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<1>
Accession Number
2012281402
Authors
Alam M. Bandeali S.J. Virani S.S. Jneid H.M. Shahzad S.A. Ramanathan K.B.
Kar B. Kleiman N.S. Lakkis N.
Institution
(Alam, Ramanathan) Department of Medicine, Section of Cardiology,
University of Tennessee Health Sciences Center, 1030 Jefferson Avenue,
Memphis, TN 38104, United States
(Alam, Bandeali, Virani, Jneid, Ramanathan, Kar, Lakkis) Department of
Medicine, Sections of Internal Medicine and Cardiovascular Diseases,
Baylor College of Medicine, Houston, TX, United States
(Kleiman) Methodist DeBakey Heart and Vascular Center, Methodist Hospital,
Houston, TX, United States
(Virani) Health Services Research and Development, Center of Excell1ence,
Michael E. DeBakey VA Medical Center, Huston, TX, United States
(Virani, Shahzad, Kar) Department of Medicine, Section of Critical Care,
Al Noor Specialty Hospital, Makkah, Saudi Arabia
Title
Clinical outcomes of percutaneous interventions in saphenous vein grafts
using drug-eluting stents compared to bare-metal stents: A comprehensive
meta-analysisof all randomized clinical trials.
Source
Clinical Cardiology. 35 (5) (pp 291-296), 2012. Date of Publication: May
2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: Clinical outcomes of percutaneous coronary intervention (PCI)
in patients with saphenous vein grafts (SVGs) remain poor despite the use
of drug-eluting stents (DES). There is a disparity in clinical outcomes in
SVG PCI based on various registries, and randomized clinical data remain
scant. We conducted a meta-analysis of all existing randomized controlled
trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs.
Hypothesis: PCI in patients with SVG disease using DES may reduce need for
repeat revascularization without an excess mortality when compared to BMS.
Methods: An aggregate data meta-analysis of clinical outcomes in RCTs
comparing PCI with DES vs BMS for SVGs reporting at least 12 months of
follow-up was performed. A literature search between Janurary 1, 2003 and
September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396).
Summary odds ratio (OR) and 95% confidence interval (CI) were calculated
using the random-effects model. The primary endpoint was all-cause
mortality. Secondary outcomes included nonfatal myocardial infarction
(MI), repeat revascularization, and major adverse cardiac events (MACE).
These outcomes were assessed in a cumulative fashion at 30 days, 18
months, and 36 months. Results: There were no intergroup differences in
baseline clinical and sociodemographic characteristics. At a median
follow-up of 25 months, patients in the DES and BMS group had similar
rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI:
0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with
DES had lower rates of repeat revascularization (OR: 0.40, 95% CI:
0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs
comparing clinical outcomes of PCI using DES vs BMS in patients with SVG
disease, use of DES was associated with a reduction in rate of repeat
revascularization and no difference in rates of all-cause death and MI.
2012 Wiley Periodicals, Inc.

<2>
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Accession Number
2012265414
Authors
Hakim S.M. Othman A.I. Naoum D.O.
Institution
(Hakim) Department of Anesthesiology, Faculty of Medicine, Ain Shams
University, 15 Gamal Nooh Street, Almaza, 11341 Cairo, Egypt
(Othman) Department of Cardiothoracic Surgery, Faculty of Medicine, Ain
Shams University, Egypt
(Naoum) Department of Neuropsychiatry, Ain Shams University Hospitals,
Egypt
Title
Early treatment with risperidone for subsyndromal delirium after on-pump
cardiac surgery in the elderly: A randomized trial.
Source
Anesthesiology. 116 (5) (pp 987-997), 2012. Date of Publication: May 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: The aim of this randomized, parallel-arm trial was to study
the effect of treating subsyndromal delirium with risperidone on the
incidence of clinical delirium in elderly patients who underwent on-pump
cardiac surgery. Methods: One hundred one patients aged 65 yr or older who
experienced subsyndromal delirium after on-pump cardiac surgery were
randomized using a computer-generated list to receive 0.5 mg risperidone
(n = 51) or placebo (n = 50) every 12 h by mouth. Patients were assessed
at 8 h by a blinded observer using the Intensive Care Delirium Screening
Checklist, and those scoring more than 3 were evaluated by a blinded
psychiatrist to confirm delirium. Patients in either group who experienced
delirium were treated according to the same algorithm. Initially,
risperidone was administered and if symptoms were not controlled,
haloperidol was administered. The primary outcome was the proportion of
patients who experienced delirium in either group. Results: Seven (13.7%)
patients in the risperidone group experienced delirium versus 17 (34%) in
the placebo group (P = 0.031) Competing-risks regression analysis showed
that failure to treat subsyndromal delirium with risperidone was an
independent risk factor for delirium (subhazard ratio, 3.83; 95% CI,
1.63-8.98; P = 0.002). Two (3.9%) patients in the risperidone group
experienced extrapyramidal manifestations versus one (2%) in the placebo
group (P = 1.0). Conclusion: Administration of risperidone to elderly
patients who experienced subsyndromal delirium after on-pump cardiac
surgery was associated with significantly lower incidence of delirium.
Larger studies are required to determine whether early administration of
risperidone during the subsyndromal phase of delirium would influence the
clinical course of such patients. 2012, the American Society of
Anesthesiologists, Inc. Lippincott Williams & Wilkins.

