Results Generated From:
Embase <1980 to 2012 Week 47>
Embase (updates since 2012-11-16)
<1>
Accession Number
2012655653
Authors
Gao D. Ning N. Niu X. Dang Y. Dong X. Wei J. Zhu C.
Institution
(Gao, Niu, Dang, Dong, Wei, Zhu) Department of Cardiology, Second
Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an,
Shaanxi, China
(Ning) Department of Nuclear Medicine, Second Affiliated Hospital, Xi'an
Jiaotong University School of Medicine, Xi'an, Shaanxi, China
Title
Erythropoietin treatment in patients with acute myocardial infarction: A
meta-analysis of randomized controlled trials.
Source
American Heart Journal. 164 (5) (pp 715-e1), 2012. Date of Publication:
November 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: In experimental models of acute myocardial infarction (AMI),
erythropoietin (EPO) reduces infarct size and improves left ventricular
(LV) function. However, in the clinical setting, the effect of EPO in AMI
was unclear. We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) of EPO to explore the safety and
therapeutic effects of EPO in patients with AMI. Methods: We identified
reports of RCTs comparing EPO to placebo for AMI in adult humans in
PubMed, Cochrane Central Register of Controlled Trials, and EMBASE.
Outcomes included all-cause mortality, major cardiovascular events,
cardiac function by LV ejection fraction and infarct size. Results: We
included 13 articles of RCTs with data for 1,564 patients. Erythropoietin
therapy did not improve LV ejection fraction (weighted mean difference
[WMD] 0.33, 95% CI -1.90 to 1.24, P =.68) and had no effect on infarct
size, as measured by cardiac magnetic resonance imaging (WMD -0.12, -2.16
to 1.91, P =.90) or serum peak value of creatine kinase-MB (WMD -2.01,
-25.70 to 21.68, P =.87). Erythropoietin treatment did not decrease the
risk of total adverse cardiac events (relative risk [RR] 1.02, 0.65-1.61,
P =.92). Erythropoietin treatment also failed to decrease the risk of
heart failure (RR, 0.69, 0.27-1.72, P =.42) and all-cause mortality (RR
0.55, 0.22-1.33, P =.18). Moreover, EPO had no effect on the risk of stent
thrombosis (RR, 0.69, 0.29-1.64, P =.40). Conclusion: Erythropoietin in
patients with AMI seems to have no clinical benefit for heart function or
reducing infarct size, cardiovascular events, and all-cause mortality.
Erythropoietin may not be a choice for patients with AMI. 2012 Mosby,
Inc.
<2>
Accession Number
2012655652
Authors
Melloni C. Sprecher D.L. Sarov-Blat L. Patel M.R. Heitner J.F. Hamm C.W.
Aylward P. Tanguay J.-F. Dewinter R.J. Marber M.S. Lerman A. Hasselblad V.
Granger C.B. Newby L.K.
Institution
(Melloni, Patel, Hasselblad, Granger, Newby) Duke Clinical Research
Institute, 2400 Pratt St., Durham, NC 27705, United States
(Sprecher, Sarov-Blat) GlaxoSmithKline Pharmaceuticals, Philadelphia, PA,
United States
(Heitner) Division of Cardiology, New York Methodist Hospital, Brooklyn,
NY, United States
(Hamm) Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim,
Germany
(Aylward) South Australian Health and Medical Research Institute, Flinders
Medical Centre, Adelaide, SA, Australia
(Tanguay) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Dewinter) Department of Cardiology, Academic Medical Center-University of
Amsterdam, Amsterdam, Netherlands
(Marber) King's College London BHF Centre, Cardiovascular Division, St
Thomas' Hospital, London, England, United Kingdom
(Lerman) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Title
The Study of LoSmapimod treatment on inflammation and InfarCtSizE
(SOLSTICE): Design and rationale.
Source
American Heart Journal. 164 (5) (pp 646-e3), 2012. Date of Publication:
November 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
The p38 mitogen-activated protein kinase (MAPK) is a nexus point in
inflammation, sensing, and stimulating cytokine production and driving
cell migration and death. In acute coronary syndromes, p38MAPK inhibition
could stabilize ruptured atherosclerotic plaques, pacify active plaques,
and improve microvascular function, thereby reducing infarct size and risk
of subsequent cardiac events. The SOLSTICE trial is randomized,
double-blind, placebo-controlled, parallel group, multicenter phase 2a
study of 535 patients that evaluates the safety and efficacy of losmapimod
(GW856553), a potent oral p38MAPK inhibitor, vs placebo in patients with
non-ST-segment elevation myocardial infarction expected to undergo an
invasive strategy. The coprimary end points are reduction in
high-sensitivity C-reactive protein at 12 weeks and reduction in infarct
size as assessed by troponin area under the curve at 72 hours. A key
secondary end point is 72-hour and 12-week B-type natriuretic peptide
levels as a measure of cardiac remodeling and ventricular strain. The
primary safety assessments are serious and nonserious adverse events,
results of liver function testing, and major adverse cardiac events.
Cardiac magnetic resonance imaging (N = 117) and coronary flow reserve (N
= 13) substudies will assess the effects of losmapimod on infarct size,
myocardial function, and coronary vasoregulation. Information gained from
the SOLSTICE trial will inform further testing of this agent in larger
clinical trials. 2012 Mosby, Inc.
<3>
Accession Number
2012639121
Authors
Michel J.-M. Willebois S. Ribinik P. Barrois B. Colin D. Passadori Y.
Institution
(Michel) Pole de gerontologie clinique, Hopitaux civils de Colmar, 39,
avenue de la Liberte, 68024 Colmar, France
(Willebois) CHU de Limoges, Section Chastaingt, 2, avenue
Martin-Luther-King, 87042 Limoges, France
(Ribinik, Barrois) Service de MPR, Centre hospitalier de Gonesse, 25, rue
Bernard-Fevrier, BP 30071, 95503 Gonesse cedex, France
(Colin) Centre de l'Arche, 72650 Saint-Saturnin, France
(Passadori) Maison medicale pour personnes agees, 5, rue du
Dr-Leon-Mangeney, BP 1370, 68024 Mulhouse cedex, France
Title
As of 2012, what are the key predictive risk factors for pressure ulcers?
