EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 17

Results Generated From:
Embase <1980 to 2012 Week 33>
Embase (updates since 2012-08-09)

<1>
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. Article Number: e001080. 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.

<2>
Accession Number
2012433146
Authors
Gerstein H.C. Bosch J. Dagenais G.R. Diaz R. Jung H. Maggioni A.P. Pogue
J. Probstfield J. Ramachandran A. Riddle M.C. Ryden L.E. Yusuf S.
Institution
(Gerstein, Yusuf) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, ON, Canada
(Bosch) Population Health Research Institute, School of Rehabilitation
Science, McMaster University, Hamilton, ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Jung) McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
Research Center, Florence, Italy
(Pogue) Population Health Research Institute, McMaster University,
Hamilton Health Sciences, Hamilton, ON, Canada
(Probstfield) University of Washington, Seattle, WA, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, OR, United States
(Ryden) Department of Medicine, Karolinska Institute, Stockholm, Sweden
Title
Basal insulin and cardiovascular and other outcomes in dysglycemia.
Source
New England Journal of Medicine. 367 (4) (pp 319-328), 2012. Date of
Publication: 26 Jul 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: The provision of sufficient basal insulin to normalize fasting
plasma glucose levels may reduce cardiovascular events, but such a
possibility has not been formally tested. METHODS: We randomly assigned
12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus
impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes
to receive insulin glargine (with a target fasting blood glucose level of
<=95 mg per deciliter [5.3 mmol per liter]) or standard care and to
receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial
design. The results of the comparison between insulin glargine and
standard care are reported here. The coprimary outcomes were nonfatal
myocardial infarction, nonfatal stroke, or death from cardiovascular
causes and these events plus revascularization or hospitalization for
heart failure. Microvascular outcomes, incident diabetes, hypoglycemia,
weight, and cancers were also compared between groups. RESULTS: The median
follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of
incident cardiovascular outcomes were similar in the insulin-glargine and
standard-care groups: 2.94 and 2.85 per 100 person-years, respectively,
for the first coprimary outcome (hazard ratio, 1.02; 95% confidence
interval [CI], 0.94 to 1.11; P = 0.63) and 5.52 and 5.28 per 100
person-years, respectively, for the second coprimary outcome (hazard
ratio, 1.04; 95% CI, 0.97 to 1.11; P = 0.27). New diabetes was diagnosed
approximately 3 months after therapy was stopped among 30% versus 35% of
1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI,
0.64 to 1.00; P = 0.05). Rates of severe hypoglycemia were 1.00 versus
0.31 per 100 person-years. Median weight increased by 1.6 kg in the
insulin-glargine group and fell by 0.5 kg in the standard-care group.
There was no significant difference in cancers (hazard ratio, 1.00; 95%
CI, 0.88 to 1.13; P = 0.97). CONCLUSIONS: When used to target normal
fasting plasma glucose levels for more than 6 years, insulin glargine had
a neutral effect on cardiovascular outcomes and cancers. Although it
reduced new-onset diabetes, insulin glargine also increased hypoglycemia
and modestly increased weight. Copyright 2012 Massachusetts Medical
Society.

<3>
Accession Number
2012453620
Authors
Brevoord D. Kranke P. Kuijpers M. Weber N. Hollmann M. Preckel B.
Institution
(Brevoord, Weber, Hollmann, Preckel) Laboratory of Experimental Intensive
Care and Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
(Brevoord, Kuijpers, Hollmann, Preckel) Department of Anesthesiology,
Academic Medical Center, Amsterdam, Netherlands
(Kranke) Department of Anesthesia and Critical Care, University Hospital
Wurzburg, Wurzburg, Germany
Title
Remote ischemic conditioning to protect against ischemia-reperfusion
injury: A systematic review and meta-analysis.
Source
PLoS ONE. 7 (7) , 2012. Article Number: e42179. Date of Publication: 31
Jul 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Remote ischemic conditioning is gaining interest as potential
method to induce resistance against ischemia reperfusion injury in a
variety of clinical settings. We performed a systematic review and
meta-analysis to investigate whether remote ischemic conditioning reduces
mortality, major adverse cardiovascular events, length of stay in hospital
and in the intensive care unit and biomarker release in patients who
suffer from or are at risk for ischemia reperfusion injury. Methods and
Results: Medline, EMBASE and Cochrane databases were searched for
randomized clinical trials comparing remote ischemic conditioning,
regardless of timing, with no conditioning. Two investigators
independently selected suitable trials, assessed trial quality and
extracted data. 23 studies in patients undergoing cardiac surgery (15
studies), percutaneous coronary intervention (four studies) and vascular
surgery (four studies), comprising in total 1878 patients, were included
in this review. Compared to no conditioning, remote ischemic conditioning
did not reduce mortality (odds ratio 1.22 [95% confidence interval 0.48,
3.07]) or major adverse cardiovascular events (0.65 [0.38, 1.14]).
However, the incidence of myocardial infarction was reduced with remote
ischemic conditioning (0.50 [0.31, 0.82]), as was peak troponin release
(standardized mean difference -0.28 [-0.47, -0.09]). Conclusion: There is
no evidence that remote ischemic conditioning reduces mortality associated
with ischemic events; nor does it reduce major adverse cardiovascular
events. However, remote ischemic conditioning did reduce the incidence of
peri-procedural myocardial infarctions, as well as the release of
troponin. 2012 Brevoord et al.