<3>
Accession Number
2012276501
Authors
Zangrillo A. Cabrini L. Biondi-Zoccai G.G.L. Monti G. Turi S. Sheiban I.
Bignami E. Landoni G.
Institution
(Zangrillo, Cabrini, Monti, Turi, Sheiban, Bignami, Landoni) Department of
Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Via
Olgettina 60, Milano, 20132, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
Universita di Torino, Torino, Italy
Title
Continuous infusion versus bolus injection of furosemide in pediatric
patients after cardiac surgery: A meta-analysis of randomized studies.
Source
Signa Vitae. 7 (1) (pp 17-22), 2012. Date of Publication: 2012.
Publisher
Pharmamed Mado Ltd (Zatisje 8 g, Zabreb 10000, Croatia)
Abstract
Introduction. Acute renal failure and fluid retention are common problems
in pediatric patients after cardiac surgery. Furosemide, a loop diuretic
drug, is frequently administered to increase urinary output. The aim of
the present study was to compare efficacy and complications of continuous
infusion of furosemide vs bolus injection among pediatric patients after
cardiac surgery. Methods. A systematic review and meta-analysis was
performed in compliance with The Cochrane Collaboration and the Quality of
Reporting of Meta-Analysis (QUORUM) guidelines. The following inclusion
criteria were employed for potentially relevant studies: a) random
treatment allocation, b) comparison of furosemide bolus vs continuous
infusion, c) surgical or intensive care pediatric patients. Non-parallel
design randomized trials (e.g. cross-over), duplicate publications and
non-human experimental studies were excluded. Results. Up to August 2008,
only three studies were found, with 92 patients randomized (50 to
continuous infusion and 42 to bolus treatment). Overall analysis showed
that continuous infusion and bolus administration were equally effective
in achieving the predefined urinary output, and were associated with a
similar amount of administered furosemide (WMD=- 1.71 mg/kg/day [-5.20;
+1.78], p for effect=0.34, p for heterogeneity<0.001, I2=99.0). However,
in the continuous infusion group, patients had a significantly reduced
urinary output (WMD=-0.48 ml/kg/day [-0.88; -0.08], p for effect=0.02, p
for heterogeneity <0.70, I2=0%). Conclusions. Existing data comparing
furosemide bolus injection with a continuous infusion are insufficient to
confidently assess the best way to administer furosemide to pediatric
patients after cardiac surgery. Larger studies are needed before any
recommendations can be made.

<4>
Accession Number
2012276453
Authors
de Leon N. Jackevicius C.A.
Institution
(de Leon, Jackevicius) College of Pharmacy, Western University of Health
Sciences, Pomona, CA, United States
(Jackevicius) Clinical Pharmacy Specialist, Cardiology, Veterans Affairs
Greater Los Angeles Healthcare System, United States
(Jackevicius) Pharmacy Department, University Health Network-Toronto
General Hospital, Toronto, ON, Canada
(Jackevicius) Department of Health Policy, Management and Evaluation,
Faculty of Medicine, University of Toronto, Canada
Title
Use of Aspirin and Clopidogrel After Coronary Artery Bypass Graft Surgery.
Source
Annals of Pharmacotherapy. 46 (5) (pp 678-687), 2012. Date of Publication:
May 2012.
Publisher
Harvey Whitney Books Company (8044 Montgomery Road, Suite 415, Cincinnati
OH 45236, United States)
Abstract
OBJECTIVE: To evaluate the evidence for the use of dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel following coronary artery
bypass graft (CABG) surgery. DATA SOURCES: Literature was accessed through
PubMed (1950-November 2011), EMBASE (1976-November 2011), and the Cochrane
databases using the terms clopidogrel and coronary artery bypass graft.
Citations from available articles were used for additional references and
ClinicalTrials.gov was accessed for abstracts of ongoing studies. STUDY
SELECTION AND DATA EXTRACTION: Peer-reviewed studies that evaluated DAPT
use after CABG surgery in adult humans were assessed for inclusion. DATA
SYNTHESIS: Four randomized clinical trials evaluating surrogate end points
and 9 studies (3 subgroup analyses, 6 observational) evaluating clinical
outcomes were reviewed. Three clinical trials assessing surrogate end
points failed to demonstrate an improvement in graft patency with DAPT
use, while 1 clinical trial found an increase in graft patency. As for
clinical outcomes, 1 subgroup analysis demonstrated that the benefit of
DAPT post-CABG after a non-ST-elevation acute coronary syndrome diminished
following surgery, while an observational study demonstrated a trend
toward decreased mortality. In post-CABG patients who did not experience
acute coronary syndrome, 2 subgroup analyses proved inconclusive and an
observational study found DAPT use to be associated with reducing
in-hospital mortality, while another observational study was not
associated with reduced long-term mortality. Three observational studies
in off-pump CABG patients showed that DAPT use was feasible. CONCLUSIONS:
Evidence for DAPT use following CABG is limited to subgroup analyses,
observational studies, and trials with surrogate end points. The majority
of clinical trials have failed to demonstrate an improvement in graft
patency with DAPT. Current evidence does not support the use of DAPT to
improve graft patency, and more evidence from randomized controlled trials
assessing clinical outcomes is necessary to make definitive
recommendations.

