Results Generated From:
Embase <1980 to 2012 Week 18>
Embase (updates since 2012-04-26)
<1>
Accession Number
2012221030
Authors
Nejad M.H.G. Baharestani B. Esfandiari R. Hashemi J. Panahipoor A.
Institution
(Nejad, Baharestani, Esfandiari, Hashemi, Panahipoor) Shaheed Rajaiee
Cardiovascular Research Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Evaluation and comparison of using low-dose aprotinin and tranexamic acid
in CABG: A double blind randomized clinical trial.
Source
Journal of Tehran University Heart Center. 7 (1) (pp 15-18), 2012. Date of
Publication: 2012.
Publisher
Tehran University of Medical Sciences (North Kargar Street, Tehran
1411713138, Iran, Islamic Republic of)
Abstract
Background: Cardiovascular operations are associated with an inherent
bleeding tendency that sometimes leads to severe bleeding and transfusion
requirement. Pharmacological intervention to minimize post-bypass bleeding
and blood product transfusions has received increasing attention from both
medical and economic viewpoints. Methods: This double-blind, randomized,
placebo-controlled clinical trial recruited three groups of patients (each
group consisting of 50 patients) undergoing on-pump coronary artery bypass
graft surgery (CABG) and blindly randomized them to receive either low
aprotinin, tranexamic acid, or placebo. The results were, subsequently,
evaluated and compared between the groups. All the patients were operated
on by one surgeon and the same surgery team. Results: The following
variables were similar between the groups, and there was no statistically
significant difference between the groups in terms of these variables: age
(p value = 0.308), sex (p value = 0.973), hyperlipidemia (p value =
0.720), hypertension (p value = 0.786), smoking (p value = 0.72), and
diabetes (p value = 0.960). The amounts of drainage from chest tubes were
less in the aprotinin and tranexamic acid groups than the amount in the
placebo group; the difference was statistically important (p value <
0.001). There was no statistically significant difference with respect to
need for reoperation for bleeding between the three groups (p value =
0.998). Complications following surgery in the three groups were
statistically the same and not significantly different. All the
complications (myocardial infarction, pericardial effusion, neurological
complication and renal complication) had a good course, and all the
patients were discharged from the hospital uneventfully. There was no
mortality in any group. Conclusion: Low-dose aprotinin and tranexamic acid
can significantly reduce blood loss and transfusion requirement in CABG
without importantly increasing mortality and morbidity.
<2>
Accession Number
2012231401
Authors
Levy J.H. Sniecinski R.M.
Institution
(Levy, Sniecinski) Department of Anesthesiology, School of Medicine, Emory
University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, United
States
Title
Prohemostatic treatment in cardiac surgery.
Source
Seminars in Thrombosis and Hemostasis. 38 (3) (pp 237-243), 2012. Date of
Publication: 2012.
Publisher
Thieme Medical Publishers, Inc. (333 7th Avenue, New York NY 10001-5004,
United States)
Abstract
Cardiac surgical patients represent a unique group of patients where
coagulopathy occurs due to multiple causes besides simple hemorrhagic
blood loss. Hemodilution, inflammation, and hemostatic activation while on
cardiopulmonary bypass all contribute to this problem and provide targets
for therapeutic intervention. Current pharmacological strategies to reduce
the need for allogeneic transfusions include both preemptive agents to
decrease the potential for bleeding as well as prohemostatic agents to
promote the coagulation process. This article will discuss pharmacological
agents including antifibrinolytics, protamine, desmopressin, fibrinogen,
purified protein concentrates, recombinant factor VIIa, factor XIII, and
topical agents used in cardiac surgery. Copyright 2012 by Thieme Medical
Publishers, Inc.
<3>
Accession Number
2012231964
Authors
Zamani P. Ganz P. Libby P. Sutradhar S.C. Rifai N. Nicholls S.J. Nissen
S.E. Kinlay S.
Institution
(Kinlay) Cardiovascular Division, Veterans Affairs Boston Healthcare
System, 1400 VFW Parkway, West Roxbury, MA 02132, United States
(Libby, Kinlay) Cardiovascular Division, Brigham and Women's Hospital,
Boston, MA, United States
(Libby, Kinlay) Harvard Medical School, Boston, MA, United States
(Zamani) Cardiovascular Division, University of California, San Diego, San
Diego CA, United States
(Ganz) Cardiovascular Division, University of California San Francisco,
San Francisco, CA, United States
(Sutradhar) Pfizer Inc, New York, NY, United States
(Rifai) Children's Hospital Boston, Harvard Medical School, Boston, MA,
United States
(Nicholls, Nissen) Cleveland Clinic Foundation, Cleveland Clinic Lerner
School of Medicine, Case Western Reserve University, Cleveland, OH, United
States
Title
Relationship of antihypertensive treatment to plasma markers of vascular
inflammation and remodeling in the Comparison of Amlodipine versus
Enalapril to Limit Occurrences of Thrombosis study.
Source
American Heart Journal. 163 (4) (pp 735-740), 2012. Date of Publication:
April 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Antihypertensive agents lower the risk of cardiovascular
events, but whether they affect pathways important in inflammation and
plaque remodeling in atherosclerosis is uncertain. We assessed whether 2
commonly used antihypertensive agents affected plasma biomarkers
reflecting specific inflammatory and remodeling processes over 2 years in
the Comparison of Amlodipine versus Enalapril to Limit Occurrences of
Thrombosis (CAMELOT) study. Methods: The study was a randomized controlled
trial of 2 antihypertensives (amlodipine and enalapril) compared with
placebo in patients with coronary artery disease and diastolic blood
pressure less than 100 mm Hg. In 196 subjects who had baseline and 2-year
intravascular coronary ultrasound examinations, we measured plasma
interleukin 18, interleukin 1 receptor antagonist, matrix
metalloproteinase 9, neopterin, and C-reactive protein. Results for both
treatment groups were pooled and compared with placebo. Results:
Antihypertensive treatment with either agent significantly lowered
diastolic blood pressure (-4.7 vs placebo 1.3 mm Hg, P =.002) and
progression of coronary atheroma ( percent atheroma volume 0.6 vs placebo
2.1, P =.031). Antihypertensive therapy did not affect plasma biomarkers
of inflammation or plaque remodeling in the 135 subjects with baseline and
2-year biomarker samples. Progression in percent atheroma volume was
significantly less in subjects taking statins at baseline (-2.5%, P
=.0008). Conclusions: In patients with coronary artery disease and
well-controlled risk factors, antihypertensive therapy lowered blood
pressure and progression of coronary atherosclerosis but did not affect
plasma biomarkers of inflammation and remodeling. Antihypertensives may
decrease atheroma progression by mechanisms other than those reflected by
these plasma biomarkers. 2012 Mosby, Inc.
<4>
Accession Number
2012231706
Authors
Kalesan B. Pilgrim T. Heinimann K. Raber L. Stefanini G.G. Valgimigli M.
Da Costa B.R. MacH F. Luscher T.F. Meier B. Windecker S. Juni P.
Institution
(Kalesan, Pilgrim, Raber, Stefanini, Meier, Windecker) Department of
Cardiology, Bern University Hospital, Bern, Switzerland
(Kalesan, Meier, Windecker, Juni) Clinical Trials Unit, University of
Bern, Bern, Switzerland
(Kalesan, Heinimann, Da Costa, Juni) Institute of Social and Preventive
Medicine, University of Bern, Switzerland
(Raber) Department of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Valgimigli) Department of Cardiology, University Hospital of Ferrara,
Italy
(MacH) Department of Cardiology, University Hospital of Geneva,
Switzerland
(Luscher) Department of Cardiology, University Hospital of Zurich,
Switzerland
Title
Comparison of drug-eluting stents with bare metal stents in patients with
ST-segment elevation myocardial infarction.