<4>
Accession Number
2012436516
Authors
Crawford G.B. Brindis R.G. Krucoff M.W. Mansalis B.P. Carroll J.D.
Institution
(Crawford) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, 649A Washington Boulevard, Baltimore, MD
21230, United States
(Brindis) Senior Advisor for Cardiovascular Disease, Northern California
Kaiser Permanente, Oakland, CA, United States
(Krucoff) Department of Medicine, Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Mansalis) Department of Internal Medicine, Northern California Kaiser
Permanente, Oakland, CA, United States
(Carroll) Department of Medicine, Division of Cardiology, University of
Colorado Denver, Aurora, CO, United States
Title
Percutaneous atrial Septal Occluder devices and cardiac erosion: A review
of the literature.
Source
Catheterization and Cardiovascular Interventions. 80 (2) (pp 157-167),
2012. Date of Publication: 01 Aug 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objective To systematically review all cases in the literature of erosion
associated with Atrial Septal Defect (ASD) occluder devices. Background
Delayed erosion of the aortic or atrial wall is an infrequent but
potentially lethal complication of percutaneous septal defect closure
using an ASD device. The epidemiology is poorly understood. Methods The
MEDLINE database was searched for cases of ASD occluder device-associated
erosion. Results Twenty-five articles present erosion events associated
with the AMPLATZER Septal Occluder (ASO) device (March 2002-June 2011),
documenting 21 independent, surgically confirmed cases. Another 79
distinct events are reported in case series and review articles. Of all
identified independent cases, 73 were reported in the United States. No
articles associate the HELEX Septal occluder and erosions. Additional
events are reported in association with FDA-unapproved percutaneous defect
closure devices (n = 16). Estimation of ASO erosion incidence is
unreliable because the numerator (number of erosion events) and
denominator (number of patients with an implanted device) are unknown;
estimates range from 0.1 to 0.3%. Conclusion Cardiac erosion is a rare but
serious complication of the ASO device. Erosion events are most often
ascribed to device over-sizing or deficient retro-aortic rims; however,
both consensus and evidence for a cogent risk factor(s) is lacking.
Further assessment of the root cause of erosion and true incidence of this
complication is required; analyses using control patients and/or device
registry establishment represent logical next steps. 2011 Wiley
Periodicals, Inc.

<5>
Accession Number
2012436499
Authors
Lee S.-W. Kim S.-H. Kim S.-O. Han S. Kim Y.-H. Park D.-W. Kang S.-J. Lee
C.W. Park S.-W. Park S.-J.
Institution
(Lee, Kim, Kim, Park, Kang, Lee, Park, Park) Department of Cardiology,
University of Ulsan College of Medicine, Asan Medical Center, 86
Asanbyeonwon-gil, Songpa-gu, Seoul, 138-736, South Korea
(Kim, Han) Department of Biostatistics, University of Ulsan College of
Medicine, Seoul, South Korea
Title
Comparative long-term efficacy and safety of drug-eluting stent versus
coronary artery bypass grafting in ostial left main coronary artery
disease: Analysis of the MAIN-COMPARE Registry.
Source
Catheterization and Cardiovascular Interventions. 80 (2) (pp 206-212),
2012. Date of Publication: 01 Aug 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: To date, drug-eluting stent (DES) implantation has not been
compared with coronary artery bypass grafting (CABG) for ostial left main
coronary artery (LMCA) lesions. Methods: Of the 263 patients in the
MAIN-COMPARE registry with ostial LMCA stenosis, 123 were treated with
percutaneous coronary intervention (PCI) with DES and 140 with CABG. We
compared their 5-year overall survival, composite outcomes of death,
Q-wave myocardial infarction (MI) or stroke, and target vessel
revascularization (TVR) rates. Results: Unadjusted analysis showed no
significant differences between CABG and DES in overall survival rates
(95% confidence interval (CI) for hazard ratio (HR): 0.44 to 1.77, P =
0.71), composite outcomes (death, Q-wave MI, or stroke)-free survival
rates (95% CI for HR: 0.41-1.63, P = 0.56), and TVR-free survival rates
(95% CI for HR: 0.79-5.03, P = 0.14). Multivariate adjusted Cox regression
analysis also showed no significant between-group differences in TVR (95%
CI for HR: 0.52-3.79, P = 0.49), death (95% CI for HR: 0.79-2.82, P =
0.22) and the composite of death, Q-wave MI, or stroke (95% CI for HR:
0.65-2.57, P = 0.46). These results were sustained after propensity score
adjustment and propensity score matching analysis. Conclusions: DES
implantation for ostial LMCA lesions showed similar 5-year outcomes of
death, major adverse events, and TVR compared with CABG. Although
meticulous adjustments decreased baseline difference between the two
treatments, the absence of statistical significance could be attributable
to the size of the study sample and hidden bias. 2011 Wiley Periodicals,
Inc.

<6>
Accession Number
2012417826
Authors
Chen Y.M. Li Z.B. Zhu M. Cao Y.M.
Institution
(Chen, Li, Zhu, Cao) Division of Geriatric Cardiology, General Hospital of
Chinese PLA, Beijing, 100853, China
Title
Effects of exercise training on left ventricular remodelling in heart
failure patients: An updated meta-analysis of randomised controlled
trials.
Source
International Journal of Clinical Practice. 66 (8) (pp 782-791), 2012.
Date of Publication: August 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objectives: The purpose of this updated meta-analysis was to determine
whether exercise training reversed left ventricular remodelling in heart
failure patients. Methods: Articles were searched in MEDLINE, Cochrane
Central Register of Controlled Trials, CINAHL, EMBASE and PubMed (up until
October, 2011). The anti-remodelling benefit of exercise training was
assessed by ejection fraction (EF), end-diastolic volume (EDV) and
end-systolic volume (ESV). Standardised mean difference (SMD) together
with 95% confidence intervals (CI) was calculated. Subgroup meta-analysis
with exercise duration was also conducted. Results: Fifteen randomised
controlled trials with 813 patients were included. Aerobic exercise
training improved EF (SMD = 0.44; 95% CI 0.28 to 0.61), EDV (SMD = -0.33;
95% CI -0.49 to -0.16) and ESV (SMD = -0.40; 95% CI -0.57 to -0.23).
Subgroup analysis indicated that long-term aerobic exercise (>=6 months)
had a marked positive effect on EF (SMD = 0.5; 95% confidence interval
0.31 to 0.69), EDV (SMD = -0.38; 95% CI -0.57 to -0.19) and ESV (SMD =
-0.48; 95% CI -0.67 to -0.29), but there was no evidence of benefit with
short-term aerobic exercise (<6 months): EF (SMD = 0.27; 95% CI -0.08 to
0.61), EDV (SMD = -0.14; 95% CI -0.48 to 0.21) and ESV (SMD = -0.08; 95%
CI -0.47 to 0.30). Strength training (alone or plus aerobic training) was
not associated with improvements in EDV and ESV, with all confidence
intervals including 0. Conclusions: Aerobic exercise training, especially
long-term duration (>=6 months) reverses left ventricular remodelling in
clinically stable patients with heart failure. Strength training (alone or
plus aerobic training) did not improve or worsen ventricular remodelling.
2012 Blackwell Publishing Ltd.