<5>
Accession Number
2012270081
Authors
Hassani E. Mahoori A. Mehdizadeh H. Noroozinia H. Aghdashi M.M. Saeidi M.
Institution
(Hassani, Mahoori, Noroozinia, Aghdashi, Saeidi) Department of
Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences,
Urmia, Iran, Islamic Republic of
(Mehdizadeh) Department of Surgery, Faculty of Medicine, Urmia University
of Medical Sciences, Urmia, Iran, Islamic Republic of
Title
The effects of tranexamic acid on postoperative bleeding in coronary
artery bypass graft surgery.
Source
Tehran University Medical Journal. 70 (3) (pp 176-182), 2012. Date of
Publication: June 2012.
Publisher
Tehran University of Medical Sciences (202 Amouzesh Building, Poursina
Ave., Ghods St, Keshavarz Blvd, Tehran, Iran, Islamic Republic of)
Abstract
Background: Perioperative administration of tranexamic acid (TA),
decreases bleeding and the need for transfusion after cardiac procedures.
Hence, the results may vary in different clinical settings and the most
appropriate timing to get the best results is unclear. The primary
objectives of the present study were to determine the efficacy of TA in
decreasing chest tube drainage, the need for perioperative allogeneic
transfusions and the best timing for TA administration following primary,
elective, coronary artery bypass grafting (CABG) in patients with a low
baseline risk of postoperative bleeding. Methods: In this double-blind,
prospective, placebo-controlled clinical trial in Seiedoshohada Hospital
during 2011-2012, we evaluated 150 patients scheduled for elective,
primary coronary revascularization. They were randomly divided into three
groups. Group B received tranexamic 10 mg/kg prior to, Group A received
tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received
an equivalent volume of saline solution. Blood requirement and
postoperative chest tube drainage were recorded. Results: The placebo
group (group C) had a greater postoperative blood loss 12 h after surgery
(501+/-288 vs. 395+/-184 in group B and 353+/-181 mL in group A, P=0.004).
The placebo group also had greater postoperative total blood loss
(800+/-347 vs. 614+/-276 in group B and 577+/-228 mL in group A, P=0.001).
There was a significant increase in allogeneic blood requirement in the
placebo group (P=0.001). Conclusion: For elective, first time coronary
artery bypass surgery, a single dose of tranexamic acid before or after
cardiopulmonary bypass is equally effective.

<6>
Accession Number
2012260768
Authors
Geukers V.G. Li Z. Ackermans M.T. Bos A.P. Jinfeng L. Sauerwein H.P.
Institution
(Geukers, Bos) Pediatric Intensive Care Department, Emma Children's
Hospital, Academic Medical Center, Amsterdam, Netherlands
(Li) Cardiac Intensive Care Unit, Shanghai Children's Medical Center,
Shanghai Second Medical University, Shanghai, China
(Ackermans) Department of Clinical Chemistry, Endocrinology Laboratory,
Academic Medical Center, Amsterdam, Netherlands
(Jinfeng) Department of Thoracic and Cardiovascular Surgery, Shanghai
Second Medical University, Shanghai, China
(Sauerwein) Department of Endocrinology and Metabolism, Academic Medical
Center, Amsterdam, Netherlands
(Sauerwein) Department of Endocrinology and Metabolism, Maastricht
University Hospital, Maastricht, Netherlands
Title
High-carbohydrate/low-protein-induced hyperinsulinemia does not improve
protein balance in children after cardiac surgery.
Source
Nutrition. 28 (6) (pp 644-650), 2012. Date of Publication: June 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objective: In pediatric cardiac surgery, fluid-restricted low-protein
(LoProt) diets account for cumulative protein deficits with increased
morbidity. In this setting, we aimed to inhibit proteolysis by a
high-carbohydrate (HiCarb)-intake-induced hyperinsulinemia and improve
protein balance. Methods: The effect of a HiCarb/LoProt (glucose 10 mg
kg^-1 min^-1/protein 0.7 g kg^-1
d^-1) versus a normal-carbohydrate (NormCarb)/LoProt (glucose
7.5 mg kg^-1 min^-1/protein 0.3 g kg^-1
d^-1) enteral diet on whole-body protein breakdown and balance
was compared in a prospective, randomized, single-blinded trial in 24
children after cardiac surgery. On the second postoperative day, plasma
insulin and amino acid concentrations, protein breakdown (endogenous rate
of appearance of valine), protein synthesis (non-oxidative disposal of
valine), protein balance, and the rate of appearance of urea were measured
by using an isotopic infusion of [1-¹³C]valine and
[¹⁵N₂]urea. Results: The HiCarb/LoProt diet led to a
serum insulin concentration that was three times higher than the
NormCarb/LoProt diet (596 pmol/L, 80-1833, and 198 pmol/L, 76-1292,
respectively, P = 0.02), without differences in plasma glucose
concentrations. There were no differences in plasma amino acid
concentrations, non-oxidative disposal of valine, and endogenous rate of
appearance of valine between the groups, with a negative valine balance in
the two groups (-0.65 mumol kg^-1 min^-1, -1.91 to
0.01, and -0.58 mumol kg^-1 min^-1, -2.32 to -0.07,
respectively, P = 0.71). The serum cortisol concentration in the
HiCarb/LoProt group was lower compared with the NormCarb/LoProt group (204
nmol/L, 50-544, and 532 nmol/L, 108-930, respectively, P = 0.02).
Conclusion: In children with fluid restriction after cardiac surgery, a
HiCarb/LoProt diet compared with a NormCarb/LoProt diet stimulates insulin
secretion but does not inhibit proteolysis further and therefore cannot be
advocated for this purpose. 2012 Elsevier Inc.

<7>
Accession Number
2012266361
Authors
Abdel Razek A.A.K. Soliman N. Elashery R.
Institution
(Abdel Razek, Soliman) Diagnostic Radiology Department, Mansoura Faculty
of Medicine, Mansoura, Egypt
(Elashery) Pediatric Oncology Department, Mansoura Faculty of Medicine,
Mansoura, Egypt
Title
Apparent diffusion coefficient values of mediastinal masses in children.
Source
European Journal of Radiology. 81 (6) (pp 1311-1314), 2012. Date of
Publication: June 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: Compare apparent diffusion coefficient (ADC) values between
benign and malignant mass lesions in a cohort of children referred for
imaging of a mediastinal mass. Material and methods: Prospective study
including 24 consecutive children (11 boys, 13 girls aged 5 months to 16
years). All underwent echo planar diffusion weighted MR imaging of the
mediastinum with b-factors of 0 and 600 s/mm². Apparent
diffusion coefficient (ADC) values were calculated and correlated with the
surgical finding or biopsy. Results: The mean ADC value of malignant
mediastinal tumors was 0.91 (S.D., 0.17) x10^-3 mm²/s
and of benign lesions 1.8 (S.D., 0.33) x10^-3 mm²/s.
There was significant different in the ADC value between malignant tumors
and benign mediastinal tumors (P < 0.001). Selection of 1.2 x
10^-3 mm²/s as a threshold value for differentiating
malignant from benign mediastinal masses has an accuracy of 93%,
sensitivity of 92%, specificity of 94%, positive predictive value of 94%,
negative predictive value of 92% and area under the curve of 0.962.
Conclusion: Apparent diffusion coefficient value is a promising
non-invasive parameter for assessment of mediastinal mass in children.
Copyright 2011 Published by Elsevier Ireland Ltd. All rights reserved.

