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Accession Number
2014103384
Authors
Athappan G. Chacko P. Patvardhan E. Gajulapalli R.D. Tuzcu E.M. Kapadia
S.R.
Institution
(Athappan, Chacko) Department of Cardiovascular Medicine, Heart and
Vascular Institute, Case Western Reserve University, MetroHealth Campus,
Cleveland, OH, United States
(Patvardhan) Department of Cardiovascular Medicine, Tufts School of
Medicine, Boston, MA, United States
(Gajulapalli, Tuzcu, Kapadia) Department of Cardiovascular Medicine, Heart
and Vascular Institute, 9500 Euclid Ave, Cleveland, OH 44195, United
States
Title
Late stroke: Comparison of percutaneous coronary intervention versus
coronary artery bypass grafting in patients with multivessel disease and
unprotected left main disease a meta-analysis and review of literature.
Source
Stroke. 45 (1) (pp 185-193), 2014. Date of Publication: January 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose-Studies have suggested that the early excess risk
of stroke in coronary artery bypass grafting (CABG) may be compensated for
by a slow but progressive catch-up phenomenon in patients undergoing
percutaneous coronary intervention (PCI). We therefore undertook this
analysis to compare the temporal stroke risk between PCI and CABG in
patients with unprotected left main stenosis and multivessel coronary
artery disease. Methods-Studies of PCI versus CABG for unprotected left
main stenosis and multivessel disease published between January 1994
(stent era) and July 2013 were identified using an electronic search and
reviewed using meta-analytic techniques. Results-We selected 57 reports
for the meta-analysis by applying the inclusion and exclusion criteria.
The analysis was performed on 80 314 patient records. There was a
significantly lower risk of cumulative stroke in patients undergoing PCI
with stenting at 1 year (odds ratio [OR], 0.55; 95% confidence interval
[CI], 0.42-0.71), 2 years (OR, 0.78; 95% CI, 0.66-0.92), 3 years (OR,
0.79; 95% CI, 0.67-0.92), 4 years (OR, 0.74; 95% CI, 0.56-0.97), and 5
years (OR, 0.79; 95% CI, 0.69-0.91). There was no significant difference
in the incidence of stroke because of the small sample size (OR, 0.71; 95%
CI, 0.46-1.08) at >5 years between PCI and CABG. Similar results were
observed on subgroup analysis (multivessel coronary artery disease,
unprotected left main, diabetics, and randomized trials) and for stroke
within 30 days. Late stroke (stroke >30 days) was similar between the 2
groups. Conclusions-There is a significantly lower risk of stroke within
30 days and cumulative stroke with PCI as compared with CABG up to year 5.
There is no late catch up of stroke in the PCI arm. The risk of stroke
should be weighed in deciding between revascularization strategies. 2013
American Heart Association Inc.
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Accession Number
2014101397
Authors
Talasaz A.H. Khalili H. Fahimi F. Jenab Y. Broumand M.A. Salarifar M.
Darabi F.
Institution
(Talasaz, Khalili) Department of Clinical Pharmacy, Faculty of Pharmacy,
Tehran University of Medical Sciences, P.O.Box 14155/6451, 1417614411
Tehran, Iran, Islamic Republic of
(Fahimi) Department of Clinical Pharmacy, Faculty of Pharmacy, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Jenab) Emergency Department, Tehran Heart Center, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Broumand) Department of Molecular Pathology, Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Salarifar) Interventional Cardiologist, Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Darabi) Resident of Cardiology, Tehran Heart Center, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effects of N-acetylcysteine on the cardiac remodeling biomarkers and major
adverse events following acute myocardial infarction: A randomized
clinical trial.
Source
American Journal of Cardiovascular Drugs. 14 (1) (pp 51-61), 2014. Date of
Publication: February 2014.
Publisher
Springer International Publishing AG (Gewerbestrasse 11, Cham (ZG) 6330,
Switzerland)
Abstract
Aims: The aims of this study were to evaluate the effects of
N-acetylcysteine (NAC) on cardiac remodeling and major adverse events
following acute myocardial infarction (AMI). Methods: In a prospective,
double-blind, randomized clinical trial, the effect of NAC on the serum
levels of cardiac biomarkers was compared with that of placebo in 98
patients with AMI. Also, the patients were followed up for a 1-year period
for major adverse cardiac events (MACE), including the occurrence of
recurrent myocardial infarction, death, and need for target vessel
revascularization. Results: In patients who received NAC, the serum levels
of matrix metalloproteinase (MMP)-9 and MMP-2 after 72 h were
significantly lower than those in the placebo group (p = 0.014 and p =
0.045, respectively). The length of hospitalization in patients who
received NAC was significantly shorter than that in the placebo group (p =
0.024). With respect to MACE, there was a significant difference between
those who received NAC (14 %) and those patients on placebo (25 %) (p =
0.024). Re-infarction took place in 4 % of patients in the NAC group as
compared with 16.7 % in patients who received placebo (p = 0.007).
Conclusion: NAC can be beneficial in preventing early remodeling by
reducing the level of MMP-2 and MMP-9. Moreover, NAC decreased the length
of hospital stays in patients after AMI. By decreasing MACE, NAC could
possibly be introduced as a 'magic bullet' in the pharmacotherapy of
patients with AMI. Further studies are needed to elucidate NAC's role in
this population. 2013 Springer International Publishing Switzerland.
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Accession Number
2014100054
Authors
Yu X.-Y. Wang Y. Zhong H. Dou Q.-L. Song Y.-L. Wen H.
Institution
(Yu, Wang, Zhong, Dou, Song) Department of Critical Care Medicine, First
Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
(Wen) Xinjiang Key Lab of Echinococcosis, First Affiliated Hospital of
Xinjiang Medical University, No. 1 Liyu Shan Road, Urumqi, Xinjiang,
830054, China
Title
Diagnostic value of serum procalcitonin in solid organ transplant
recipients: A systematic review and meta-analysis.
Source
Transplantation Proceedings. 46 (1) (pp 26-32), 2014. Date of Publication:
January-February 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Purpose To perform a systematic review and meta-analysis to define the
role of procalcitonin (PCT) in identifying infectious complication in
organ transplant recipients. Methods We searched EMBASE, MEDLINE, the
Cochrane database, and reference lists of relevant articles, with no
language restrictions, published from inception through May 2013. We
selected original research that reported the diagnostic performance of PCT
alone or when compared with other biomarkers to diagnose infectious
complication among organ transplant recipients. We summarized test
performance characteristics with the use of forest plots, hierarchical
summary receiver operating characteristic curves, and bivariate
random-effects models. Results We found 7 qualifying studies (studying
1226 episodes of suspected infection with 186 confirmed infectious
episodes) from 4 countries. The patients were lung, kidney, liver, and
heart transplant recipients. Bivariate pooled sensitivity, specificity,
positive likelihood ratios, and negative likelihood ratios for
identification of bacterial infections in patients after transplantation
were 85% (95% confidence interval [CI], 75%-92%), 81% (95% CI, 72%-88%),
4.41 (95% CI, 2.86-6.81), and 0.18 (95% CI, 0.10-0.33), respectively. Of
the 4 studies that reported the experience of liver transplant patients,
the pooled sensitivity, specificity, positive likelihood ratios, and
negative likelihood ratios were 90% (95% CI, 75%-97%), 85% (95% CI,
77%-91%), 6.12 (95% CI, 3.79-9.88), and 0.11 (95% CI, 0.04-0.32),
respectively. There was no evidence of significant heterogeneity.
Conclusion The existing literature suggests reasonable sensitivity and
specificity for the PCT test in identifying infection complications among
patients undergoing solid organ transplantation. Given the imperfect
sensitivity and specificity of the PCT test, medical decisions should be
based on both PCT test results and clinical findings. 2014 by Elsevier
Inc. All rights reserved.
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Accession Number
2014093641
Authors
Shah B. Sharma P. Brahmbhatt A. Shah R. Rathod B. Shastri N. Patel J.
Malhotra A.
Institution
(Shah, Sharma, Brahmbhatt, Shah, Rathod, Shastri, Patel, Malhotra) Chief
Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India
Title
Study of levosimendan during off-pump coronary artery bypass grafting in
patients with LV dysfunction: A double-blind randomized study.
Source
Indian Journal of Pharmacology. 46 (1) (pp 29-34), 2014. Date of
Publication: January-February 2014.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objectives: Levosimendan is a calcium sensitizer drug which has been used
in cardiac surgery for the prevention of postoperative low cardiac output
syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass
(CPB). This study aims to evaluate perioperative hemodynamic effects of
levosimendan pretreatment in patients for off-pump coronary artery bypass
graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF
< 30%). Materials and Methods: Fifty patients undergoing OPCABG surgery
with low LVEF (<30%) were enrolled in the study. Patients were randomly
divided in two groups: Levosimendan pretreatment (Group L) and placebo
pretreatment (Group C) of 25 each. Group L, patients received levosimendan
infusion 200 mug/kg over 24 h and in Group C Patients received placebo.
The clinical parameters measured before and after the drug administration
up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac
index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement
of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit
(ICU) stay, and hospital stay were also measured. Results: The patients in
group L exhibited higher CI and PCWP during operative in early
postoperative period as compared to control group C. Group L also had a
less requirement for inotropes, CPB support and IABP with shorter ICU stay
as well as hospital stay. Conclusion: Levosimendan pretreatment (24 h
infusion) in patient for OPCABG with poor LVEF shows better outcomes and
hemodynamics in terms of inotropes, CPB and IABP requirements. It also
reduces ICU stay.
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Accession Number
2014093133
Authors
Knobler R. Berlin G. Calzavara-Pinton P. Greinix H. Jaksch P. Laroche L.
Ludvigsson J. Quaglino P. Reinisch W. Scarisbrick J. Schwarz T. Wolf P.
Arenberger P. Assaf C. Bagot M. Barr M. Bohbot A. Bruckner-Tuderman L.
Dreno B. Enk A. French L. Gniadecki R. Gollnick H. Hertl M. Jantschitsch
C. Jung A. Just U. Klemke C.-D. Lippert U. Luger T. Papadavid E.
Pehamberger H. Ranki A. Stadler R. Sterry W. Wolf I.H. Worm M. Zic J.
Zouboulis C.C. Hillen U.
Institution
(Knobler, Just, Pehamberger) Department of Dermatology, Medical University
of Vienna, Vienna, Austria
(Berlin) Department of Clinical Immunology and Transfusion Medicine,
University Hospital, Linkoping, Sweden
(Calzavara-Pinton) Department of Dermatology, University Hospital Spedali
Civili, Brescia, Italy
(Greinix) Department of Internal Medicine I/Bone Marrow Transplantation,
Medical University of Vienna, Vienna, Austria
(Jaksch) Department of Thoracic Surgery, Medical University of Vienna,
Vienna, Austria
(Laroche) Department of Dermatology, Avicenne Hospital, Bobigny, France
(Ludvigsson) Department of Clinical and Experimental Medicine, Faculty of
Health Sciences, Linkoping University, Linkoping, Sweden
(Quaglino) Dermatology Clinic, Department of Medical Sciences, University
of Turin, Turin, Italy
(Reinisch) Department of Internal Medicine III, Division of
Gastroenterology and Hepatology, Medical University of Vienna, Vienna,
Austria
(Scarisbrick) Department of Dermatology, University Hospital, Birmingham,
United Kingdom
(Schwarz) Department of Dermatology and Allergology, University Hospital
Schleswig-Holstein, Kiel, Germany
(Wolf, Wolf) Department of Dermatology, Medical University of Graz, Graz,
Austria
(Arenberger) Department of Dermatology, Charles University in Prague,
Prague, Czech Republic
(Assaf) Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld,
Germany
(Bagot) Department of Dermatology, Saint Louis Hospital, Universite Paris
7 Sorbonne Paris Cite, Paris, France
(Barr) Department of Surgery, University of Southern California, Los
Angeles, United States
(Bohbot) Department of Haematology and Oncology, University of Strasbourg,
Strasbourg, France
(Bruckner-Tuderman) Department of Dermatology, University Medical Centre
Freiburg, Freiburg, Germany
(Dreno) Department of Skin Cancer, Nantes University Hospital, Nantes,
France
(Enk) Department of Dermatology, University of Heidelberg, Heidelberg,
Germany
(French) Department of Dermatology, Zurich University Hospital, Zurich,
Switzerland
(Gniadecki) Department of Dermatology, Bispebjerg Hospital, Copenhagen,
Denmark
(Gollnick) Department of Dermatology and Venereology, Otto-von-Guericke
University, Magdeburg, Germany
(Hertl) Department of Dermatology and Allergology, University Hospital
Marburg, Marburg, Germany
(Jantschitsch, Lippert, Zouboulis) Department of Dermatology, Venereology,
Allergology and Immunology, Dessau Medical Center, Dessau, Germany
(Jung, Klemke) Department of Dermatology, Venereology and Allergology,
University Medical Centre Mannheim, Ruprecht-Karls University of
Heidelberg, Mannheim, Germany
(Luger) Department of Dermatology, University of Munster, Munster, Germany
(Papadavid) Department of Dermatology, Athens University School of
Medicine, ATTIKON General University Hospital, Athens, Greece
(Ranki) Department of Dermatology and Allergology, University of Helsinki
and Helsinki University Central Hospital, Helsinki, Finland
(Stadler) Department of Dermatology, Johannes Wesling Medical Centre,
Minden, Germany
(Sterry) Department of Dermatology, Charite University Hospital, Berlin,
Germany
(Worm) Department of Dermatology and Allergology, Charite University
Hospital, Berlin, Germany
(Zic) Division of Dermatology, Vanderbilt University School of Medicine,
Nashville, TN, United States
(Hillen) Department of Dermatology, Venereology and Allergology,
University Duisburg-Essen, Essen, Germany
Title
Guidelines on the use of extracorporeal photopheresis.
Source
Journal of the European Academy of Dermatology and Venereology. 28 (SUPPL.
1) (pp 1-37), 2014. Date of Publication: 2014.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background After the first investigational study on the use of
extracorporeal photopheresis for the treatment of cutaneous T-cell
lymphoma was published in 1983 with its subsequent recognition by the FDA
for its refractory forms, the technology has shown significant promise in
the treatment of other severe and refractory conditions in a
multi-disciplinary setting. Among the major studied conditions are graft
versus host disease after allogeneic bone marrow transplantation, systemic
sclerosis, solid organ transplant rejection and inflammatory bowel
disease. Materials and methods In order to provide recognized expert
practical guidelines for the use of this technology for all indications
the European Dermatology Forum (EDF) proceeded to address these questions
in the hands of the recognized experts within and outside the field of
dermatology. This was done using the recognized and approved guidelines of
EDF for this task. 2013 The Authors. Journal of the European Academy of
Dermatology and Venereology.
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Accession Number
2014090253
Authors
Eskandar A.M.
Institution
(Eskandar) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Menoufiya University, Shibeen Elkoom, Egypt
Title
Effect of sildenafil in the management of preoperative pulmonary
hypertension.
Source
Alexandria Journal of Medicine. 50 (1) (pp 13-16), 2014. Date of
Publication: March 2014.
Publisher
Alexandria University (22 Sharia al-Gaish Str, Al-Shatby, Alexandria
21544, Egypt)
Abstract
Background: Pulmonary arterial hypertension (PAH) is a disabling chronic
disorder of the pulmonary vasculature, which is characterized by increased
pulmonary artery pressure (PAP) as a result of increased pulmonary
vascular resistance (PVR). The most accepted hemodynamic definition of PH
is a mean PAP >25. mmHg. It is accidentally discovered preoperatively
through performing an echocardiogram in patients suspected of having PH,
as these patients suffer from dyspnea which is the most frequently
presenting symptom. Additional symptoms include fatigue, weakness, angina,
syncope, and lower limb edema. The aim of the study was to evaluate the
efficacy and safety of preoperative oral sildenafil administration in the
management of pulmonary hypertensive patients scheduled for non-cardiac
surgery. Patients and methods: 30 Patients, (ASA II-III), suffering from
pulmonary hypertension and scheduled for non-cardiac surgery were randomly
assigned to one of two groups. Group I received 25. mg sildenafil twice
daily for one week before surgery. Group II received placebo in the same
way. PAP, LVEF and RVEF (through echocardiogram), heart rate, mean
arterial blood pressure, SpO2 (oxygen saturation), functional class and
6-min walk distance were measured and recorded at baseline and one week
after treatment in both groups. Results: Sildenafil significantly reduced
PAP and improved exercise tolerance, functional class, 6-min walk distance
and SpO2 without significant alteration of heart rate and mean arterial
blood pressure. Conclusion: The study showed effective and safe
administration of preoperative oral sildenafil in the management of
pulmonary hypertensive patients scheduled for non-cardiac surgery. 2014.
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Accession Number
2014084292
Authors
Peng L. Xu L. Ouyang W.
Institution
(Peng, Ouyang) Department of Anesthesiology, Third Xiangya Hospital of
Central South University, Changsha, China
(Xu) Department of Gastrointestinal Surgery, First Xiangya Hospital of
Central South University, Changsha, China
Title
Role of peripheral inflammatory markers in Postoperative Cognitive
Dysfunction (POCD): A meta-analysis.
Source
PLoS ONE. 8 (11) , 2013. Article Number: e79624. Date of Publication: 13
Nov 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is common following
cardiac and non-cardiac surgery, but the pathogenic mechanisms remain
unknown. Many studies suggest that an inflammatory response is a key
contributor to POCD. The current meta-analysis shows that the levels of
peripheral inflammatory markers are associated with POCD. Methods: An
online search was performed to identify peer-reviewed studies without
language restriction that measured peripheral inflammatory markers of
patients with and without POCD, using PubMed, ScienceDirect, SinoMed and
the National Knowledge Infrastructure database. Extracted data were
analyzed with STATA (version 12).The standardized mean difference (SMD)
and the 95% confidence interval (95%CI) were calculated for each outcome
using a random effect model. Tests of heterogeneity assessment of bias,
and meta-regression were performed in the meta-analysis. Results: A total
of 13 studies that measured the concentrations of peripheral inflammatory
markers were included. The current meta-analysis found significantly
higher concentrations of S-100beta(SMD[95%CI]) (1.377 [0.423, 2.331],
p-value < 0.001, N [POCD/non-POCD] =178/391, 7 studies), and
interleukin(IL)-6 (SMD[95%CI]) (1.614 [0.603,2.624], p-value < 0.001,
N[POCD/non-POCD] = 91/99, 5 studies), but not of neuron specific enolase,
interleukin-1beta, or tumor necrosis factor-alpha, in POCD compared with
patients without POCD. In meta-regression analyses, a significant positive
association was found between the SMD and the preoperative interleukin-6
peripheral blood concentration in patients with POCD (Coef.= 0.0587,
p-value=0.038, 5 studies). Conclusions: This study shows that POCD is
indeed correlated with the concentrations of peripheral inflammatory
markers, particularly interleukin-6 and S-100beta. 2013 Peng et al.
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Accession Number
2014088408
Authors
Dussaussoy C. Peres M. Jaoul V. Liu N. Chazot T. Picquet J. Fischler M.
Beydon L.
Institution
(Dussaussoy, Peres, Jaoul, Beydon) Pole d'Anesthesie Reanimation, CHU
d'Angers, 49933 Angers Cedex 9, France
(Picquet) Service de Chirurgie Vasculaire et Thoracique, CHU d'Angers,
49933 Angers Cedex 9, France
(Liu, Chazot, Fischler) Service d'Anesthesie, Hopital Foch, 40 rue Worth,
92150 Suresnes, France
(Liu) Outcomes Research Consortium, Cleveland, OH, United States
Title
Automated titration of propofol and remifentanil decreases the
anesthesiologist's workload during vascular or thoracic surgery: A
randomized prospective study.
Source
Journal of Clinical Monitoring and Computing. 28 (1) (pp 35-40), 2014.
Date of Publication: February 2014.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Closed loop target-control infusion systems using a Bispectral (BIS)
signal as an input (TCI Loop) can automatically maintain intravenous
anesthesia in a BIS range of 40-60 %. Our purpose was to assess to what
extent such a system could decrease anesthesia workload in comparison to
the use of a stand alone TCI system manually adjusted to fit the same BIS
range of 40-60 % (TCI Manual). Patients scheduled for elective vascular or
thoracic surgery were randomized to the TCI Loop or TCI Manual method for
administering propofol and remifentanil during both induction and
maintenance of general anesthesia. Assessment of workload was performed by
an independent observer who quoted each time the physician looked at the
BIS monitor. The number of propofol and remifentanil target modifications,
the percentage of time of adequate anesthesia i.e. BIS in the range 40-60
and hemodynamic data were recorded. Eighteen patients per group were
enrolled. Characteristics, duration of surgery and propofol-remifentanil
consumption were similar between groups. However, the percentage of time
in the BIS range 40-60 % was higher in the TCI Loop versus TCI Manual
groups (94 % + 12 vs. 74 % + 19, p < 0.001). Mean arterial pressure was
lower with TCI Manual (78 + 6 vs. 88 + 13 mmHg, p < 0.001). The number of
times the anesthesiologist watched the controller or BIS monitor (p <
0.05) and the number of manual adjustments (p < 0.001) performed in each
group was lower with TCI Loop group during induction and maintenance of
anesthesia. An automated controller strikingly frees the anesthesiologist
from manual intervention to adjust drug delivery. 2013 Springer
Science+Business Media New York.
<9>
Accession Number
2014079756
Authors
Palmerini T. Biondi-Zoccai G. Della Riva D. Mariani A. Sabate M. Smits
P.C. Kaiser C. D'Ascenzo F. Frati G. Mancone M. Genereux P. Stone G.W.
Institution
(Palmerini, Della Riva, Mariani) Dipartimento Cardiovascolare, Policlinico
Sant' Orsola, Bologna, Italy
(Biondi-Zoccai, Frati, Mancone) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Sabate) Hospital Clinic, Barcelona, Spain
(Smits) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Kaiser) University Hospital Basel, Basel, Switzerland
(D'Ascenzo) Division of Cardiology, Department of Internal Medicine,
University of Turin, Turin, Italy
(Frati) Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (IS),
Italy
(Genereux, Stone) Columbia University Medical Center, New York
Presbyterian Hospital, Cardiovascular Research Foundation, 111 East 59th
Street, New York, NY 10022, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, Canada
Title
Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based
drug-eluting and bare-metal stents: Evidence from a comprehensive network
meta-analysis.
Source
Journal of the American College of Cardiology. 63 (4) (pp 299-307), 2014.
Date of Publication: 04 Feb 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to investigate the relative safety and
efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES)
versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal
stents (BMS) by means of a network meta-analysis. Background Studies have
suggested that BP-BES might reduce the risk of stent thrombosis (ST) and
late adverse outcomes compared with first-generation DES. However, the
relative safety and efficacy of BP-BES versus newer-generation DES coated
with more biocompatible DP have not been investigated in depth. Methods
Randomized controlled trials comparing BP-BES versus currently
U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and
Cochrane databases. Information on study design, inclusion and exclusion
criteria, sample characteristics, and clinical outcomes was extracted.
Results Data from 89 trials including 85,490 patients were analyzed. At
1-year follow-up, BP-BES were associated with lower rates of cardiac
death/myocardial infarction (MI), MI, and target vessel revascularization
(TVR) than BMS and lower rates of TVR than fast-release
zotarolimus-eluting stents. The BP-BES had similar rates of cardiac
death/MI, MI, and TVR compared with other second-generation DP-DES but
higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents
(CoCr-EES). The BP-BES were associated with improved late outcomes
compared with BMS and paclitaxel-eluting stents, considering the latest
follow-up data available, with nonsignificantly different outcomes
compared with other DP-DES although higher rates of definite ST compared
with CoCr-EES. Conclusions In this large-scale network meta-analysis,
BP-BES were associated with superior clinical outcomes compared with BMS
and first-generation DES and similar rates of cardiac death/MI, MI, and
TVR compared with second-generation DP-DES but higher rates of definite ST
than CoCr-EES. 2014 by the American College of Cardiology Foundation.
<10>
Accession Number
2014091351
Authors
Gerbaud E. Montaudon M. Chasseriaud W. Gilbert S. Cochet H. Pucheu Y.
Horovitz A. Bonnet J. Douard H. Coste P.
Institution
(Gerbaud, Chasseriaud, Coste) Soins Intensifs Cardiologiques - Plateau de
Cardiologie Interventionnelle, Hopital Haut-Leveque, 5, avenue de
Magellan, 33600 Pessac, France
(Montaudon, Cochet) Unite d'Imagerie Thoracique, CHU de Bordeaux, Pessac,
France
(Pucheu, Horovitz, Bonnet, Douard) Service de Cardiologie, CHU de
Bordeaux, Pessac, France
(Gerbaud, Montaudon, Gilbert, Cochet, Bonnet, Douard, Coste) Institut de
Rythmologie et de Modelisation Cardiaque LIRYC, CHU/universite de
Bordeaux/Inserm U1045, Pessac, France
Title
Effect of ivabradine on left ventricular remodelling after reperfused
myocardial infarction: A pilot study.
Source
Archives of Cardiovascular Diseases. 107 (1) (pp 33-41), 2014. Date of
Publication: January 2014.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Heart rate is a major determinant of myocardial oxygen demand;
in ST-segment elevation myocardial infarction (STEMI), patients treated
with primary percutaneous intervention (PPCI), heart rate at discharge
correlates with mortality. Ivabradine is a pure heart rate-reducing agent
that has no effect on blood pressure and contractility, and can reverse
left ventricular (LV) remodelling in patients with heart failure. Aims To
evaluate whether ivabradine, when added to current guideline-based
therapy, improves LV remodelling in STEMI patients treated with PPCI.
Methods This paired-cohort study included 124 patients between June 2011
and July 2012. Ivabradine (5 mg twice daily) was given promptly after
PPCI, along with beta-blockers, to obtain a heart rate < 60 beats per
minute (ivabradine group). This group was matched with STEMI patients
treated in line with current guidelines, including beta-blockers
(bisoprolol), according to age, sex, infarct-related coronary artery,
ischaemia time and infarct size determined by initial cardiac magnetic
resonance imaging (CMR) (control group). Statistical analyses were
performed according to an intention-to-continue treatment principle. CMR
data at 3 months were available for 122 patients. Results Heart rate was
lower in the ivabradine group than in the control group during the initial
CMR (P = 0.02) and the follow-up CMR (P = 0.006). At the follow-up CMR,
there was a smaller increase in LV end-diastolic volume index in the
ivabradine group than in the control group (P = 0.04). LV end-systolic
volume index remained unchanged in the ivabradine group, but increased in
the control group (P = 0.01). There was a significant improvement in LV
ejection fraction in the ivabradine group compared with in the control
group (P = 0.04). Conclusions In successfully reperfused STEMI patients,
ivabradine may improve LV remodelling when added to current
guideline-based therapy. 2012 Elsevier Masson SAS. All rights reserved.
<11>
Accession Number
2014092388
Authors
Pisters R. Hohnloser S.H. Connolly S.J. Torp-Pedersen C. Naditch-Brule L.
Page R.L. Crijns H.J.G.M.
Institution
(Pisters, Crijns) Department of Cardiology, Maastricht University Medical
Centre, PO Box 5800, 6202 AZ, Maastricht, Netherlands
(Hohnloser) Department of Cardiology, J. W. Goethe University Hospital,
Frankfurt, Germany
(Connolly) McMaster University, Population Health Research Institute,
Hamilton, ON, Canada
(Torp-Pedersen) Institute of Health, Science and Technology, Aalborg
University, Aalborg Ost, Denmark
(Page) University of Washington, SE, United States
Title
Effect of dronedarone on clinical end points in patients with atrial
fibrillation and coronary heart disease: Insights from the ATHENA trial.
Source
Europace. 16 (2) (pp 174-181), 2014. Date of Publication: February 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims This study aimed to assess safety and cardiovascular outcomes of
dronedarone in patients with paroxysmal or persistent atrial fibrillation
(AF) with coronary heart disease (CHD). Coronary heart disease is
prevalent among AF patients and limits antiarrhythmic drug use because of
their potentially life-threatening ventricular proarrhythmic effects.
Methods and Results This post hoc analysis evaluated 1405 patients with
paroxysmal or persistent AF and CHD from the ATHENA trial. Follow-up
lasted 2.5 years, during which patients received either dronedarone (400
mg twice daily) or a double-blind matching placebo. Primary outcome was
time to first cardiovascular hospitalization or death due to any cause.
Secondary end points included first hospitalization due to cardiovascular
events. The primary outcome occurred in 350 of 737 (47%) placebo patients
vs. 252 of 668 (38%) dronedarone patients [hazard ratio (HR) = 0.73; 95%
confidence interval (CI) = 0.62-0.86; P = 0.0002] without a significant
increase in number of adverse events. In addition, 42 of 668 patients
receiving dronedarone suffered from a first acute coronary syndrome
compared with 67 of 737 patients from the placebo group (HR = 0.67; 95% CI
= 0.46-0.99; P = 0.04). Conclusion In this post hoc analysis, dronedarone
on top of standard care in AF patients with CHD reduced cardiovascular
hospitalization or death similar to that in the overall ATHENA population,
and reduced a first acute coronary syndrome. Importantly, the safety
profile in this subpopulation was also similar to that of the overall
ATHENA population, with no excess in proarrhythmias. The mechanism of the
cardiovascular protective effects is unclear and warrants further
investigation. 2013 The Author 2013. Published by Oxford University
Press on behalf of the European Society of Cardiology.
<12>
Accession Number
2014099644
Authors
Stergiopoulos K. Boden W.E. Hartigan P. Mobius-Winkler S. Hambrecht R.
Hueb W. Hardison R.M. Abbott J.D. Brown D.L.
Institution
(Stergiopoulos, Brown) Department of Medicine, State University of New
York-Stony Brook, School of Medicine, Stony Brook, NY 11794, United States
(Boden) Samuel S Stratton VA Medical Center, Albany Medical Center,
Albany, NY, United States
(Hartigan) VA Cooperative Studies Program Coordinating Center, VA
Connecticut Healthcare System, West Haven, United States
(Mobius-Winkler) Universitat Leipzig, Leipzig, Germany
(Hambrecht) Klinikum, Links derWeser GmbH, Chefarzt Klinik fur Kardiologie
und Angiologie, Bremen, Germany
(Hueb) Heart Institute of the University of Sao Paolo, Sao Paolo, Brazil
(Hardison) Department of Epidemiology, University of Pittsburgh, Graduate
School of Public Health, Pittsburgh, Pennsylvania, United States
(Abbott) Warren Alpert Brown University, School of Medicine, Providence,
Rhode Island, United States
Title
Percutaneous coronary intervention outcomes in patients with stable
obstructive coronary artery disease and myocardial ischemia : A
collaborativemeta-analysis of contemporary randomized clinical trials.
Source
JAMA Internal Medicine. 174 (2) (pp 232-240), 2014. Date of Publication:
February 2014.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE Myocardial ischemia in patients with stable coronary artery
disease (CAD) has been repeatedly associated with impaired survival.
However, it is unclear if revascularization with percutaneous coronary
intervention (PCI) to relieve ischemia improves outcomes compared with
medical therapy (MT). OBJECTIVE The objective of this study was to compare
the effect of PCI and MT with MT alone exclusively in patients with stable
CAD and objectively documented myocardial ischemia on clinical outcomes.
DATA SOURCES MEDLINE, Cochrane, and PubMed databases from 1970 to November
2012. Unpublished data were obtained from investigators. STUDY SELECTION
Randomized clinical trials of PCI and MT vs MT alone for stable coronary
artery disease in which stents and statins were used in more than 50% of
patients. DATA EXTRACTION For studies in which myocardial ischemia
diagnosed by stress testing or fractional flow reserve was required for
enrollment, descriptive and quantitative data were extracted from the
published report. For studies in which myocardial ischemia was not a
requirement for enrollment, authors provided data for only those patients
with ischemia determined by stress testing prior to randomization. The
outcomes analyzed included death from any cause, nonfatal myocardial
infarction (MI), unplanned revascularization, and angina. Summary odds
ratios (ORs) were obtained using a random-effects model. Heterogeneity was
assessed using the Q statistic and I2. RESULTS In 5 trials enrolling 5286
patients, myocardial ischemia was diagnosed in 4064 patients by exercise
stress testing, nuclear or echocardiographic stress imaging, or fractional
flow reserve. Follow-up ranged from 231 days to 5 years (median, 5 years).
The respective event rates for PCI with MT vs MT alone for death were
6.5%and 7.3%(OR, 0.90 [95%CI, 0.71-1.16); for nonfatal MI, 9.2%and
7.6%(OR, 1.24 [95%CI, 0.99-1.56]); for unplanned revascularization,
18.3%and 28.4%(OR, 0.64 [95%CI, 0.35-1.17); and for angina, 20.3%and
23.3%(OR, 0.91 [95%CI, 0.57-1.44]). CONCLUSIONS AND RELEVANCE In patients
with stable CAD and objectively documented myocardial ischemia, PCI with
MT was not associated with a reduction in death, nonfatal MI, unplanned
revascularization, or angina compared with MT alone. Copyright 2014
American Medical Association. All rights reserved.
<13>
Accession Number
2014099643
Authors
Sipahi I. Akay M.H. Dagdelen S. Blitz A. Alhan C.
Institution
(Sipahi, Dagdelen) Department of Cardiology, Acibadem University Medical
School, Buyukdere Cad 40, 34457 Istanbul, Turkey
(Sipahi, Blitz) University Hospitals Case Medical Center, Case Western
Reserve University, School of Medicine, Cleveland, Ohio, United States
(Akay, Alhan) Department of Cardiovascular Surgery, Acibadem University
Medical School, Istanbul, Turkey
Title
Coronary artery bypass grafting vs percutaneous coronary intervention and
long-term mortality and morbidity in multivessel disease : Meta-analysis
of randomized clinical trials of the arterial grafting and stenting ERA.
Source
JAMA Internal Medicine. 174 (2) (pp 223-230), 2014. Date of Publication:
February 2014.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE Recent trials of percutaneous coronary intervention (PCI) vs
coronary artery bypass grafting (CABG) for multivessel disease were not
designed to detect a difference in mortality and therefore were
underpowered for this outcome. Consequently, the comparative effects of
these 2 revascularization methods on long-term mortality are still
unclear. In the absence of solid evidence for mortality difference, PCI is
oftentimes preferred over CABG in these patients, given its less invasive
nature. OBJECTIVES To determine the comparative effects of CABG vs PCI on
long-term mortality and morbidity by performing ameta-analysis of all
randomized clinical trials of the current era that compared the 2
treatment techniques in patients with multivessel disease. DATA SOURCES A
systematic literature search was conducted for all randomized clinical
trials directly comparing CABG with PCI. STUDY SELECTION To reflect
current practice, we included randomized trials with 1 or more arterial
grafts used in at least 90%, and 1 or more stents used in at least 70% of
the cases that reported outcomes in patients with multivessel disease.
DATA EXTRACTION Numbers of events at the longest possible follow-up and
sample sizes were extracted. DATA SYNTHESIS A total of 6 randomized trials
enrolling a total of 6055 patients were included, with a weighted average
follow-up of 4.1 years. There was a significant reduction in total
mortality with CABG compared with PCI (I2 = 0%; risk ratio [RR], 0.73
[95%CI, 0.62-0.86]) (P < .001). There were also significant reductions in
myocardial infarction (I2 = 8.02%; RR, 0.58 [95%CI, 0.48-0.72]) (P < .001)
and repeat revascularization (I2 = 75.6%; RR, 0.29 [95%CI, 0.21-0.41]) (P
< .001) with CABG. There was a trend toward excess strokes with CABG (I2 =
24.9%; RR, 1.36 [95%CI, 0.99-1.86]), but this was not statistically
significant (P = .06). For reduction in total mortality, there was no
heterogeneity between trials that were limited to and not limited to
patients with diabetes or whether stents were drug eluting or not. Owing
to lack of individual patient-level data, additional subgroup analyses
could not be performed. CONCLUSIONS AND RELEVANCE In patients with
multivessel coronary disease, compared with PCI, CABG leads to an
unequivocal reduction in long-term mortality and myocardial infarctions
and to reductions in repeat revascularizations, regardless of whether
patients are diabetic or not. These findings have implications for
management of such patients. Copyright 2014 American Medical Association.
All rights reserved.
<14>
Accession Number
2014099636
Authors
Ho P.M. Lambert-Kerzner A. Carey E.P. Fahdi I.E. Bryson C.L. Dee Melnyk S.
Bosworth H.B. Radcliff T. Davis R. Mun H. Weaver J. Barnett C. Baron A.
Del Giacco E.J.
Institution
(Ho, Lambert-Kerzner, Carey, Davis, Baron) Department of Medicine, Denver
VA Medical Center, 1055 Clermont St (111B), Denver, CO 80220, United
States
(Ho) Department of Medicine, University of Colorado, Denver, United States
(Ho) Colorado Cardiovascular Outcomes Research Group, Denver, United
States
(Carey, Baron) Department of Biostatistics and Informatics, Colorado
School of Public Health, University of Colorado, Aurora, United States
(Fahdi, Weaver, Barnett, Del Giacco) John L. McClellan Memorial Veterans
Hospital, Little Rock, Arkansas, United States
(Bryson, Mun) VA Puget Sound Health Care System, Seattle, WA, United
States
(Dee Melnyk, Bosworth) Center for Health Services Research in Primary
Care, Durham Veterans Affairs Medical Center, Durham, NC, United States
(Bosworth) School of Nursing, Duke University, Durham, NC, United States
(Bosworth) Division of General Internal Medicine, Department of Medicine,
Duke University, Durham, NC, United States
(Bosworth) Department of Psychiatry and Behavioral Sciences, Duke
University, Durham, North Carolina, United States
(Radcliff) Department of Health Policy and Management, Texas A and M
School of Rural Public Health, College Station, United States
Title
Multifaceted intervention to improve medication adherence and secondary
prevention measures after acute coronary syndrome hospital discharge : A
randomized clinical trial.
Source
JAMA Internal Medicine. 174 (2) (pp 186-193), 2014. Date of Publication:
February 2014.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE Adherence to cardioprotective medication regimens in the year
after hospitalization for acute coronary syndrome (ACS) is poor. OBJECTIVE
To test a multifaceted intervention to improve adherence to cardiac
medications. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical
trial, 253 patients from 4 Department of Veterans Affairs medical centers
located in Denver (Colorado), Seattle (Washington); Durham (North
Carolina), and Little Rock (Arkansas) admitted with ACS were randomized to
the multifaceted intervention (INT) or usual care (UC) prior to discharge.
INTERVENTIONS The INT lasted for 1 year following discharge and comprised
(1) pharmacist-led medication reconciliation and tailoring; (2) patient
education; (3) collaborative care between pharmacist and a patient's
primary care clinician and/or cardiologist; and (4) 2 types of voice
messaging (educational and medication refill reminder calls). MAIN
OUTCOMES AND MEASURES The primary outcome of interestwas proportion of
patients adherent to medication regimens based on a mean proportion of
days covered (PDC) greater than 0.80 in the year after hospital discharge
using pharmacy refill data for 4 cardioprotective medications
(clopidogrel, beta-blockers, 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitors [statins], and angiotensin-converting enzyme
inhibitors or angiotensin receptor blockers [ACEI/ARB]). Secondary
outcomes included achievement of blood pressure (BP) and low-density
lipoprotein cholesterol (LDL-C) level targets. RESULTS Of 253 patients,
241 (95.3%) completed the study (122 in INT and 119 in UC). In the INT
group, 89.3%of patients were adherent compared with 73.9%in the UC group
(P = .003). Mean PDC was higher in the INT group (0.94 vs 0.87; P< .001).
A greater proportion of intervention patients were adherent to clopidogrel
(86.8%vs 70.7%; P = .03), statins (93.2%vs 71.3%; P < .001), and ACEI/ARB
(93.1% vs 81.7%; P = .03) but not beta-blockers (88.1%vs 84.8%; P = .59).
There were no statistically significant differences in the proportion of
patients who achieved BP and LDL-C level goals. CONCLUSIONS AND RELEVANCE
A multifaceted intervention comprising pharmacist-led medication
reconciliation and tailoring, patient education, collaborative care
between pharmacist and patients' primary care clinician and/or
cardiologist, and voice messaging increased adherence to medication
regimens in the year after ACS hospital discharge without improving BP and
LDL-C levels. Understanding the impact of such improvement in adherence on
clinical outcomes is needed prior to broader dissemination of the program.
Copyright 2014 American Medical Association. All rights reserved.
<15>
Accession Number
2014091436
Authors
Hu Z.-P. Wang Z.-W. Dai X.-F. Zhan B.-T. Ren W. Li L.-C. Zhang H. Ren
Z.-L.
Institution
(Hu, Wang, Dai, Ren, Li, Zhang, Ren) Department of Cardiothoracic Surgery,
Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, Hubei Province
430060, China
(Hu, Zhan) Department of Cardiothoracic Surgery, Xiangyang Central
Hospital, Xiangyang, China
Title
Outcomes of surgical versus balloon angioplasty treatment for native
coarctation of the aorta: A meta-analysis.
Source
Annals of Vascular Surgery. 28 (2) (pp 394-403), 2014. Date of
Publication: February 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background Native coarctation of the aorta (COA) accounts for 5-7% of
congenital heart disease. Open surgical treatment was the only choice
until balloon angioplasty (BA) treatment was introduced as an alternative
therapy for COA in the 1980s. BA treatment was thought to be a less
invasive and potentially safer technique, and has been used on numerous
patients. But as has been reported during the past 30 years, the risk of
aneurysm formation and recoarctation existed in either of those 2
procedures. Unfortunately, follow-up for either type of treatment has been
limited, making it difficult to draw any meaningful conclusions as to
which treatment option is superior. Our objective was to compare results
of 2 therapeutic modalities to treat native COA: BA without stent
implantation and surgery. Methods We performed a meta-analysis of
controlled trials of surgical versus BA treatment for native COA. MEDLINE,
EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of
Science, and the Chinese Biomedical Database of clinical trials were
searched using PubMed and OVID. Controlled trials in which patients with
COA were assigned to surgical repair or BA treatment were included. For
each outcome, we evaluated the quality of the evidence with reference to
the Grading of Recommendations Assessments, Development, and Evaluation
criteria. We used RevMan 5.1 software (The Nordic Cochrane Centre,
Copenhagen, Denmark) to analyze the data. Results A literature search
yielded 9 comparable studies, for a total of 623 patients, of whom 378 and
245 were assigned to surgery and BA. Meta-analysis of these studies showed
no significant difference in postintervention gradient (inverse variance
fixed mean difference: 1.44 [95% CI: -1.16 to 4.04]), midterm
recoarctation (Mantel-Haenszel [M-H] random odds ratio [OR]: 0.24 [95% CI:
0.04-1.58]), and long-term recoarctation (M-H fixed OR: 0.61 [95% CI:
0.34-1.11]). BA reduces the risk of severe complications (M-H fixed OR:
2.67 [95% CI: 1.37-5.21]; P < 0.001) but increases the risk of short-term
recoarctation (M-H fixed OR: 0.25 [95% CI]: 0.12-0.54]; P < 0.001) and
aortic aneurysm formation (M-H fixed OR: 0.12 [95% CI]: 0.04-0.34]; P <
0.001). Conclusions BA provides immediate results comparable to surgery
and reduces invasion, but it does not provide better results compared with
surgery when considering medium- and long-term complications and even
increases the incidence of aneurysm formation. 2014 Elsevier Inc. All
rights reserved.
<16>
Accession Number
2014068739
Authors
Kumar P. Joshi V.S. Madhu P.V.
Institution
(Kumar, Joshi) Military Hospital (CTC), Pune 40, India
(Madhu) Command Hospital Air Force, Bengaluru, India
Title
Diagnostic pediatric cardiac catheterization: Experience of a tertiary
care pediatric cardiac centre.
Source
Medical Journal Armed Forces India. 70 (1) (pp 10-16), 2014. Date of
Publication: January 2014.
Publisher
Medical Journal Armed Forces India (Pune411040India)
Abstract
Background: Cardiac catheterization was considered gold standard for
confirmation of diagnosis and analyzing various management issues in
congenital heart diseases. In spite of development of various non invasive
tools for investigation of cardiac disorders diagnostic catheterization
still holds an important place in pediatric patients. Methods: 300
consecutive diagnostic cardiac catheterization performed since April 2007
were included in this study. The study was undertaken to evaluate the
profile of patients undergoing diagnostic cardiac catheterization, its
results, assess its safety and its contribution toward solving various
management issues. Result & Conclusion: Children who underwent cardiac
catheterization ranged in weight from 1.6 kg to 35 kg, with their age
range 0 daye12 years. The information obtained was of great importance for
further management in over 90% cases. The procedure of cardiac cath is
invasive, still it was proved to be quite safe even in smallest baby.
2013, Armed Forces Medical Services (AFMS). All rights reserved.
<17>
Accession Number
2014090374
Authors
Earley A. Persson R. Garlitski A.C. Balk E.M. Uhlig K.
Institution
(Earley, Persson, Balk) Tufts Medical Center, 800 Washington Street, Box
61, Boston, MA 02111, United States
(Garlitski) Tufts Medical Center, 800 Washington Street, Box 197, Boston,
MA 02111, United States
(Uhlig) Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA
02111, United States
Title
Effectiveness of implantable cardioverter defibrillators for primary
prevention of sudden cardiac death in subgroups: A systematic review.
Source
Annals of Internal Medicine. 160 (2) (pp 111-121), 2014. Date of
Publication: 21 Jan 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Previous systematic reviews of implantable cardioverter
defibrillators (ICDs) used for primary prevention of sudden cardiac death
(SCD) concluded that ICDs are less effective in women and the elderly.
Purpose: To examine ICD effectiveness for primary prevention of SCD across
subgroups by sex, age, New York Heart Association class, left ventricular
ejection fraction, heart failure, left bundle branch block, QRS interval,
time since myocardial infarction, blood urea nitrogen level, and diabetes.
Data Sources: MEDLINE and the Cochrane Central Register of Controlled
Trials through 3 September 2013 with no language restriction. Study
Selection: Researchers screened articles for studies comparing ICD versus
no ICD for primary prevention. Data Extraction: Data were extracted about
study design, patients, interventions, mortality and SCD outcomes,
subgroup characteristics, and subgroup effects. Quality of subgroup
analyses was determined by consensus. Relative odds ratios comparing
subgroup effects were calculated, and random-effects model meta-analyses
were conducted on these ratios. Data Synthesis: Meta-analysis of 14
studies showed a decrease in deaths and SCDs due to ICD treatment. Ten
studies provided subgroup analyses. Nine studies compared ICD versus no
ICD, whereas one compared cardiac resynchronization therapy plus a
defibrillator versus no ICD. Within-study interaction tests and
across-study meta-analyses yielded weak evidence that did not show
differences for all-cause mortality in subgroups by sex, age, and QRS
interval. The evidence was indeterminate for other evaluated subgroups
because of a paucity of data. Limitation: Many subgroup analyses were
underpowered, which may have resulted in false-negative findings.
Conclusion: Weak evidence fails to show differences for all-cause
mortality in subgroups of sex, age, and QRS interval. Evidence is
indeterminate for all-cause mortality in the other subgroups and for SCD.
Primary Funding Source: Agency for Healthcare Research and Quality.
Copyright 2014 American College of Physicians. All Rights Reserved.
<18>
Accession Number
2014063936
Authors
Bogachev-Prokophiev A. Zheleznev S. Pivkin A. Pokushalov E. Romanov A.
Nazarov V. Karaskov A.
Institution
(Bogachev-Prokophiev, Zheleznev, Pivkin, Karaskov) Heart Valves Surgery
Department, State Research Institute of Circulation Pathology,
Rechkunovskaya 15, 630055 Novosibirsk 55, Russian Federation
(Pokushalov, Romanov, Nazarov) Arrhythmia Department and Electrophysiology
Laboratory, State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
Title
Assessment of concomitant paroxysmal atrial fibrillation ablation in
mitral valve surgery patients based on continuous monitoring: Does a
different lesion set matter?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (2) (pp 177-182),
2014. Date of Publication: February 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESThe efficacy of concomitant ablation techniques in patients with
paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery
remains under debate. The aim of this prospective, randomized,
single-centre study was to compare pulmonary vein isolation (PVI) only
versus a left atrial maze (LAM) procedure in patients with paroxysmal AF
during mitral valve surgery.METHODSBetween February 2009 and June 2011, 52
patients with a mean age of 54.2 (standard deviation 7.2 years) underwent
mitral valve surgery and concomitant bipolar radiofrequency ablation for
paroxysmal AF. Patients were randomized into the PVI group (n = 27) and
the LAM group (n = 25). After surgery, an implantable loop recorder for
continuous electrocardiography (ECG) monitoring was implanted. Patients
with an AF burden (AF%) of <0.5% were considered AF free (responders). The
mean follow-up was 18.6 months (standard deviation 2.1 months), and the
patient' data were evaluated every 3 months.RESULTSAll patients were alive
at discharge. No procedure-related complications occurred for either the
ablation or the loop recorder implantation. Mean aortic clamping and
ablation times were significantly longer in the LAM group than in the PVI
group. The incidence of early AF paroxysm recurrence was significantly
higher in the PVI group than in the LAM group (62.9 vs 24.0%, P < 0.001).
At 20 months after surgery, 15 (55.6%) of the 27 patients in the PVI group
and 22 (88.0%) of the 25 patients in the LAM group had no documented
atrial arrhythmias and were considered responders (AF burden <0.5%). The
mean AF burden during all follow-up periods was significantly lower in the
LAM group (23.6 + 8.7%) than in the PVI group (6.8 + 2.2%) (P <
0.001).CONCLUSIONSAccording to continuous ECG monitoring data, freedom
from AF was significantly higher after the concomitant LAM procedure than
after PVI in patients with paroxysmal AF who underwent mitral valve
surgery. 2013 The Author.
<19>
Accession Number
2014082927
Authors
Erturk E. Topaloglu S. Dohman D. Kutanis D. Besir A. Demirci Y. Kayir S.
Mentese A.
Institution
(Erturk, Topaloglu, Dohman, Kutanis, Besir, Demirci, Kayir) Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz
Technical University, 61080 Trabzon, Turkey
(Mentese) Department of Biochemistry, Faculty of Medicine, Karadeniz
Technical University, 61080 Trabzon, Turkey
Title
The comparison of the effects of sevoflurane inhalation anesthesia and
intravenous propofol anesthesia on oxidative stress in one lung
ventilation.
Source
BioMed Research International. 2014 , 2014. Article Number: 360936. Date
of Publication: 2014.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. The aim of this study is to compare the effects of sevoflurane
and propofol on one lung ventilation (OLV) induced ischemia-reperfusion
injury (IRI) by determining the blood gas, ischemia-modified albumin
(IMA), and malonyldialdehyde (MDA). Material and Methods. Forty-four
patients undergoing thoracic surgery with OLV were randomized in two
groups (sevoflurane Group S, propofol Group P). Anesthesia was inducted
with thiopental and was maintained with 1-2.5% of sevoflurane within the
40/60% of ON mixture in Group S. In Group P anesthesia was inducted with
propofol and was maintained with infusion of propofol and remifentanil.
Hemodynamic records and blood samples were obtained before anesthesia
induction (t 1), 1 min before two lung ventilation (t 2), 30 min after two
lung ventilation (t 3), and postoperative sixth hours (t 4). Results.
Heart rate at t 2 and t 3 in Group P was significantly lower than that in
Group S. While there were no significant differences in terms of pH and
pCO pOat t 2 and t 3 in Group S was significantly lower than that in Group
P. IMA levels at t 4 in Group S were significantly lower than those in
Group P. Conclusion. Sevoflurane may offer protection against IRI after
OLV in thoracic surgery. 2014 Engin Erturk et al.
<20>
Accession Number
2014085595
Authors
Santoro F. Di Biase L. Santangeli P. Ieva R. Burkhardt J.D. Natale A.
Institution
(Santoro, Di Biase, Santangeli, Ieva) Department of Cardiology, University
of Foggia, viale L Pinto, 1, 71100, Foggia, Italy
(Di Biase, Santangeli, Burkhardt, Natale) Texas Cardiac Arrhythmia
Institute, Heart and Vascular Department, St. David's Medical Center, 3000
N. IH 35 Suite 720, 78705, Austin, TX, United States
(Di Biase) Division of Cardiology and Montefiore-Einstein Center for Heart
and Vascular Care, Montefiore Medical Center, Albert Einstein College of
Medicine, 111 East 210th Street, 10467, Bronx, NY, United States
(Di Biase, Natale) Department of Biomedical Engineering, Cockrell School
of Engineering, The University of Texas at Austin, 107 W. Dean Keeton, BME
Building, 78712, Austin, TX, United States
(Natale) EP Services, California Pacific Medical Center, 2100 Webster
Street, 94115, San Francisco, CA, United States
(Natale) Division of Cardiology, Stanford Arrhythmia Service, Stanford
University, 300 Pasteur Drive, 94305, Stanford, CA, United States
(Natale) Division of Cardiovascular Medicine, Case Western Reserve
University, University Hospitals of Cleveland, 11100 Euclid Avenue,
44106-5038 Cleveland, OH, United States
(Natale) Interventional Electrophysiology, Department of Cardiology,
Scripps Clinic, 10666 N Torrey Pines Road, 92037, La Jolla, CA, United
States
Title
The role of cardiac imaging in stroke prevention.
Source
Cardiac Electrophysiology Clinics. 6 (1) (pp 17-29), 2014. Date of
Publication: March 2014.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
This article reviews the role of cardiac imaging in stroke prevention,
defining how imaging tools can be useful in this field. Cardioembolic
sources during atrial fibrillation are discussed. New closure devices can
be implanted in the left atrial appendage and routinely monitored with
imaging modalities. Acute and chronic left ventricular dysfunction is
reviewed, identifying the possible mechanism of thrombus formation and its
early detection. Valvular evaluation of native heart disease and possible
implications for stroke risk are defined. 2014 Elsevier Inc.
<21>
Accession Number
2014088574
Authors
Bortnick A.E. Epps K.C. Selzer F. Anwaruddin S. Marroquin O.C. Srinivas V.
Holper E.M. Wilensky R.L.
Institution
(Bortnick, Srinivas) Division of Cardiology, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, NY, United States
(Epps, Anwaruddin, Wilensky) Division of Cardiovascular Medicine, Hospital
of the University of Pennsylvania, Philadelphia, PA, United States
(Selzer, Marroquin) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Marroquin) UPMC Heart and Vascular Institute, Pittsburgh, PA, United
States
(Holper) Division of Cardiology, Medical City Hospital, Dallas, TX, United
States
Title
Five-year follow-up of patients treated for coronary artery disease in the
face of an increasing burden of co-morbidity and disease complexity (from
the nhlbi dynamic registry).
Source
American Journal of Cardiology. 113 (4) (pp 573-579), 2014. Date of
Publication: 15 Feb 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Management of coronary artery disease (CAD) has evolved over the past
decade, but there are few prospective studies evaluating long-term
outcomes in a real-world setting of evolving technical approaches and
secondary prevention. The aim of this study was to determine how the
mortality and morbidity of CAD has changed in patients who have undergone
percutaneous coronary intervention (PCI), in the setting of co-morbidities
and evolving management. The National Heart, Lung, and Blood Institute
Dynamic Registry was a cohort study of patients undergoing PCI at various
time points. Cohorts were enrolled in 1999 (cohort 2, n = 2,105), 2004
(cohort 4, n = 2,112), and 2006 (cohort 5, n = 2,176), and each was
followed out to 5 years. Primary outcomes were death, myocardial
infarction (MI), coronary artery bypass grafting, repeat PCI, and repeat
revascularization. Secondary outcomes were PCI for new obstructive lesions
at 5 years, 5-year rates of death and MI stratified by the severity of
coronary artery and co-morbid disease. Over time, patients were more
likely to have multiple co-morbidities and more severe CAD. Despite
greater disease severity, there was no significant difference in death
(16.5% vs 17.6%, adjusted hazard ratio [HR] 0.89, 95% confidence interval
[CI] 0.74 to 1.08), MI (11.0% vs 10.6%, adjusted HR 0.87, 95% CI 0.70 to
1.08), or repeat PCI (20.4% vs 22.2%, adjusted HR 0.98, 95% CI 0.85 to
1.17) at 5-year follow-up, but there was a significant decrease in
coronary artery bypass grafting (9.1% vs 4.3%, adjusted HR 0.44, 95% CI
0.32 to 0.59). Patients with 5 co-morbidities had a 40% to 60% death rate
at 5 years. There was a modestly high rate of repeat PCI for new lesions,
indicating a potential failure of secondary prevention for this population
in the face of increasing co-morbidity. Overall 5-year rates of death, MI,
repeat PCI, and repeat PCI for new lesions did not change significantly in
the context of increased co-morbidities and complex disease. 2014
Elsevier Inc. All rights reserved.
<22>
Accession Number
2013639080
Authors
Mirhosseini S.J. Forouzannia S.K. Mostafavi Pour Manshadi S.M.Y.
Ali-Hassan-Sayegh S. Naderi N. Sanatkar M.
Institution
(Mirhosseini) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Forouzannia) Yazd Cardiovascular Research Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mostafavi Pour Manshadi, Naderi) Department of Medicine, Ali ben Abitaleb
Medical College, Islamic Azad University, Yazd, Iran, Islamic Republic of
(Ali-Hassan-Sayegh) Yazd Cardiovascular Research Center, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Sanatkar) Department of Anesthesiology, Razi Hospital, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Comparison of aspirin plus heparin with heparin alone on asymptomatic
perioperative deep vein thrombosis in candidates for elective off-pump
coronary artery bypass graft: A randomized clinical trial.
Source
Cardiology Journal. 20 (2) (pp 139-143), 2013. Date of Publication: 2013.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Symptomatic or asymptomatic deep vein thrombosis (DVT) is a
common complication following coronary artery bypass graft (CABG), in
which less than 1% of these patients suffer from clinically evident
pulmonary embolism (PE). DVT and PE can increase other morbidities of
coronary revascularization from short to long period, but no clear
consensus still exists regarding proper thromboprophylaxis strategy in the
literatures. This study was designed to compare the anti-platelet
prophylaxis of aspirin plus heparin with heparin alone on asymptomatic
perioperative DVT in patients that are candidates for elective off-pump
CABG. Methods: One hundred and twenty patients, who are candidates for
elective off-pump CABG, were randomly assigned to two groups: the aspirin
plus heparin group (Group 1, n = 60) that received 80 mg daily aspirin
orally and 5000 U unfractionated heparin per 8 h subcutaneously from
admission to discharge time, and the heparin group (group 2, n = 60) that
received same dose of heparin alone. All patients underwent right and left
leg venous ultrasound examination during hospitalization, after which
post-operative off-pump CABG complications such as deep vein thrombosis,
bleeding and pulmonary embolism were evaluated in this study cases.
Results: The mean age of the patients was 62.10 + 10.71 years with a male
to female ratio of 2.24. Asymptomatic DVT occurred in 12 (10%) patients
who underwent elective off-pump CABG. DVT was found more in Group 2
(16.6%) as compared to Group 1 (3.3%) with statistical significant
difference (p = 0.015). Bleeding was detected in 5 (4.1%) cases in the
patients sampled in this study (p = 0.34), 4 cases of which are from Group
1 and 1 case from Group 2. However, PE was shown in none of this study
cases. Conclusions: The incidence of DVT decreased more with aspirin plus
heparin as compared to heparin alone in patients who underwent elective
off-pump CABG. As regards the results obtained in this study, more studies
need to be conducted to establish this strategy for prophylaxis of DVT in
CABG. 2013 Via Medica.
<23>
Accession Number
71317109
Authors
Jiang L. Renqiang Y. Yingli F. Rui Z. Lijuan H. Xiaoshu C.
Institution
(Jiang, Renqiang, Yingli, Rui, Xiaoshu) Second Affiliated Hospital,
Nanchang University, China
(Lijuan) First Affiliated Hospital, Nanchang University, China
Title
A meta-analysis of percutaneous coronary intervention for chronic total
coronary occlusions.
Source
Heart. Conference: 24th Great Wall International Congress of Cardiology,
Asia Pacific Heart Congress 2013, International Congress of Cardiovascular
Prevention and Rehabilitation 2013 Beijing China. Conference Start:
20131010 Conference End: 20131013. Conference Publication: (var.pagings).
99 (pp A179), 2013. Date of Publication: August 2013.
Publisher
BMJ Publishing Group
Abstract
Objectives The aim of this meta-analysis is to perform an evaluation on
short-term and longterm effectiveness of PCI for CTO recanalisation.
Methods We conducted with a search of PUBMED, ELSEVIER, and CLINICAL. COM
from January 2000 until July 2012. Either observational studies or
randomised clinical trials which compared PCI treatment of CTO
recanalisation to medical management were included. Two investigators
independently extracted data in standard forms. The endpoints were
analysed by using pooled estimates for death, myocardial infarction (MI),
CABG, angina symptoms, repeat revascularisation, and the major adverse
cardiac event (MACE). Results Sixteen observational studies comparing
outcomes after failed vs. successful CTO recanalisation with PCI were
found. These studies enrolling 10,256 patients observed at an average
follow-up period of 5 years. Successful CTO recanalisation group
significantly reduced the rates of all-cause death (OR-0.47, 95% CI
0.39-0.56, P < 0.00001), cardiac death (OR-0.43, 95% CI 0.31-0.62, P <
0.00001), MACE (OR-0.49, 95% CI 0.35-0.67, P < 0.0001), MI (OR-0.73, 95%
CI 0.60-0.90, P = 0.003), and subsequence coronary artery bypass surgery
(OR-0.19, 95% CI 0.15-0.23, P < 0.00001), as well as in long-term repeat
revascularisation (OR-0.60, 95% CI 0.37-0.96, P = 0.03). In addition,
successful CTO improved quality of life (P = 0.0001), reduced both MACE (P
< 0.00001) and mortality (P = 0.004) in patients with multivessel disease,
but only resulted in lower rate of death in patients with single vessel
disease (P = 0.02). Conclusions Base on this meta-analysis, PCI should be
considered a efficacious option for the patients with CTO lesions and the
future randomised trials should confirmed these results.
<24>
Accession Number
71316961
Authors
Jiang L. Yang R.-Q. Fan Y.-L. Zhan R. Hu L.-J. Cheng X.-S.
Institution
(Jiang, Yang, Fan, Zhan, Hu, Cheng) Second Affiliated Hospital, Nanchang
University, China
Title
Meta-analysis of effectiveness of percutaneous coronary intervention for
chronic total coronary occlusions.
Source
Heart. Conference: 24th Great Wall International Congress of Cardiology,
Asia Pacific Heart Congress 2013, International Congress of Cardiovascular
Prevention and Rehabilitation 2013 Beijing China. Conference Start:
20131010 Conference End: 20131013. Conference Publication: (var.pagings).
99 (pp A129), 2013. Date of Publication: August 2013.
Publisher
BMJ Publishing Group
Abstract
Objectives The aim of this meta-analysis is to perform an up-todate
assessment on short-term and long-term effectiveness of PCI for CTO
recanalisation. Despite advances in procedural techniques and expertise,
percutaneous coronary intervention (PCI) for chronic total occlusions
(CTO) in select patients remains a challenge. Recently, several
observational studies which compared successful CTO with PCI versus failed
CTO procedures have controversial outcomes. Methods We conducted with a
search of PUBMED, ELSEVIER, and CLINICAL.COM and had concluded all of
published studies, from January 2000 until July 2012, which compared PCI
treatment of successful CTO to failed CTO procedures. Results A total of
sixteen observational studies enrolling 10,256 patients (7,320 patients in
successful CTO and 2,936 patients in failed CTO group) were included.
Compared with failed CTO, successful CTO recanalisation group
significantly reduced allcause death (3.6% vs. 8.2%; P < 0.00001), cardiac
death (2.6% vs. 6.0%; P < 0.00001), major adverse cardiac event (MACE;
10.1% vs. 20.6%; P < 0.0001) and subsequence coronary artery bypass
surgery (3.4% vs. 17.1%; P < 0.00001) in the overall population, and these
benefits were sustained in studies which more than 2 years follow-up.
Meanwhile, in the overall population, the risk of myocardial infarction
(MI) was reduced in successful CTO group (4.0% vs. 5.9%; P = 0.02), but
there was a trend in studies with more than 2 years follow up in
successful PCI CTO (P = 0.09). In addition, successful CTO improved
quality of life (P = 0.0001), reduced both MACE (P < 0.00001) and
mortality (P = 0.004) in patients with multivessel disease, and also
resulted in lower rate of death in patients with single vessel disease
(SVD; P = 0.02), but had no different MACE events in SAD patients (P =
0.07). However, although successful CTO group had a low rate of repeat
revascularisation in studies with more than 2 years follow-up (P = 0.03),
it increased the inhospital revascularisation events (P = 0.007) and there
was no difference in overall population (13.6% vs. 16.0%; P = 0.40).
Conclusions Base on this meta-analysis, successful PCI recanalisation may
be considered a efficacious option for the patients with CTO lesions and
should be comfirmed by future randomised trials.
<25>
Accession Number
71320372
Authors
Khan I.Y. Singer L.G. De Perrot M. Granton J.T. Keshavjee S. Chau C. Kron
A.T. Johnson S.R.
Institution
(Khan) Pulmonary Hypertension Programme, University Health Network,
University of Toronto, Toronto, ON, Canada
(Singer) Division of Respirology, University of Toronto, University Health
Network, Toronto, ON, Canada
(De Perrot, Keshavjee) Division of Thoracic Surgery, University Health
Network, University of Toronto, Toronto, ON, Canada
(Granton) Toronto Pulmonary Hypertension Programme, Toronto General
Hospital, University of Toronto, Toronto, ON, Canada
(Chau, Kron) Toronto Scleroderma Research Program, Toronto Western
Hospital, University of Toronto, Toronto, ON, Canada
(Johnson) Division of Rheumatology, Toronto Western Hospital, University
of Toronto, Toronto, ON, Canada
Title
Survival after lung transplantation in systemic sclerosis. A systematic
review.
Source
Arthritis and Rheumatism. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2013 San Diego, CA United States. Conference
Start: 20131025 Conference End: 20131030. Conference Publication:
(var.pagings). 65 (pp S1252), 2013. Date of Publication: October 2013.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Lung transplantation is a life-saving option for
systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH)
and interstitial lung disease (SSc-ILD) patients. Yet, there is risk of
posttransplantation mortality. The objective of this study was to evaluate
survival of SSc patients post-lung transplantation. We secondarily
evaluated SSc lung transplant recipient characteristics, and compared
post-lung transplantation survival of SSc patients to non-SSc patients
(idiopathic PAH, and ILD). Methods: A systematic review of MEDLINE,
EMBASE, Cochrane Central Registry of Controlled Trials and CINAHL (all
inception to 2012) was performed to identify studies evaluating post-lung
transplant survival in SSc compared to non-SSc patients. Two reviewers
independently abstracted study and survival data using a standardized
form. Results: 226 citations were screened to identify 7 observational
studies reporting SSc patients who underwent single lung, double lung, or
heart-lung transplantation. Mean age at transplantations ranged 46-53
years. SSc post-transplantation survival ranged 69%-91% at 30-days,
69%-85% at 6-months, 59%-93% at 1-year, 49%-80% at 2-years, and 46%-79% at
3-years. ILD post-transplant survival was 80% at 30-days, 80%-90% at
6-months, 59%-83% at 2-years, and 69% at 3-years. IPAH post transplant
survival was 79% at 30-days, 79%-90% at 6-months, and 74%-90% at 1-year.
The reporting of overlapping cohorts potentially including the same
patients precluded meta-analysis. Causes of death in SSc patients, when
reported, included graft failure (n=6), infection (n=8), cardiac events
(n=3), hemorrhagic stroke (n=1), respiratory failure (n=3), malignancy
(n=2), pulmonary hypertension (n=1), complications of bronchiolitis
obliterans syndrome (BOS) (n=1), anesthetic complication (n=1), and
scleroderma renal crisis (n=1). There were no reports of recurrence of SSc
in the lung allograft. Conclusion: SSc survival post-lung transplantation
is very good, and improving with time. The short-term and
intermediate-term survival post-lung transplantation are similar to IPAH
and ILD patients requiring lung transplantation. Future researchers should
delineate the access process for lung transplantation and report the
occurrence of acute rejection, infection, bronchiolitis obliterans
syndrome, renal dysfunction and dialysis, gastroparesis, and need for tube
feeding.
<26>
Accession Number
71319579
Authors
Bass A.R. Lee Y.-Y. Lyman S. Westrich G.H. Gage B.F.
Institution
(Bass) Hospital for Special Surgery, Weill Cornell Medical College, New
York, NY, United States
(Lee, Lyman, Westrich) Hospital for Special Surgery, New York, NY, United
States
(Gage) Washington University, School of Medicine in St. Louis, St. Louis,
MO, United States
Title
The effect of statin therapy on venous thromboembolism after hip or knee
arthroplasty.
Source
Arthritis and Rheumatism. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2013 San Diego, CA United States. Conference
Start: 20131025 Conference End: 20131030. Conference Publication:
(var.pagings). 65 (pp S901), 2013. Date of Publication: October 2013.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Patients undergoing hip and knee arthroplasty are at
high risk of venous thromboembolism (VTE). HMG Co-A reductases ("statins")
can reduce the risk of post-operative cardiovascular complications in some
populations undergoing cardiac or non-cardiac surgery, and may reduce the
risk of venous thromboembolism (VTE) in healthy adults. We used the
Hospital for Special Surgery Legacy Registry (HSS Registry) to determine
whether statins protect against VTE after arthroplasty. Methods: Of the
20,764 patients in the HSS Registry who underwent hip or knee arthroplasty
between July 1, 2007 and December 31, 2011, 16183 returned 6-month
questionnaires. VTE was identified using hospital discharge ICD-9 codes
and self report on 6-month questionnaires. Self-reports of VTE were
validated through a structured telephone interview. Among the patients who
returned 6-month questionnaires, 230 patients (1.4%) experienced VTE
postoperatively (76 pulmonary embolism (PE), 173 deep vein thrombosis
(DVT), 19 both). We performed logistic regression to determine the risk of
postoperative VTE in patients taking statins. Results: Forty percent of
patients in the HSS Registry were on statins. Compared to patients not on
statins, patients on statins were older (68.9 vs 63 years), heavier (BMI
29.6 vs 28.3) and more commonly male (49.2% vs 38.5%). More patients on
statins underwent knee (as opposed to hip) arthroplasty (52.4% vs 42.9%)
and fewer underwent bilateral arthroplasty (6.5% vs 9.4%). Patients on
statins had a longer length of stay (5.0 vs 4.9 days) and were more
commonly discharged to a rehabilitation center (46.9% vs 37.9%). More
patients on statins had coronary artery disease (22.5% vs 4.2%),
congestive heart failure (1.5% vs 0.7%), and diabetes (15% vs 5.7%) while
fewer had rheumatoid arthritis (2.75% vs 4.1%). More patients on statins
received warfarin rather than aspirin as VTE prophylaxis (61.8% vs 50.6%).
These differences were all significant, p<0.001. In logistic regression
analysis statins were associated with a lower rate of PE (OR 0.6, 95% CI
0.4-0.98) but not DVT (OR 1.3, 95% CI 0.9-1.7) or total VTE (OR 0.97, 95%
CI 0.7-1.3). Conclusion: In this observational cohort, statins protected
against PE but not total VTE following hip or knee arthroplasty. Given
significant differences in the characteristics of patients on statins and
those not on statins, a prospective randomized controlled trial is needed
to determine whether statins protect these patients from VTE.
<27>
Accession Number
71316595
Authors
Munkholm-Larsen S.
Institution
(Munkholm-Larsen) Collaborative Research (CORE) Group International,
Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement for severe aortic stenosis: A meta-analysis.
Source
Cardiology (Switzerland). Conference: 24th Nordic-Baltic Congress of
Cardiology Oslo Norway. Conference Start: 20130613 Conference End:
20130615. Conference Publication: (var.pagings). 125 (pp 28-30), 2013.
Date of Publication: July 2013.
Publisher
S. Karger AG
Abstract
Background: Although transcatheter aortic valve implantation (TAVI) has
been considered as an acceptable treatment modality for patients with
severe aortic stenosis who are deemed inoperable by conventional surgical
aortic valve replacement (AVR). The role of TAVI in patients who are
potential surgical candidates remains controversial. Methods: The present
meta-analysis was conducted using five electronic databases, identifying
all relevant studies with comparative data on TAVI versus AVR. The primary
endpoint was all-cause mortality. A number of periprocedural outcomes were
also assessed according to the Valve Academic Research Consortium endpoint
definitions. Results: Fourteen studies were quantitatively assessed and
included for meta-analysis, including two randomized controlled trials and
eleven observational studies (table 1). Results indicated no significant
differences between TAVI and AVR in terms of all-cause (fig. 1) and
cardiovascular (Figure Presented) related mortality, stroke, myocardial
infarction or acute renal failure. A subgroup analysis of randomized
controlled trials identified a higher combined incidence of stroke or
transient ischemic attacks in the TAVI group compared to the AVR group
(fig. 2). TAVI was also found to be associated with a significantly higher
incidence of vascular complications, permanent pacemaker requirement and
moderate or severe aortic regurgitation. However, patients who underwent
AVR were more likely to experience major bleeding. Both treatment
modalities appeared to effectively reduce the transvalvular mean pressure
gradient. Conclusion: The available data on TAVI versus AVR for patients
at a higher surgical risk showed that major adverse outcomes such as
mortality and stroke appeared to be similar between the two treatment
modalities. Evidence on the outcomes of TAVI compared with AVR in the
current literature is limited by inconsistent patient selection criteria,
heterogeneous definitions of clinical endpoints and relatively short
follow-up periods. The indications for TAVI should therefore be limited to
inoperable surgical candidates until longterm data become available.
<28>
Accession Number
71316594
Authors
Munkholm-Larsen S. Wan B. Tian D. Dixen U. Kober L. Alfeiri O. Yan T.D.
Institution
(Munkholm-Larsen, Dixen) Hvidovre Hospital, Denmark
(Wan, Tian) Collaborative Research Group (CORE), Australia
(Kober) National Hospital, Denmark
(Alfeiri) Ospedale San Raffaele Via Olgettina, Italy
(Yan) Royal Prince Alfred Hospital, Australia
Title
A systematic review on safety and efficacy of percutaneous edge-to-edge
mitral valve repair with the mitraclip for high surgical risk candidates.
Source
Cardiology (Switzerland). Conference: 24th Nordic-Baltic Congress of
Cardiology Oslo Norway. Conference Start: 20130613 Conference End:
20130615. Conference Publication: (var.pagings). 125 (pp 26-28), 2013.
Date of Publication: July 2013.
Publisher
S. Karger AG
Abstract
Background: MitraClip implantation has emerged as a viable option in high
surgical risk patients with severe mitral regurgitation (MR). We performed
the present systematic review to assess (Figure Presented) the safety and
efficacy of the MitraClip system for high surgical risk candidates with
severe organic and/or functional MR (fig 1, 2). Methods: Six electronic
databases were searched for original published studies from January 2000
to March 2013. Two reviewers independently appraised studies, using a
standard form, and extracted data on methodology, quality criteria, and
outcome measures. All data were extracted and tabulated from the relevant
articles' texts, tables, and figures and double-checked by another
reviewer. Results: Overall 111 publications were identified. After
applying selection criteria and removing serial publications with
accumulating numbers of patients or increased length of followup, 12
publications with the most complete dataset were included for quality
appraisal and data extraction. All twelve studies were prospective
observational studies. Immediate procedural success ranged from 71.8% to
100%; 30-day mortality ranged from 1% to 7.7% and stroke ranged from 0% to
6.2%. There was a significant improvement in haemodynamic profile and
functional status after implantation. One-year survival ranged from 75.4%
to 89.6%. No mid-term or long-term outcomes have been reported for high
surgical risk patients. Conclusion: MitraClip implantation is an option in
managing selected high surgical risk patients with severe MR. The current
evidence suggests that MitraClip can be implanted with reproducible safety
and feasibility profile in this subgroup of patients. Further prospective
trials with mid-to long-term follow up are required.
<29>
Accession Number
71316509
Authors
Li J. Hua K. Yang X.
Institution
(Li, Hua, Yang) Department of Cardiac Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, China
Title
The effects of fractional flow reserve guided percutaneous coronary
intervention: A systematic review and meta-analysis from comparative
studies.
Source
Cardiology (Switzerland). Conference: China Heart Congress International
Heart Forum 2013 Beijing China. Conference Start: 20130808 Conference End:
20130811. Conference Publication: (var.pagings). 126 (pp 149), 2013. Date
of Publication: September 2013.
Publisher
S. Karger AG
Abstract
Background: Myocardial fractional flow reserve has performed more and more
popular at present. Clinicians use it to guide the percutaneous coronary
intervention. The effect of FFR in the therapy of coronary artery disease
needs to evaluate. We intend to perform a systematic review and
meta-analysis of studies reporting clinical outcomes of FFR-guided PCI vs
angiography-guided PCI. Methods: We searched PubMed from the beginning of
this century to March, 20, 2103, and also identified abstracts published
at this period. Prospective and retrospective studies were all included in
for analysis if data for two strategies guided PCI were available. Result:
In published data from 4 trials (9 203 patients, 1 874 for FFR-guided PCI,
7 329 for angiography), we could conclude that the FFR-guided strategy of
PCI could reduce the rate of MACE (OR = 0.53, 95% CI, 0.39 - 0.73)) and
its components such as death (OR = 0.71, 95% CI, 0.45 - 1.12), myocardial
ischemia (OR = 0.51, 95% CI, 0.36 -0.71), and repeat revascularization (OR
= 0.53, 95% CI, 0.39 - 0.73). We could conclude that the FFR-guided
strategy of PCI could also limit the usage of stents and reduce the cost
of hospitalization relatively. Conclusion: The FFR-guided strategy
performs much better than angiograph-guided. Being the examination guiding
the myocardial revascularization at present, although it has several
aspects to improve and refine, FFR has opened a new era of incomplete
revascularization of the interventions to coronary artery disease. And its
systematic use will make PCI more effective and appropriate than at
present.
<30>
Accession Number
71316470
Authors
Jiang L.
Institution
(Jiang) Second Affiliated Hospital of Nanchang University, China
Title
A meta-analysis of npercutaneous coronary interventio for chronic total
coronary occlusions recanalization.
Source
Cardiology (Switzerland). Conference: China Heart Congress International
Heart Forum 2013 Beijing China. Conference Start: 20130808 Conference End:
20130811. Conference Publication: (var.pagings). 126 (pp 135), 2013. Date
of Publication: September 2013.
Publisher
S. Karger AG
Abstract
Objective: To perform an evaluation (meta-analysis) on short-term and
long-term prognosis of percutaneous coronary intervention (PCI) for
patients with chronic total occlusions (CTO) recanalization. Background
Despite advances in procedural techniques and expertise, PCI for CTO
recanalization in select patients remains a challenge. Methods: Data
sources include published studies from a search of PUBMED, ELSEVIER, and
CLINICAL.COM from Jan. 2000 to Jul. 2012. Selected studies wer either
observational studies or randomized clinical trials that compared PCI
treatment of CTO recanalization to medical management. The endpoints were
analyzed using pooled estimates for death, myocardial infarction (MI),
coronary artery bypass surgery (CABG), angina symptoms, repeat
revascularization, and major adverse cardiac events (MACE). Result:
Sixteen observational studies comparing outcomes after failed or
successful CTO recanalization with PCI were included in the current
analysis. Collectively, these studies enrolled 10 256 patients who were
observed at an average follow-up period of 5 years. Patients with
successful CTO recanalization demonstrated significantly reduced rates of
all-cause death (P < 0.00001), cardiac death (P < 0.00001), MACE (P <
0.0001), MI (P = 0.003), subsequent CABG (P < 0.00001), and long-term
repeat revascularization (P = 0.03). In addition, successful CTO improved
quality of life (P = 0.0001), reduced both MACE (P < 0.00001) and
mortality (P = 0.004) in patients with multivessel disease; although there
was no difference in the rates of death and MACE in patients with SAD.
Conclusion: PCI should be considered an effective option for the patients
with CTO lesions.
<31>
Accession Number
71316427
Authors
Gong B. Zhou S. Wang W. Sun Y. