EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012603753
Authors
Tleyjeh I.M. Alasmari F.A. Bin Abdulhak A.A. Riaz M. Garbati M.A. Erwin
P.J. Kashour T. Al-Mallah M.H. Baddour L.M.
Institution
(Tleyjeh, Alasmari, Bin Abdulhak, Garbati) Department of Internal
Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
(Tleyjeh, Riaz) Research and Scientific Publication Center, King Fahad
Medical City, Aldabab Street, PO Box 59046, Riyadh 11525, Saudi Arabia
(Tleyjeh, Baddour) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Kashour) Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia
(Al-Mallah) King Fahad National Guard Hospital, Riyadh, Saudi Arabia
(Al-Mallah) Wayne State University, Detroit, MI, United States
Title
Association between preoperative statin therapy and postoperative
infectious complications in patients undergoing cardiac surgery: A
systematic review and meta-analysis.
Source
Infection Control and Hospital Epidemiology. 33 (11) (pp 1143-1151), 2012.
Date of Publication: November 2012.
Publisher
University of Chicago Press (1427 E. 60th Street, Chicago IL 60637-2954,
United States)
Abstract
Infectious complications of cardiac surgery are often severe and life
threatening. Statins having both immunomodulatory and anti-inflammatory
effects were intuitively thought to influence the development of
postsurgical infections.We sought to systematically examine whether any
association exists between statin use and risk of infectious complications
in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid
EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from
inception through February 2011 for comparative studies examining the
association between statin use and risk of postoperative infections in
patients undergoing cardiac surgery.We contacted a study's author for
missing information. We conducted a random-effects meta-analysis of
individual studies' odds ratios (adjusted for potential confounders). We
identified 6 cohort studies for inclusion, 3 of which were conducted in
Canada and 3 of which were conducted in the United States. Four were
single-center studies, and 2 were population based. 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), or any other
postoperative infection. Statin use in the preoperative period was
associated with a trend toward reduction in the incidence of postoperative
infections in patients who underwent cardiac surgery (odds ratio, 0.81
[95% confidence interval, 0.64-1.01]; P=.06; I²=75%).
Heterogeneity was explained by country effect. Studies performed in Canada
showed weaker associations than studies performed in the United States.
This difference could not be attributed to study quality alone. We did not
find good evidence to support an association between statin use and
postoperative infectious complications. However, the trend toward
statistical significance for this association indicates that further
investigation is warranted. 2012 by The Society for Healthcare
Epidemiology of America.

<2>
Accession Number
2012601318
Authors
van Dieren S. Kengne A.P. Chalmers J. Beulens J.W.J. Cooper M.E. Grobbee
D.E. Harrap S. Mancia G. Neal B. Patel A. Poulter N. van der Schouw Y.T.
Woodward M. Zoungas S.
Institution
(van Dieren, Kengne, Chalmers, Neal, Patel, Woodward, Zoungas) George
Institute for Global Health, University of Sydney, Sydney, Australia
(van Dieren, Beulens, Grobbee, van der Schouw) Julius Center for Health
Sciences and Primary Care, University Medical Center Utrecht, Utrecht,
Netherlands
(Cooper) Baker Heart Research Institute, Melbourne, Australia
(Harrap) University of Melbourne, Royal Melbourne Hospital, Melbourne,
Australia
(Mancia) University of Milan-Bicocca, San Gerardo Hospital, Milan, Italy
(Poulter) Imperial College, St Mary's Hospital, London, United Kingdom
(Zoungas) School of Public Health, Monash University, Melbourne, Australia
Title
Effects of blood pressure lowering on cardiovascular outcomes in different
cardiovascular risk groups among participants with type 2 diabetes.
Source
Diabetes Research and Clinical Practice. 98 (1) (pp 83-90), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims: To asses differences in treatment effects of a fixed combination of
perindopril-indapamide on major clinical outcomes in patients with type 2
diabetes across subgroups of cardiovascular risk. Methods: 11,140
participants with type 2 diabetes, from the ADVANCE trial, were randomized
to perindopril-indapamide or matching placebo. The Framingham equation was
used to calculate 5-year CVD risk and to divide participants into two risk
groups, moderate-high risk (<25% and no history of macrovascular disease),
very high risk (>25% and/or history of macrovascular disease). Endpoints
were macrovascular and microvascular events. Results: The mean age of
participants was 66 years (42.5% female). 1000 macrovascular and 916
microvascular events were recorded over follow-up of 4.3 years. Relative
treatment effects were similar across risk groups, (all P-values for
heterogeneity >=0.38). Hazard ratios for combined macro- and microvascular
events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92
(0.81-1.03) for the very high risk. Absolute treatment effects tended to
be greater in the high risk groups although differences were not
statistically significant (P>0.05). Conclusions: Relative effects of blood
pressure lowering with perindopril-indapamide on cardiovascular outcomes
were similar across risk groups whilst absolute effects trended to be
greater in the high risk group. 2012 Elsevier Ireland Ltd.

<3>
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Accession Number
2012605525
Authors
Kunadian V. Pugh A. Zaman A.G. Qiu W.
