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<1>
Accession Number
2012576590
Authors
Cormack F. Shipolini A. Awad W.I. Richardson C. McCormack D.J. Colleoni L.
Underwood M. Baldeweg T. Hogan A.M.
Institution
(Cormack) MRC Cognition and Brain Sciences Unit, 15 Chaucer Road,
Cambridge, United Kingdom
(Shipolini, Awad, McCormack, Colleoni, Hogan) Barts and The London NHS
Trust, Queen Mary University of London, United Kingdom
(Richardson) Brighton and Sussex Medical School, University of Sussex,
Brighton, United Kingdom
(Underwood) Prince of Wales Hospital, Shatin, NT, Hong Kong
(Baldeweg, Hogan) UCL Institute of Child Health, Guildford Street, London,
United Kingdom
(Hogan) University College London Hospital NHS Trust, Euston Road, London,
United Kingdom
Title
A meta-analysis of cognitive outcome following coronary artery bypass
graft surgery.
Source
Neuroscience and Biobehavioral Reviews. 36 (9) (pp 2118-2129), 2012. Date
of Publication: October 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Coronary artery bypass graft (CABG) surgery is an established treatment
for complex coronary artery disease. There is a widely held belief that
cognitive decline presents post-operatively. A consensus statement of core
neuropsychological tests was published in 1995 with the intention of
guiding investigation into this issue. We conducted a meta-analysis
evaluating the evidence for cognitive decline post-CABG surgery.
Twenty-eight published studies, accumulating data from up to 2043 patients
undergoing CABG surgery, were included. Results were examined at 'very
early' (<2 weeks), 'early' (3 months) and 'late' (6-12 months) time
periods post-operatively. Two of the four tests suggested an initial very
early decrease in psychomotor speed that was not present at subsequent
testing. Rather, the omnibus data indicated subtle improvement in function
relative to pre-operative baseline testing. Our findings suggest
improvement in cognitive function in the first year following CABG
surgery. This is contrary to the more negative interpretation of results
of some individual publications included in our review, which may reflect
poor outcomes in a few patients and/or methodological issues. 2012
Elsevier Ltd.
<2>
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Accession Number
2012574547
Authors
Dale O. Somogyi A.A. Li Y. Sullivan T. Shavit Y.
Institution
(Dale, Somogyi, Li, Shavit) Discipline of Pharmacology, Faculty of Health
Sciences, University of Adelaide, Adelaide, Australia
(Dale) Department of Circulation and Medical Imaging, Pain and Palliation
Research Group, Norwegian University of Science and Technology, N-7491
Trondheim, Norway
(Dale) Department of Anaesthesia and Emergency Medicine, St. Olav's
University Hospital, Trondheim, Norway
(Sullivan) Discipline of Public Health, Faculty of Health Sciences,
University of Adelaide, Adelaide, Australia
(Shavit) Department of Psychology, Hebrew University, Jerusalem, Israel
Title
Does intraoperative ketamine attenuate inflammatory reactivity following
surgery? A systematic review and meta-analysis.
Source
Anesthesia and Analgesia. 115 (4) (pp 934-943), 2012. Date of Publication:
October 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Reports regarding the ability of the anesthetic drug ketamine
to attenuate the inflammatory response to surgery are conflicting. In this
systematic review we examined the effect of perioperative ketamine
administration on postoperative inflammation as assessed by concentrations
of the biomarker interleukin-6 (IL-6). Methods: This study was based on a
systematic search in PubMed, Scopus, Web of Knowledge, and the Cochrane
Library. English written randomized controlled trials conducted in humans
were eligible. To be included in the analysis, outcome had to relate to
inflammation or immune modulation. Each study was reviewed independently
by 2 assessors. Data were analyzed according to the GRADE's approach and
reported in compliance with the PRISMA recommendations. Results: Fourteen
studies were eligible for evaluation (684 patients). Surgery was performed
under general anesthesia, and ketamine was given before or during the
surgery in varied doses Eight studies involved cardiopulmonary bypass
operations, 4 were for abdominal surgery, 1 thoracic surgery, and 1
cataract surgery. Three studies were deemed of low quality. Nine studies
measured IL-6 concentrations within the first 6 hours postoperatively; but
in 3 studies, other potent anti-inflammatory drugs were used as
premedication or during the operation; thus 6 studies (n = 331) were
included in the meta-analysis. Using postoperative IL-6 concentrations as
an outcome, ketamine had an anti-inflammatory effect; the meta-analysis
showed a mean preoperative-postoperative IL-6 concentration difference
(95% confidence interval) of -71 (-101 to -41) pg/mL. Conclusions: It can
be concluded that intraoperative administration of ketamine significantly
inhibits the early postoperative IL-6 inflammatory response. Future
studies should further examine the anti-inflammatory effect of ketamine
during major surgery, determine whether ketamine treatment alters
functional outcomes, elucidate the mechanisms of its anti-inflammatory
effect, and suggest an appropriate dosing regimen. Copyright 2012
International Anesthesia Research Society.
<3>
Accession Number
2012569451
Authors
Hirsch J.C. Jacobs M.L. Andropoulos D. Austin E.H. Jacobs J.P. Licht D.J.
Pigula F. Tweddell J.S. Gaynor J.W.
Institution
(Hirsch) Department of Cardiac Surgery, University of Michigan Medical
Center, Ann Arbor, MI, United States
(Jacobs) Department of Pediatric and Congenital Heart Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Andropoulos) Departments of Anesthesiology and Pediatrics, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Austin) Department of Surgery, University of Louisville, Kosair
Children's Hospital, Louisville, KY, United States
(Jacobs) Department of Cardiac Surgery, All Children's Hospital,
University of South, Tampa, FL, United States
(Licht) Department of Pediatrics, Division of Neurology, Children's
Hospital of Philadelphia, Philadelphia, PA, United States
(Gaynor) Department of Surgery, Division of Pediatric Cardiothoracic
Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Pigula) Department of Cardiac Surgery, Children's Hospital of Boston,
Boston, MA, United States
(Tweddell) Department of Surgery, Division of Cardiothoracic Surgery,
Medical College of Wisconsin, Milwaukee, WI, United States
Title
Protecting the infant brain during cardiac surgery: A systematic review.