Developing French guidelines for clinical practice.
Source
Annals of Physical and Rehabilitation Medicine. 55 (7) (pp 454-465), 2012.
Date of Publication: October 2012.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction: An evaluation of predictive risk factors for pressure ulcers
is essential in development of a preventive strategy on admission to
hospitals and/or nursing homes. Objectives: Identification of the
predictive factors for pressure ulcers as of 2012. Method: Systematic
review of the literature querying the databases PASCAL Biomed, Cochrane
Library and PubMed from 2000 through 2010. Results: Immobility should be
considered as a predictive risk factor for pressure ulcers (grade B).
Undernutrition/malnutrition may also be a predictive risk factor for
pressure ulcers (grade C). Discussion: Even if the level of evidence is
low, once these risk factors have been detected, management is essential.
Sensitizing and mobilizing health care teams requires training in ways of
tracking and screening. According to the experts, risk scales should be
used. As decision aids, they should always be balanced and complemented by
the clinical judgment of the treatment team. Conclusion: According to
experts, it is important to know and predictively evaluate risk of
pressure ulcers at the time of hospital admission. The predictive risk
factors found in this study are identical to those highlighted at the 2001
consensus conference of which was PERSE was the promoter. 2012.
<4>
Accession Number
2012655639
Authors
Povsic T.J. Losordo D.W. Story K. Junge C.E. Schatz R.A. Harrington R.A.
Henry T.D.
Institution
(Povsic, Harrington) Duke Clinical Research Institute, Duke University
Medical Center, 2400 Pratt Street, Durham, NC 27705, United States
(Losordo, Story, Junge) Baxter Healthcare Corporation, Deerfield, IL,
United States
(Schatz) Scripps Clinic Torrey Pines, San Diego, CA, United States
(Henry) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, Minneapolis, MN, United States
Title
Incidence and clinical significance of cardiac biomarker elevation during
stem cell mobilization, apheresis, and intramyocardial delivery.
Source
American Heart Journal. 164 (5) (pp 689-e3), 2012. Date of Publication:
November 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Cell therapy is a promising therapeutic for a variety of
cardiovascular conditions including refractory angina. Elevation of
cardiac biomarkers during cell delivery has been frequently described, but
the clinical implications have never been studied. Methods: ACT34-CMI was
a randomized double-blind study assessing the use of intramyocardial
delivery of autologous CD34<sup>+</sup> cells for the treatment of
refractory angina. Patients (n = 167) underwent G-CSF-mediated (5 mug/[kg
day] x 5 days) stem cell mobilization, apheresis, and intramyocardial
injection of 1 x 10 <sup>5</sup>/kg or 5 x 10<sup>5</sup>/kg
CD34<sup>+</sup> cells or placebo. Troponin and creatinine kinase MB were
assessed at baseline (n = 161), after cell mobilization and apheresis (n =
153 and 143, respectively), and post-intramyocardial injection (n = 155
and 141, respectively). Major adverse cardiac events (MACE) included
death, myocardial infarction, acute congestive heart failure, urgent
revascularization, or sustained ventricular arrhythmia. Results: Seven
(4.3%) subjects had troponin above the upper limits of normal (ULN) at
baseline. Thirty-four (22.2%) and 11 (7.2%) subjects had troponin levels >
ULN or >3x ULN after cell mobilization and apheresis, whereas 72 (46.1%)
and 39 (25.2%) subjects had troponin elevations > ULN or >3x ULN,
respectively, after intramyocardial injections. Age, but no other
preprocedural factors, was predictive of troponin elevation.
Periprocedural troponin elevation was not associated with an increased
risk of MACE during 1 year, especially in cell therapy-treated patients.
Conclusions: Troponin elevation is common during stem cell harvesting and
intramyocardial administration, is usually asymptomatic, and does not
appear to be associated with long-term MACE in subjects undergoing stem
cell mobilization and intramyocardial injection. 2012 Mosby, Inc.
<5>
Accession Number
2012650500
Authors
Cassese S. Ndrepepa G. King L.A. Tada T. Fusaro M. Kastrati A.
Institution
(Cassese, Ndrepepa, King, Tada, Fusaro, Kastrati) Deutsches Herzzentrum,
Technische Universitat, Lazaretstr. 36, Munich 80636, Germany
Title
Two zotarolimus-eluting stent generations: A meta-analysis of 12
randomised trials versus other limus-eluting stents and an adjusted
indirect comparison.
Source
Heart. 98 (22) (pp 1632-1640), 2012. Date of Publication: November 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective To evaluate efficacy and safety of two zotarolimus-eluting stent
generations versus other limuseluting stents (LES), and to compare
Resolute zotarolimus-eluting stents (R-ZES) with Endeavor
zotarolimus-eluting stents (E-ZES). Background The performance of
zotarolimus-eluting stents versus other LES, and the possible improvements
of R-ZES versus E-ZES still remain to be defined. Methods We undertook a
meta-analysis of trials in which patients were randomly assigned to
percutaneous coronary interventions (PCI) with R-ZES versus LES, or with
E-ZES versus LES, as well as an indirect comparison of R-ZES versus E-ZES,
with LES as common comparator. The primary efficacy endpoint was
ischaemia-driven target vessel revascularisation (ID-TVR); the primary
safety endpoints were myocardial infarction (MI), cardiac death and
cumulative definite/probable stent thrombosis (ST). Results Overall,
13'709 patients were assigned to PCI with R-ZES versus LES (n=7185) or
with E-ZES versus LES (n=6524). The risk of ID-TVR (OR (95% CI)=1.06 (0.90
to 1.25), p=0.47), MI (1.00 (0.81 to 1.25), p=0.97), cardiac death (0.99
(0.69 to 1.42), p=0.96) and ST (1.18 (0.68 to 2.03), p=0.56) did not
differ between RZES and LES. Patients receiving E-ZES were more likely to
undergo ID-TVR as compared with those receiving LES (1.95 (1.40 to 2.73),
p<0.0001). The risk of MI (0.91 (0.54 to 1.54), p=0.73), cardiac death
(1.02 (0.54 to 1.91), p=0.96) and ST (1.10 (0.50 to 2.44), p=0.81) was
similar between E-ZES and LES. At indirect comparison, PCI with R-ZES
versus E-ZES reduced the risk of ID-TVR (0.54 (0.37 to 0.78), p=0.001),
without increasing MI (1.09 (0.62 to 1.93), p=0.74), cardiac death (0.97
(0.46 to 2.00), p=0.93) and ST (1.07 (0.40 to 2.80), p=0.88). Conclusions
The antirestenotic efficacy of Resolute zotarolimus-eluting stents is
superior to Endeavor zotarolimus-eluting stents and similar to other
limuseluting stents. Endeavor zotarolimus-eluting stents increase the risk
of reinterventions as compared with other limus-eluting stents. First and
second-generation zotarolimus-eluting stents have similar thrombogenicity
compared with other limus-eluting stents.
