Results Generated From:
Embase <1980 to 2012 Week 14>
Embase (updates since 2012-03-29)
<1>
Accession Number
2011584754
Authors
Dorresteijn J.A.N. Visseren F.L.J. Ridker P.M. Wassink A.M.J. Paynter N.P.
Steyerberg E.W. Van Der Graaf Y. Cook N.R.
Institution
(Dorresteijn, Visseren, Wassink) Department of Vascular Medicine,
University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht,
Netherlands
(Ridker, Paynter, Cook) Division of Preventive Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Steyerberg) Department of Public Health, Erasmus Medical Center,
Rotterdam, Netherlands
(Van Der Graaf) Julius Center for Health Sciences and Primary Care,
Utrecht, Netherlands
Title
Estimating treatment effects for individual patients based on the results
of randomised clinical trials.
Source
BMJ (Online). 343 (7828) , 2011. Date of Publication: 22 Oct 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objectives: To predict treatment effects for individual patients based on
data from randomised trials, taking rosuvastatin treatment in the primary
prevention of cardiovascular disease as an example, and to evaluate the
net benefit of making treatment decisions for individual patients based on
a predicted absolute treatment effect. Setting: As an example, data were
used from the Justification for the Use of Statins in Prevention (JUPITER)
trial, a randomised controlled trial evaluating the effect of rosuvastatin
20 mg daily versus placebo on the occurrence of cardiovascular events
(myocardial infarction, stroke, arterial revascularisation, admission to
hospital for unstable angina, or death from cardiovascular causes).
Population: 17 802 healthy men and women who had low density lipoprotein
cholesterol levels of less than 3.4 mmol/L and high sensitivity C reactive
protein levels of 2.0 mg/L or more. Methods: Data from the Justification
for the Use of Statins in Prevention trial were used to predict
rosuvastatin treatment effect for individual patients based on existing
risk scores (Framingham and Reynolds) and on a newly developed prediction
model. We compared the net benefit of prediction based rosuvastatin
treatment (selective treatment of patients whose predicted treatment
effect exceeds a decision threshold) with the net benefit of treating
either everyone or no one. Results: The median predicted 10 year absolute
risk reduction for cardiovascular events was 4.4% (interquartile range
2.6-7.0%) based on the Framingham risk score, 4.2% (2.5-7.1%) based on the
Reynolds score, and 3.9% (2.5-6.1%) based on the newly developed model
(optimal fit model). Prediction based treatment was associated with more
net benefit than treating everyone or no one, provided that the decision
threshold was between 2% and 7%, and thus that the number willing to treat
(NWT) to prevent one cardiovascular event over 10 years was between 15 and
50. Conclusions: Data from randomised trials can be used to predict
treatment effect in terms of absolute risk reduction for individual
patients, based on a newly developed model or, if available, existing risk
scores. The value of such prediction of treatment effect for medical
decision making is conditional on the NWT to prevent one outcome event.
Trial registration number: Clinicaltrials.gov NCT00239681.
<2>
Accession Number
2010217102
Authors
Crowe E. Lovibond K. Gray H. Henderson R. Krause T. Camm J.
Institution
(Crowe, Lovibond, Krause) National Clinical Guideline Centre, Royal
College of Physicians of London, London NW1 4LE, United Kingdom
(Gray) Southampton University Hospital, Southampton SO16 6YD, United
Kingdom
(Henderson) Nottingham University Hospitals, Nottingham NG5 1PB, United
Kingdom
(Camm) St. George's, University of London, London SW17 0RE, United Kingdom
Title
Early management of unstable angina and non-ST segment elevation
myocardial infarction: Summary of NICE guidance.
Source
BMJ (Online). 340 (7750) (pp 805-807), 2010. Date of Publication: 10 Apr
2010.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<3>
Accession Number
2012177813
Authors
Leslie K. Myles P.S. Halliwell R. Paech M.J. Short T.G. Walker S.
Institution
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Department of Pharmacology, University of Melbourne, Melbourne,
VIC, Australia
(Leslie) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Myles) Academic Board of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, VIC, Australia
(Myles) National Health and Medical Research Council, Canberra, ACT,
Australia
(Halliwell) Department of Anaesthesia, Westmead Hospital, Sydney, NSW,
Australia
(Paech) School of Medicine and Pharmacology, University of Western
Australia, Perth, WA, Australia
(Paech) Department of Anaesthesia and Pain Medicine, King Edward Memorial
Hospital for Women, Perth, WA, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Auckland, New
Zealand
(Walker) Department of Anaesthesia, Middlemore Hospital, Auckland, New
Zealand
Title
Beta-blocker management in high-risk patients presenting for non-cardiac
surgery: Before and after the POISE Trial.