Source
Annals of Thoracic Surgery. 94 (4) (pp 1365-1373), 2012. Date of
Publication: October 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Prevention of brain injury during congenital heart surgery has focused on
intraoperative and perioperative neuroprotection and neuromonitoring. Many
strategies have been adopted as "standard of care." However, the strength
of evidence for these practices and the relationship to long-term outcomes
are unknown. We performed a systematic review (January 1, 1990 to July 30,
2010) of neuromonitoring and neuroprotection strategies during
cardiopulmonary bypass (CPB) in infants of age 1 year or less. Papers were
graded individually and as thematic groups, assigning evidence-based
medicine and American College of Cardiology/American Heart Association
(ACC/AHA) level of evidence grades. Consensus scores were determined by
adjudication. Literature search identified 527 manuscripts; 162 met
inclusion criteria. Study designs were prospective observational cohort
(53.7%), case-control (21.6%), randomized clinical trial (13%), and
retrospective observational cohort (9.9%). Median sample size was 43
(range 3 to 2,481). Primary outcome was evidence of structural brain
injury or functional disability (neuroimaging, electroencephalogram,
formal neurologic examination, or neurodevelopmental testing) in 43%.
Follow-up information was reported in only 29%. The most frequent level of
evidence was evidence-based medicine level 4 (33.3%) or ACC/AHA class IIB:
level B (42%). The only intervention with sufficient evidence to recommend
"the procedure or treatment should be performed" was avoidance of extreme
hemodilution during CPB. Data supporting use of current neuromonitoring
and neuroprotective techniques are limited. The level of evidence is
insufficient to support effectiveness of most of these strategies.
Well-designed studies with correlation to clinical outcomes and long-term
follow-up are needed to develop guidelines for neuromonitoring and
neuroprotection during CPB in infants. 2012 The Society of Thoracic
Surgeons.
<4>
Accession Number
2012567118
Authors
Sato H. Carvalho G. Sato T. Hatzakorzian R. Lattermann R. Codere-Maruyama
T. Matsukawa T. Schricker T.
Institution
(Sato, Carvalho, Sato, Hatzakorzian, Lattermann, Codere-Maruyama,
Schricker) Department of Anaesthesia, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Matsukawa) Department of Anesthesiology, Yamanashi University, Yamanashi,
Japan
Title
Statin intake is associated with decreased insulin sensitivity during
cardiac surgery.
Source
Diabetes Care. 35 (10) (pp 2095-2099), 2012. Date of Publication: October
2012.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE - Surgical trauma impairs intraoperative insulin sensitivity and
is associated with postoperative adverse events. Recently, preprocedural
statin therapy is recommended for patients with coronary artery disease.
However, statin therapy is reported to increase insulin resistance and the
risk of new-onset diabetes. Thus, we investigated the association between
preoperative statin therapy and intraoperative insulin sensitivity in
nondiabetic, dyslipidemic patients undergoing coronary artery bypass
grafting. RESEARCH DESIGN AND METHODS - In this prospective, nonrandomized
trial, patients taking lipophilic statins were assigned to the statin
group and hypercholesterolemic patients not receiving any statins were
allocated to the control group. Insulin sensitivity was assessed by the
hyperinsulinemic-normoglycemic clamp technique during surgery. The mean,
SD of blood glucose, and the coefficient of variation (CV) after surgery
were calculated for each patient. The association between statin use and
intraoperative insulin sensitivity was tested by multiple regression
analysis. RESULTS - We studied 120 patients. In both groups, insulin
sensitivity gradually decreased during surgery with values being on
average ~20% lower in the statin than in the control group. In the statin
group, the mean blood glucose in the intensive care unit was higher than
in the control group (153 +/- 20 vs. 140 +/- 20 mg/dL; P < 0.001). The
oscillation of blood glucose was larger in the statin group (SD, P <
0.001; CV, P = 0.001). Multiple regression analysis showed that statin use
was independently associated with intraoperative insulin sensitivity (beta
= -0.16; P = 0.03). CONCLUSIONS - Preoperative use of lipophilic statins
is associated with increased insulin resistance during cardiac surgery in
nondiabetic, dyslipidemic patients. 2012 by the American Diabetes
Association.
<5>
Accession Number
2012571642
Authors
Agus M.S.D. Steil G.M. Wypij D. Costello J.M. Laussen P.C. Langer M.
Alexander J.L. Scoppettuolo L.A. Pigula F.A. Charpie J.R. Ohye R.G. Gaies
M.G.
Institution
(Agus, Steil, Wypij, Costello, Laussen, Alexander, Scoppettuolo, Pigula)
Boston Children's Hospital, Harvard Medical School, Boston, MA, United
States
(Langer) Tufts University School of Medicine, Boston, MA, United States
(Charpie, Ohye) Maine Medical Center, Portland, ME, United States
(Gaies) C.S. Mott Children's Hospital, University of Michigan Medical
School, Ann Arbor, MI, United States
Title
Tight glycemic control versus standard care after pediatric cardiac
surgery.
