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<1>
Accession Number
2013709075
Authors
Chen W.S. Gao B.R. Chen W.Q. Li Z.Z. Xu Z.Y. Zhang Y.H. Yang K. Guan X.Q.
Institution
(Chen, Gao, Li, Xu, Zhang, Yang, Guan) Department of Cardiac Surgery,
Second Hospital of Lanzhou University, Lanzhou, China
(Chen) Department of Radiology, First People's Hospital of Baiyin, Baiyin,
China
Title
Comparison of pharmacological and electrical cardioversion in permanent
atrial fibrillation after prosthetic cardiac valve replacement: A
prospective randomized trial.
Source
Journal of International Medical Research. 41 (4) (pp 1067-1073), 2013.
Date of Publication: April 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: To compare the efficacy of electrical versus pharmacological
cardioversion following prosthetic cardiac valve replacement in patients
with permanent atrial fibrillation (AF). Methods: Patients with permanent
AF who had undergone prosthetic cardiac valve replacement, who had a
cardiothoracic ratio <=0.5 and a left atrial diameter <=50mm for >=6
months after surgery were randomly divided to receive either electrical or
pharmacological cardioversion. Patients in the electrical cardioversion
group were given direct-current synchronized electrical defibrillation
under general anaesthesia. Patients in the pharmacological cardioversion
group were given oral combination therapy with amiodarone, captopril and
simvastatin for 3 months. Results: A total of 115 patients received either
electrical cardioversion (n = 59) or pharmacological cardioversion (n =
56); reversion to sinus rhythm occurred in 98.3% and 26.8%, respectively.
Recurrence rates were similar in the two groups (3.4% and 6.7% for
electrical and pharmacological cardioversion, respectively). No deaths or
severe complications were reported. Conclusion: Electrical cardioversion
has a favourable safety profile and appears to be a more effective method
than pharmacological cardioversion for the treatment of permanent AF after
cardiac valve replacement, once the heart has returned close to its normal
size. The Author(s) 2013.

<2>
Accession Number
2013706857
Authors
Kufner S. Byrne R.A. Mehilli J. Massberg S. Birkmeier K.A. Schulz S. Pache
J. Schomig A. Kastrati A.
Institution
(Kufner, Byrne, Mehilli, Massberg, Birkmeier, Schulz, Pache, Kastrati)
Deutsches Herzzentrum, Technische Universitat, Munich, Germany
(Schomig) 1. Medizinische Klinik, Klinikum Rechts der Isar, Technische
Universitat, Munich, Germany
Title
Second-versus first-generation "limus"-eluting stents in diabetic patients
with coronary artery disease: A randomized comparison in setting of
ISAR-TEST-4 trial.
Source
Catheterization and Cardiovascular Interventions. 82 (6) (pp E769-E776),
2013. Date of Publication: 15 Nov 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background Patients with diabetes mellitus remain at higher risk for
adverse events following percutaneous coronary intervention and the
identification of the optimum drug eluting stents (DES) in these patients
is of high clinical relevance. We compared effectiveness of
everolimus-eluting stents (EES; Xience) versus sirolimus-eluting stents
(SES; Cypher) in patients with diabetes mellitus enrolled in the
Intracoronary Stenting and Angiographic Results: Test Efficacy of 3
Limus-Eluting Stents (ISAR-TEST-4) trial. Methods In the setting of the
ISAR-TEST-4 trial, 1304 patients with broad inclusion criteria were
randomized to treatment with EES or SES. The focus of the present analysis
is on a cohort of 377 patients with diabetes mellitus assigned to receive
EES (n = 184) or SES (n = 193). The primary endpoint was the composite of
cardiac death, myocardial infarction (MI) related to the target vessel, or
target lesion revascularization (TLR) at 3-year follow-up. Secondary
endpoints were parameters of angiographic and clinical restenosis
(in-stent late lumen loss, binary restenosis, and TLR), all-cause
mortality and definite/probable stent thrombosis. Results EES was
comparable to SES concerning the incidence of the primary endpoint (21%
vs. 24%, respectively; relative risk = 0.87; 95% CI, 0.57-1.34; P = 0.53).
Concerning the secondary endpoint, TLR at 3 years with EES versus SES
stents was not statistically different (14.7% vs. 16.6%, respectively;
relative risk = 0.85; 95% CI, 0.51-1.43; P = 0.55). In terms of
angiographic outcomes patients treated with EES as compared to SES had
significantly lower late lumen loss (0.22 +/- 0.46 mm vs. 0.44 +/- 0.66
mm, respectively; P < 0.001) and binary restenosis (8.4% vs. 17%,
respectively; P = 0.02) at 6- to 8-month angiographic follow-up. EES was
comparable to SES concerning the incidence of all-cause death (10% vs.
16%, respectively; relative risk = 0.66; 95% CI, 0.37-1.18; P = 0.16) and
stent thrombosis (1.1% vs. 3.1%, respectively; P = 0.19). Conclusions In
patients with diabetes mellitus enrolled in a real-world randomized
control trial, EES is comparable to SES in terms of clinical efficacy and
safety out to 3 years; angiographic markers of antirestenotic efficacy
favored EES. 2013 Wiley Periodicals, Inc. Copyright 2013 Wiley
Periodicals, Inc.

<3>
Accession Number
2013706860
Authors
Dudek D. Mehran R. Dziewierz A. Witzenbichler B. Brodie B.R. Kornowski R.
Fahy M. Lansky A.J. Rakowski T. Legutko J. Bryniarski L. Stone G.W.
Institution
(Dudek, Dziewierz, Rakowski, Legutko, Bryniarski) Department of
Interventional Cardiology, Jagiellonian University Medical College,
Kopernika 17 Street, 31-501 Krakow, Poland
(Mehran, Fahy, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, United States
(Witzenbichler) Charite University, Medicine Campus Benjamin Franklin,
Berlin, Germany
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro, NC, United States
(Kornowski) Cardiology Department, Rabin Medical Center, Petach Tikva,
Israel
(Lansky) Yale University School of Medicine Connecticut, New Haven, United
States
Title
Impact of advanced age on the safety and effectiveness of
paclitaxel-eluting stent implantation in patients with ST-segment
elevation myocardial infarction undergoing primary angioplasty: The
HORIZONS-AMI trial.
Source
Catheterization and Cardiovascular Interventions. 82 (6) (pp 869-877),
2013. Date of Publication: 15 Nov 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives To assess the impact of age on safety and efficacy of
paclitaxel-eluting stent (PES) implantation during primary percutaneous
coronary intervention (PCI) in patients with ST-segment elevation
myocardial infarction (STEMI). Background The benefits of
paclitaxel-eluting stent (PES) implantation during primary PCI were
confirmed by the long-term results of the HORIZONS-AMI trial. Whether the
effects of PES are independent of age has not been reported. Methods Data
on 3,006 patients from the HORIZONS-AMI study randomized in a 3:1 ratio to
PES or bare-metal stent (BMS) in whom at least one stent was implanted
were assessed. There were 2,302 (76.6%) patients <70, and 704 patients
>=70 years of age. Results At 3 years, among older patients a trend toward
lower risk of major adverse cardiac events (MACE; death from any cause,
stroke, reinfarction and unplanned revascularization for ischemia) related
to PES use was observed (PES vs. BMS: 18.0% vs. 21.3%; P = 0.07). There
was also a trend for reduction of MACE related to PES in older patients
(26.4% vs. 33.1%; P = 0.09). Both, patients <70 and >=70 years of age
treated with PES were at lower risk for ischemic target vessel
revascularization. However, a higher risk of major bleeding in elderly
patients treated with PES was observed (P = 0.02 for interaction between
age group and PES effects). No interaction between age and stent type in
terms of the risk of other clinical end points, including all-cause death,
was confirmed. Conclusions For STEMI patients undergoing primary PCI, the
implantation of PES as compared with BMS reduced ischemic TVR, and this
effect was independent of age. [NCT00433966]. 2013 Wiley Periodicals,
Inc.

<4>
Accession Number
2013706872
Authors
Akin I. Hochadel M. Schneider S. Abdel-Wahab M. Zahn R. Senges J. Richardt
G. Kuck K.-H. Nienaber C.A.
Institution
(Akin, Nienaber) Department of Internal Medicine i, Heart Center Rostock,
Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
(Hochadel, Schneider, Senges) IHF Ludwigshafen, Germany
(Abdel-Wahab, Richardt) Department of Cardiology, Heart Center Bad
Segeberg, Germany
(Zahn) Department of Cardiology, Heart Center Ludwigshafen, Germany
(Kuck) Department of Cardiology, Asklepios Hospital Hamburg, Germany
Title
Volume-outcomes relationship in the Era of modern coronary intervention -
Results from the prospective multicenter German DES.DE Registry.
Source
Catheterization and Cardiovascular Interventions. 82 (6) (pp E788-E797),
2013. Date of Publication: 15 Nov 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objective We compare clinical outcomes among unselected patients
undergoing percutaneous coronary intervention (PCI) with drug-eluting
stents (DES) stratified in categories of treating hospital PCI volume.
Background Previous observational evidence suggests an inverse relation
between hospital volume and patients' outcomes. However, there are no
mid-term outcomes data with the use of DES. Methods We used data from
DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and
1-year outcomes among unselected patients. Primary endpoints at one year
follow-up were the rate of major adverse cardiac and cerebrovascular
events (MACCE) and target vessel revascularization (TVR). Results Between
2005 and 2006, 2,075 patients were treated in group I hospitals (<1,000
PCIs/year), 1,624 in group II hospitals (1,000-1,500 PCIs/year), and 1,790
in group III hospitals (>1,500 PCIs/year). Compared with group II and
group III, group I allocation was associated with higher rates of overall
hospital mortality (1.1% versus 0.2% versus 0.2%; P < 0.0001) and severe
bleeding (1.0% versus 0.4% versus 0.5%; P < 0.05); similarly, poorer
outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; P < 0.01),
stent thrombosis (5.2% versus 5.0% versus 3.0%; P < 0.01), and non-fatal
stroke (1.5% versus 0.9% versus 0.7%; P < 0.05) were documented in group
I. Conversely, TVR rates were highest in group II (10.2% versus 14.2%
versus 11.7%; P < 0.01); these differences persisted after risk adjustment
for heterogeneous baseline characteristics. Conclusions In the era of
modern coronary intervention technological advances such as DES have not
offset the inverse relation between procedural volume and both in-hospital
and 1-year outcomes after PCI. 2013 Wiley Periodicals, Inc.

