EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012484604
Authors
Dong M.-F. Ma Z.-S. Ma S.-J. Chai S.-D. Tang P.-Z. Yao D.-K. Wang L.
Institution
(Dong, Ma, Ma, Chai, Tang, Wang) Department of Cardiac Surgery, Taishan
Medical University, Liaocheng People's Hospital, Liaocheng, Shandong,
China
(Ma, Wang) School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2678, Australia
(Yao) Department of Cardiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
Title
Effect of prostaglandin E1 on pulmonary arterial hypertension following
corrective surgery for congenital heart disease.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 17 (3) (pp
303-307), 2012. Date of Publication: September 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: To evaluate the therapeutic effects of prostaglandin E1 (PGE1)
on residual pulmonary arterial hypertension (PAH) after corrective surgery
for congenital heart disease. Methods: Thirty-one patients with
postoperational PAH were randomly divided into control group (n = 15) and
PGE1 group (n = 16, 6 courses of intravenous PGE1 plus conventional
therapy). Mean pulmonary arterial pressure (MPAP), right ventricular
ejection fraction (RVEF), and left ventricular ejection fraction (LVEF)
were measured by echocardiography before and 3, 6, and 12 months after the
treatment. Arterial oxygen pressure (PaO2) was monitored. Results: In both
groups, MPAP decreased and RVEF, LVEF, and PaO2 increased at 6 and 12
months following surgery. In the PGE1 group, the MPAP (32.2+/-5.2 vs
40.2+/-5.1 mm Hg; P = .008) was lower and RVEF (66.6%+/-6.5% vs
54.9%+/-2.1%; P = .019), LVEF (65.9%+/-3.9% vs 53.5%+/-5.1%; P = .031),
and PaO2 (94.3%+/-11.2% vs 93.1%+/-11.3%; P = .009) was higher than in the
control group 12 months after the surgery. Four patients (26.7%) in the
control group died of pulmonary hypertension crisis, but there was no
death in the PGE1 group (P = .029). Cumulative survival rate in the
control group were 86.7%, 80%, 73.3%, and 73.3% at 1, 2, 3, and 5 years,
respectively. Conclusions: Intravenous PGE1 therapy after corrective
surgery for congenital heart disease was associated with a reduction in
mean pulmonary arterial pressure and a lower risk of death. 2012 The
Author(s).

<2>
Accession Number
2012476872
Authors
Khawaja O. Gaziano M. Djousse L.
Institution
(Khawaja, Gaziano, Djousse) Division of Aging, Brigham and Women's
Hospital and Harvard Medical School, Boston, MA, United States
(Gaziano) Division of Preventive Medicine, Brigham and Women's Hospital
and Harvard Medical School, Boston, MA, United States
(Khawaja, Gaziano, Djousse) Massachusetts Veterans Epidemiology and
Research Information, Geriatric Research, Education, Clinical Center,
Boston Veterans Affairs Healthcare System, Boston, MA, United States
(Gaziano, Djousse) Geriatric Research, Education, Clinical Center, Boston
Veterans Affairs Healthcare System, Boston, MA, United States
Title
A Meta-analysis of omega-3 fatty acids and incidence of atrial
fibrillation.
Source
Journal of the American College of Nutrition. 31 (1) (pp 4-13), 2012. Date
of Publication: February 2012.
Publisher
American College of Nutrition (300 South Duncan Avenue, Clearwater FL
33755, United States)
Abstract
Objectives: Atrial fibrillation (AF) is associated with higher health care
costs. Although omega-3 (n-3) fatty acids have been associated with a
decreased risk of coronary heart disease, their effects on the risk of AF
are inconsistent. We therefore sought to review the relation between n-3
fatty acids and the risk of AF. Methods: Using an extensive online search,
we conducted a meta-analysis of new onset incident/recurrent AF following
exposure to fish/fish oil or long-chain n-3 polyunsaturated fatty acids. A
random-effect model was used and between-studies heterogeneity was
estimated with I². The quality of studies was assessed using
Jadad and United States Preventive Services Task Force (USPSTF) scoring
systems. All analyses were performed with RevMan (version 5.0.20).