<8>
Accession Number
2012273544
Authors
Garg A.X. Devereaux P.J. Yusuf S. Cuerden M.S. Parikh C.R. Coca S.G. Walsh
M. Cook R.J. Whitlock R.P. Noiseux N. Novick R.J. Ou Y. Lamy A.
Institution
(Garg, Cuerden) Division of Nephrology, Department of Medicine, Western
University, London, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
(Garg, Devereaux, Yusuf, Walsh, Whitlock, Lamy) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Devereaux, Yusuf, Walsh, Whitlock, Ou, Lamy) Population Health Research
Institute, Hamilton, ON, Canada
(Cuerden, Cook) Department of Statistics and Actuarial Science, University
of Waterloo, Waterloo, ON, Canada
(Parikh, Coca) Section of Nephrology, Yale University School of Medicine,
New Haven, United States
(Whitlock, Lamy) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Noiseux) Department of Cardiac Surgery, Universite de Montreal, Montreal,
QC, Canada
(Novick) Division of Cardiac Surgery, Western University, London, ON,
Canada
Title
Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularisation
Study (CORONARY): Kidney substudy analytic protocol of an international
randomised controlled trial.
Source
BMJ Open. 2 (2) , 2012. Date of Publication: 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Introduction: CORONARY is a large international randomised controlled
trial comparing coronary artery bypass graft (CABG) surgery done with and
without a bypass pump. Compared with on-pump, off-pump surgery may prevent
acute kidney injury (AKI) in the short term and may better preserve kidney
function 1 year following surgery. Secondary analyses may also clarify
whether effects are similar in patients with and without pre-operative
chronic kidney disease and whether AKI avoidance mediates preserved 1-year
kidney function. Methods and analysis: With respect to the study schedule,
the last of 4752 patients from 79 sites in 19 countries were randomised in
November 2011 to cardiac surgery performed with an on-pump or off-pump
procedure. The authors will use regression models to compare the groups in
the outcome of peri-operative AKI (per cent change in serum creatinine,
>=50% increase in serum creatinine) and 1-year kidney function (per cent
change in estimated glomerular filtration rate (eGFR), >=20% eGFR loss 1
year after surgery). The authors will use interaction terms in regression
models to determine if there is a differential impact of the intervention
in those with and without pre-existing chronic kidney disease. The authors
will use regression-based tests to determine the proportion of the total
effect of surgery type (off-pump vs on-pump CABG) on 1-year eGFR that is
mediated by peri-operative AKI. Ethics and dissemination: In the year
2009, the authors were competitively awarded a grant from the Canadian
Institutes of Health Research to answer these kidney questions in
CORONARY. Ethics approval was obtained for additional renal data
collection in centres that agreed to study participation (>90% of
participating centres). This collection began for patients enrolled after
1 January 2010. Remaining 1-year renal outcome data will be collected
throughout 2012. Results will be reported in 2013. Clinical trial
registration number: NCT 00463294.

<9>
Accession Number
2012262724
Authors
Aversano T. Lemmon C.C. Liu L.
Institution
(Aversano, Lemmon) Johns Hopkins University, Baltimore, United States
(Liu) Clinical Trials and Surveys, Owings Mills, MD, United States
Title
Outcomes of PCI at hospitals with or without on-site cardiac surgery.
Source
New England Journal of Medicine. 366 (19) (pp 1792-1802), 2012. Date of
Publication: 10 May 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Performance of percutaneous coronary intervention (PCI) is
usually restricted to hospitals with cardiac surgery on site. We conducted
a noninferiority trial to compare the outcomes of PCI performed at
hospitals without and those with on-site cardiac surgery. METHODS:We
randomly assigned participants to undergo PCI at a hospital with or
without on-site cardiac surgery. Patients requiring primary PCI were
excluded. The trial had two primary end points: 6-week mortality and
9-month incidence of major adverse cardiac events (the composite of death,
Q-wave myocardial infarction, or target-vessel revascularization).
Noninferiority margins for the risk difference were 0.4 percentage points
for mortality at 6 weeks and 1.8 percentage points for major adverse
cardiac events at 9 months. RESULTS:A total of 18,867 patients were
randomly assigned in a 3:1 ratio to undergo PCI at a hospital without
on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery
(4718 patients). The 6-week mortality rate was 0.9% at hospitals without
on-site surgery versus 1.0% at those with on-site surgery (difference,
-0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P =
0.004 for noninferiority). The 9-month rates of major adverse cardiac
events were 12.1% and 11.2% at hospitals without and those with on-site
surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to
1.80; P = 0.05 for noninferiority). The rate of target-vessel
revascularization was higher in hospitals without on-site surgery (6.5%
vs. 5.4%, P = 0.01). CONCLUSIONS: We found that PCI performed at hospitals
without on-site cardiac surgery was non-inferior to PCI performed at
hospitals with on-site cardiac surgery with respect to mortality at 6
weeks and major adverse cardiac events at 9 months. (Funded by the
Cardiovascular Patient Outcomes Research Team [C-PORT] participating
sites; ClinicalTrials.gov number, NCT00549796.) Copyright 2012
Massachusetts Medical Society.

