Results Generated From:
Embase <1980 to 2012 Week 13>
Embase (updates since 2012-03-22)
<1>
Accession Number
2012142392
Authors
El-Morsy G.Z. El-Deeb A.
Institution
(El-Morsy, El-Deeb) Department of Anesthesia, Faculty of Medicine,
Mansoura University, Mansoura, Egypt
Title
The outcome of thoracic epidural anesthesia in elderly patients undergoing
coronary artery bypass graft surgery.
Source
Saudi Journal of Anaesthesia. 6 (1) (pp 16-21), 2012. Date of Publication:
January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Thoracic epidural anesthesia (TEA) improves analgesia and
outcomes after a cardiac surgery. As aging is a risk factor for
postoperative pulmonary complications, TEA is of particular importance in
elderly patients undergoing coronary artery bypass graft (CABG). Methods:
Fifty patients aged 65-75 years; ASA II and III scheduled for elective
CABG were included in the study. Patients were randomized to receive
either general anesthesia (GA) group alone or GA combined with TEA group.
Heart rate (HR), mean arterial pressure (MAP), and central venous pressure
were recorded. Total dose of fentanyl g/kg, aortic cross clamping,
cardiopulmonary bypass (CPB) time, time to first awaking and extubation,
arterial blood gases, visual analog scale (VAS) score in intensive care
unit were reported. Postoperative pulmonary function tests were done.
Results: TEA showed a significant HR and lower MAP compared with the GA
group. The total dose of intraoperative fentanyl and nitroglycerine were
significantly lower in the TEA. Patients in TEA group have statistically
significantly higher PaO <sub>2</sub>, lower PaCO <sub>2</sub>, increase
in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second
(FEV <sub>1</sub>) Conclusions: TEA reduced severity of postoperative
pulmonary function and restoration was faster in TEA group in elderly
patients undergoing CABG. Also, it resulted in earlier extubation and
awakening, better analgesia, lower VAS.
<2>
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Accession Number
2012161069
Authors
Jensen L.O. Thayssen P. Hansen H.S. Christiansen E.H. Tilsted H.H. Krusell
L.R. Villadsen A.B. Junker A. Hansen K.N. Kaltoft A. Maeng M. Pedersen
K.E. Kristensen S.D. Botker H.E. Ravkilde J. Sanchez R. Aaroe J. Madsen M.
Sorensen H.T. Thuesen L. Lassen J.F.
Institution
(Jensen, Thayssen, Hansen, Junker, Hansen, Pedersen) Department of
Cardiology, Odense University Hospital, Sdr Blvd. 29, 5000 Odense C,
Denmark
(Christiansen, Krusell, Kaltoft, Maeng, Kristensen, Botker, Thuesen,
Lassen) Department of Cardiology, Aarhus University Hospital, Skejby
Hospital, Aarhus, Denmark
(Tilsted, Villadsen, Ravkilde, Aaroe) Department of Cardiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark
(Sanchez) HeartCenter Varde, Varde, Denmark
(Madsen, Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
Title
Randomized comparison of everolimus-eluting and sirolimus-eluting stents
in patients treated with percutaneous coronary intervention: The
Scandinavian Organization for Randomized Trials with Clinical Outcome IV
(SORT OUT IV).
Source
Circulation. 125 (10) (pp 1246-1255), 2012. Date of Publication: 13 Mar
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Among drug-eluting stents released to date, the
sirolimus-eluting stent has demonstrated the least amount of late lumen
loss, but its efficacy and safety have not been compared head-to-head with
the next-generation everolimus-eluting stent. Methods and Results: The
Scandinavian Organization for Randomized Trials with Clinical Outcome IV
(SORT OUT IV) trial was a randomized multicenter, single-blind, all-comer,
2-arm, noninferiority trial comparing the everolimus-eluting stent with
the sirolimus-eluting stent in patients with coronary artery disease. The
primary end point was a composite of safety (cardiac death, myocardial
infarction, definite stent thrombosis) and efficacy (target vessel
revascularization) parameters. The noninferiority criterion was a risk
difference of 0.015. Intention-to-treat analyses were done at 9- and
18-month follow-ups. A total of 1390 patients were assigned to receive the
everolimus-eluting stent and 1384 patients to the sirolimus-eluting stent.
At the 9-month follow-up, 68 patients (4.9%) treated with the
everolimus-eluting stent compared with 72 patients (5.2%) treated with the
sirolimus-eluting stent experienced the primary end point (hazard ratio,
0.94; 95% confidence interval, 0.67-1.31; P for noninferiority=0.01). At
the 18-month follow-up, this differential remained: 99 patients (7.2%)
treated with the everolimus-eluting stent versus 105 (7.6%) treated with
the sirolimuseluting stent (hazard ratio, 0.94; 95% confidence interval,
0.71-1.23). At the 9-month follow-up, the rate of definite stent
thrombosis was higher in the sirolimus-eluting group (2 patients [0.1%]
versus 9 patients [0.7%]; hazard ratio, 0.22; 95% confidence interval,
0.05-1.02). At the 18-month follow-up, this difference was sustained (3
patients [0.2%] versus 12 patients [0.9%]; hazard ratio, 0.25; 95%
confidence interval, 0.07-0.88). Conclusion: The everolimus-eluting stent
was found to be noninferior to the sirolimus-eluting stent. 2012 American
Heart Association, Inc.
<3>
Accession Number
2012160079
Authors
Tuomainen P.O. Ylitalo A. Niemela M. Kervinen K. Pietila M. Sia J. Nyman
K. Nammas W. Airaksinen K.E.J. Karjalainen P.P.
Institution
(Tuomainen) Heart Center, Department of Internal Medicine, Kuopio
University Hospital, Kuopio, Finland
(Ylitalo, Nammas, Karjalainen) Department of Cardiology, Satakunta Central
Hospital, Pori, Finland
(Niemela, Kervinen) Department of Internal Medicine, Division of
Cardiology, University of Oulu, Oulu, Finland
(Pietila, Airaksinen) Department of Medicine, Turku University Hospital,
Turku, Finland
(Sia) Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
(Nyman) Department of Medicine, Jyvaskyla Central Hospital, Jyvaskyla,
Finland
Title
Gender-based analysis of the 3-year outcome of bioactive stents versus
paclitaxel-eluting stents in patients with acute myocardial infarction: An
insight from the TITAX-AMI trial.
Source
Journal of Invasive Cardiology. 24 (3) (pp 104-108), 2012. Date of
Publication: March 2012.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
BACKGROUND: The TITAX-AMI trial demonstrated a better clinical outcome of
titanium-nitride-oxide-coated bioactive stents (BAS) as compared with
paclitaxel-eluting stents (PES) in patients with acute myocardial
infarction (MI) undergoing early percutaneous coronary intervention (PCI).
We explored the gender-based 3-year outcome of BAS as compared with PES in
a subgroup analysis of the TITAX-AMI trial. METHODS: A total of 214
patients (52 women) with acute MI were randomly assigned to BAS, and 211
patients (54 women) to PES. The primary endpoint was major adverse cardiac
events (MACE) including cardiac death, recurrent MI, and target lesion
revascularization (TLR). Secondary endpoints were all-cause death, a
composite of cardiac death or recurrent MI, and stent thrombosis (ST).
RESULTS: Women were older and had smaller reference vessel diameter
(P<.001 for both) as compared with men. At 3-year follow-up, both MACE and
TLR showed a trend to be higher in women as compared with men (24.5%
versus 16.3% [P=.059] and 15.1% versus 8.8% [P=.065], respectively). The
rate of all-cause death was significantly higher in women as compared with
men (13.2% versus 6.0%, respectively; P=.02). Among female patients, MACE,
cardiac death, recurrent MI, TLR, and ST were all statistically similar
between the two stent groups (P>.05 for all). CONCLUSIONS: In the current
post hoc gender-based analysis of the TITAX-AMI trial, the 3-year outcome
of patients undergoing PCI for acute MI was slightly worse in female
patients as compared with their male counterparts, as reflected by a trend
toward a higher primary composite endpoint of MACE and TLR.
<4>
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Accession Number
2012166749
Authors
Cunnington C. Van Assche T. Shirodaria C. Kylintireas I. Lindsay A.C. Lee
J.M. Antoniades C. Margaritis M. Lee R. Cerrato R. Crabtree M.J. Francis
J.M. Sayeed R. Ratnatunga C. Pillai R. Choudhury R.P. Neubauer S. Channon
K.M.