<7>
[Use Link to view the full text]
Accession Number
2012446542
Authors
Wang G. Xie G. Jiang T. Wang Y. Wang W. Ji H. Liu M. Chen L. Li L.
Institution
(Wang, Wang, Wang, Ji, Liu, Chen, Li) Department of Anesthesiology, Fuwai
Hospital and Cardiovascular Institute, Chinese Academy of Medical
Sciences, Beijing 100037, China
(Xie) Department of Data Management, Peking University Clinical Research
Institute, Beijing, China
(Jiang) Department of Anesthesiology, 3201 Hospital, Shanxi Province,
China
Title
Tranexamic acid reduces blood loss after off-pump coronary surgery: A
prospective, randomized, double-blind, placebo-controlled study.
Source
Anesthesia and Analgesia. 115 (2) (pp 239-243), 2012. Date of Publication:
August 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
BACKGROUND: Bleeding and the need for allogeneic transfusions are still
problems after off-pump coronary artery bypass grafting (OPCAB) surgery.
We therefore evaluated the effects of an antifibrinolytic, tranexamic
acid, on postoperative bleeding and transfusion requirements in patients
undergoing OPCAB surgery. METHODS: Two hundred thirty-one consecutive
patients scheduled for elective OPCAB were enrolled in the study. Using a
double-blind method, the patients were randomly assigned to receive either
tranexamic acid (bolus 1 g before surgical incision followed by an
infusion of 400 mg/h during surgery; n = 116) or a placebo (infusion
equivalent volume of saline solution; n = 115). The primary outcome was
24-hour postoperative chest tube drainage. Allogeneic transfusion,
mortality, major morbidities, and resource utilization were also recorded.
RESULTS: In comparison with the placebo group, the patients receiving
tranexamic acid had a significant reduction in chest tube drainage at 6
hours (270 +/- 118 mL vs 416 +/- 179 mL, P < 0.001) and 24 hours (654 +/-
224 mL vs 891 +/- 295 mL, P < 0.001). There was also a significant
reduction in allogeneic red blood cell transfusions (47 vs 31.9%, P =
0.019) and fresh frozen plasma (29.6% vs 17.2%, P = 0.027) transfusions.
There were no differences in mortality, morbidity, and resource
utilization between the 2 groups. CONCLUSIONS: Tranexamic acid reduces
postoperative chest tube drainage and the requirement for allogeneic
transfusion in off-pump coronary surgery. Copyright 2012 International
Anesthesia Research Society.

<8>
Accession Number
2012434282
Authors
Etezadi F. Najafi A. Yarandi K.K. Moharari R.S. Khajavi M.R.
Institution
(Etezadi, Najafi, Moharari, Khajavi) Department of Anesthesiology and
Critical Care, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Yarandi) Department of Neurosurgery, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
ICU sedation with haloperidol-propofol infusion versus midazolam-propofol
infusion after coronary artery bypass graft surgery: A prospective,
double-blind randomized study.
Source
Annals of Cardiac Anaesthesia. 15 (3) (pp 185-189), 2012. Date of
Publication: July-September 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Combinations of hypnotics with or without opiates are commonly used in
agitated patients. We hypothesized that combination of
haloperidol-propofol in comparison with midazolam-propofol would lower
consumption of propofol and lead to better hemodynamic and respiratory
profile during sedation of agitated patients. Among 108 patients admitted
in our ICU, 60 patients were agitated according to Ramsay Sedation Score
(RSS) and randomly divided into two groups. Morphine sulfate (0.05 mg/kg)
was administered to all patients for relief of postoperative pain. In one
group, sedative infusion was started with 1 mg/h of haloperidol plus 25
g/kg/min of propofol after bolus injection of 2 mg haloperidol. In the
other group, midazolam1 mg/h and propofol 25 g/kg/min were infused after a
bolus injection of 2 mg midazolam. Propofol infusion was adjusted to keep
bi-spectral index between 61-80 and the RSS between 3-5. Hourly propofol
consumption was recorded during 24 h of sedation and compared
statistically. We also compared SpO ₂ , arterial blood gas
variables, hemodynamic parameters and episodes of respiratory depression
(SpO ₂ 85%) requiring respiratory support between the groups.
Haloperidol, when added to propofol infusion, decreased its consumption at
all the measured times (P = 0.001). There was no significant difference in
hemodynamic variables between two groups, but the episodes of respiratory
depression was significantly higher in propofol-midazolam group (P =
0.02). We conclude that haloperidol-propofol infusion decreases propofol
requirements in the agitated patients. Besides, this combination showed a
better profile in terms of occurrence of respiratory depression.