Institution
(Kunadian, Zaman) Faculty of Medical Sciences, Newcastle University,
Freeman Hospital, Newcastle upon Tyne NE2 4HH, United Kingdom
(Pugh) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University Medical School, Newcastle Upon Tyne, United Kingdom
(Qiu) Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital/Harvard Medical School, Boston, MA, United States
Title
Percutaneous coronary intervention among patients with left ventricular
systolic dysfunction: A review and meta-analysis of 19 clinical studies.
Source
Coronary Artery Disease. 23 (7) (pp 469-479), 2012. Date of Publication:
November 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
BACKGROUND: Coronary artery disease (CAD) is the most common cause for
left ventricular dysfunction. Coronary artery bypass surgery (CABG) has
not reduced mortality among patients with CAD and left ventricular
systolic dysfunction receiving guideline-indicated pharmacological
therapy. However, the benefit of percutaneous coronary intervention (PCI)
among patients with left ventricular systolic dysfunction is not clear.
OBJECTIVES: A meta-analysis of studies utilizing PCI among patients with
left ventricular systolic dysfunction (ejection fraction<=40%) was
performed to determine in-hospital and long-term (>=1 year) mortality.
METHODS: A systematic computerized literature search was performed using
the search terms 'poor left ventricle', 'percutaneous coronary
intervention', 'revascularization', 'LV dysfunction' and 'heart failure'.
Studies of patients undergoing PCI for CAD in the presence of left
ventricular systolic dysfunction were included. Studies that did not
report long-term mortality data and same-centre studies were excluded.
RESULTS: In total, 4766 patients from 19 studies were included in this
meta-analysis. The mean (pooled estimate) age was 65 years [95% confidence
interval (CI) 62-68] with 80% (95% CI 75-84%) males. The mean (pooled
estimate) ejection fraction was 30% (95% CI 27-33%). The in-hospital
mortality using random-effects model (13 studies, total PCI n=2202) was
1.8%, n=39 (95% CI 1.0-2.9%). The long-term mortality (mean pooled
estimate 24 months) using the random-effects model (19 studies, total
follow-up n=2937) was 15.6%, n=401 (95% CI 11.0-20.7%). Five studies
compared PCI versus CABG (n=455 vs. n=502) and provide long-term mortality
data (deaths-PCI: n=102 vs. CABG: n=115). The relative risk using the
random-effects model (PCI vs. CABG) was 0.98 (95% CI 0.8-1.2, P=0.83).
CONCLUSION: The present meta-analysis demonstrates that on the basis of
available clinical studies, PCI among patients with left ventricular
systolic dysfunction is feasible with acceptable in-hospital and long-term
mortality and yields similar outcomes to CABG. However, neither
intervention may improve outcome compared with pharmacological therapy
alone. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

<4>
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Accession Number
2012605526
Authors
Sa M.P.B.O. Ferraz P.E. Escobar R.R. Martins W.N. Nunes E.O. Vasconcelos
F.P. Lima R.C.
Institution
(Sa, Ferraz, Escobar, Martins, Nunes, Vasconcelos, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco,
PROCAPE, Edf. Paqueta, Av. Eng. Domingos Ferreira n 4172, Recife,
51021-040, Pernambuco, Brazil
(Sa, Ferraz, Escobar, Martins, Nunes, Vasconcelos, Lima) University of
Pernambuco, UPE, Pernambuco, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences,
Faculty of Medical Sciences and Biological Sciences Institute, FCM/ICB,
Recife, Pernambuco, Brazil
Title
Prophylactic intra-aortic balloon pump in high-risk patients undergoing
coronary artery bypass surgery: A meta-analysis of randomized controlled
trials.
Source
Coronary Artery Disease. 23 (7) (pp 480-486), 2012. Date of Publication:
November 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVES: The aim of this study was to assess the efficacy of a
prophylactic intra-aortic balloon pump (IABP) in high-risk patients
undergoing coronary artery bypass graft surgery. METHODS: MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar, and reference lists of
relevant articles were searched. We included only randomized controlled
trials. Assessments for eligibility, relevance, and study validity and
data extraction were performed in duplicate using prespecified criteria.
Meta-analysis was carried out using fixed-effect and random-effect models.
RESULTS: Seven publications fulfilled our eligibility criteria. There was
no important statistical heterogeneity or publication bias among included
studies. In total, 177 patients received prophylactic IABP and 168 did
not. Overall relative risk (RR) for hospital mortality in patients treated
with prophylactic IABP was 0.255 [95% confidence interval (CI),
0.122-0.533; P<0.001; same results for both effect models]. Pooled RR for
postoperative low cardiac output syndrome was 0.206 (95% CI, 0.109-0.389;
P<0.001) for the fixed-effect model and 0.219 (95% CI, 0.095-0.504;
P<0.001) for the random-effect model. Patients treated with prophylactic
IABP presented an overall difference in means for length of intensive care
unit stay and hospital stay, which was lower than that in the control
group (P<0.001 for both effect models). Only 7.4% (13/177) of patients who
received prophylactic IABP developed complications at an insertion site,
with no IABP-related death. CONCLUSION: This meta-analysis supports the
use of prophylactic IABP in high-risk patients to reduce hospital
mortality. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

<5>
Accession Number
2012600219
Authors
Kongkaew C. Sakunrag I. Jianmongkol P.
