Results Generated From:
Embase <1980 to 2012 Week 06>
Embase (updates since 2012-02-02)
<1>
Accession Number
2012052617
Authors
Suleiman M. Koestler C. Lerman A. Lopez-Jimenez F. Herges R. Hodge D.
Bradley D. Cha Y.-M. Brady P.A. Munger T.M. Asirvatham S.J. Packer D.L.
Friedman P.A.
Institution
(Suleiman) Rambam Medical Center, Haifa, Israel
(Koestler, Lerman, Lopez-Jimenez, Herges, Hodge, Bradley, Cha, Brady,
Munger, Asirvatham, Packer, Friedman) Division of Cardiovascular Medicine,
Mayo Clinic, Rochester, MN 55905, United States
Title
Atorvastatin for prevention of atrial fibrillation recurrence following
pulmonary vein isolation: A double-blind, placebo-controlled, randomized
trial.
Source
Heart Rhythm. 9 (2) (pp 172-178), 2012. Date of Publication: February
2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: It is known that statins are effective in preventing atrial
fibrillation (AF) in patients undergoing cardiac surgery. Objective: The
purpose of this study was to evaluate the efficacy of statins in
preventing AF recurrence following left atrial ablation. Methods: One
hundred twenty-five patients who had no statin indication undergoing
catheter ablation due to drug-refractory paroxysmal (n = 90) or persistent
(n = 35) AF were randomized in a prospective, double-blind,
placebo-controlled trial to receive 80 mg atorvastatin (n = 62) or placebo
(n = 63) for 3 months. The primary endpoint was freedom from symptomatic
AF at 3 months. Secondary endpoints included freedom from any atrial
arrhythmia recurrence irrespective of symptoms, quality of life (QoL), and
reduction in C-reactive protein (CRP). Results: At 3 months, 95% of
patients in the atorvastatin group were free of symptomatic AF compared
with 93.5% in the placebo group (P =.75). Similarly, 85% of patients
treated in the atorvastatin group remained free of any recurrent atrial
arrhythmia vs 88% of patients in the placebo group (P =.37). Mean CRP
levels decreased in the atorvastatin group (mean change -0.75 +/- 3, P
=.02) and increased in the placebo group (mean change 2.1 +/- 19.9, P
=.48). Mean QoL score improved significantly in both groups (mean change
13.14 +/- 18.2 in the atorvastatin group and 11.10 +/- 17.7 in the placebo
group, P =.53). Conclusion: In patients with no standard indication for
statin therapy, treatment with atorvastatin 80 mg/day following AF
ablation does not decrease the risk of AF recurrence in the first 3 months
and should not be routinely administered to prevent periprocedural
arrhythmias. 2012 Heart Rhythm Society.
<2>
Accession Number
2012059171
Authors
Boden H. Van Der Hoeven B.L. Liem S.-S. Atary J.Z. Cannegieter S.C. Atsma
D.E. Bootsma M. Jukema J.W. Zeppenfeld K. Oemrawsingh P.V. Van Der Wall
E.E. Schalij M.J.
Institution
(Boden, Van Der Hoeven, Liem, Atary, Atsma, Bootsma, Jukema, Zeppenfeld,
Van Der Wall, Schalij) Dept. of Cardiology, Leiden University Medical
Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Oemrawsingh) Department of Cardiology, Medical Center Haaglanden, The
Hague, Netherlands
(Schalij) P.O. Box 9600, 2300 RC Leiden, Netherlands
Title
Five-year clinical follow-up from the MISSION! Intervention Study:
Sirolimus-eluting stent versus bare metal stent implantation in patients
with ST-segment elevation myocardial infarction, a randomised controlled
trial.
Source
EuroIntervention. 7 (9) (pp 1021-1029), 2012. Date of Publication:
January 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To evaluate the clinical outcomes of sirolimus-eluting stent (SES)
versus bare metal stent (BMS) implantation in patients with ST-segment
elevation myocardial infarction (STEMI) at long-term follow-up. Methods
and results: After five years, 310 STEMI patients randomly assigned to
implantation of either SES or BMS, were compared. Survival rates were
comparable between groups (SES 94.3% vs. BMS 92.8%, p=0.57), as were the
rates of reinfarction (10.6% vs. 13.7%, p=0.40), freedom of death/re-MI
(84.4% vs. 79.8%, p=0.29) and target vessel failure (14.9% vs. 21.7%,
p=0.11). Likewise, rates of overall stent thrombosis (ST) (5.4% vs. 2.7%,
p=0.28) and very late ST (4.1% vs. 0.7%, p=0.07) did not significantly
differ between the SES- and BMSgroup. In 184 patients with IVUS data,
definite and definite/probable VLST was more common in those with late
stent malapposition versus those without late stent malapposition (4.3%
and 6.6% vs. no events [p=0.018 and p=0.004], respectively). The
cumulative incidences of target vessel and target lesion revascularisation
(TVR and TLR) were not significantly lower in the SES-group (11.2% vs.
17.9%, p=0.09 and 7.2% vs. 12.9%, p=0.08), as was the rate of clinically
driven TLR (6.6% vs. 9.5%, p=0.30). Conclusions: SES implantation was
neither associated with increased rates of major adverse cardiac events,
nor with a reduction in re-intervention, compared to implantation of a BMS
in patients with STEMI after five years. However, a trend of more very
late stent thrombosis was observed after SES implantation
(ISRCTN62825862). Europa Edition 2012. All rights reserved.
<3>
Accession Number
2012057982
Authors
Cohen D.J. Lavelle T.A. Van Hout B. Li H. Lei Y. Robertus K. Pinto D.
Magnuson E.A. McGarry T.F. Lucas S.K. Horwitz P.A. Henry C.A. Serruys P.W.
Mohr F.W. Kappetein A.P.
Institution
(Cohen, Li, Lei, Robertus, Magnuson) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, School of Medicine, 4401
Wornall Road, Kansas City, MO 64111, United States
(Lavelle) Harvard School of Public Health, Boston, MA, United States
(Van Hout) University of Sheffield, Sheffield, United Kingdom
(Pinto) Beth Israel Deaconess Medical Center, Boston, MA, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, Oklahoma City,
OK, United States
(Lucas) St. Anthony Hospital, Oklahoma City, OK, United States
(Horwitz) University of Iowa Hospital and Clinics, Iowa City, IA, United
States
(Henry) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Economic outcomes of percutaneous coronary intervention with drug-eluting
stents versus bypass surgery for patients with left main or three-vessel
coronary artery disease: One-year results from the SYNTAX trial.
Source
Catheterization and Cardiovascular Interventions. 79 (2) (pp 198-209),
2012. Date of Publication: 01 Feb 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: To evaluate the cost-effectiveness of alternative approaches
to revascularization for patients with three-vessel or left main coronary
artery disease (CAD). Background: Previous studies have demonstrated that,
despite higher initial costs, long-term costs with bypass surgery (CABG)
in multivessel CAD are similar to those for percutaneous coronary
intervention (PCI). The impact of drug-eluting stents (DES) on these
results is unknown. Methods: The SYNTAX trial randomized 1,800 patients
with left main or three-vessel CAD to either CABG (n = 897) or PCI using
paclitaxel-eluting stents (n = 903). Resource utilization data were
collected prospectively for all patients, and cumulative 1-year costs were
assessed from the perspective of the U.S. healthcare system. Results:
Total costs for the initial hospitalization were $5,693/patient higher
with CABG, whereas follow-up costs were $2,282/patient higher with PCI due
mainly to more frequent revascularization procedures and higher outpatient
medication costs. Total 1-year costs were thus $3,590/patient higher with
CABG, while quality-adjusted life expectancy was slightly higher with PCI.
Although PCI was an economically dominant strategy for the overall
population, cost-effectiveness varied considerably according to
angiographic complexity. For patients with high angiographic complexity
(SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and
the incremental cost-effectiveness ratio for CABG was $43,486 per
quality-adjusted life-year gained. Conclusions: Among patients with
three-vessel or left main CAD, PCI is an economically attractive strategy
over the first year for patients with low and moderate angiographic
complexity, while CABG is favored among patients with high angiographic
complexity. 2011 Wiley Periodicals, Inc.
