedure. Their mean age was 77 years, >50% had previous
cardiac surgery, and 46 had functional MR and 32 degenerative MR.
MitraClip devices were successfully placed in 96% of patients.
Protocol-predicted surgical mortality rate in the HRS and concurrent
comparator group was 18.2% and 17.4%, respectively, and Society of
Thoracic Surgeons calculator estimated mortality rate was 14.2% and 14.9%,
respectively. The 30-day procedure-related mortality rate was 7.7% in the
HRS and 8.3% in the comparator group (p = NS). The 12-month survival rate
was 76% in the HRS and 55% in the concurrent comparator group (p = 0.047).
In surviving patients with matched baseline and 12-month data, 78% had an
MR grade of <=2+. Left ventricular end-diastolic volume improved from 172
ml to 140 ml and end-systolic volume improved from 82 ml to 73 ml (both p
= 0.001). New York Heart Association functional class improved from III/IV
at baseline in 89% to class I/II in 74% (p < 0.0001). Quality of life was
improved (Short Form-36 physical component score increased from 32.1 to
36.1 [p = 0.014] and the mental component score from 45.5 to 48.7 [p =
0.065]) at 12 months. The annual rate of hospitalization for congestive
heart failure in surviving patients with matched data decreased from 0.59
to 0.32 (p = 0.034). Conclusions: The MitraClip device reduced MR in a
majority of patients deemed at high risk of surgery, resulting in
improvement in clinical symptoms and significant left ventricular reverse
remodeling over 12 months. (Pivotal Study of a Percutaneous Mitral Valve
Repair System [EVEREST II]; NCT00209274). 2012 by the American College of
Cardiology Foundation.
<2>
Accession Number
2012035869
Authors
Fernandez-Sabe N. Cervera C. Farinas M.C. Bodro M. Munoz P. Gurgui M.
Torre-Cisneros J. Martin-Davila P. Noblejas A. Len O. Garcia-Reyne A. Del
Pozo J.L. Carratala J.
Institution
(Fernandez-Sabe, Bodro, Carratala) Infectious Disease Service, Institut
d'Investigacio Biomedica de Bellvitge (IDIBELL), Hospital Universitari de
Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
(Cervera) Infectious Disease Service, Hospital Clinic, University of
Barcelona, Spain
(Farinas) Infectious Disease Unit, Hospital Universitario Marques de
Valdecilla, University of Cantabria, Santander, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
Hospital General Universitario Gregorio Maranon, Universidad Complutense
de Madrid, Spain
(Gurgui) Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau,
Universitat Autonoma de Barcelona, Spain
(Torre-Cisneros) Unidad Clinica de Enfermedades Infecciosas, Hospital
Universitario Reina Sofia-IMIBIC, Universidad de Cordoba, Spain
(Martin-Davila) Department of Infectious Diseases, Hospital Universitario
Ramon y Cajal, Spain
(Noblejas) Transplant Department, Hospital Universitario Puerta de Hierro,
Madrid, Spain
(Len) Infectious Disease Service, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Garcia-Reyne) Infectious Disease Unit, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Del Pozo) Infectious Diseases Division, Clinica Universidad de Navarra,
Spain
Title
Risk factors, clinical features, and outcomes of toxoplasmosis in
solid-organ transplant recipients: A matched case-control study.
Source
Clinical Infectious Diseases. 54 (3) (pp 355-361), 2012. Date of
Publication: 01 Feb 2012.
Publisher
Oxford University Press (2001 Evans Road, Cary NC 27513, United States)
Abstract
Background. Solid-organ transplant (SOT) recipients are considered to be
at increased risk for toxoplasmosis. However, risk factors for this
infection have not been assessed. The aim of this study was to determine
the risk factors, clinical features, and outcomes of toxoplasmosis in SOT
recipients. Methods. A multicenter, matched case-control study (1:2 ratio)
was conducted between 2000 and 2009. Control subjects were matched for
center, transplant type, and timing. Cases were identified from the
hospitals' microbiology and transplantation program databases. Logistic
regression was performed to identify independent risk factors. Results.