<5>
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Accession Number
2013757102
Authors
Puri R. Nissen S.E. Libby P. Shao M. Ballantyne C.M. Barter P.J. Chapman
M.J. Erbel R. Raichlen J.S. Uno K. Kataoka Y. Nicholls S.J.
Institution
(Puri, Nissen, Uno, Kataoka, Nicholls) Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, OH, United States
(Libby) Cardiovascular Division, Brigham and Women's Hospital, Boston, MA,
United States
(Shao) C5Research, Cleveland Clinic, Cleveland, OH, United States
(Ballantyne) Section of Cardiovascular Research, Baylor College of
Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Barter) Centre for Vascular Research, University of New South Wales,
Sydney, Australia
(Chapman) INSERM Dyslipidaemia and Atherosclerosis Research Unit, Hopital
de la Pitie, Paris, France
(Erbel) West German Heart Center, Essen, Germany
(Raichlen) AstraZeneca, Wilmington, DE, United States
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Level 9, 121 King William St, Adelaide, SA, 5001,
Australia
Title
C-reactive protein, but not low-density lipoprotein cholesterol levels,
associate with coronary atheroma regression and cardiovascular events
after maximally intensive statin therapy.
Source
Circulation. 128 (22) (pp 2395-2403), 2013. Date of Publication: 26 Nov
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - : Baseline C-reactive protein (CRP) levels predict major
adverse cardiovascular events (MACE: death, myocardial infarction, stroke,
coronary revascularization, and hospitalization for unstable angina). The
association between changes in CRP levels with plaque progression and MACE
in the setting of maximally intensive statin therapy is unknown. METHODS
AND RESULTS - : The Study of Coronary Atheroma by Intravascular
Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used
serial intravascular ultrasound measures of coronary atheroma volume in
patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24
months. The treatment groups did not differ significantly in the change
from baseline of percent atheroma volume on intravascular ultrasound,
CRP-modulating effects, or MACE rates, thus allowing for a (prespecified)
post hoc analysis to test associations between the changes in CRP levels
with coronary disease progression and MACE. Patients with nonincreasing
CRP levels (n=621) had higher baseline (2.3 [1.1-4.7] versus 1.1 [0.5-1.8]
mg/L; P<0.001) and lower follow-up CRP levels (0.8 [0.5-1.7] versus 1.6
[0.7-4.1] mg/L; P<0.001) versus those with increasing CRP levels (n=364).
Multivariable analysis revealed a nonincreasing CRP level to independently
associate with greater percent atheroma volume regression (P=0.01).
Although the (log) change in CRP did not associate with MACE (hazard
ratio, 1.18; 95% confidence interval, 0.93-1.50; P=0.17), the (log)
on-treatment CRP associated significantly with MACE (hazard ratio, 1.28;
95% confidence interval, 1.04-1.56; P=0.02). On-treatment low-density
lipoprotein cholesterol levels did not correlate with MACE (hazard ratio,
1.09; 95% confidence interval, 0.88-1.35; P=0.45). CONCLUSIONS - :
Following 24 months of potent statin therapy, on-treatment CRP levels
associated with MACE. Inflammation may be an important driver of residual
cardiovascular risk in patients with coronary artery disease despite
aggressive statin therapy. CLINICAL TRIAL REGISTRATION - : URL:
http://clinicaltrials.gov. Unique identifier: NCT000620542. 2013 American
Heart Association, Inc.

<6>
Accession Number
2013700162
Authors
Patel V.G. Brayton K.M. Kumbhani D.J. Banerjee S. Brilakis E.S.
Institution
(Patel, Banerjee, Brilakis) VA North Texas Health Care System, University
of Texas Southwestern Medical Center at Dallas, Division of Cardiology
(111A), 4500 S. Lancaster Rd, Dallas, TX 75216, United States
(Brayton) Stanford University, Stanford, CA, United States
(Kumbhani) University of Texas Southwestern Medical Center, Dallas, TX,
United States
Title
Meta-analysis of stroke after transradial versus transfemoral artery
catheterization.
Source
International Journal of Cardiology. 168 (6) (pp 5234-5238), 2013. Date of
Publication: 15 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Transradial (TR) catheterization is gaining popularity due to
its association with lower bleeding and access site complications,
improved patient comfort, and lower costs compared to transfemoral (TF)
catheterization; however, there is concern that TR catheterization may be
associated with an increased risk of neurological complications. New
randomized data has emerged since the publication of the last
meta-analysis evaluating the risk of stroke between TR and TF
catheterization in 2009. Methods We conducted a meta-analysis of
randomized studies published until 2013 reporting risk of stroke in TR vs.
TF catheterization. Results Data from 11,273 patients in 13 studies were
collated. The majority of patients were men, and 8987 (79.7%) were
enrolled in acute coronary syndrome trials. Very few patients had a
history of prior coronary artery bypass grafting, and approximately 2/3 of
patients underwent percutaneous coronary intervention. Stroke occurred in
25 of 5659 patients in the TR group, vs. 24 of 5614 patients in the TF
group. There was no difference in stroke rates between the TR and TF
groups (risk difference 0.00%, 95% confidence interval - 0.29%-0.25%, p =
0.88). Conclusions TR catheterization is not associated with a significant
increase in stroke compared to TF catheterization. 2013 Published by
Elsevier Ireland Ltd.

<7>
Accession Number
2013700185
Authors
De Waha A. Stefanini G.G. King L.A. Byrne R.A. Serruys P.W. Kufner S.
Meier B. Juni P. Kastrati A. Windecker S.
Institution
(De Waha, King, Byrne, Kufner, Kastrati) Deutsches Herzzentrum, Technische
Universitat, ISARESEARCH Centre, Lazarettstr. 36, 80636, Munich, Germany
(Stefanini, Meier, Windecker) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Serruys, Windecker) Thoraxcenter, Erasmus University, Rotterdam,
Netherlands
(Juni) Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
Title
Long-term outcomes of biodegradable polymer versus durable polymer
drug-eluting stents in patients with diabetes a pooled analysis of
individual patient data from 3 randomized trials.
Source
International Journal of Cardiology. 168 (6) (pp 5162-5166), 2013. Date of
Publication: 15 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background There is ongoing debate on the optimal drug-eluting stent (DES)
in diabetic patients with coronary artery disease. Biodegradable polymer
drug-eluting stents (BP-DES) may potentially improve clinical outcomes in
these high-risk patients. We sought to compare long-term outcomes in
patients with diabetes treated with biodegradable polymer DES vs. durable
polymer sirolimus-eluting stents (SES). Methods We pooled individual
patient-level data from 3 randomized clinical trials (ISAR-TEST 3,
ISAR-TEST 4 and LEADERS) comparing biodegradable polymer DES with durable
polymer SES. Clinical outcomes out to 4 years were assessed. The primary
end point was the composite of cardiac death, myocardial infarction and
target-lesion revascularization. Secondary end points were target lesion
revascularization and definite or probable stent thrombosis. Results Of
1094 patients with diabetes included in the present analysis, 657 received
biodegradable polymer DES and 437 durable polymer SES. At 4 years, the
incidence of the primary end point was similar with BP-DES versus SES
(hazard ratio = 0.95, 95% CI = 0.74-1.21, P = 0.67). Target lesion
revascularization was also comparable between the groups (hazard ratio =
0.89, 95% CI = 0.65-1.22, P = 0.47). Definite or probable stent thrombosis
was significantly reduced among patients treated with BP-DES (hazard ratio
= 0.52, 95% CI = 0.28-0.96, P = 0.04), a difference driven by
significantly lower stent thrombosis rates with BP-DES between 1 and 4
years (hazard ratio = 0.15, 95% CI = 0.03-0.70, P = 0.02). Conclusions In
patients with diabetes, biodegradable polymer DES, compared to durable
polymer SES, were associated with comparable overall clinical outcomes
during follow-up to 4 years. Rates of stent thrombosis were significantly
lower with BP-DES. 2013 Elsevier Ireland Ltd 2013 Published by Elsevier
Ireland Ltd.

<8>
Accession Number
2013700191
Authors
Zhang B. Zhou J. Li H. Zhou M. Chen A. Zhao Q.
Institution
(Zhang, Zhou, Li, Zhou, Chen, Zhao) Department of Cardiac Surgery, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er
Road, Shanghai 200025, China
Title
Minimally invasive direct coronary artery bypass reduces the need for
repeated revascularization at long-term follow-up compared with stenting:
A meta-analysis.
Source
International Journal of Cardiology. 168 (6) (pp 5469-5471), 2013. Date of
Publication: 15 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<9>
Accession Number
2013698907
Authors
Matata B. Mediratta N. Morgan M. Shirley S. Scawn N. Kemp I. Stables R.
Haycox A. Houten R. Richards S. McLeod C. Lane S. Sharma A. Wilson K.
Institution
(Matata, Mediratta, Morgan, Shirley, Scawn, Kemp, Stables) Liverpool Heart
and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
(Haycox, Houten, Richards, McLeod, Lane) University of Liverpool,
Liverpool, United Kingdom
(Sharma) Aintree University Hospital NHS Foundation Trust, Liverpool,
United Kingdom
(Wilson) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Liverpool, United Kingdom
Title
The impact of continuous haemofiltration with high-volume fluid exchange
during cardiopulmonary bypass surgery on the recovery of patients with
impaired renal function: A pilot randomised trial.
Source
Health Technology Assessment. 17 (49) (pp i-xiv+1-53), 2013. Date of
Publication: 2013.
Publisher
NIHR Journals Library (Alpha House, Enterprise Road, Southampto SO16 7NS,
United Kingdom)
Abstract
Background: There is widespread variability in clinical practice within
cardiac surgery units worldwide on the use of haemofiltration. The
clinical impact and safety of this modality is, however, unknown.
Objectives: The primary pilot trial objectives were as follows: to assess
the feasibility of randomising 60 patients with impaired kidney function
undergoing on-pump coronary artery bypass graft (CABG) surgery within 6
months; to assess the suitability and reliability of our chosen outcome
measures; to explore issues that may impact on recruitment into a
definitive trial; and to undertake an exploratory economic evaluation.
Design: A pilot, single-centre, open-label randomised trial. Setting:
Liverpool Heart and Chest Hospital NHS Foundation Trust between November
2010 and March 2012. Participants: Men and women, aged > 18 years of age,
undergoing on-pump CABG surgery, who had pre-operative impaired kidney
function indicated by an estimated glomerular filtration rate (eGFR) of <
60 ml/minute adjusted for 1.73 m² of body surface area.
Interventions: Group 1: patients who received haemofiltration during
bypass (experimental group). Group 2: patients who did not receive
haemofiltration during bypass (control group). Main outcome measures: (1)
Feasibility outcome measures: barriers to recruitment to a larger trial
were documented as observations made during the recruitment period of the
trial. Reliability of data collection methods was monitored using a
13-point case record form validation check for data entry against the
patient clinical notes and the trial database. (2) The main clinical
outcomes were frequency of intensive care unit (ICU) stay of duration > 3
days and the length of ICU stay days. (3) Other clinical outcomes were the
need for postoperative haemofiltration in the ICU, mechanical ventilation
time, hospital stay, composite of outcome of unfavourable perioperative
events and eGFR values at 6 weeks' follow-up. (4) Secondary health
economic feasibility outcomes. Results: Recruitment into the pilot trial
was from 21 November 2010 to 30 March 2012. Thirty-seven eligible patients
were consented and successfully randomised into the trial arms (30%). The
main issues impacting on recruitment were the high volume of off-pump CABG
surgery within the centre; recruitment being restricted to research
nurses' working hours of the week; issues arising associated with the
screening process for identifying prospective eligible patients based on
eGFR values; protocol deviations/treatment crossovers; and unexpected
outbreaks of pandemic influenza and other infectious conditions. The data
collection process was sufficiently robust, with few errors detected. The
length of ICU stay days was deemed a suitable primary outcome. There was
an overall trend towards reduction in the length of ICU stay for patients
who were given intraoperative haemofiltration, more so for those with
diabetes. The economic evaluation estimated that the incremental costs per
person were 1744 lower for the intraoperative haemofiltration group, while
the incremental benefits per person increased by 0.11. Conclusion: Given
sufficient resources and broadening of the inclusion criteria, the
recruitment into a larger multicentre trial is feasible and may
demonstrate potential clinical and cost benefits of using intraoperative
haemofiltration in this group of patients. However, owing to the small
sample size in this pilot trial, no firm conclusions can be drawn from the
findings at this stage. The outcomes of this pilot study are very
encouraging and suggest that it is feasible to design a continuous
superiority trial with the length of ICU stay days or time to tracheal
extubation as the primary outcome measure, provided that guidelines for
avoiding bias are implemented. An alternative primary outcome measure that
avoids bias is mortality. The inclusion criteria should also be widened to
include all cardiac surgery patients with impaired renal function.
Queen's Printer and Controller of HMSO 2013.

<10>
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Accession Number
2013745312
Authors
Van Boven W.-J.P. Gerritsen W.B. Driessen A.H. Van Dongen E.P. Klautz R.J.
Aarts L.P.
Institution
(Van Boven, Klautz) Department of Cardio-Thoracic Surgery, Leiden
University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
(Gerritsen) Department of Clinical Chemistry and Haematological
Laboratory, Gelre Hospital, Apeldoorn, Netherlands
(Driessen) Department of Cardio-Thoracic Surgery, Academic Medical Centre
Amsterdam, Amsterdam, Netherlands
(Van Dongen) Department of Anaesthesiology, Intensive Care and Pain
Management, St Antonius Hospital, Nieuwegein, Netherlands
(Aarts) Department of Anaesthesiology Leiden University Medical Centre,
Leiden, Netherlands
Title
Minimised closed circuit coronary artery bypass grafting in the elderly is
associated with lower levels of rgan-specific biomarkers: A prospective
randomised study.
Source
European Journal of Anaesthesiology. 30 (11) (pp 685-694), 2013. Date of
Publication: November 2013.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
BACKGROUND Restrictive fluid management may protect organ function and
improve postoperative outcome in elderly coronary artery bypass grafting
(CABG) patients. OBJECTIVE We assessed organ-specific biomarker release to
study the contribution of a fluid restrictive closed circuit concept to
organ protection in elderly CABG patients. Cardiac, respiratory and
abdominal organ injury was measured during and following minimal fluid
coronary artery bypass grafting (mCABG), off-pump coronary artery bypass
(opCAB) surgery and conventional CABG with high volume prime and cold
crystalloid cardioplegia (cCABG). The results were related to differences
in clinical outcome. DESIGN Prospective randomised trial. SETTING Dutch
tertiary single centre study. PATIENTS Sixty patients over 70 years of age
(38 men and 22 women) were randomised to one of the three different
techniques. Inclusion criteria were as follows: first time CABG, elective
surgery, ejection fraction more than 30% and multivessel disease.
Acetylsalicylic acid and clopidogrel administration or requiring less than
three distal anastomoses were an exclusion. MAIN OUTCOME MEASURES
Organ-specific markers of the heart - heart fatty acid binding protein
(HFABP), troponin T, pro-brain natriuretic peptide (pro-BNP) and
creatinine phosphokinase (CPK), lung clara cell 16 protein, pneumoprotein
(CC16), intestinal fatty acid binding protein (IFABP) and liver
glutathione S-transferase (alpha-GST) - were measured perioperatively.
Postoperative PaO₂ levels, ventilation time, blood product
consumption and adverse events were noted. RESULTS Myocardial
organ-specific biomarker troponin T showed significantly lower median
levels during mCABG compared with the cCABG and opCAB groups [troponin
0.25mgl^-1 (interquartile range, IQR 0.18 to 0.40), 0.39mgl
^-1 (IQR 0.23 to 0.49) and 0.36mgl^-1 (IQR 0.23 to
0.50), respectively (P<0.003)]. HFABP, IFABP and alpha-GST levels were
significantly higher during cCABG compared with opCAB and mCABG [HFABP
38.6mgl^-1 (IQR 29.6 to 47.1), 23.3mgl^-1 (IQR 16.5 to
31.0) and 21.1mgl^-1 (IQR 15.7 to 28.8; P<0.001), IFABP 0.57mgl
^-1 (IQR 0.37 to 1.11), 0.44mgl^-1 (IQR0.16 to 0.74)
and 0.37mgl^-1 (IQR 0.13 to 1.05; P<0.02) and alpha-GST 11.5mgl
^-1 (IQR 7.7 to 15.7), 7.0mgl^-1 (IQR 4.5 to 13.8) and
7.3mgl^-1 (IQR 6.2 to 11.2), respectively (P<0.009)]. There was
a trend towards higher median CC16 levels in the cCABG group (P<0.07). CPK
and pro-BNP were not significantly different. On the first postoperative
day, PaO₂ levels and duration of mechanical ventilation were
significantly improved, and there was lower use of blood products in the
mCABG group than in the cCABG and opCAB groups (P<0.05). CONCLUSION
Following mCABG with low volume myocardial preservation and restrictive
fluid management, early respiratory performance was improved and
consumption of blood products reduced compared with opCAB and cCABG. 2013
Copyright European Society of Anaesthesiology.

<11>
Accession Number
2013700149
Authors
Dignan R. Keech A.C. Gebski V.J. Mann K.P. Hughes C.F.
Institution
(Dignan) Liverpool Hospital, University of New South Wales, Sydney, NSW,
Australia
(Keech, Gebski, Mann) NHMRC Clinical Trials Centre, University of Sydney,
Sydney, NSW, Australia
(Hughes) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Hughes) Baird Institute, Sydney, NSW, Australia
Title
Is home warfarin self-management effective? Results of the randomised
Self-Management of Anticoagulation Research Trial.
Source
International Journal of Cardiology. 168 (6) (pp 5378-5384), 2013. Date of
Publication: 15 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims The Warfarin Self-Management Anticoagulation Research Trial (Warfarin
SMART) was designed to determine whether patients self-managing warfarin
(PSM) using the CoaguChek device and a dosing algorithm developed for the
trial could keep the INR (International Normalised Ratio) test in target
range at least as often as patients managed by usual care by the family
doctor or hospital clinic. Methods and results 310 patients were randomly
assigned to PSM or usual care. The PSM group was trained to perform home
INR testing and warfarin dosing using a validated ColourChart algorithm.
The primary endpoint was the proportion of times over 12 months that a
monthly, blinded "outcome INR test", measured in a central laboratory, was
outside the patient's target therapeutic range. The rate of out-of-range
outcome INRs was lower in PSM, and non-inferior to the usual care group
(PSM: 36% vs. usual care: 41%, P < 0.001 for non-inferiority; P = 0.08 for
superiority in closed-loop testing). The deviations from the patient's
midpoint of target INR range (P = 0.02) and number of extreme INRs (P =
0.03) were significantly less in the PSM group than the usual-care group.
There was no significant difference between groups in rates of bleeding or
thrombotic adverse events. Conclusion Patient self-management performed at
least as well as usual care in maintaining the INR within the target
range, without any safety concerns. This treatment modality for the
long-term use of warfarin has the potential to change current local and
international practice. 2013 Elsevier Ireland Ltd 2013 Published by
Elsevier Ireland Ltd.

<12>
Accession Number
2013751972
Authors
Ghodsizad A. Ruhparwar A. Bordel V. Mirsaidighazi E. Klein H.M. Koerner
M.M. Karck M. El-Banayosy A.
Institution
(Ghodsizad, Koerner, El-Banayosy) Heart and Vascular Institute, Milton S.
Hershey Medical Center, College of Medicine, Pennsylvania State
University, Hershey, PA, United States
(Ghodsizad, Ruhparwar, Bordel, Karck) Department of Cardiac Surgery,
University of Heidelberg, Heidelberg, Germany
(Mirsaidighazi, Klein) Department of Cardiac Surgery, University of
Duesseldorf, Duesseldorf, Germany
Title
Clinical application of adult stem cells for therapy for cardiac disease.
Source
Cardiovascular Therapeutics. 31 (6) (pp 323-334), 2013. Date of
Publication: December 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Introduction: Cardiovascular disease is a major cause of death worldwide.
Different medical and surgical therapeutic options are well established,
but a significant number of patients are not amenable to standard
therapeutic options. Cell-based therapies after clinical application have
shown different results in recent years. Here, we are giving a
comprehensive overview on major available clinical data regarding cell
therapy. Background: Cell-based therapies and tissue engineering provide
new promising platforms to develop upcoming therapeutic options. Initial
clinical trials were able to generate promising results. A variety of
different stem cell types have been used for the clinical application.
Different adult cardiac stem cells and progenitor cells, including
mesenchymal, CD34⁺ and CD133⁺ autologous human bone
marrow-derived stem cells (BMCs), human myoblasts, and peripheral
blood-derived stem and progenitor cells (PBSCs) have been used for the
therapy for end-stage heart failure. Future experiments will show the
importance of novel cell populations and clarify the mechanism causing
cell therapy-mediated observed effects. Conclusion: Several clinical
trials have reported on sole therapy, as well as combined application of
autologous adult stem cells with conventional revascularization. The
reported promising findings encourage further research in the field of the
translational research. 2013 John Wiley & Sons Ltd.

<13>
Accession Number
2013749369
Authors
Esfandiari B.R. Bistgani M.M. Kabiri M.
Institution
(Esfandiari, Bistgani) Department of Cardiothoracic Surgery, Faculty of
Medicine, Shahr-e-kord University of Medical Sciences, Shahrekord, Iran,
Islamic Republic of
(Kabiri) Department of Anesthesiology, Faculty of Medicine, Shahr-e-kord
University of Medical Sciences, Shahr-e-kord, Iran, Islamic Republic of
Title
Low dose tranexamic acid effect on post-coronary artery bypass grafting
bleeding.
Source
Asian Cardiovascular and Thoracic Annals. 21 (6) (pp 669-674), 2013. Date
of Publication: 2013.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objective: This study investigated the effects of low-dose tranexamic acid
on post-coronary artery bypass surgery bleeding. Background: Diffuse
microvascular bleeding is still a common problem after cardiac procedures.
This study was designed to evaluate the hemostatic effects of low-dose
tranexamic acid in on-pump coronary artery bypass graft surgery. Methods:
In this prospective randomized placebo-controlled study, 150 patients who
were candidates for coronary artery bypass were enrolled and randomly
assigned to 1 of 2 groups (tranexamic acid or placebo). Total drainage
volume and the need for transfusion as well as surgical complications were
recorded and compared in the 2 groups. Results: There was significantly
less mediastinal chest tube drainage up to 48 h in the tranexamic acid
group (432+/-210 mL) compared to the placebo group (649+/-235 mL,
p=0.006). In the placebo group, 43 (58%) patients were given allogeneic
blood during hospital stay compared to 22 (25%) in the tranexamic acid
group (p<0.001). No significant difference in postoperative complications
was seen. Conclusion: The use of low-dose tranexamic acid can
significantly reduce blood loss and need for transfusion, with no increase
in complications. The Author(s) 2012 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.

<14>
Accession Number
2013716822
Authors
Vasdekis S.N. Athanasiadis D. Lazaris A. Martikos G. Katsanos A.H.
Tsivgoulis G. Machairas A. Liakakos T.
Institution
(Vasdekis, Athanasiadis, Lazaris) Vascular Unit, Third Department of
Surgery, School of Medicine Athens, University of Athens, Athens, Greece
(Martikos, Machairas, Liakakos) Third Department of Surgery, University of
Athens, School of Medicine, Athens, Greece
(Katsanos) Department of Neurology, University of Ioannina, School of
Medicine, Ioannina, Greece
(Tsivgoulis) Second Department of Neurology, University of Athens, School
of Medicine, Athens, Greece
(Tsivgoulis) International Clinical Research Center, St. Anne's University
Hospital in Brno, Czech Republic
Title
The role of remote ischemic preconditioning in the treatment of
atherosclerotic diseases.
Source
Brain and Behavior. 3 (6) (pp 606-616), 2013. Date of Publication:
November 2013.
Publisher
Wiley-Blackwell Publishing Ltd (9600 Garsington Rd, Chiswell Green Ln,
Oxford OX4 2DQ, United Kingdom)
Abstract
Background: Remote ischemic preconditioning (RIPC) is the application of a
transient and brief ischemic stimulus to a distant site from the organ or
tissue that is afterward exposed to injury ischemia, and has been found to
reduce ischemia-reperfusion injury (IRI) in various animal models. RIPC
appears to offer two distinct phases of endothelial IRI protection, which
are presumably mediated through neuronal and humoral pathways. Methods: We
conducted a comprehensive literature review on the available published
data about the potential effect of RIPC in patients undergoing IRI in one
or more vital organs. Results: Our search highlighted 24 randomized
clinical trials about the effect of RIPC on variable clinical settings
(abdominal aortic aneurysm repair, open heart surgery, percutaneous
coronary intervention, living donor renal transplantation, coronary
angiography, elective decompression surgery, carotid endarterectomy,
recent stroke, or transient ischemic attack combined with intracranial
carotid artery stenosis). Most of the trials focused on postoperative
cardiac or renal function after RIPC with conflicting results.
Preconditioning protocols, age limits, comorbidities, and concomitant drug
use varied significantly across trials, and therefore no firm conclusions
can be drawn using the available data. However, no severe local adverse
events were observed in any patient undergoing limb or arm
preconditioning. Conclusions: RIPC is a safe and well-tolerated procedure
that may constitute a potentially promising innovative treatment in
atherosclerotic diseases. Large, multicenter, randomized clinical trials
are required to determine an optimal protocol for the RIPC procedure, and
to evaluate further the potential benefits of RIPC in human ischemic
injury. We conducted a comprehensive literature review on the available
published data about the potential effect of remote ischemic
preconditioning in patients undergoing ischemia reperfusion injury on
variable clinical settings (abdominal aortic aneurysm repair, open heart
surgery, percutaneous coronary intervention, living donor renal
transplantation, coronary angiography, elective decompression surgery,
carotid endarterectomy, recent stroke or transient ischemic attack
combined with intracranial carotid artery stenosis). Most of the trials
focused on postoperative cardiac or renal function after RIPC with
conflicting results, partly because preconditioning protocols, age limits,
comorbidities and concomitant drug use varied significantly across the
aforementioned trials. However, no severe local adverse events were
observed in any patient undergoing limb or arm preconditioning, suggesting
that RIPC is a safe and well tolerated procedure that may constitute a
potentially promising innovative treatment in atherosclerotic diseases.
2013 The Authors.