Source
European Heart Journal. 33 (8) (pp 977-987), 2012. Date of Publication:
April 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To evaluate safety and effectiveness of early generation drug-eluting
stents (DES) compared with bare-metal stents (BMS) in patients with
ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (PCI), and to determine whether
benefits and risks vary over time.Methods and resultsWe performed a
meta-analysis of 15 randomized controlled trials enrolling a total of 7867
patients comparing first-generation FDA-approved DES with BMS in patients
with STEMI. Random effect models were used to assess differences in
outcomes between DES and BMS among different time periods with regard to
the pre-specified primary outcomes stent thrombosis (ST) and target vessel
revascularization (TVR). The overall risk of definite ST was similar for
DES and BMS [risk ratio (RR) 1.08, 95 CI 0.821.43]. However, there were
time-dependent effects, with a RR of 0.80 during the first year (95 CI
0.581.12) and 2.10 during subsequent years (95 CI 1.203.69), with a
positive test for interaction between RR of ST and time (P for interaction
0.009). Results were similar for definite or probable ST (P for
interaction 0.015). In the overall analysis, TVR was performed less
frequently in patients with DES when compared with BMS (RR 0.51, 95 CI
0.430.61), with a greater benefit in the first year (RR 0.46, 95 CI
0.380.55) when compared with subsequent years (RR 0.75, 95 CI 0.590.94; P
for interaction 0.007).ConclusionAn early benefit of early generation DES
in primary PCI for STEMI with a reduction in TVR and a trend towards less
definite ST is offset in subsequent years by an increased risk of very
late ST. 2011 The Author.
<5>
Accession Number
2012232375
Authors
Yin X.-R. Pei L.
Institution
(Yin, Pei) Department of Anesthesiology, The First Affiliated Hospital,
China Medical University, Shenyang 110001, China
Title
Effects of magnesium sulfate on postoperative pain and complications after
general anesthesia: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (3) (pp 334-340), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically evaluate the effects of magnesium sulfate on
postoperative pain and complications after general anesthesia. Methods A
literature search was conducted in following databases as The Cochrane
Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date
of establishment to September 2011 to identify randomized controlled
trials (RCTs) about intravenous infusion of magnesium sulfate during
general anesthesia. All included RCTs were assessed and the data were
extracted according to the standard of Cochrane systematic review. The
homogenous studies were pooled using RevMan 5.1 software. Results A total
of 11 RCTs involving 905 patients were included. The results of
meta-analyses showed that compared with the control group, intravenous
infusion of magnesium sulfate during general anesthesia significantly
reduced the visual analog scale (VAS) scores at the time-points of 2, 4,
6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24
hours morphine requirements, and the incidents of postoperative nausea and
vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29,
95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia
(RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse
events or significant differences in the incidents of hypotension and
serum concentration changes of magnesium. Conclusion Intravenous infusion
of magnesium sulfate during general anesthesia may obviously decrease the
pain intensity, and the incidents of nausea and vomiting and chilling
after surgery, without increasing cardiovascular adverse events and risk
of hypermagnesemia. The results still need to be confirmed by more
high-quality and large-sample RCTs.
<6>
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Accession Number
2012231947
Authors
Mora S. Wenger N.K. Demicco D.A. Breazna A. Boekholdt S.M. Arsenault B.J.
Deedwania P. Kastelein J.J.P. Waters D.D.
Institution
(Mora) Brigham and Women's Hospital, Harvard Medical School, 900
Commonwealth Ave E, Boston, MA 02215, United States
(Wenger) Emory University School of Medicine, Atlanta, GA, United States
(Demicco, Breazna) Pfizer, New York, NY, United States
(Boekholdt, Arsenault, Kastelein) University of Amsterdam, Amsterdam,
Netherlands
(Deedwania) University of California San Francisco, Fresno, United States
(Waters) University of California San Francisco, San Francisco, United
States
Title
Determinants of residual risk in secondary prevention patients treated
with high-versus low-dose statin therapy: The treating to new targets
(TNT) study.