<4>
Accession Number
2012067513
Authors
Stevenson W.G. Hernandez A.F. Carson P.E. Fang J.C. Katz S.D. Spertus J.A.
Sweitzer N.K. Tang W.H.W. Albert N.M. Butler J. Westlake Canary C.A.
Collins S.P. Colvin-Adams M. Ezekowitz J.A. Givertz M.M. Hershberger R.E.
Rogers J.G. Teerlink J.R. Walsh M.N. Stough W.G. Starling R.C.
Institution
(Stevenson, Givertz) Department of Medicine, Division of Cardiology
Brigham, Women's Hospital, Boston, MA, United States
(Hernandez, Rogers) Department of Medicine, Division of Cardiology, Duke
University Medical Center, Durham, NC, United States
(Carson) Georgetown University, Washington DC Veterans Affairs Medical
Center, Washington, DC, United States
(Fang) Harrington-McLaughlin Heart and Vascular Institute, School of
Medicine, Case Western Reserve University, Cleveland, OH, United States
(Katz) Leon H. Charney Division of Cardiology, New York University, School
of Medicine, New York, NY, United States
(Spertus) Mid-America Heart Institute, St Luke's Hospital, University of
Missouri-Kansas City, Kansas City, MI, United States
(Sweitzer) Department of Medicine, University of Wisconsin, Madison, WI,
United States
(Tang, Starling) Department of Cardiovascular Medicine, Cleveland Clinic,
9500 Euclid Avenue, Cleveland, OH 44195, United States
(Albert) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Butler) Department of Medicine, Division of Cardiology, Emory University,
Atlanta, GA, United States
(Westlake Canary) School of Nursing, Azusa Pacific University, Azusa, CA,
United States
(Collins) Department of Emergency Medicine, Vanderbilt University,
Nashville, TN, United States
(Colvin-Adams) Cardiovascular Division, University of Minnesota,
Minneapolis, MN, United States
(Ezekowitz) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Hershberger) Department of Medicine, Division of Cardiology, University
of Miami, Miami, FL, United States
(Teerlink) Department of Medicine, University of California, San
Francisco, CA, United States
(Walsh) Care Group, Indianapolis, IN, United States
(Stough) Department of Clinical Research, Campbell University College of
Pharmacy and Health Sciences, Buies Creek, NC, United States
Title
Indications for cardiac resynchronization therapy: 2011 update from the
Heart Failure Society of America guideline committee.
Source
Journal of Cardiac Failure. 18 (2) (pp 94-106), 2012. Date of
Publication: February 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Cardiac resynchronization therapy (CRT) improves survival, symptoms,
quality of life, exercise capacity, and cardiac structure and function in
patients with New York Heart Association (NYHA) functional class II or
ambulatory class IV heart failure (HF) with wide QRS complex. The totality
of evidence supports the use of CRT in patients with less severe HF
symptoms. CRT is recommended for patients in sinus rhythm with a widened
QRS interval (>=150 ms) not due to right bundle branch block (RBBB) who
have severe left ventricular (LV) systolic dysfunction and persistent NYHA
functional class II-III symptoms despite optimal medical therapy (strength
of evidence A). CRT may be considered for several other patient groups for
whom evidence of benefit is clinically significant but less substantial,
including patients with a QRS interval of >=120 to <150 ms and severe LV
systolic dysfunction who have persistent mild to severe HF despite optimal
medical therapy (strength of evidence B), some patients with atrial
fibrillation, and some with ambulatory class IV HF. Several evidence gaps
remain that need to be addressed, including the ideal threshold for QRS
duration, QRS morphology, lead placement, degree of myocardial scarring,
and the modality for evaluating dyssynchrony. Recommendations will evolve
over time as additional data emerge from completed and ongoing clinical
trials. 2012 Elsevier Inc. All rights reserved.
<5>
Accession Number
2012066336
Authors
Jukema J.W. Collet J.-P. De Luca L.
