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<1>
Accession Number
2013480091
Authors
Joshi S.S. Jagadeesh A.M.
Institution
(Joshi, Jagadeesh) Department of Cardiac Anesthesiology, Sri Jayadeva
Institute of Cardiovascular Sciences and Research, Bannerghatta Road,
Bangalore - 560 069, Karnataka, India
Title
Efficacy of perioperative pregabalin in acute and chronic post-operative
pain after off-pump coronary artery bypass surgery: A randomized,
double-blind placebo controlled trial.
Source
Annals of Cardiac Anaesthesia. 16 (3) (pp 180-185), 2013. Date of
Publication: July-September 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aims and Objectives: We evaluated the efficacy of perioperative pregabalin
on acute and chronic post-operative pain after off-pump coronary artery
bypass (OPCAB) surgery. Materials and Methods: Forty patients undergoing
elective OPCAB surgery were randomized to pregabalin and control groups.
Pregabalin group received 150 mg pregabalin 2 h prior to induction of
anesthesia and 75 mg twice daily for 2 post-operative days whereas the
control group received placebo at similar timings; pregabalin and placebo
were administered by an anesthesiologist blinded to the drugs. Pain scores
(visual analogue scale [VAS]) and sedation scores were observed at 0, 4,
6, 12, 24, 36 and 48 h after extubation. Time to extubation, tramadol
consumption and side-effects were noted. VAS score was analyzed by
Mann-Whitney U test. The analysis of variance test for repeated measures
was used for comparison of the means of continuous variables. Group
comparisons were made using the Chi-square-test. Results: Pain-scores at
6, 12, 24 and 36 h from extubation at rest and at deep breath were less in
pregabalin treated patients ( P < 0.05). Tramadol consumption was reduced
by 60% in pregabalin group ( P < 0.001). Extent of sedation, extubation
times and incidence of nausea were comparable. The effect on chronic
post-operative pain was not significant. Conclusions: Perioperative
pregabalin reduced pain scores at rest and deep breath and reduced
consumption of tramadol in the post-operative period without delaying
extubation and causing excessive sedation.
<2>
Accession Number
2013506235
Authors
Bouza E. Granda M.J.P. Hortal J. Barrio J.M. Cercenado E. Munoz P.
Institution
(Bouza, Cercenado, Munoz) Department of Clinical Microbiology and
Infectious Diseases, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Bouza, Granda, Hortal, Barrio, Cercenado, Munoz) Ciber de Enfermedades
Respiratorias (CIBERES), Madrid, Spain
(Granda, Hortal, Barrio) Department of Anesthesiology, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Bouza, Cercenado, Munoz) Department of Medicine, Universidad Complutense,
Madrid, Spain
(Bouza, Cercenado, Munoz) Red Espanola de Investigacion en Patologia
Infecciosa (REIPI), Madrid, Spain
(Bouza, Cercenado, Munoz) Servicio de Microbiologia Clinica y Enfermedades
Infecciosas, Hospital General Universitario Gregorio Maranon, Dr. Esquerdo
46, 28007 Madrid, Spain
Title
Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia
in high-risk patients.
Source
Intensive Care Medicine. 39 (9) (pp 1547-1555), 2013. Date of Publication:
September 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Patients requiring mechanical ventilation (MV) for >48 h after
major heart surgery (MHS) are at a high risk of acquiring
ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most
non-pharmacological interventions to prevent VAP in such patients are
usually already implemented. The objective of this study was to evaluate
the efficacy in preventing lower respiratory infections of antibiotics
active against multidrug-resistant pathogens in this very high-risk
population. Methods: We performed a prospective randomized open-label
study of MHS patients requiring MV for >48 h. Patients were randomly
allocated to one of two groups: the intervention group, which received a
3-day course of linezolid and meropenem, and the control group, which
received the standard of care. The main outcome was the development of VAP
or VAT. Results: Overall, of the 78 patients included in the study, 40
were in the intervention group and 38 in the control group. Both groups
were comparable. Data for the intervention and control groups respectively
were as follows: VAP + VAT/1,000 days was 31.79 vs 64.78 (p = 0.03),
median length of MV before the first episode of VAP or VAT 9 vs 4.5 days
(p = 0.02). No significant differences were observed in median length of
stay in the intensive care unit, median length of hospital stay,
antibiotic use, Clostridium difficile infection, and overall mortality
rate. We detected linezolid-resistant coagulase-negative and
coagulase-positive staphylococci in the MHS intensive care unit after the
study period. Conclusions: A pre-emptive approach with broad-spectrum
antibiotics may be effective in reducing the incidence and delaying the
onset of VAP + VAT after MHS. The ecological consequences have to be
carefully evaluated in future trials. 2013 Springer-Verlag Berlin
Heidelberg and ESICM.