<15>
Accession Number
2013744483
Authors
Matuska P. Kara T. Homolka P. Belehrad M.
Institution
(Matuska, Kara, Belehrad) International Clinical Research Center, Sleep
and Cardiovascular Research Center, St. Anne's University Hospital Brno,
Brno, Czech Republic
(Homolka) International Clinical Research Center, Department of Sports
Medicine and Rehabilitation, St. Annes University Hospital Brno, Brno,
Czech Republic
Title
Advances in the management of sleep-disordered breathing in heart failure.
Source
Cor et Vasa. 55 (5) (pp E411-E418), 2013. Date of Publication: October
2013.
Publisher
Elsevier Science B.V. (P.O. Box 1527, Amsterdam 1000 BM, Netherlands)
Abstract
Obstructive (OSA) and central sleep apnea (CSA) are very common in
patients with congestive heart failure (CHF). This is clearly a risk
factor for worsening the prognosis of patients. Treatment of sleep apnea
in these patients may stop disease progression. Modern therapy, primarily
central sleep apnea, is provided by adaptive servoventilation (ASV).
Short-term randomized trials have demonstrated that treatment with ASV
increased ejection fraction (EF), reduces sympathetic activity and blood
pressure. Unfortunately, there is not enough data on whether there are
effects on mortality and morbidity. Studies of this issue, such as
SERVE-HF and ADVENT-HF, are currently in progress and results are
expected. There are other forms of therapy of OSA like CPAP, oxygen,
theophylline, acetazolamide, heart synchronisation therapy and
transplantation. In patients with a predominance of OSA, in addition to
previous methods, there are other recommended forms of therapy like
appropriate weight loss, orthodontic appliances and surgical treatment.
2013 The Czech Society of Cardiology. Published by Elsevier Urban &
Partner Sp. z o.o. All rights reserved.

<16>
Accession Number
2013744028
Authors
Deschamps A. Lambert J. Couture P. Rochon A. Lebon J.-S. Ayoub C. Cogan J.
Denault A.
Institution
(Deschamps, Couture, Rochon, Lebon, Ayoub, Cogan, Denault) Department of
Anesthesiology, Montreal Heart Institute, Universite de Montreal, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Lambert) Social and Preventive Medicine, Universite de Montreal,
Montreal, QC, Canada
Title
Reversal of decreases in cerebral saturation in high-risk cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1260-1266),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To measure the incidence of cerebral desaturation during
high-risk cardiac surgery and to evaluate strategies to reverse cerebral
desaturation. Design: Prospective observational study followed by a
randomized controlled study with 1 intervention group and 1 control group.
Setting: Tertiary care center specialized in cardiac surgery.
Participants: All patients were scheduled for high-risk cardiac surgery,
279 consecutive patients in the prospective study and 48 patients in the
randomized study. Interventions: An algorithmic approach of strategies to
reverse cerebral desaturation. In the control group, no attempts were made
to reverse cerebral desaturation. Measurements and Main Results: Cerebral
saturation was measured using near-infrared reflectance spectroscopy. A
decrease of 20% from baseline for 15 seconds defined cerebral
desaturation. The success or failure of the interventions was noted.
Demographic data were collected. Models for predicting the probability and
the reversal of cerebral desaturation were based on multiple logistic
regressions. In the randomized study, 12 hours of measurements were
continued in the intensive care unit without interventions. Differences in
desaturation load (% desaturationxtime) were compared between groups. Half
of the high-risk patients had cerebral desaturation that could be reversed
88% of the time. Interventions resulted in smaller desaturation loads in
the operating room and in the intensive care unit. Conclusions: Cerebral
desaturation in high-risk cardiac surgery is frequent but can be reversed
most of the time resulting in a smaller desaturation load. A large
randomized study will be needed to measure the impact of reversing
cerebral desaturation on patient's outcome. 2013 Elsevier Inc.

<17>
Accession Number
2013744027
Authors
Denault A.Y. Pearl R.G. Michler R.E. Rao V. Tsui S.S.L. Seitelberger R.
Cromie M. Lindberg E. D'Armini A.M.
Institution
(Denault) Department of Anesthesiology, Montreal Heart Institute,
Universite de Montreal, 5000 rue Belanger, Montreal, QC H1T 1C8, Canada
(Pearl) Department of Anesthesia, Stanford University School of Medicine,
Stanford, CA, United States
(Michler) Department of Cardiovascular and Thoracic Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, NY, United
States
(Rao) Department of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Canada
(Tsui) Department of Cardiac Surgery, Papworth Hospital, Cambridge, United
Kingdom
(Seitelberger) Department of Cardiothoracic Surgery, University of Vienna,
Vienna, Austria
(Cromie, Lindberg) Department of Clinical Science and Therapeutic Area
Head, Actelion Pharmaceuticals Ltd., Allschwil, Switzerland
(D'Armini) Department of Cardiovascular Surgery, San Matteo Hospital,
University of Pavia, Pavia, Italy
Title
Tezosentan and right ventricular failure in patients with pulmonary
hypertension undergoing cardiac surgery: The TACTICS trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1212-1217),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To evaluate the efficacy of tezosentan in reducing the
incidence of right ventricular (RV) failure and associated mortality in
patients with pre-existing pulmonary hypertension. The primary endpoint
was the proportion of patients with RV failure during weaning from
cardiopulmonary bypass (CPB), assessed 30 minutes after the end of CPB.
Design: Multicenter, double-blind, randomized, placebo-controlled trial.
Setting: Thirty-one cardiac surgical centers in 14 countries.
Participants: Two hundred seventy-four patients with pulmonary
hypertension aged>=18 years scheduled to undergo cardiac surgery.
Intervention: Intravenous tezosentan (5 mg/h) during surgery and up to 24
hours afterwards (1 mg/h), or matched placebo. Measurements and Main
Results: One-hundred thirty-three patients received tezosentan and 141
placebo. RV failure occurred in 30 patients (10.9%), 37% of whom died.
There was no difference in the incidence of RV failure between the two
treatment groups (relative risk reduction: 0.07 [95% CI-0.83, 0.53; P =
0.8278]). Conclusion: A reduction in RV failure with tezosentan was not
observed in this study.(Current Controlled Trials, identifier
NCT00458276). 2013 Elsevier Inc.

<18>
[Use Link to view the full text]
Accession Number
2013745463
Authors
Chatterjee S. Nerella N. Chakravarty S. Shani J.
Institution
(Chatterjee, Nerella, Shani) Department of Medicine, Maimonides Medical
Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
(Chakravarty) Department of Medicine, Division of Cardiology, University
of Connecticut School of Medicine, Farmington, CT, United States
Title
Angioplasty alone versus angioplasty and stenting for subclavian artery
stenosis-;A systematic review and meta-analysis.
Source
American Journal of Therapeutics. 20 (5) (pp 520-523), 2013. Date of
Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Subclavian artery stenosis has long been treated with great success with
bypass surgery. Percutaneous intervention, often used in combination with
stent placement, has come into vogue for the past few years as a safe and
effective therapeutic modality. This study aimed to compare angioplasty
alone with angioplasty followed by stent placement by combining available
data. The objective of this study was to perform a review of the available
literature to compare the efficacy of percutaneous transluminal
angioplasty (PTA) alone with PTA followed by stent placement for proximal
subclavian artery stenosis. Successful recanalization was defined as
patency at the end of 1 year, and reocclusions and restenoses were noted
as events for the purpose of pooling the data. The authors searched the
Specialized Register and the Cochrane Central Register of Controlled
Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, and CINAHL
databases for relevant trials/studies comparing PTA and PTA with stenting.
Review authors independently assessed the methodological quality of
studies (focusing on the adequacy of the randomization process, allocation
concealment, blinding, completeness of follow-up, and intention-to-treat
analysis) and selected studies for inclusion. All retrospective
observational studies were also included in the analysis in the absence of
doubleblinded randomized trials for increasing sample size. All analyses
were done using RevMan 5.0. Odds ratio was calculated using
Mantel-Haenszel test with a fixed effect model. All included studies were
assessed by all authors for potential sources of bias. Eight studies were
included in the analysis having 544 participants. Stenting after PTA was
significantly superior to angioplasty alone for treatment of subclavian
artery stenosis and maintenance of patency at 1 year, as indicated by
absence of events (P 5 0.004; 95% confidence interval, odds ratio 2.37
[1.32-4.26]) without significant complication rates for either procedure.
There is evidence in favor of stent placement after angioplasty for
successful recanalization of stenosed subclavian arteries and long-term
maintenance of patency without significant increase in risk for major
complications in subjects. 2013 Lippincott Williams & Wilkins.

<19>
Accession Number
2013755851
Authors
Steg P.G. Van'T Hof A. Clemmensen P. Lapostolle F. Dudek D. Hamon M.
Cavallini C. Gordini G. Huber K. Coste P. Thicoipe M. Nibbe L. Steinmetz
J. Ten Berg J. Eggink G.J. Zeymer U. Campo Dell'Orto M. Kanic V.
Deliargyris E.N. Day J. Schuette D. Hamm C.W. Goldstein P.
Institution
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, Hopital Bichat, 46
rue H.Huchard, 75018 Paris, France
(Steg) INSERM U-698, Paris, France
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Assistance Publique - Hopitaux de Paris, Paris, France
(Van'T Hof) Deparment of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Clemmensen) Department of Cardiology, University of Copenhagen, Heart
Center, Copenhagen, Denmark
(Lapostolle) SAMU 93 - UF Recherche-Enseignement-Qualite, Paris, France
(Lapostolle) Hopital Avicenne, Bobigny, France
(Lapostolle) Universite Paris 13, Sorbonne Paris Cite, Paris, France
(Dudek) Jagiellonian University Medical College, Krakow, Poland
(Hamon) Universite de Caen, France, INSERM U 744, Institut Pasteur de
Lille, Caen, France
(Cavallini) Ospedale S. Maria della Misericordia, Azienda Ospedaliera,
Perugia, Italy
(Cavallini, Gordini) Rianimazione-118 Ospedale Maggiore, Azienda USL di
Bologna, Italy
(Huber) 3rd Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Coste) Cardiology Hospital, University of Bordeaux, Bordeaux, France
(Thicoipe) University Hospital of Bordeaux, SAMU, Bordeaux, France
(Nibbe) Department of Nephrology and Medical Intensive Care, Charite -
Campus Virchow, Universitatsmedizin, Berlin, Germany
(Steinmetz) Department of Anaesthesia 4231, HOC, Rigshospitalet,
Copenhagen, Denmark
(Ten Berg) St Antonius Hospital, Nieuwegein, Netherlands
(Eggink) RAV IJsselvecht, Zwolle (EMS Service Zwolle area), Netherlands
(Zeymer) Klinikum Ludwigshafen, Ludwigshafen, Germany
(Campo Dell'Orto, Hamm) Department of Cardiology, Kerckhoff Clinic and
Thoraxcenter, Benekestr., Bad Nauheim, Germany
(Kanic) Cardiology and Angiology Department, University Medical Centre
Maribor, Maribor, Slovenia
(Deliargyris) Medicines Company Ltd., Parsippany NJ, United States
(Day, Schuette) Medicines Company Ltd., Abingdon Oxfordshire, United
Kingdom
(Goldstein) Emergency Department, SAMU, Lille University Hospital, Lille,
France
Title
Design and methods of European Ambulance Acute Coronary Syndrome
Angiography Trial (EUROMAX): An international randomized open-label
ambulance trial of bivalirudin versus standard-of-care anticoagulation in
patients with acute ST-segment-elevation myocardial infarction transferred
for primary percutaneous coronary intervention.
Source
American Heart Journal. 166 (6) (pp 960-967.e6), 2013. Date of
Publication: December 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background In patients with ST-segment elevation myocardial infarction
(STEMI) triaged to primary percutaneous coronary intervention (PCI),
anticoagulation often is initiated in the ambulance during transfer to a
PCI site. In this prehospital setting, bivalirudin has not been compared
with standard-of-care anticoagulation. In addition, it has not been tested
in conjunction with the newer P2Y₁₂ inhibitors prasugrel or
ticagrelor. Design EUROMAX is a randomized, international, prospective,
open-label ambulance trial comparing bivalirudin with standard-of-care
anticoagulation with or without glycoprotein IIb/IIIa inhibitors in 2200
patients with STEMI and intended for primary percutaneous coronary
intervention (PCI), presenting either via ambulance or to centers where
PCI is not performed. Patients will receive either bivalirudin given as a
0.75 mg/kg bolus followed immediately by a 1.75-mg/kg per hour infusion
for >=30 minutes prior to primary PCI and continued for >=4 hours after
the end of the procedure at the reduced dose of 0.25 mg/kg per hour, or
heparins at guideline-recommended doses, with or without routine or
bailout glycoprotein IIb/IIIa inhibitor treatment according to local
practice. The primary end point is the composite incidence of death or
non-coronary-artery-bypass-graft related protocol major bleeding at 30
days by intention to treat. Conclusion The EUROMAX trial will test whether
bivalirudin started in the ambulance and continued for 4 hours after
primary PCI improves clinical outcomes compared with guideline-recommended
standard-of-care heparin-based regimens, and will also provide information
on the combination of bivalirudin with prasugrel or ticagrelor. 2013
Mosby, Inc.