<10>
Accession Number
2012253315
Authors
Young P.J. Dalley P. Garden A. Horrocks C. La Flamme A. Mahon B. Miller J.
Pilcher J. Weatherall M. Williams J. Young W. Beasley R.
Institution
(Young, Dalley, Garden, Horrocks, Mahon, Young, Beasley) Wellington
Hospital, Capital and Coast District Health Board, Private Bag 7902,
Wellington 6242, New Zealand
(Young, Pilcher, Weatherall, Beasley) Medical Research Institute of New
Zealand, Private Bag 7902, Wellington 6242, New Zealand
(Garden, La Flamme, Miller, Williams, Beasley) School of Biological
Sciences, Victoria University of Wellington, PO Box 600, Wellington 6140,
New Zealand
(Weatherall) University of Otago, Wellington, PO Box 7343, Wellington
South, Wellington 6021, New Zealand
Title
A pilot study investigating the effects of remote ischemic preconditioning
in high-risk cardiac surgery using a randomized controlled double-blind
protocol.
Source
Basic Research in Cardiology. 107 (3) , 2012. Article Number: 0256. Date
of Publication: 2012.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
The efficacy of remote ischemic preconditioning (RIPC) in high-risk
cardiac surgery is uncertain. In this study, 96 adults undergoing
high-risk cardiac surgery were randomised to RIPC (3 cycles of 5 min of
upper-limb ischemia induced by inflating a blood pressure cuff to 200 mmHg
with 5 min of reperfusion) or control. Main endpoints were plasma
high-sensitivity troponin T (hsTNT) levels at 6 and 12 h, worst
post-operative acute kidney injury (AKI) based on RIFLE criteria, and
noradrenaline duration. hsTNT levels were log-normally distributed and
higher with RIPC than control at 6-h post cross-clamp removal [810 ng/ml
(IQR 527-1,724) vs. 634 ng/ml (429-1,012); ratio of means 1.41 (99.17% CI
0.92-2.17); P=0.04] and 12 h [742 ng/ml (IQR 427-1,700) vs. 514 ng/ml (IQR
356-833); ratio of means 1.56 (99.17% CI 0.97-2.53); P=0.01]. After
adjustment for baseline confounders, the ratio of means of hsTNT at 6 h
was 1.23 (99.17% CI 0.88-1.72; P=0.10) and at 12 h was 1.30 (99.17%CI
0.92-1.84; P=0.05). In the RIPC group, 35/48 (72.9%) had no AKI, 5/48
(10.4%) had AKI risk, and 8/48 (16.7%) had either renal injury or failure
compared to the control group where 34/48 (70.8%) had noAKI, 7/48 (14.6%)
hadAKI risk, and 7/48 (14.6%) had renal injury or failure (Chi-squared
0.41; two degrees of freedom; P = 0.82). RIPC increased post-operative
duration of noradrenaline support [21 h (IQR 7-45) vs. 9 h (IQR 3-19);
ratio of means 1.70 (99.17% CI 0.86-3.34); P=0.04]. RIPC does not reduce
hsTNT, AKI, or ICU-support requirements in high-risk cardiac surgery.
2012 Springer-Verlag.

<11>
Accession Number
2012268810
Authors
Hausenloy D.J. Candilio L. Laing C. Kunst G. Pepper J. Kolvekar S. Evans
R. Robertson S. Knight R. Ariti C. Clayton T. Yellon D.M.
Institution
(Hausenloy, Candilio, Yellon) Hatter Cardiovascular Institute, University
College London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Laing) Royal Free Hospital, London, United Kingdom
(Kunst) Kings College London, London, United Kingdom
(Pepper) Royal Brompton Hospital, London, United Kingdom
(Kolvekar) Heart Hospital, University College London Hospitals, London,
United Kingdom
(Evans, Robertson, Knight, Ariti, Clayton) Clinical Trials Unit, London
School of Hygiene and Tropical Medicine, London, United Kingdom
Title
Effect of remote ischemic preconditioning on clinical outcomes in patients
undergoing coronary artery bypass graft surgery (ERICCA): Rationale and
study design of a multi-centre randomized double-blinded controlled
clinical trial.
Source
Clinical Research in Cardiology. 101 (5) (pp 339-348), 2012. Date of
Publication: May 2012.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background: Novel cardioprotective strategies are required to improve
clinical outcomes in high risk patients undergoing coronary artery bypass
graft (CABG) +/- valve surgery. Remote ischemic preconditioning (RIC), in
which brief episodes of non-lethal ischemia and reperfusion are applied to
the arm or leg, has been demonstrated to reduce perioperative myocardial
injury following CABG +/- valve surgery. Whether RIC can improve clinical
outcomes in this setting is unknown and is investigated in the effect of
remote ischemic preconditioning on clinical outcomes (ERICCA) trial in
patients undergoing CABG surgery. (ClinicalTrials.gov Identifier:
NCT01247545). Methods: The ERICCA trial is a multicentre randomized
double-blinded controlled clinical trial which will recruit 1,610
high-risk patients (Additive Euroscore >= 5) undergoing CABG +/- valve
surgery using blood cardioplegia via 27 tertiary centres over 2 years. The
primary combined endpoint will be cardiovascular death, non-fatal
myocardial infarction, coronary revascularization and stroke at 1 year.
Secondary endpoints will include peri-operative myocardial and acute
kidney injury, intensive care unit and hospital stay, inotrope score, left
ventricular ejection fraction, changes of quality of life and exercise
tolerance. Patients will be randomized to receive after induction of
anesthesia either RIC (4 cycles of 5 min inflation to 200 mmHg and 5 min
deflation of a blood pressure cuff placed on the upper arm) or sham RIC (4
cycles of simulated inflations and deflations of the blood pressure cuff).
Implications: The findings from the ERICCA trial have the potential to
demonstrate that RIC, a simple, non-invasive and virtually cost-free
intervention, can improve clinical outcomes in higher-risk patients
undergoing CABG +/- valve surgery. Springer-Verlag 2011.