Results: Seven cohort studies and 11 randomized controlled trials (RCTs)
were included in this metaanalysis. The pooled odds ratio (OR) was 0.79
(95% confidence interval [CI]=0.56-1.12; p=0.19) for RCTs and 0.83 (95% CI
= 0.59-1.16; p = 0.27) for cohort studies. On sensitivity analysis, no
statistically significant difference was noted when stratified by study
design or quality of the studies (as graded by Jadad or USPSTF scoring
systems). Conclusion: This study does not suggest a major effect of
fish/fish oil or n-3 fatty acids on the risk of AF.

<3>
Accession Number
22910755
Authors
Raber L. Kelbaek H. Ostoijc M. Baumbach A. Heg D. Tuller D. von Birgelen
C. Roffi M. Moschovitis A. Khattab A.A. Wenaweser P. Bonvini R. Pedrazzini
G. Kornowski R. Weber K. Trelle S. Luscher T.F. Taniwaki M. Matter C.M.
Meier B. Juni P. Windecker S. COMFORTABLE AMI Trial Investigators
Institution
(Raber) Department of Cardiology, Bern University Hospital, Bern,
Switzerland.
Title
Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal
stents on cardiovascular events among patients with acute myocardial
infarction: the COMFORTABLE AMI randomized trial.
Source
JAMA : the journal of the American Medical Association. 308 (8) (pp
777-787), 2012. Date of Publication: 22 Aug 2012.
Abstract
The efficacy and safety of drug-eluting stents compared with bare-metal
stents remains controversial in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI). To compare stents eluting biolimus from a
biodegradable polymer with bare-metal stents in primary PCI. A
prospective, randomized, single-blinded, controlled trial of 1161 patients
presenting with STEMI at 11 sites in Europe and Israel between September
19, 2009, and January 25, 2011. Clinical follow-up was performed at 1 and
12 months. Patients were randomized 1:1 to receive the biolimus-eluting
stent (n = 575) or the bare-metal stent (n = 582). Primary end point was
the rate of major adverse cardiac events, a composite of cardiac death,
target vessel-related reinfarction, and ischemia-driven target-lesion
revascularization at 1 year. Major adverse cardiac events at 1 year
occurred in 24 patients (4.3%) receiving biolimus-eluting stents with
biodegradable polymer and 49 patients (8.7%) receiving bare-metal stents
(hazard ratio [HR], 0.49; 95% CI, 0.30-0.80; P = .004). The difference was
driven by a lower risk of target vessel-related reinfarction (3 [0.5%] vs
15 [2.7%]; HR, 0.20; 95% CI, 0.06-0.69; P = .01) and ischemia-driven
target-lesion revascularization (9 [1.6%] vs 32 [5.7%]; HR, 0.28; 95% CI,
0.13-0.59; P < .001) in patients receiving biolimus-eluting stents
compared with those receiving bare-metal stents. Rates of cardiac death
were not significantly different (16 [2.9%] vs 20 [3.5%], P = .53).
Definite stent thrombosis occurred in 5 patients (0.9%) treated with
biolimus-eluting stents and 12 patients (2.1%; HR, 0.42; 95% CI,
0.15-1.19; P = .10) treated with bare-metal stents. Compared with a
bare-metal stent, the use of biolimus-eluting stents with a biodegradable
polymer resulted in a lower rate of the composite of major adverse cardiac
events at 1 year among patients with STEMI undergoing primary PCI.
clinicaltrials.gov Identifier: NCT00962416.

<4>
Accession Number
2012478987
Authors
Yang L. Stanworth S. Hopewell S. Doree C. Murphy M.
Institution
(Yang, Stanworth, Hopewell, Doree, Murphy) Blood and Transplant, Oxford,
United Kingdom
(Yang, Stanworth, Hopewell, Doree, Murphy) Addenbrooke's Hospital,
Cambridge, United Kingdom
(Yang, Stanworth, Hopewell, Doree, Murphy) UK Cochrane Centre, Oxford,
United Kingdom
Title
Is fresh-frozen plasma clinically effective? An update of a systematic
review of randomized controlled trials (CME).