Source
Anaesthesia and Intensive Care. 40 (2) (pp 319-327), 2012. Date of
Publication: March 2012.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
The POISE Trial was a randomised, placebo-controlled, double-blind study
of the effectiveness of perioperative beta-blockade in preventing cardiac
events including death in 8351 patients. Our hypothesis was that knowledge
of the results of the POISE Trial would either increase or decrease the
use of effective perioperative beta-blockade, depending on the result.
Patients presenting for non-cardiac surgery and at risk of perioperative
cardiac events were recruited in two cohorts before and after the release
of the POISE Trial results. Effective perioperative beta-blockade was
defined as heart rate <65 beats per minute for at least 80% of the
perioperative period in patients prescribed beta-blockers. Effective
perioperative beta-blockade was achieved in 22 (11.5%) of 191 patients
prescribed perioperative beta-blockade in the first cohort (n=392) and
seven (6%) of 118 patients in the second cohort (n=241) (P=0.10).
Effective heart rate control was achieved in 29 (9%) patients prescribed
perioperative beta-blockers compared with 10 (3%) patients not prescribed
perioperative beta-blockers (P=0.001). The rate of implementation of
effective beta-blockade was low before POISE and this did not change
significantly after publication. Our finding does not provide reliable
evidence of a change in practice as a result of the POISE Trial.
<4>
Accession Number
2012144860
Authors
Marfella R. Sasso F.C. Cacciapuoti F. Portoghese M. Rizzo M.R. Siniscalchi
M. Carbonara O. Ferraraccio F. Torella M. Petrella A. Balestrieri M.L.
Stiuso P. Nappi G. Paolisso G.
Institution
(Marfella, Cacciapuoti, Rizzo, Siniscalchi, Paolisso) Department of
Geriatrics and Metabolic Diseases, Second University of Naples, 80138
Naples, Italy
(Sasso, Carbonara) Department of Internal and Experimental Medicine,
Center of Cardiovascular Excellence, Second University of Naples, 80138
Naples, Italy
(Portoghese) Cardiovascular Surgery Unit, Sassari Hospital, 07100 Sassari,
Italy
(Ferraraccio) Department of Clinical, Public, and Preventive Medicine,
Second University of Naples, 80138 Naples, Italy
(Torella, Nappi) Division of Cardiac Surgery, Second University of Naples,
80138 Naples, Italy
(Petrella) Department of Pharmaceutical Sciences, University of Salerno,
84084 Salerno, Italy
(Balestrieri, Stiuso) Department of Biochemistry and Biophysics, Second
University of Naples, 80138 Naples, Italy
Title
Tight glycemic control may increase regenerative potential of myocardium
during acute infarction.
Source
Journal of Clinical Endocrinology and Metabolism. 97 (3) (pp 933-942),
2012. Date of Publication: March 2012.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Aims: We analyzed the effects of tight glycemic control on regenerative
potential of myocardium during acute myocardial infarction. Patients and
Methods: Seventy-five patients with their first acute myocardial
infarction undergoing coronary bypass surgery were studied: 25 patients
with glycemia below 140 mg/dl served as the control group; hyperglycemic
patients (glucose >140 mg/dl) were randomized to intensive glycemic
control (IGC; n=20; glucose goal, 80-140 mg/dl), conventional glycemic
control (CGC; n= 20; glucose goal, 180-200 mg/dl), or
glucose-insulin-potassium (GIK; n=10; glucose goal, 180-200 mg/dl) for
almost 3 d before surgery, using insulin infusion followed by sc insulin
treatment. During surgery, myocyte precursor cells (MPC)
(c-kit/MEFC2/GATA4- positive cells), oxidation of MPC DNA
(c-kit/8-hydroxydeoxyguanosine-positive cells), senescent MPC
(c-kit/p16<sup>INK4a</sup>-positive cells), and cycling cardiomyocytes
(Ki-67-positive cells) were analyzed in biopsy specimens taken from the
peri-infarcted area. Results and Discussion: Before surgery, plasma
glucose reduction was greater in the IGC group than in the CGC and GIK
groups (P < 0.001 for both). IGC patients had higher MPC (P < 0.01) and
cycling myocytes (P < 0.01), as well as less oxidized (P < 0.01) and
senescent MPC (P < 0.01) in peri-infarcted specimens compared with both
CGC and GIK patients. Tight glycemic control, by reducing senescent MPC,
may increase regenerative potential of the ischemic myocardium. Copyright
2012 by The Endocrine Society.