Institution
(Kongkaew, Sakunrag) Faculty of Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
(Jianmongkol) Buddhachinaraj Hospital, Phitsanulok, Thailand
Title
Non-compliance with digoxin in patients with heart failure and/or atrial
fibrillation: A systematic review and meta-analysis of observational
studies.
Source
Archives of Cardiovascular Diseases. 105 (10) (pp 507-516), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Digoxin is highly potent and efficacious for treatment of
heart failure (HF) and/or atrial fibrillation (AF) yet compliance is often
poor. Aims: To examine prevalence rates of non-compliance with digoxin;
variations between clinical settings, types of non-compliance and methods
of detection; and potential factors influencing non-compliance with
digoxin. Methods: This was a systematic review and meta-analysis of
prospective observational studies of non-compliance with digoxin in
patients with HF and/or AF, published in English. The studies were
identified through these bibliographic databases: MEDLINE, EMBASE, CINAHL,
IPA and Cochrane CENTRAL. Subgroup analysis examined the influence of
clinical settings, types of non-compliance and methods of detection.
Results: Ten studies met the inclusion criteria, comprising 1841 patients
with HF and/or AF. The corresponding prevalence rates of non-compliance
for outpatients, after hospital discharge and inpatients were 43.1%
(interquartile range [IQR] 29-48%), 25% (95% confidence interval [CI]
12-37%) and 4.5%, respectively. In patients with HF and AF co-morbidities,
the prevalence rate of non-compliance with digoxin was 38.7% (IQR 27-46%);
the corresponding prevalence rates of overdosing and underdosing were
33.04% (IQR 22-49%) and 33.8% (95% CI 25-42%), respectively. Rates varied
depending on the methods of detecting non-compliance. Regularity of
prescribed dose, diuretic use, coronary artery bypass, implantable
cardioverter-defibrillator, number of office visits and pill boxes
demonstrated strong associations with non-compliance with digoxin.
Conclusions: Non-compliance with digoxin is prevalent among patients with
HF and/or AF. A better understanding of the factors influencing compliance
and improved intervention strategies are necessary to increase digoxin
compliance. 2012 Elsevier Masson SAS.

<6>
Accession Number
2012597899
Authors
Eriksson E.A. Willekes C.L. McAllen K.J. Romeo O.M. Hooker R.L. Hoogeboom
J.E. Barletta J.F.
Institution
(Eriksson) Medical University of South Carolina, Department of Trauma and
General Surgery, Charleston, SC 29425, United States
(Willekes, Hooker) West Michigan Cardiothoracic Surgery, Grand Rapids, MI
49503, United States
(McAllen) Adult Critical Care, Department of Pharmacy Services, Spectrum
Health, Grand Rapids, MI 49503, United States
(Romeo) Hancock Regional Hospital, General Surgery Department, Greenfield,
IN 46140, United States
(Hoogeboom) Division of Surgical Critical Care, Spectrum Health, Grand
Rapids, MI 49503, United States
(Barletta) Department of Pharmacy Practice, Midwestern University, College
of Pharmacy-Glendale, Glendale, AZ 85308, United States
Title
Adrenal insufficiency in cardiothoracic patients: An evaluation of the
corticotrophin stimulation test and other diagnostic methods.
Source
Journal of Critical Care. 27 (5) (pp 528.e1-528.e6), 2012. Date of
Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Purpose: The purposes of the study were to determine the incidence of
adrenal insufficiency (AI) using several published techniques, compare the
response rates using a low-dose (LD) corticotropin (ACTH) stimulation test
vs a standard dose (SD), and identify the technique that is most closely
related to vasopressor use. Materials and Methods: Consecutive adult
patients who were undergoing open heart surgery for CAD or valvular
disease were prospectively enrolled. Exclusion criteria included history
of steroid use, operative steroid, or etomidate administration.
Postoperatively, each patient underwent ACTH stimulation with 1 mug (LD)
and 249 mug (SD), 60 minutes apart. Agreement among the tests was
evaluated, and vasopressor use was compared between groups. Results: There
were 40 patients evaluated. The incidence of AI based on operative change,
postoperative values, and LD-ACTH and SD-ACTH tests was 53%, 38%, 60%, and
38%, respectively. Agreement between the LD- and SD-ACTH tests was 73% ( =
0.476, P = .001). There was a significant difference in the need for (93%
vs 52%, P = .013) and duration (18.9 [0-180.6] vs 0.6 [0-73.2] hours, P =
.003) of vasopressor therapy in patients with and without AI but only
using the SD-ACTH definition. Conclusion: The incidence of AI will vary
greatly based on technique used for diagnosis. The SD-ACTH stimulation
test should be used to determine AI in open heart patients postoperatively
because of the close association with vasopressor usage. 2012 Elsevier
Inc.

<7>
Accession Number
2012600822
Authors
Fang W.-T. Li H.-J. Zhang H. Jiang S.