<12>
Accession Number
2012268805
Authors
Zeymer U. Arntz H.-R. Mark B. Fichtlscherer S. Werner G. Scholler R. Zahn
R. Diller F. Darius H. Dill T. Huber K.
Institution
(Zeymer, Mark, Zahn) Klinikum Ludwigshafen, Medizinische Klinik B,
Ludwigshafen, Germany
(Zeymer, Diller) Institut fur Herzinfarktforschung Ludwigshafen,
Universitat Heidelberg, Bremserstr. 79, 67063 Ludwigshafen am Rhein,
Germany
(Arntz) Medizinische Klinik II, Charite Campus Benjamin Franklin, Berlin,
Germany
(Fichtlscherer) Universitatsklinikum, Frankfurt/Main, Germany
(Werner) Klinikum Darmstadt, Hessen, Germany
(Scholler) DRK-Klinikum Westend, Berlin, Germany
(Darius) Vivantes Klinikum Neukolln, Berlin, Germany
(Dill) Sana Krankenhaus Benrath, Dusseldorf, Germany
(Huber) Cardiology and Emergency Medicine, 3rd Medical Department,
Wilhelminenspital, Vienna, Austria
Title
Efficacy and safety of a high loading dose of clopidogrel administered
prehospitally to improve primary percutaneous coronary intervention in
acute myocardial infarction: The randomized CIPAMI trial.
Source
Clinical Research in Cardiology. 101 (4) (pp 305-312), 2012. Date of
Publication: April 2012.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Objectives: To compare a loading dose of 600 mg clopidogrel given in the
prehospital phase versus clopidogrel administered only after the
diagnostic angiogram in patients with STEMI scheduled for primary PCI.
Background The optimal time and dose for the initiation of clopidogrel
therapy in patients with STEMI scheduled for primary PCI has not been
studied in prospective randomized trials. Methods: The primary efficacy
endpoint was the TIMI 2/3 patency of the infarct-related artery in the
diagnostic angiography immediately prior to PCI. Results: We randomized
337 patients to prehospital (n = 166) loading dose versus standard therapy
(n = 171). The time interval between initiation of clopidogrel therapy and
diagnostic angiography was 47 min. TIMI 2/3 patency before PCI was not
different between the groups (49.3 vs. 45.1%, P = 0.5). We observed a
trend towards a reduction of the combined endpoint death, re-infarction,
and urgent target vessel revascularization in the prehospital-treated
patients (3.0 vs. 7.0%, P = 0.09), this difference was significant if
patients were classified as treated (4/161 vs. 13/174; 2.5 vs. 7.5%,
P<0.05). There was no difference in TIMI major bleeding complications (9.1
vs. 8.2%, P = 0.8). Conclusions: Early inhibition of the platelet
ADP-receptor with a high loading dose of 600 mg clopidogrel given in the
prehospital phase in patients with STEMI scheduled for primary PCI is
safe, did not increase pre-PCI patency of the infarct vessel, but was
associated with a trend towards a reduction in clinical events.
Springer-Verlag 2011.

<13>
[Use Link to view the full text]
Accession Number
2012268310
Authors
Wakabayashi K. Waksman R. Weissman N.J.
Institution
(Wakabayashi, Waksman, Weissman) Washington Hospital Center, 100 Irving
Street, Washington DC 20010, United States
Title
Edge effect from drug-eluting stents as assessed with serial intravascular
ultrasound: A systematic review.
Source
Circulation: Cardiovascular Interventions. 5 (2) (pp 305-311), 2012. Date
of Publication: April 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<14>
[Use Link to view the full text]
Accession Number
2012268299
Authors
Wakabayashi K. Mintz G.S. Weissman N.J. Stone G.W. Ellis S.G. Grube E.
Ormiston J.A. Turco M.A. Pakala R. Xue Z. Desale S. Laynez-Carnicero A.
Romaguera R. Sardi G. Pichard A.D. Waksman R.
Institution
(Wakabayashi, Weissman, Pakala, Xue, Desale, Laynez-Carnicero, Romaguera,
Sardi, Pichard, Waksman) Washington Hospital Center, 110 Irving Street,
Washington, DC 20010, United States
(Mintz, Stone) Cardiovascular Research Foundation, Columbia University,
Medical Center, New York, NY, United States
(Ellis) Cleveland Clinic (S.G.E.), Cleveland, OH, United States
(Grube) University Hospital Bonn, Bonn, Germany
(Ormiston) North Shore Hospital, Auckland, New Zealand
(Turco) Washington Adventist Hospital, Takoma Park, MD, United States
Title
Impact of drug-eluting stents on distal vessels.
Source
Circulation: Cardiovascular Interventions. 5 (2) (pp 211-219), 2012. Date
of Publication: April 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Previous studies have not addressed vessel response >5 mm
distal to the stent edge. Therefore, we investigated the impact of
paclitaxel-eluting stents (PES) versus bare metal stents (BMS) on distal
vessels in the serial intravascular ultrasound substudies of TAXUS IV, V,
and VI. Methods and Results-TAXUS IV, V, and VI were double-blind,
randomized, multicenter, controlled trials comparing PES with BMS. In
their intravascular ultrasound substudies, 103 patients (54 BMS, 49 PES)
had intravascular ultrasound data >=10 mm distal to the stent both
postprocedure and at 9 months follow-up. Baseline characteristics were
similar between the 2 groups. Multilevel modeling was used to account for
the variation between patients and within patients among distal segments.
Effect of stent type, time, and their interaction was tested using a mixed
effect model controlling for distal segments. Postprocedure lumen and
vessel were not significantly different between PES versus BMS; however,
lumen (P=0.006) and vessel (P=0.0001) were significantly reduced for BMS
at 9-month follow-up but not for PES. Conversely, there was a significant
plaque increase from postprocedure to 9-month follow-up for PES (P=0.0008)
but not for BMS. These vessel responses were statistically consistent
among 0- to 5-mm versus 5- to 10-mm versus 10- to 15-mm segments distal to
the stent in both groups. Conclusions-PES use was associated with plaque
increase from baseline to 9-month follow-up >5 mm distal to the stent
along with positive remodeling, whereas BMS use was associated with
negative remodeling and no plaque increase. These vessel responses were
consistent in 5-mm long subsegments: 0 to 5 mm versus 5 to 10 mm versus 10
to 15 mm distal to the stent. Clinical Trial Registration-URL:
http://www.clinicaltrial.gov. Unique identifiers: TAXUS IV-NCT00292474;
TAXUS V-NCT00301522; TAXUS VI-NCT00297804. 2012 American Heart
Association, Inc.