<6>
Accession Number
2012657211
Authors
Gu W.-J. Wei C.-Y. Huang D.-Q. Yin R.-X.
Institution
(Gu, Wei, Yin) Department of Cardiology, Institute of Cardiovascular
Diseases, The First Affiliated Hospital, Guangxi Medical University,
Nanning, Guangxi, China
(Gu) Department of Anaesthesiology, The First Affiliated Hospital, Guangxi
Medical University, Nanning, Guangxi, China
(Huang) Department of Encephalopathy, The First Affiliated Hospital,
Guangxi Traditional Chinese Medical University, Nanning, Guangxi, China
Title
Meta-analysis of randomized controlled trials on the efficacy of thoracic
epidural anesthesia in preventing atrial fibrillation after coronary
artery bypass grafting.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 67. Date of
Publication: 19 Aug 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Postoperative atrial fibrillation (POAF) is one of the most
common complications in patients undergoing coronary artery bypass
grafting (CABG). The goal of this meta-analysis was to evaluate the
efficacy of thoracic epidural anesthesia (TEA) in preventing POAF in adult
patients undergoing CABG.Methods: MEDLINE and EMBASE were searched to
identify randomized controlled trails in adult patients undergoing CABG
who were randomly assigned to receive general anesthesia plus thoracic
epidural anesthesia (GA + TEA) or general anesthesia only (GA). Two
authors independently extracted data using a standardized Excel file. The
primary outcome measure was the incidence of POAF. We used
DerSimonian-Laird random-effects models to compute summary risk ratios
with 95% confidence intervals.Results: Five studies involving 540 patients
met our inclusion criteria. No significant difference in the incidence of
POAF was observed between the two groups (risk ratio, 0.61; 95% confidence
interval, 0.33 to 1.12; P = 0.11), with significant heterogeneity among
the studies (I<sup>2</sup> = 73%, P = 0.005). Sensitivity analyses by
primary endpoint, methodological quality and surgical technique yielded
similar results.Conclusions: The limited evidence suggests that TEA shows
no beneficial efficacy in preventing POAF in adult patients undergoing
CABG. However, the results of this meta-analysis should be interpreted
with caution due to significant heterogeneity of the studies included.
Thus, the potential infuence of TEA on the incidence of atrial
fibrillation following CABG warrants further investigation. 2012 Gu et
al.; licensee BioMed Central Ltd.
<7>
Accession Number
2012647876
Authors
Golabchi A. Basati F. Kargarfard M. Sadeghi M.
Institution
(Golabchi) Isfahan Cardiovascular Research Center, Isfahan Cardiovascular
Research Institute, Isfahan, Iran, Islamic Republic of
(Golabchi) Cardiac Electrophysiology Research Center, Rajaie
Cardiovascular Medical and Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Basati) School of Physical Education and Sport Sciences, University of
Isfahan, Isfahan, Iran, Islamic Republic of
(Kargarfard) School of Exercise Physiology, School of Physical Education
and Sport Sciences, University of Isfahan, Isfahan, Iran, Islamic Republic
of
(Sadeghi) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Title
Can cardiac rehabilitation programs improve functional capacity and left
ventricular diastolic function in patients with mechanical reperfusion
after ST elevation myocardial infarction?: A double-blind clinical trial.
Source
ARYA Atherosclerosis. 8 (3) (pp 2), 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: Current guidelines recommend cardiac rehabilitation programs
(CRP) as a means to improve functional status of patients after coronary
revascularization. However, research supporting this recommendation has
been limited and positive effects of CRP on diastolic function are
controversial. The aim of this study was to examine the effects of an
8-week CRP on left ventricular diastolic function. METHODS: This
randomized, clinical trial included 29 men with ST elevation myocardial
infarction (MI) who had received reperfusion therapy, i.e. coronary artery
bypass grafting (CABG) or percutaneous coronary intervention (PCI). They
were randomized to a training group (n = 15; mean age: 54.2 +/- 9.04 years
old) and a control group (n = 14; mean age: 51.71 +/- 6.98 years old).
Patients in the training group performed an 8-week CRP with an intensity
of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes
and were held three times a week. At the start and end of the study, all
patients performed symptom-limited exercise test based on Naughton
treadmill protocol. Pulsed-wave Doppler echocardiography was also used to
determine peak velocity of early (E) and late (A) waves, E/A ratios, and
the deceleration time of E (DT). RESULTS: Left ventricular diastolic
indices (E, A, E/A ratio, DT) did not change significantly after the CRP.
Compared to baseline, patients in the training group had significant
improvements in functional capacity (8.30 +/- 1.30 vs. 9.7 +/- 1.7) and
maximum heart rate (118.50 +/- 24.48 vs. 126.85 +/- 22.75). Moreover,
resting heart rate of the training group was significantly better than the
control group at the end of the study (75.36 +/- 7.94 vs. 79.80 +/- 7.67;
P < 0.001). CONCLUSION: An 8-week CRP in post-MI patients revascularized
with PCI or CABG led to improved exercise capacity. However, the CRP
failed to enhance diastolic function.
<8>
[Use Link to view the full text]
Accession Number
2012656293
Authors
Pursnani S. Korley F. Gopaul R. Kanade P. Chandra N. Shaw R.E. Bangalore
S.