<5>
Accession Number
2012142681
Authors
Vorobcsuk A. Aradi D. Farkasfalvi K. Horvath I.G. Komocsi A.
Institution
(Aradi, Horvath, Komocsi) University of Pecs, Heart Institute, Department
of Interventional Cardiology, Hungary
(Vorobcsuk, Farkasfalvi) University of Pecs, Heart Institute, Department
of Cardiovascular Intensive Care, Hungary
Title
Outcomes of patients receiving clopidogrel prior to cardiac surgery.
Source
International Journal of Cardiology. 156 (1) (pp 34-40), 2012. Date of
Publication: 05 Apr 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Clinical impact of the concomitant clopidogrel therapy on
clinical outcomes in patients undergoing cardiac surgery is unclear. We
aimed to pool and systematically analyze outcomes in clopidogrel-treated
patients undergoing cardiac operations to achieve greater statistical
power and to define precise effect-estimates. Methods: PubMed and Central
databases were searched for relevant studies published between January
2001 and May 2010. The main outcome measures were the rates of red blood
cell (RBC) transfusion, reoperation, myocardial infarction and
postoperative mortality. The outcome parameters were pooled with the
random-effect model via generic-inverse variance-weighting. Results:
Twenty studies comprising a total number of 23,668 patients were analyzed.
Pooled analysis revealed that the administration of clopidogrel had a
higher risk for postoperative mortality (OR: 1.24; 95% CI: 1.03-1.49, p =
0.03) that was consistent among studies. The rates of myocardial
infarction were similar between groups. Clopidogrel-exposed patients were
associated with a significantly higher rate of RBC transfusion (OR: 1.82;
95% CI: 1.40-2.37; p < 0.00001) and reoperation (OR: 2.15; 95% CI:
1.38-3.34; p < 0.00001), although there was a marked heterogeneity among
studies. According to subgroup analysis the mortality and the rates of
transfusions were higher in studies in which clopidogrel was not
discontinued 5 days prior to surgery, while the higher risk for
reoperation was only apparent in studies published before 2006.
Conclusion: Meta-analysis of observational studies demonstrated that
concomitant treatment with clopidogrel before cardiac surgery is
associated with a significant risk of bleeding-related complications and
with a higher mortality. 2009 Elsevier Ireland Ltd. All rights reserved.
<6>
Accession Number
2012142679
Authors
Faggiano P. Frattini S. Piovesana P. Lorusso R. Chiari E. Scolari F.
Padovani A. Cas L.D.
Institution
(Faggiano, Frattini, Chiari, Cas) Divisione e Cattedra di Cardiologia,
Spedali Civili, Universita di Brescia, Brescia, Italy
(Piovesana) Divisione di Cardiologia, Ospedale di Camposampiero, Padova,
Italy
(Lorusso) Divisione di Cardiochirurgia, Spedali Civili di Brescia, Italy
(Scolari) Divisione di Nefrologia, Ospedale di Montichiari and Cattedra di
Nefrologia, Universita di Brescia, Italy
(Padovani) Divisione di Neurologia e Cattedra di Neurologia, Spedali
Civili, Universita di Brescia, Italy
Title
Low cerebrovascular event rate in subjects with patent foramen ovale and
different clinical presentations: Results from a prospective non
randomized study on a population including patients with and without
patent foramen ovale closure.
Source
International Journal of Cardiology. 156 (1) (pp 47-52), 2012. Date of
Publication: 05 Apr 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: There are conflicting data on the role of a patent foramen
ovale (PFO) in the pathogenesis of cryptogenic stroke. The aim of this
study was to evaluate the incidence of cerebrovascular events associated
with PFO in a large population of patients during mid-term follow-up.