Source
Circulation. 125 (16) (pp 1979-1987), 2012. Date of Publication: 24 Apr
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiovascular events occur among statin-treated patients,
albeit at lower rates. Risk factors for this "residual risk" have not been
studied comprehensively. We aimed to identify determinants of this risk
above and beyond lipid-related risk factors. Methods and Results-A total
of 9251 coronary patients with low-density lipoprotein cholesterol <130
mg/dL randomized to double-blind atorvastatin 10 or 80 mg/d in the
Treating to New Targets (TNT) study had complete on-treatment 1-year lipid
data. Median follow-up was 4.9 years. The primary end point was major
cardiovascular events (n=729): coronary death, nonfatal myocardial
infarction, resuscitation after cardiac arrest, or fatal or nonfatal
stroke. Multivariable determinants of increased risk were older age
(adjusted hazard ratio [aHR], 1.13 per 1 SD [8.8 years]; 95% confidence
interval [CI], 1.04-1.23), increased body mass index (aHR, 1.09; 95% CI,
1.02-1.17 per 4.5 kg/m), male sex (aHR, 1.33; 95% CI, 1.07-1.65),
hypertension (aHR, 1.38; 95% CI, 1.17-1.63), diabetes mellitus (aHR, 1.33;
95% CI, 1.11-1.60), baseline apolipoprotein B (aHR, 1.19; 95% CI,
1.11-1.28 per 19 mg/dL), and blood urea nitrogen (aHR, 1.10; 95% CI,
1.03-1.17 per 4.9 mg/dL), in addition to current smoking, prior
cardiovascular disease, and calcium channel blocker use. Determinants of
decreased risk were high-dose statin (aHR, 0.82; 95% CI, 0.70-0.94),
aspirin use (aHR, 0.67; 95% CI, 0.56-0.81), and baseline apolipoprotein
A-I (aHR, 0.91; 95% CI, 0.84-0.99 per 25 mg/dL). On-treatment 1-year
lipids or apolipoproteins were not additionally associated with risk in
multivariable models. Known baseline variables performed moderately well
in discriminating future cases from noncases (Harrell c index=0.679).
Conclusions-Determinants of residual risk in statin-treated secondary
prevention patients included lipid-related and nonlipid factors such as
baseline apolipoproteins, increased body mass index, smoking,
hypertension, and diabetes mellitus. A multifaceted prevention approach
should be underscored to address this risk. 2012 American Heart
Association, Inc.
<7>
Accession Number
2012229304
Authors
Tang Y. Tang X.-W.
Institution
(Tang, Tang) Department of Cardiology, People's Hospital of Banan District
of Chongqing, Chongqing 401320, China
Title
Sirolimus-eluting stents versus bare-metal stents for patients with
ST-segment elevation myocardial infarction: A meta-analysis of randomized
controlled trials.
Source
Chinese Journal of Evidence-Based Medicine. 12 (2) (pp 188-193), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically evaluate the efficacy and safety of
sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in treating
patients with ST-segment elevation myocardial infarction. Methods The
databases such as PubMed (1960 to Mar. 2011), EMbase (1980 to Mar. 2011),
the Cochrane Central Register of Controlled Trials (1989 to Mar. 2011),
CBM (1979 to Mar. 2011), VIP (1989 to Mar. 2011) and CNKI (1979 to Mar.
2011) were searched to collect all the randomized controlled trials (RCTs)
on SES versus BMS in patients with ST-segment elevation myocardial
infarction. After the data extraction and methodological quality
evaluation, meta-analysis was conducted with RevMan 4.2 software. Results
A total of 7 RCTs were included. Among 2 555 patients involved, 1 282 were
in the SES group, while the other 1273 were in the BMS group. The results
of meta-analyses showed that SES was superior to BMS in the target-lesion
revascularization (OR=0.27, 95%CI 0.16 to 0.45, P<0.000 01) and
target-vessel revascularization (OR=0.33, 95%CI 0.24 to 0.46, P<0.000 01).
