Results Generated From:
Embase <1980 to 2013 Week 45>
Embase (updates since 2013-10-31)
<1>
Accession Number
2013660641
Authors
Hsu J.C. Badhwar N. Gerstenfeld E.P. Lee R.J. Mandyam M.C. Dewland T.A.
Imburgia K.E. Hoffmayer K.S. Vedantham V. Lee B.K. Tseng Z.H. Scheinman
M.M. Olgin J.E. Marcus G.M.
Institution
(Hsu, Badhwar, Gerstenfeld, Lee, Mandyam, Dewland, Imburgia, Hoffmayer,
Vedantham, Lee, Tseng, Scheinman, Olgin, Marcus) Section of Cardiac
Electrophysiology, Division of Cardiology, Department of Medicine,
University of California, San Francisco, San Francisco, CA, United States
Title
Randomized trial of conventional transseptal needle versus radio frequency
energy needle puncture for left atrial access (the traverse-la study).
Source
Journal of the American Heart Association. 2 (5) , 2013. Article Number:
e000428. Date of Publication: 2013.
Publisher
American Heart Association Inc. (7272 Greenville Avenue, Dallas TX
75231-4596, United States)
Abstract
Background--Transseptal puncture is a critical step in achieving left
atrial (LA) access for a variety of cardiac procedures. Although the
mechanical Brockenbrough needle has historically been used for this
procedure, a needle employing radiofrequency (RF) energy has more recently
been approved for clinical use. We sought to investigate the comparative
effectiveness of an RF versus conventional needle for transseptal LA
access. Methods and Results--In this prospective, single-blinded,
controlled trial, 72 patients were randomized in a 1:1 fashion to an RF
versus conventional (BRK-1) transseptal needle. In an intention-to-treat
analysis, the primary outcome was time required for transseptal LA access.
Secondary outcomes included failure of the assigned needle, visible
plastic dilator shavings from needle introduction, and any procedural
complication. The median transseptal puncture time was 68% shorter using
the RF needle compared with the conventional needle (2.3 minutes
[interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR,
2.7 to 14.1 minutes], P=0.005). Failure to achieve transseptal LA access
with the assigned needle was less common using the RF versus conventional
needle (0/36 [0%] versus 10/36 [27.8%], P0.001). Plastic shavings were
grossly visible after needle advancement through the dilator and sheath in
0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P0.001).
There were no differences in procedural complications (1/36 [2.8%] versus
1/36 [2.8%]). Conclusions--Use of an RF needle resulted in shorter time to
transseptal LA access, less failure in achieving transseptal LA access,
and fewer visible plastic shavings. Clinical Trial Registration--URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01209260. 2013 The
Authors.
<2>
Accession Number
2013676379
Authors
Mao L. Jian C. Changzhi L. Dan H. Suihua H. Wenyi T. Wei W.
Institution
(Mao, Jian, Changzhi, Dan, Suihua, Wenyi, Wei) Department of Cardiology,
Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, China
Title
Cytochrome CYP2C19 polymorphism and risk of adverse clinical events in
clopidogrel-treated patients: A meta-analysis based on 23,035 subjects.
Source
Archives of Cardiovascular Diseases. 106 (10) (pp 517-527), 2013. Date of
Publication: October 2013.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Previous studies have investigated the relationship between
CYP2C19 polymorphism and clinical prognosis in coronary artery disease
patients treated with clopidogrel, but the results were inconsistent. Aims
To assess the impact of CYP2C19 polymorphism on the risk of adverse
clinical events by performing a meta-analysis of relevant studies in the
last few years. Methods Prospective cohort studies or post-hoc analyses of
randomized controlled trials were identified from the databases of
PubMed/Medline, EMBASE and the Cochrane Library. Endpoints were fatal or
non-fatal myocardial infarction, cardiovascular or all-cause death,
definite or probable stent thrombosis, target vessel revascularization,
target lesion revascularization, urgent revascularization, ischaemic
stroke and bleeding. Pooled effects were measured by odds ratios (ORs)
with 95% confidence intervals (CIs). Results A total of 21 studies
involving 23,035 patients were included. Compared with non-carriers of the
CYP2C19 variant allele, the carriers were found to have an increased risk
of adverse clinical events (OR 1.50, 95% CI 1.21-1.87; P = 0.0003),
myocardial infarction (OR 1.62, 95% CI 1.35-1.95; P < 0.00001), stent
thrombosis (OR 2.08, 95% CI 1.67-2.60; P < 0.00001), ischaemic stroke (OR
2.14, 95% CI 1.36-3.38; P = 0.001) and repeat revascularization (OR 1.35,
95% CI 1.10-1.66; P = 0.004), but not of mortality (P = 0.500) and
bleeding events (P = 0.930). Conclusion CYP2C19 polymorphism is
significantly associated with risk of adverse clinical events in
clopidogrel-treated patients. 2013 Elsevier Masson SAS.
<3>
Accession Number
2013682769
Authors
Fanari Z. Weiss S.A. Weintraub W.S.
Institution
(Fanari, Weiss, Weintraub) Christiana Care Health System, Newark, DE,
United States
Title
Comparative effectiveness of revascularization strategies in stable
ischemic heart disease: Current perspective and literature review.