Methods and results: We prospectively investigated 446 consecutive
patients (58% female, age 50 +/- 14 years) in whom PFO was detected by
contrast echocardiography following cryptogenic stroke (30.5%), transient
ischemic attack (TIA, 23.7%), migraine(10.5%) or evaluation for other
cardiac diseases(35%). Prevalence of other clinical conditions potentially
associated with cerebral embolism, such as mitral valve disease, atrial
fibrillation and aortic atherosclerosis were 31%, 12.5%, 11.2%,
respectively; 99 out of 446 patients (22%, group 1) underwent PFO closure,
shortly after diagnosis, while 347 (78%, group 2) received only medical
therapy (antiplatelet drugs and vitamin K antagonists). During 54 months
(range 12-96) of average follow-up few events had been observed: one fatal
stroke (1%) in group 1 and 3 nonfatal strokes (0.86%) in group 2 (not
significant); there were more TIAs in group 1 than in group 2 (5, 5%
versus 3, 0.86%, p = 0.02): 8/12 new cerebrovascular events occurred in
patients with previous cerebral ischemia and in 7/12 there were other
cardioembolic sources. Kaplan-Meier survival free from cerebrovascular
events showed a slightly better prognosis in unclosed PFO patients
compared to closed PFO ones, statistically significant (p = 0.004).
Conclusions: New cerebrovascular events are rare in unselected subjects
with PFO, even in those with previous cerebral ischemia and those who have
not undergone PFO closure, with an event rate similar to that observed in
the general population. 2009 Elsevier Ireland Ltd. All rights reserved.
<7>
Accession Number
2012172022
Authors
Scheller B. Clever Y.P. Kelsch B. Hehrlein C. Bocksch W. Rutsch W. Haghi
D. Dietz U. Speck U. Bohm M. Cremers B.
Institution
(Scheller, Clever, Bohm, Cremers) Klinik fur Innere Medizin III,
Universitatsklinikum des Saarlandes, Kirrberger Strasse, 66421 Homburg,
Saar, Germany
(Kelsch, Speck) Institut fur Radiologie, Campus Mitte,
Charite-Universittsmedizin, Berlin, Germany
(Hehrlein) Klinik fur Innere Medizin III, Universitatsklinikum, Freiburg,
Germany
(Bocksch) Abteilung fur Kardiologie und Kreislauferkrankungen,
Universitatsklinikum Tubingen, Tubingen, Germany
(Rutsch) Kardiologie, Helios Emil von Behring Klinikum, Berlin, Germany
(Haghi) I. Medizinische Klinik, Universitatsklinikum Mannheim,
Ruprecht-Karls-Universitt Heidelberg, Mannheim, Germany
(Dietz) Kardiologie, Deutsche Klinik fur Diagnostik, Wiesbaden, Germany
Title
Long-term follow-up after treatment of coronary in-stent restenosis with a
paclitaxel-coated balloon catheter.
Source
JACC: Cardiovascular Interventions. 5 (3) (pp 323-330), 2012. Date of
Publication: March 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study presents long-term clinical follow-up, including
binary restenosis rate and major adverse cardiovascular events, of the
PACCOCATH-ISR (Treatment of In-Stent Restenosis by Paclitaxel Coated PTCA
Balloons) I and II trial. Background: The PACCOCATH-ISR trial was a
first-in-human study with a drug-coated balloon catheter and the first
study for the treatment of coronary ISR with a drug-coated balloon. So,
far no long-term follow-up data have been presented. Methods: This study
enrolled 108 patients in a randomized, double-blinded multicenter trial on
the efficacy and safety of a paclitaxel-coated balloon (3
mug/mm<sup>2</sup> balloon surface; PACCOCATH [Bayer AG, Germany])
compared with an uncoated balloon. The main inclusion criteria were a
diameter stenosis of <70% and <30-mm length with a vessel diameter of 2.5
to 3.5 mm. The primary endpoint was angiographic late lumen loss
in-segment after 6 months. Combined antiplatelet therapy was continued
only for 1 month followed by treatment with aspirin alone. Results: During
a follow-up of 5.4 +/- 1.2 years, the clinical event rate was
significantly reduced in patients treated with the drug-coated balloon
(major adverse cardiovascular events: 59.3% vs. 27.8%, p = 0.009), which
was mainly driven by the reduction of target lesion revascularization from
38.9% to 9.3% (p = 0.004). Conclusions: Treatment of coronary ISR with
paclitaxel-coated balloon catheters is safe and persistently reduces
repeat revascularization during long-term follow-up. The initial results
were sustained over the 5-year period. 2012 American College of
Cardiology Foundation.