Institution
(Fang, Zhang, Jiang) Department of Pharmacy, The First Affiliated Hospital
with Nanjing Medical University, Nanjing, Jiangsu 210029, China
(Li) Department of Pharmacy, Qianfoshan Hospital of Shandong Province,
Jinan, Shandong 250014, China
Title
The role of statin therapy in the prevention of atrial fibrillation: A
meta-analysis of randomized controlled trials.
Source
British Journal of Clinical Pharmacology. 74 (5) (pp 744-756), 2012. Date
of Publication: November 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
AIMS The use of statins has been suggested to protect against atrial
fibrillation (AF) in some clinical observational and experimental studies
but has remained inadequately explored. This study was designed to examine
whether statins can reduce the risk of AF. METHODS Meta-analysis of
randomized, controlled trials with use of statins on incidence or
recurrence of AF was performed. RESULTS Twenty studies with 23577 patients
were included in the analysis. Seven studies investigated the use of
statins in patients with AF, 11 studies investigated the primary
prevention of statins in patients without AF, and two studies investigated
mixed populations of patients. The incidence or recurrence of AF occurred
in 1543 patients. Overall, statin therapy was significantly associated
with a decreased risk of AF compared with control (odds ratio 0.49, 95%
confidence interval 0.37-0.65; P<0.00001). A beneficial effect was found
in the atorvastatin subgroup and the simvastatin subgroup, but not in the
pravastatin subgroup or the rosuvastatin subgroup. The benefit of statin
therapy appeared to be more pronounced in secondary prevention (odds ratio
0.34, 95% confidence interval 0.18-0.64; P<0.0008) than in primary
prevention (odds ratio 0.54, 95% confidence interval 0.40-0.74; P<0.0001).
CONCLUSIONS Statin therapy was significantly associated with a decreased
risk of incidence or recurrence of AF. Heterogeneity was explained by
differences in statin types, patient populations and surgery types. The
benefit of statin therapy seemed more pronounced in secondary than in
primary prevention. 2012 The Authors. British Journal of Clinical
Pharmacology 2012 The British Pharmacological Society.

<8>
Accession Number
2012592731
Authors
Hueb W. Gersh B.J. Rezende P.C. Garzillo C.L. Lima E.G. Vieira R.D. Garcia
R.M.R. Favarato D. Segre C.A.W. Pereira A.C. Soares P.R. Ribeiro E. Lemos
P. Perin M.A. Strunz C.C. Dallan L.A.O. Jatene F.B. Stolf N.A.G. Hueb A.C.
Dias R. Gaiotto F.A. da Costa L.M.A. Oikawa F.T.C. de Melo R.M.V. Serrano
Junior C.V. de Avila L.F.R. Villa A.V. Filho J.R.P. Nomura C. Ramires
J.A.F. Filho R.K.
Institution
(Hueb, Rezende, Garzillo, Lima, Vieira, Garcia, Favarato, Segre, Pereira,
Soares, Ribeiro, Lemos, Perin, Strunz, Dallan, Jatene, Stolf, Hueb, Dias,
Gaiotto, da Costa, Oikawa, de Melo, Serrano Junior, de Avila, Villa,
Filho, Nomura, Ramires, Filho) Heart Institute of the University of Sao
Paulo, Sao Paulo, Brazil
(Gersh) Mayo Clinic, Rochester, MN, United States
(Hueb) Av. Dr. Eneas de Carvalho Aguiar 44 AB-114 Cerqueira Cesar, Sao
Paulo-SP, 05403-000, Brazil
Title
Hypotheses, rationale, design, and methods for prognostic evaluation of
cardiac biomarker elevation after percutaneous and surgical
revascularization in the absence of manifest myocardial infarction. A
comparative analysis of biomarkers and cardiac magnetic resonance. The
MASS-V Trial.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 65. Date of
Publication: 16 Aug 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Although the release of cardiac biomarkers after percutaneous
(PCI) or surgical revascularization (CABG) is common, its prognostic
significance is not known. Questions remain about the mechanisms and
degree of correlation between the release, the volume of myocardial tissue
loss, and the long-term significance. Delayed-enhancement of cardiac
magnetic resonance (CMR) consistently quantifies areas of irreversible
myocardial injury. To investigate the quantitative relationship between
irreversible injury and cardiac biomarkers, we will evaluate the extent of
irreversible injury in patients undergoing PCI and CABG and relate it to
postprocedural modifications in cardiac biomarkers and long-term
prognosis.Methods/Design: The study will include 150 patients with
multivessel coronary artery disease (CAD) with left ventricle ejection
fraction (LVEF) and a formal indication for CABG; 50 patients will undergo
CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial
and ventricular condition indicated for myocardial revascularization will
undergo CABG without CPB; and another 50 patients with CAD and preserved
ventricular function will undergo PCI using stents. All patients will
undergo CMR before and after surgery or PCI. We will also evaluate the
release of cardiac markers of necrosis immediately before and after each
procedure. Primary outcome considered is overall death in a 5-year
follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin
in association with presence of myocardial fibrosis and systolic left
ventricle dysfunction assessed by CMR.Discussion: The MASS-V Trial aims to
establish reliable values for parameters of enzyme markers of myocardial
necrosis in the absence of manifest myocardial infarction after mechanical
interventions. The establishments of these indices have diagnostic value
and clinical prognosis and therefore require relevant and different
therapeutic measures. In daily practice, the inappropriate use of these
necrosis markers has led to misdiagnosis and therefore wrong treatment.