Source
Expert Review of Cardiovascular Therapy. 11 (10) (pp 1321-1336), 2013.
Date of Publication: 2013.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) are established strategies for coronary revascularization
in the setting of ischemic heart disease. Multiple randomized controlled
trials and observational studies have compared the impact of the two
modalities on the patients' quality of life, mortality and morbidity, as
well as the cost-effectiveness of these modalities in different clinical
setting. CABG is the preferred strategy for revascularizations in patients
with multi-vessel disease, especially in those with higher risk secondary
to associated diabetes, left ventricular dysfunction or more complex
lesions. PCI is a reasonable revascularization modality in patients with
ischemia and single or low-risk multi-vessel disease and those with
unprotected left main with low complexity anatomy. Compared with PCI, CABG
is associated with less repeat revascularization, better quality of life
and improved survival in high-risk patients. Although CABG is associated
with higher cost, it is probably associated with a reasonable cost per
quality-adjusted life-year gained in many patients. Therefore, CABG will
often be a cost-effective strategy, especially in patients with high
angiographic complexity and/or diabetes. 2013 Informa UK Ltd.
<4>
Accession Number
23756547
Authors
Panchal H.B. Ladia V. Desai S. Shah T. Ramu V.
Institution
(Panchal) Quillen College of Medicine, East Tennessee State University,
Johnson City, TN, USA.
Title
A meta-analysis of mortality and major adverse cardiovascular and
cerebrovascular events following transcatheter aortic valve implantation
versus surgical aortic valve replacement for severe aortic stenosis.
Source
The American journal of cardiology. 112 (6) (pp 850-860), 2013. Date of
Publication: 15 Sep 2013.
Abstract
The purpose of this meta-analysis was to compare postprocedural mortality
and major adverse cardiovascular and cerebrovascular events between
transcatheter aortic valve implantation (TAVI) and surgical aortic valve
replacement (SAVR) for severe aortic stenosis. Seventeen studies (n =
4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End
points were baseline logistic European System for Cardiac Operative Risk
Evaluation score, all-cause mortality, cardiovascular mortality,
myocardial infarction, stroke, transient ischemic attack, and major
bleeding events. Mean differences or risk ratios with 95% confidence
intervals were computed, and p values <0.05 were considered significant.
The population was matched for risk between the 2 groups on the basis of
logistic European System for Cardiac Operative Risk Evaluation score for
all outcomes except 30-day all-cause mortality, which had a high-risk
population in the TAVI group (p = 0.02). There was no significant
difference found in all-cause mortality at 30 days (p = 0.97) and at an
average of 85 weeks (p = 0.07). There was no significant difference in
cardiovascular mortality (p = 0.54) as well as the incidence of myocardial
infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p
= 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared
with patients who underwent TAVI, those who underwent SAVR had a
significantly higher frequency of major bleeding events (p <0.0001) at
mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular
and all-cause mortality to SAVR at early and long-term follow-up. TAVI is
superior to SAVR for major bleeding complications and noninferior to SAVR
for postprocedural myocardial infarctions and cerebrovascular events. TAVI
is a safe alternative to SAVR in selected high-risk elderly patients with
severe aortic stenosis. Copyright 2013 Elsevier Inc. All rights reserved.
<5>
Accession Number
23819523
Authors
Li X. Kong M. Jiang D. Dong A.
Institution
(Li) Cardiaovascular surgery, Department of second affiliated hospital,
school of Medicine, Zhejiang university, No, 88, Jie fang road, Hangzhou,
Zhejiang province 310009, China.
Title
Comparison 30-day clinical complications between transfemoral versus
transapical aortic valve replacement for aortic stenosis: a meta-analysis
review.
Source
Journal of cardiothoracic surgery. 8 (pp 168), 2013. Date of Publication:
2013.
Abstract
Since 2002, transapical aortic valve replacement has been developed as a
clinical pathway for transcatheter aortic valve implantation (TAVI).
However the appropriate role of TA in the AS population versus TF remains
unclear. We performed a meta-analysis to assess if TF has any benefit in
reduction of 30-day clinical complications in AS. We conducted a
comprehensive search on pub-med and web of knowledge from 2002 through
September 2012 using following terms: aortic stenosis, aortic valve
replacement, transcatheter aortic valve implantation, TAVI, trans-artery,
transfemoral, trans-apical. Studies in the original research or review
articles were also considered. Included studies must meet the
preconditioned criterias. Two investigators independently browsed the
studies by title and abstract, finally making decision according to
full-text. Disagreements were discussed in group. A total of 20 studies
met inclusion criteria's and were included in the analysis (including 4267
patients in TF group, 2242 in TA group). No random clinical trial, one was
a retrospective study, others were prospective trials. Our meta-analysis
found that TF had the low incidence of 30-day mortality compared with TA
procedure (7.5% versus 11.3%). The incidence of stroke at <= 30 days was
relatively low (3.8% in TF versus 4.0% in TA). Although the incidence of
post-operative heart block was high (8.5% versus 7.5%), but no differences
were indicated [1.06,95% CI(0.85,1.33)]. The result of our meta-analysis
suggested that TF may have a low risk for 30-day mortality against TA
procedure. No difference was found in the incidence of post-operative
stroke and heart block.