Institution
(Cunnington, Van Assche, Shirodaria, Kylintireas, Lindsay, Lee,
Antoniades, Margaritis, Lee, Cerrato, Crabtree, Francis, Sayeed,
Ratnatunga, Pillai, Choudhury, Neubauer, Channon) Department of
Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital,
Oxford OX3 9DU, United Kingdom
Title
Systemic and vascular oxidation limits the efficacy of oral
tetrahydrobiopterin treatment in patients with coronary artery disease.
Source
Circulation. 125 (11) (pp 1356-1366), 2012. Date of Publication: 20 Mar
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: The endothelial nitric oxide synthase cofactor
tetrahydrobiopterin (BH4) plays a pivotal role in maintaining endothelial
function in experimental vascular disease models and in humans.
Augmentation of endogenous BH4 levels by oral BH4 treatment has been
proposed as a potential therapeutic strategy in vascular disease states.
We sought to determine the mechanisms relating exogenous BH4 to human
vascular function and to determine oral BH4 pharmacokinetics in both
plasma and vascular tissue in patients with coronary artery disease.
METHODS AND RESULTS-: Forty-nine patients with coronary artery disease
were randomized to receive low-dose (400 mg/d) or high-dose (700 mg/d) BH4
or placebo for 2 to 6 weeks before coronary artery bypass surgery.
Vascular function was quantified by magnetic resonance imaging before and
after treatment, along with plasma BH4 levels. Vascular superoxide,
endothelial function, and BH4 levels were determined in segments of
saphenous vein and internal mammary artery. Oral BH4 treatment
significantly augmented BH4 levels in plasma and in saphenous vein (but
not internal mammary artery) but also increased levels of the oxidation
product dihydrobiopterin (BH2), which lacks endothelial nitric oxide
synthase cofactor activity. There was no effect of BH4 treatment on
vascular function or superoxide production. Supplementation of human
vessels and blood with BH4 ex vivo revealed rapid oxidation of BH4 to BH2
with predominant BH2 uptake by vascular tissue. CONCLUSIONS-: Oral BH4
treatment augments total biopterin levels in patients with established
coronary artery disease but has no net effect on vascular redox state or
endothelial function owing to systemic and vascular oxidation of BH4.
Alternative strategies are required to target BH4-dependent endothelial
function in established vascular disease states. 2012 American Heart
Association, Inc.
<5>
Accession Number
2012157901
Authors
Reynolds H.R. Forman S.A. Tamis-Holland J.E. Steg P.G. Mark D.B. Pearte
C.A. Carvalho A.C. Sopko G. Liu L. Lamas G.A. Kruk M. Loboz-Grudzien K.
Ruzyllo W. Hochman J.S.
Institution
(Reynolds, Pearte, Hochman) Cardiovascular Clinical Research Center, New
York University, School of Medicine, New York, NY, United States
(Forman, Liu) Clinical Trials and Surveys Corporation, Owings Mills, MD,
United States
(Tamis-Holland) St Luke's-Roosevelt Hospital Center, Columbia University,
College of Physicians and Surgeons, New York, NY, United States
(Steg) INSERM U-698, Department of Cardiology, Universite Paris 7, Paris,
France
(Mark) Duke Clinical Research Institute, Duke University, Durham, NC,
United States
(Carvalho) Hospital Sao Paulo, UNIFESP, Sao Paulo, Brazil
(Sopko) National Heart Lung and Blood Institute, Bethesda, MD, United
States
(Lamas) Columbia University Division of Cardiology, Mount Sinai Medical
Center, Miami Beach, FL, United States
(Kruk, Ruzyllo) National Institute of Cardiology, Warsaw, Poland
(Loboz-Grudzien) Wroclaw Medical University, T. Marciniak Hospital,
Wroclaw, Poland
Title
Relationship of female sex to outcomes after myocardial infarction with
persistent total occlusion of the infarct artery: Analysis of the Occluded
Artery Trial (OAT).
Source
American Heart Journal. 163 (3) (pp 462-469), 2012. Date of Publication:
March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Long-term follow-up (up to 9 years) from the OAT allows for
the examination of sex differences in outcomes and the effect of
percutaneous coronary intervention (PCI) in a relatively homogeneous
cohort of myocardial infarction (MI) survivors. Methods: The OAT
randomized 484 (22%) women and 1717 men to PCI of the occluded
infarct-related artery vs medical therapy alone >24 hours post-MI. There
was no benefit of PCI on the composite of death, MI, and class IV heart
failure. We analyzed outcomes by sex and investigated for sex-based trial
selection bias using a concurrent registry. Results: Women were older and
more likely to have left anterior descending infarct-related artery,
diabetes and hypertension, history of heart failure, and rales at
randomization but were less likely to smoke. The proportion and
characteristics of women enrolled in the trial and the registry were
similar, including left ventricular ejection fraction and extent of
disease. Women had higher rates of the primary composite (hazard ratio
[HR] 1.48, P =.0002), death (HR 1.50, P =.001), and heart failure (HR
2.53, P <.0001) but not reinfarction (HR 1.12, P =.57). Female sex was not
independently associated with the primary end point or death on
multivariate analysis. There was a trend toward independent association of
female sex with heart failure (HR 1.66, P =.02). Conclusion: Women in OAT
had a higher primary end point event rate than did men, mainly driven by
heart failure. Female sex was not independently associated with death or
MI in this well-defined cohort with comparable extent of coronary artery
disease, similar medical therapy, and equivalent left ventricular ejection
fraction by sex. 2012 Mosby, Inc. All rights reserved.
<6>
Accession Number
2012157889
Authors
Vasques F. Messori A. Lucenteforte E. Biancari F.
Institution
(Vasques, Biancari) Department of Surgery, Oulu University Hospital, PO
Box 21, 90029 Oulu, Finland
(Messori) Laboratory of Pharmacoeconomics, Co Area Vasta Centro, Regional
Health System, Florence, Italy
(Lucenteforte) Department of Preclinical, Clinical Pharmacology M. Aiazzi
Mancini, University of Florence, Florence, Italy
Title
Immediate and late outcome of patients aged 80 years and older undergoing
isolated aortic valve replacement: A systematic review and meta-analysis
of 48 studies.
Source
American Heart Journal. 163 (3) (pp 477-485), 2012. Date of Publication:
March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: This study was planned to evaluate the outcome of patients >=80
years old undergoing isolated conventional aortic valve replacement (AVR).
Methods: Systematic review of the literature and meta-analysis of data on
octogenarians and nonagenarians who underwent isolated AVR were performed.
Results: The literature search yielded 48 observational studies reporting
on 13 216 patients >=80 years old. Pooled proportion of immediate
postoperative mortality was 6.7 % (95% CI 5.8-7.5, 47 studies, 13,092
patients), and it was 5.8% (95% CI 4.8-6.9) in 18 studies with a mid-date
from 2000 to 2006 and 7.5% (95% CI 6.8-8.2) in 30 studies with a mid-date
from 1982 to 1999 (P =.004). Pooled proportion of postoperative stroke was
2.4% (95% CI 2.1-2.7, 21 studies, 8,436 patients), that of postoperative
dialysis was 2.6% (95% CI 1.6-3.8, 10 studies, 1,945 patients), and that
of postoperative implantation of a pacemaker was 4.6% (95% CI 3.6-5.8, 6
studies, 1,470 patients). Pooled survival rates at 1, 3, 5, and 10 years
after isolated AVR were 87.6%, 78.7%, 65.4%, and 29.7%, respectively.
Conclusions: Immediate postoperative mortality and morbidity after
isolated AVR in patients >=80 years old are rather low. Postoperatively
mortality decreased even further in the most recent series. Importantly,
isolated AVR in these high-risk patients was associated with good late
survival. These findings suggest that advanced age alone cannot be
considered as a contraindication to conventional isolated AVR and that any
new valve prosthesis implanted in these patients should be durable enough
to guarantee the results so far offered by conventional surgery. 2012
Mosby, Inc. All rights reserved.
<7>
Accession Number
2012157878
Authors
Stone G.W. Clayton T.C. Mehran R. Dangas G. Parise H. Fahy M. Pocock S.J.
Institution
(Stone, Mehran, Dangas, Parise, Fahy) Columbia University Medical Center,
Cardiovascular Research Foundation, 111 E. 59th St, New York, NY 10022,
United States
(Clayton, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
Title
Impact of major bleeding and blood transfusions after cardiac surgery:
Analysis from the acute catheterization and urgent intervention triage
strategy (ACUITY) trial.
Source
American Heart Journal. 163 (3) (pp 522-529), 2012. Date of Publication:
March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Prior retrospective studies have identified a relationship
between bleeding after cardiac surgery and subsequent mortality. Whether
this is attributable to bleeding, anemia, or transfusions is undetermined.
Methods: ACUITY was an international prospective trial of patients with
acute coronary syndromes. Coronary artery bypass grafting (CABG) before
hospital discharge was performed in 1,491 patients. Major bleeding was
adjudicated as CABG- or non-CABG related. The relationship between
CABG-related bleeding and 1-year mortality was determined using a
time-updated covariate-adjusted Cox model. Results: Coronary artery bypass
grafting-related major bleeding after surgery occurred in 789 patients
(52.9%); allogeneic blood product transfusions were administered in 612
patients (41.0%), including red blood cell (RBC) transfusions in 570
(38.2%, range 1-53 U), platelet transfusions in 180 (12.1%), and
fresh-frozen plasma in 195 (13.1%). One-year mortality occurred in 95
patients (6.4%). Red blood cell transfusion (but not transfusion of
platelets or fresh-frozen plasma, CABG-related major bleeding per se, or
nadir hemoglobin) was an independent predictor of 1-year mortality, but
only after transfusion of >=4 U (adjusted hazard ratio for death after
transfusion of 1-3, 4-6, and >=7 RBC units = 0.74, 2.01, and 5.22,
respectively). Of the 95 deaths after CABG, 23 (24.2%) were attributable
to CABG-related RBC transfusions. Conclusions: In patients with acute
coronary syndromes, RBC transfusion of >=4 U after CABG is strongly
associated with subsequent mortality. Future strategies should focus on
reducing major hemorrhagic complications and RBC transfusions after CABG.
2012 Mosby, Inc. All rights reserved.
<8>
Accession Number
2012157875
Authors
Palmerini T. Caixeta A. Genereux P. Cristea E. Lansky A. Mehran R. Dangas
G. Lazar D. Sanchez R. Fahy M. Xu K. Stone G.W.
Institution
(Palmerini) Istituto di Cardiologia, Policlinico S. Orsola, Bologna, Italy
(Palmerini, Caixeta, Genereux, Cristea, Lazar, Sanchez, Fahy, Xu, Stone)
Columbia University Medical Center, New York-Presbyterian Hospital,
Cardiovascular Research Foundation, 111 E. 59th St, New York, NY 10022,
United States
(Lansky) Yale University, School of Medicine, New Haven. CT, United States
(Mehran, Dangas) Mount Sinai Medical Center, New York, NY, United States
Title
Comparison of clinical and angiographic prognostic risk scores in patients
with acute coronary syndromes: Analysis from the Acute Catheterization and
Urgent Intervention Triage StrategY (ACUITY) trial.
Source
American Heart Journal. 163 (3) (pp 383-391.e5), 2012. Date of
Publication: March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Several prognostic risk scores have been developed for
patients with coronary artery disease, but their comparative use in
patients with non-ST-segment elevation acute coronary syndromes (NSTEACS)
undergoing percutaneous coronary intervention (PCI) has not been examined.
We therefore investigated the accuracy of the Synergy Between PCI With
Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI
With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS)
score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global
Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in
Myocardial Infarction (TIMI) score for risk assessment of 1-year
mortality, cardiac mortality, myocardial infarction, target vessel
revascularization, and stent thrombosis in patients with NSTEACS
undergoing PCI. Methods: The 6 scores were determined in 2,094 patients
with NSTEACS treated with PCI enrolled in the angiographic substudy of the
ACUITY trial. The prognostic accuracy of the 6 scores was assessed using
the c statistic for discrimination and the Hosmer-Lemeshow test for
calibration. The index of separation and net reclassification improvement
(NRI) were also determined. Results: Scores incorporating clinical and
angiographic variables (CSS and NERS) showed the best tradeoff between
discrimination and calibration for most end points, with the best
discrimination for all end points and good calibration for most of them.
The CSS had the best index of separation for most ischemic endpoints and
displayed an NRI for cardiac death and myocardial infarction (MI) compared
to the other scores, whereas NERS displayed an NRI for all-cause death and
target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were
the only scores to have both good discrimination and calibration for
cardiac mortality. Conclusions: In patients with NSTEACS undergoing PCI,
risk scores incorporating clinical and angiographic variables had the
highest predictive accuracy for a broad spectrum of ischemic end points.
2012 Mosby, Inc. All rights reserved.
<9>
Accession Number
2012158242
Authors
Miller D.C. Blackstone E.H. MacK M.J. Svensson L.G. Kodali S.K. Kapadia S.
Rajeswaran J. Anderson W.N. Moses J.W. Tuzcu E.M. Webb J.G. Leon M.B.
Smith C.R.
Institution
(Miller) Stanford University, Medical School, Stanford, CA, United States
(Blackstone, Svensson, Kapadia, Rajeswaran, Tuzcu) Cleveland Clinic
Foundation, Cleveland, OH, United States
(MacK) Baylor Healthcare System, Dallas, TX, United States
(Kodali, Moses, Leon, Smith) Columbia University Medical Center/New York
Presbyterian Hospital, New York, NY, United States
(Anderson) Edwards Lifesciences, Irvine, CA, United States
(Webb) University of British Columbia/St Paul's Hospital, Vancouver, BC,
Canada
Title
Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement:
Occurrence, hazard, risk factors, and consequences of neurologic events in
the PARTNER trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (4) (pp 832-843.e13),
2012. Date of Publication: April 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: All neurologic events in the PARTNER randomized trial
comparing transcatheter aortic valve replacement (TAVR) with surgical
aortic valve replacement (AVR) were analyzed. Methods: High-risk patients
with aortic stenosis were stratified into transfemoral (TF, n = 461) or
transapical (TA, n = 196) strata based on their arterial anatomy and
randomized: 657 received treatment assigned ("as treated"), 313 underwent
AVR, and 344 TAVR. Neurologic events were prospectively adjudicated by an
independent Clinical Events Committee. Multivariable, multiphase hazard
analysis elucidated factors associated with increased likelihood of
neurologic events. Results: Forty-nine neurologic events (15 transient
ischemic attacks, 34 strokes) occurred in 47 patients (TAVR, n = 31; AVR,
n = 16). An early peaking high hazard phase occurred within the first
week, which declined to a constant late hazard phase out to 2 years. The
risk in the early phase was higher after TAVR than AVR, and in the TAVR
arm in patients with a smaller aortic valve area index. In the late risk
phase, the likelihood of neurologic event was linked to patient-related
factors in both arms ("non-TF candidate," history of recent stroke or
transient ischemic attack, and advanced functional disability), but not by
treatment (TAVR vs AVR) or any intraprocedural variables. The likelihood
of sustaining a neurologic event was lowest in the AVR subgroup in the TF
stratum during all available follow-up. Conclusions: After either
treatment, there were 2 distinct hazard phases for neurologic events that
were driven by different risk factors. Neurologic complications occurred
more frequently after TAVR than AVR early, but thereafter the risk was
influenced by patient- and disease-related factors. Copyright 2012 by The
American Association for Thoracic Surgery.
<10>
Accession Number
2012155458
Authors
Schadler D. Engel C. Elke G. Pulletz S. Haake N. Frerichs I. Zick G.
Scholz J. Weiler N.
Institution
(Schadler, Elke, Pulletz, Frerichs, Zick, Scholz, Weiler) Department of
Anesthesiology and Intensive Care Medicine, University Medical Center
Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel,
Germany
(Engel) Department of Cardiovascular Surgery, University Medical Center
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Haake) Institute for Medical Informatics, Statistics and Epidemiology,
University of Leipzig, Leipzig, Germany
Title
Automatic control of pressure support for ventilator weaning in surgical
intensive care patients.
Source
American Journal of Respiratory and Critical Care Medicine. 185 (6) (pp
637-644), 2012. Date of Publication: 15 Mar 2012.
Publisher
American Thoracic Society (61 Broadway 4th Floor, New York NY 10006 -
2755, United States)
Abstract
Rationale: Despite its ability to reduce overall ventilation time,
protocol-guided weaning from mechanical ventilationis not routinely used
in daily clinical practice. Clinical implementation of weaning protocols
could be facilitated by integration of knowledge-based, closedloop
controlled protocols into respirators. Objectives:To determine whether
automated weaning decreases overall ventilation time compared with weaning
based on a standardized written protocol in an unselected surgical patient
population. Methods: In this prospective controlled trial patients
ventilated for longer than 9 hours were randomly allocated to receive
either weaning with automatic control of pressure support ventilation
(automated-weaning group) orweaning based on a standardized written
protocol (control group) using the same ventilation mode. The primary end
point of the study was overall ventilation time. Measurements and Main
Results: Overall ventilation time (median [25th and 75th percentile]) did
not significantly differ between the automated-weaning (31 [19-101] h;
n=150) and control groups (39 [20-118] h; n = 150; P = 0.178). Patients
who underwent cardiac surgery (n = 132) exhibited significantly shorter
overall ventilation times in the automated-weaning (24 [18-57] h) than in
the control group (35 [20-93] h; P = 0.035). The automated-weaning group
exhibited shorter ventilation times until the first spontaneous breathing
trial (1 [0-15] vs. 9 [1-51] h; P = 0.001) and a trend toward fewer
tracheostomies (17 vs. 28; P = 0.075). Conclusions: Overall ventilation
times did not significantly differ between weaning using automatic control
of pressure support ventilation and weaning based on a standardized
written protocol. Patients after cardiac surgery may benefit from
automated weaning. Implementation of additional control variables besides
the level of pressure support may further improve automated-weaning
systems. Clinical trial registered with www.clinicaltrials.gov (NCT
00445289). Copyright 2012 by the American Thoracic Society.
<11>
Accession Number
2012142402
Authors
Alsatli R.A.
Institution
(Alsatli) Department of Anesthesiologist, King Fahad Cardiac Center, King
Saud University, Riyadh, Saudi Arabia
Title
Assessment of the hemodynamic changes following fluid preloading in
cardiac surgery.
Source
Saudi Journal of Anaesthesia. 6 (1) (pp 56-58), 2012. Date of Publication:
January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: This prospective double-blind randomized study aims to study
the hemodynamic changes following fluid preloading with Hydroxyethyl
starch (HES) 6% (130/0.4) compared with normal saline (NS) in cardiac
surgery patients. Methods: Forty patients undergoing coronary artery
bypass grafting (CABG) were enrolled in this study, then they were divided
in 2 equal groups, HES and NS. After fast administration of 10 mL/kg from
either solutions over 5 min only, hemodynamic parameters, such as heart
rate, mean arterial pressure (MAP), central venous pressure (CVP),
pulmonary artery occlusion pressure (PAOP), mean pulmonary artery
pressure, systemic vascular resistance, and pulmonary vascular resistance
were measured every 5min for the total duration of 40 minutes. Results:
There were significant differences in the cardiac index measurements
between both groups at 15 min onward; also PAOP was significantly higher
in HES group at 10min onward. CVP was higher in HES group but
statistically significant at 10 min only. MAP was higher in HES group, but
that was statistically significant at 40 min only. On the other hand PAP
was significantly higher at 10 and 40 min. Conclusion: Fluid preloading
with HES led to a significant increase in filling pressure of the left
ventricle (PAOP) and cardiac index compared with NS. We believe that HES
(130/0.4) could be a suitable solution for fluid preloading in CABG
surgery patients. However, further studies are needed on different fluid
preloading modalities with different dosing regimens.
<12>
Accession Number
2012151644
Authors
Song H.-G. Park D.-W. Kim Y.-H. Ahn J.-M. Kim W.-J. Lee J.-Y. Kang S.-J.
Lee C.W. Park S.-W. Han S. Seong I.-W. Lee N.-H. Lee B.-K. Lee K. Lee
S.-W. Nah D.-Y. Park S.-J.
Institution
(Song, Park, Kim, Ahn, Kim, Lee, Kang, Lee, Lee, Park, Park) Department of
Cardiology, College of Medicine, University of Ulsan, 388-1 Poongnap-dong,
Songpa-gu, Seoul 138-736, South Korea
(Han) Division of Biostatistics, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Seong) Chungnam National University Hospital, Daejeon, South Korea
(Lee) Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Lee) Seoul Veterans Hospital, Seoul, South Korea
(Lee) Kwangju Christian Hospital, Kwangju, South Korea
(Nah) Donguk University Gyeongju Hospital, Gyeongju, South Korea
Title
Randomized trial of optimal treatment strategies for in-stent restenosis
after drug-eluting stent implantation.
Source
Journal of the American College of Cardiology. 59 (12) (pp 1093-1100),
2012. Date of Publication: 20 Mar 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study is to compare the efficacy of the
treatment strategies for in-stent restenosis (ISR) of drug-eluting stents
(DES) according to the morphologic pattern of restenosis. Background:
Optimal treatment strategies for ISR within DES have not been adequately
addressed yet. Methods: Patients with ISR of DES were randomized according
to the lesion length to compare outcomes of sirolimus-eluting stent (SES)
versus cutting balloon angioplasty for focal type (<=10 mm) and SES versus
everolimus-eluting stent (EES) for diffuse type (>10 mm). The primary
endpoint was in-segment late loss at 9 months. Overall 162 patients, 96
with focal ISR and 66 with diffuse ISR, were enrolled. Results: In focal
lesions, in-segment late loss was significantly higher in the cutting
balloon group (n = 48) than in the SES group (n = 48; 0.25 mm,
interquartile range [IQR]: -0.01 to 0.68 mm vs. 0.06 mm, IQR: -0.08 to
0.17 mm; p = 0.04). Consequently, in-segment restenosis rate tended to be
higher in the cutting balloon group than in the SES group (20.7% vs. 3.1%,
p = 0.06) with comparable incidences of the composite of death, myocardial
infarction, or target vessel revascularization at 12 months of clinical
follow up (6.3% vs. 6.3%, p > 0.99). In 66 cases of diffuse ISR,
in-segment late loss (0.11 mm, IQR: -0.02 to 0.30 mm; vs. 0.00 mm, IQR:
-0.08 to 0.25 mm; p = 0.64), in-segment restenosis rate (5.0% vs. 14.3%, p
= 0.32), and the composite incidence of death, myocardial infarction, or
target lesion revascularization (9.6% vs. 8.8%, p > 0.99) did not differ
between SES group (n = 32) and EES group (n = 34). Conclusions: For
lesions of focal DES restenosis, repeat implantation of SES is more
effective in reducing late luminal loss and subsequent restenosis rate
than cutting balloon angioplasty. For diffuse DES restenosis, implantation
of SES or EES is comparably effective in terms of angiographic and
clinical outcomes. 2012 American College of Cardiology Foundation.
<13>
Accession Number
2012159852
Authors
Dridi N.P. Holmvang L. Clemmensen P.
Institution
(Dridi, Holmvang, Clemmensen) Department of Cardiology, Rigshospitalet,
Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
Title
Oral antiplatelet agents in ischemic heart disease: A review of the latest
clinical evidence.
Source
Clinical Investigation. 1 (9) (pp 1315-1328), 2011. Date of Publication:
September 2011.
Publisher
Future Science Ltd (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Platelet activation and aggregation play a central role in the
pathophysiology of thrombogenesis in ischemic heart disease. Dual
antiplatelet therapy with aspirin and clopidogrel is currently the golden
standard in the prevention of cardiovascular complications after
percutaneous coronary intervention. Newer antiplatelet drugs are
continuously marketed to respond to the limitations of clopidogrel, namely
a delayed onset of action, an irreversible inhibition of platelet
aggregation as well as a substantial variability in antiplatelet effect,
in part due to genetic polymorphism. The second-generation thienopyridine
prasugrel is more potent than clopidogrel, but also manifests a greater
bleeding risk. Ticagrelor, a third-generation thienopyridine, seems to
have a better safety profile and has recently been approved as a
first-choice antiplatelet treatment in acute coronary syndrome in Europe.
This article will review the different oral antiplatelet drugs currently
available, compare pharmacology and safety/efficacy profiles, and discuss
their limitations. 2011 Future Science Ltd.
<14>
Accession Number
2012157831
Authors
Skinner H.J. Mahmoud A. Uddin A. Mathew T.
Institution
(Skinner, Mahmoud, Uddin, Mathew) Trent Cardiac Centre, Nottingham
University Hospitals, Nottingham, United Kingdom
Title
An investigation into the causes of unexpected intra-operative
transoesophageal echocardiography findings.
Source
Anaesthesia. 67 (4) (pp 355-360), 2012. Date of Publication: April 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
There is uncertainty regarding echocardiography before cardiac surgery,
especially with regard to timing and disease progression as well as
potential errors. We investigated the causes of unexpected intra-operative
transoesophageal echocardiography findings by performing a 33-month audit.
We found that there were 50/797 (6%) unexpected findings that led to an
alteration in surgical strategy in 34 (4%) patients. Of the unexpected
findings, 25 (50%) were unrelated to pre-operative pathology. After
reviewing pre-operative studies and reports, unexpected findings were
found to be due to: reporting errors in 20 patients (44%); limitations in
transthoracic compared to transoesophageal echocardiography in 14 patients
(30%); disease progression in 10 patients (22%); and inter-observer
variability in two patients (4%). We identified six reports out of 797
(0.8%) that contained potentially serious errors. Surgical management
changed in 18/20 (90%) patients in whom the unexpected change was due to
reporting error, compared to 16/30 (53%) patients whose pre-operative
echocardiogram was correctly reported (p = 0.006). Our study suggests that
pre-operative echocardiography reporting errors are common and important.
2012 The Association of Anaesthetists of Great Britain and Ireland.
<15>
Accession Number
2012156970
Authors
Lou S. Bian L. Long C. Wang Z. Ma J. Zhou B.
Institution
(Lou, Bian, Long, Wang, Ma, Zhou) Department of Cardiopulmonary Bypass,
Cardiovascular Institute, FuWai Hospital, Bei Li Shi Road 167#, Beijing
100037, China
Title
Does 6% hydroxyethyl starch 130/0.4 impact differently on blood glucose
than 4% gelatin in patients receiving open heart surgery?.
Source
Perfusion. 27 (2) (pp 113-118), 2012. Date of Publication: March 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objectives: To investigate whether starch-based colloid may impact
differently on blood glucose than a gelatin-based colloid in adult
patients receiving open heart surgery.Methods: 70 adult patients scheduled
for elective first-time cardiac surgery were enrolled and randomized into
two groups. The circuits were primed with either 6% HES 130/0.4 or 4%
gelatin. The peak glucose level, incidence of hyperglycemia, glucose
variation and glucose level at different time points during operation were
compared between the two groups. A p-value >= 0.05 was accepted as
significant.Results: The peak glucose (150+/-30mg/dl vs 142+/-27, p=0.236)
and glucose variation demonstrated by standard deviation (26+/-12mg/dl vs
23+/-11mg/dl, p=0.202) were comparable between the two groups. Repeated
measurement ANOVA revealed that the main effect for artificial colloid was
not significant (p=0.349).Conclusions: With the data available, we could
not prove that starch-based colloid (HES130) had a different impact on
intra-operative blood glucose than a gelatin-based colloid in adult
patients receiving open heart surgery. SAGE Publications 2011.
<16>
Accession Number
2012151776
Authors
Zheng G.-H. Liu J.-P. Wang N.S. Chen H.-Y. Chu J.-F.
Institution
(Zheng, Chen, Chu) Centre of Evidence Based Medicine, Fujian University of
Traditional Chinese Medicine, Shangjie University Town, NO. 1 Huatuo Road,
Fuzhou 350108, China
(Liu) Centre for Evidence-Based Chinese Medicine, Beijing University of
Chinese Medicine, Beijing 100029, China
(Wang) Pamir Communications, Daly City, CA 94015, United States
Title
Systematic review of chinese herbal medicines for preventing in-stent
coronary restenosis after percutaneous coronary intervention.
Source
Evidence-based Complementary and Alternative Medicine. 2012 , 2012.
Article Number: 253409. Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Percutaneous coronary intervention (PCI) with stent placement is a
standard treatment for coronary artery disease (CAD). In-stent restenosis
after PCI remains a challenging clinical problem. In China, Chinese herbal
medicines (CHMs) are widely used for preventing restenosis. This paper
systematically reviewed the literature on the effectiveness and safety of
CHMs in preventing restenosis after PCI in patients with CAD. Electronic
databases were searched for randomized controlled trials that compared
CHMs plus RWM with the same RWM plus placebo in preventing restenosis
after PCI. A total of 52 trials (4905 patients) on 34 CHMs met the
inclusion criteria and were analyzed. Ten trials had low risk of bias.
Methodological quality of included trials was generally poor.
Meta-analysis showed that at the end of at least 3 months' followup, CHMs
plus RWM could significantly reduce restenosis rate, cardiac mortality,
recurrence rate of angina, acute myocardial infarction, numbers of repeat
PCI, and numbers of coronary artery bypass graft. Reported adverse events
included gastrointestinal upset, granulocytopenia, and increased alanine
transaminase (ALT). CHMs may help prevent restenosis, thus reducing
cardiac mortality after PCI. Caution should be exercised in drawing a
definitive conclusion due to the poor methodological quality of the trials
reviewed. Copyright 2012 Guo-Hua Zheng et al.
<17>
[Use Link to view the full text]
Accession Number
2012156810
Authors
Hunter R.J. Diab I. Tayebjee M. Richmond L. Sporton S. Earley M.J.
Schilling R.J.
Institution
(Hunter, Diab, Tayebjee, Richmond, Sporton, Earley, Schilling) Cardiology
Department, Barts and the London NHS Trust QMUL, St Bartholomew's
Hospital, London, United Kingdom
Title
Characterization of fractionated atrial electrograms critical for
maintenance of atrial fibrillation a randomized, controlled trial of
ablation strategies (the CFAE AF trial).
Source
Circulation: Arrhythmia and Electrophysiology. 4 (5) (pp 622-629), 2011.
Date of Publication: October 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Whether ablation of complex fractionated atrial electrograms
(CFAE) modifies atrial fibrillation (AF) by eliminating drivers or atrial
debulking remains unknown. This randomized study aimed to determine the
effect of ablating different CFAE morphologies compared with normal
electrograms (ie, debulking normal tissue) on the cycle length of
persistent AF (AFCL). Methods and Results-After pulmonary vein isolation
left and right atrial CFAE were targeted, until termination of AF or
abolition of CFAE before DC cardioversion. Ten-second electrograms were
classified according to a validated scale, with grade 1 being most
fractionated and grade 5 normal. Patients were randomly assigned to have
CFAE grades eliminated sequentially, from grade 1 to 5 (group 1) or grade
5 to 1 (group 2). An increase in AFCL (mean of left and right atrial
appendage) >=5 ms after a lesion was regarded as significant. CFAE (n=968)
were targeted in 20 patients. AFCL increased after targeting 51+/-35% of
grade 1 CFAE, 30+/-15% grade 2, 12+/-5% grade 3, 33+/-12% grade 4, and
8+/-15% grade 5 CFAE (P<0.01 for grades 1, 2, and 4 versus 5; 3 versus 5,
not significant). The proportion of lesions causing AFCL prolongation was
unaffected by the order in which CFAE were targeted. Conclusions-Targeting
CFAE is not simply atrial debulking. Ablating certain grades of CFAE
increases AFCL, suggesting they are more important in maintaining AF.
2011 American Heart Association, Inc.
<18>
Accession Number
2012150963
Authors
Song S.-W. Sul S.-Y. Lee H.-J. Yoo MD K.-J.
Institution
(Song) Department of Thoracic and Cardiovascular Surgery, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea
(Sul, Lee, Yoo MD) Department of Thoracic and Cardiovascular Surgery,
Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-gu, Seoul 120-752, South Korea
Title
Comparison of the radial artery and saphenous vein as composite grafts in
off-pump coronary artery bypass grafting in elderly patients: A randomized
controlled trial.
Source
Korean Circulation Journal. 42 (2) (pp 107-112), 2012. Date of
Publication: February 2012.
Publisher
Korean Society of Circulation (553 Dowha-dong, Mapo-gu, Seoul 121-040,
South Korea)
Abstract
Background and Objectives: Arterial grafts have a better long-term patency
rate than saphenous vein (SV) when used in off-pump coronary artery bypass
surgery (OPCAB). However, arterial grafts in elderly patients are often
diseased. We sought to compare the early outcomes achieved by using the
two different types of composite grafts. Subjects and Methods: We
conducted a randomized trial to compare radial artery (RA) and SV
composite grafts based on the in situ left internal mammary artery in 60
elderly (>70 years old) patients, who were scheduled to undergo OPCAB.
Clinical outcomes and 1-year post-operative CT angiography results were
compared. The quality of the conduit was evaluated by employing vascular
ultrasonography, optical coherence tomography (OCT), and histologic
examination. Results: No differences in immediate postoperative morbidity
and mortality were observed between the two groups. Early postoperative CT
angiography revealed a SV patency rate of 100%, which was not different
from that of RA composite grafts (99.1%). CT angiography after a year
showed an overall patency rate of 96.3%. The overall patency rate of the
SV group at 1 year was 94.7%, which was similar to that of the RA group
(97.4%). Also, there was no difference in overall survival rate between
the two groups. Vascular ultrasonographic images showed strong
correlations between OCT and histopathology. Conclusion: Our analysis of
early outcomes revealed that the SV could be used as an alternative
composite graft to the RA in elderly patients. Vascular ultrasonography is
an accurate, real-time, and reproducible method for assessing the quality
of the RA conduit. Copyright 2012 The Korean Society of Cardiology.
<19>
Accession Number
22338468
Authors
Maravic-Stojkovic V. Lausevic-Vuk L. Jovic M. Rankovic A. Borzanovic M.
Marinkovic J.
Institution
(Maravic-Stojkovic) Immunology Lab, Dedinje Cardiovascular Institute,
Belgrade, Serbia
(Lausevic-Vuk, Jovic, Rankovic) Clinic for Anaesthesia and Intensive Care,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Jovic) School of Medicine, University of Belgrade, Belgrade, Serbia
(Borzanovic) Department of Cardiology, Dedinje Cardiovascular Institute,
Belgrade, Serbia
(Marinkovic) Institute of Medical Statistics and Informatics, School of
Medicine, University of Belgrade, Belgrade, Serbia
Title
Procalcitonin-based therapeutic strategy to reduce antibiotic use in
patients after cardiac surgery: A randomized controlled trial.
Source
Srpski Arhiv za Celokupno Lekarstvo. 139 (11-12) (pp 736-742), 2011. Date
of Publication: November-December 2011.
Publisher
Srpsko Lekarsko Drutsvo (UREDNISTVO CASOPISA SRPSKI ARHIV, UL DZORDZA
VASINGTONA 19, Beograd 11000, Serbia)
Abstract
Introduction Procalcitonin (PCT) is a thyroid gland prohormone, and its
serum concentration is elevated in systemic bacterial infections. The
diagnostic cut-off value of PCT in patients early after cardiac surgery
remains unclear. Objective We investigated whether procalcitonin-guidance
could reduce antibiotic usage safely. Methods The prospective study
included 205 patients who underwent open heart surgery. The patients were
randomly assigned for procalcitonin-guided antibiotic treatment
(PCT-group; n=102) or standard care (standard group; n=103). On the basis
of serum procalcitonin concentrations, usage of antibiotics was encouraged
(PCT>=0.5 ng/mL) or discouraged. Results A relative risk of antibiotic
exposure in the standard group compared with the PCT-group was 3.81 (95%
CI=2.03-7.17; p<0.0001). The mean cost of antibiotics per patient in
procalcitonin group was 193.3+/-636.6 vs. 372.1+/-841.1 (p=0.206) in the
standard group, while the mean cost per hospital day was 8.0+/-18.4 vs.
17.8+/-36.3 (p=0.028). We found that non-infectious complications occurred
in 40/102 vs. 41/103 (p=0.592) while infections appeared in 5/102 vs.
22/103 (p=0.001) cases. A statistically significant difference was
observed in the treatment of urinary infections between PCT-group and
standard group; 1/102 vs. 9/103 (p=0.016). In the PCT-group, the ICU stay
was 5.74+/-11.49 days and in the standard group 6.97+/-11.61 (p=0.812).
The hospital stay was 12.08+/-11.28 vs. 12.93+/-10.73 (p>0.05) days,
respectively. Mortality rates were equal in both groups of patients
(p=0.537). Conclusion Procalcitonin-guided antibiotic treatment is safe
and can significantly reduce the cost of postoperative care. Additionally,
the antibiotic use during immediate postoperative course should be timely
controlled and limited to documented bacterial infections.
<20>
Accession Number
70697056
Authors
Miceli A. Gilmanov D. Caputo M. Angelini G.D. Romeo F. Glauber M.
Institution
(Miceli, Gilmanov, Glauber) Fondazione G. Monasterio, Massa, Italy
(Miceli, Caputo, Angelini) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Miceli, Romeo) Universita Tor Vergata, Roma, Italy
Title
Renin-angiotensin antagonism systems and acute kidney injury after cardiac
surgery. A metanalysis of over 20 000 patients.
Source
Giornale Italiano di Cardiologia. Conference: 42 Congresso Nazionale di
Cardiologia dell'ANMCO Fortezza da Basso Italy. Conference Start: 20110511
Conference End: 20110514. Conference Publication: (var.pagings). 12 (5
SUPPL. 1) (pp 26S), 2011. Date of Publication: May 2011.
Publisher
CEPI s.r.l.
Abstract
Introduction. Acute kidney injury (AKI) after cardiac surgery is
associated with an increased risk of mortality. Several studies report
controversial results with regard to the effect of angiotensin converting
enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on
postoperative renal function. The aim of the study was to estimate the
risk of preoperative angiotensin antagonism on AKI in patients undergoing
cardiac surgery. Methods. A systematic review of all studies reporting the
impact of preoperativeACEI/ARB therapy on the incidence of AKI after
cardiac surgery was performed. Results. Six observational studies were
identified reporting the incidence of postoperativeAKI in 22304 patients
having cardiac surgerywith (n=8216, 36.8%) or without (n=14088; 63.2%)
preoperativeACEI/ARB use. Postoperative AKI was significantly higher (8.6
vs 6%, p<0.0001) in patients undergoing cardiac surgery who received
preoperative ACEI/ARB treatment compared with controls. Pooled analysis
showed a 41% of increased in the risk of AKI (OR 1.41, 95%CI 1.07 to 1.87;
p=0.01 for overall effect) in patients receiving ACEI/ARB therapy before
cardiac surgery. Conclusion. Cumulative analysis of studies currently
available in literature documents that preoperative angiotensin antagonism
therapy is associated with increased in the risk of postoperative acute
kidney injury. Randomized trials need to confirm these data. (Table
presented).
<21>
Accession Number
70693754
Authors
Deveci O.S. Yavuz B. Sen O. Akin K.O. Dal K. Ata N. Ertutrul D.T. Tokatli
A.
Institution
(Deveci, Tokatli) Department of Cardiology, GATA Haydarpasa Training
Hospital, Istanbul, Turkey
(Yavuz, Sen) Department of Cardiology, Kecioren Research and Training
Hospital, Ankara, Turkey
(Dal, Ata, Ertutrul) Department of Internal Medicine, Kecioren Research
and Training Hospital, Ankara, Turkey
(Akin) Department of Biochemistry, Kecioren Research and Training
Hospital, Ankara, Turkey
Title
Serum IGF-I levels are correlated with mitral valve calcification score in
patients with rheumatic mitral stenosis.
Source
International Journal of Cardiology. Conference: 8th International
Congress of Update in Cardiology and Cardiovascular Surgery Antalya
Turkey. Conference Start: 20120301 Conference End: 20120304. Conference
Publication: (var.pagings). 155 (pp S123-S124), 2012. Date of
Publication: March 2012.
Publisher
Elsevier
Abstract
Objective: Although the prevalence of rheumatic fever has greatly
decreased in developed countries, rheumatic mitral stenosis (RMS) still
causes significant morbidity and mortality. Relatively recent awareness
that IGF-I regulate immune function has cast this pathway in an unexpected
light; it may represent an important switch governing the quality and
amplitude of immune responses. IGF-I/IGF-IR signaling may also participate
in the pathogenesis of autoimmune diseases, although its relationship with
these processes seems complex and relatively unexplored. At present, there
have been no controlled clinical trial on the levels of IGF-1 in the
patients with RMS. The aim of this study was to assess the levels of
insulin like growth factor-I (IGF-I) and its correlation with Wilkins
score in patients with RMS. Methods: SIxty-two patients with RMS and
fifty-eight healthy age and sex matched control subjects were enrolled in
this study. All subjects underwent transthoracic echocardiography after a
complete medical evaluation and laboratory examination. Planimetric mitral
valve area and Wilkins score were evaluated for all patients. BIochemical
parameters, serum IGF-I levels were measured. IGF-I levels are compared
both in the patients with RMS and control groups and in the the group of
patients with lower Wilkins score (<=8, n:35) and higher Wilkins score
(>8, n:27). Results: Mean age was similar in RMS and control groups
(50+/-10 vs 52+/-10 years, p= NS). Level of IGF-I was significantly higher
in RMS than in controls (111.7+/-48.3 ng/ml vs 91.3+/-44.9 ng/ml, p =
0.018). Similarly mean IGF-I levels were significantly higher in the group
of patients with higher Wilkins score than in the patients with lower
Wilkins score 121.3+/-37.2 ng/ml vs 101.8+/-34.5 ng/ml, p < 0.05). A
moderate correlation between IGF-I and Wilkins score was determined (r:
0.554). There was no correlation between IGF-I level and other
echocardiographic parameters of mitral stenosis. Conclusions: The present
study demonstrated that serum IGF-I levels were significantly higher both
in patients with RMS compared to control subjects and in the group of
patients with higher Wilkins score than in the patients with lower Wilkins
score. IGF-I levels were also correlated with Wilkins score. It can be
suggested that there may be a link between serum IGF-I levels and
inflammation process of RMS.
<22>
Accession Number
70693626
Authors
Arslan Z. Tavlasoglu M.
Institution
(Arslan) Gelibolu Asker Hastanesi, Kardiyoloji Servisi, Canakkale, Turkey
(Tavlasoglu) Diyarbakir Asker Hastanesi, Kalp Damar Cerrahisi Servisi,
Diyarbakir, Turkey
Title
Appropriate time to infusion of stem cells for the treatment of acute
myocardial infarction.
Source
International Journal of Cardiology. Conference: 8th International
Congress of Update in Cardiology and Cardiovascular Surgery Antalya
Turkey. Conference Start: 20120301 Conference End: 20120304. Conference
Publication: (var.pagings). 155 (pp S69), 2012. Date of Publication:
March 2012.
Publisher
Elsevier
Abstract
Objective: Stem cell (SC) therapy has emerged as a novel therapeutic
treatment alternative for LV dysfunction. With the aid of developing
techniques, the approach consists of transplanting SC into infarcted
myocardium improve regeneration; rebuild neovascularization and the
contractile function. Theoretically, for timing of SC administration after
myocardial infarction (MI), the days between the 3rd and 7th seems to be
the most appropriate period, at which the inflammatory cytokines
increased, cell adhesion and migration are at the highest level, and the
matrix collagen synthesis has not increased yet. Therefore, the first week
after MI has been selected in most of the intracoronary (IC) SC treatment
studies (Table 1). In the meta-analyses, BMSC didn't have any benefit if
they infused in the first days. But, limited numbers of studies are
heterogeneous in terms of cell count, selected patients criteria and
baseline left ventricular ejection fraction (LVEF). We sought to determine
if the first days are better for stem cell infusion when total ischemic
time and baseline LVEF to be considered. Methods: A systematic search of
electronic medical literature was made to identify the randomized
controlled trials with primary end point of LVEF improvement during
follow-up for patients with MI undergoing primary coronary intervention
(PCI) and who received IC bone marrow (BM) SC. The clinical trials were
grouped according to their given stem cell count, stem cell infusion time
(early <2 days or late 2-9 days) and total ischemic time (<6 hours or >6
hours). (Figure presented) Results: 10 trials (871 patients) were included
in this study. Compared to late infusion, BMSC treatment in patients with
earlier infusion improved LVEF by 6.7% in the patients with longer
ischemic time (Figure-1). Whereas, although the given SC number was
higher, late SC received patients had less improvement in their LVEF (4%).
SC treatment seems to have best benefit if the patients received in the
first days, have lower baseline LVEF and longer ischemic time.
Conclusions: In general aspects, many of the studies reported a similar
increase in global LVEF, between 2% and 7%, especially when the cells were
used in the 3-7 day-period. However, these results showed us metaanalysis
should consider baseline LVEF, total ischemic time and SC number when they
group the trials for timing of SC administration. However, large clinical
studies comparing the different time periods are still required for
understanding the best choice. (Table presented).
<23>
Accession Number
70693579
Authors
Ari H. Aradi D. Komocsi A. Price M.J. Cuisset T. Hazarbasanov D. Trenk D.
Sibbing D. Valgimigli M. Bonello L.
Institution
(Ari) Bursa Postgraduate Hospital, Bursa, Turkey
(Aradi, Komocsi) University of Pecs, Heart Institute, Pecs, Hungary
(Price) Scripps Clinic and Scripps Translational Science Institute, San
Diego, CA, United States
(Cuisset) Departement de Cardiologie, CHU Timone, Faculte de Medecine,
Marseille, France
(Hazarbasanov) Cardiology Department, St Anna University Hospital, Sofia,
Bulgaria
(Trenk) Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
(Sibbing) Deutsches Herzzentrum, Munchen, Germany
(Valgimigli) Department of Cardiology, University of Ferrara, Ferrara,
Italy
(Bonello) Departement de Cardiologie, Hopital Universitaire Nord, Inserm
UMRS, 608 AP-HM, Marseille, France
Title
Efficacy and safety of platelet function-guided antiplatelet therapy:
Systematic review and meta-analysis.
Source
International Journal of Cardiology. Conference: 8th International
Congress of Update in Cardiology and Cardiovascular Surgery Antalya
Turkey. Conference Start: 20120301 Conference End: 20120304. Conference
Publication: (var.pagings). 155 (pp S49-S50), 2012. Date of Publication:
March 2012.
Publisher
Elsevier
Abstract
Objective: There is a balance between thrombosis and bleeding with P2Y12
ADP-receptor antagonists. Platelet assays can predict the risk of
thrombotic events and therefore might be helpful to tailor the degree of
platelet inhibition. This meta-analysis aim, to determine the clinical
efficacy and safety of intensified antiplatelet therapy on the basis of
platelet function assessment in patients with high on-clopidogrel platelet
reactivity. (Figure prsented) Methods: Electronic databases were searched
to find prospective, randomized, controlled trials that aimed to report
the clinical impact of an intensified antiplatelet protocol on the basis
of ADP-specific platelet function assessment in patients receiving aspirin
and clopidogrel. Key efficacy measures were cardiovascular death,
non-fatal myocardial infarction and definite/probable stent thrombosis,
while major bleeding events were recorded as safety endpoint. Results:
Between 2008 and 2011, ten clinical trials comprising 4,213 randomized
patients were identified. As compared to standard antiplatelet therapy,
the intensified protocol was associated with a significant reduction in
cardiovascular mortality (OR: 0.38, 95% CI: 0.18-0.78, p = 0.008), in
definite/probable stent thrombosis (OR: 0.38, 95% CI: 0.19-0.75, p =
0.006) and in myocardial infarction (OR: 0.47, 95% CI: 0.28-0.80, p =
0.006). (figure 1) There was no difference in the rate of major and major
or minor bleeding events between the two strategies (OR: 0.81, 95% CI:
0.46-1.40, p = 0.44 and OR: 1.15, 95%CI: 0.91-1.45, p = 0.24,
respectively) (Figure 1). Although the observed effects in cardiovascular
death, stent thrombosis and bleeding were not heterogeneous,
meta-regression analysis revealed that the net clinical benefit of the
intensified approach was larger in studies including patients at higher
risk for stent thrombosis (P = 0.024). Conclusions: Intensifying
antiplatelet therapy on the basis of ADP-specific platelet function
assessment reduces cardiovascular mortality and stent thrombosis without a
significant increase in major bleeding complications.
<24>
Accession Number
70692463
Authors
Cerrato E. D'Ascenzo F. Biondi-Zoccai G. Moretti C. Omede P. Presutti D.