In contrast, there were no differences between SES and BMS in death, stent
thrombosis and recurrence of myocardial infarction. Conclusion With the
one-year clinical outcomes, SES is more effective than BMS in reducing the
rate of target-vessel revascularization and target-lesion
revascularization.
<8>
Accession Number
2012231846
Authors
Erkapic D. De Rosa S. Kelava A. Lehmann R. Fichtlscherer S. Hohnloser S.H.
Institution
(Erkapic, Hohnloser) Division of Clinical Electrophysiology, Department of
Cardiology, J.W. Goethe University, Theodor Stern Kai 7, D-60590
Frankfurt, Germany
(De Rosa, Lehmann, Fichtlscherer) Department of Cardiology, J.W. Goethe
University, Frankfurt, Germany
(Kelava) Faculty of Human Sciences, Institute of Psychology, Technical
University of Darmstadt, Darmstadt, Germany
Title
Risk for permanent pacemaker after transcatheter aortic valve
implantation: A comprehensive analysis of the literature.
Source
Journal of Cardiovascular Electrophysiology. 23 (4) (pp 391-397), 2012.
Date of Publication: April 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Risk for Permanent Pacemaker After Transcatheter Aortic Valve
Implantation. Background: Permanent pacemaker (PM) requirement is a known
complication after transcatheter aortic valve implantation (TAVI). There
are, however, no systematic data concerning this complication. Objective:
To determine the incidence and potential predictors of permanent PM
requirement after TAVI based on published literature. Methods: We
conducted a MEDLINE search to identify potentially relevant literature
dealing with PM requirement after TAVI. Data were collected on paper
extraction forms by 2 independent investigators. Results: There were 32
relevant published studies comprising data of 5,258 patients without an
implanted PM before TAVI. An Edwards-Sapiens prosthesis (ESP) was
implanted in 2,887 patients, whereas 2,371 patients received a CoreValve
prosthesis (CVP). The crude incidence of PM implantation after TAVI was
15%. Six hundred and fourteen of 2,371 (25.8%) CVP patients and 189 of the
2,887 (6.5%) ESP patients had to receive a permanent PM (odds ratio [OR]
4.91, 95% confidence interval [CI] 4.12-5.86, P < 0.001). Presence of
right bundle branch block (RBBB) before TAVI was a significant predictor
for development of complete atrioventricular (AV) block and subsequent PM
need (OR 1.358, 95% CI 1.001-1.841, P = 0.02). More than 90% of all
AV-block requiring PM implantation occurred immediately or within 7 days
after TAVI. Conclusion: Patients undergoing TAVI with implantation of CVP
are at significantly higher risk for development of AV block and
subsequent need for permanent PM, particularly if RBBB preexists. Since AV
block occurs in >90% within the first week after the procedure, careful
monitoring should be performed for at least 7 days after TAVI. 2012 Wiley
Periodicals, Inc.
<9>
Accession Number
2012219009
Authors
Jovic M. Stancic A. Nenadic D. Cekic O. Nezic D. Milojevic P. Micovic S.
Buzadzic B. Korac A. Otasevic V. Jankovic A. Vucetic M. Velickovic K.
Golic I. Korac B.
Institution
(Jovic, Nenadic, Cekic, Nezic, Milojevic, Micovic) University of Belgrade,
Medical School, Dedinje Cardiovascular Institute, Serbia
(Stancic, Buzadzic, Otasevic, Jankovic, Vucetic, Korac) University of
Belgrade, Institute for Biological Research Sinisa Stankovic, Department
of Physiology, Bulevar despota Stefana 142, 11060 Belgrade, Serbia
(Korac, Velickovic, Golic) Faculty of Biology, Institute of Zoology,
University of Belgrade, Serbia
Title
Mitochondrial molecular basis of sevoflurane and propofol cardioprotection
in patients undergoing aortic valve replacement with cardiopulmonary
bypass.