<6>
Accession Number
23758929
Authors
Vretzakis G. Georgopoulou S. Stamoulis K. Tassoudis V. Mikroulis D.
Giannoukas A. Tsilimingas N. Karanikolas M.
Institution
(Vretzakis) Cardiac Anesthesia Unit, Anesthesiology Clinic, University of
Thessaly, Biopolis, Larissa, Greece.
Title
Monitoring of brain oxygen saturation (INVOS) in a protocol to direct
blood transfusions during cardiac surgery: a prospective randomized
clinical trial.
Source
Journal of cardiothoracic surgery. 8 (pp 145), 2013. Date of Publication:
2013.
Abstract
Blood transfusions are common in cardiac surgery, but have been associated
with increased morbidity and long-term mortality. Efforts to reduce blood
product use during cardiac surgery include fluid restriction to minimize
hemodilution, and protocols to guide transfusion decisions. INVOS is a
modality that monitors brain tissue oxygen saturation, and could be useful
in guiding decisions to transfuse. However, the role of INVOS (brain
tissue oxygen saturation) as part of an algorithm to direct blood
transfusions during cardiac surgery has not been evaluated. This study was
conducted to investigate the value of INVOS as part of a protocol for
blood transfusions during cardiac surgery. Prospective, randomized,
blinded clinical trial, on 150 (75 per group) elective cardiac surgery
patients. The study was approved by the Institution Ethics committee and
all patients gave written informed consent. Data were initially analyzed
based on "intention to treat", but subsequently were also analyzed "per
protocol". When protocol was strictly followed ("per protocol analysis"),
compared to the control group, significantly fewer patients monitored with
INVOS received any blood transfusions (46 of 70 patients in INVOS group
vs. 55 of 67 patients in the control group, p = 0.029). Similarly,
patients monitored with INVOS received significantly fewer units of red
blood cell transfusions intraoperatively (0.20 +/- 0.50 vs. 0.52 +/- 0.88,
p = 0.008) and overall during hospital stay (1.31 +/- 1.20 vs. 1.82 +/-
1.46, p = 0.024). When data from all patients (including patient with
protocol violation) were analyzed together ("intention to treat
analysis"), the observed reduction of blood transfusions in the INVOS
group was still significant (51 of 75 patients transfused in the INVOS
group vs. 63 of 75 patients transfused in the control group, p = 0.021),
but the overall number of units transfused per patient did not differ
significantly between the groups (1.55 +/- 1.97 vs. 1.84 +/- 1.41, p =
0.288). Our data suggest that INVOS could be a useful tool as part of an
algorithm to guide decisions for blood transfusion in cardiac surgery.
Additional data from rigorous, well designed studies are needed to further
evaluate the role of INVOS in guiding blood transfusions in cardiac
surgery, and circumvent the limitations of this study.
<7>
Accession Number
2013676759
Authors
Epstein S.E. Waksman R. Pichard A.D. Kent K.M. Panza J.A.
Institution
(Epstein, Waksman, Pichard, Kent, Panza) MedStar Cardiovascular Research
Network, MedStar Heart Institute, MedStar Washington Hospital Center,
Washington, DC, United States
Title
Percutaneous coronary intervention versus medical therapy in stable
coronary artery disease: The unresolved conundrum.
Source
JACC: Cardiovascular Interventions. 6 (10) (pp 993-998), 2013. Date of
Publication: October 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
One of the major dilemmas facing physicians is what diagnostic and
therapeutic approaches should be recommended to those stable coronary
artery disease patients whose symptoms are adequately controlled on
medical therapy. This study sought to assess the evidence-based data
relating to whether: 1) all patients with significant coronary lesions
(i.e., ischemia-producing) should undergo percutaneous coronary
intervention (PCI); 2) the best therapeutic approach is optimal medical
therapy; or 3) PCI should be performed, but only in certain subsets of
patients. We reviewed all recent meta-analyses of prospective randomized
trials that compared the outcomes of medical therapy and PCI in stable,
symptomatically controlled, coronary artery disease patients. To provide
greater insights to the clinician, we then analyzed, in depth, 3
comprehensive and widely quoted randomized trials. Review of recently
published (2012) meta-analyses, and the detailed analyses of 3 widely
quoted individual studies, indicate no difference exists between PCI and
medical therapy in nonfatal MI or in all-cause or cardiovascular
mortality. Thus, clinical equipoise exists: in other words, there is no
evidence-based justification for adopting 1 therapeutic strategy over the
other. Therefore, it is not inappropriate, until additional evidence
emerges, for the responsible, experienced physician to weigh several
sources of information in formulating a recommendation to the patient,
even though definitive evidence-based data are not as yet available. Such
sources may include assessment of the individual patient's clinical
presentation, assessment of the severity of ischemia, and the patient's
precise coronary anatomy. Critical for more-reliable decision making will
be future development of accurate measures of the individual patient's
risk of MI and/or death, whether by biomarker, imaging, or ischemia
assessments. 2013 by the American College of Cardiology Foundation.
<8>
Accession Number
2013676428
Authors
Kazemi B. Akbarzadeh F. Safaei N. Yaghoubi A. Shadvar K. Ghasemi K.