<3>
Accession Number
2013506354
Authors
Wang J. Guo T.
Institution
(Wang, Guo) Department of Cardiology, First Affiliated Hospital of Kunming
Medical University, Kunming 650032, China
Title
Metabolic remodeling in chronic heart failure.
Source
Journal of Zhejiang University: Science B. 14 (8) (pp 688-695), 2013. Date
of Publication: August 2013.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Although the management of chronic heart failure (CHF) has made enormous
progress over the past decades, CHF is still a tremendous medical and
societal burden. Metabolic remodeling might play a crucial role in the
pathophysiology of CHF. The characteristics and mechanisms of metabolic
remodeling remained unclear, and the main hypothesis might include the
changes in the availability of metabolic substrate and the decline of
metabolic capability. In the early phases of the disease, metabolism
shifts toward carbohydrate utilization from fatty acids (FAs) oxidation.
Along with the progress of the disease, the increasing level of the
hyperadrenergic state and insulin resistance cause the changes that shift
back to a greater FA uptake and oxidation. In addition, a growing body of
experimental and clinical evidence suggests that the improvement in the
metabolic capability is likely to be more significant than the selection
of the substrate. 2013 Zhejiang University and Springer-Verlag Berlin
Heidelberg.
<4>
Accession Number
2013492117
Authors
Takagi H. Niwa M. Mizuno Y. Goto S.-N. Umemoto T.
Institution
(Takagi, Niwa, Mizuno, Goto, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of transcatheter aortic valve implantation versus surgical
aortic valve replacement.
Source
Annals of Thoracic Surgery. 96 (2) (pp 513-519), 2013. Date of
Publication: August 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Our preliminary meta-analysis suggests that transcatheter
aortic valve implantation (TAVI) may not reduce the 30-day mortality rate
over surgical aortic valve replacement (AVR) in high-risk patients with
severe aortic stenosis (AS). We performed an updated formal meta-analysis
of TAVI vs AVR for reduction not only of early but also of late all-cause
mortality in AS. Methods: MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials were searched through October 2012. Eligible
studies were randomized controlled trials or adjusted observational
comparative studies of TAVI vs AVR enrolling individuals with AS and
reporting early (30-day or in-hospital) or late all-cause mortality, or
both, as an outcome. Odds ratios or hazard ratios with 95% confidence
intervals (adjusted odds ratios or hazard ratios in case of observational
studies) were abstracted from each study. Results: We identified two
randomized trials and 15 adjusted observational studies enrolling 4,873
patients with severe AS. Pooled analysis suggested no significant
difference in early (odds ratio, 0.92; 95% confidence interval, 0.70 to
1.19) and midterm (3-month to 3-year) total mortality (hazard ratio, 0.99;
95% confidence interval, 0.83 to 1.17) among patients assigned to TAVI vs
AVR. Exclusion of any single study from the analysis did not substantively
alter the overall result of our analysis. No evidence of significant
publication bias was found. Conclusions: Our meta-analysis of data of
approximately 5,000 patients from 17 studies showed that TAVI is likely
ineffective in reducing early and midterm all-cause mortality vs AVR in
high-risk patients with AS. 2013 The Society of Thoracic Surgeons.
<5>
Accession Number
2013492123
Authors
Watanabe G. Noda Y. Takagi T. Tomita S. Yamaguchi S. Kiuchi R.