Institution
(Pursnani, Korley, Gopaul, Kanade, Chandra) Johns Hopkins Bloomberg School
of Public Health, Baltimore MD, United States
(Pursnani, Shaw) California Pacific Medical Center, San Francisco, CA,
United States
(Bangalore) Leon H. Charney Division of Cardiology, Cardiovascular
Outcomes Group, New York University School of Medicine, New York, NY
10016, United States
Title
Percutaneous coronary intervention versus optimal medical therapy in
stable coronary artery disease: A systematic review and meta-analysis of
randomized clinical trials.
Source
Circulation: Cardiovascular Interventions. 5 (4) (pp 476-490), 2012. Date
of Publication: August 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: The role of percutaneous coronary intervention (PCI) in the
management of stable coronary artery disease remains controversial. Given
advancements in medical therapies and stent technology over the last
decade, we sought to evaluate whether PCI, when added to medical therapy,
improves outcomes when compared with medical therapy alone. Methods and
Results: We performed a systematic review and meta-analysis, searching
PubMed, EMBASE, and CENTRAL databases, until January 2012, for randomized
clinical trials comparing revascularization with PCI to optimal medical
therapy (OMT) in patients with stable coronary artery disease. The primary
outcome was all-cause mortality, and secondary outcomes included
cardiovascular death, nonfatal myocardial infarction, subsequent
revascularization, and freedom from angina. Primary analyses were based on
longest available follow-up with secondary analyses stratified by trial
duration, with short-term (<=1 year), intermediate (1-5 years), and
long-term (>=5 years) time points. We identified 12 randomized clinical
trials enrolling 7182 participants who fulfilled our inclusion criteria.
For the primary analyses, when compared with OMT, PCI was associated with
no significant improvement in mortality (risk ratio [RR], 0.85; 95% CI,
0.71-1.01), cardiac death (RR, 0.71; 95% CI, 0.47-1.06), nonfatal
myocardial infarction (RR, 0.93; 95% CI, 0.70-1.24), or repeat
revascularization (RR, 0.93; 95% CI, 0.76-1.14), with consistent results
over all follow-up time points. Sensitivity analysis restricted to studies
in which there was >50% stent use showed attenuation in the effect size
for all-cause mortality (RR, 0.93; 95% CI, 0.78-1.11) with PCI. However,
for freedom from angina, there was a significant improved outcome with
PCI, as compared with OMT (RR, 1.20; 95% CI, 1.06-1.37), evident at all of
the follow-up time points. Conclusions: In this most rigorous and
comprehensive analysis in patients with stable coronary artery disease,
PCI, as compared with OMT, did not reduce the risk of mortality,
cardiovascular death, nonfatal myocardial infarction, or
revascularization. PCI, however, provided a greater angina relief compared
with OMT alone, larger studies with sufficient power are required to prove
this conclusively. 2012 American Heart Association, Inc.
<9>
Accession Number
2012647226
Authors
Mazandarani M. Yousefshahi F. Abdollahi M. Hamishehkar H. Barkhordari K.
Boroomand M.A. Jalali A. Ahmadi A. Moharari R.S. Bashirzadeh M.
Mojtahedzadeh M.
Institution
(Mazandarani, Mojtahedzadeh) Department of Pharmacotherapy, Faculty of
Pharmacy, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Yousefshahi, Barkhordari, Ahmadi, Moharari) Department of Anesthesia and
Critical Care, Faculty of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Abdollahi) Pharmaceutical Sciences Research Center, Tehran University of
Medical Science, Tehran, Iran, Islamic Republic of
(Hamishehkar) Department of Pharmacotherapy, Faculty of Pharmacy, Tabriz
University of Medical Science, Tabriz, Iran, Islamic Republic of
(Boroomand) Department of Pathology, Faculty of Medicine, Tehran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Jalali) Department of Epidemiology and Biostatistics, Faculty of
Statistics, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Bashirzadeh) Department of Pharmacotherapy, School of Pharmacy, Islamic
Azad University of Pharmaceutical Sciences, Tehran, Iran, Islamic Republic
of
Title
Comparison of hypertonic saline versus normal saline on cytokine profile
during CABG.
Source
DARU, Journal of Pharmaceutical Sciences. 20 (1) , 2012. Article Number:
49. Date of Publication: 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background and the purpose of the study. Blood contact with artificial
surfaces of the extracorporeal circuit and ischemia-reperfusion injury in
CABG with CPB, may lead to a systemic inflammatory response. Hypertonic
saline have been recently investigated as a fluid in order to decrease
inflammatory response and cytokines generation in patients undergo cardiac
operations. Our purpose is to study the prophylactic effect of HS 5%
infusion versus NS on serum IL-6 as an inflammatory & IL-10 as an
anti-inflammatory biomarker in CABG patients. Methods. The present study
is a randomized double-blinded clinical trial. 40 patients undergoing CABG
were randomized to receive HS 5% or NS before operation. Blood samples
were obtained after receiving HS or NS, just before operation, 24 and 48
hours post-operatively. Plasma levels of IL-6 and IL-10 were measured by
ELISA. Results and major conclusion. Patients received HS had lower levels
of IL-6 and higher level of IL-10 compared with NS group, however these
differences were not statistically significant. Results of this study
suggest that pre-treatment with small volume hypertonic saline 5% may have
beneficial effects on inflammatory response following CABG operation.
2012 Mazandarani et al.; licensee BioMed Central Ltd.
<10>
Accession Number
2012654160
Authors
Jhaveri R.R. Reynolds H.R. Katz S.D. Jeger R. Zinka E. Forman S.A. Lamas
G.A. Hochman J.S.
Institution
(Jhaveri, Reynolds, Katz, Hochman) Cardiovascular Clinical Research
Center, Leon Charney Division of Cardiology, New York University School of
Medicine, 530 First Avenue, New York, NY 10016, United States
(Jeger) Cardiology University Hospital, Basel, Switzerland
(Zinka) Division of Cardiology, Voivode Hospital, Koszalin, Poland
(Forman) Clinical Trials and Surveys Corporation, Owings Mills, MD, United
States
(Lamas) Columbia University, Division of Cardiology, Mount Sinai Medical
Center, Miami Beach, FL, United States
Title
Heart failure in post-MI patients with persistent IRA occlusion:
Prevalence, risk factors, and the long-term effect of PCI in the Occluded
Artery Trial (OAT).