Institution
(Kazemi, Akbarzadeh, Safaei, Yaghoubi, Shadvar, Ghasemi) Cardiovascular
Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Prophylactic high-dose oral-N-acetylcysteine does not prevent atrial
fibrillation after heart surgery: A prospective double blind
placebo-controlled randomized clinical trial.
Source
PACE - Pacing and Clinical Electrophysiology. 36 (10) (pp 1211-1219),
2013. Date of Publication: 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Aims Postoperative atrial fibrillation (POAF) following cardiac surgery is
a frequent complication with multifactorial etiologies. Recently
inflammation due to enhanced oxidative stress has been implicated in its
pathogenesis. N-acetylcysteine (NAC) is a promising and novel antioxidant
agent. The purpose of this study was to evaluate the efficacy of high-dose
oral-NAC for prevention of POAF. Methods Two hundred and forty patients
were randomized in this prospective, double blind placebo-controlled trial
to either 1,200-mg oral-NAC two times a day (n = 120) or placebo (n = 120)
starting 48 hours before and up to 72 hours after open heart surgery.
Results The mean age was about 60 years, and 75% were male. Patients in
the NAC group were older, with higher percentage of acute coronary
syndrome, hypercholesterolemia, and left internal mammary artery use.
Coronary involvement and hypertension were more prevalent in the placebo
group. All other baseline patient characteristics were similar between
groups. Overall POAF developed in 13.8% of the patients. There was no
difference in the incidence of POAF between the NAC vs placebo groups
(11.7% vs 15.8%, respectively; P = 0.34). Postoperative hospital stay,
morbidity, and mortality were similar in both groups. Conclusions
Prophylactic high-dose oral-NAC begun 2 days before open heart surgery and
continued for 5 days, and had no significant effect on the incidence of
POAF, in-hospital stay, and postoperative morbidity or mortality. 2013,
The Authors.
<9>
Accession Number
71204571
Title
66th Annual Meeting of the Canadian Cardiovascular Society.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) , 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
The proceedings contain 676 papers. The topics discussed include: a
prospective multicenter study of balloon angioplasty for the treatment of
native and recurrent coarctation of the aorta; bacterial endocarditis in
patients with adult congenital heart disease; sequential right and left
ventricular assessment in patients with tetralogy of fallot or pulmonary
valvuloplasty; successful implementation of a pediatric nurse practitioner
role within a pediatric cardiac care team: positive impacts on
stakeholders; indication and outcome of cardiology referrals from a
pediatric emergency department; characteristics of patients with atrial
fibrillation using dabigatran vs. warfarin-evidence from a population
based cohort; atrial fibrillation innovation program: transitioning
emergency atrial fibrillation management (TEAM) - lessons from a
feasibility trial; safety and efficacy of dabigatran compared to warfarin
for patients undergoing radio frequency catheter ablation of atrial
fibrillation: a meta-analysis.
<10>
Accession Number
71204462
Authors
Bainey K.R. Rahim S. Etherington K. Rokoss M.J. Natarajan M.K. Velianou
J.L. Brons S. Mehta S.R.
Institution
(Bainey, Rahim, Etherington, Rokoss, Natarajan, Velianou, Brons, Mehta)
HamiltonONCanada
Title
Angiotensin converting enzyme inhibitors/angiotensin receptor blockers and
contrast induced nephropathy in patients receiving cardiac
catheterization: Captain trial.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S383), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: It is unclear if holding angiotensin converting enzyme
inhibitors (ACEI) or angiotensin receptor blockers (ARB) prior to coronary
angiography reduces contrastinduced nephropathy (CIN). Accordingly, we
undertook a randomized controlled trial to investigate the effect of
holding ACEI/ARB therapy prior to coronary angiography on the incidence of
CIN. METHODS: We randomly assigned 208 patients with moderate renal
insufficiency (creatinine >= 150 umol/L within 3 months and/or documented
creatinine >= 132 umol/L within 1 week before cardiac catheterization) to
hold ACEI/ARB (hold >= 24 hours pre-procedure and restart 48-96 hours
post-procedure after serum creatinine measurement) or continue ACEI/ARB
prior to cardiac catheterization. All patients had appropriate fluid
hydration prior to cardiac catheterization. The primary outcome was the
incidence of CIN defined as an absolute rise in serum creatinine of >=
44umol/L from baseline and/or a relative rise in serum creatinine of >=
25% compared with baseline measured at 48-96 hours post cardiac
catheterization. RESULTS: All patients were taking an ACEI (72.1%) or ARB
(27.9%) prior to randomization. At 48-96 hours, the primary endpoint
occurred in 10.9% of the patients who held ACEI/ARB as compared with 18.4%
of patients who continued ACEI/ARB (hazard ratio 0.59; 95% confidence
interval 0.30 to 1.19; p=0.16). In a prespecified secondary analysis,
there was a lower rise in mean serum creatinine following the procedure in
patients who held ACEI/ARB (13.1 +/-22.6 versus 24.1 +/-46.2 umol/L,
p=0.03). A numeric reduction in the secondary outcome of death, myocardial
infarction, stroke, congestive heart failure post-procedure or need for
dialysis postprocedure in patients who held the ACEI/ARB (0%), as compared
with patients who continued ACEI/ARB (3.0%) (hazard ratio 0.14, 95%
confidence interval 0.01- 2.63; p=0.12). CONCLUSION: In patients with
moderate renal insufficiency undergoing cardiac catheterization,
withholding ACEI/ARB did not significantly reduce the incidence of CIN,
but did result in a lower rise post procedural creatinine levels. This low
cost intervention could be considered when referring a patient for cardiac
catheterization.