<8>
Accession Number
2012172007
Authors
Wijnbergen I. Helmes H. Tijssen J. Brueren G. Peels K. Van Dantzig J.M.
Van'T Veer M. Koolen J.J. Pijls N.H.J. Michels R.
Institution
(Wijnbergen, Helmes, Brueren, Peels, Van Dantzig, Van'T Veer, Koolen,
Pijls, Michels) Department of Cardiology, Catharina Hospital Eindhoven,
Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Van'T Veer) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
Title
Comparison of drug-eluting and bare-metal stents for primary percutaneous
coronary intervention with or without abciximab in ST-segment elevation
myocardial infarction: DEBATER: The Eindhoven reperfusion study.
Source
JACC: Cardiovascular Interventions. 5 (3) (pp 313-322), 2012. Date of
Publication: March 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The goal of this study was to demonstrate superiority of
sirolimus-eluting stents (SES) over bare-metal stents (BMS) and of
abciximab over no abciximab in primary percutaneous coronary intervention
(PCI). Background: Drug-eluting stents (DES) are increasingly used in
primary PCI, but the recommendations for use in primary PCI are based on a
few randomized controlled trials with selected patients. The usefulness of
abciximab in primary PCI is not established. Methods: Nine hundred seven
patients referred to the Catharina Hospital were randomized to SES or BMS,
and to abciximab or no abciximab in a prospective, randomized, open 2 x 2
factorial trial with blinded evaluation. Primary endpoint was major
adverse cardiac and cerebrovascular events (MACCE), defined as the
composite of death, myocardial infarction (MI), stroke, repeat
revascularization, and bleeding at 1 year (stent arm) and the composite of
death, target vessel MI, target vessel revascularization (TVR), and
bleeding at 30 days (abciximab arm). Results: At 1 year, the rate of MACCE
was lower in the SES arm (16.5% vs. 25.8%, p = 0.001), mainly driven by
less repeat revascularization (9.8% vs. 16.8%; p = 0.003) and without
influencing the cumulative incidence of death and MI (5.2% vs. 5.8%; p =
0.68). At 30 days, the rate of the composite of death, target vessel MI,
TVR, and bleeding was lower in the abciximab arm (8.2% vs. 12.4%, p =
0.04), mainly driven by less TVR due to less stent thrombosis (1.2%
vs.7.4%, p < 0.001). However, bleeding complications occurred more
frequently in the abciximab group (5.7% vs. 2.8%, p = 0.03). Conclusions:
Primary PCI with SES reduces adverse events at 1 year, mainly by reduction
of repeat revascularization, whereas abciximab reduces early stent
thrombosis, at the expense of more bleeding complications. 2012 American
College of Cardiology Foundation.
<9>
Accession Number
2012173676
Authors
Araki A. Iimuro S. Sakurai T. Umegaki H. Iijima K. Nakano H. Oba K. Yokono
K. Sone H. Yamada N. Ako J. Kozaki K. Miura H. Kashiwagi A. Kikkawa R.
Yoshimura Y. Nakano T. Ohashi Y. Ito H.
Institution
(Araki, Ito) Department of Diabetes Mellitus Metabolism and Endocrinology,
Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
(Iimuro, Ohashi) Department of Biostatistics, School of Public Health, The
University of Tokyo, Tokyo, Japan
(Iijima, Ako, Kozaki) Department of Geriatric Medicine, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan
(Iijima) Institute of Gerontology, The University of Tokyo, Tokyo, Japan
(Nakano, Oba) Department of Geriatric Medicine, Nippon Medical School,
Tokyo, Japan
(Nakano) Department of Endocrinology, Tokyo Metropolitan Tama Geriatric
Hospital, Tokyo, Japan
(Sakurai, Yokono) Department of Geriatric Medicine, Graduate School of
Medicine, University of Kobe, Kobe, Japan
(Sakurai, Miura) Center for Comprehensive Care and Research on Demented
Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi,
Japan
(Umegaki) Department of Geriatrics and Community Healthcare, Graduate
School of Medicine, University of Nagoya, Nagoya, Japan
(Sone, Yamada) Department of Internal Medicine, University of Tsukuba
Institute of Clinical Medicine, Tsukuba, Ibaraki, Japan
(Kashiwagi, Kikkawa) Division of Diabetes Mellitus and Endocrinology,
Department of Internal Medicine, Shiga University of Medical Science,
Otsu, Shiga, Japan
(Yoshimura) Training Department of Administrative Dietician, Faculty of
Human Life Science, University of Shikoku, Tokushima, Japan
(Ito) Department of Diabetes, Metabolism and Endocrinology, Tokyo
Metropolitan Geriatric Hospital, Institute of Gerontology, 35-2 Sakae-cho,
Itabashi-ku, Tokyo 173-0015, Japan
Title
Long-term multiple risk factor interventions in Japanese elderly diabetic
patients: The Japanese Elderly Diabetes Intervention Trial - study design,
baseline characteristics and effects of intervention.