Source
Journal of Cardiac Failure. 18 (11) (pp 813-821), 2012. Date of
Publication: November 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Background: The incidence and predictors of heart failure (HF) after
myocardial infarction (MI) with modern post-MI treatment have not been
well characterized. Methods and Results: A total of 2,201 stable patients
with persistent infarct-related artery occlusion >24 hours after MI with
left ventricular ejection fraction <50% and/or proximal coronary artery
occlusion were randomized to percutaneous intervention plus optimal
medical therapy (PCI) or optimal medical therapy (MED) alone. Centrally
adjudicated HF hospitalizations for New York Heart Association (NYHA)
III/IV HF and mortality were determined in patients with and without
baseline HF, defined as a history of HF, Killip Class >I at index MI,
rales, S3 gallop, NYHA II at randomization, or NYHA >I before index MI.
Long-term follow-up data were used to determine 7-year life-table
estimated event rates and hazard ratios. There were 150 adjudicated HF
hospitalizations during a mean follow-up of 6 years with no difference
between the randomized groups (7.4% PCI vs. 7.5% MED, P =.97). Adjudicated
HF hospitalization was associated with subsequent death (44.0% vs. 13.1%,
HR 3.31, 99% CI 2.21-4.92, P <.001). Baseline HF (present in 32% of
patients) increased the risk of adjudicated HF hospitalization (13.6% vs.
4.7%, HR 3.43, 99% CI 2.23-5.26, P <.001) and death (24.7% vs. 10.8%, HR
2.31, 99% CI 1.71-3.10, P <.001). Conclusions: In the overall Occluded
Artery Trial (OAT) population, adjudicated HF hospitalizations occurred in
7.5% of subjects and were associated with increased risk of subsequent
death. Baseline or prior HF was common in the OAT population and was
associated with increased risk of hospitalization and death. 2012
Elsevier Inc. All rights reserved.
<11>
[Use Link to view the full text]
Accession Number
2012653889
Authors
Viterbo J.F. Lourenco A.P. Leite-Moreira A.F. Pinho P. Barros F.
Institution
(Viterbo, Lourenco, Barros) Department of Anesthesiology, Hospital Sao Joa
o, EPE, 4202-451 Porto, Portugal
(Leite-Moreira, Pinho) Department of Physiology and Cardiothoracic
Surgery, Faculty of Medicine, University of Porto, Portugal
Title
Prospective randomised comparison of Marsh and Schnider pharmacokinetic
models for propofol during induction of anaesthesia in elective cardiac
surgery.
Source
European Journal of Anaesthesiology. 29 (10) (pp 477-483), 2012. Date of
Publication: October 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Context Haemodynamic stability during induction is a cornerstone of
cardiac anaesthesia. The evaluation of pharmacokinetic models for propofol
during induction is lacking. Objective To compare haemodynamics during
cardiac anaesthesia induction with two pharmacokinetic models. Design
Randomised controlled trial. Setting Department of Cardiothoracic Surgery,
Sao Joao Hospital; July to December 2010. Patients Ninety consecutive
elective adult cardiac surgical patients. Intervention Random assignment
to effect-site targetcontrolled infusion by Marsh (n=45) or Schnider
(n=45) pharmacokinetic models with an equilibration constant of 1.2
min<sup>-1</sup> adapted to Marsh's model. Invasive blood pressure
measurements, propofol dose, and bispectral index (BIS) were recorded.
After an initial target concentration of 1.5mugml<sup>-1</sup>,
concentrations were upward-titrated in 0.5mgml <sup>-1</sup> increments
until the BIS was <50. Results No differences were observed between Marsh
and Schnider models in required propofol dose (0.99+/-0.26 vs.
0.93+/-0.31mgkg<sup>-1</sup>, P=0.322), decrease in mean blood pressure
(25+/-13 vs. 22+/-14%, P=0.192) or the need for vasopressors (20 vs. 24%,
P=0.800), but the use of the Marsh model resulted in a lower predicted
effect-site concentration (2.3+/-0.4 vs. 2.7+/-0.6mgml<sup>-1</sup>,
P=0.006) and shorter time to induction (296+/-59 vs. 338+/-87 s, P=0.024).
There was a greater decrease in mean blood pressure in older patients (>60
years; 29+/-10 vs. 22+/-11%, P=0.004) irrespective of model, butobese
(BMI>=30 kgm <sup>-2</sup>) and nonobese patients did not differ. Main
outcome measures Decrease in mean blood pressure. Conclusion In
effect-site targeting with a 1.2 min<sup>-1</sup> equilibration constant,
Marsh's model is comparable to Schnider's during induction of anaesthesia.
Copyright 2012 European Society of Anaesthesiology.
<12>
Accession Number
2012643959
Authors
Lee J.-H. Yang W.-D. Han S.-Y. Noh J.-I. Cho S.-H. Kim S.-H. Chae W.-S.
Jin H.-C.
Institution
(Lee, Yang, Han, Noh, Cho, Kim, Chae, Jin) Department of Anesthesiology
and Pain Medicine, Soonchunhyang University Bucheon Hospital, 1174
Jung-dong, Wonmi-gu, Bucheon, Gyeonggi-do, South Korea
Title
Effect of epidural magnesium on the incidence of chronic postoperative
pain after video-assisted thoracic surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (6) (pp 1055-1059),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The aim of this study was to determine whether the epidural
administration of magnesium during the perioperative period decreased the
incidence of chronic postoperative pain (CPOP) at 3 months after
video-assisted thoracic surgery. Design: Prospective, randomized, and
blinded. Setting: A university hospital. Participants: Patients.
Interventions: Before the induction of anesthesia, the patients were
assigned randomly to receive normal saline, 5 mL, (group C, n = 72) or
magnesium sulfate, 100 mg (group M, n = 72), epidurally. At the end of
surgery, group C received a continuous infusion of a mixture of 0.2%
ropivacaine, 226 mL, and fentanyl, 1,200 mug, through a patient-controlled
epidural analgesia pump for 48 hours. In group M, magnesium sulfate, 500
mg, was added to the infusion. Measurements and Main Results: The
incidence and severity of CPOP were assessed by a telephone survey 3
months after surgery. Patients were asked whether they experienced pain
and to rank the severity of the pain using a 3-point scale (1, mild; 2,
moderate; 3, severe). The incidences of CPOP were 42.4% in group C and
49.1% in group M. The severities of pain in the patients with CPOP were
1.0 (1-2) in group C and 1.0 (1-2) in group M. The incidence and severity
of CPOP did not differ between the 2 groups. Conclusions: The epidural
administration of magnesium from before the induction of anesthesia to 48
hours postoperatively did not decrease significantly the incidence or
severity of CPOP in patients undergoing video-assisted thoracic surgery.