<11>
Accession Number
71204275
Authors
Al Ali J. Franck C. Filion K.B. Eisenberg M.J.
Institution
(Al Ali, Franck, Filion, Eisenberg) MontrealQCCanada
Title
Efficacy and safety of drug eluting stents versus coronary artery bypass
grafting: A meta-analysis of randomized controlled trials.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S284), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The efficacy of DES versus CABG remains controversial. While
several randomized controlled trials (RCTs) have examined the efficacy of
CABG and DES, these RCTs have produced heterogeneous results. Our
objective was to conduct a meta-analysis of RCTs comparing the efficacy of
DES to CABG and to examine if the efficacy varies across patient
subpopulations. METHODS: We systematically searched the Cochrane Library,
Clinicaltrials.gov, Cardiosource, Circulation, EMBASE, and Medline through
December 2012 for RCTs comparing DES to CABG. Primary endpoints included
major adverse cardiovascular events (MACE), major adverse cardiovascular
and cerebrovascular events (MACCE), mortality, revascularization, stroke,
and MI. Results were meta-analyzed using random-effects models. RESULTS: A
total of 7 trials were identified (n=4,730) investigating multi-vessel
disease (3 trials), single-vessel proximal LAD disease (2 trials), and
unprotected left main disease (2 trials). When data were pooled across
RCTs, CABG patients had a lower relative risk (RR) of MACE than DES
patients (RR 0.64, 95% CI 0.51-0.8). Similarly, CABG patients had a
reduced risk of MI (RR 0.56, 95% CI 0.42-0.75). Stratified analyses found
these effects differed across subpopulations: CABG had beneficial effects
for MACE among those with multi-vessel and left main disease trials, but
not among those with proximal LAD lesions (Figure 1). Similarly, risk of
MI was lower with CABG for multi-vessel (RR 1.85, 95% CI 0.46-7.40) and
left main (RR 0.69, 95% CI 0.41-1.16), but not for proximal LAD (RR 1.85,
95% CI 0.46-7.40). CABG patients had a reduced risk of MACCE (RR 0.7, 95%
CI 0.6-0.82), particularly in multi-vessel disease (RR 0.64, 95%CI 0.55-
0.74). No MACCE benefit was observed among those with left main disease
(RR 0.83, 95%CI 0.61-1.13). However, risk of stroke was higher in the CABG
patients (RR 1.87, 95% CI 1.29-2.72). Death at end of follow-up was
marginally lower among CABG patients (RR 0.84, 95% CI 0.65-1.09), also
driven by multi-vessel disease trials (RR 0.96, 95% CI 0.66-1.40; left
main: RR 1.22, 95% CI 0.71- 2.11); proximal LAD: RR 2.00, 95% CI
0.19-21.52). There was no significant difference between the two groups in
mortality at 1 year (RR 1.05, 95% CI 0.78-1.4). Revascularization was
significantly lower for CABG (RR 0.47, 95% CI 0.35-0.64) relative to DES
groups. CONCLUSION: Overall, CABG was more efficacious than DES for the
prevention of cardiovascular events. However, this benefit was driven by
trials of patients with multi-vessel disease, and was not present in
patients with proximal LAD or left main disease. (Figer Presented) .
<12>
Accession Number
71204272
Authors
Tu B. Rich B. Brophy J.
Institution
(Tu, Rich, Brophy) MontrealQCCanada
Title
Revascularization techniques in diabetics-a (network) meta-analysis in
progress.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S282-S283), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Coronary artery disease (CAD) is a frequent complication in
diabetes mellitus (DM). Several trials have examined whether percutaneous
coronary interventions (PCI) or coronary artery bypass grafting (CABG) is
the preferred revascularization method for people with DM. Small sample
sizes, evolving technologies and differing statistical models have
complicated this evaluation. METHODS: An electronic systematic review of
all pertinent randomized control trials comparing drug eluting stents to
CABG in DM was performed using PUBMED. A similar search strategy was
employed to identify RCTs in DM comparing drug eluting stents (DES) to
bare metal stents (BMS), BMS to CABG and PCI to CABG in large cohort
studies. Data were abstracted for the primary composite endpoint of death,
non-fatal myocardial infarction and nonfatal stroke. Analyses were
performed using both frequentist and Bayesian statistical models. RESULTS:
A total of 6 RCTS comparing contemporary PCI with DES to CABG were
identified. The primary outcome was an increased risk for
revascularization with PCI (Fixed effects odds ratio (OR) 1.32, 95%
confidence interval (CI) 1.10 - 1.59, random effects OR 1.31, 95% CI 1.08
- 1.59). While the I2 statistic suggest little heterogeneity (I2 = 1.5%),
as is typical when the number of studies is small the CI is extremely wide
(0-75%). Using non-informative priors, the Bayesian OR was 1.24 (95%
credible interval (CrI) 0.77 1.81). CONCLUSION: Conventional frequentist
meta-analysis suggests a statistically significant 31% increase in
composite adverse cardiovascular outcomes for DM patients treated with
PCI. However this analysis may significantly underestimate the between
study variability potentially resulting in inappropriately narrow CIs.