Source
New England Journal of Medicine. 367 (13) (pp 1208-1219), 2012. Date of
Publication: 27 Sep 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In some studies, tight glycemic control with insulin improved
outcomes in adults undergoing cardiac surgery, but these benefits are
unproven in critically ill children at risk for hyperinsulinemic
hypoglycemia. We tested the hypothesis that tight glycemic control reduces
morbidity after pediatric cardiac surgery. METHODS: In this two-center,
prospective, randomized trial, we enrolled 980 children, 0 to 36 months of
age, undergoing surgery with cardiopulmonary bypass. Patients were
randomly assigned to either tight glycemic control (with the use of an
insulindosing algorithm targeting a blood glucose level of 80 to 110 mg
per deciliter [4.4 to 6.1 mmol per liter]) or standard care in the cardiac
intensive care unit (ICU). Continuous glucose monitoring was used to guide
the frequency of blood glucose measurement and to detect impending
hypoglycemia. The primary outcome was the rate of health care-associated
infections in the cardiac ICU. Secondary outcomes included mortality,
length of stay, organ failure, and hypoglycemia. RESULTS: A total of 444
of the 490 children assigned to tight glycemic control (91%) received
insulin versus 9 of 490 children assigned to standard care (2%). Although
normoglycemia was achieved earlier with tight glycemic control than with
standard care (6 hours vs. 16 hours, P<0.001) and was maintained for a
greater proportion of the critical illness period (50% vs. 33%, P<0.001),
tight glycemic control was not associated with a significantly decreased
rate of health care-associated infections (8.6 vs. 9.9 per 1000
patient-days, P = 0.67). Secondary outcomes did not differ significantly
between groups, and tight glycemic control did not benefit high-risk
subgroups. Only 3% of the patients assigned to tight glycemic control had
severe hypoglycemia (blood glucose <40 mg per deciliter [2.2 mmol per
liter]). CONCLUSIONS: Tight glycemic control can be achieved with a low
hypoglycemia rate after cardiac surgery in children, but it does not
significantly change the infection rate, mortality, length of stay, or
measures of organ failure, as compared with standard care. (Funded by the
National Heart, Lung, and Blood Institute and others; SPECS
ClinicalTrials.gov number, NCT00443599.) Copyright 2012 Massachusetts
Medical Society.
<6>
Accession Number
2012571045
Authors
Masoumi G. Pour E.H. Sadeghpour A. Ziayeefard M. Alavi M. Anbardan S.J.
Shirani S.
Institution
(Masoumi) Department of Cardiology, Shahid Rajaee Hospital, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
(Pour, Sadeghpour, Ziayeefard, Alavi) Department of Cardiology, Shahid
Rajaee Hospital, Iran University of Medical Science, Tehran, Iran, Islamic
Republic of
(Anbardan) Tehran University of medical science, Tehran, Iran, Islamic
Republic of
(Shirani) Department of Cardiology, Shahid Chamran Hospital, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
Title
Effect of different dosages of nitroglycerin infusion on arterial blood
gas tensions in patients undergoing on- pump coronary artery bypass graft
surgery.
Source
Journal of Research in Medical Sciences. 17 (2) (pp 123-127), 2012. Date
of Publication: 2012.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: On-pump coronary artery bypass graft (CABG) surgery impairs
gas exchange in the early postoperative period. The main object on this
study was evaluation of changes in arterial blood gas values in patients
underwent on pump CABG surgery receiving different dose of intravenous
nitroglycerin (NTG). Materials and Methods: sixty-seven consecutive
patients undergoing elective on-pump CABG randomly enrolled into three
groups receiving NTG 50 mug/min (Group N1, n =67), 100 mug/min (Group N2,
n = 67), and 150 mug/min (Group N3, n = 67). Arterial blood gas (ABG)
tensions were evaluated just before induction of anesthesia, during
anesthesia, at the end of warming up period, and 6 h after admission to
the intensive care unit. Results: Pao2 and PH had the highest value during
surgery in Group N1, Group N2, and Group N3. No significant difference was
noted in mean values of Pao2 and PH during surgery between three groups (P
> 0.05). There was no significant difference in HCO<sub>3</sub> values in
different time intervals among three groups (P > 0.05). Conclusion: our
results showed that infusing three different dosage of NTG (50, 100, and
150 mug/min) had no significant effect on ABG tensions in patients
underwent on-pump CABG surgery.
<7>
Accession Number
2012569423
Authors
Liu Y. Zhang S.-L. Duan W.-X. Lei L.-P. Yu S.-Q. Qian X.-H. Jin Z.-X.
Institution
(Liu, Zhang, Duan, Lei, Yu, Jin) Department of Cardiovascular Surgery,
Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
(Qian) Department of Pediatric Medicine, Xijing Hospital, Fourth Military
Medical University, Xi'an, Shaanxi Province, China
(Zhang) Department of Cardiovascular Surgery, Shaanxi Provincial Armed
Police Corps Hospital, Xi'an, Shaanxi Province, China
Title
The myocardial protective effects of a moderate-potassium blood
cardioplegia in pediatric cardiac surgery: A randomized controlled trial.
Source
Annals of Thoracic Surgery. 94 (4) (pp 1295-1301), 2012. Date of
Publication: October 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: We investigated the myocardial protective effect of a
moderate-potassium cold blood cardioplegic solution (K<sup>+</sup>, 10
mmol/L) in pediatric cardiac surgery. Methods: Sixty-eight pediatric
patients with congenital heart disease and undergoing open heart surgery
with cardiopulmonary bypass were randomly allocated to the high potassium
(HP [K<sup>+</sup>, 20 mmol/L, n = 31]) cold blood cardioplegia group or
the moderate potassium (MP [K<sup>+</sup>, 10 mmol/L, n = 37]) cold blood
cardioplegia group. Heart arresting time, rhythm recovery time, mechanical
ventilation time, inotropic drug use in the intensive care unit,
perioperative serum cardiac troponin I concentrations, morbidities, and
mortalities were compared between the two groups. Results: There were no
differences in cardiopulmonary bypass time, aorta cross-clamping time,
cardioplegia volume, lowest body temperature during cardiopulmonary
bypass, total volume of cardioplegia delivered, hematocrit value, and
fluid output during the operation between the two groups. However, there
was a longer arresting time and a shorter rhythm recovery time in the MP
group (35.6 +/- 2.4 s, and 30.8 +/- 3.1 s) when compared with that in the
HP group (24.7 +/- 2.7 s, and 42.0 +/- 4.0 s, both p < 0.05). The total
mediastinal drainage volume, the length of stay in the intensive care
unit, the postoperative inotropic drug use, and the postoperative hospital
time were similar between the two groups, but the number of patients with
a long postoperative mechanical ventilation time (>24 hours) in the MP
group (6 of 36) was less than that in HP group (13 of 30; p < 0.05). At 1
hour, 3 hours, and 6 hours after myocardium reperfusion, the serum
concentration of cardiac troponin I significantly decreased in the MP
group (in ng/mL: 15.18 +/- 3.57, 24.83 +/- 4.91, and 19.62 +/- 3.93,
respectively) when compared with that in the HP group (in ng/mL: 32.67 +/-
5.31, 39.26 +/- 7.43, and 30.52 +/- 5.17, respectively, p < 0.05).