<9>
Accession Number
2012427663
Authors
Krzych L.J. Bochenek-Klimczyk K. Wasiak M. Bialek K. Bolkowski M. Gierek
D. Bochenek A.
Institution
(Krzych, Bochenek-Klimczyk, Wasiak, Bialek, Bolkowski, Bochenek)
Department of Cardiac Surgery, Medical University of Silesia, Katowice,
Poland
(Gierek) Department of Anesthesiology and Intensive Care, Upper-Silesian
Medical Centre, Katowice, Poland
Title
Left main disease management strategy: Indications and revascularization
methods in particular groups of subjects.
Source
Cardiology Journal. 19 (4) (pp 347-354), 2012. Date of Publication: 2012.
Publisher
Grupa Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Surgical revascularization with coronary artery by-pass grafting is still
recommended in vast majority of patients with unprotected left main
disease. The aim of the paper was to analyze optimal treatment of left
main disease in selected groups of patients, on the basis of current
guidelines and information gained from literature data. We focused on data
in relation to treatment of elderly patients, diabetics and those
hemodynamically unstable. Additionally we discussed the issue of
anti-platelet therapy and informed consent. As far as efficacy of
treatment is concerned, not only method of revascularization but also
general condition of the patient, the factors influencing peri-operative
risk and optimal pharmacotherapy should be taken into account. Therefore
establishment of the heart team is crucial when choosing the most suitable
method of invasive treatment of left main disease. 2012 Via Medica.

<10>
Accession Number
2012447835
Authors
Ntsekhe M. Wiysonge C.S. Commerford P.J. Mayosi B.M.
Institution
(Ntsekhe, Commerford, Mayosi) Department of Medicine, Groote Schuur
Hospital, University of Cape Town, Cape Town, South Africa
(Wiysonge) Institute of Infectious Disease and Molecular Medicine, School
of Child and Adolescent Health, University of Cape Town, Cape Town, South
Africa
Title
The prevalence and outcome of effusive constrictive pericarditis: A
systematic review of the literature.
Source
Cardiovascular Journal of Africa. 23 (5) (pp 281-285), 2012. Date of
Publication: June 2012.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
There is sparse information on the epidemiology of effusive constrictive
pericarditis (ECP). The objective of this article was to review and
summarise the literature on the prevalence and outcome of ECP, and
identify gaps for further research. The prevalence of ECP ranged from 2.4
to 14.8%, with a weighted average of 4.5% [95% confidence interval (CI)
2.2-7.5%]. Sixty-five per cent (95% CI: 43-82%) of patients required
pericardiectomy regardless of the aetiology. The combined death rate
across the studies was 22% (95% CI: 4-50%). The prevalence of ECP is low
in non-tuberculous pericarditis, while pericardiectomy rates are high and
mortality is variable. In this review, of 10 patients identified with
tuberculous ECP, only one presumed case had a definite diagnosis of ECP.
Appropriate studies are needed to determine the epidemiology of ECP in
tuberculous pericarditis, which is one of the leading causes of
pericardial disease in the world.

<11>
Accession Number
2012447290
Authors
Bertrand O.F. Jolly S.S. Rao S.V. Patel T. Belle L. Bernat I. Parodi G.
Costerousse O. Mann T.
Institution
(Bertrand, Costerousse) Quebec Heart-Lung Institute, Quebec City, QC,
Canada
(Jolly) Hamilton General Hospital, McMaster University, Hamilton, ON,
Canada
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Patel) Seth N.H.L. Municipal Medical College, Ahmedabad, India
(Belle) Annecy Regional Hospital, France
(Bernat) University Hospital, Faculty of Medicine, Pilsen, Czech Republic
(Parodi) Careggi Hospital, Florence, Italy
(Mann) WakeMed Heart Center, Raleigh, NC, United States
Title
Meta-analysis comparing Bivalirudin versus heparin monotherapy on ischemic
and bleeding outcomes after percutaneous coronary intervention.
Source
American Journal of Cardiology. 110 (4) (pp 599-606), 2012. Date of
Publication: 15 Aug 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
With femoral access, bivalirudin decreases risks of major bleeding after
percutaneous coronary intervention (PCI) and provides better net clinical
benefit compared to unfractionated heparin (UFH) plus planned glycoprotein
IIb/IIIa inhibitors. Whether this benefit exists compared to UFH
monotherapy is less clear. We performed a systematic review and
meta-analysis to compare outcomes in patients undergoing transfemoral PCI
with UFH or bivalirudin. Randomized trials (n = 3) and observational
studies (n = 13) comparing bivalirudin to UFH monotherapy were reviewed.
Primary outcomes were 30-day rates of major adverse cardiovascular events
(MACEs) including death, myocardial infarction (MI), urgent
revascularization, as well as all-cause mortality, MI, major bleeding, and
blood transfusion. We collected data from 16 studies involving 32,492
patients undergoing PCI. Most observational studies were performed in the
United States, whereas all randomized trials were done in Europe. Compared
to UFH monotherapy, bivalirudin was associated with similar risk of MACEs
(odds ratios [OR] 0.92, 95% confidence interval [CI] 0.75 to 1.12), a
substantial 45% relative decrease in major bleeding (OR 0.55, 95% CI 0.43
to 0.72), and a trend in the decrease of transfusion (OR 0.87, 95% CI 0.70
to 1.08). A decrease in mortality was seen in observational studies (OR
0.62, 95% CI 0.45 to 0.85) but remained inconclusive in randomized trials
(OR 0.63, 95% CI 0.20 to 2.01). MI rate was similar with the 2
anticoagulants. In conclusion, in patients undergoing transfemoral PCI,
the benefit of bivalirudin over UFH monotherapy is driven by a significant
decrease in major bleeding with similar rates of MACE. As PCI practice
moves toward other bleeding-avoidance strategies such as the radial
approach, future studies should focus on the interaction between
anticoagulant strategy and access-site choice. 2012 Elsevier Inc. All
rights reserved.