Conversely, Bayesian analysis using non- informative priors provides
unrealistically wide CI. A Bayesian network analysis (in progress) using
the totality of the available evidence in DM by incorporating previous
RCTs comparing DES to BMS, previous RCTs comparing BMS to CABG, and large
cohort studies of PCI to CABG should help resolve this conflict and
provide the most valid estimates.
<13>
Accession Number
71204221
Authors
Verma S. Yanagawa B. Ahsan M. Fitchett D. Latter D. Ruel M. Farkouh M.
Friedrich J.
Institution
(Verma, Yanagawa, Ahsan, Fitchett, Latter, Ruel, Farkouh, Friedrich)
TorontoONCanada
Title
CABG versus PCI in patients with diabetes: A metaanalysis of randomized
controlled trials in the era of DES.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S254-S255), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Diabetic patients are at increased risk of coronary artery
disease, and the choice of revascularization strategy can have important
implications on long-term outcomes in these patients. Despite the
remarkable results of the FREEDOM trial, controversy still exists
regarding whether coronary artery bypass graft (CABG) surgery is superior
to percutaneous coronary intervention (PCI) in diabetic patients with
multi-vessel coronary artery disease (CAD), particularly in the setting of
drug-eluting stents (DES). METHODS: A systematic literature search was
performed according to the Cochrane Handbook Collaboration to identify
randomized controlled trials (RCTs) comparing CABG vs. DES in patients
with diabetes. Our search revealed 3413 publications of potential
relevance (1946- present). Studies considered for inclusion met the
following inclusion criteria: the design was an RCT; diabetic patients
were randomly assigned to either CABG or PCI with a DES; at least 2 year
or greater follow up was available. This approach identified 5 RCTs that
met criteria, namely FREEDOM, SYNTAX, VA-CARDS, CARDia and MASS II. A
pooled summary effect estimate was calculated by means of a random effects
model. RESULTS: Pooled analysis of 5 RCTs provided data on 2908 patients.
Overall mean age of the cohort was 63.7+/-9 years, and the mean follow up
was 5.4 years. At one year follow-up there was no difference in all-cause
mortality (hazard ratio 1.02; 95% CI 0.73-1.41), and non-fatal myocardial
infarction (MI; HR 0.9; 95% CI 0.46-1.77). However, rates of repeat
revascularization were markedly lower in CABG vs. PCI groups (HR 0.38; 95%
CI 0.23-0.65). At a mean follow up of 5.4 years, all-cause mortality was
significantly lower in CABG vs. PCI groups (HR 0.68; 95% CI 0.51-0.90), as
were nonfatal MI (HR 0.54; 95% CI 0.38-0.77) and repeat revascularization
rates (HR 0.49; 95% CI 0.33-0.71). CABG was associated with an increase
rate of non-fatal stroke compared to PCI (HR 1.84; 95% CI 1.22-2.78)
(Figure). CONCLUSION: We report the first meta-analysis of RCTs comparing
CABG vs. PCI in diabetic patients in the contemporary era of DES.
Allocation to CABG vs. PCI was associated with an ~50% lower rate of
repeat revascularization, an ~45% lower incidence of non-fatal MI, and an
~30% lower rate of all-cause mortality, noted particularly in longer term
follow up. These data argue strongly in favor of choosing CABG over DES in
diabetic patients with multivessel disease. (Figer Presented) .
<14>
Accession Number
71204162
Authors
Saczkowski R. Malas T. El Khoury G. Mesana T. Boodhwani M.
Institution
(Saczkowski, Malas, El Khoury, Mesana, Boodhwani) OttawaONCanada
Title
Aortic valve repair in acute type-a aortic dissection.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S222), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
OBJECTIVE: Repair and preservation of the aortic valve in type- A aortic
dissection remains controversial. We performed a meta-analysis of outcomes
for AV repair and preservation in acute type-A aortic dissection focusing
on long-term valverelated events. METHODS: Structured searches were
performed in Embase (1980-2012) and Pubmed (1966-2012) for studies
reporting AV repair or preservation in acute type-A aortic dissection.
Early mortality and linearized rates for late mortality and valve-related
events were derived. Outcome data were pooled with an inverse-variance
weighted random-effects model. RESULTS: Of 5325 screened articles, 19
observational studies met eligibility criteria consisting of 2402 patients
with a median follow-up of 4.1 years (range: 3.1 - 12.6, total 13733
pt-yrs). The cohort was principally male (median = 68.1%, 39 - 89%) with a
median age of 59 years (range: 55 - 68) and Marfan's syndrome was present
in 2.5%. AV resuspension was performed in 85% and the remainder underwent
valve-sparing root replacement. Pooled early and late mortality were 18.7
% (CI: 12.2 - 26.2), and 4.7 %/pt-yr (CI: 3.3 - 6.4), respectively.
Linearized rates for AV reintervention was 2.8 %/pt-yr (CI: 1.5 - 4.4),
recurrent AI (>2+) was 4.6 %/ptyr (CI: 3.1 - 6.2), and endocarditis was
0.5 %/pt-yr (CI: 0.08 - 1.3). The composite rate of thromboembolism and
bleeding was 1.4 %/pt-yr (CI: 0.7 - 2.3). CONCLUSION: Repair of acute
type-A aortic dissection is associated with poor long-term survival.