Source
Geriatrics and Gerontology International. 12 (SUPPL.1) (pp 7-17), 2012.
Date of Publication: April 2012.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Aim: To evaluate long-term, multiple risk factor intervention on physical,
psychological and mental prognosis, and development of complications and
cardiovascular disease in elderly type2 diabetes patients. Methods: Our
randomized, controlled, multicenter, prospective intervention trial
included 1173 elderly type2 diabetes patients who were enrolled from 39
Japanese institutions and randomized to an intensive or conservative
treatment group. Glycemic control, dyslipidemia, hypertension, obesity,
diabetic complications and atherosclerotic disease were measured annually.
Instrumental activity of daily living, cognitive impairment, depressive
symptoms and diabetes burden were assessed at baseline and 3years.
Results: There was no significant difference in clinical or cognitive
parameters at baseline between the two groups. The prevalence of low
activities of daily living, depressive symptoms and cognitive impairment
was 13%, 28% and 4%, respectively, and was similar in the two groups. A
small, but significant difference in HbA1c between the two groups was
observed at 1 year after the start of intervention (7.9% vs 8.1%, P<0.05),
although this significant difference was not observed after the second
year. With the exception of coronary revascularization, there was no
significant difference in fatal or non-fatal events between the two
groups. Composite events were also similar in the two groups. Conclusions:
This study showed no significant differences in fatal or non-fatal events
between intensive and conventional treatment. The present study might
clarify whether treatment of risk factors influences function and quality
of life in elderly diabetic patients. 2012 Japan Geriatrics Society.
<10>
Accession Number
2012162331
Authors
Aghadavoudi O. Kamran M. Masoudifar M.
Institution
(Aghadavoudi) Anesthesiology and Critical Care Research Center, IUMS,
Isfahan, Iran, Islamic Republic of
(Kamran) Resident of Anesthesiology and Critical Care, IUMS, Isfahan,
Iran, Islamic Republic of
(Masoudifar) Dept of Anesthesiology and Critical Care, IUMS, Isfahan,
Iran, Islamic Republic of
Title
Comparison of two modes of ventilation after fast-track cardiac surgery:
Adaptive support ventilation versus synchronized intermittent mandatory
ventilation.
Source
Pakistan Journal of Medical Sciences. 28 (2) (pp 303-308), 2012. Date of
Publication: January-March 2012.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: There is substantial debate regarding the appropriate protocol
for ventilatory management in fast-track cardiac anesthesia (FTCA). This
study was carried out to assess and compare the risks and benefits of
respiratory weaning based on adaptive support ventilation (ASV) and
synchronized intermittent mandatory ventilation (SIMV) after uncomplicated
cardiac surgery. Methodology: In a randomized clinical trial, after
receiving approval of the Department Research Committee and informed
consent from study subjects, 100 patients undergoing elective coronary
artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) were
enrolled during a 4-month period at a university-based hospital. After
surgery and admission to the intensive care unit (ICU), patients were
randomized to ASV and SIMV groups. Arterial blood gas (ABG) and
hemodynamic variables, respiratory and ventilator characteristics
including lung compliance, rapid shallow breathing index (RSBI), tidal
volume (TV), respiratory rate (RR), peak inspiratory pressure (P peak),
mean airway pressure (p mean), Pao2/FIo2, duration of mechanical
ventilation and tracheal intubation, and length of ICU stay were recorded
and compared between the two groups. The data were analyzed in 82 patients
after considering the exclusion criteria. Results: There were no
differences between ASV and SIMV groups in demographics and preoperative
characteristics. The duration of tracheal intubation and the length of ICU
stay were similar in both groups. There were no statistically and
clinically relevant differences between the two groups in ABG, hemodynamic
changes, and respiratory and ventilator characteristics during ICU stay.