Source
Transfusion. 52 (8) (pp 1673-1686), 2012. Date of Publication: August
2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: The clinical use of frozen plasma (FP) continues to increase,
both in prophylactic and in therapeutic settings. In 2004, a systematic
review of all published randomized controlled trials (RCTs) revealed a
lack of evidence that supported the efficacy of FP use. This is an update
that includes all new RCTs published since the original review. Study
Design and Methods: Trials involving transfusion of FP up to July 2011
were identified from searches of MEDLINE, EMBASE, CINAHL, The Cochrane
Library, and the UKBTS/SRI Transfusion Evidence Library. Methodologic
quality was assessed. The primary outcome measure was the effect of FP on
survival. Results: Twenty-one new trials were eligible for inclusion.
These covered prophylactic and therapeutic FP use in liver disease, in
cardiac surgery, for warfarin anticoagulation reversal, for thrombotic
thrombocytopenic purpura treatment, for plasmapheresis, and in other
settings, including burns, shock, and head injury. The largest number of
recent RCTs were conducted in cardiac surgery; meta-analysis showed no
significant difference for FP use for the outcome of 24-hours
postoperative blood loss (weighted mean difference, -35.24 mL; 95%
confidence interval, -84.16 to 13.68 mL). Overall, there was no
significant benefit for FP use across all the clinical conditions. Only
two of the 21 trials fulfilled all the criteria for quality assessment.
Conclusion: Combined with the 2004 review, 80 RCTs have investigated FP
with no consistent evidence of significant benefit for prophylactic and
therapeutic use across a range of indications evaluated. There has been
little improvement in the overall methodologic quality of RCTs conducted
in the past few years. 2012 American Association of Blood Banks.

<5>
Accession Number
2012469397
Authors
Kim J.-C. Shim J.-K. Lee S. Yoo Y.-C. Yang S.-Y. Kwak Y.-L.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Kyungpook National
University Hospital, Daegu, South Korea
(Shim, Yoo, Yang, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
(Lee) Division of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of combined remote ischemic preconditioning and postconditioning on
pulmonary function in valvular heart surgery.
Source
Chest. 142 (2) (pp 467-475), 2012. Date of Publication: August 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: The aim of this study was to evaluate the lung-protective
effect of combined remote ischemic preconditioning (RIPCpre) and
postconditioning (RIPCpost ) in patients undergoing complex valvular heart
surgery. Methods: In this randomized, placebo-controlled, double-blind
trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a
control group (1:1). Patients in the RIPCpre plus RIPCpost group received
three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both
10 min after anesthetic induction and weaning from cardiopulmonary bypass.
The primary end point was to compare postoperative
Pa_O2/F_IO2. Secondary end points were to compare
pulmonary variables, incidence of acute lung injury, and inflammatory
cytokines. Results: In both groups, Pa_O2/F_IO2 at 24
h postoperation was significantly decreased compared with each
corresponding baseline value. However, intergroup comparisons of pulmonary
variables, including Pa_O2/F_IO2 and incidence of
acute lung injury, revealed no significant differences. Serum levels of
IL-6, IL-8, IL-10, and tumor necrosis factor-alpha were all significantly
increased in both groups compared with each corresponding baseline value,
without any significant intergroup differences. There were also no
significant differences in transpulmonary gradient of IL-6, IL-10, and
tumor necrosis factor- a between the groups. Conclusions: RIPC pre plus
RIPCpost as tested in this randomized controlled trial did not provide
significant pulmonary benefit following complex valvular cardiac surgery.
Trial registry: ClinicalTrials.gov; No.: NCT01427621; URL:
www.clinicaltrials.gov. 2012 American College of Chest Physicians.

<6>
Accession Number
2012469385
Authors
Carteaux G. Lyazidi A. Cordoba-Izquierdo A. Vignaux L. Jolliet P. Thille
A.W. Richard J.-C.M. Brochard L.