Twenty-two cases (0.14%) of toxoplasmosis were identified among 15 800
SOTs performed in 11 Spanish hospitals, including 12 heart, 6 kidney, and
4 liver recipients. Diagnosis was made by seroconversion (n = 17),
histopathologic examination (n = 5), polymerase chain reaction (n = 2),
and autopsy (n = 2). In a comparison of case patients with 44 matched
control subjects, a negative serostatus prior to transplantation was the
only independent risk factor for toxoplasmosis (odds ratio, 15.12 [95%
confidence interval, 2.37-96.31]; P =. 004). The median time to diagnosis
following transplantation was 92 days. Primary infection occurred in 18
(81.8%) cases. Manifestations included pneumonitis (n = 7), myocarditis (n
= 5), brain abscesses (n = 5), chorioretinitis (n = 3), lymph node
enlargement (n = 2), hepatosplenomegaly (n = 2), and meningitis (n =1).
Five patients (22.7%) had disseminated disease. Crude mortality rate was
13.6% (3 of 22 patients). Conclusions. Although uncommon, toxoplasmosis in
SOT patients causes substantial morbidity and mortality. Seronegative
recipients are at high risk for developing toxoplasmosis and should be
given prophylaxis and receive careful follow-up. The Author 2011.
Published by Oxford University Press on behalf of the Infectious.
<3>
Accession Number
2012033138
Authors
Nojiri T. Yamamoto K. Maeda H. Takeuchi Y. Funakoshi Y. Inoue M. Okumura
M.
Institution
(Nojiri, Maeda, Takeuchi, Funakoshi) Department of General Thoracic
Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka City
560-8552, Osaka, Japan
(Nojiri, Inoue, Okumura) Department of General Thoracic Surgery, Osaka
University, Graduate School of Medicine, Suita-City, Japan
(Yamamoto) Department of Cardiology, Osaka University, Graduate School of
Medicine, Suita-City, Japan
Title
Effect of low-dose human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer: A double-blind, placebo-controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 488-494),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We previously reported that patients with preoperative B-type
natriuretic peptide levels of 30 pg/mL or more have increased risk of
postoperative atrial fibrillation after pulmonary resection. This study
evaluated the effects of human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer. Methods: A prospective, randomized study was conducted with 40
patients who had preoperative elevated B-type natriuretic peptide (>=30
pg/mL) and underwent a scheduled pulmonary resection for lung cancer.
Results were compared between patients who received low-dose human atrial
natriuretic peptide and those who received a placebo. The primary end
point was the incidence of postoperative atrial fibrillation during the
first 4 days after surgery. Results: The incidence of postoperative atrial
fibrillation was significantly lower in the human atrial natriuretic
peptide group than in the placebo group (10% vs 60%; P < .001). Patients
in the human atrial natriuretic peptide group also showed significantly
lower white blood cell counts and C-reactive protein levels after surgery.
Conclusions: Continuous infusion of low-dose human atrial natriuretic
peptide during lung cancer surgery had a prophylactic effect against
postoperative atrial fibrillation after pulmonary resection in patients
with preoperative elevation of B-type natriuretic peptide levels. A larger
sample size is needed to establish the safety and efficacy of this
intervention. 2012 by The American Association for Thoracic Surgery.
<4>
Accession Number
2012033160
Authors
Desai S.P. Henry L.L. Holmes S.D. Hunt S.L. Martin C.T. Hebsur S. Ad N.
Institution
(Desai, Henry, Holmes, Hunt, Martin, Hebsur, Ad) Inova Heart and Vascular
Institute, 3300 Gallows Road, Falls Church, VA 22042, United States
Title
Strict versus liberal target range for perioperative glucose in patients
undergoing coronary artery bypass grafting: A prospective randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 318-325),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of this study was to test the hypothesis that a
liberal blood glucose strategy (121-180 mg/dL) is not inferior to a strict
blood glucose strategy (90-120 mg/dL) for outcomes in patients after
first-time isolated coronary artery bypass grafting and is superior for
glucose control and target blood glucose management. Methods: A total of
189 patients undergoing coronary artery bypass grafting were investigated
in this prospective randomized study to compare 2 glucose control
strategies on patient perioperative outcomes. Three methods of analyses
(intention to treat, completer, and per protocol) were conducted. Observed
power was robust (>80%) for significant results. Results: The groups were
similar on preoperative hemoglobin A <sub>1c</sub> and number of diabetic
patients. The liberal group was found to be noninferior to the strict
group for perioperative complications and superior on glucose control and
target range management. The liberal group had significantly fewer
patients with hypoglycemic events (<60 mg/dL; P < .001), but severe
hypoglycemic events (<40 mg/dL) were rare and no group differences were
found (P = .23). These results were found with all 3 methods of analysis
except for blood glucose variability, maximum blood glucose, and
perioperative atrial fibrillation. Conclusions: This study demonstrated
that maintenance of blood glucose in a liberal range after coronary artery
bypass grafting led to similar outcomes compared with a strict target
range and was superior in glucose control and target range management. On
the basis of the results of this study, a target blood glucose range of
121 to 180 mg/dL is recommended for patients after coronary artery bypass
grafting as advocated by the Society of Thoracic Surgeons. 2012 by The
American Association for Thoracic Surgery.