Institution
(Jukema) Department of Cardiology, Leiden University Medical Centre, PO
Box 9600, 2300 RC Leiden, Netherlands
(Collet) Groupe Hospitalier Pitie-Salpetriere, Institut de Cardiologie,
Paris, France
(De Luca) Department of Cardiovascular Sciences, Interventional Cardiology
Unit, European Hospital, Rome, Italy
Title
Antiplatelet therapy in patients with ST-elevation myocardial infarction
undergoing myocardial revascularisation: Beyond clopidogrel.
Source
Current Medical Research and Opinion. 28 (2) (pp 203-211), 2012. Date of
Publication: February 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background: Despite revascularisation, outcomes among patients presenting
with ST-elevation myocardial infarction (STEMI) remain suboptimal. Scope:
This review compares clopidogrel, ticagrelor and prasugrel as antiplatelet
strategies with a particular focus on STEMI. Medline and Google Scholar
were searched for relevant terms and citations from these articles were
also assessed. Findings: While clopidogrel represented an important
therapeutic advance, variations in platelet response and a relatively slow
onset of action compromise outcomes in some patients. Ticagrelor and
prasugrel are more effective than clopidogrel, although essentially only
one large study supports each drug. Nevertheless, a detailed examination
of the evidence reveals several issues that may influence the decision to
prescribe ticagrelor instead of prasugrel and vice versa. Arguably,
prasugrel could be the preferred strategy in STEMI, reflecting the drugs'
efficacy in clopidogrel-nave patients, the most common group in clinical
practice. Conversely, ticagrelor may be a better option than clopidogrel
in clopidogrel-pretreated patients showing a mortality benefit
irrespective of clopidogrel pre-treatment. The clinical benefits offered
by prasugrel and ticagrelor need to be offset against the increased cost
and we suggest an algorithm for using these new compounds in the primary
percutaneous coronary intervention (PCI) setting. The risk of bleeding
associated with prasugrel is similar to that of clopidogrel and ticagrelor
following exclusion of at-risk patients. Nevertheless, prasugrel may be
especially appropriate for STEMI patients undergoing PCI who are
considered to be at high risk of ischaemia. Conversely, ticagrelor's short
half-life, while potentially a limitation during maintenance therapy, may
reduce bleeding risk if the patient undergoes CABG during the same
hospital admission, although confirmatory studies are needed. Conclusion:
Future studies also need to address several other outstanding issues, such
as the subsequent approach if patients do not undergo PCI, and to overcome
limitations in and differences between the primary studies. In particular,
head-to-head comparisons need to compare directly the risks and benefits
of ticagrelor and prasugrel in STEMI patients. These caveats
notwithstanding, ticagrelor and prasugrel markedly improve the prognosis
for patients with STEMI. 2012 Informa UK Ltd.
<6>
[Use Link to view the full text]
Accession Number
2012051045
Authors
Landoni G. Biondi-Zoccai G. Greco M. Greco T. Bignami E. Morelli A.
Guarracino F. Zangrillo A.
Institution
(Landoni, Greco, Greco, Bignami, Zangrillo) Department of Anesthesia and
Intensive Care, Universita Vita-Salute San Raffaele, Milano, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
(Morelli) Department of Anesthesiology and Intensive Care, University of
Rome, La Sapienza, Rome, Italy
(Guarracino) Cardiothoracic Department, Azienda Ospedaliera Universitaria
Pisana, Pisa, Italy
Title
Effects of levosimendan on mortality and hospitalization. A meta-analysis
of randomized controlled studies.
Source
Critical Care Medicine. 40 (2) (pp 634-646), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Catecholaminergic inotropes have a place in the management of
low output syndrome and decompensated heart failure but their effect on
mortality is debated. Levosimendan is a calcium sensitizer that enhances
myocardial contractility without increasing myocardial oxygen use. A
meta-analysis was conducted to determine the impact of levosimendan on
mortality and hospital stay. Data Sources: BioMedCentral, PubMed, Embase,
and the Cochrane Central Register of clinical trials were searched for
pertinent studies. International experts and the manufacturer were
contacted. Study Selection: Articles were assessed by four trained
investigators, with divergences resolved by consensus. Inclusion criteria
were random allocation to treatment and comparison of levosimendan vs.