Institution
(Watanabe, Noda, Takagi, Tomita, Yamaguchi, Kiuchi) Department of General
and Cardiothoracic Surgery, Kanazawa University, Graduate School of
Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Japan
Title
Fasudil is a superior vasodilator for the internal thoracic artery in
coronary surgery.
Source
Annals of Thoracic Surgery. 96 (2) (pp 543-547), 2013. Date of
Publication: August 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The internal thoracic artery (ITA) is a very useful conduit
for coronary artery bypass artery (CABG), with excellent long-term
patency. With the purpose to dilate the ITA graft and increase graft free
flow (GFF) intraoperatively, we evaluated the usefulness of intraluminal
injection of fasudil, a Rho-kinase inhibitor, in comparison to the
conventional graft dilating agent, papaverine. Methods: Between June 2011
and January 2012, 30 patients with ischemic heart disease who underwent
isolated CABG using ITA were enrolled. The patients were randomly assigned
to 2 groups: the fasudil group (n = 15) in which fasudil solution 0.9
mg/dL was injected into the ITA, and the papaverine group (n = 15) in
which papaverine solution (0.4 mg/mL) mixed with heparinized blood was
used. Outcome measures were left ITA GFF, heart rate, and mean blood
pressure during flow measurements, and histopathologic examination of the
ITA. Results: In the fasudil group, GFF increased significantly (p < 0.01)
from 19.7 +/- 15.2 mL/minute at baseline to 66.9 +/- 31.7 mL/minute after
fasudil injection. In the papaverine group, GFF increased significantly (p
< 0.01) from 22.9 +/- 17.3 mL/minute at baseline to 44.8 +/- 26.7
mL/minute after papaverine injection. Blood pressure and heart rate did
not change significantly after drug injection in both groups. The GFF was
significantly higher (p = 0.038) in fasudil-treated ITA than in
papaverine-treated ITA. Histopathologically, the diameter of the ITA was
markedly increased after fasudil injection. Elastica van Gieson staining
showed that the multiple elastic lamellae structure was intact.
Conclusions: Fasudil exhibited very potent vasodilatory effect on the ITA
compared with conventional papaverine resulting in increased GFF. This
agent is a useful graft dilating agent. 2013 The Society of Thoracic
Surgeons.
<6>
Accession Number
2013481358
Authors
Jimenez-Quevedo P. Hernando L. Antoni J. Iniguez A. SanRoman A. Alfonso F.
Hernandez-Antolin R. Angiolillo D.J. Banuelos C. Escaned J. Gonzalo N.
Fernandez C. Macaya C. Sabate M.
Institution
(Jimenez-Quevedo, Hernando, Alfonso, Hernandez-Antolin, Angiolillo,
Banuelos, Escaned, Gonzalo, Fernandez, Macaya) Servicio de Cardiologia,
Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos
(IdISSC), Madrid, Spain
(Antoni) Princeps d'Espanya University Hospital, Barcelona, Spain
(Iniguez) Meixoeiro University Hospital, Vigo, Spain
(SanRoman) Hospital Clinic, Thorax Institute, Cardiology Department,
Barcelona, Spain
(Sabate) Servicio de Cardiologia, Clinic Hospital, c/ Villarroel 170,
08036 Barcelona, Spain
Title
Sirolimus-eluting stent versus bare metal stent in diabetic patients: The
final five-year follow-up of the DIABETES trial.