<15>
Accession Number
70744877
Authors
Alam M. Huang H. Rogers P. Paniagua D. Kar B. Ramanathan K. Kleiman N.
Jneid H.
Institution
(Alam) University of Tennessee Health Science Center Memphis TN, Memphis,
TN, United States
(Alam, Ramanathan) University of Tennessee Health Sciences Center, Memphis
VA Medical Center, Memphis, TN, United States
(Huang, Rogers) Baylor College of Medicine, Houston, TX, United States
(Paniagua, Kar, Jneid) Baylor College of Medicine, Michael E. DeBakey
Veterans Affair Medical Center, Houston, TX, United States
(Kleiman) Methodist Debakey Heart and Vascular Center, Houston, TX, United
States
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass graft surgery for unprotected left main coronary
artery stenosis: Evaluation of long term clinical outcomes.
Source
Catheterization and Cardiovascular Interventions. Conference: 35th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI Las Vegas, NV United States. Conference Start: 20120509
Conference End: 20120512. Conference Publication: (var.pagings). 79 (pp
S48-S49), 2012. Date of Publication: 01 May 2012.
Publisher
Wiley-Liss Inc.
Abstract
Background: PCI with drug eluting stents(DES) is progressively adopted as
a revascularization strategy for unprotected left main (Table presented)
coronary artery disease(ULMCA) . Long-term outcomes data of PCI vs. CABG
in ULMCA disease are largely lacking. Methods: We performed meta-analyses
of all studies reporting at least 36 months follow-up of PCI(DES) compared
to CABG in patients with ULMCA disease. A search of Medline & conference
proceedings from 01/01/2003 - 12/01/2011 identified 11 studies enrolling
4,936 patients(PCI = 2,151 & CABG = 2,785). These studies reported the
longest follow-up periods up to 48 and 60 months from randomized clinical
trials and registries, respectively. Clinical endpoints of interest
include all cause death, MACCE, non-fatal MI, repeat revascularization,
stroke and the composite safety endpoint(death, MI & stroke). Metaanalyses
were performed using Review Manager 5.1(Cochrane Collaboration) & summary
odds ratios & 95% confidence intervals were calculated( random-effects
model). Results: Patients in the PCI and CABG arm had similar baseline
characteristics. Compared with CABG, the PCI group had shorter hospital
stay(6.2+/-1.2 vs. 15.2+/-2.4 days,p<0.001). At a maximum follow-up of 60
months, patients in PCI group had lower rates of stroke (OR = 0.35, 95% CI
0.20-0.63), lower composite safety endpoint (OR = 0.73, 95% CI 0.57-0.93),
& similar rates of death (OR = 0.82, 95% CI 0.68- 1.00) and non-fatal MI
(OR = 1.42, 95% CI 0.76-2.67) compared with CABG. PCI group experienced an
increased risk of MACCE (OR 1.38, 95% CI 1.15-1.66) driven primarily by
higher rates of repeat revascularization (OR 3.47; 95% CI = 2.40-5.02)
(Table-1). Conclusion: At a maximum follow-up of 60 months, PCI with DES
for ULMCA disease was associated with lower rates of stroke & composite of
death, MI and stroke, but higher rates of MACCE and repeat
revascularization. Patients undergoing PCI and CABG sustained comparable
rates of all-cause death and non-fatal MI.

<16>
Accession Number
70739976
Authors
Weijie C.
Institution
(Weijie) Second Affiliated Hospital, Chongqing Medical University, China
Title
The effect of statins on prevention and therapy of atrial fibrillation: A
metaanalysis of randomised controlled trials.
Source
Heart. Conference: 22nd Great Wall International Congress of Cardiology
and Asia Pacific Heart Congress 2011, GWICC and APHC Beijing China.
Conference Start: 20111013 Conference End: 20111016. Conference
Publication: (var.pagings). 97 (pp A169-A170), 2011. Date of Publication:
October 2011.
Publisher
BMJ Publishing Group
Abstract
Objective To investigate the effect of statins on prevention and therapy
of atrial fibrillation. Method The authors searched the electronic
databases from inception to 14 April 2011 for publicly published
randomised controlled trials evaluating the effect of statins on
prevention and therapy of atrial fibrillation. The quality of trials were
evaluated by title and abstract of literature according to the eligibility
criteria. If the clinical RCTs conformed to the inclusive criteria without
the exclusive criteria items, they would be enrolled in this
meta-analysis. The authors conducted the meta-analysis of the data
collected from included studies with the software of review manager 5.1.
Results After searching of electronic databases and evaluating of the RCTs
according to the inclusive criteria and exclusive criteria, thirteen RCTs
with 4902 subjects were included in this meta-analysis. There were seven
high quality studies with Jadad scores of three to five points and six low
quality studies with Jadad scores of one to two points of the thirteen
included RCTs. As the results of heterogeneity test showed significant
heterogeneity, we chosen random effect model to analyse the data. The
meta-analysis of RCTs showed significant effect of statins on the
prevention and therapy of atrial fibrillation of patients who just
underwent the procedure of cardiac surgery (RR 0.53, 95% CI 0.41 to 0.57,
p<0.00001) and also for patients without history of cardiac surgery (RR
0.62, 95% CI 0.47 to 0.81, p=0.0006); The results also showed significant
effect of statins on prevention of new onset atrial fibrillation (RR 0.58,
95% CI 0.42 to 0.80, p=0.0009). The results showed significant effect of
statins on prevention and therapy of atrial fibrillation of patients who
were administered statins for short duration (3 weeks to 1 year) (RR 0.55,
95% CI 0.40 to 0.75, p=0.0002) and also for patients with long-term
therapy (more than 1 year) of statins (RR 0.63, 95% CI 0.46 to 0.84,
p=0.002); furthermore, the results of this meta-analysis also showed
positive effect of statins on the recurrence and progress of atrial
fibrillation (RR 0.56, 95% CI 0.38 to 0.81, p=0.002). However, sensitivity
analysis showed that the results of statins on the recurrence and progress
of atrial fibrillation were unreliable, which could be inversed by
excluding the low quality randomised controlled trials. Therefore the
effect of statins on the recurrence and progress of atrial fibrillation
was uncertain, which need more large scale RCTs to be detected. Conclusion
This meta-analysis of RCTs showed significant effect of statins on
prevention and therapy of atrial fibrillation of patients who had history
of cardiac surgery, and also showed significant effect of statins on
prevention of new onset of atrial fibrillation. Considering the results of
sensitivity analysis, however, the effect of statins on the recurrence and
progress of atrial fibrillation was uncertain, which require larger scale
RCTs for detection.