<20>
Accession Number
2013744013
Authors
McNair E. McKay W. Qureshi A.M. Rosin M. Gamble J. Dalshaug G. Mycyk T.
Prasad K.
Institution
(McNair, Rosin, Dalshaug, Mycyk) College of Medicine of Saskatchewan,
Royal University Hospital, Department of Surgery, 103 Hospital Drive,
Saskatoon, SK S7N OW8, Canada
(McNair, Qureshi) Department of Pathology and Laboratory Medicine,
University of Saskatchewan, Royal University Hospital, Saskatoon, SK,
Canada
(McKay, Gamble) Department of Anesthesiology and Pain Management,
University of Saskatchewan, Royal University Hospital, Saskatoon, SK,
Canada
(Prasad) Department of Physiology, University of Saskatchewan, Royal
University Hospital, Saskatoon, SK, Canada
Title
Outcomes and biochemical parameters following cardiac surgery: Effects of
transfusion of residual blood using centrifugation and multiple-pass
hemoconcentration.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1174-1180),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives To determine whether or not there was a significant difference
between the methods of centrifugation (CF) and multiple-pass
hemoconcentration (MPH) of the residual cardiopulmonary-bypass volume in
relation to biochemical measurements and patient outcomes. Design
Prospective, randomized, and controlled. Setting Conducted at a western
Canadian tertiary care hospital. Participants Consisted of 61 consecutive
male and female patients from ages 40 to 80 who were scheduled for cardiac
surgery with cardiopulmonary bypass. Interventions Either the
centrifugation or multiple-pass hemoconcentration method was used to
process the residual blood from the cardiopulmonary bypass circuit.
Results The 12-hour postoperative levels of serum hemoglobin were not
significantly different in the centrifugation group as compared to the
multiple-pass hemoconcentration group. However, the serum levels of total
protein and albumin were significantly higher in the multiple-pass
hemoconcentration group as compared to the centrifugation group.
Additionally, after 12-hours postoperatively, the serum fibrinogen and
platelet counts were significantly higher in the multiple-pass
hemoconcentration group as compared to those of the centrifugation group.
The allogeneic product transfusion index and the chest-tube blood drainage
indices were lower in the multiple-pass hemoconcentration group as
compared to the centrifugation group. Conclusion Although the CF method
provided a product in a shorter turnaround time, with consistent clearance
of heparin, the MPH method trended towards enhanced biochemical and
clinical patient outcomes over the 12-hour postoperative period. 2013
Elsevier Inc.

<21>
Accession Number
2013746948
Authors
Boothroyd L.J. Lambert L.J. Sas G. Guertin J.R. Ducharme A. Charbonneau E.
Carrier M. Cecere R. Morin J.E. Bogaty P.
Institution
(Boothroyd, Lambert, Sas, Guertin, Morin, Bogaty) Institut national
d'excellence en sante et en services sociaux (INESSS), Montreal, QC,
Canada
(Ducharme, Carrier) Institut de cardiologie de Montreal, Montreal, QC,
Canada
(Charbonneau, Bogaty) Institut universitaire de cardiologie et pneumologie
de Quebec, Quebec City, QC, Canada
(Cecere, Morin) McGill University Health Centre, Montreal, QC, Canada
Title
Should eligibility for heart transplantation be a requirement for left
ventricular assist device use? Recommendations based on a systematic
review.
Source
Canadian Journal of Cardiology. 29 (12) (pp 1712-1720), 2013. Date of
Publication: December 2013.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Left ventricular assist devices (LVADs) are used in chronic end-stage
heart failure as "bridge to transplantation" (BTT) and, more recently, for
transplant-ineligible patients as "destination therapy" (DT). We reviewed
the evidence on clinical effects and cost-effectiveness of 2 types of
continuous-flow LVADs (HeartMate II [HM II] and HeartWare), for BTT and DT
patients. We systematically searched the scientific literature (January
2008-June 2012) and identified 14 clinical studies (approximately 2900 HM
II and approximately 200 HeartWare patients), and 3 economic evaluations
(HM II) using simulation models. Data were, however, limited to 2-3
studies per outcome. We made policy recommendations on the basis of our
systematic review. Although complications after implantation are frequent,
LVAD therapy is often highly effective across transplantation eligibility
status and device, with 1-year survival reaching 86% for BTT and 78% for
DT (compared with 25% for medical therapy). Neither BTT nor DT currently
meet traditional cost-effectiveness limits in models using historical
data, although BTT is standard practice for a limited number of patients
in many regions. We found that BTT and DT as implantation strategies tend
to be no longer mutually exclusive. We conclude that evidence is
sufficient to support LVAD use, regardless of transplantation eligibility
status, as long as patients are carefully selected and program
infrastructure and budget are adequate. However, evidence gaps,
limitations in economic models, and the lack of Canadian data point to the
importance of mandatory, systematic monitoring of LVAD use and outcomes.
2013 Canadian Cardiovascular Society.

<22>
Accession Number
2013743991
Authors
Landoni G. Bove T. Szekely A. Comis M. Rodseth R.N. Pasero D. Ponschab M.
Mucchetti M. Azzolini M.L. Caramelli F. Paternoster G. Pala G. Cabrini L.
Amitrano D. Borghi G. Capasso A. Cariello C. Carpanese A. Feltracco P.
Gottin L. Lobreglio R. Mattioli L. Monaco F. Morgese F. Musu M. Pasin L.
Pisano A. Roasio A. Russo G. Slaviero G. Villari N. Vittorio A. Zucchetti
M. Guarracino F. Morelli A. De Santis V. Del Sarto P.A. Corcione A.
Ranieri M. Finco G. Zangrillo A. Bellomo R.
Institution
(Landoni, Bove, Mucchetti, Azzolini, Cabrini, Borghi, Carpanese, Mattioli,
Monaco, Pasin, Villari, Vittorio, Zangrillo) San Raffaele Scientific
Institute, Department of Anesthesia and Intensive Care, Via Olgettina 60,
Milan, 20132, Italy
(Szekely) Department of Anesthesiology and Intensive Care, Semmelweis
University, Budapest, Hungary
(Comis) Cardiac and Vascular Department, Mauriziano Hospital, Turin, Italy
(Rodseth) Department of Anesthestics, University of KwaZula-Natal, Inkosi
Albert Luthuli Central Hospital, Durban, South Africa
(Pasero, Lobreglio) Anesthesia and Critical Care Medicine, Citta della
Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Ponschab) Department of Anesthesia and Intensive Care, Trauma Hospital
Linz, Linz, Austria
(Caramelli) Cardiothoracic and Vascular Anesthesia and Intensive Care, S.
Orsola-Malpighi University Hospital, Bologna, Italy
(Paternoster) Cardiovascular Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Pala) Cardioanesthesia and Intensive Care, Civil Hospital SS Annunziata,
Sassari, Italy
(Amitrano, Cariello, Guarracino) Cardiothoracic Department, University
Hospital of Pisa, Pisa, Italy
(Capasso, Pisano, Corcione) Anesthesia and Intensive Care, Azienda
Ospedaliera Dei Colli, V Monaldi, Naples, Italy
(Feltracco) Department of Pharmacology and Anesthesiology, University
Hospital of Padova, Padova, Italy
(Gottin) Intensive Care and Perioperative Medicine Unit, University
Hospital of Verona, Verona, Italy
(Morgese) Anesthesia and Intensive Care, Casa di Cura Villa Verde,
Taranto, Italy
(Musu) Department of Anesthesia and Intensive Care, University of
Cagliari, Cagliari, Italy
(Roasio) Department of Anesthesia, Intensive Care Medicine, Cardinal
Massaia Hospital, Asti, Italy
(Russo) Anesthesia and Intensive Care, Azienda Ospedaliera di Lodi, Italy
(Slaviero) Department of Nephrology, Universita Vita-Salute San Raffaele,
Milan, Italy
(Zucchetti) Anesthesia and Resuscitation, United Company Hospital
Papardo-Piemonte, Messina, Italy
(Morelli, De Santis) Department of Anesthesiology and Intensive Care,
University of Rome Sapienza, Rome, Italy
(Del Sarto) Department of Anesthesia and ICU, FTGM-G. Pasquinucci Heart
Hospital, Massa, Italy
(Ranieri) Department of Anesthesia and Intensive Care Medicine, University
of Turin, Turin, Italy
(Finco) Department of Medical Sciences M. Aresu, University of Cagliari,
Cagliari, Italy
(Bellomo) Faculty of Medicine, University of Melbourne, Melbourne,
Australia
Title
Reducing mortality in acute kidney injury patients: Systematic review and
international web-based surveY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1384-1398),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To identify all interventions that increase or reduce mortality
in patients with acute kidney injury (AKI) and to establish the agreement
between stated beliefs and actual practice in this setting. Design and
Setting Systematic literature review and international web-based survey.
Participants More than 300 physicians from 62 countries. Interventions
Several databases, including MEDLINE/PubMed, were searched with no time
limits (updated February 14, 2012) to identify all the
drugs/techniques/strategies that fulfilled all the following criteria: (a)
published in a peer-reviewed journal, (b) dealing with critically ill
adult patients with or at risk for acute kidney injury, and (c) reporting
a statistically significant reduction or increase in mortality.
Measurements and Main Results Of the 18 identified interventions, 15
reduced mortality and 3 increased mortality. Perioperative hemodynamic
optimization, albumin in cirrhotic patients, terlipressin for hepatorenal
syndrome type 1, human immunoglobulin, peri-angiography hemofiltration,
fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased
intensity of renal replacement therapy (RRT), CVVH in severely burned
patients, vasopressin in septic shock, furosemide by continuous infusion,
citrate in continuous RRT, N-acetylcysteine, continuous and early RRT
might reduce mortality in critically ill patients with or at risk for AKI;
positive fluid balance, hydroxyethyl starch and loop diuretics might
increase mortality in critically ill patients with or at risk for AKI.
Web-based opinion differed from consensus opinion for 30% of interventions
and self-reported practice for 3 interventions. Conclusion The authors
identified all interventions with at least 1 study suggesting a
significant effect on mortality in patients with or at risk of AKI and
found that there is discordance between participant stated beliefs and
actual practice regarding these topics. 2013 Elsevier Inc.