Conclusions: The present study demonstrated that the M (10 mmol/L) cold
blood cardioplegia formula is associated with better myocardial protective
effects when compared with conventional HP cardioplegia in pediatric
patients. 2012 The Society of Thoracic Surgeons.
<8>
Accession Number
22234002
Authors
Canguven O. Albayrak S. Selimoglu A. Balaban M. Sasmazel A. Baysal A.
Institution
(Canguven, Albayrak, Selimoglu, Balaban) Clinic of Urology II, Kartal
Teaching and Research Hospital, Istanbul, Turkey
(Sasmazel) Department of Cardiac Surgery, Kartal Kosuyolu Heart and
Research Center, Istanbul, Turkey
(Baysal) Department of Anesthesiology, Kartal Kosuyolu Heart and Research
Center, Istanbul, Turkey
Title
The effect of cardiopulmonary bypass in coronary artery bypass surgeries
(on-pump versus off-pump) on erectile function and endothelium-derived
nitric oxide levels.
Source
International Braz J Urol. 37 (6) (pp 733-738), 2011. Date of Publication:
November/December 2011.
Publisher
Brazilian Society of Urology (Rua Bambina 153, Rio de Janeiro, RJ
22251-050, Brazil)
Abstract
Purpose: To investigate the effects of on-pump and off-pump coronary
artery bypass grafting (cabg) on the erectile Function and
endothelium-derived nitric oxide (eno) levels. Materials and methods:
twenty-eight consecutive patients were randomized into two groups
depending on use of cardiopulmonary Bypass in cabg surgery. The erectile
function was evaluated by using the iief-5 questionnaire. The Plasma eno
levels were determined at baseline and after reactive hyperemia before and
after surgery. Blood was collected In one minute after cuff deflation from
the radial artery on the same side. Results: after cabg surgery the mean
iief-5 score increased insignificantly over baseline from 14.8 to 15.8 (p
= 0.29) And 12.4 to 14.3 (p = 0.11) after on-pump and off-pump cabg
surgeries, respectively. The baseline plasma no levels Before surgery were
18.16 +/- 7.63 nmol/l in on-pump and 21.76 +/- 11.08 nmol/l in off-pump
cabg. After reactive Hyperemia the plasma no levels were 22.14 +/- 10.52
nmol/l in on-pump and 21.49 +/- 9.13 nmol/l in off-pump cabg Before the
surgery. The difference in the plasma no levels before surgery was not
significant (p = 0.51). Two hours after Surgery, the difference of the
plasma no levels at baseline (24.44 +/- 12.31on-pump and 20.58 +/- 6.74
nmol/l off-pump Cabg) and after reactive hyperemia (35.55 +/- 23.54 nmol/l
on-pump and 23.00 +/- 15.40 nmol/l off-pump cabg) were Not significantly
different from each other (p = 0.11).Conclusions: patients who had on-pump
or off-pump cabg surgeries had higher iief-5 scores. Nevertheless, the
improvement Was insignificant in both groups. Meanwhile, on-pump or
off-pump cabg surgeries did not have significant effect on plasma eNO
levels.
<9>
Accession Number
70887293
Authors
Eggebrecht H.
Institution
(Eggebrecht) Cardioangiological Center Bethanien, Frankfurt, Germany
Title
Risk of stroke after TAVI: A metaanalysis of 10,037 published patients.
Source
EuroIntervention. Conference: EuroPCR 2012 Paris France. Conference Start:
20120515 Conference End: 20110518. Conference Publication: (var.pagings).
8 (pp N198), 2012. Date of Publication: May 2012.
Publisher
EuroPCR
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) represents a novel
treatment option for inoperable or high surgical risk patients with severe
symptomatic aortic valve disease. Recent randomised studies have raised
major safety concerns because of increased stroke/transient ischaemic
attack (TIA) rates with TAVI compared to medical treatment and
conventional aortic valve replacement, respectively. We aimed to review
all currently published literature and estimate the incidence of
peri-procedural stroke and outcomes in patients undergoing TAVI. Methods
and results: Fifty-three studies including a total of 10,037 patients
undergoing transfemoral, transapical or trans-subclavian TAVI for native
aortic valve stenosis published between 01/2004 and 11/2011 were
identified and included in a meta-analysis. Patients were 81.5+/-1.8 years
old and had a mean logistic EuroSCORE of 24.77+/-5.60%. Procedural stroke
(<24 h) occurred in 1.5+/-1.4%. The overall 30 day stroke/TIA was
3.3+/-1.8%, with the majority being major strokes (2.9+/-1.8%). During the
first year after TAVI, stroke/TIA increased up to 5.2+/-3.4%. Differences
in stroke rates were associated with different approaches and valve
prostheses used with lowest stroke rates after transapical TAVI
(2.7+/-1.4%). Thirty- day mortality was significantly higher in patients
with compared to those without stroke (25.5+/-21.9% vs. 6.9+/-4.2%).
Conclusions: TAVI was associated with average 30-day stroke/TIA rate of
3.3+/-1.8% (range 0-6%). Most of these strokes were major strokes and were
associated with significantly increased mortality within in the first 30
days.
<10>
Accession Number
70886493
Authors
Cerrato E. D'Ascenzo F. Biondi-Zoccai G. Moretti C. Omede' P. Presutti D.
Cavallero E. Sheiban I. Gaita F.