<17>
Accession Number
70739773
Authors
Zhiyu H. Lin Y. Jinhui T. Kehu Y. Julong W. Yali Y.
Institution
(Zhiyu, Jinhui, Kehu) Evidencebased Medicine Center, School of Basic
Medical Sciences, Lanzhou University, Lanzhou, China
(Lin) First Clinical Medical School, Lanzhou University, Lanzhou, China
(Julong) School of Basic Medical Sciences, Lanzhou University, Lanzhou,
China
(Yali) The First Hospital of Lanzhou University, First Clinical Medical
School, Lanzhou University, Lanzhou, China
Title
Efficacy and safety of -3 fatty acids for the prevention of atrial
fibrillation: A meta-analysis of randomised controlled trials.
Source
Heart. Conference: 22nd Great Wall International Congress of Cardiology
and Asia Pacific Heart Congress 2011, GWICC and APHC Beijing China.
Conference Start: 20111013 Conference End: 20111016. Conference
Publication: (var.pagings). 97 (pp A100), 2011. Date of Publication:
October 2011.
Publisher
BMJ Publishing Group
Abstract
Purpose The effects of -3 fatty acids (PUFA) on the prevention of atrial
fibrillation (AF) appear inconsistent in randomised controlled trials
(RCTs). Several RCTs appeared to show benefit, but others provided
conflicting findings. The authors performed a meta-analysis of RCTs to
assess the effi- cacy and safety of PUFA for the prevention of AF. Methods
The authors searched the electronic databases of Medline via PubMed
(January 1966 to March 2011), EMBASE (January 1974 to March 2011), Web of
Science (January 1986 to March 2011), the Cochrane Central Register of
Controlled Trials (Cochrane Library Issue 3, 2011) and the Chinese
Biomedical Literature Database (January 1978 to March 2011) for all RCTs
dealing with the prevention of AF with PUFA compared with placebo. No
language restriction was applied. Two reviewers independently selected
studies for inclusion and extracted the data. Outcomes of interest include
incidence or recurrence of AF, complications and adverse events. The same
reviewers independently assessed the methodological quality of every study
using the Jadad's scale that assessed randomisation, allocation
concealment, blinding and withdrawals/dropout of studies by classing them
on a scale 1~7. Disagreements were resolved by discussion or by involving
a third reviewer. RevMan 5.1 was used to combine and analyse the data.
Studies were pooled using relative risk (RR) after assessing for
heterogeneity. The data were analysed using fixed effects models. When
significant heterogeneity was present, a random effects model was used.
Results The authors identified twelve RCTs with 2146 patients that met our
inclusion criteria. of the twelve studies, six studies with 859 patients
were designed to evaluate the effects of PUFA on postoperative AF (POAF)
in patients undergoing open heart surgery as primary prevention, and six
studies with 1287 patients were designed to evaluate the effects of PUFA
on AF either in the postelectrical cardioversion setting or in patients
with symptomatic paroxysmal or persistent AF as secondary prevention. For
primary prevention: the use of high dose of PUFA (content of DHA>1g/d)
significantly reduced the incidence of POAF (RR 0.70, 95% CI 0.52 to 0.93,
p=0.01), whereas low dose of PUFA (content of DHA<=1g/d) did not
significantly reduce the risk of POAF (RR 1.06, 95% CI 0.83 to 1.35,
p=0.65). For secondary prevention: the use of PUFA no significantly
reduced the recurrence of AF compared with control (RR 0.94, 95% CI 0.75
to 1.17, p=0.57). Complications and adverse events are no different
between two groups (RR 1.09, 95% CI 0.92 to 1.29, p=0.30). Conclusion Our
meta-analysis shows that high dose of PUFA revealed statistically
significant prevention effects on primary prevention, whereas low dose of
PUFA did not reduce the risk of POAF. PUFA did not reveal statistically
significant prevention effects on secondary prevention. Complications and
adverse events are no different between two groups. Unfortunately, our
meta-analysis does not provide the optimal duration and dosage of
perioperative PUFA. Large-scale RCTs designed to compare different dose
intensity and lengths of PUFA therapy should be conducted in the future.
PUFA might be a choice for patients undergoing open heart surgery.
However, as it is now, the authors cannot recommend the routine use of
PUFA for the prevention of AF.