The appearance of a more sensitive tool such as CMR provides an
unprecedented diagnostic accuracy of myocardial damage when correlated
with necrosis enzyme markers. We aim to correlate laboratory data with
imaging, thereby establishing more refined data on the presence or absence
of irreversible myocardial injury after the procedure, either percutaneous
or surgical, and this, with or without the use of cardiopulmonary bypass.
2012 Hueb et al.; licensee BioMed Central Ltd.

<9>
Accession Number
2012592170
Authors
Wang P. Zhou S. Zhou R. Liu G. Tang P. He J. Ma C. He Y. Yang J.
Institution
(Wang, Zhou, Zhou, Tang, He, Ma, He, Yang) State Key Laboratory of
Biotherapy, West China Hospital, Sichuan University, Keyuan Road 4, No. 1,
Chengdu, Sichuan, 610041, China
(Zhou) Department of Electrophysiology, Institute of Cardiovasology,
Luzhou Medical College, Luzhou, Sichuan, China
(Liu) Department of Dermatology, First Hospital, Chongqing Medical
University, Chongqing, China
Title
The effectiveness and safety of triple-antiplatelet treatment based on
cilostazol for patients receiving percutaneous coronary intervention: A
meta-analysis.
Source
Clinical Cardiology. 35 (10) (pp 598-604), 2012. Date of Publication:
October 2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
The combination of cilostazol, aspirin, and clopidogrel (triple therapy)
after percutaneous coronary intervention has been considered as an
alternative therapy. We performed a meta-analysis based on 8 randomized
controlled trials with a total of 3332 patients to compare the
effectiveness and safety of this triple therapy with traditional dual
therapy (aspirin and clopidogrel). Our findings suggested that the triple
therapy is more effective than dual therapy in preventing restenosis (odds
ratio [OR]: 0.52, 95% confidence interval [CI]: 0.40-0.66, P < 0.00001),
maintaining minimal lumen diameter (OR: 0.15, 95% CI: 0.10-0.20, P <
0.00001), and avoiding target-vessel revascularization (OR: 0.62, 95% CI:
0.47-0.82, P = 0.001). There is also no significant difference in major
adverse cardiac and cerebrovascular events between the 2 therapies, except
the smaller occurrence rate of target-lesion revascularization in the
triple-therapy group (OR: 0.42, 95% CI: 0.26-0.69, P = 0.0005). However,
the triple therapy is associated with a higher level of adverse drug
events, including rash (OR: 2.45, 95% CI: 1.41-4.23, P = 0.001),
gastrointestinal disorders (OR: 2.59, 95% CI: 1.26-5.30, P = 0.009), and
drug discontinuation (OR: 3.80, 95% CI: 1.59-9.10, P = 0.003), but it has
no difference in bleeding compared with the dual therapy (OR: 1.05, 95%
CI: 0.71-1.55, P = 0.80). 2012 Wiley Periodicals, Inc.

<10>
Accession Number
2012599387
Authors
Florian A. Slavich M. Masci P.G. Janssens S. Bogaert J.
Institution
(Florian, Slavich, Bogaert) Department of Radiology, UZ Leuven, Herestraat
49, B-3000 Leuven, Belgium
(Masci) Cardiac MRI and Cardiovascular Medicine Departments, Fondazione
CNR-Regione Toscana G. Monasterio, Pisa, Italy
(Janssens) Department of Cardiovascular Diseases, UZ Leuven, Leuven,
Belgium
Title
Electrocardiographic Q-wave "remodeling" in reperfused ST-segment
elevation myocardial infarction: Validation study with CMR.
Source
JACC: Cardiovascular Imaging. 5 (10) (pp 1003-1013), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The aim of this study was to evaluate the evolution in Q-wave
expression during the first 5 years after a primary, successfully
reperfused ST-segment elevation myocardial infarction (MI), using cardiac
magnetic resonance (CMR) for infarct location, and to depict changes in
infarct size and left ventricular remodeling over time. Background: In the
absence of QRS confounders, abnormal Q waves are usually diagnostic of
myocardial necrosis. It is hypothesized that Q-wave regression after MI
could be related to smaller infarct sizes. Late gadolinium enhancement
accurately depicts MI of any age. Methods: Forty-six MI patients underwent
electrocardiography and CMR at 1 week (baseline), 4 months, 1 year, and 5
years post-infarction. Conventional CMR parameters were analyzed, and
infarct presence, location, and size were assessed using late gadolinium
enhancement CMR. Infarct locations were anterior or nonanterior (inferior
and/or lateral), using late gadolinium enhancement CMR as a reference. For
each time point, patients were classified as having a
diagnostic/nondiagnostic electrocardiogram (ECG) using the European
Society of Cardiology/American College of Cardiology Foundation/American
Heart Association/World Heart Federation consensus criteria for previous
Q-wave infarct. Results: At baseline, 11 patients (23%) did not meet the
criteria for Q-wave MI. Non-Q-wave infarcts were significantly smaller
than Q-wave infarcts (p < 0.0001). All anterior Q-wave infarcts (n = 17)
were correctly localized, whereas in 7 of 19 nonanterior Q-wave infarcts,
the location or extent of the infarct was misjudged by
electrocardiography. At 4-month/1-year follow-up, in 10 patients (3
anterior/7 nonanterior), the ECG became nondiagnostic. The ECG remained
nondiagnostic at 5-year follow-up. A cutoff infarct size of 6.2% at 1 year
yielded a sensitivity of 89% and a specificity of 74% to predict the
presence or absence of Q waves. Conclusions: The incidence of
nondiagnostic ECGs for previous MI using the current European Society of
Cardiology/American College of Cardiology Foundation/American Heart
Association/World Heart Federation criteria is substantial and increases
with time post-infarction from 23% immediately post-infarction to 44% at
5-year follow-up. 2012 American College of Cardiology Foundation.