Source
Cellular Physiology and Biochemistry. 29 (1-2) (pp 131-142), 2012. Date of
Publication: 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background/Aims: Study elucidates and compares the mitochondrial
bioenergetic-related molecular basis of sevoflurane and propofol
cardioprotection during aortic valve replacement surgery due to aortic
valve stenosis. Methods: Twenty-two patients were prospectively randomized
in two groups regarding the anesthetic regime: sevoflurane and propofol.
Hemodynamic parameters, biomarkers of cardiac injury and brain natriuretic
peptide (BNP) were measured preoperatively and postoperatively. In tissue
samples, taken from the interventricular septum, key mitochondrial
molecules were determined by Western blot, real time PCR, as well as
confocal microscopy and immunohisto-and immunocyto-chemical analysis.
Results: The protein levels of cytochrome c oxidase and ATP synthase were
higher in sevoflurane than in propofol group. Nevertheless, cytochrome c
protein content was higher in propofol than sevoflurane receiving
patients. Propofol group also showed higher protein level of connexin 43
(Cx43) than sevoflurane group. Besides, immunogold analysis showed its
mitochondrial localization. The mRNA level of mtDNA and uncoupling protein
(UCP2) were higher in propofol than sevoflurane patients, as well. On the
other hand, there were no significant differences between groups in
hemodynamic assessment, intensive care unit length of stay, troponin I and
BNP level. Conclusions: Our data indicate that sevoflurane and propofol
lead to cardiac protection via different mitochondrially related molecular
mechanisms. It appears that sevoflurane acts regulating cytochrome c
oxidase and ATP synthase, while the effects of propofol occur through
regulation of cytochrome c, Cx43, mtDNA transcription and UCP2. 2012 S.
Karger AG, Basel.
<10>
Accession Number
2012222376
Authors
Braga J.R. Santos I.S.O. Mcdonald M. Shah P.S. Ross H.J.
Institution
(Braga, Mcdonald, Ross) Division of Cardiology, Peter Munk Cardiac Centre,
University Health Network, Toronto General Hospital, Toronto, ON, Canada
(Santos) Department of Heart Transplantation, Hospital de Messejana,
Fortaleza, Brazil
(Shah) Department of Paediatrics, Department of Health Policy, Evaluation
and Management, University of Toronto, ON, Canada
Title
Factors associated with the development of cardiac allograft vasculopathy
- a systematic review of observational studies.
Source
Clinical Transplantation. 26 (2) (pp E111-E124), 2012. Date of
Publication: March/April 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Cardiac allograft vasculopathy (CAV) is a significant factor impacting
outcomes after heart transplant. We performed a systematic review of risk
factors for the development of CAV. A search of electronic databases was
performed. The eligibility criteria included cohort and case-control
studies with more than 50 adult patients submitted to a heart transplant.
The outcome should be CAV diagnosed by angiography and/or intravascular
ultrasound (IVUS). Two reviewers performed study selection, data
abstraction, and quality assessment. Of 2514 citations, 66 articles were
included - 46 had 200 participants or less; 61 were single-center; and 44
were retrospective cohorts. The most used definition of CAV using
angiography was the detection of any degree of abnormality (21 studies of
58). In studies using IVUS, an intimal thickness >=0.5mm was the most used
definition (five of eight studies). Quality assessment revealed an
inadequate description of patient selection, attrition, and accounting of
potential confounders. Donor age, recipient age, recipient gender,
etiology of heart failure, ischemic time, human leukocyte antigen
matching, cytomegalovirus, lipid profile, and rejection episodes were the
most studied factors. Our review indicates that the current evidence is
not consistent across different studies. The definite contribution of risk
factors for the development of CAV is still to be determined. 2011 John
Wiley & Sons A/S.