Source
EuroIntervention. 9 (3) (pp 328-335), 2013. Date of Publication: July
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The DIABETES (DIABETes and sirolimus-Eluting Stent) trial is a
prospective, multicentre, randomised, controlled trial aimed at
demonstrating the efficacy of sirolimus-eluting stent (SES) as compared to
bare metal stent (BMS) implantation in diabetic patients. The aim of the
present analysis was to assess the five-year clinical follow-up of the
patients included in this trial. Methods and results: One hundred and
sixty patients (222 lesions) were included: 80 patients were randomised to
SES and 80 patients to BMS. Patients were eligible for the study if they
were identified as non-insulin-dependent diabetics (NIDDM) or
insulin-dependent diabetics (IDDM), with significant native coronary
stenoses in =1 vessel. There was a sub-randomisation according to diabetes
status. Clinical follow-up was extended up to five years. Five-year
clinical follow-up was obtained in 96.2%. Overall, MACE at five years was
significantly lower in the SES group as compared with the BMS arm, mainly
due to a significant reduction in TLR. There were no significant
differences in cardiac death or myocardial infarction (MI). This was also
observed in both prespecified subgroups IDDM and NIDDM. In the SES group,
the incidence density of definite/probable stent thrombosis was 0.53 per
100 person-years, whereas in the BMS group it was 0.8 per 100
person-years. Independent predictors of MACE were: SES implantation
(p<0.001), multivessel stent implantation (p=0.04), and creatinine levels
(p=0.001). Conclusions: Five-year follow-up of the DIABETES trial suggests
the effect of SES in reducing TLR is similar in both IDDM and NIDDM. No
major safety concerns in terms of ST, MI or mortality were observed.
Europa Digital and Publishing 2013. All rights reserved.
<7>
Accession Number
2013481356
Authors
Meredith I.T. Verheye S. Weissman N.J. Barragan P. Scott D. Chavarri M.V.
West N.E.J. Kelbaek H. Whitbourn R. Walters D.L. Kubica J. Thuesen L.
Masotti M. Banning A. Sjogren I. Stables R.H. Allocco D.J. Dawkins K.D.
Institution
(Meredith) MonashHeart, Clayton, VIC, Australia
(Verheye) Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Barragan) Polyclinique Les Fleurs, Ollioules, France
(Scott) Middlemore Hospital, Auckland, New Zealand
(Chavarri) Hospital Clinico Universitario Virgen de la Arrixaca, Facultad
de Medicina, Murcia, Spain
(West) Papworth Hospital, Cambridge, United Kingdom
(Kelbaek) Rigshospitalet, Copenhagen, Denmark
(Whitbourn) CVRC, St Vincent's Hospital Melbourne, Melbourne, Australia
(Walters) Prince Charles Hospital, Chermside, Australia
(Kubica) Nicolaus Copernicus University, Collegium Medicum, Torun, Poland
(Thuesen) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Masotti) Hospital Clinic, University of Barcelona, Barcelona, Spain
(Banning) Department of Cardiology, John Radcliffe Hospital, Oxford
University Hospitals, Oxford, United Kingdom
(Sjogren) Falu Lasarett, Falun, Sweden
(Stables) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Allocco, Dawkins) Boston Scientific Corporation, Natick, MA, United
States
(Walters) University of Queensland St Lucia, Brisbane, Australia
(Meredith) MonashHeart, Southern Health, 246 Clayton Road, Clayton,
Melbourne, Australia
Title
Six-month IVUS and two-year clinical outcomes in the EVOLVE FHU trial: A
randomised evaluation of a novel bioabsorbable polymer-coated,
everolimus-eluting stent.
Source
EuroIntervention. 9 (3) (pp 308-315), 2013. Date of Publication: July
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The EVOLVE FHU trial demonstrated non-inferiority of six-month late
loss with two dose formulations of SYNERGY, a novel bioabsorbable polymer
everolimus-eluting stent (EES) compared with the durable polymer PROMUS
Element (PE) EES. The current analysis describes the six-month IVUS and
clinical results through two years from the EVOLVE FHU trial. Methods and
results: EVOLVE recruited 291 patients from 29 centres. At six months,
IVUS-assessed in-stent net volume obstruction was 3.40+/-5.06% for PROMUS
Element (PE) vs. 2.68+/-4.60% for SYNERGY (p=0.34) and 3.09+/-4.29% for
SYNERGY 1/2 dose (p=0.68 vs. PE). There were no significant differences
between groups for any other measured IVUS parameter including resolved,
persistent, and late-acquired incomplete stent apposition (ISA). At two
years, target lesion failure (TLF) was 6.1% for PE vs. 5.5% for SYNERGY
(p=0.87) and 5.2% for SYNERGY 1/2 dose (p=0.81). There were no significant
differences between groups for cardiac death, repeat revascularisation, MI
or stent thrombosis through two years. Conclusions: At six months,
everolimus delivered from an ultrathin bioabsorbable abluminal polymer
resulted in equivalent net volume obstruction and ISA compared with a
permanent polymer EES. There were no significant differences between PE
and either SYNERGY stent for any major cardiac endpoint through two years.