<11>
Accession Number
2012596707
Authors
Alston R.P.
Institution
(Alston) Royal Infirmary of Edinburgh, University of Edinburgh, United
Kingdom
Title
Anaesthesia for off-pump coronary artery bypass grafting surgery.
Source
Anaesthesia and Intensive Care Medicine. 13 (10) (pp 510-512), 2012. Date
of Publication: October 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Coronary artery bypass grafting (CABG) surgery may be undertaken with or
without cardiopulmonary bypass (CPB), that is, on- or off-pump.
Traditional high-dose opioid techniques of general anaesthesia should be
avoided and either inhalation or total intravenous (IV) anaesthesia may be
used. Meticulous monitoring, including electrocardiograph and invasive
arterial pressure measurement, is required. During grafting, good
communication between anaesthetist and surgeon is essential. Maintenance
of diastolic arterial pressure (DAP) is the key to preventing myocardial
ischaemia and cardiovascular collapse. Surgical positioning for grafting
to minimize hypotension is paramount and during grafting, IV fluid loading
or vasoconstrictors and inotropes are effective treatments. Correction of
bradycardia with atropine 0.3 mg IV or epicardial pacing also helps to
maintain DAP. Persisting hypotension may require intra-aortic balloon
pumping or conversion to on-pump CABG surgery. As there is less blood
loss, there is a minimal requirement for cardiovascular support and early
recovery of consciousness associated with off-pump compared with on-pump
CABG surgery; patients in some institutions may be managed in a recovery
room then transferred to a high-dependency unit, thus bypassing the
intensive care unit. 2012 Published by Elsevier Ltd.

<12>
Accession Number
2012593424
Authors
Hutton B. Joseph L. Fergusson D. Mazer C.D. Shapiro S. Tinmouth A.
Institution
(Hutton, Fergusson, Tinmouth) Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Joseph, Shapiro) McGill University, Department of Epidemiology and
Biostatistics, Montreal, QC, Canada
(Mazer) Department of Anesthesia, University of Toronto, Keenan Research
Center, Toronto, ON, Canada
Title
Risks of harms using antifibrinolytics in cardiac surgery: Systematic
review and network meta-analysis of randomised and observational studies.
Source
BMJ (Online). 345 (7877) , 2012. Article Number: e5798. Date of
Publication: 06 Oct 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To estimate the relative risks of death, myocardial infarction,
stroke, and renal failure or dysfunction between antifibrinolytics and no
treatment following the suspension of aprotinin from the market in 2008
for safety reasons and its recent reintroduction in Europe and Canada.
Design: Systematic review and network meta-analysis. Data sources: A
Cochrane review of antifibrinolytic treatments was chosen as the starting
point for this systematic review. Medline, Embase, and the Cochrane
register of trials were searched with no date restrictions for
observational evidence. Study selection: Propensity matched or adjusted
observational studies with two or more of the interventions of interest
(aprotinin, tranexamic acid, epsilon-aminocaproic acid, and no treatment)
that were carried out in patients undergoing cardiac surgery. Data
analysis: Network meta-analysis was used to compare treatments, and odds
ratios with 95% credible intervals were estimated. Meta-analyses were
carried out for randomised controlled trials alone and for randomised
controlled trials with observational studies. Results: 106 randomised
controlled trials and 11 observational studies (43 270 patients) were
included. Based on the results from analysis of randomised controlled
trials, tranexamic acid was associated on average with a reduced risk of
death compared with aprotinin (odds ratio 0.64, 95% credible interval 0.41
to 0.99). When observational data were incorporated, comparisons showed an
increased risk of mortality with aprotinin on average relative to
tranexamic acid (odds ratio 0.71, 95% credible interval 0.50 to 0.98) and
epsilon-aminocaproic acid (0.60, 0.43 to 0.87), and an increased risk of
renal failure or dysfunction on average relative to all comparators: odds
ratio 0.66 (95% credible interval 0.45 to 0.88) compared with no
treatment, 0.66 (0.48 to 0.91) versus tranexamic acid, and 0.65 (0.45 to
0.88) versus epsilon-aminocaproic acid. Conclusion: Although meta-analyses
of randomised controlled trials were largely inconclusive, inclusion of
observational data suggest concerns remain about the safety of aprotinin.