<12>
Accession Number
2012429620
Authors
Siniawski H. Lehmkuhl H. Dandel M. Unbehaun A. Kemper D. Weng Y. Hetzer R.
Institution
(Siniawski, Lehmkuhl, Dandel, Unbehaun, Kemper, Weng, Hetzer) Department
of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum,
Augustenburger Platz 1, Berlin 13353, Germany
Title
Prediction of True Circulatory Decompensation in Chronic Heart Failure for
Optimal Timing of Mechanical Circulatory Support: Non-invasive
arterial-ventricular coupling.
Source
Journal of Functional Biomaterials. 3 (1) (pp 100-113), 2012. Date of
Publication: March 2012.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
Background: Prospective comparative studies to predict the risk of
hemodynamic deterioration in patients referred for transplantation were
performed on the basis of standard invasive and non-invasive data and new
wave intensity (WI) parameters. Methods and results: Study Group 1
consisted of 151 consecutive outpatients (age 48.7 +/- 12 years; 110 men)
with end-stage dilative cardiomyopathy. Group 2, consisting of 11
consecutive patients (age 50 +/- 11 years; 6 men) with sinus rhythm and
"true" decompensation, was used to create "critical values" of WI. There
were no demographic or somatic (weight and height) differences between the
groups. The follow-up period of ambulatory patients was 31 +/- 8 months.
Non-invasive WI was studied in the common carotid artery. Complete
invasive and non-invasive data were also recorded on the day of
investigation. During follow-up 44 pts were lost; there were 15 cardiac
deaths (10%), life-saving ventricular assist device implantation in 10
(6.6%) and transplantation in 19 (12.7%). For statistical purposes this
group was named the "events" Group B (n = 44). A predisposing factor for
events (death, "true" decompensation and "urgent" transplantation in
ambulatory patients) was low first peak (" cut-off value" assessed in
Group 2 < 4100 mmHg*s3) (OR 45.6, CI 14.5-143.3, p < 0.001). Less powerful
predictors of the risk of deterioration were pulmonary capillary pressure
(PCP), diastolic pulmonary artery pressure (PAP) and E/A mitral wave
relation (p = 0.05). Conclusions: The new ventricular-arterial coupling
parameter 1st peak of WI can potentially be used to distinguish patients
at high risk for true deterioration and death. This parameter can be used
to predict the need for assist device implantation. 2012 by the authors.

<13>
Accession Number
70827280
Authors
Kepka L.
Institution
(Kepka) Maria Sklodowska-Curie Memorial Cancer Center, Department of
Radiation Oncology, Warsaw, Poland
Title
Adjuvant and definitive radiotherapy in elderly patients with lung cancer.
Source
Radiotherapy and Oncology. Conference: 2012 Annual Conference of the
European Society for Radiotherapy and Oncology, ESTRO 31 Barcelona Spain.
Conference Start: 20120509 Conference End: 20120513. Conference
Publication: (var.pagings). 103 (pp S146), 2012. Date of Publication: May
2012.
Publisher
Elsevier Ireland Ltd
Abstract
Lung cancer is a disease of older people in developed countries; for
example, the median age at diagnosis is 68 and 71 years in Poland and the
USA, respectively. This contrasts with data from prospective studies on
radio(chemo)therapy to treat lung cancer, in which the median age of
included patients is 61-63 years. Comorbidity, which is often associated
with advanced age, and age more than 70 years are often used to exclude
patients from prospective studies. Thus, given the paucity of clinical
trials on radiotherapy for lung cancer designed exclusively for older
patients, we are guided in our daily clinical practice by results derived
only from studies that included selected elderly patients. Initial
analyses of outcomes of prospective studies by cooperative groups that
compared radiotherapy alone with radiochemotherapy showed inferior
survival among elderly patients receiving more aggressive treatment,
because of higher toxicity, compared with their younger counterparts. It
was concluded that older patients should be managed with a less aggressive
approach that still leaves some chance of a cure [1, 2]. Surprisingly,
more recent prospective trials that compared the outcomes for elderly
patients (defined by different thresholds within the range 65-70 years)
with those for their younger counterparts observed similar (improved)
outcomes for concomitant radiochemotherapy compared with a sequential
approach or radiotherapy alone in older patients, despite a significantly
higher rate of severe toxicity [3, 4]. This lack of impact of the higher
rate of severe toxicity on survival urges additional caution when
generalizing these results to the whole population of elderly patients
because of the possible selection bias toward older patients with a
favorable prognostic profile in clinical trials. We should also be aware
of the limitations of the data on toxicity in elderly patients. Data from
1208 patients participating in six prospective EORTC trials of thoracic
irradiation showed no difference in acute toxicity in patients older than
70 years compared with younger patients. However, older patients
experienced more weight loss during therapy and a higher rate of late
esophageal toxicity. These findings may also indicate limitations of the
current toxicity scales and suggest a decrease in the capacity of
compensation mechanisms with advanced age [5]. Adjuvant radiotherapy is
not a standard treatment in non-small cell lung cancer (NSCLC) if one
considers the results of meta-analysis of the possible deleterious effects
of irradiation in postoperative setting. Thus, it is a more doubtful
treatment for older patients. However, if one finds strong indications for
the use of postoperative radiotherapy for elderly patients, the clinician
should be particularly careful about the quality of treatment delivered
because some data indicate that the quality and use of modern technologies
improve outcomes. The morbidity associated with thoracic surgery increases
with advanced age, and radiotherapy alone is commonly used as a standard
approach in elderly patients in the early stages of NSCLC. The use of
modern technologies, especially stereotactic techniques, emerges as a
therapeutic alternative with outcomes that are not inferior to those of
surgery, thus reducing morbidity in this population.