Preservation and repair of the aortic valve is associated with a moderate
risk of reoperation and recurrent AI and a low risk of thromboembolism,
bleeding, and endocarditis.
<15>
Accession Number
71204110
Authors
Nascimento T. Birnie D. Healey J.S. Verma A. Joza J. Bernier M.L. Essebag
V.
Institution
(Nascimento, Birnie, Healey, Verma, Joza, Bernier, Essebag)
MontrealQCCanada
Title
Perioperative management of novel oral anticoagulants in patients with
atrial fibrillation undergoing cardiac rhythm device surgery: A survey of
canadian centers.
Source
Canadian Journal of Cardiology. Conference: 66th Annual Meeting of the
Canadian Cardiovascular Society Montreal, QC Canada. Conference Start:
20131017 Conference End: 20131020. Conference Publication: (var.pagings).
29 (10 SUPPL. 1) (pp S193-S194), 2013. Date of Publication: October 2013.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The annual rate of patients receiving oral anticoagulation
(OAC) that require treatment interruption for surgeries or invasive
procedures is about 10% and physicians must balance the thromboembolic
(TE) and bleeding risks when choosing which strategy is adequate for
individual clinical situations. Novel oral anticoagulants (NOACs) were
recently approved based on studies that showed non-inferiority or even
superiority when compared to warfarin. However, evidence is lacking
regarding the optimal management of these drugs when the patients need
device implantation. The aimof the survey is to determine how Canadian
cardiac rhythm device implantation centers manage this new and common
situation of patients with atrial fibrillation (AF) onNOACs that need
device implantation. METHODS: A Web-based survey and questionnaire tool,
www. surveymonkey.com, was used to create the link that was subsequently
delivered by e-mail to 22 representative electrophysiology centers that
perform device implantation. The survey was designed to collect data
regarding perioperative anticoagulation practice in patients with AF,
including those usingNOACs,undergoing device implantation in 2012. There
were also questions about consideration of renal dysfunction as well as
procedural complications. RESULTS: The survey was completed by 22 centers,
that together performed in 2012 approximately 14,971 procedures and 1150
(8%) of these were in patients takingNOACs. TheNOACs were always
discontinued for the device implant in 82%of centers and 73%of these
centers do not bridge with heparin in this situation. Lowmolecular height
heparin was used in 67%and IV heparin in 33% of the cases, at centers
where bridging was used during NOAC cessation. In patients with normal
renal function and at high risk of TE events (CHADS2 >= 2), 72% of the
centers restart theNOACs within 48 hours of surgery. For patients at high
risk of TE events and abnormal renal function (GFR <80 ml/ min), the
timing of NOAC discontinuation was variable according the degree of renal
impairment and between centers. Centers estimated hematoma rates in
patients operated with interruption of NOACs ranging from uncertain up to
30%. CONCLUSION: Most Canadian centers have been performing device
implantation with interruption the NOACs and without bridging with heparin
therapy, but with different periods of holding and re-starting the NOACs,
especially in patients with abnormal renal function. The incidence of
bleeding complications was very variable. These findings emphasize the
need for randomized controlled studies to guide the optimal approach to
management of NOACs around the time of device surgery.
<16>
Accession Number
71208869
Authors
Cosphiadi I. Santoso T. Kosasih A. Atmakusumah D. Lyana S. Abdulmuthalib
A. Harryanto R. Auda A. Alwi I. Sudoyo A.W.
Institution
(Cosphiadi, Santoso, Atmakusumah, Abdulmuthalib, Harryanto, Alwi, Sudoyo)
RSCM, Jakarta, Indonesia
(Kosasih, Lyana, Auda) Darmais National Cancer Center, Jakarta, Indonesia
Title
Hemostatic status pre-post intracoronary injection of peripheral blood
stem cells in patients with recent myocardial infarction.
Source
Journal of Thrombosis and Haemostasis. Conference: 24th Congress of the
International Society on Thrombosis and Haemostasis Amsterdam Netherlands.
Conference Start: 20130629 Conference End: 20130704. Conference
Publication: (var.pagings). 11 (pp 831-832), 2013. Date of Publication:
July 2013.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiovascular disease has increased in the last half century,
it is becoming one of the major cause of morbidity in all hospital
admission. Myocardial infarction (MI) constitutes half of all coronary
heart disease cases. Current guidelines emphasize early coronary
reperfusion on acute myocardial infarction (AMI) to alleviates mortality
rates. However these conventional therapy sometimes cannot reverse the
damage to infarcted myocardium. Even with timely executed rapid
reperfusion, there are still patients with AMI surviving with significant
LV dysfunction. On the other hand patients undergoing PCI procedure are at
risk for further ischemic events not only because procedure-related
platelet activation occurs, but also due to the persistent platelet
hyperreactivity and enchanced thrombin generation associated with ACS.