<5>
Accession Number
2012033153
Authors
Lee H.J. Kim Y.T. Park P.J. Shin Y.S. Kang K.N. Kim Y. Kim C.W.
Institution
(Lee, Kim) Department of Molecular Oncology, Cancer Research Institute,
Seoul National University, Seoul, South Korea
(Lee) National Evidence-Based Healthcare Collaborating Agency, Seoul,
South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Clinical Research
Institute, Seoul National University Hospital, Seoul, South Korea
(Park, Shin, Kang) Bioinfra Inc, Cancer Research Institute, Seoul National
University, Seoul, South Korea
(Kim) Department of Statistics, Seoul National University, Seoul, South
Korea
(Kim) Department of Pathology, Cancer Research Institute, Seoul National
University, Seoul, South Korea
Title
A novel detection method of non-small cell lung cancer using multiplexed
bead-based serum biomarker profiling.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 421-427),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Non-small cell lung cancer (NSCLC) is the leading cause of
cancer-related mortality. Development of an early diagnosis method may
improve survivals. We aimed to develop a new diagnostic model for NSCLC
using serum biomarkers. Methods: We set up a patient group diagnosed with
NSCLC (n = 122) and a healthy control group (n = 225). Thirty serum
analytes were selected on the basis of previous studies and a literature
search. An antibody-bead array of 30 markers was constructed using the
Luminex bead array platform (Luminex Inc, Austin, Tex) and was analyzed.
Each marker was ranked by importance using the random forest method and
then selected. Using selected markers, multivariate classification
algorithms were constructed and were validated by application to
independent validation cohort of 21 NSCLC and 28 control subjects.
Results: There was no difference in demographics between patients and the
control population except for age (64.8 +/- 10.0 for patients vs 53.0 +/-
7.6 years for the control group). Among the 30 serum proteins, 23 showed a
difference between the 2 groups (12 increased and 11 decreased in the
patient group). We found the highest accuracy of multivariate
classification algorithms when using the 5 highest-ranked biomarkers
(A1AT, CYFRA 21-1, IGF-1, RANTES, AFP). When we applied the algorithms on
a validation cohort, each method recognized the patients from the controls
with high accuracy (89.8% with random forest, 91.8% with support vector
machine, 88.2% with linear discriminant analysis, and 90.5% with logistic
regression). Conclusions: We confirmed that a new diagnostic method using
5 serum biomarkers profiling constructed by multivariate classification
algorithms could distinguish NSCLC from healthy controls with high
accuracy. 2012 by The American Association for Thoracic Surgery.
<6>
Accession Number
2012041563
Authors
van Loon R.B. Veen G. Baur L.H.B. Kamp O. Bronzwaer J.G.F. Twisk J.W.R.
Verheugt F.W.A. van Rossum A.C.
Institution
(van Loon, Veen, Kamp, Bronzwaer, van Rossum) Department of Cardiology, VU
University Medical Center, Amsterdam, Netherlands
(Baur) Department of Cardiology, Atrium Medical Center Parkstad, Heerlen
and Faculty of Health, Medicine and Life Sciences, University Maastricht,
Netherlands
(Twisk) Department of Clinical Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, Netherlands
(Verheugt) Heartcenter, University Medical Center, St Radboud, Nijmegen,
Netherlands
Title
Improved clinical outcome after invasive management of patients with
recent myocardial infarction and proven myocardial viability: Primary
results of a randomized controlled trial (VIAMI-trial).