<23>
Accession Number
2013743990
Authors
Zhao L. Lu J. Wang C. Zhao W. Qing E. Ma J.
Institution
(Zhao, Lu, Wang, Zhao, Qing, Ma) Beijing Anzhen Hospital, Capital Medical
University, Department of Anesthesiology, No. 2 Anzhen Road, Chaoyang
District, Beijing 100029, China
Title
Prostaglandin E1 increases the blood flow rate of saphenous vein grafts in
patients undergoing off-pump coronary artery bypass grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1208-1211),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To compare the effects of prostaglandin E₁ (PGEl)
versus placebo on blood flow rate in coronary artery bypass grafts. Design
A prospective, randomized, double-blinded study. Setting A teaching
hospital. Participants Forty-six patients with stable angina scheduled for
isolated elective OPCAB were recruited and randomized into group PGE1 and
group placebo. Intervention Following randomization, the patients in the
PGE1 group (Group PGE1, n = 23) received a continuous intravenous infusion
of PGEl (10 ng/kg/min) after endotracheal intubation and the placebo group
(Group placebo, n = 23) received the same volume of normal saline. The
infusion administration was removed after leaving the intensive care unit.
Measurements and Main Results The grafts' blood flow rate was measured
with a transit time flowmeter at 10 minutes and 30 minutes after coronary
artery grafting. The hemodynamic parameters, including mean arterial
pressure (MAP), heart rate, and SvO ₂, VO₂I,
DO₂I, ERO₂ monitored by a pulmonary artery catheter,
were recorded. The blood flow of the saphenous vein grafts was
significantly higher in the PGE1 group than the placebo group at both 10
and 30 minutes after coronary artery grafting. At the 10-minute mark, the
graft flow was 54.9+/-31.4 mL/min versus 47.3 +/-24.6 mL/min in venous
nonsequential grafts to the left coronary artery for group PGE1 and
placebo (p = 0.000). Corresponding values at 30 minutes were 60.1+/-27.8
mL/min versus 48.4+/-26.3 mL/min (p = 0.002). In the venous non-sequential
grafts to the right coronary artery, a tendency of blood flow also was
found to be higher in the PGE1 group than in the placebo group at
10-minutes (52.7+/-29.4 mL/min versus 49.3 +/-23.8 mL/min, p = 0.048) and
the 30-minutes (58.6+/-26.5 mL/min, 50.9+/-25.9 mL/min, p = 0.037). The
blood flow rate of the left internal mammary artery (LIMA) grafts in group
PGE1 was higher than that in the placebo group but did not reach
statistical significance. The VO₂I, DO₂I, and
ERO₂ in the 2 groups at the 2 time points did not reach
statistical significance. The cardiac index (CI) in group PGE1 was higher
than that of the placebo group at T3 and T4 (p = 0.035 and p = 0.012,
respectively). The lactate (LAC) at the end of the operation
(T₂), 4 hours after the operation (T₃), and 24 hours
after operation (T ₄) in the placebo group were higher than
that of group PGE1 (p = 0.023, p = 0.015, and p = 0.043, respectively).
The oxygenation saturation of the mixed venous blood (SvO₂) in
the 2 groups was decreased but without significant difference. Conclusion
PGE1 significantly increased the flow rate in anastomosed saphenous vein
grafts, and its beneficial effects on hemodynamics and oxygen metabolism
were observed. 2013 Elsevier Inc.

<24>
Accession Number
2013747334
Authors
Tsai S.-K.
Institution
(Tsai) National Taiwan University School of Medicine, Taipei, Taiwan
(Republic of China)
(Tsai) National Yang-Ming University School of Medicine, Taipei, Taiwan
(Republic of China)
(Tsai) Department of Anesthesiology, Cheng-Hsin General Hospital, Taipei,
Taiwan (Republic of China)
Title
The role of transesophageal echocardiography in clinical use.
Source
Journal of the Chinese Medical Association. 76 (12) (pp 661-672), 2013.
Date of Publication: December 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Transesophageal echocardiography (TEE) is not only an invaluable
diagnostic tool for cardiac patients, but also is essential for cardiac
monitoring in critically ill patients in cardiac and non-cardiac surgery
settings and in the differential diagnosis of unexplained hemodynamic
collapse. The advantage of TEE over transthoracic echocardiography (TTE)
is usually clearer images, especially when viewing structures that are
difficult to see transthoracically. TEE is essential in monitoring adult
and congenital heart surgery perioperatively. The adequacy of the repair
can be ensured immediately through a review of TEE images directly after
surgery. Although TEE is considered to be relatively safe and noninvasive,
TEE-associated complications, such as esophageal laceration, must be taken
seriously. Recently, real-time three-dimensional (3D) TEE imaging has
played an important role defining valvular and congenital abnormalities
and aiding in operative and percutaneous repair. 2013.

<25>
Accession Number
2013744004
Authors
Makhija N. Sarupria A. Kumar Choudhary S. Das S. Lakshmy R. Kiran U.
Institution
(Makhija, Sarupria, Das, Kiran) Department of Cardiac Anaesthesia,
Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi-110029, India
(Kumar Choudhary) Cardiothoracic Surgery, Cardiothoracic Centre, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Lakshmy) Cardiac Biochemistry, Cardiothoracic Centre, All India Institute
of Medical Sciences, Ansari Nagar, New Delhi, India
Title
Comparison of epsilon aminocaproic acid and tranexamic acid in thoracic
aortic surgery: Clinical efficacy and safety.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1201-1207),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To evaluate the efficacy and safety of tranexamic acid (TXA)
versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic
aortic surgery. Design A prospective randomized study. Setting A tertiary
care center. Participant The study was conducted on 64 consecutive adult
patients undergoing thoracic aortic surgery with cardiopulmonary bypass
(CPB). Interventions Group EACA received a bolus of 50 mg/kg of EACA after
induction of anesthesia over 20 minutes followed by maintenance infusion
of 25 mg/kg/h until chest closure. Group TXA received a bolus of 10 mg/kg
of TXA after induction of anesthesia over 20 minutes followed by
maintenance infusion of 1 mg/kg/h until chest closure. Measurements and
Main Results Cumulated mean blood loss, total packed red blood cells, and
blood product requirement up to 24 h postoperatively were comparable
between groups. A significant renal injury (EACA 40% v TXA 16%; p = 0.04)
and increased tendency for renal failure (EACA 10% v TXA 0%, p = 0.11;
relative risk 2.15) were observed with EACA compared to TXA. There was
increased tendency of seizure with TXA (EACA v TXA: 3.3% v 10%; p>0.05,
relative risk 1.53). There was significant increase in the D-dimer from
preoperative to postoperative values in Group EACA. (p< 0.01). Conclusions
Both EACA and TXA were equally effective in reducing the perioperative
blood loss and transfusion requirement in patients undergoing thoracic
aortic surgery. While significant renal injury was observed with EACA,
there was a tendency for higher incidence of seizure with TXA. Prospective
placebo-controlled trials recruiting larger sample size using sensitive
biomarkers are required before any recommendations. 2013 Elsevier Inc.

<26>
Accession Number
2013744010
Authors
Harrison R.W. Hasselblad V. Mehta R.H. Levin R. Harrington R.A. Alexander
J.H.
Institution
(Harrison, Hasselblad, Mehta, Harrington, Alexander) Duke Clinical
Research Institute, 2400 Pratt Street, Durham, NC 27705, United States
(Levin) Vanderbilt University, 1211 Medical Center Drive, Nashville, TN,
United States
Title
Effect of levosimendan on survival and adverse events after cardiac
surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (6) (pp 1224-1232),
2013. Date of Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective Left ventricular systolic dysfunction is associated with
increased morbidity and mortality in patients undergoing cardiac surgery.
The authors performed a meta-analysis investigating the effects of
levosimendan in cardiac surgery patients with and without preoperative
systolic dysfunction. Design Meta-analysis of randomized controlled
trials. Setting Hospital. Participants The 1,155 patients who participated
in 14 randomized controlled trials of perioperative levosimendan were
included. Interventions None. Measurements and Main Results PubMed,
EMBASE, the Cochrane database of clinical trials, and conference
proceedings were searched for clinical trials of perioperative
levosimendan in patients undergoing cardiac surgery through May 1, 2012.
Studies were grouped by mean ejection fraction (EF). Those with a mean EF
<40% were designated as low-EF. Pooled results demonstrated a reduction in
mortality with levosimendan (risk difference [RD]-4.2%; 95% CI -7.2%,
-1.1%; p = 0.008). Subgroup analysis showed that this benefit was confined
to the low-EF studies (RD -7.0%; 95% CI -11.0%, -3.1%; p < 0.001). No
benefit was observed in the preserved-EF subgroup (RD +1.1%; 95% CI -3.8%,
+5.9%; p = 0.66). Significant reductions also were seen in the need for
dialysis (RD -4.9%; 95% CI -8.2%, -1.6%; p = 0.003), myocardial injury (RD
-5.0%; 95% CI -8.3%, -1.7%; p = 0.003), and postoperative atrial
fibrillation (RD -8.1%; 95% CI -13.3%, -3.0%; p = 0.002). Conclusions
Levosimendan was associated with reduced mortality and other adverse
outcomes in patients undergoing cardiac surgery, and these benefits were
greatest in patients with reduced EF. These data support the need for
adequately powered randomized clinical trials to confirm the benefits of
levosimendan in patients with reduced EF undergoing cardiac surgery. 2013
Elsevier Inc.

<27>
Accession Number
2013756404
Authors
Holman W.L. Davies J.E. Lin J.Y. Wang Y. Goldman S. Bakaeen F.G. Kelly R.
Fremes S.E. Lee K.K. Wagner T.H. Sethi G.K.
Institution
(Holman, Davies) Department of Surgery, Birmingham, Alabama VA Medical
Center, 700 S 19th St, Birmingham, AL 35233, United States
(Lin, Wang, Lee, Wagner) CSP Coordinating Center, VA Palo Alto Health Care
System, Mountain View, CA, United States
(Goldman, Sethi) Department of Medicine and Surgery, Southern Arizona VA
Health Care System, Tucson, AZ, United States
(Bakaeen) Department of Surgery, Michael E. DeBakey VA Medical Center,
Houston, TX, United States
(Kelly) Department of Surgery, Minneapolis VA Medical Center, Minneapolis,
MN, United States
(Fremes) Department of Surgery, Sunnybrook Health Sciences Center,
Toronto, ON, Canada
Title
Consequences of radial artery harvest: Results of a prospective,
randomized, multicenter trial.
Source
JAMA Surgery. 148 (11) (pp 1020-1023), 2013. Date of Publication: November
2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE: To date, no study has defined the consequences of radial
artery harvest based on a large number of patients in a prospective
randomized trial. OBJECTIVE: To compare pain at the harvest site and
functional changes associated with harvesting the radial artery vs
saphenous vein for coronary artery bypass grafting. DESIGN, SETTING, AND
PARTICIPANTS: This study compares the consequences of radial artery
harvest with saphenous vein harvest in patients undergoing elective
coronary artery bypass grafting procedures in Veterans Affairs hospitals.
MAIN OUTCOMES AND MEASURES: Eleven hospitals screened 6148 patients, of
whom 751 were included in this trial. We analyzed 2 variables: pain at the
harvest site as measured on a scale of 0 to 100 (least to most painful)
and hand performance testing. Patients included in this analysis had
radial artery only (n = 80) or saphenous vein only (n = 337) harvest. Pain
score, grip strength, and dexterity were measured before surgery and at 3
and 12 months after surgery. We adjusted for pain scores of the
nonharvested extremity, age, whether the patient underwent endoscopic vein
harvesting, and comorbid health conditions (smoking history, type 2
diabetes mellitus, hypertension, and heart failure). RESULTS: There was a
significant difference in change of pain score at 3 months from the
preoperative baseline between radial artery and saphenous vein groups
after adjusting for covariates (P < .001) but not at 12 months (P = .07).
No significant changes occurred in grip strength or dexterity from
preoperative baseline to 3 and 12 months after surgery (P > .05).
CONCLUSIONS AND RELEVANCE: The radial artery group reported significantly
more pain than the saphenous vein group 3 months after surgery; however,
similar levels of pain were observed in both groups at 12 months after
surgery. Grip strength and manual dexterity were not changed by radial
artery harvesting at 3 and 12 months. Copyright 2013 American Medical
Association. All rights reserved.