2012 Elsevier Inc.
<13>
Accession Number
2012643947
Authors
Nielsen D.V. Bhavsar R. Greisen J. Ryhammer P.K. Sloth E. Jakobsen C.-J.
Institution
(Nielsen, Bhavsar, Greisen, Ryhammer, Sloth, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby,
DK-8200 Aarhus N, Denmark
Title
High thoracic epidural analgesia in cardiac surgery: Part 2 - High
thoracic epidural analgesia does not reduce time in or improve quality of
recovery in the intensive care unit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (6) (pp 1039-1047),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To evaluate the postoperative effect of high thoracic epidural
analgesia on the time in the intensive care unit (ICU) and the quality of
cardiac recovery in patients undergoing cardiac surgery. Design: A
randomized prospective study. Participants: Sixty low-risk patients 65 to
80 years of age scheduled for elective coronary artery bypass graft
surgery with or without aortic valve replacement. Setting: A university
hospital. Interventions: Patients randomized to receive high thoracic
epidural analgesia (HTEA) as a supplement to general anesthesia.
Measurements and Main Results: The eligible time to discharge from the ICU
and the quality of recovery were evaluated by an objective ICU scoring
system. The time to eligible discharge from the ICU, the ventilation time,
and the actual time in the ICU were not shorter in the HTEA group compared
with patients receiving conventional general anesthesia. Patients
receiving HTEA in addition to general anesthesia received less morphine
postoperatively but with no consequent beneficial effect on respiration,
nausea, sedation, or motor function. Conclusions: HTEA does not reduce the
time in the ICU or improve the quality of recovery in the ICU. 2012
Elsevier Inc.
<14>
Accession Number
2012643946
Authors
Jakobsen C.-J. Bhavsar R. Nielsen D.V. Ryhammer P.K. Sloth E. Greisen J.
Institution
(Jakobsen, Bhavsar, Nielsen, Ryhammer, Sloth, Greisen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby,
8200 Aarhus N, Denmark
Title
High thoracic epidural analgesia in cardiac surgery: Part 1 - High
thoracic epidural analgesia improves cardiac performance in cardiac
surgery patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (6) (pp 1048-1054),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The purpose of this study was to evaluate the perioperative
cardioprotective effect of high thoracic epidural analgesia (HTEA),
primarily expressed as an effect on cardiac performance and hemodynamics
in patients undergoing cardiac surgery. Design: A randomized, prospective
study. Participants: Sixty low-to-moderate risk patients between the ages
of 65 and 80 years scheduled for elective coronary artery bypass graft
surgery with or without aortic valve replacement. Setting: A university
hospital. Intervention: Patients randomized to receive HTEA as a
supplement to general anesthesia. Measurements and Main Results:
Perioperative hemodynamic measurements, perioperative fluid balance, and
postoperative release of cardiac enzymes were collected. The end-diastolic
volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the
cardiac index (overall 2.35 v. 2.18 L/minute/m <sup>2</sup>), the central
venous pressure, and central venous oxygenation were higher in the HTEA
group. The mean arterial blood pressure was marginally lower in the HTEA
group, whereas no difference was noted in the heart rate or peripheral
saturation between the groups. No differences were found in the
postoperative levels of troponin T and CK-MB between groups. NT-proBNP
changed over time (p < 0.001) and was lower in the HTEA group (p = 0.013),
with maximal values of 291 +/- 265 versus 326 +/- 274. Conclusions: The
findings of a higher stroke volume index and central venous oxygenation
without an increase in heart rate or mean arterial pressure suggest that
HTEA improves cardiac performance in elderly cardiac surgery patients.
2012 Elsevier Inc.
<15>
Accession Number
2012643944
Authors
Cove M.E. Spelman D.W. MacLaren G.
Institution
(Cove) Department of Critical Care Medicine, University of Pittsburgh,
3550 Terrace Street, Pittsburgh, PA 15261, United States
(Spelman) Department of Infectious Diseases and Microbiology, Alfred
Hospital, Melbourne, VIC, Australia
(MacLaren) Paediatric Intensive Care Unit, Royal Children's Hospital,
Melbourne, VIC, Australia
(MacLaren) Department of Cardiac, Thoracic and Vascular Surgery, National
University Health System, Singapore, Singapore
Title
Infectious complications of cardiac surgery: A clinical review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (6) (pp 1094-1100),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
<16>
Accession Number
2012644159
Authors
Tzanetos D.R.T. Yu C. Hernanz-Schulman M. Barr F.E. Brown N.J.
Institution
(Tzanetos) Department of Pediatrics, Division of Critical Care, University
of Kentucky, Lexington, KY, United States
(Yu) Department of Pediatrics, Division of Critical Care, University of
Mississippi, Jackson, MS, United States
(Hernanz-Schulman) Department of Medicine, Vanderbilt University, School
of Medicine, Nashville, TN, United States
(Barr) Department of Biostatistics, Vanderbilt University, School of
Medicine, Nashville, TN, United States
(Brown) Department of Radiology, Vanderbilt University, School of
Medicine, Nashville, TN, United States
Title
Prospective study of the incidence and predictors of thrombus in children
undergoing palliative surgery for single ventricle physiology.
Source
Intensive Care Medicine. 38 (1) (pp 105-112), 2012. Date of Publication:
January 2012.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: To determine the incidence and clinical and biomarker predictors
of perioperative thrombosis in children with single ventricle physiology
undergoing staged palliation. Methods: Nineteen patients were enrolled and
16 completed the study. Serial ultrasounds of the central venous system
were performed to evaluate for thrombus. Plasma antithrombin III,
thrombin-antithrombin complex, protein C, protein S, tissue factor pathway
inhibitor, plasminogen activator inhibitor-1, tissue plasminogen activator
antigen, D-dimer, soluble CD40 ligand, and urinary thromboxane were
measured serially before and after surgery. Cardiopulmonary bypass time,
aortic cross clamp time, blood product administration, inotrope score,
chest tube output, cardiac function by echocardiography, intensive care
unit and hospital lengths of stay, and central venous catheter days were
recorded. Results: The incidence of perioperative thrombus was 31%.