Clinical trials number: NCT01135225. Europa Digital and Publishing 2013.
All rights reserved.
<8>
Accession Number
2013499030
Authors
Cayla G. Morange P.-E. Chambost H. Schved J.-F.
Institution
(Cayla) GHU Caremeau, Service de Cardiologie, CHU de Nimes, France
(Morange) Hopital de la Timone, Laboratoire d'Hematologie, CHU de
Marseille, France
(Chambost) Hopital de la Timone, Service de Pediatrie, CHU de Marseille,
France
(Schved) Hopital Saint-Eloi, Departement d'Hematologie Biologique, CHU de
Montpellier, 34295Montpellier cedex 5, France
Title
Management of cardiovascular disease in haemophilia.
Source
Thrombosis Research. 132 (1) (pp 8-14), 2013. Date of Publication: July
2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Improvements in the management of haemophilia have led to a significant
increase in the life expectancy of haemophilia patients, which is now
close to the life expectancy in the general male population. Therefore,
age-related conditions, especially cardiovascular disease (CVD), have
become increasingly common in these patients. The management of CVD,
especially that of coronary artery disease (CAD), acute coronary syndrome
(ACS) and atrial fibrillation (AF), is particularly challenging in
patients with haemophilia due to the need to find an adequate balance
between bleeding and ischemic risk, requiring close coordination between
cardiologists and haemophilia specialists. However, specific
recommendations and relevant literature and data are scarce. Therefore, we
propose pragmatic and practical therapeutic suggestions, based on the
available literature and our own experience, for the management of ACS,
stable angina and AF in patients with haemophilia. Overall, evidence and
experience suggest that they should be treated much in the same way as the
general CVD population, following standard guidelines, while choosing
available treatment options known to be associated with low rates of
bleeding complications. Treatments advocated for patient with haemophilia
include antiplatelet therapy (aspirin and P2Y12 inhibitors), antithrombin
therapy such as heparin or bivalirudin, glycoprotein IIb/IIIa inhibitors
(GPIIb/IIIa inhibitors), transradial cardiac catheterization, and use of
bare metal (BMS) or drug-eluting stents (DES). Antithrombotic agents with
shorter half-lives that are reversible or have an antidote offer a safer
choice in this setting. In addition, optimal clotting factor replacement
therapy should be tailored to the increased risk of bleeding associated
with invasive procedures and antithrombotic therapies, particularly during
the acute phase of ACS. 2013 Elsevier Ltd. All rights reserved.
<9>
Accession Number
2013482212
Authors
Bang C.N. Greve A.M. Abdulla J. Kober L. Gislason G.H. Wachtell K.
Institution
(Bang, Greve, Kober, Wachtell) Department of Cardiology, Heart Center,
Rigshospitalet, Copenhagen, Denmark
(Bang, Greve, Gislason, Wachtell) Department of Cardiology, Gentofte
University Hospital, Hellerup, Denmark
(Abdulla) Division of Cardiology, Department of Medicine, Glostrup
University Hospital, Glostrup, Denmark
Title
The preventive effect of statin therapy on new-onset and recurrent atrial
fibrillation in patients not undergoing invasive cardiac interventions: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 167 (3) (pp 624-630), 2013. Date of
Publication: 10 Aug 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Previous meta-analyses suggest that pre-procedural use of
statin therapy may reduce atrial fibrillation (AF) following invasive
cardiac interventions (coronary artery by-pass grafting and percutaneous
coronary intervention). However, the current evidence on the benefit of
statins unrelated to invasive cardiac interventions has not been clarified
systematically. Methods: Through a systematic literature search, trials
examining the effect of statin therapy on AF were selected. Trials using
statins before any percutaneous or surgical cardiac interventions were
excluded. Results: The search identified 11 randomized and 16
observational eligible studies, totaling 106,640 patients receiving statin
therapy and 129,305 serving as controls. Fourteen studies investigated the
effect of statins on new-onset AF, 13 studies investigated the effect of
statins on recurrent AF and one in both new-onset and recurrent AF. In the
statin versus control group the mean age was 60.7 +/- 8.3 versus 68.6 +/-
6.2 years and females comprised 8.4% versus 10.3%. Statin therapy was
associated with significant reduction of AF (Risk ratio (RR): 0.81 [95%
confidence interval (CI): 0.80-0.83], p < 0.001) combining all studies.