This hypercoagulable state, in addition to vascular injury and platelet
activation from PCI may lead to abrupt vessel closure, restenosis, and
subacute stent thrombosis. It is not known how the acute coronary
thrombosis alter the kinetics of the systemic coagulation system. In the
recent researches, Stem cell therapy has been highlighted as new therapy
for patient population at risk for heart failure. Meta-analysis showed
safety and favorable effects of stem cell transplantation in patients with
AMI. In our latest research we successfully demonstrate the effect of
injecting Peripheral Blood Stem Cells (PBSCs) in improving cardiac
functions in patients with ST-segment elevation AMI. Intercorrelation
between arterial and venous thrombosis risk factor 'vice versa' have not
been established yet. Aims: The purpose of this study is to report
hemostatic parameter changes, such as platelet aggregation, blood and
plasma viscosity, prothrombin time, APTT, CRP and fibrinogen, before and
after (3 months) intracoronary administration of stem cell therapy.
Methods: A total of 24 patients diagnosed with anterior ST-segment
elevation AMI who had successful percutaneous coronary intervention (PCI)
with drug-eluting stent implantation within 15 days after onset of symptom
were enrolled. PBSCs were harvested and injected into the infarct-related
artery after five consecutive days of G-CSF administration. Recombinant
human erythropoietin was administered at the time of intracoronary PBSCs
injection. Results: This research produce surprising results. Some of the
patients' hemostatic parameter show 'normalization', which is is rarely
achieved even by optimal AMI treatment. There were no significant
difference between baseline vs. 3 months in spontaneous aggregation (P =
0.350), PT (P = 0.793), APTT (P = 0.255) and TT (P = 0.254). There were
also no significant difference between baseline vs. 3 months in plasma
viscosity (P = 0.442) and blood viscosity (P = 0.843). Nevertheless the
patient who has their blood and plasma viscosity above or below normal
laboratory range return to normal point after the treatment. Both PT and
APTT also show normalization value, as seen in table 4. Both Fibrinogen
and CRP level show significant decrease between baseline and 3 months
after treatment (P = 0.009) and (P = 0.04) respectively. Conclusion: PBSC
mobilization with G-CSF and EPO based-intracoronary injection, showed
normalization and improvement of hypercoagulable state beyond optimal
conventional treatment post AMI.
<17>
Accession Number
71206445
Authors
Mutters N.T. Neubert T. Nieth R. Mutters R.
Institution
(Mutters) Heidelberg University Hospital, Department of Infectious
Diseases, Heidelberg, Germany
(Neubert, Nieth, Mutters) Marburg University Hospital, Marburg, Germany
Title
The role of Octenidol and Chlorhexidine mouthwash in the prevention of
mucositis and in the reduction of the oropharyngeal flora: A double-blind
randomized controlled trial.
Source
International Journal of Medical Microbiology. Conference: 65th Annual
Meeting of the German Society for Hygiene and Microbiology, DGHM 2013
Rostock Germany. Conference Start: 20130922 Conference End: 20130925.
Conference Publication: (var.pagings). 303 (pp 32-33), 2013. Date of
Publication: September 2013.
Publisher
Urban und Fischer Verlag GmbH und Co. KG
Abstract
Background: The flora of the oropharyngeal region is of utmost importance
for the development of oral mucositis, which is a frequent complication of
the chemotherapy and radiotherapy regimens commonly used in oncologic
practice, and for the development of nosocomial infections, especially of
ventilator-associated pneumonia. Furthermore, oral mucositis is associated
with significantly worse clinical and economic outcomes. The primary goals
of our study were to assess the efficacy of octenidol compared to
chlorhexidine in the reduction of the oropharyngeal flora and in the
prevention of mucositis in ventilated surgical patients and in patients
with haemato-oncological malignancies requiring stem cell transplantation.
Material/Methods: Trial Design:A prospective, double-blinded,
randomized-controlled clinical trial including two strata was conducted at
the Marburg University Hospital, Germany betweenOctober 1, 2008and
November 30, 2010. The protocol was approved by the institutional medical
ethics committees. The surgical stratum consisted of ventilated
cardiothoracic surgical patients regardless of a specific diagnosis. The
haemato-oncological stratum consisted of ventilated medical patients with
haemato-oncological malignancies requiring stem cell transplantation.
Study Medication and Trial Protocol:A 0.1% chlorhexidine solution was used
in the control group and and a 2% Octenidin-dihydrochlorid (Octenidol)
solution was used in the intervention group. Both solutions were used as
an oral rinse (100 ml). In addition, 20 ccm per flushing (5 times daily)
of chlorhexidine or Octenidol, respectively, were applied to buccal,
pharyngeal, gingival and tooth surfaces for 30 seconds 2 times daily. End
Points and Definitions:The primary outcome measures were reduction of
mucositis regarding to OMAS or WHO score and reduction of the
oropharyngeal flora. Results: Both strata showed low OMAS scores which did
not differ significantly between the chlorhexidine and the octenidol
group. The overall mean reduction of colony forming units was
significantly higher in the Octenidol group compared to the Chlorhexidine
group. Discussion: No significant differences in the development of
mucositis were found, thus both solutions proved to be successful in the
prevention of mucositis. In our study, however, octenidol proved to be
clearly superior in the reduction of the oropharyngeal flora compared to
chlorhexidine. Hence, the preventive effect on nosocomial infections might
be higher in patients using octenidol than patients using chlorhexidine.
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