Institution
(Carteaux, Cordoba-Izquierdo, Thille, Brochard) Reanimation Medicale,
Groupe Hospitalier Albert Chenevier-Henri Mondor, Universite Paris EST,
Creteil, France
(Carteaux, Lyazidi, Cordoba-Izquierdo, Thille, Brochard) INSERM Unite 955
(Equipe 13), Universite Paris EST, Creteil, France
(Vignaux, Brochard) Department of Intensive Care, Geneva University
Hospital, Geneva University, Geneva, Switzerland
(Jolliet) Service de Medecine Intensive Adulte et Centre des Brules,
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Jolliet) Faculte de Biologie et de Medicine, Universite de Lausanne,
Lausanne, Switzerland
(Richard) Reanimation Medicale, Centre Hospitalier Universitaire Charles
Nicolle, Rouen, France
Title
Patient-ventilator asynchrony during noninvasive ventilation: A bench and
clinical study.
Source
Chest. 142 (2) (pp 367-376), 2012. Date of Publication: August 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: Different kinds of ventilators are available to perform
noninvasive ventilation (NIV) in ICUs. Which type allows the best
patient-ventilator synchrony is unknown. The objective was to compare
patient-ventilator synchrony during NIV between ICU, transport - both with
and without the NIV algorithm engaged - and dedicated NIV ventilators.
Methods: First, a bench model simulating spontaneous breathing efforts was
used to assess the respective impact of inspiratory and expiratory leaks
on cycling and triggering functions in 19 ventilators. Second, a clinical
study evaluated the incidence of patient-ventilator asynchronies in 15
patients during three randomized, consecutive, 20-min periods of NIV using
an ICU ventilator with and without its NIV algorithm engaged and a
dedicated NIV ventilator. Patient-ventilator asynchrony was assessed using
flow, airway pressure, and respiratory muscles surface electromyogram
recordings. Results: On the bench, frequent auto-triggering and delayed
cycling occurred in the presence of leaks using ICU and transport
ventilators. NIV algorithms unevenly minimized these asynchronies, whereas
no asynchrony was observed with the dedicated NIV ventilators in all
except one. These results were reproduced during the clinical study: The
asynchrony index was significantly lower with a dedicated NIV ventilator
than with ICU ventilators without or with their NIV algorithm engaged
(0.5% [0.4%-1.2%] vs 3.7% [1.4%-10.3%] and 2.0% [1.5%-6.6%], P < .01),
especially because of less auto-triggering. Conclusions: Dedicated NIV
ventilators allow better patient-ventilator synchrony than ICU and
transport ventilators, even with their NIV algorithm. However, the NIV
algorithm improves, at least slightly and with a wide variation among
ventilators, triggering and/or cycling off synchronization. 2012 American
College of Chest Physicians.

<7>
Accession Number
21914173
Authors
Siegelaar S.E. Hickmann M. Hoekstra J.B. Holleman F. DeVries J.H.
Institution
(Siegelaar) Department of Internal Medicine, Academic Medical Center,
Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Title
The effect of diabetes on mortality in critically ill patients: a
systematic review and meta-analysis.
Source
Critical care (London, England). 15 (5) (pp R205), 2011. Date of
Publication: 2011.
Abstract
Critically ill patients with diabetes are at increased risk for the
development of complications, but the impact of diabetes on mortality is
unclear. We conducted a systematic review and meta-analysis to determine
the effect of diabetes on mortality in critically ill patients, making a
distinction between different ICU types. We performed an electronic search
of MEDLINE and Embase for studies published from May 2005 to May 2010 that
reported the mortality of adult ICU patients. Two reviewers independently
screened the resultant 3,220 publications for information regarding ICU,
in-hospital or 30-day mortality of patients with or without diabetes. The
number of deaths among patients with or without diabetes and/or mortality
risk associated with diabetes was extracted. When only crude survival data
were provided, odds ratios (ORs) and standard errors were calculated. Data
were synthesized using inverse variance with ORs as the effect measure. A
random effects model was used because of anticipated heterogeneity. We
included 141 studies comprising 12,489,574 patients, including 2,705,624
deaths (21.7%). Of these patients, at least 2,327,178 (18.6%) had
diabetes. Overall, no association between the presence of diabetes and
mortality risk was found. Analysis by ICU type revealed a significant
disadvantage for patients with diabetes for all mortality definitions when
admitted to the surgical ICU (ICU mortality: OR [95% confidence interval]
1.48 [1.04 to 2.11]; in-hospital mortality: 1.59 [1.28 to 1.97]; 30-day
mortality: 1.62 [1.13 to 2.34]). In medical and mixed ICUs, no effect of
diabetes on all outcomes was found. Sensitivity analysis showed that the
disadvantage in the diabetic surgical population was attributable to
cardiac surgery patients (1.77 [1.45 to 2.16], P < 0.00001) and not to
general surgery patients (1.21 [0.96 to 1.53], P = 0.11). Our
meta-analysis shows that diabetes is not associated with increased
mortality risk in any ICU population except cardiac surgery patients.