Source
Trials. 13 , 2012. Article Number: 1. Date of Publication: 03 Jan
2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) not
treated with primary or rescue percutaneous coronary intervention (PCI)
are at risk for recurrent ischemia, especially when viability in the
infarct-area is present. Therefore, an invasive strategy with PCI of the
infarct-related coronary artery in patients with viability would reduce
the occurrence of a composite end point of death, reinfarction, or
unstable angina (UA).Methods: Patients admitted with an (sub)acute
myocardial infarction, who were not treated by primary or rescue PCI, and
who were stable during the first 48 hours after the acute event, were
screened for the study. Eventually, we randomly assigned 216 patients with
viability (demonstrated with low-dose dobutamine echocardiography) to an
invasive or a conservative strategy. In the invasive strategy stenting of
the infarct-related coronary artery was intended with abciximab as adjunct
treatment. Seventy-five (75) patients without viability served as registry
group. The primary endpoint was the composite of death from any cause,
recurrent myocardial infarction (MI) and unstable angina at one year. As
secondary endpoint the need for (repeat) revascularization procedures and
anginal status were recorded.Results: The primary combined endpoint of
death, recurrent MI and unstable angina was 7.5% (8/106) in the invasive
group and 17.3% (19/110) in the conservative group (Hazard ratio 0.42; 95%
confidence interval [CI] 0.18-0.96; p = 0.032). During follow up
revascularization-procedures were performed in 6.6% (7/106) in the
invasive group and 31.8% (35/110) in the conservative group (Hazard ratio
0.18; 95% CI 0.13-0.43; p < 0.0001). A low rate of recurrent ischemia was
found in the non-viable group (5.4%) in comparison to the
viable-conservative group (14.5%). (Hazard-ratio 0.35; 95% CI 0.17-1.00; p
= 0.051).Conclusion: We demonstrated that after acute MI (treated with
thrombolysis or without reperfusion therapy) patients with viability in
the infarct-area benefit from a strategy of early in-hospital stenting of
the infarct-related coronary artery. This treatment results in a long-term
uneventful clinical course. The study confirmed the low risk of recurrent
ischemia in patients without viability. Trial registration:
ClinicalTrials.gov: NCT00149591. 2012 van Loon et al; licensee BioMed
Central Ltd.
<7>
Accession Number
22253393
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J. BRIDGE Investigators
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, USA.
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: a randomized controlled trial.
Source
JAMA : the journal of the American Medical Association. 307 (3) (pp
265-274), 2012. Date of Publication: 18 Jan 2012.
Abstract
Thienopyridines are among the most widely prescribed medications, but
their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding. To
evaluate the use of cangrelor, an intravenous, reversible P2Y(12) platelet
inhibitor for bridging thienopyridine-treated patients to coronary artery
bypass grafting (CABG) surgery. Prospective, randomized, double-blind,
placebo-controlled, multicenter trial, involving 210 patients with an
acute coronary syndrome (ACS) or treated with a coronary stent and
receiving a thienopyridine awaiting CABG surgery to receive either
cangrelor or placebo after an initial open-label, dose-finding phase (n =
11) conducted between January 2009 and April 2011. Interventions
Thienopyridines were stopped and patients were administered cangrelor or
placebo for at least 48 hours, which was discontinued 1 to 6 hours before
CABG surgery. The primary efficacy end point was platelet reactivity
(measured in P2Y(12) reaction units [PRUs]), assessed daily. The main
safety end point was excessive CABG surgery-related bleeding. The dose of
cangrelor determined in 10 patients in the open-label stage was 0.75
mug/kg per minute. In the randomized phase, a greater proportion of
patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P < .001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P = .763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Among patients who discontinue thienopyridine therapy prior to cardiac
surgery, the use of cangrelor compared with placebo resulted in a higher
rate of maintenance of platelet inhibition. clinicaltrials.gov Identifier:
NCT00767507.
<8>
Accession Number
2012028337
Authors
Yazici D. Tas S. Emir H. Sunar H.
Institution
(Yazici) Sub-department of Endocrinology and Metabolism, Department of
Internal Medicine, School of Medicine, Marmara University, Istanbul,
Turkey
(Tas, Sunar) Cardiac and Vascular Surgery Clinic, Kartal Kosuyolu
Education and Research Hospital, Istanbul, Turkey
(Emir) Diabetes Education Nurse, Kartal Education and Research Hospital,
Istanbul, Turkey
Title
A Comparison of preprandial mixed insulin given three times daily and
basal-bolus insulin therapy started postoperatively on patients having
coronary artery bypass graft surgery.
Source
Marmara Medical Journal. 25 (1) (pp 16-19), 2012. Date of Publication:
2012.
Publisher
Marmara University (Haydarpasa, Istanbul, Turkey)
Abstract
Objective: Insulin therapy initiated after coronary artery bypass graft
(CABG) surgery has decreased long-term mortality. The aim was to compare
the effectiveness of prandial premixed therapy (PPT) using insulin thrice
daily and basal-bolus therapy (BBT) on patients having CABG surgery.
Patients and Methods: Thirty-four patients having CABG surgery were
included. Fasting blood glucose (FBG), postprandial blood glucose (PPBG),
hemoglobin A1c (HbA1c) and hemoglobin levels were determined
preoperatively and at the first week postoperatively when the patients
were randomized to either PPT or BBT. Initial measurements were repeated
at the end of three months. Results: Seventeen patients (F/M:9/8;
61.5+/-8.5 years) were assigned on a random basis to the mixed insulin arm
and 17 patients (F/M:10/7; 57.4+/-9.2 years) to the basal-bolus arm. FBG,
PPBG and HbA1c levels of both groups (7.6+/-0.8 % vs 6.7+/-0.5 % in the
BBT and 7.3+/-0.7 % vs 7.3+/-1.0 % in the PPT group) at the end of the 3
months were not different than at the time of randomization. The
percentage of patients reaching HbA1c levels below 6.0%, 6.5% and 7.0%
were higher in the BBT group compared to the PPT group. Conclusion: For
patients who had undergone CABG surgery, BBT provided more patients with
HbA1c levels below the target than did PPT. Marmara Medical Journal,
Published by Galenos Publishing.
<9>
Accession Number
2012031984
Authors
De Luca G. Iorio S. Venegoni L. Marino P.
Institution
(De Luca, Iorio, Venegoni, Marino) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carit, Eastern Piedmont
University, Novara, Italy
Title
Evaluation of intracoronary adenosine to prevent periprocedural
myonecrosis in elective percutaneous coronary intervention (from the
PREVENT-ICARUS trial).
Source
American Journal of Cardiology. 109 (2) (pp 202-207), 2012. Date of
Publication: 15 Jan 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Great interest has focused on pharmacotherapy to prevent periprocedural
myocardial injury during elective percutaneous coronary intervention
(PCI). The aim of the present trial was to investigate the benefits of
preprocedural intracoronary administration of high-dose adenosine during
elective PCI. This was a single-center, double-blind, randomized trial of
patients undergoing elective PCI. The patients were randomized (1:1) by
sealed envelops to intracoronary adenosine (120 mug for the right coronary
artery and 180 mug for the left coronary artery) or placebo. The primary
study end point was a periprocedural increase in troponin I >3 times the
upper limit of normal. The secondary study end points were (1) the
corrected Thrombolysis In Myocardial Infarction frame count; (2) troponin
I release >10 times the upper limit of normal; (3) creatine kinase-MB mass
release <3 times the upper limit of normal; and (4) the combined
cumulative incidence of in-hospital death, periprocedural myocardial
infarction, and in-hospital urgent target vessel revascularization. The
safety end point was the occurrence of bradycardia and ventricular
arrhythmias during study drug administration. From November 2009 to
September 2010, we randomized 260 patients who were undergoing elective
PCI to intracoronary adenosine (n = 130) or placebo (n = 130). A greater
prevalence of calcified lesions was observed in the adenosine group (p =
0.002). In contrast, a greater prevalence of type C lesions (p = 0.091),
chronic occlusions (p = 0.015), worse preprocedural Thrombolysis In
Myocardial Infarction flow (p = 0.038), and more severely stenotic lesions
(p = 0.005) were observed in the placebo group. No difference was found in
the primary (67.7% vs 70%, p = 0.69) or secondary end points. No serious
side effects were observed with adenosine. In conclusion, our randomized
trial showed that preprocedural intracoronary administration of a single
high-dose bolus of adenosine does not provide any benefit in terms of
periprocedural myonecrosis in patients undergoing elective PCI. 2012
Elsevier Inc.
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