control. There were no restrictions on dose or time of levosimendan
administration or on language. Exclusion criteria were: duplicate
publications, nonadult studies, oral administration of levosimendan, and
no data on main outcomes. Data Extraction: Study end points, main
outcomes, study design, population, clinical setting, levosimendan dosage,
and treatment duration were extracted. Data Synthesis: Data from 5,480
patients in 45 randomized clinical trials were analyzed. The overall
mortality rate was 17.4% (507 of 2,915) among levosimendan-treated
patients and 23.3% (598 of 2,565) in the control group (risk ratio 0.80
[0.72; 0.89], p for effect <.001, number needed to treat = 17 with 45
studies included). Reduction in mortality was confirmed in studies with
placebo (risk ratio 0.82 [0.69; 0.97], p = .02) or dobutamine (risk ratio
0.68 [0.52-0.88]; p = .003) as comparator and in studies performed in
cardiac surgery (risk ratio 0.52 [0.35; 0.76] p = .001) or cardiology
(risk ratio 0.75 [0.63; 0.91], p = .003) settings. Length of hospital stay
was reduced in the levosimendan group (weighted mean difference = -1.31
[-1.95; -0.31], p for effect = .007, with 17 studies included). A trend
toward a higher percentage of patients experiencing hypotension was noted
in levosimendan vs. control (risk ratio 1.39 [0.97-1.94], p = .053).
Conclusions: Levosimendan might reduce mortality in cardiac surgery and
cardiology settings of adult patients. Copyright 2012 by the Society of
Critical Care Medicine and Lippincott Williams & Wilkins.
<7>
[Use Link to view the full text]
Accession Number
2012051026
Authors
Lim T. Ryu H.-G. Jung C.-W. Jeon Y. Bahk J.-H.
Institution
(Lim, Jung, Jeon, Bahk) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Ryu) Department of Anesthesiology and Pain Medicine, Boramae Medical
Center, Seoul National University, Seoul, South Korea
Title
Effect of the bevel direction of puncture needle on success rate and
complications during internal jugular vein catheterization.
Source
Critical Care Medicine. 40 (2) (pp 491-494), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Artery puncture and hematoma formation are the most common
immediate complications during internal jugular vein catheterization. This
study was performed to assess whether the bevel-down approach of the
puncture needle decreases the incidence of posterior venous wall damage
and hematoma formation during internal jugular vein catheterization.
Design: Prospective, randomized, controlled study. Setting: A
university-affiliated hospital. Patients: Three hundred thirty-eight
patients for scheduled for thoracic surgery requiring central venous
catheterization in the right internal jugular vein. Interventions:
Patients requiring internal jugular vein catheterization were enrolled and
randomized to either the bevel-down group (n = 169) or the bevel-up group
(n = 169). All patients were placed in the Trendelenburg position with the
head turned to the left. After identifying the right internal jugular vein
with ultrasound imaging, a double-lumen central venous catheter was
inserted using the modified Seldinger technique. Venous entry of the
needle was recognized by return of venous blood during needle advance or
withdrawal. The internal jugular vein was assessed cross-sectionally and
longitudinally after catheterization to identify any complications. A p
value of <.05 was considered to be statistically significant. Measurements
and Main Results; There was no difference in the incidence of the
puncture-on-withdrawal between the two groups (37 of 169 in the bevel-down
group and 25 of 169 in the bevel-up group). However, the incidence of
posterior hematoma formation was lower in the bevel-down group (six of 169
vs. 17 of 169, p = .031). Additionally, there was less incidence of the
posterior hematoma formation associated with puncture-on-withdrawal in the
bevel-down group (six of 37 vs. 11 of 25, p = .034). Conclusions: The
bevel-down approach of the right internal jugular vein may decrease the
incidence of posterior venous wall damage and hematoma formation compared
with the bevel-up approach, which implicates a reduced probability of
carotid artery puncture with the bevel-down approach during internal
jugular vein catheterization. Copyright 2012 by the Society of Critical
Care Medicine and Lippincott Williams & Wilkins.