<8>
Accession Number
22032777
Authors
Mitaka C. Kudo T. Haraguchi G. Tomita M.
Institution
(Mitaka) Department of Critical Care Medicine, Tokyo Medical and Dental
University Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan.
Title
Cardiovascular and renal effects of carperitide and nesiritide in
cardiovascular surgery patients: a systematic review and meta-analysis.
Source
Critical care (London, England). 15 (5) (pp R258), 2011. Date of
Publication: 2011.
Abstract
Acute kidney injury (AKI) following cardiovascular surgery is a common
disease process and is associated with both morbidity and mortality. The
aim of our study was to evaluate the cardiovascular and renal effects of
an atrial natriuretic peptide (ANP, carperitide) and a B-type (or brain)
natriuretic peptide (BNP, nesiritide) for preventing and treating AKI in
cardiovascular surgery patients. Electronic databases, including PubMed,
EMBASE and references from identified articles were used for a literature
search. Data on the infusion of ANP or BNP in cardiovascular surgery
patients was collected from fifteen randomized controlled trials and
combined. The infusion of ANP or BNP increased the urine output and
creatinine clearance or glomerular filtration rate, and reduced the use of
diuretics and the serum creatinine levels. A meta-analysis showed that ANP
infusion significantly decreased peak serum creatinine levels, incidence
of arrhythmia and renal replacement therapy. The meta-analysis also showed
that ANP or BNP infusion significantly decreased the length of ICU stay
and hospital stay compared with controls. However, the combined data were
insufficient to determine how ANP or BNP infusion during the perioperative
period influences long-term outcome in cardiovascular surgery patients.
The infusion of ANP or BNP may preserve postoperative renal function in
cardiovascular surgery patients. A large, multicenter, prospective,
randomized controlled trial will have to be performed to assess the
therapeutic potential of ANP or BNP in preventing and treating AKI in the
cardiovascular surgical setting.

<9>
Accession Number
2012470208
Authors
Saczkowski R. Maklin M. Mesana T. Boodhwani M. Ruel M.
Institution
(Saczkowski, Maklin, Mesana, Boodhwani, Ruel) Department of Cardiac
Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
Title
Centrifugal Pump and Roller Pump in Adult Cardiac Surgery: A Meta-Analysis
of Randomized Controlled Trials.
Source
Artificial Organs. 36 (8) (pp 668-676), 2012. Date of Publication: August
2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Centrifugal pump (CP) and roller pump (RP) designs are the dominant main
arterial pumps used in cardiopulmonary bypass (CPB). Trials reporting
clinical outcome measures comparing CP and RP are controversial.
Therefore, a meta-analysis was undertaken to evaluate clinical variables
from randomized controlled trials (RCTs). Keyword searches were performed
on Medline (1966-2011), EmBase (1980-2011), and CINAHL (1981-2011) for
studies comparing RP and CP as the main arterial pump in adult CPB. Pooled
fixed-effects estimates for dichotomous and continuous data were
calculated as an odds ratio and weighted-mean difference, respectively.