<28>
Accession Number
2013701792
Authors
Kruk M. Menon V. Kadziela J. Sadowski Z. Ruzyllo W. Janas J. Roik M.
Opolski G. Zmudka K. Czunko P. Kurowski M. Busz-Papiez B. Zinka E.
Jablonski W. Jaworska K. Raczynska A. Skonieczny G. Forman S. Li D.
Hochman J.
Institution
(Kruk, Kadziela, Sadowski, Ruzyllo, Janas) Institute of Cardiology,
Warsaw, Poland
(Menon) Cleveland Clinic, Cleveland, Ohio, United States
(Roik, Opolski) Medical University, Warsaw, Poland
(Zmudka, Czunko) John Paul II Hospital, Krakow, Poland
(Kurowski, Busz-Papiez) County Hospital, Szczecin, Poland
(Zinka, Jablonski) County Hospital, Koszalin, Poland
(Jaworska, Raczynska, Skonieczny) County Hospital, Torun, Poland
(Forman, Li) Clinical Trials and Surveys Corporation, Owings Mills, MD,
United States
(Hochman) New York University School of Medicine, New York, United States
(Hochman) Cardiovascular Clinical Research Center, Leon Charney Division
of Cardiology, New York University School of Medicine, 530 First Ave,
Skirball 9R, New York, NY 10016, United States
Title
Impact of percutaneous coronary intervention on biomarker levels in
patients in the subacute phase following myocardial infarction: The
Occluded Artery Trial (OAT) biomarker ancillary study.
Source
BMC Cardiovascular Disorders. 13 , 2013. Article Number: 91. Date of
Publication: 24 Oct 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: The purpose of the Occluded Artery Trial (OAT) Biomarker
substudy was to evaluate the impact of infarct related artery (IRA)
revascularization on serial levels of N-terminal prohormone of brain
natriuretic peptide (NT-proBNP) and dynamics of other biomarkers related
to left ventricular remodeling, fibrosis and angiogenesis.Methods:
Patients were eligible for OAT-Biomarker based on the main OAT criteria.
Of 70 patients (age 60.8 +/- 8.8, 25% women) enrolled in the substudy, 37
were randomized to percutaneous coronary intervention (PCI) and 33 to
optimal medical therapy alone. Baseline serum samples were obtained prior
to OAT randomization with follow up samples taken at one year. The primary
outcome was percent change of NT-proBNP from baseline to 1 year. The
secondary outcomes were respective changes of matrix metalloproteinases
(MMP) 2 and 9, tissue inhibitor of matrix metalloproteinase 2 (TIMP-2),
Vascular Endothelial Growth Factor (VEGF), and Galectin-3.Results: Paired
(baseline and one-year) serum samples were obtained in 62 subjects.
Baseline median NT-proBNP level was 944.8 (455.3, 1533) ng/L and decreased
by 69% during follow-up (p < 0.0001). Baseline MMP-2 and TIMP-2 levels
increased significantly from baseline to follow-up (p = 0.034, and p =
0.027 respectively), while MMP-9 level decreased from baseline (p =
0.038). Levels of VEGF and Galectin-3 remained stable at one year (p = NS
for both). No impact of IRA revascularization on any biomarker dynamics
were noted.Conclusions: There were significant changes in measured
biomarkers related to LV remodeling, stress, and fibrosis following MI
between 0 and 12 month. Establishing infarct vessel patency utilizing
stenting 24 hours-28 days post MI did not however influence the
biomarkers' release. 2013 Kruk et al.; licensee BioMed Central Ltd.

<29>
Accession Number
2013697232
Authors
Habib P.J. Green J. Butterfield R.C. Kuntz G.M. Murthy R. Kraemer D.F.
Percy R.F. Miller A.B. Strom J.A.
Institution
(Habib, Green, Murthy, Percy, Miller, Strom) Department of Medicine,
College of Medicine, University of Florida, 655 West 8th Street,
Jacksonville, FL 32209, United States
(Butterfield, Kraemer) Center for Health Equity and Quality Research,
University of Florida, College of Medicine, Jacksonville, FL, United
States
(Kuntz) Borland Health Sciences Library, University of Florida, College of
Medicine, Jacksonville, FL, United States
(Kraemer) Department of Neurology, University of Florida, College of
Medicine, Jacksonville, FL, United States
Title
Association of cardiac events with coronary artery disease detected by
64-slice or greater coronary CT angiography: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 169 (2) (pp 112-120), 2013. Date of
Publication: 30 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background The value of >= 64-slice coronary CT angiography (CCTA) to
determine odds of cardiac death or non-fatal myocardial infarction (MI)
needs further clarification. Methods We performed a systematic review and
meta-analysis using publications reporting events/severity of coronary
artery disease (CAD) in patients with suspected CAD undergoing CCTA.
Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis
< 50%), and obstructive CAD (>= 50% stenosis). Odds ratios with 95%
confidence intervals were calculated using a fixed or random effects
model. Heterogeneity was assessed using the I² index. Results
We included thirty-two studies comprising 41,960 patients with 363
all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69
unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96
(SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04%
without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR
for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive
CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD,
and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD
and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends
were noted for all-cause mortality and composite major adverse
cardiovascular events. Conclusions Increasing CAD severity detected by
CCTA is associated with cardiac death or MI, all-cause mortality, and
composite major adverse cardiovascular events. Absence of CAD is
associated with very low odds of major adverse events, but non-obstructive
disease significantly increases odds of cardiac adverse events in this
follow-up period. 2013 Elsevier Ireland Ltd.

<30>
Accession Number
2013697239
Authors
Ntaios G. Papavasileiou V. Makaritsis K. Michel P.
Institution
(Ntaios, Papavasileiou, Makaritsis) Department of Medicine and Research
Lab, University of Thessaly, Biopolis 41110, Larissa, Greece
(Michel) Neurology Service, Centre Hospitalier Universitaire Vaudois,
University of Lausanne, Lausanne, Switzerland
Title
PFO closure vs. medical therapy in cryptogenic stroke or transient
ischemic attack: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 169 (2) (pp 101-105), 2013. Date of
Publication: 30 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background/objectives This study aims to assess whether patent foramen
ovale (PFO) closure is superior to medical therapy in preventing
recurrence of cryptogenic ischemic stroke or transient ischemic attack
(TIA). Methods We searched PubMed for randomized trials which compared PFO
closure with medical therapy in cryptogenic stroke/TIA using the items:
"stroke or cerebrovascular accident or TIA" and "patent foramen ovale or
paradoxical embolism" and "trial or study". Results Among 650 potentially
eligible articles, 3 were included including 2303 patients. There was no
statistically significant difference between PFO-closure and medical
therapy in ischemic stroke recurrence (1.91% vs. 2.94% respectively, OR:
0.64, 95%CI: 0.37-1.10), TIA (2.08% vs. 2.42% respectively, OR: 0.87,
95%CI: 0.50-1.51) and death (0.60% vs. 0.86% respectively, OR: 0.71,
95%CI: 0.28-1.82). In subgroup analysis, there was significant reduction
of ischemic strokes in the AMPLATZER PFO Occluder arm vs. medical therapy
(1.4% vs. 3.04% respectively, OR: 0.46, 95%CI: 0.21-0.98,
relative-risk-reduction: 53.2%, absolute-risk-reduction: 1.6%,
number-needed-to-treat: 61.8) but not in the STARFlex device (2.7% vs.
2.8% with medical therapy, OR: 0.93, 95%CI: 0.45-2.11). Compared to
medical therapy, the number of patients with new-onset atrial fibrillation
(AF) was similar in the AMPLATZER PFO Occluder arm (0.72% vs. 1.28%
respectively, OR: 1.81, 95%CI: 0.60-5.42) but higher in the STARFlex
device (0.64% vs. 5.14% respectively, OR: 8.30, 95%CI: 2.47-27.84).
Conclusions This meta-analysis does not support PFO closure for secondary
prevention with unselected devices in cryptogenic stroke/TIA. In subgroup
analysis, selected closure devices may be superior to medical therapy
without increasing the risk of new-onset AF, however. This observation
should be confirmed in further trials using inclusion criteria for
patients with high likelihood of PFO-related stroke recurrence. 2013
Elsevier Ireland Ltd.

<31>
Accession Number
2013748828
Authors
Liu Y. Guo W. Zhang J. Xu C. Yu S. Mao Z. Wu J. Ye C. Mei C. Dai B.
Institution
(Liu, Xu, Yu, Mao, Wu, Ye, Mei, Dai) Division of Nephrology, Second
Military Medical University, Shanghai Changzheng Hospital, 415 Fengyang
Road, Shanghai, 200003, China
(Guo) Department of Organ Transplantation, Shanghai Changzheng Hospital,
Second Military Medical University, Shanghai, China
(Zhang) Division of Cardiology, Shanghai Changzheng Hospital, Second
Military Medical University, Shanghai, China
Title
Urinary interleukin 18 for detection of acute kidney injury: A
meta-analysis.
Source
American Journal of Kidney Diseases. 62 (6) (pp 1058-1067), 2013. Date of
Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Interleukin 18 (IL-18) has been proposed as a biomarker for
the early detection of acute kidney injury (AKI), but a broad range of its
predictive accuracy has been reported. Study Design: Meta-analysis of
diagnostic test studies. Setting & Population: Various clinical settings
of AKI, including after cardiac surgery, after contrast infusion, in the
emergency department, or in the intensive care unit. Selection Criteria
for Studies: Prospective studies that investigated the diagnostic accuracy
of IL-18 level to predict AKI. Index Tests: Increasing or increased
urinary IL-18 excretion. Reference Tests: The primary outcome was AKI
development, mainly based on serum creatinine level (definition varied
across studies). The other outcome was in-hospital mortality. Results: We
analyzed data from 23 studies and 7 countries involving 4,512 patients. Of
these studies, 18 could be included in the meta-analysis. Across all
settings, the diagnostic odds ratio (DOR) for urinary IL-18 level to
predict AKI was 4.22 (95% CI, 2.90-6.14), with sensitivity and specificity
of 0.58 and 0.75, respectively. The area under the receiver operating
characteristic curve (AUROC) of urinary IL-18 level to predict AKI was
0.70 (95% CI, 0.66-0.74). Subgroup analysis showed the DOR/AUROC of
urinary IL-18 was 5.32 (95% CI, 2.92-9.70)/0.72 (95% CI, 0.68-0.76) in
cardiac surgery patients and 3.65 (95% CI, 1.88-7.10)/0.66 (95% CI,
0.62-0.70) in intensive care unit or coronary care unit patients. After
stratification for age, IL-18 level had better diagnostic accuracy in
children and adolescents versus adults: 8.12 (95% CI, 3.79-17.41)/0.78
(95% CI, 0.75-0.82) versus 3.31 (95% CI, 2.28-4.80)/0.66 (95% CI,
0.62-0.70). There was no significant difference in predictive performance
of urinary IL-18 level among various times. Limitations: Various clinical
settings; different definition of AKI and serum creatinine level as the
reference standard test for the diagnosis of AKI. Conclusions: Urinary
IL-18 is a useful biomarker of AKI with moderate predictive value across
all clinical settings. 2013 National Kidney Foundation, Inc.