<8>
Accession Number
2012053813
Authors
Chen Y.-B. Shu J. Yang W.-T. Shi L. Guo X.-F. Wang F.-G. Qian Y.-Y.
Institution
(Chen, Shu, Yang, Shi, Guo, Wang, Qian) Department of Cardiothoracic
Surgery, Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu
215004, China
Title
Meta-analysis of randomized trials comparing the effectiveness of on-pump
and off-pump coronary artery bypass.
Source
Chinese Medical Journal. 125 (2) (pp 338-344), 2012. Date of
Publication: January 2012.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background The growing enthusiasm for coronary artery bypass grafting
(CABG) without cardiopulmonary bypass (CPB) is emerging, but the role of
off-pump coronary artery bypass (OPCAB) in clinical practice remains
controversial. The purpose of this study was to assess differences in the
incidences of stroke, atrial fibrillation (AF), and myocardial infarction
(MI) between OPCAB and conventional coronary artery bypass grafting
(CCABG) by meta-analyses of randomized clinical trials. Methods A
literature search for the period before March 2010 supplemented with
manual bibliographic review was performed for all Chinese or English
publications in Medline, the Science Citation Index Expanded, the Cochrane
Central Register of Controlled Trials (CENTRAL) and CBMdisc. A systematic
overview (meta-analyses) of randomized clinical trials was conducted to
evaluate the differences between OPCAB and CCABG in the incidences of
stroke, AF, and MI. The meta-analysis was performed using RevMan 5
software. Results Forty-three randomized clinical trials were selected for
meta-analysis after screening a total of 356 references, with 8104
patients in the OPCAB group and 8724 cases in the CCABG group. The
meta-analyses of these trials showed no significant difference between
OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80, 95%
confidence interval (CI)=0.52-1.22, P=0.30) and MI (OR=0.73,
95%CI=0.52-1.02, P=0.06). However, we found a significantly reduced risk
of AF (OR=0.65, 95%CI = 0.52-0.82, P=0.0002) in off-pump patients.
Conclusions Our meta-analyses suggest that OPCAB reduces the risk of
postoperative AF compared with CCABG, but there is no significant
difference in the incidences of stroke and MI between OPCAB and CCABG.
<9>
Accession Number
2012050053
Authors
Boden W.E. Probstfield J.L. Anderson T. Chaitman B.R. Desvignes-Nickens P.
Koprowicz K. McBride R. Teo K. Weintraub W.
Institution
(Boden) University at Buffalo, Buffalo, NY, United States
(Probstfield) University of Washington, Seattle, WA, United States
(Anderson) University of Calgary, Libin Cardiovascular Institute, Calgary,
AB, Canada
(Chaitman) Saint Louis University, St. Louis, United States
(Desvignes-Nickens) National Institutes of Health, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Koprowicz, McBride) Axio Research, 2601 Fourth Ave., Seattle, WA 98121,
United States
(Teo) McMaster University, Hamilton, ON, Canada
(Weintraub) Christiana Care Health Services, Wilmington, DE, United States
Title
Niacin in patients with low HDL cholesterol levels receiving intensive
statin therapy.