The P value was utilized to assess statistical significance (P<0.05)
between CP and RP groups. Eighteen RCTs met inclusion criteria, which
represented 1868 patients (CP=961, RP=907). The prevailing operation was
isolated coronary artery bypass graft surgery (CP=88%, RP=87%).
Fixed-effects pooled estimates were performed for end-of-CPB (ECP) and
postoperative day one (PDO) for platelet count (ECP: P=0.51, PDO: P=0.16),
plasma free hemoglobin (ECP: P=0.36, PDO: P=0.24), white blood cell count
(ECP: P=0.21, PDO: P=0.66), and hematocrit (ECP: P=0.06, PDO: P=0.51). No
difference was demonstrated for postoperative blood loss (P=0.65) or red
blood cell transfusion (P=0.71). Intensive care unit length of stay
(P=0.30), hospital length of stay (P=0.33), and mortality (P=0.91) were
similar between the CP and RP groups. Neurologic outcomes were not
amenable to pooled analysis; nevertheless, the results were inconclusive.
There was no reported pump-related malfunction or mishap. The
meta-analysis of RCTs comparing CP and RP in adult cardiac surgery
suggests no significant difference for hematological variables,
postoperative blood loss, transfusions, neurological outcomes, or
mortality. 2012, the Authors. Artificial Organs 2012, International
Center for Artificial Organs and Transplantation and Wiley Periodicals,
Inc.

<10>
Accession Number
2012475688
Authors
Fath-Ordoubadi F. Barac Y. Abergel E. Danzi G.B. Kerner A. Nikolsky E.
Halabi M. Mamas M. El-Omar M. Fraser D. Roguin A.
Institution
(Fath-Ordoubadi, Mamas, El-Omar, Fraser) Department of Cardiology, Royal
Infirmary, Manchester, United Kingdom
(Barac, Abergel, Kerner, Nikolsky, Halabi, Roguin) Department of
Cardiology, Rambam Medical Center, Haifa, Israel
(Danzi) Department of Cardiology, Fondazione IRCCS Ca Granda, Ospedale
Maggiore Policlinico, Milan, Italy
Title
Gender impact on prognosis of acute coronary syndrome patients treated
with drug-eluting stents.
Source
American Journal of Cardiology. 110 (5) (pp 636-642), 2012. Date of
Publication: 01 Sep 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Women have a higher risk of adverse outcomes after percutaneous coronary
intervention (PCI) than men. However, in acute coronary syndrome (ACS),
long-term outcomes after contemporary PCI with drug-eluting stent (DES)
have not been fully investigated. We aimed to test the impact of gender on
outcomes in patients with ACS after PCI with DES. We analyzed all patients
with ACS from the prospective NOBORI-2 trial who underwent PCI with a
Nobori DES from 2008 through 2009 in 125 centers worldwide. End points of
the study were target lesion failure, cardiac death, myocardial infarction
(MI), and clinically driven target lesion revascularization, and major
adverse cardiac events (composite of cardiac death, MI, and target vessel
revascularization) at 1 year and yearly up to 5 years. There were 1,640
patients with ACS, 1,268 men (77%) and 372 women (23%). Compared to men,
women were 5 years older and more frequently had co-morbidities such as
diabetes mellitus and hypertension. There were no gender differences for
cardiac death (1.3% vs 2.7%), MI (2.1% vs 3.2%), or target lesion
revascularization (2.6% vs 3.8%) at 1 year after the procedure for men and
women, respectively. The trend was the same at 2 years (cardiac death 2.0%
vs 2.3%, MI 2.5% vs 3.5%, target lesion revascularization 3.2% vs 4.6%).
Target lesion failure rates were 4.5% and 5.9% at 1 year and 5.7% and 7.3%
at 2 years in men and women, respectively (p = NS). Multivariate analysis,
which included age, hypertension, diabetes mellitus, and number of
diseased vessels, showed that gender was not a predictor for outcome.
There were no differences in bleeding or stent thrombosis rates. Relief
from anginal symptoms was similar. The same rate of adherence to dual
antiplatelet therapy was observed and reached 73% at 1 year and 31% at 2
years after the ACS event and PCI. In conclusion, although women had worse
baseline characteristics, no differences in outcomes were observed between
men and women treated for ACS with contemporary DES. 2012 Elsevier Inc.