<11>
Accession Number
2012219290
Authors
Lamy A. Devereaux P.J. Prabhakaran D. Taggart D.P. Hu S. Paolasso E.
Straka Z. Piegas L.S. Akar A.R. Jain A.R. Noiseux N. Padmanabhan C.
Bahamondes J.-C. Novick R.J. Vaijyanath P. Reddy S. Tao L.
Olavegogeascoechea P.A. Airan B. Sulling T.-A. Whitlock R.P. Ou Y. Ng J.
Chrolavicius S. Yusuf S.
Institution
(Lamy, Devereaux, Whitlock, Ou, Ng, Chrolavicius, Yusuf) Population Health
Research Institute, Hamilton Health Sciences, McMaster University,
Hamilton, ON L8L 2X2, Canada
(Novick) London Health Sciences Center, London, ON, Canada
(Prabhakaran) Centre for Chronic Disease Control, New Delhi, India
(Airan) All India Institute of Medical Sciences, New Delhi, India
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Padmanabhan) G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
(Vaijyanath) Dr. K.M. Cherian Heart Foundation, Chennai, India
(Reddy) Mediciti Hospitals, Hyderabad, India
(Taggart) University of Oxford, Oxford, United Kingdom
(Hu) Fu Wai Cardiovascular Hospital, Xicheng District, Beijing, China
(Paolasso) Instituto de Investigaciones Clinicas de Rosario, Rosario,
Argentina
(Straka) Third Faculty of Medicine, Charles University, Prague, Czech
Republic
(Piegas) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Akar) Ankara University School of Medicine, Ankara, Turkey
(Noiseux) Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
(Bahamondes) Hospital Regional Temuco, Temuco, Chile
(Tao) Frontier Lifeline, Wuhan Asia Heart Hospital, Wuhan, China
(Olavegogeascoechea) Fundacion Medica de Rio Negro Y Neuguen, Rio Negro,
Argentina
(Sulling) North Estonia Medical Center, Tallinn, Estonia
Title
Off-pump or on-pump coronary-artery bypass grafting at 30 days.
Source
New England Journal of Medicine. 366 (16) (pp 1489-1497), 2012. Date of
Publication: 19 Apr 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND:The relative benefits and risks of performing coronary-artery
bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as
compared with cardiopulmonary bypass (on-pump CABG), are not clearly
established. METHODS:At 79 centers in 19 countries, we randomly assigned
4752 patients in whom CABG was planned to undergo the procedure off-pump
or on-pump. The first coprimary outcome was a composite of death, nonfatal
stroke, nonfatal myocardial infarction, or new renal failure requiring
dialysis at 30 days after randomization. RESULTS:There was no significant
difference in the rate of the primary composite outcome between off-pump
and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group,
0.95; 95% confidence interval [CI], 0.79 to 1.14; P = 0.59) or in any of
its individual components. The use of off-pump CABG, as compared with
on-pump CABG, significantly reduced the rates of blood-product transfusion
(50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001),
reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk,
0.61; 95% CI, 0.40 to 0.93; P = 0.02), acute kidney injury (28.0% vs.
32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P = 0.01), and
respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI,
0.63 to 0.98; P = 0.03) but increased the rate of early repeat
revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to
12.0; P = 0.01). CONCLUSIONS:There was no significant difference between
off-pump and on-pump CABG with respect to the 30-day rate of death,
myocardial infarction, stroke, or renal failure requiring dialysis. The
use of off-pump CABG resulted in reduced rates of transfusion, reoperation
for perioperative bleeding, respiratory complications, and acute kidney
injury but also resulted in an increased risk of early revascularization.
(Funded by the Canadian Institutes of Health Research; CORONARY
ClinicalTrials.gov number, NCT00463294.). Copyright 2012 Massachusetts
Medical Society.
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