Assessing exclusively randomized trials, statin therapy showed no
significant risk reduction (RR: 0.97 [95%CI: 0.90-1.05], p = 0.509),
heterogeneity p > 0.05. Assessing exclusively observational studies the
risk reduction of new-onset AF was 12% (RR: 0.88 [95%CI: 0.85-0.91], p <
0.001) and recurrent AF 15% (RR: 0.85 [95%CI: 0.80-0.90], p < 0.001),
heterogeneity p < 0.001. Conclusion: The hitherto published randomized
clinical trials do not support a beneficial effect of statins on AF in
patients not undergoing invasive cardiac interventions. This is in
contrast to the results of observational and interventional studies. 2012
Elsevier Ireland Ltd.
<10>
Accession Number
2013470418
Authors
Ejaz A.A. Dass B. Lingegowda V. Shimada M. Beaver T.M. Ejaz N.I. Abouhamze
A.S. Johnson R.J.
Institution
(Ejaz, Dass, Lingegowda, Ejaz, Johnson) Division of Nephrology,
Hypertension and Transplantation, University of Florida, Gainesville, FL,
United States
(Shimada) Division of Cardiology, Respiratory Medicine and Nephrology,
Hirosaki University Graduate School of Medicine, Hirosaki, Japan
(Beaver) Division of Thoracic and Cardiovascular Surgery, University of
Florida, Gainesville, FL, United States
(Abouhamze) Division of Inflammation Biology and Surgical Sciences,
University of Florida, Gainesville, FL, United States
(Johnson) Division of Renal Diseases and Hypertension, University of
Colorado Health Sciences Center, Denver, CO, United States
Title
Effect of uric acid lowering therapy on the prevention of acute kidney
injury in cardiovascular surgery.
Source
International Urology and Nephrology. 45 (2) (pp 449-458), 2013. Date of
Publication: April 2013.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Purpose: Serum uric acid (SUA) is a novel risk factor for acute kidney
injury (AKI), which adversely affects renal blood flow autoregulation,
glomerular filtration rate (GFR), and promotes inflammation and
angiogenesis. This pilot study investigated the effect of lowering SUA
therapy on AKI, by using traditional and non-traditional markers.
Materials and methods: In this prospective, double-blind,
placebo-controlled, randomized pilot trial, 26 hyperuricemic patients
undergoing cardiac surgery were randomized to receive rasburicase or
placebo in the preoperative period. Results: Subjects receiving
rasburicase showed no difference in serum creatinine compared with the
control group receiving placebo. Despite no difference in primary
endpoint, the rasburicase group had less evidence of renal structural
injury as reflected by urine neutrophil-associated lipocalin (uNGAL)
concentrations, especially in subjects with higher SUA levels, more severe
renal dysfunction (baseline GFR <= 45 mL/min/1.73 m<sup>2</sup>) or heart
failure (left ventricular ejection fraction <=45 %). Conclusions: In this
study, rasburicase showed no benefit on postoperative serum creatinine in
hyperuricemic subjects undergoing cardiac surgery. However, the
observation that markers of structural renal injury such as uNGAL tended
to be lower in rasburicase-treated subjects suggests potential different
effects of uricase treatment on hemodynamic alterations in renal function
versus structural mechanisms of kidney injury. 2012 Springer
Science+Business Media, B.V.
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