Source
New England Journal of Medicine. 365 (24) (pp 2255-2267), 2011. Date of
Publication: 15 Dec 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In patients with established cardiovascular disease, residual
cardiovascular risk persists despite the achievement of target low-density
lipoprotein (LDL) cholesterol levels with statin therapy. It is unclear
whether extended-release niacin added to simvastatin to raise low levels
of high-density lipoprotein (HDL) cholesterol is superior to simvastatin
alone in reducing such residual risk. METHODS: We randomly assigned
eligible patients to receive extended-release niacin, 1500 to 2000 mg per
day, or matching placebo. All patients received simvastatin, 40 to 80 mg
per day, plus ezetimibe, 10 mg per day, if needed, to maintain an LDL
cholesterol level of 40 to 80 mg per deciliter (1.03 to 2.07 mmol per
liter). The primary end point was the first event of the composite of
death from coronary heart disease, nonfatal myocardial infarction,
ischemic stroke, hospitalization for an acute coronary syndrome, or
symptom-driven coronary or cerebral revascularization. RESULTS: A total of
3414 patients were randomly assigned to receive niacin (1718) or placebo
(1696). The trial was stopped after a mean follow-up period of 3 years
owing to a lack of efficacy. At 2 years, niacin therapy had significantly
increased the median HDL cholesterol level from 35 mg per deciliter (0.91
mmol per liter) to 42 mg per deciliter (1.08 mmol per liter), lowered the
triglyceride level from 164 mg per deciliter (1.85 mmol per liter) to 122
mg per deciliter (1.38 mmol per liter), and lowered the LDL cholesterol
level from 74 mg per deciliter (1.91 mmol per liter) to 62 mg per
deciliter (1.60 mmol per liter). The primary end point occurred in 282
patients in the niacin group (16.4%) and in 274 patients in the placebo
group (16.2%) (hazard ratio, 1.02; 95% confidence interval, 0.87 to 1.21;
P = 0.79 by the log-rank test). CONCLUSIONS: Among patients with
atherosclerotic cardiovascular disease and LDL cholesterol levels of less
than 70 mg per deciliter (1.81 mmol per liter), there was no incremental
clinical benefit from the addition of niacin to statin therapy during a
36-month follow-up period, despite significant improvements in HDL
cholesterol and triglyceride levels. (Funded by the National Heart, Lung,
and Blood Institute and Abbott Laboratories; AIM-HIGH ClinicalTrials.gov
number, NCT00120289.) Copyright 2011 Massachusetts Medical Society. All
rights reserved.
<10>
Accession Number
70655312
Authors
Rodseth R.N. Buse G.A.L. Bolliger D.
Title
The predictive ability of preoperative B-type natriuretic peptide in
vascular patients for major adverse cardiac events: An individual patient
data meta-analysis.
Source
Journal of Vascular Surgery. Conference: 40th Annual Symposium of the
Society for Clinical Vascular Surgery, SCVS 2012 Las Vegas, NV United
States. Conference Start: 20120314 Conference End: 20120317. Conference
Publication: (var.pagings). 55 (2) (pp 616), 2012. Date of Publication:
February 2012.
Publisher
Mosby Inc.
Abstract
Conclusion: Preoperative natriuretic peptide levels are independent
predictors of cardiovascular events in the first 30 days following
vascular surgery and improve predictive performance of the revised cardiac
risk index. Summary: A recent randomized international controlled study of
8351 patients from 23 countries found a 6.9 % incidence of cardiovascular
events in patients >45 years of age undergoing non cardiac surgery.
(Devereaux PG. Lancet 2008;371:1839-47). There have been even higher rates
of preoperative mortality, adverse cardiovascular events, and
rehospitalizations reported in vascular surgery patients. (Noordzij PJ.
Anesthesiology 2010; 112:1105-15, and Jencks SF. N Engl J Med
2009;360:418-28). Current guidelines for stratifying cardiac risk utilize
clinical risk factors, type of surgery and exercise tolerance to direct
preoperative investigation. (Fleisher LA et al. J Am Coll Cardiol
2007;50:1707-32). Clinical factors include a history of compensated or
prior heart failure, a history of ischemic heart disease, cerebral
vascular events, renal insufficiency, and diabetes mellitus. (Lee TH et
al. Circulation 1999;100:1043-9). However, use of the revised cardiac risk
index has not provided good discrimination when applied to patients
undergoing vascular surgery (Kertai MD et al. Heart 2003;89: 1327-34).