Institution
(Cerrato, D'Ascenzo, Moretti, Omede', Presutti, Cavallero, Sheiban, Gaita)
University of Turin, San Giovanni Battista Molinette Hospital, Cardiology
Department 1, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and Biotechnologies
Sapienza, University of Rome, Rome, Italy
Title
Acute coronary syndromes in human immunodeficiency virus patients: A
meta-analysis investigating adverse event rates and the role of
antiretroviral therapy.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 1087), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aims: Highly active antiretroviral therapy (HAART) dramatically reduces
human immunodeficiency virus (HIV)-associated morbidity and mortality, but
adverse effects of HAART are becoming an increasing challenge, especially
in the setting of acute coronary syndromes (ACS). We thus performed a
comprehensive review of studies focusing on ACS in HIV patients. Methods
and results: MEDLINE/PubMed was systematically screened for studies
reporting on ACS in HIV patients. Baseline, treatment, and outcome data
were appraised and pooled with random-effect methods computing summary
estimates [95% confidence intervals (CIs)]. A total of 11 studies
including 2442 patients were identified, with a notably low prevalence of
diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were
8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90%
(2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing
cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95%
CI), no deaths were recorded, with an incidence of 9.42% of acute
myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51;
95% CI) of percutaneous coronary revascularization. Moreover, pooled
analysis of the studies reporting incidence of acute myocardial infarction
in patients exposed to protease inhibitors showed an overall significant
risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). Conclusions: Human
immunodeficiency virus patients admitted for ACS face a substantial
short-term risk of death and a significant long-term risk of coronary
revascularization and myocardial infarction, especially if receiving
protease inhibitors.
<11>
Accession Number
70886106
Authors
Arnoult M. Latcu D.G. Saoudi N. Anselme F. Deharo J.C. Maury P. Boule S.
Traule S. Extramiana F. Zimmerman M.
Institution
(Arnoult, Latcu, Saoudi) Princess Grace Hospital Centre, Monaco, Monaco
(Anselme) University Hospital of Rouen, Rouen, France
(Deharo) AP-HM - Hospital La Timone, Marseille, France
(Maury) University Hospital of Toulouse, Rangueil Hospital, Department of
Cardiology, Toulouse, France
(Boule) Hospital Regional University of Lille, Cardiological Hospital,
Department of Cardiology, Lille, France
(Traule) Amiens University Hospital, Department of Cardiology, Amiens,
France
(Extramiana) AP-HP-Hospital Lariboisiere, Department of Cardiology, Paris,
France
(Zimmerman) University Hospital of Geneva, Geneva, Switzerland
Title
Incidence and mechanisms of cardiac perforation during radiofrequency
atrial fibrillation ablation in medium size centers.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 986), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Introduction: Radiofrequency catheter ablation of atrial fibrillation
(CAAF) is being increasingly performed in medium size centers. In a recent
meta-analysis it was shown that Cardiac perforation (CP) occurs in 1.3% of
patients (pts) undergoing CAAF in many high volume centers. In moderate
volume centers little is known about the rate and mechanism of CP.
Methods: A 14 item questionnaire was sent to 8 medium-size EP centers (30
to 150 CAAF/y) in 3 European countries. The per-procedural (<24 h)
incidence rate and the mechanisms of CP were analyzed. Results: Between
1998 and 2011, 3027 CAAF were performed and 42 pts (31 male; mean age
60.5+/-10.2 y) presented CP (incidence rate of 1.46%). In the past year,
the CAAF median range performed per center was 78 (42 to 110). CAAF was
done under general anesthesia for 349 pts (11.7%). Indications of CAAF
were paroxysmal atrial fibrillation (AF) in 28 pts (65.1%), persistent AF
in 12 pts (27.9%) and atrial tachycardia post AF in 3 pts (6.9%). Mean
left atrial size was 35.3+/-10.9 mm. A transesophageal echocardiography
was used to guide transseptal puncture in 6 pts (13.9%). The occurrence of
CP in 16 pts (37.2%) was related to transseptal puncture, in 9 pts (20.9%)
it was due to steam popping during radiofrequency delivery, and in 6 pts
(13.9%) it was attributed to high pressure catheter manipulation. In the
remaining 12 pts CP mechanism was unknown. One pt had CP during a magnetic
navigation procedure (the likely mechanism being steam popping). Invasive
blood pressure monitoring was not performed in any of the CP cases. The
management of CP was conservative in 18 pts (41.8%). Percutaneous
pericardiocentesis was done in 19 pts (44.1%) and 8 pts (18.6%) required
surgery. A total of 6 pts (13.9%) died (mortality rate of 0.19%).
Conclusion: The incidence of CP in medium-size centers appears to be
similar to the results of previous studies in high volume centers. The
three main CP mechanisms identified are steam popping during
radiofrequency delivery, transseptal puncture and high pressure during
catheter manipulation.
<12>
Accession Number
70884463
Authors
Ricci F. Zimarino M. Corazzini A. Romanello M. Cicchitti V. De Caterina R.
Institution
(Ricci, Zimarino, Corazzini, Romanello, Cicchitti, De Caterina) G.
D'Annunzio University, Institute of Cardiology, Center of Excellence on
Aging, Chieti, Italy
Title
Outcomes of complete versus incomplete myocardial revascularization in
multivessel coronary artery disease: A meta-analysis of randomized and
observational studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 546), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: The optimal extent of myocardial revascularization with either
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) in patients with multi-vessel coronary artery disease
(MVCAD) is controversial for the lack of trials specifically designed at
directly comparing complete (CR) versus incomplete revascularization
(IR).We compared the effectiveness of CR and IR in a pooled patient
population presenting with MVCAD with a meta-analysis of randomized
clinical trials (RCT) and non-randomized observational studies (nROS) in
all coronary heart disease patients excluding STEMI, where selective
treatment of the culprit lesion is currently recommended. Methods: We
performed a systematic PubMed literature search for RCT and nROS published
between 1990 through January 2012 reporting on clinical outcomes of
patients treated with CR and IR. Search terms included "multi-vessel",
"coronary", "*complete*" and "revasculariz*". Mantel-Haenszel pooled
estimates of Relative Risk (RR) and 95% confidence intervals (CI) for
all-cause mortality and myocardial infarction (MI) were assessed at the
longest follow-up. Subgroup analyses stratified by revascularization type
(PCI versus CABG) were also performed. Results: A total of 15 studies were
identified, including a total of 17,624 patients with MVCAD (median
follow-up 2 years). Compared with IR, CR was associated with a significant
relative risk reduction of all-cause mortality (RR 0.77; 95% CI
0.69-0.85), MI (RR 0.80;95% CI 0.68-0.93). When analyzed according to the
type of revascularization, pooled estimates of relative risk (and
associated 95% confidence interval) for all-cause mortality and MI were
0.71 (0.63-0.80) for CABG vs 0.91 (0.76-1.10) for PCI and 0.84 (0.69-1.02)
for CABG vs 0.74 (0.57-0.95) for PCI, respectively. Conclusions: CR with
either CABG or PCI confers a benefit on survival and MI as compared with
IR in patients with MVCAD, and should be therefore considered the optimal
strategy to be pursued when planning a revascularization procedure in
patients with MVCAD. A significant reduction in mortality was only related
to CR with CABG.
<13>
Accession Number
70884409
Authors
Boriani G. Diemberger I. Gardini B. Biffi M. Martignani C. Valzania C.
Ziacchi M. Gasparini M. Padeletti L. Branzi A.
Institution
(Boriani, Diemberger, Gardini, Biffi, Martignani, Valzania, Ziacchi,
Branzi) Institute of Cardiology, Univ. of Bologna, Bologna, Italy
(Gasparini) IRCCS Istituto Clinico Humanitas Rozzano, Milano, Italy
(Padeletti) Dept. Cardiology, Firenze, Italy
Title
Meta-analysis of randomized controlled trials comparing left
ventricular-only pacing to biventricular pacing in heart failure: Effect
on all-cause mortality and hospitalizations.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 532), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aim: Randomized controlled trials (RCT) showed that biventricular (BiV)
pacing reduces heart failure (HF) hospitalizations and mortality in
patients with NYHA class III-IV heart failure (HF), left ventricular (LV)
dysfunction and wide QRS. We performed a systematic review and
meta-analysis of the randomized trials (RCTs) comparing LV-only versus BiV
pacing in candidates for cardiac resynchronization therapy (CRT). Methods
and Results: The systematic review selected 5 RCTs (out of 1888 analyzed
reports) with a cumulative number of 372 patients randomized to BiV pacing
and 258 to LV-only pacing, respectively. The meta-analysis based on RCTs
shows that BiV pacing is not superior to LV-onlypacing and that these two
pacing modalities do not differ with regard to death or heart
transplantation (LV-only vs. BiV pacing OR 1.24, 95% CI 0.57-2.70 with
fixed effect model, OR 1.25, 95% CI 0.48-3.24 with random effect model).
Specific data on hospitalizations were available only in 2 RCTs with a
cumulative number of 127 patients randomized to BiV and 123 to LV-only
pacing, respectively. The meta-analysis shows that BiV pacing is not
superior to LV-only pacing and that these two pacing modalities do not
differ with regard to hospitalizations (LV-only vs. BiV pacing OR 0.86,
95% CI 0.49-1.50 with fixed effect model, OR 0.86, 95% CI 0.49-1.50 with
random effect model). Furthermore, addition of data from two observational
studies, thus reaching an overall population of 376 patients treated with
LV-only pacing and 686 patients treated with BiV pacing, results in the
same conclusions of the previous metaanalysis based only on RCTs. In
detail, the two pacing modalities do not differ with regard to death or
heart transplantation (LV-only vs. BiV pacing OR 0.98, 95% CI 0.61-1.57
with fixed effect model, OR 0.98, 95% CI 0.61-1.59 with random effect
model) and no statistically significant heterogeneity is observed (Test
for heterogeneity Chi-square =6.03 [d.f. = 6], p = 0.419; I-square = 0.6%;
Test for overall effect z =0.10, p = 0.920). Conclusions: BiV pacing is
not superior to LV-only pacing and these two pacing modalities appear to
achieve similar efficacy in candidates for CRT for moderate to severe HF,
in terms of all-cause mortality and hospitalizations during follow up.
<14>
Accession Number
70883999
Authors
Savarese G. Paolillo S. Musella F. D'Amore C. Losco T. Perrone-Filardi P.
Institution
(Savarese, Paolillo, Musella, D'Amore, Losco, Perrone-Filardi) University
of Naples Federico II, Department of Clinical Medicine, Cardiovascular and
Immunological Science, Naples, Italy
Title
6-minute walk distance and clinical events in pulmonary arterial
hypertension: a meta-analysis of 22 randomized studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 423), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: 6-minute walk distance (6MWD) has usually been employed as
endpoint (often primary) in clinical trials to assess the benefit of
therapies in pulmonary arterial hypertension (PAH). The aim of the current
study was to verify whether changes in 6MWD reflect incidence of clinical
events in PAH patients. Methods: MEDLINE, Cochrane, ISI Web of Science and
SCOPUS databases were searched for articles about PAH treatment until
August 2011. Study inclusion criteria were: report of 6MWD at baseline and
at end of follow-up, and of clinical end-points (all-cause death,
hospitalization for PAH and/or lung orheart-lung transplantation,
initiation of PAH rescue therapy); randomized protocol design.
Meta-analysis was performed to assess the influence of treatments on
outcomes. Meta-regression analysis was performed to test the relationship
between 6MWD changes and outcomes. The influence of potential effect
modifiers and the presence of publication bias were also explored.
Results: 22 trials enrolling 3,112 participants were included. Active
treatments led to significant reduction in the risk of all-cause death
(odds ratio [OR]:0.429; 95% confidence interval [CI]:0.277 to 0.664;
comparison (c)p<0.01; heterogeneity (h)p=0.796), hospitalization for PAH
and/or lung or heart-lung transplantation (OR:0.442; CI:0.309 to 0.632; c
p<0.01; h p=0.838), initiation of PAH rescue therapy (OR:0.555; CI:0.347
to 0.889; c p=0.01; h p=0.648) and composite outcome (OR:0.400; CI:0.313
to 0.510; c p<0.01; h p=0.345). In meta-regression analysis, no
relationship between 6MWD changes from baseline to end of follow-up and
outcomes was observed. No publication bias was detected. (Figure
presented) Conclusions: In patients with PAH, improvement in 6MWD, induced
by pharmacological treatment, does not reflect reduction in clinical
events.
<15>
Accession Number
70883998
Authors
Savarese G. Musella F. D'Amore C. Cecere M. Losco T. Marciano C. Gargiulo
P. Perrone-Filardi P.
Institution
(Savarese, Musella, D'Amore, Cecere, Losco, Marciano, Gargiulo,
Perrone-Filardi) University of Naples Federico II, Department of Clinical
Medicine, Cardiovascular and Immunological Science, Naples, Italy
Title
Pulmonary hemodynamic changes, functional capacity and clinical events in
pulmonary arterial hypertension. A meta-analysis of 16 randomized trials.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 423), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: In patients with pulmonary arterial hypertension (PAH) it is
unknown whether changes in pulmonary hemodynamic parameters induced by
therapy correlate with functional capacity and clinical events (CE).
Methods: MEDLINE, Cochrane, ISI Web of Science and SCOPUS database were
searched for randomized trials investigating PAH therapy until November
2011, measuring hemodynamic parameters by right heart catheterization at
baseline and at end of follow-up and reporting CE (all-cause death,
hospitalization for PAH and/or lung or heart-lung transplantation,
initiation of PAH rescue therapy). Meta-analysis and meta-regression
analysis were performed to assess the effects of treatments on outcomes
and the relationship between hemodynamic (pulmonary artery pressure,
pulmonary vascular resistance (PVR), cardiac index and right atrial
pressure) changes and CE. Spearman correlation was used to test the
relationship between changes in hemodynamics and 6 minute walking distance
(6MWD). The influence of baseline patients' characteristics,hemodynamics
at baseline, 6-minute walk distance (6MWD), Detsky quality score,
follow-up and study publication year were also explored. Macaskill's
modified test was used to assess the presence of publication bias.
Results: 16 trials enrolling 2,353 patients were included in
meta-analysis. Treatments significantly reduced composite
outcome(including all CE) (odds ratio [OR]:0.346; 95% confidence interval
[CI]:0.259 to 0.462; p<0.01) as well allcause death (OR:0.467; CI:0.292 to
0.747; p<0.01), hospitalization for PAH and/or lung or heart-lung
transplantation (OR:0.384; CI:0.218 to 0.674; p<0.01), initiation of PAH
rescue therapy (OR:0.341; CI:0.200 to 0.582; p<0.01). No relationship was
found between changes of hemodynamic parameters and CE, whereas changes of
cardiac index and PVR significantly correlated to changes of 6MWD
(r=0.636, p=0.035; r=-0.547; p=0.043 respectively). No heterogeneity among
trials included in meta-analysis, potential confounding variable or
publication bias was detected. Conclusions: In PAH patients, improvement
of pulmonary hemodynamic parameters correlate with functional capacity
changes but do not predict CE.
<16>
Accession Number
70883737
Authors
Mansur A.P. Hueb W.A. Takada J.Y. Avakian S.D. Soares P.R. Garzilo C.L.
Ramires J.A.F. Kalil Filho R.
Institution
(Mansur, Hueb, Takada, Avakian, Soares, Garzilo, Ramires, Kalil Filho)
Heart Institute (InCor), University of Sao, Paulo Medical School, Sao
Paulo, Brazil
Title
Ten-year follow-up survival of the medicine, angioplasty, or surgery study
(MASS II): Randomized controlled clinical trial of 3 therapeutic
strategies for multivessel coronary artery disease in women.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 354), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: Coronary artery disease (CAD) is the leading cause of death in
women. The proposed treatments, percutaneous coronary intervention (PCI),
medical treatment (MT) or coronary artery bypass graft (CABG), are similar
to those made for men. However, in women with multivessel stable CAD and
normal left ventricular (LV) function, the best treatment is unknown.
Methods: Prospective study with 10 years of follow-up randomized 188 women
with chronic stable CAD to MT (N = 63; 33%), PCI (N = 69; 37%) or CABG (N
= 56; 30%). CAD was defined by the presence of angina pectoris CCS class
II and III, positive stress test, LV ejection fraction >40% and >=2
coronary lesions >70%. The primary end points were the incidence of total
mortality, Q-wave MI, or refractory angina that required
revascularization. All data were analyzed according to the
intention-to-treat principle. Results: Patients treated with PCI and MT
had more primary events than CABG and, respectively, of 34%, 44% and 22%
(p=0.003) (Figure). The 10-year survival rates were 72% with CABG, 72%
with PCI, and 56% with MT (p=0.156). Relative to the composite end point,
Cox regression analysis showed a higher incidence of primary events in MT
than in CABG [HR=2.38 (95%CI: 1.40 to 4.05); p=0.001], lower incidence in
PCI than in MT [HR=0.60 (95%CI: 0.38 to 0.95); p=0.031] but no differences
between CABG and PCI [HR=1.42 (95%CI: 0.83 to 2.45); p=0.203]. To death, a
protective effect of PCI compared to MT [HR=0.44 (95%CI: 0.21 to 0.90);
p=0.025] was observed but not between PCI and CABG or MT and CABG. (Figure
psented) Conclusion: Women with multivessel CAD and normal LV function,
CABG and PCI were associated with fewer primary events and PCI with lower
mortality.
<17>
Accession Number
70883709
Authors
Lopatin Y.M. Ilyukhin O.V. Ilyukhina M.V. Kalganova E.L. Tarasov D.L.
Ivanenko V.V.
Institution
(Lopatin, Ilyukhin, Ilyukhina, Kalganova) Volgograd State Medical
University, Volgograd, Russian Federation
(Tarasov, Ivanenko) Volgograd Regional Cardiology Centre, Volgograd,
Russian Federation
Title
Long-term trimetazidine modified release therapy improves prognosis in
post-myocardial infarction patients with angina pectoris and heart
failure.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 346-347), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aim: Several preliminary trials and meta-analysis showed that
trimetazidine (TMZ) reduces mortality in patients (pts) with coronary
artery disease (CAD) and heart failure. However, long-term effects of TMZ
on the prognosis of postmyocardial infarction (post-MI) pts remain
unclear. The aim of our study was to determine long-term effects of TMZ 35
mg modified release (MR) on all-cause mortality in post-MI pts with stable
angina and heart failure. Methods: 120 post-MI pts (mean age 58.4+/-2.2)
with stable angina (mean CCS functional class: 2.4+/-0.1) and heart
failure (mean NYHA functional class: 2.5+/-0.1) were included in this
long-term, prospective, randomized clinical trial. Pts were randomized
into two groups - the group of active therapy (TMZ MR on top of standard
post-MI therapy after discharge from hospital, continued for the next 6
years, n=61) and the control group (standard therapy without TMZ MR,
n=59). Results: Baseline characteristics were the same in the two groups
of post-MI pts. Six-year survival in post-MI pts receiving TMZ MR was 84%
vs. 69% in the Control group), p<0.05. Over the 6 year follow-up, long
term TMZ MR therapy was characterized by a significant reduction of
all-cause mortality (RR 0.51; 95% CI 0.25 - 0.92, p<0.05) (Figure 1), as
well as major cardiovascular events (cardiac death, nonfatal myocardial
infarction, acute stroke, need for coronary revascularization,
hospitalization for unstable angina or heart failure) (RR 0.61; 95% CI
0.35 - 0.97, p<0.05). (Figure presented) Conclusions: Long-term
trimetazidine modified release therapy is associated with a significant
reduction in mortality in post-MI pts with angina and heart failure.
Large-scale randomized clinical trials are needed to further confirm this
data.
<18>
Accession Number
70883434
Authors
Eindhoven J.A. Van Den Bosch A.E. Jansen P.R. Boersma E. Roos-Hesselink
J.W.
Institution
(Eindhoven, Van Den Bosch, Jansen, Boersma, Roos-Hesselink) Erasmus
Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam,
Netherlands
Title
Brain natriuretic peptide in patients with tetralogy of fallot-a
systematic review.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 270-271), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: Brain natriuretic peptide (BNP) and N-terminal-probrain
natriuretic peptide (NT-proBNP) are well-established markers for heart
failure in the general population. However, the value of BNP and NT-proBNP
as a diagnostic and prognostic marker for patients with surgically
corrected Tetralogy of Fallot (TOF) is still unclear. Methods: A
systematic review was conducted including all articles focusing on TOF.
Data on BNP measurement, patient characteristics and cardiac functional
parameters were extracted. Results: A total of 770 patients from 20
articles were included. Both symptomatic and asymptomatic patients after
surgically corrected TOF revealed higher BNP levels compared to age and
gender matched controls. The severity of pulmonary valve regurgitation
(PVR) and right ventricular end-diastolic volume (RVEDD) correlated
positively with BNP values. Negative correlations between BNP and exercise
capacity were observed. Three small studies with longitudinal data,
describing a total of 77 patients, showed a significant decrease of BNP
levels 6 months or longer after pulmonary valve replacement compared to
BNP levels before the intervention. (Figure Presented) Conclusion: This
systematic review shows higher plasma BNP levels in patients with TOF
compared to controls. The observed significant correlations between BNP
and RVEDD, PVR and exercise capacity mirror the possible future use of BNP
as an indicator of disease severity and additional diagnostic tool for
timing of pulmonary valve replacement. However, as BNP values differ
widely, conclusions for individual patients should be drawn with caution.
Further investigation with sequential BNP measurement in large,
prospective studies is warranted.
<19>
Accession Number
70883251
Authors
Patti G. Cannon C.P. Mega S. Bennet R. Ray K.K. Cavallari I. Ricottini E.
Chello M. Mannacio V. Di Sciascio G.
Institution
(Patti, Mega, Cavallari, Ricottini, Chello, Di Sciascio) Campus Bio-Medico
University of Rome, Department of Cardiovascular Sciences, Rome, Italy
(Cannon) Brigham and Women's Hospital, Department of Medicine,
Cardiovascular Division, Boston, United States
(Bennet, Ray) St George's University of London, Cardiac and Vascular
Sciences Research Centre, London, United Kingdom
(Mannacio) University of Naples Federico II, Department of Cardiac
Surgery, Naples, Italy
Title
Prevention of post-operative atrial fibrillation by statin pre-treatment
in patients undergoing cardiac surgery: A collaborative patient level
meta-analysis of 11 randomized studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 223), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Background: Previous studies suggested that statin pre-treatment prevents
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery. However, those data were observational and single randomized
trials included limited numbers of patients. Methods: We performed a
collaborative meta-analysis using individual patient data from 11
randomized studies in which 1106 patients received before elective cardiac
surgery statin therapy (N=552) vs no statin therapy (N=554). Postoperative
atrial fibrillation was defined as arrhythmic episodes lasting >= 5
minutes. Results: Post-operative AF occurred in 19% of patients in the
statin vs 36% of those in the control group (60% risk reduction in the
active treatment arm; OR by fixed effects model 0.40, 95% CI 0.30-0.53;
P<0.00001). Arrhythmic prevention by statin pre-treatment was maintained
across various subgroups, and appeared greater in the subset of patients
with elevated baseline C-reactive protein (CRP) levels (71% risk reduction
vs 54% in those with normal CRP). Pre-operative CRP levels were reduced in
patients without vs those with post-operative AF (1.7+/-3.3 vs 4.1+/-10.6
mg/L; P=0.0001) and statin pre-treatment was associated with lower
baseline CRP levels (1.8+/-4.0 vs 2.9+/-7.9 mg/L in the control arm;
P=0.01). Incidence of peri-operative myocardial injury (creatine kinase-MB
>5x ULN or Troponin-I >8x ULN) was significantly lower in the statin arm
(44% vs 56%; P=0.007). Conclusions: Statin pre-treatment prevents from
post-operative AF and perioperative myocardial injury in patients
undergoing cardiac surgery; this supports a routine early initiation of
statin treatment in such patients.
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