<14>
Accession Number
70826896
Authors
Scaravilli V. Bonacina D. Citerio G.
Institution
(Scaravilli, Bonacina) Department of Experimental Medicine, University of
Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
(Citerio) Neuroanesthesia and Neurointensive Care Unit, Department of
Perioperative Medicine and Intensive Care, Ospedale San Gerardo, Monza,
Italy
Title
Rewarming: Facts and myths from the systemic perspective.
Source
Critical Care. Conference: Update on Therapeutic Temperature Management
2012 Portoroz Slovenia. Conference Start: 20120607 Conference End:
20120609. Conference Publication: (var.pagings). 16 , 2012. Date of
Publication: 07 Jun 2012.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Rewarming is a delicate phase of therapeutic hypothermia
(TH). Adverse consequences of rewarming on the whole body may seriously
limit the protective effects of hypothermia, leading to secondary injury.
Thus, understanding, predicting, and managing possible systemic side
effects of rewarming is important for guaranteeing TH efficacy. The aim of
this brief report is to describe rewarming effects from a systemic
perspective. Hemodynamics and imbalance in oxygen consumption and
delivery: TH linearly decreases the metabolic rate of homeothermic
organisms. During the cooling process, tissue oxygen consumption
(VO₂) slows by roughly 6%/degreeC reduction in body temperature
[1,2], obeying the van't Hoff-Arrhenius law, which states that the rate of
a biochemical reaction is halved for each 10degreeC decrease in
temperature. The reduction in brain metabolism is similar [3]. In
contrast, during rewarming, the possible appearance of a mismatch between
total body oxygen demand and oxygen delivery (DO₂) [4] has been
recognized since the pioneer works of Hegnauer and colleagues on dogs [5]
and Bigelow on humans [6]. Bigelow has described this side effect of
rewarming as rewarming shock: 'This syndrome of acute acidosis, or
rewarming shock, was characterized by a progressive decline in blood pH
[...] associated with respiratory inadequacy [...]. A fall in blood
pressure and tachycardia were features in some cases'. In more recent
studies, rewarming shock after moderate TH seems to be a more infrequent
eventuality, probably because TH management has been completely changed by
the advent of ICUs and a far less hypothermic regimen. The mismatch
between oxygen supply and consumption during rewarming could depend on
numerous factors, including metabolic rate, abnormalities in oxygen
extraction, cardiac output (CO), circulating blood volume, regional blood
flow, pH, blood viscosity, and a shift in the hemoglobin dissociation
curve. The physiopathology of this side effect of rewarming is not known.
Rewarming from hypothermia is such a complex and metabolism-pervasive
process to alter all of the possible determinants of a
VO₂/DO₂ mismatch. Of the possible determinants of
VO₂/DO₂, cardiac dysfunction has been the most
investigated. Cooling determines a proportional decrease in cardiac output
[1], heart rate, and mean arterial blood pressure, with no change in
stroke volume and increased peripheral vascular resistance. During the
maintenance stage of TH, the decrease in metabolic rate is equal to or
greater than the decrease in cardiac output, and alteration of oxygen
delivery is not a matter of concern. Preliminary clinical studies [7] and
a recent meta-analysis [8] have shown a decrease in myocardial ischemic
injury. Many of the alterations in the cardiovascular system occurring
during hypothermia completely reverse during rewarming. Therefore, the
rewarming phase could lead to a permanent deterioration of myocardial
function and cardiac output. The pathophysiological mechanism underlying
cardiac dysfunction induced by hypothermia rewarming has been studied by
Tveita's group, first in vitro using a rat left ventricular papillary
muscle [9] and then in vivo [10] in an intact rat model. These studies
showed how postrewarming systolic left ventricular dysfunction can be
related to decreased myofibrillar Ca²⁺ sensitivity due to
increased troponin C phosphorylation. In addition, Blair and colleagues
[11] and Morray and Pavlin [12] documented an increase in total oxygen
consumption to values above prehypothermic controls in a dog model of
rewarming after deep hypothermia. The authors suggested many possible
explanations for this event. First, heterogeneous blood flow distribution
[13] during hypothermia may determine areas of oxygen debt, with decreased
or absent perfusion, that become hypoxic and generate lactate. During
rewarming, these areas are reperfused and lactate re-enters normal
oxidative pathways, consuming oxygen in the process. Second, with a return
to normothermia, free radical oxidation [14,15] and inflammatory response
to injury [16,17] could resume, leading to nonrespiratory utilization of
oxygen and an increase of VO₂ over pre-injury control. Third,
shivering can occur during rewarming as a response to deviations from the
temperature set point. The shivering response to maintain a constant core
temperature is a concerted reaction involving skeletal muscle contraction
and peripheral vasoconstriction. When shivering occurs during rewarming,
it is associated with increased VO₂ [18,19] and hemodynamic
instability [20]. Cain and Bradley 21] and Schumacker and colleagues [22]
have described abnormalities of peripheral oxygen extraction in dogs
during hypothermia, even with adequate oxygen delivery. An alteration in
the temperature transition of oxidative phosphorylation has been
documented in an animal model. Leducq and colleagues presented evidence
for an abnormal pattern of oxidative phosphorylation control that
correlated with a transition in mitochondrial permeability and persisted
after rewarming [23]. This phenomenon may cause alterations in oxygen
utilization during and after rewarming. Kondratiev and colleagues
addressed the problem of oxygen supply in a rat model of deep hypothermia
(15degreeC) and rewarming [24]. The experiment demonstrated a reduction in
cardiac output and oxygen delivery after prolonged deep hypothermia
(15degreeC for 5 hours) compared with less prolonged exposure. The
rewarming-related rightward shift of the oxygen hemoglobin saturation
curve, which facilitates oxygen dissociation at the tissue level,
compensated for compromised peripheral oxygen transport, leading to a
stable oxygen supply. Knowing the events causing
VO₂/DO₂ mismatch during rewarming is important in
this phase of TH for monitoring and assuring adequate cerebral and whole
body oxygen delivery. Low oxygen delivery accounts for the development of
secondary injury, which limits the safety and effectiveness of TH. With
this perspective in mind, we can suggest various measures to limit
VO₂/DO₂ mismatch during rewarming. First, rewarming
after TH should be done slowly and in a controlled manner [25]. Eshel, in
a rat model of TH, showed how rapid rewarming from moderate hypothermia is
associated with more acute hemodynamic alterations compared with slow
rewarming [25]. Similar effects were described in humans [26] and
pediatric patients [27] undergoing TH for hypoxic ischemic encephalopathy
and deep intraoperative hypothermia (27degreeC), respectively, as well as
in the work of Hanhela and colleagues [28] on adults undergoing
cardiopulmonary bypass for cardiac surgery. Second, controlling pain,
sedation, and preventing shivering should limit oxygen consumption.
Michenfelder and colleagues [29], Rodriguez and colleagues [30], and
Zwischenberger and colleagues [31] demonstrated that the suppression of
shivering by neuromuscular blockade is an effective method for diminishing
VO₂. More recently, Badjata and colleagues [32] proposed a
simple shivering grading tool, the Bedside Shivering Assessment Scale
(BSAS), developed by assessing the correlation of bedside shivering and
systemic metabolic stress quantified by indirect calorimetry. Using
clinical observation of muscle involvement, the BSAS provides an accurate
representation of shivering-related oxygen consumption. Accurately
defining shivering intensity assures the possibility of a stepwise
treatment for shivering. We recommend initially managing shivering with
nonsedating interventions, such as correcting hypomagnesemia, or a
serotonin (5-TH) 1A partial agonist like buspirone or meperidine.
Meperidine has been demonstrated to effectively reduce VO₂
augmentation associated with postoperative shivering at a dosage that does
not cause respiratory depression [33]. When these first line interventions
fail, sedation with shortacting sedative agents and neuromuscular blockade
can be used. Third, oxygen content and transport should be optimized.
Anemia and arterial desaturation must be avoided during rewarming. To
date, no clinical trials have examined hemodynamic optimization in
patients that have undergone TH, least of all during rewarming, and no
evidence is currently available to indicate the best strategy for
hemodynamic support in such a critical phase. We suggest a strict control
of hemodynamics, with the aim of guaranteeing adequate oxygen delivery and
avoiding VO₂/DO₂ mismatch, using at least continuous
arterial pressure monitoring, volume balance and urine output
surveillance, and frequent serum lactate measurements. In the case of
hemodynamic instability, advanced monitoring capable of finer management
could be useful. Thus, in this context, echocardiography and goal-directed
hemodynamic optimization [34] may have a place. Treatment of systolic left
ventricular impairment presents additional concerns. Pharmacological
therapy with catecholamines presents substantial limitations [35,36], as
the decreased myofilament Ca²⁺ sensitivity during rewarming
significantly diminishes badrenoceptor effects. In addition,
catecholamines determine elevated myocardial oxygen consumption and
arrhythmogenesis. A recent study by Rungatscher and colleagues [37] tested
the efficacy of levosimendan in improving myocardial dysfunction after
rewarming from deep hypothermia in a rat model. Levosimendan, as a
Ca²⁺ sensitizer, demonstrated better inotropic and lusitropic
effects than epinephrine. Glycemic homeostasis: Animal models have shown
that hypothermia induces alterations in blood glucose homeostasis via
several mechanisms: reduced glucose utilization [38], decreased endogenous
insulin secretion [39-41], and increased resistance to exogenous insulin
[42,43].