Conclusion: Although ASV may facilitate postoperative respiratory
management in FTCA, both ASV and SIMV provide similarly safe and
practicable respiratory weaning in the cardiac ICU. The evaluation of
potential advantages in patient outcomes and resource utilization of
respiratory weaning based on ASV deserves further study.
<11>
Accession Number
2012165251
Authors
Bignami E. Landoni G. Gerli C. Testa V. Mizzi A. Fano G. Nuzzi M. Franco
A. Zangrillo A.
Institution
(Bignami, Landoni, Gerli, Testa, Mizzi, Fano, Nuzzi, Franco, Zangrillo)
Department of Anesthesia and Intensive Care, Universita Vita-Salute San
Raffaele, Milan, Italy
(Landoni) Outcomes Research Consortium, Cleveland, OH, United States
(Landoni) Department of Cardiothoracic Anesthesia and Intensive Care,
Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy
Title
Sevoflurane vs. propofol in patients with coronary disease undergoing
mitral surgery: A randomised study.
Source
Acta Anaesthesiologica Scandinavica. 56 (4) (pp 482-490), 2012. Date of
Publication: April 2012.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background Myocardial ischemic damage is reduced by volatile anaesthetics
in patients undergoing low-risk coronary artery bypass graft surgery; few
and discordant results exist in other settings. We therefore performed a
randomised controlled trial (sevoflurane vs. propofol) to compare cardiac
troponin release in patients with coronary disease undergoing mitral
surgery. Methods Patients with coronary artery disease undergoing mitral
surgery were randomly allocated to receive either sevoflurane (50
patients) or propofol (50 patients) as main hypnotic. The primary endpoint
of the study was peak post-operative cardiac troponin release defined as
the maximum value among the post-operative values measured at intensive
care unit arrival, 4 h later, on the first and second post-operative day.
Results There was no significant difference in post-operative peak
troponin release, the median (25th-75th percentiles) values being 14.9
(10.1-22.1) ng/ml and 14.5 (8.8-17.6) ng/ml in the sevoflurane and
propofol groups, respectively (P = 0.4). Fentanyl administration was
different between the two groups: 1347 +/- 447 mug in patients receiving
sevoflurane and 1670 +/- 469 mug in those receiving propofol, P = 0.002.
The 1-year follow-up identified two patients who died in the propofol
group (one myocardial infarction and one low cardiac output syndrome) and
one in the sevoflurane group (myocardial infarction). Conclusion In this
study, patients with coronary artery disease undergoing mitral surgery did
not benefit from the cardioprotective properties of halogenated
anaesthetics. Sevoflurane anaesthesia was not associated to lower cardiac
troponin release when compared with propofol anaesthesia. 2011 The Acta
Anaesthesiologica Scandinavica Foundation.
<12>
Accession Number
2012152096
Authors
Liu C.-P. Lin M.-S. Chiu Y.-W. Lee J.-K. Hsu C.-N. Hung C.-S. Kao H.-L.
Institution
(Liu) Department of Internal Medicine, Yuan's General Hospital, Kaohsiung
Medical University, Taiwan (Republic of China)
(Lin) Department of Internal Medicine, National Taiwan University
Hospital, Taiwan (Republic of China)
(Chiu) Department of Cardiology, Far Eastern Memorial Hospital, Taiwan
(Republic of China)
(Lee) Department of Laboratory Medicine, National Taiwan University
Hospital, Taiwan (Republic of China)
(Hsu, Hung, Kao) Cardiovascular Center, National Taiwan University
Hospital, Yun-Lin Branch, 7 Chung-Shan South Road, Taipei, 100, Taiwan
(Republic of China)
(Kao) School of Medicine, National Taiwan University, Taiwan (Republic of
China)
Title
Additive benefit of glycoprotein IIb/IIIa inhibition and adjunctive
thrombus aspiration during primary coronary intervention: Results of the
Initial Thrombosuction and Tirofiban Infusion (ITTI) trial.