Tranexamic and epsilon-aminocaproic acid are effective alternatives that
may be safer for patients.

<13>
Accession Number
70898887
Authors
Morici N. Moja L. Rosato V. Oreglia J.A. Sacco A. De Marco F. Bruschi G.
Klugmann S. La Vecchia C. Savonitto S.
Institution
(Morici, Oreglia, Sacco, De Marco, Bruschi, Klugmann, Savonitto) Divisione
di Cardiologia 1-Emodinamica, Dipartimento Cardio-toracovascolare A. De
Gasperis, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy
(Moja) Italian Cochrane Centre, Mario Negri Institute for Pharmacological
Research, Milan, Italy
(Rosato, La Vecchia) Dipartimento di Epidemiologia, Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy
(La Vecchia) Dipartimento di Medicina del Lavoro, Universita di Milano,
Milan, Italy
Title
Time from adenosine di-phosphate receptor antagonists (ADPRAs)
discontinuation to coronary bypass surgery. A metaanalysis.
Source
Giornale Italiano di Cardiologia. Conference: 43 Congresso Nazionale di
Cardiologia dell'ANMCO Firenze Italy. Conference Start: 20120530
Conference End: 20120602. Conference Publication: (var.pagings). 13 (5
SUPPL. 2) (pp 176S), 2012. Date of Publication: May 2012.
Publisher
CEPI s.r.l.
Abstract
Background. Adenosine di-phosphate receptor antagonists (ADPRAs) blunt
hemostasis for several days after administration. This effect, aimed at
preventing cardiac ischemic complications, may increase peri-operative
hemorrhagic events in patients undergoing cardiac surgery. The aim of this
study was to determine whether preoperative ADPRAs discontinuation may be
beneficial prior to coronary artery bypass grafting (CABG). Methods. The
MEDLINE, EMBASE, and Cochrane Library databases were searched for
prospective and retrospective studies published between 2001 and 2012.
Results. There were 39 studies, with 23486 participants, 536 deaths and
562 re-operations due to bleeding. ADPRAs continuation up to CABG was
associated with an increased risk of postoperative mortality (OR 1.6, 95%
confidence interval (CI) 1.25 to 2.05) and reoperations due to bleeding
(OR 1.97; 95% CI 1.51-2.56). Between-study heterogeneity was low (Isquared
4.5%). Meta-analysis limited to high quality or prospective studies gave
consistent results. Discontinuation gave similar benefit at all days
although the majority of studies considered five days as cut-off.
Conclusions. ADPRAs administered within 7 days prior to CABG are
associated with an increased risk of death and reoperations due to
bleeding.

<14>
Accession Number
70900903
Authors
Khawaja M. Haran H. Nadra I. Wilson K. Clack L. MacGillivray K. Hancock J.
Young C.P. Bapat V. Thomas M. Redwood S.
Institution
(Khawaja, Nadra, Wilson, Clack, MacGillivray, Hancock, Young, Bapat,
Thomas, Redwood) Guy's and St Thomas NHS Trust, London, United Kingdom
(Haran) King's College School of Medicine, London, United Kingdom
Title
The effects of pre-existing significant coronary artery disease upon
outcome after TAVI using the Edwards bioprosthesis.
Source
EuroIntervention. Conference: EuroPCR 2011 Paris France. Conference Start:
20110517 Conference End: 20110520. Conference Publication: (var.pagings).
7 (pp M222), 2011. Date of Publication: May 2011.
Publisher
EuroPCR
Abstract
Aims: Patients undergoing surgical aortic valve replacement (sAVR)
routinely undergo simultaneous coronary artety bypass grafting (CABG) for
significant coronary arteiy disease (CAD) due to adverse prognostic
impact. Whilst manufacturers advise percutaneous intervention (PCI) of
significant CAD prior to transcatheter aortic valve implantation (TAVI)
there is considerable variation amongst operators. The aim of this study
was to investigate die impact of significant coronary artety disease upon
outcome after TAVI. Methods and results: We performed a retrospective
analysis of 168 patients who underwent TAVI using the Edwards
bioprosthesis from March 2008 to October 2010 at St. Thomas' Hospital,
London. They were divided into two groups according to the results of the
pre-TAVI coronary angiogram. (Group 1) patients with >=l coronary stenosis
of >=70% severity and those without (Group 2). The end-point was all-cause
mortality.There were no significant differences in the baseline
characteristics between the two groups. The mean age was 83.7+/-7.5 years
(mean+/-SD) in Group 1 vs.81.7+/-8.5 years in Group 2 (p=0.112). Rates of
diabetes (22.9% vs. 27.6%, p=0.492), cerebrovascular disease (15.7% vs.
17.3%, p=0.780), peripheral vascular disease (21.4% vs. 12.2%, p-0.110),
previous percutaneous coronary intervention (PCI) (22.9% vs. 12.2%,
p=0.070) and previous coronary arteiy bypass grafting (CABG) (25.7% vs.
27.6%, p=0.791) showed no statistically significant difference. Nor was
there any difference in either glomerular filtration rate (48.4+/-27.9 vs.
46.8+/-23.1 mls/min/1.73 m², p=0.685), logistic EuroScore
(23.5+/-12.9% vs. 21.5+/-16 2%, p=0.399), left ventricular ejection
fraction (48.8+/-11.3% vs. 47.9+/-12.4%, p=0.658 or aortic valve area (0
63+/-0 20 vs. 0.67+/-0 22 cm², p=0.219). There any difference
in approach (transfemoral, transapical and transaortic) between the
groups: 44.9%, 48.0% and 7.1%vs41.4%, 52.9% and 5.7%
respectively(p=0.778). In total, 70 patients (41.7%) had significant CAD
prior to TAVI, with 10 (6.0%) undergoing PCI prior to their procedure. At
a mean follow up of335+/-277 days (mean+/-SD), the overall mortality was
22.6%; Group 1 mortality was 30% and in group 2 was 17.3% (p=0.124). There
was no difference seen in the length of stay in the intensive care unit
(2.7+/-6.2 vs. 4.1+/-14.9 days, p=0.462) nor in the number of days to
discharge (126+/-10.1 vs. 12 8+/-13, p=0.928). Amongst those patients who
underwent PCI in Group 1,8 had single vessel intervention and 2 had PCI to
2 vessels. The target vessels were left main stem[LMS] (n=2), proximal
left anterior descending artery [LAD] (n=5), circumflex (n=l), right
coronary artery [RCA] (n=2), saphenous vein graftfSVG] to LAD (n=l) and
SVG to circumflex (n=l). Mortality in this sub-group was not significantly
different from the CAD patients who did not receive PCI (50% vs. 26 7%,
p=0.272). Conclusions: The presence of significant CAD had no
statistically significant impact upon the all-cause mortality of patients
after TAVI in our study. As yet, the impact of PCI to significant CAD upon
outcome after TAVI is not known and will be assessed in a prospective,
randomised controlled trial currently underway.

<15>
Accession Number
70898663
Authors
De Lucia V. Cantinotti M. Assanta N. Murzi B. Spadoni I.
Institution
(De Lucia, Cantinotti, Assanta, Murzi, Spadoni) Fondazione Toscana G.
Monasterio, Massa, Italy
Title
Limitations in the prophylaxis and treatment of post-surgical pericardial
syndromes: A critical review with a special emphasis on paediatric age.
Source
Giornale Italiano di Cardiologia. Conference: 42nd Congresso Nazionale
della Societa Italiana di Cardiologia Pediatrica Jesi Italy. Conference
Start: 20121011 Conference End: 20121013. Conference Publication:
(var.pagings). 13 (10 SUPPL. 1) (pp 18S-19S), 2012. Date of Publication:
2012.
Publisher
CEPI s.r.l.
Abstract
Background. Post-surgical pericardial syndromes are common complications
after cardiac surgery, however their treatment remains not well
established. The accuracy/limits of clinical trials on prophylaxis and
treatment of these diseases have been reviewed to identify an
evidencebased therapeutic approach. Methods. A literature search in the
National Library of Medicine has been performed using the keywords
pericardial effusion +/- cardiac surgery +/- paediatric/congenital. The
research was then redefined adding separately the keywords
post-pericardiotomy syndrome (PPS), non-steroidal antiinflammatory drugs
(NSAID), steroids and colchicine. Results. Twelve clinical trials, 8
regarding the prophylaxis, and 4 the treatment of PPS, have been found.
Three majors agent classes, NSAID, corticosteroids, and colchicine, were
tested. Therapy of post-surgical pericardial syndromes is generally based
on NSAID +/- steroids with the adjunct of colchicine for recurrences. Just
a few targeted studies however support actual pharmacological approaches.
NSAID therapy is supported only a few randomized controlled adult trials
(RCT); while efficacy of steroids have been proved only in one small
paediatric work, and no studies are available for colchicine. Studies
furthermore presented some limitations: not univocal end-points (not
allowing for a meta-analysis), a limited sample-size, scarce attention to
confounders (such as the underlying cardiac disease and diuretic/analgesic
regimen). When to start therapy furthermore remain unclear and therapy
based on drug associations have not been assessed. As far as prophylaxis
is concerned (Table 1), more evidence (two wide RCT plus a meta-analysis)
supports the role of colchicine in adults. Prophylaxis with
NSAID/corticosteroids instead failed to prove significant advantage in
children, while a few data are available for adults. (Table presente)
Conclusions. Evidences for the treatment of PSPS are fragmentary and
incomplete. As a result, on the basis of actual knowledge, it results
difficult to establish the treatment of choice and the optimal timing for
starting therapy, especially in children. Treatment in pediatric age is
usually based on personal experience and institutional practice with NAIDS
generally employed first and steroids reserved for more severe forms of
PSPS or recurrences. Further wider and multi-agents studies are advised in
order to establish a therapeutical flow-chart for the treatment of PSPS.