Patients who developed a thrombus had poorer preoperative ventricular
function (p = 0.03) and longer cardiopulmonary bypass times (p = 0.03)
than those who did not develop a thrombus. Preoperative plasma
antithrombin III was lower (p = 0.01) and tissue plasminogen activator
antigen concentrations were higher (p = 0.02) in patients with a thrombus
compared with patients without a thrombus. When measured over time,
antithrombin III remained lower (p = 0.002) and tissue plasminogen
activator antigen higher (p = 0.005) in those who developed a thrombus
compared with those who did not. There were no other statistically
significant differences in biomarkers of coagulation between patients with
and without thrombosis. Conclusion: One-third of patients undergoing
palliative surgery for single ventricle physiology develop thrombosis.
Decreased ventricular function, low antithrombin III, and increased tissue
plasminogen activator may predict those most suitable for randomized
clinical trials of anticoagulation. jointly held by Springer and ESICM
2011.
<17>
Accession Number
2012644936
Authors
Pilcher J.M. Young P. Weatherall M. Rahman I. Bonser R.S. Beasley R.W.
Institution
(Pilcher, Young, Beasley) Medical Research Institute of New Zealand,
Wellington 6242, New Zealand
(Young, Weatherall, Beasley) Capital and Coast District Health Board,
Wellington 6242, New Zealand
(Weatherall) University of Otago Wellington, Wellington 6242, New Zealand
(Rahman, Bonser) University Hospital, Birmingham NHS Trust, Birmingham B15
2PR, United Kingdom
(Bonser) University of Birmingham, Edgbaston, Birmingham B15 2TT, United
Kingdom
Title
A systematic review and meta-analysis of the cardioprotective effects of
remote ischaemic pre-conditioninginopencardiacsurgery.
Source
Journal of the Royal Society of Medicine, Supplement. 105 (10) (pp
436-445), 2012. Date of Publication: October 2012.
Publisher
Royal Society of Medicine Press Ltd (P.O. Box 9002, London W1A 0ZA, United
Kingdom)
Abstract
Objective To investigate the cardioprotective efficacy of remote ischaemic
preconditioning (RIPC) in cardiac surgery.Design We have performed a
systematic search of MEDLINE, EMBASE and Cochrane Central Register of
Controlled Trials to identify randomized controlled trials involving RIPC.
Setting Randomized controlled trials of RIPC in open cardiac surgery
patients. Main outcome measures Meta-analysis was performed with the
primary outcome the standardized mean difference between intervention and
control groups in 12 hour postoperative troponin concentration.
Heterogeneity was examined by fixed effects meta-regression. Results Ten
studies with a total of 693 participants were included in the
meta-analysis. RIPC reduced troponin levels 12 hours after surgery
compared with control. The fixed and random effects differences were 0.35
(95% CI 0.19 to 0.51) and 0.53 (95% CI 0.18-0.88) respectively. However,
important heterogeneity was present. Fixed effects meta-regression
partially accounted for heterogeneity based on whether studies had full
blinding, comprising blinding of patients, surgeons, anaesthetists and
investigators. Studies with incomplete or no blinding demonstrated a
larger estimate of effect, 0.74 (95% CI 0.47 to 1.00) compared to those
with full blinding, 0.13 (95% CI - 0.07 to 0.33). Conclusions Although our
analysis suggests RIPC may result in cardiac protection during cardiac
surgery, the effect was most marked in studies without full blinding, with
a smaller and statistically nonsignificant effect in fully blinded
studies. We propose that further double blind randomized controlled trials
investigating the cardioprotective effects of RIPC in cardiac surgery are
required to resolve the current clinical uncertainty.
<18>
Accession Number
2012643973
Authors
Ono M. Joshi B. Brady K. Easley R.B. Kibler K. Conte J. Shah A. Russell
S.D. Hogue C.W.
Institution
(Ono, Conte, Shah) Division of Cardiac Surgery, Department of Surgery,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
(Russell) Division of Cardiology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Joshi, Hogue) Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed
6208, Baltimore, MD 21287, United States
(Brady, Easley, Kibler) Department of Pediatrics and Anesthesiology,
Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United
States
Title
Cerebral blood flow autoregulation is preserved after continuous-flow left
ventricular assist device implantation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (6) (pp 1022-1028),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To compare cerebral blood flow (CBF) autoregulation in patients
undergoing continuous-flow left ventricular assist device (LVAD)
implantation with that in patients undergoing coronary artery bypass
grafting (CABG). Design: Prospective, observational, controlled study.
Setting: Academic medical center. Participants: Fifteen patients
undergoing LVAD insertion and 10 patients undergoing CABG. Measurements
and Main Results: Cerebral autoregulation was monitored with transcranial
Doppler and near-infrared spectroscopy. A continuous Pearson correlation
coefficient was calculated between mean arterial pressure (MAP) and CBF
velocity and between MAP and near-infrared spectroscopic data, rendering
the variables mean velocity index (Mx) and cerebral oximetry index (COx),
respectively. Mx and COx approach 0 when autoregulation is intact (no
correlation between CBF and MAP), but approach 1 when autoregulation is
impaired. Mx was lower during and immediately after cardiopulmonary bypass
in the LVAD group than in the CABG group, indicating better-preserved
autoregulation. Based on COx monitoring, autoregulation tended to be
better preserved in the LVAD group than in the CABG group immediately
after surgery (p = 0.0906). On postoperative day 1, COx was lower in the
LVAD group than in the CABG group, indicating preserved CBF autoregulation
(p = 0.0410). Based on COx monitoring, 3 patients (30%) in the CABG group
had abnormal autoregulation (COx <0.3) on the first postoperative day but
no patient in the LVAD group had this abnormality (p = 0.037).
Conclusions: These data suggest that CBF autoregulation is preserved
during and immediately after surgery in patients undergoing LVAD
insertion. 2012 Elsevier Inc.