Source
International Journal of Cardiology. 156 (2) (pp 174-179), 2012. Date of
Publication: 19 Apr 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Thrombus aspiration has been shown to provide significant
benefits during primary percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI). The aim of the current
study was to evaluate the additional benefit of tirofiban to thrombus
aspiration during primary PCI in myocardial reperfusion. Methods: 100
STEMI patients were randomized according to a 2 x 2 factorial design into
1 of the 4 groups: standard PCI, PCI with initial thrombus aspiration
(IT), PCI with tirofiban infusion (TI), and PCI with both treatments (IT +
TI). Results: The myocardial blush grade (MBG) 3 was achieved in 30.4%,
45.8%, 56% and 78.6% in the 4 groups respectively. More frequent MBG 3 (p
= 0.015) and complete (> 70%) ST-segment resolution (STR, 67.9% vs. 41.7%,
p = 0.058) were observed in IT +/- TI group compared with IT group. If
actuarial analysis was done after reassigning the 2 TI patients who
crossed over to IT + TI, the difference between IT + TI and IT groups
became more significant (MBG 3 rates: 76.7% vs. 45.8%, p = 0.009; complete
STR rates: 70% vs. 41.7%, p = 0.036). Infusion of tirofiban resulted in
improved MBG and STR (p = 0.003 and 0.037, respectively). Thrombus
aspiration resulted in improved MBG only (p = 0.048) but not in STR.
6-month MACE (death, reinfarction, target lesion revascularization and
stroke) was similar among groups (p = 0.725). Conclusions: Tirofiban may
augment thrombus aspiration therapy on myocardial reperfusion in primary
PCI. The benefit of thrombus aspiration treatment without tirofiban might
be less significant, especially on resolution of ST-segment elevation.
2010 Elsevier Ireland Ltd.
<13>
Accession Number
70703216
Authors
Shin E.-S. Park J. Chung H.-C. Lee J.-S. Kim. S.-J.
Institution
(Shin, Park, Chung, Lee, Kim.) Ulsan University Hospital, Ulsan, South
Korea
Title
Effect of remote ischemic preconditioning on myocardial injury during
hemodialysis: A pilot study.
Source
American Journal of Cardiology. Conference: 17th Annual Interventional
Vascular Therapeutics Angioplasty Summit-Transcatheter Cardiovascular
Therapeutics Asia Pacific Symposium, TCTAP 2012 Seoul South Korea.
Conference Start: 20120424 Conference End: 20120427. Conference
Publication: (var.pagings). 109 (7 SUPPL. 1) (pp 53S-54S), 2012. Date of
Publication: 2012.
Publisher
Elsevier
Abstract
Background: Recently, it has been known that hemodialysis (HD) itself may
result in a myocardial regional wall motion abnormality, that is
myocardial stunning, and this repeated insult may be associated with rapid
decrease in cardiac function and high cardiovascular mortality in HD
patients. Remote ischemic preconditioning (IPC) could attenuate cardiac
injury during coronary artery bypass surgery or percutaneous coronary
angioplasty. We made the hypothesis that remote IPC attenuates myocardial
injury during HD and did a pilot study. Methods: We evaluated the effect
of remote IPC by determining a change of serum cardiac troponin T (cTnT)
level. It is rapid and sensitive marker of myocardial injury and also well
correlated with long-term cardiovascular mortality in HD patient. Thirty
four stable HD patients were recruited. [median age 55.5 yrs (IQR 49.8 =
62.0) M:F = 21:13] Subjects were randomized to the remote IPC or control
group (1:1), and received the procedure assigned before every HD session
for 4 weeks. cTnT was measured before HD session at baseline 2, 7 and 28
days. Primary outcome was a change of cTnT level (+/-cTnT) at day 28 from
baseline. Results: Baseline characteristics and baseline cTnT level were
not different in both groups. The cTnT level tended to decrease
continuously in the remote IPC group through from day 2 to day 28, in the
contrast to the control group. At day 28, there was significant difference
in +/-cTnT between groups [median +/-cTnT (IQR); +/-0.015 ng/mL (+/-0.055
= 0.004) in remote IPC group vs. +/-0.002 ng/mL (+/-0.008 +/- 0.018) in
control group, p-value = 0.01]. Conclusion: Although it was small
difference, remote IPC significantly decreased cTnT level in HD patients
compared with control for short period. It means that remote IPC may
attenuate HD-induced myocardial injury. This pilot study can be a
rationale for further large randomized controlled trial.
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