<32>
Accession Number
2013748834
Authors
Yacoub R. Patel N. Lohr J.W. Rajagopalan S. Nader N. Arora P.
Institution
(Yacoub) Division of Nephrology, Department of Medicine, Mount Sinai
School of Medicine, New York, NY, United States
(Patel) Division of Nephrology, VAMC, Richmond, VA, United States
(Patel) Department of Medicine, Virginia Commonwealth University,
Richmond, VA, United States
(Lohr, Arora) Division of Nephrology at VAMC, Buffalo, Department of
Medicine, SUNY at Buffalo, 3495 Bailey Ave, Buffalo, NY 14215, United
States
(Lohr, Arora) Department of Medicine, SUNY at Buffalo, NY, United States
(Rajagopalan) Medical Analytics Inc, Buffalo, NY, United States
(Nader) Department of Anesthesia at VAMC, Buffalo, NY, United States
Title
Acute kidney injury and death associated with renin angiotensin system
blockade in cardiothoracic surgery: A meta-analysis of observational
studies.
Source
American Journal of Kidney Diseases. 62 (6) (pp 1077-1086), 2013. Date of
Publication: December 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Acute kidney injury (AKI) is a common complication after
cardiovascular surgery. The use of renin angiotensin system (RAS) blockers
preoperatively is controversial due to conflicting results of their effect
on the incidence of postoperative AKI and mortality. Study Design:
Meta-analysis of prospective or retrospective observational studies (1950
to January 2013) using MEDLINE, EMBASE, the Cochrane Library, conferences,
and ClinicalTrials.gov, without language restriction. Setting &
Population: Patients undergoing cardiovascular surgery. Selection Criteria
for Studies: Retrospective or prospective studies evaluating the effect of
preoperative use of RAS blockers in the development of postoperative AKI
and/or mortality in adult patients. Intervention: Preoperative use of RAS
blockers. RAS-blocker use was defined as long-term use of either
angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
until the day of surgery. Outcomes: The primary outcome was the
development of postoperative AKI; the secondary outcome was mortality. AKI
was defined by different authors using different criteria. Death was
ascertained in the hospital, at 30 days, or at 90 days in different
studies. Results: 29 studies were included (4 prospective and 25
retrospective); 23 of these involving 69,027 patients examined AKI, and 18
involving 54,418 patients studied mortality. Heterogeneity was found
across studies regarding AKI (I² = 82.5%), whereas studies were
homogeneous regarding mortality (I² = 20.5%). Preoperative
RAS-blocker use was associated with increased odds for both postoperative
AKI (OR, 1.17; 95% CI, 1.01-1.36; P = 0.04) and mortality (OR, 1.20; 95%
CI, 1.06-1.35; P = 0.005). Limitations: Lack of randomized controlled
trials, different definitions of AKI, different durations of follow-up
used to analyze death outcome, and inability to exclude outcome reporting
bias. Conclusions: In retrospective studies, preoperative use of RAS
blockers was associated with increased odds of postoperative AKI and
mortality in patients undergoing cardiovascular surgery. A large,
multicenter, randomized, controlled trial should be performed to confirm
these findings. 2013 National Kidney Foundation, Inc.

<33>
Accession Number
71246268
Authors
Osnabrugge R.L. Mylotte D. Head S.J. Van Mieghem N.M. Nkomo V.T. Lereun
C.M. Bogers A.J. Piazza N. Kappetein A.P.
Institution
(Osnabrugge, Head, Van Mieghem, Bogers, Kappetein) Erasmus University
Medical Center, Rotterdam, Netherlands
(Mylotte, Piazza) McGill University Health Center, Montreal, QC, Canada
(Nkomo) Mayo Clinics, Rochester, MN, United States
(Lereun) Self-employed, Wrenville, Carrigaline, Ireland
Title
Aortic stenosis in the elderly: Disease prevalence and impact on TAVI. A
meta-analysis and modelling study.
Source
EuroIntervention. Conference: EuroPCR 2013 Paris France. Conference Start:
20130521 Conference End: 20130524. Conference Publication: (var.pagings).
9 (pp 278), 2013. Date of Publication: May 2013.
Publisher
EuroPCR
Abstract
Aims: Severe aortic stenosis is a leading cause of morbidity and mortality
in the elderly. A proportion of these patients is considered at high or
prohibitive risk for surgical aortic valve replacement and is now
considered for transcatheter aortic valve implantation (TAVI). The aims of
this study were i) to perform a meta-analysis on the prevalence of aortic
stenosis in the elderly and ii) to systematically estimate the number of
candidates for TAVI. Methods and results: A systematic search was
conducted in multiple databases and prevalence rates of patients (>75
years) were pooled. A random effect model was used and potential sources
of heterogeneity were investigated. A second literature search identified
decision-making studies in patients with aortic stenosis. We searched for
studies that reported: (i) the percentage of patients with severe aortic
stenosis patients experiencing symptoms; (ii) the percentage of
symptomatic severe aortic stenosis patients who did not undergo surgical
aortic valve replacement, and were therefore potential TAVI candidates;
and/or (iii) the percentage of patients referred for TAVI that actually
received a transcatheter valve. As TAVI is also approved for patients at
high operative risk, we also searched the literature for the proportion of
elderly patients that underwent surgical aortic valve replacement and had
a Society of Thoracic Surgeons predicted risk of mortality >10%. Results
from the literature search were pooled and used in a systematic projection
model. Monte Carlo simulations were used to estimate the number
ofpotential TAVI candidates in 19 European countries and the U.S. and
Canada. Of 1,524 studies identified, 7 (n=9,723 subjects) were used. The
pooled prevalence of aortic stenosis in the elderly was 13.1 (95%
confidence interval, 3.5%-22.6%), while the prevalence of severe aortic
stenosis was 3.4% (95% confidence interval, 1.1-5.7%). The second search
yielded 21 decision-making studies. Of all elderly patients with severe
aortic stenosis, 75.6% was symptomatic. Of these, 40.5% was not treated
surgically. Of the symptomatic severe AS patients who were not treated
surgically, 40.3% received TAVI. In total, 12.3% of the prohibitive risk
group was TAVI candidate. Of the high-risk patients, 5.2% were potential
TAVI candidates. Consequently, there are approximately 189,836 (95%
percentile confidence interval 80,281-347,372) TAVI candidates in 19
European countries and 102,558 (95% percentile confidence interval
43,612-187,002) in North America. The five countries with the highest
number of potential TAVI candidates were The United States (91,227),
Germany (36,220), Italy (29,597), France (28,026) and the United Kingdom
(23,838). Conclusions: This systematic review and meta-analysis of
population-based studies found that the prevalence of aortic stenosis and
severe aortic stenosis in the elderly is 13.1%, and 3.4%, respectively. Of
these 3.4%, approximately 75% was symptomatic. The overall burden of
disease due to severe aortic stenosis in the general elderly population is
substantial. Our model showed that, under the current indications,
approximately 290,000 elderly patients at high or prohibitive surgical
risk could potentially be treated with TAVI in Europe and North-America.
These estimates have considerable clinical, economic, and social
implications.

<34>
Accession Number
71245865
Authors
Giannini F. Candreva A. Latib A. Figini F. Durante A. Sticchi A. Maisano
F. Ferrarello S. Bernelli C. Naim C. Costopoulos C. Naganuma T. Chieffo A.
Montorfano M. Cioni M. Alfieri O. Colombo A.
Institution
(Giannini, Candreva, Latib, Figini, Durante, Sticchi, Ferrarello,
Bernelli, Naim, Chieffo, Montorfano, Colombo) San Raffaele Scientific
Institute, Milan, Milano, Italy
(Maisano, Cioni, Alfieri) Department of Cardiothoracic Surgery, San
Raffaele Scientific Institute, Milan, Milano, Italy
(Costopoulos, Naganuma) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus, Milan, Milano, Italy
Title
Prognostic impact of post-procedural hyperglycemia on acute kidney injury
after TAVI.
Source
EuroIntervention. Conference: EuroPCR 2013 Paris France. Conference Start:
20130521 Conference End: 20130524. Conference Publication: (var.pagings).
9 (pp 263), 2013. Date of Publication: May 2013.
Publisher
EuroPCR
Abstract
Aims: Peri-operativehyperglycemia, in individuals with and without
diabetes, has been identified as a marker of AKI in cardiac surgery
patients. This aspect is not known in the TAVI setting. We sought to
evaluate whether post-procedural glucose levels are associated with acute
kidney injury (AKI) after transcatheter aortic valve implantation (TAVI).
Methods and results: We prospectively evaluated 422 patients undergoing
TAVI. For each patient, plasma glucose level were assessed at hospital
admission, 4 hours after the procedure and every day during
hospitalisation. Post-procedural hyperglycemia was defined as 2
consecutive blood glucose readings of 150 mg/dL or greater during 72 hours
after TAVI. AKI was defined based onthe VARC standardised endpoint
definitions. The predictive value of post-procedural hyperglycemia for the
risk of AKI was assessed using multivariable logistic regression. Overall,
137 (32%) patients had post-procedural hyperglycemia and 138 (33%)
patients developed AKI. Hyperglycemic patients had a 2-fold higher
incidence of AKI than those without hyperglycemia (48% vs. 25%, p<0.001).
In-hospital mortality was higher in patients with hyperglycemia than in
those without hyperglycemia (9.6% vs. 1.8%, p<0.001). At multivariable
regression analysis post-procedural hyperglycemiawas an independent
predictor of AKI (OR 2, 95% CI 1.3-3.1, p=0.002) and in-hospital mortality
(OR 4.4, 95% CI 1.5-13, p=0.007). Conclusions: Post-procedural
hyperglycemia iscorrelated with higher incidence of AKI and mortality
after TAVI. Randomised controlled trials are needed to determine whether
post-procedural hyperglycemia management improves clinical outcome in
patients undergoing TAVI and could become an adjunctive strategy of AKI
prevention.

<35>
Accession Number
71245780
Authors
Conrotto F. Giordana F. D'Ascenzo F. Moretti C. Salizzoni S. D'Amico M.
Tamburino C. Schnabel R. Seiffert M. Wilde S. Treede H. Gasparetto V.
Taratini G. Presbitero P. Gaita F.
Institution
(Conrotto, Giordana, D'Ascenzo, Moretti, Salizzoni, D'Amico, Gaita) Citta
delle Salute e Della Scienza, Turin, Italy
(Tamburino) Ferrarotto Hospital, University of Catania, Catania, Italy
(Schnabel, Seiffert, Wilde, Treede) University Heart Center Hamburg,
Hamburg, Germany
(Gasparetto, Taratini) Division of Cardiology, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padova, Italy, Padova, Italy
(Presbitero) Division of Cardiology, Humanitas, Milan, Italy
Title
Mid-term prognostic value of coronary artery disease in patients
undergoing TAVI: A meta-analysis of adjusted observational results.
Source
EuroIntervention. Conference: EuroPCR 2013 Paris France. Conference Start:
20130521 Conference End: 20130524. Conference Publication: (var.pagings).
9 (pp 177), 2013. Date of Publication: May 2013.
Publisher
EuroPCR
Abstract
Aims: Coronary artery disease (CAD) negatively affects prognosis in
patients undergoing surgical aortic valve replacement, consequently being
appraised in the most common used risk score. Our meta-analysis aims to
clarify the association of CAD on mid-term survival in patients undergoing
TAVI. Methods and results: A systematic literature review was performed
looking for studies reporting multivariate predictors of adverse outcomes
in patients undergoing TAVI and pooled, when appropriate, using a
random-effect method.960 citations were first screened and finally 7
studies (2472 patients)were included. Diagnosis of CAD was reported in 37%
to 51% of patients and 1169 Edwards SAPIEN and 1303 CoreValve prostheses
were implanted. Follow-up time was 452 (357-585) days. After a median
follow-up of 452 days (357-585) 24% of patients (19-33) died, and 23 (14-
32) for cardiovascular death which was mentioned only in three studies. At
pooled analysis of multivariate approach, diagnosis of coronary artery
disease did not increase risk of death (OR 1.0, 95% CI, Confidence
Interval, 0.67-1.50). Conclusions: CAD does not affect mid-term TAVI
outcome, and this finding should be weighted to accurately evaluate risk
and strategies for patients with severe aortic stenosis.