<19>
Accession Number
22968722
Authors
Hutton B. Joseph L. Fergusson D. Mazer C.D. Shapiro S. Tinmouth A.
Institution
(Hutton) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada.
Title
Risks of harms using antifibrinolytics in cardiac surgery: systematic
review and network meta-analysis of randomised and observational studies.
Source
BMJ (Clinical research ed.). 345 (pp e5798), 2012. Date of Publication:
2012.
Abstract
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.
Systematic review and network meta-analysis. 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.
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. 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. 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. 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.
<20>
Accession Number
70916648
Authors
Ariyaratne T.V. Ademi Z. Yap C.H. Billah B. Rosenfeldt F. Yan B.P. Reid
C.M.
Institution
(Ariyaratne, Billah, Reid) Monash University, Melbourne, VIC, Australia
(Ademi) University of Melbourne, Melbourne, Australia
(Yap) Geelong Hospital and Monash University, Geelong, VIC, Australia
(Rosenfeldt) Alfred Hospital and Monash University, Melbourne, VIC,
Australia
(Yan) Prince of Wales Hospital, Monash University, Hong Kong, Hong Kong
Title
Prolonged effectiveness of coronary artery bypass surgery versus
drug-eluting stents in diabetics with multi-vessel disease: An updated
meta-analysis.
Source
Value in Health. Conference: ISPOR 15th Annual European Congress Berlin
Germany. Conference Start: 20121103 Conference End: 20121107. Conference
Publication: (var.pagings). 15 (7) (pp A402), 2012. Date of Publication:
November 2012.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: Individuals with pre-existing multi-vessel disease (MVD) and
type-II diabetes mellitus (DM) are at increased risk of complications
following coronary revascularisation. The global rise in prevalence of DM
warrants frequent monitoring of medium-term outcomes in real-world
patients undergoing contemporary coronary artery bypass surgery (CABG) or
percutaneous coronary intervention. METHODS: We conducted a meta-analysis
comparing the effectiveness of CABG versus drug-eluting stents (DES) in
the MVD-DM population. Using a set of prespecified criteria, a search
strategy was developed to retrieve published reports to date (April 2012)
in the English language. An electronic search for non-randomised
controlled studies was conducted in five medical databases (MEDLINE,
EMBASE, PUBMED, CINAHL and the Cochrane). A panel comprising three
reviewers were involved in systematically screening the selected
abstracts, whilst two performed the data extraction. Data were pooled
using both fixed- and random-effects models. Effects sizes were measured
through relative risks (RR) and 95% confidence intervals (CI). RESULTS: Of
13 reports that met our pre-specified criteria, we included 11 studies
which enrolled 4,162 patients (2,033 CABG and 2,129 DES). The average
length follow-up was 2.5 years (range 12- and 60-months). Whilst no
significant mortality benefit was observed by either CABG or DES at mean
follow-up (RR = 0.9; 95%-CI: 0.6 to 1.3), CABG was associated with lower
risk of myocardial infarction (RR= 0.5; 95%-CI: 0.4 to 0.8), repeat
revascularisation (RR=0.3; 95%-CI: 0.2 to 0.4), and MACCE (RR= 0.7;
95%-CI: 0.6 to 0.8). In contrast, CABG was associated with higher risk of
cerebrovascular events (CVE) (RR = 1.8; 95%-CI: 1.04 to 3.2). Both
procedures showed no significant difference in the combined outcome of
all-cause mortality, myocardial infarction or CVE (RR = 0.9; 95%-CI: 0.8
to 1.1). CONCLUSIONS: In a real-world population we demonstrated a unique
finding of increased risk of myocardial infarction with DES compared to
CABG at mean follow- up of 2.5 years.
<21>
Accession Number
70916349
Authors
Jaworska E. Wlodarczyk A. Budasz-Swiderska M.
Institution
(Jaworska, Wlodarczyk, Budasz-Swiderska) Agency for Health Technology
Assessment In Poland (AHTAPol), Warsaw, Poland
Title
Clinical and cost-effectiveness of third-generation, implantable left
ventricular assist devices for people with end-stage heart failure: A
systematic review.
Source
Value in Health. Conference: ISPOR 15th Annual European Congress Berlin
Germany. Conference Start: 20121103 Conference End: 20121107. Conference
Publication: (var.pagings). 15 (7) (pp A345), 2012. Date of Publication:
November 2012.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: To systematically review the current clinical and
cost-effectiveness literature of third-generation, implantable left
ventricular assist devices (LVADs) for people with end-stage heart failure
(ESHF). METHODS: Three implantable, third-generation LVADs were identified
as available in the EU. A systematic literature review was conducted of
published and unpublished cost-effectiveness and clinical data
(comparative studies) in the ESHF population, since their inception till
April 2012, using a number of medical databases. RESULTS: One relevant
economic evaluation and four comparative clinical studies (1 vs. virtual
control arm & 3 vs. older-generation LVADs) met the inclusion criteria.
Therapy success defined as survival LVAD or explant to receive a heart
transplant or for recovery, occurred in approx. 92.0% of patients with
third-generation LVADs and 90.1% of control patients (second-generation
LVAD) in a 6-months period. The 1-year survival of patients who were
implanted with third-generation LVADs ranged from 82% to 91%. The most
frequently reported adverse events were arrhythmias, bleeding, infection,
respiratory and renal failure, right heart failure, and stroke. One
included study evaluates the cost-effectiveness of the implantable,
third-generation LVADs as destination therapy for patients with ESHF as
compared to patients on medical management in the UK. Results showed that
at 5ys LVADs had an additional cost of about 20,500 per patient and QALY
gain of 1.05, giving an incremental cost per QALY of 19 500, which is
below the commonly adopted threshold of 25,000 per QALY. However, this
finding seems unreliable due to controversial assumptions. CONCLUSIONS:
Despite the poor methodological quality of included studies,
thirdgeneration of implantable LVADs seems beneficial due to improving
survival, therapy success and functional status. Adverse events serious
concern. No prospective controlled data are available as bridge to
recovery, nor destination therapy. There is an urgent need for additional,
reliable cost-effectiveness studies evaluating third-generation pumps
versus previous generations of LVADs.