All rights reserved.

<11>
Accession Number
22499961
Authors
Litton E. Delaney A.
Institution
(Litton) Intensive Care Unit, Royal Perth Hospital, Western Australia.
Title
Preoperative intra-aortic balloon pump in high-risk coronary bypass
grafting.
Source
Asian cardiovascular & thoracic annals. 20 (2) (pp 146-152), 2012. Date of
Publication: Apr 2012.
Abstract
Prophylactic intra-aortic balloon pumping prior to coronary artery bypass
grafting is employed variably despite some evidence to support its use.
The aim of this study was to describe the characteristics, preoperative
balloon pump utilization, and outcomes of high-risk patients undergoing
coronary artery bypass. The study cohort included all patients in the
Australian National Cardiac Surgery Database over an 8 year period. The
primary outcome was 30-day mortality adjusted for preoperative illness
severity. Coronary artery bypass was performed in 18,662 patients
including 2,348 (12.6%) identified as high-risk. Of these high-risk
patients, 359 (15.3%) received a balloon pump preoperatively. For
high-risk patients, 30-day mortality was significantly higher in those
with a preoperative balloon pump than in those who did not receive a
preoperative balloon pump (15.3% vs. 4.9%). After adjusting for
preoperative illness severity, there was no significant association
between preoperative balloon pumping and 30-day mortality. High-risk
patients represent a significant proportion of those undergoing coronary
artery bypass grafting. Despite their increased risk of postoperative
mortality, only a small minority currently receive a preoperative balloon
pump. After adjusting for illness severity, there was no significant
association between preoperative balloon pumping and 30-day mortality,
although we could not rule out a 20% reduction in mortality.

<12>
Accession Number
2012473992
Authors
D'Ascenzo F. Cavallero E. Moretti C. Omede P. Sciuto F. Rahman I.A. Bonser
R.S. Yunseok J. Wagner R. Freiberger T. Kunst G. Marber M.S. Thielmann M.
Ji B. Amr Y.M. Modena M.G. Zoccai G.B. Sheiban I. Gaita F.
Institution
(D'Ascenzo, Cavallero, Moretti, Omede, Sciuto, Sheiban, Gaita) Division of
Cardiology, University of Turin, Turin, Italy
(D'Ascenzo, Moretti, Zoccai) Meta-analysis and Evidence Based Medicine
Training in Cardiology (METCARDIO), Ospedaletti, Italy
(Rahman, Bonser) Department of Cardiothoracic Surgery, University Hospital
Birmingham NHS Trust, Birmingham, United Kingdom
(Yunseok) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul, South Korea
(Wagner, Freiberger) Centre for Cardiovascular Surgery and
Transplantation, Brno, Czech Republic
(Freiberger) Ceitec, Masaryk University, Brno, Czech Republic
(Kunst, Marber) Department of Anaesthetics, Intensive Care Medicine and
Pain Therapy, King's College Hospital NHS Foundation Trust, London, United
Kingdom
(Thielmann) Department of Thoracic and Cardiovascular Surgery, West-German
Heart Center Essen, University Hospital Essen, Germany
(Ji) Department of Cardiopulmonary Bypass, Cardiovascular Institute and
Fuwai Hospital, PUMC and CAMS, Beijing, China
(Amr) Tanta Faculty of Medicine, Egypt
(Modena, Zoccai) Division of Cardiology, University of Modena and Reggio
Emilia, Modena, Italy
Title
Remote ischaemic preconditioning in coronary artery bypass surgery: A
meta-analysis.
Source
Heart. 98 (17) (pp 1267-1271), 2012. Date of Publication: September 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Aim: Randomised trials exploring remote ischaemic preconditioning (RIPC)
in patients undergoing coronary artery bypass graft (CABG) surgery have
yielded conflicting data regarding potential cardiovascular and renal
protection, and are individually flawed by small sample size. Methods:
Three investigators independently searched the MEDLINE, EMBASE and
Cochrane databases to identify randomised trials testing RIPC in patients
undergoing CABG. Results: Nine studies with 704 patients were included.