Bollati M. Sciuto F. Sturnia S. Gaita F. Sheiban I.
Institution
(Cerrato, D'Ascenzo, Moretti, Omede, Presutti, Bollati, Sciuto, Sturnia,
Gaita, Sheiban) Division of Cardiology, University of Turin, S. Giovanni
Battista Molinette Hospital, Turin, Italy
(Biondi-Zoccai) Division of Cardiology, University of Modena and Reggio
Emilia, Modena, Italy
Title
Acute coronary syndrome in HIV patients: A meta-analysis investigating
adverse event rates and antiretroviral therapy influence.
Source
Giornale Italiano di Cardiologia. Conference: 72 Congresso Nazionale Della
Societa Italiana di Cardiologia Rome Italy. Conference Start: 20111210
Conference End: 20111212. Conference Publication: (var.pagings). 12 (12
SUPPL. 3) (pp e207-e208), 2011. Date of Publication: December 2011.
Publisher
CEPI s.r.l.
Abstract
Introduction. Antiretroviral therapies dramatically reduced human
immunodeficiency virus (HIV) associated morbidity and mortality, but
detrimental effects of both disease progression and anti-retroviral
therapy are becoming an increasing challenge especially in the setting of
acute coronary syndromes (ACS). Material and methods. PubMed was
systematically screened for original researches appraising HIV patients
admitted with ACS; baseline features, long term outcomes and influence of
antiretroviral therapy were appraised and pooled. Results. 10 studies,
with a total of 700 patients, were included, demonstrating low incidence
of diabetes (9.08%: 3.38, 14.78; CI 95%). Time from diagnosis of HIV to
ACS was of 7.45 years [2.38, 12.51; CI 95%], with most of patients exposed
to nucleoside reverse-transcriptase inhibitors (84.23% [74.15, 94.3; CI
95%]) and protease inhibitors (66.21% [59.77, 72.65; CI 95%]).Rates of
inhospital deaths were 9.80% [3.93, 15.67; CI 95%], ascribable to
cardiovascular events for 7.90% [2.43, 13.37; CI 95%]. At a median
follow-up of 25.50 (11.25- 42 months, CI 95%) no deaths were recorded,
with an incidence of 9.42% of acute myocardial infarction [2.68, 16.17; CI
95%] and of 20.18% [9.84, 30.51; CI 95%] of percutaneous coronary
revascularization. Moreover exposition to protease inhibitors was an
independent predictor of myocardial infarction (RR 2.68, 1.89-3.89; CI
95%). Conclusions. HIV patients showed a notable risk of non
fatal-reinfarction after ACS, both related to their clinical features and
to antiretroviral therapy.
<25>
Accession Number
70692462
Authors
Ferrante G. Pagnotta P. Valgimigli M. Belli G. Rossi M. Gasparini G.
Zavalloni D. Presbitero P.
Institution
(Ferrante, Pagnotta, Belli, Rossi, Gasparini, Zavalloni, Presbitero)
Department of Interventional Cardiology, Istituto Clinico Humanitas IRCCS,
University of Ferrara, Ferrara, Italy
(Valgimigli) Cardiovascular Institute, Arcispedale S. Anna, University of
Ferrara, Ferrara, Italy
Title
Percutaneous coronary intervention versus bypass surgery for left main
coronary artery disease: A meta-analysis of randomized trials.
Source
Giornale Italiano di Cardiologia. Conference: 72 Congresso Nazionale Della
Societa Italiana di Cardiologia Rome Italy. Conference Start: 20111210
Conference End: 20111212. Conference Publication: (var.pagings). 12 (12
SUPPL. 3) (pp e207), 2011. Date of Publication: December 2011.
Publisher
CEPI s.r.l.
Abstract
Background. Recent guidelines consider coronary artery bypass graft
surgery (CABG) as the treatment of choice for unprotected left main
coronary disease (ULMCA), although they recognize percutaneous coronary
intervention (PCI) with stent implantation as a feasible therapeutic
option. We aimed to perform a meta-analysis of randomized trials that
compared PCI with CABG for the treatment of ULMCA. Methods. PubMed, and
other databases were searched. Data were expressed as odds ratios (OR)
with 95% confidence interval (CI). Results. Four randomized trials
enrolling 1596 patients with 12 month follow up were selected. One study
was excluded due to missing stroke data. PCI, as compared to CABG, was
associated with a significant reduction of stroke [0.14% vs 1.89%, OR
0.14, 95% CI (0.03 to 0.60), p=0.008, number needed to treat (NNT) 61, 95%
CI 55 to 133], with an increased risk of repeat revascularization [10.6%
vs 5.37%, OR 2.11, 95% CI (1.40 to 3.18), p<0.001; NNT 19, 95% CI 10 to
50], similar risk of mortality [OR 0.78, 95% CI (0.44 to 1.39), p=0.40] or
myocardial infarction [OR 0.96, 95% CI (0.51 to 1.81), p=0.90], resulting
in similar hazard of major adverse cardiac or cerebrovascular events [OR
1.25, 95% CI (0.90 to 1.72), p=0.18]. After pooling all 4 studies, similar
results were obtained with respect to mortality, myocardial infarction,
repeat revascularization. Conclusions. PCI, as compared to CABG, is
associated with a similar hazard of major adverse cardiac or
cerebrovascular events at 12-month followup. The choice of the most
appropriate therapeutic mode of revascularization for ULMCA should be
tailored on patient individual risk and preferences.
<26>
Accession Number
70692288
Authors
Imazio M. Brucato A. Cemin R. Trinchero R. Belli R. Spodick D.H. Adler Y.
Institution
(Imazio, Trinchero, Belli) Cardiology Dpt, Maria Vittoria Hospital,
Torino, Italy
(Brucato) Department of Medicine, Ospedali Riuniti, Bergamo, Italy
(Cemin) Department of Cardiology, San Maurizio Regional Hospital, Bolzano,
Italy
(Spodick) Department of Medicine, St. Vincent Hospital, University of
Massachusetts, Worcester, MA, United States
(Adler) Sackler Faculty of Medicine, Tel-Aviv and Misgav ladach Hospital,
Jerusalem, Kupat Holim Meuhedet, Israel
Title
Prevention of the post-pericardiotomy syndrome. A metaanalysis of
published randomized trials.
Source
Giornale Italiano di Cardiologia. Conference: 72 Congresso Nazionale Della
Societa Italiana di Cardiologia Rome Italy. Conference Start: 20111210
Conference End: 20111212. Conference Publication: (var.pagings). 12 (12
SUPPL. 3) (pp e108), 2011. Date of Publication: December 2011.
Publisher
CEPI s.r.l.
Abstract
Background. The natural history of post-pericardiotomy syndrome (PPS), a
relatively common complication of cardiac surgery, is variable ranging
from mild, self-limited episodes to cases with protracted courses,
recurrences and readmissions. Preventive strategies may be valuable to
reduce morbidity and management costs. We thus aimed to conduct a
comprehensive systematic review on available data for the pharmacologic
primary prevention of the PPS. Methods. Controlled clinical studies were
searched in several databases and were included provided they focused on
the pharmacologic primary prevention of the PPS. Random-effect odds ratios
(ORs) were computed for the occurrence of the PPS. Results. From the
initial sample of 343 citations, 4 controlled clinical trials for the
primary prevention of the PPS were finally included (894 patients); 3
studies were double-blind randomised controlled trials (RCT). Treatment
comparisons were as follows: colchicine vs. placebo (2 RCTs enrolling a
total of 471 patients), methylprednisolone vs. placebo (a single RCT on
246 pediatric patients), and aspirin vs. historical controls (a single
non-randomised study on 177 pediatric patients). Meta-analytic pooling
showed that colchicine was associated with a reduced risk of PPS (OR=0.38
[0.22-0.65], p for effect< 0.001, p for heterogeneity= 0.81,
I<sup>2</sup>=0%). Data either on methylpredisolone (OR=1.13 [0.57-2.25],
p for effect=0.72), or aspirin (OR=1.00 [0.16-6.11], p for effect=0.01)
were inconclusive. Conclusions. Clinical evidence informing
decision-making for the primary prevention of the PPS is still limited to
few studies of variable quality. Nevertheless, available data suggest a
beneficial profile for colchicine, the only efficacious agent for PPS
primary prevention.