Preoperative elevations of B-type natriuretic peptide (BNP) or its
prohormone have consistently been associated with cardiovascular events
following major vascular surgery. (Feringa HH. Heart 2007;93:226-31). The
aim of this study was to determine optimal BNP cutoffs to predict
cardiovascular events after vascular surgery and to determine whether the
use of preoperative levels of BNP, or its prohormone, could improve
current risk stratification prior to vascular surgery. The authors used an
electronic database search to identify studies reporting association of
preoperative natriuretic protein concentrations with post operative major
adverse cardiovascular events (cardiovascular death, nonfatal MI) in
vascular surgery. Secondary endpoints included all cause mortality,
cardiac death and non fatal MI. There were six data sets obtained, five
were for BNP (n = 632) and for 1 N-terminal pro-BNP (n = 218). A BNP level
higher than the optimal cut point independently predicted the primary
composite end point (odds ratio, 7.9; 95% CI, 4.7 to 13.3). BNP cut points
were 30pg/mL for screening (95% sensitivity; 44% specificity), 116 pg/mL
for highest accuracy (66% sensitivity; 82% specificity). Reclassification
of risks following the revised cardiac risk index stratification using NP
levels improved risk prediction. (Net reclassification improvement, 58%; P
< .000001). This was particularly so in the intermediate risk group (net
reclassification improvement, 84%; P < .001). Comment: Cardiac risk
stratification in vascular surgery has only been, at best, modestly
successful in predicting preoperative events in the vascular surgical
patient. The results here, suggest that in patients risk stratified with
the revised cardiac risk index, a BNP cut off point can be used to
reclassify these patients and provide a more accurate risk assessment.
This may help better identify patients who would benefit from further
cardiac evaluation. Importantly, it is also crucial to recognize that this
meta analysis, and other studies in this area (Ford MK et al. Ann Intern
Med 2010;152:26-35), raise serious concerns regarding the use the revised
cardiac risk index as a "stand alone" tool in the preoperative cardiac
evaluation of the vascular surgical patient.
<11>
Accession Number
70653771
Authors
Singh S. Kong Loke Y. Spangler J. Furberg C.D.
Institution
(Singh) Johns Hopkins University, Baltimore, MD, United States
(Kong Loke) University of East Anglia, Norwich, United Kingdom
(Spangler, Furberg) Wake Forest University, School of Medicine,
Winston-Salem, NC, United States
Title
ODDS of major adverse cardiovascular events associated with varenicline: A
systematic review and metaanalysis of randomized controlled trials.
Source
Journal of General Internal Medicine. Conference: 34th Annual Meeting of
the Society of General Internal Medicine Phoenix, AZ United States.
Conference Start: 20110504 Conference End: 20110507. Conference
Publication: (var.pagings). 26 (pp S290), 2011. Date of Publication:
May 2011.
Publisher
Springer New York
Abstract
BACKGROUND: Varenicline is a partial agonist at the I 4-I<sup>2</sup> 2
nicotinic acetylcholine receptors and a full agonist at I-7 nicotinic
acetylcholine receptors. Varenicline is associated with myocardial
infarction and cardiac arrest in spontaneous reports. Its effect on
cardiovascular outcomes is unknown. Our objective was to ascertain the
risk of major adverse cardiovascular effects of varenicline compared to
placebo controls among tobacco users. METHODS: Systematic searches were
conducted in August 2010 of relevant articles in MEDLINE, EMBASE,
regulatory authorityWeb-sites in the United States and Europe and
manufacturers' trial registries with no date restrictions. Randomized
controlled trials of varenicline for treatment of nicotine addiction among
smokers or smokeless tobacco users, had at least 7 days of treatment, and
reported on any major adverse cardiovascular event (including zero events)
of myocardial infarction, unstable angina, coronary revascularization,
coronary artery disease, arrythmias, transient ischemic attacks, strokes
and sudden death or cardiovascular death and congestive heart failure were
included. RESULTS: The initial search yielded 347 citations. After a
detailed screening of 45 full text studies for cardiovascular events, 14
double blind placebo controlled randomized controlled trials enrolling
8216 tobacco users were included. Follow-up duration ranged from 7 weeks
to 1 year. Major adverse cardiovascular events occurred among 52 of 4908
participants receiving varenicline and 27 of 3308 patients receiving
placebo therapy (Peto Odds Ratio (OR), 1.72 [95% confidence interval {CI},
1.09-2.71]; P=.02 I2=0%). Sensitivity analysies using treatment arm
continuity correction to account for imbalance in zero events among the
included trials yielded similar results. These estimates were also robust
to the choice of comparators (placebo vs active controls). There was no
evidence of publication bias via funnel plot asymmetry. CONCLUSION: Among
tobacco users varenicline use is associated with significantly increased
odds of major adverse cardiovascular events. (Table presented).
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