<15>
Accession Number
70823698
Authors
Mavros M. Mitsikostas P. Alexiou V. Peppas G. Falagas M.
Institution
(Mavros, Mitsikostas, Alexiou, Peppas, Falagas) AthensGreece
Title
Gentamicin collagen sponges for the prevention of sternal wound infection:
A meta-analysis of randomised controlled trials.
Source
Clinical Microbiology and Infection. Conference: 22nd European Congress of
Clinical Microbiology and Infectious Diseases London United Kingdom.
Conference Start: 20120331 Conference End: 20120403. Conference
Publication: (var.pagings). 18 (pp 566), 2012. Date of Publication: April
2012.
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: To determine if the application of gentamicin collagen sponges
(GCS) reduces sternal wound infections (SWI) in cardiac surgery patients.
Methods: Meta-analysis of randomized controlled trials (RCTs). Results:
Four RCTs were eligible for inclusion. Pooling data from four RCTs (4672
per-protocol patients), GCS reduced deep SWI (relative risk [RR] = 0.62,
95% confidence intervals [CI]: 0.39-0.97, p = 0.04) and any SWI (RR = 0.61
[0.39, 0.98], p = 0.04). In contrast, no benefit was demonstrated
regarding superficial SWI (four RCTs, 4672 patients, RR = 0.65 [0.34,
1.25], p = 0.20) and all-cause mortality (three RCTs, 3994 patients, RR =
0.90 [0.57, 1.42], p = 0.66). Based on data from two RCTs (3410 patients),
GCS also appeared to reduce surgically treated SWI (RR = 0.59 [0.41,
0.86], p = 0.005). The most commonly isolated pathogens were
coagulase-negative Staphylococcus spp. (38.8%) and S. aureus (29.8%).
(Table presented) Conclusion: GCS appear to reduce SWI rate in cardiac
surgery patients. The statistical heterogeneity among the existing trials
underlines the need for additional large, high-quality RCTs.

<16>
Accession Number
70823082
Authors
Perez M.J. Barrio J.M. Rincon C. Hortal J. Martin-Rabadan P. Pernia S.
Bouza E.
Institution
(Perez, Barrio, Rincon, Hortal, Martin-Rabadan, Pernia, Bouza) MadridSpain
Title
Ethanol lock therapy in the prevention of catheter-related bloodstream
infections after major heart surgery.
Source
Clinical Microbiology and Infection. Conference: 22nd European Congress of
Clinical Microbiology and Infectious Diseases London United Kingdom.
Conference Start: 20120331 Conference End: 20120403. Conference
Publication: (var.pagings). 18 (pp 351), 2012. Date of Publication: April
2012.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: E-Lock has been successful in the cure and eradication of
pathogens in patients with CR-BSI. Randomized trials with E-Lock as a
therapeutic agent, however, are very limited and results are yet
inconclusive. Furthermore, the potential value of Ethanol lock therapy
(E-locks) in the prevention of catheter-related bloodstream infections
(CR-BSI) has not been evaluated. Our work consist in the assessment of the
value of E-Locks in the prevention of CR-BSI in the particular setting of
patients with non-tunneled, short-term, Central Vascular Catheters (CVCs)
in the postoperative period of patients undergoing Major Hear Surgery
(MHS). Methods: This is an academic, prospective, randomized, open and
controlled clinical trial comparing patients with E-Lock and patients
receiving conventional catheter-care (CCC). Patients with CVCs for >48
hours were invited to participate in the study and randomly allocated to
one of the two arms. Patients with E-lock had CCC and all their catheters
ethanol locked for a period of approximately 2 hours per day and catheter.
The control group of patients received CCC according to standard
recommendations. All catheters were withdrawn when clinically required and
the catheter tips were systematically sent for culture. Definitions of
Catheter Colonization and CR-BSI were standard (Mermel et al., CID 2009).
Results: The study is scheduled to finish in 31 December 2011. Up to the
present time, 138 patients with 208 catheters were included. Overall 115
catheters (74 patients) received E-Locks and 93 catheters (64 patients)
received CCC. Both groups were comparable in severity (Euroscore 3.78 vs.
4.31 p = 0.21). The results for the E-Lock and CCC were respectively as
follows: episodes of Catheter Colonization 8.8% vs. 14.34% (p = 0.48),
colonization of catheter's hubs 4.09 vs. 4.40 (p = 0.88), colonization of
skin around catheter entrance 22.54 vs. 22.02 (p = 0.90), CR-BSI 1 vs. 3
(p = 0.24), median days of antibiotic use 7.76 vs. 7.79 (p = 0.99), median
length of ICU stay, 5 vs. 6 days (p = 0.82) and median length of hospital
stay, 11 vs. 14.5 days (p = 0.40). No severe clinical side effects of
E-Locks were observed. The E-Locks were much more time demanding for the
nursing staff than CCC. Conclusion: At this interim analysis, Ethanol
Catheter Locks do not significantly prevent CR-BSIs nor improve in other
surrogate markers of catheter infection. The process is well tolerated by
the patients but cumbersome and time-consuming for the Health Care
Workers.

<17>
Accession Number
70822855
Authors
Tleyjeh I. Alasmari F. Riaz M. Bin Abdulhak A. Baddour L.
Institution
(Tleyjeh, Alasmari, Riaz, Bin Abdulhak, Baddour) RiyadhSaudi Arabia
(Tleyjeh, Alasmari, Riaz, Bin Abdulhak, Baddour) RochesterUnited States
Title
Does preoperative statin therapy reduce postoperative infectious
complications in patients undergoing cardiac surgery? A systematic review
and meta-analysis.
Source
Clinical Microbiology and Infection. Conference: 22nd European Congress of
Clinical Microbiology and Infectious Diseases London United Kingdom.
Conference Start: 20120331 Conference End: 20120403. Conference
Publication: (var.pagings). 18 (pp 272-273), 2012. Date of Publication:
April 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Post cardiac surgery infectious complications are a major
problem with significant morbidity and mortality. Statins have been shown
to have a modulation impact on both innate and adaptive immune system and
anti-inflammatory effects, as well as direct inhibitory effects on
pathogenic microorganisms. Having this pleiotropic effect, statins might
help in the prevention of post-surgical infections. We sought to
systematically examine the association between statins use and the risk of
post-operative infectious complications in patients who undergo cardiac
surgeries. Methods: We searched OVID MEDLINE from 1950 to 2010; EMBASE
from 1988 to 2010; Scientific Web of Science (inception through February
2011), and Elsevier Scopus (inception through February 2011); for any
comparative studies examining the association between statins use and risk
of post-operative infections in patients who undergo cardiac surgeries.
Two reviewers independently extracted data. We contacted study's authors
for missing information. We conducted a random-effects meta-analysis of
individual studies' odds ratios (adjusted for potential confounders).
I-squared was used to examine for heterogeneity. Results: We identified
six cohort studies. All studies were published between 2005 and 2010.
Three studies were conducted in Canada and three in USA. Three studies
were single-center studies, two were population-based, and one was
unclear. Statin exposure ascertainment was based on a review of admission
medication list, or prescription databases. Infectious outcomes were
heterogeneous and included surgical site infections within 30 days,
serious infections (sepsis and deep sternal wound infection) or any
postoperative infection. Use of statins in preoperative period was
associated with a trend for reduced incidence of post-operative infections
in patients who underwent cardiac surgeries (OR 0.81; 95% CI [0.64-1.01]),
I2 = 75% (Figure 1). (Figure presented) Conclusion: Our meta-analysis
suggests that statins use may be associated with a lower risk of
post-operative infectious complications after cardiac surgeries. Given the
safety of statins and the major sequalae of post-operative infections, our
results merit further validation in randomized controlled trials.