Standardised mean difference of troponin I and T release showed a
significant decrease (-0.36 (95% CI -0.62 to -0.09)). This difference held
true after excluding the trials with cross-clamp fibrillation, the study
with off-pump CABG and studies using a flurane as anaesthetic agent (-0.41
(95% CI -0.69 to -0.12), -0.38 (95% CI -0.70 to -0.07) and -0.37 (95% CI
-0.63 to -0.12), respectively). A similar trend was also obtained for
patients with multivessel disease (-0.41 (95% CI -0.73 to -0.08)). The
trials evaluating postoperative creatinine reported a non-significant
reduction (0.02 (95% CI -0.09 to 0.13)). Moreover, the length of
in-hospital stay was not influenced by the kind of treatment (weighted
mean difference 0.27 (95% CI -0.24 to 0.79)). Conclusion: RIPC reduced the
release of troponin in patients undergoing CABG. Larger randomised trials
are needed to clarify the presence of a causal relationship between
RIPC-induced troponin release and clinical adverse events.

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Accession Number
70839115
Authors
Kaw R. Pasupuleti V. Alraies M.C. Hernandez A.V.
Institution
(Kaw, Pasupuleti, Alraies, Hernandez) Cleveland Clinic, Cleveland, OH,
United States
Title
Effect of obesity on duration of mechanical ventilation in the surgical
intensive care unit.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2010 New Orleans,
LA United States. Conference Start: 20100514 Conference End: 20100519.
Conference Publication: (var.pagings). 181 (1 MeetingAbstracts) , 2010.
Date of Publication: 01 May 2010.
Publisher
American Thoracic Society
Abstract
Rationale: Nearly one-third of intensive care unit (ICU) patients are
obese and nearly 7% are morbidly obese. Obese patients are prone to
atelectasis, aspiration and have decreased lung and chest wall compliance.
Consequently, increased duration of mechanical ventilation (MV) and longer
ICU stay has been reported in critically sick obese patients compared to
non-obese. However, a recent meta-analysis reported no association between
obesity and duration of MV in critically sick patients.Obesity has not
been associated with postoperative pulmonary complications and no studies
have reported its effect on duration of MV in patients in surgical ICU.
Methods: We included cohort studies evaluating the association between
obesity (BMI>=30) and duration of mechanical ventilation in patients
admitted to a surgical ICU. We classified studies according to baseline
risk of moderate to high mortality among patients undergoing emergency
non-cardiac surgical (NCS); trauma surgery and patients undergoing
elective Coronary Artery Bypass Graft (CABG). Three investigators
conducted independent literature searches using Medline, the Web of
Sciences and Scopus until September 1, 2009. The association between
obesity and duration of MV was expressed as the mean difference (MD) in
days and its 95% confidence interval (CI). Analysis was stratified by risk
of studies and random effects models were used to account for
heterogeneity. Results: A total of 14 studies that provided duration of MV
with mean and standard deviation in obese and non-obese groups were
included. The eight NCS and trauma studies had a total of 8069 patients
(1906 [24%] obese). In these studies, duration of MV was non-significantly
longer for the obese than for the non-obese group (MD 0.85 days, 95% CI
-0.37 to 2.07, p = 0.2). Differences of duration of MV were significantly
heterogeneous among NCS and trauma studies (I²=97%, p<0.00001).
The six CABG studies included 16715 patients (3035 [18%] obese). The
duration of MV was slightly longer for the obese than for the non-obese
group (MD 0.07 days, 95% CI 0.01 to 0.13, p=0.02); however, this
difference was deemed as clinically non-significant. Differences in
duration of MV were homogeneous among CABG studies (I²=26%,
p=0.2). Conclusions: There is no difference in the duration of MV between
obese and non-obese patients after emergency non-cardiac and elective
cardiac surgery. Given marked heterogeneity of the data (except in
patients with CABG) as well as lack of risk adjustment for potential
differences in severity of illness between the obese and non-obese, these
results should be viewed with caution.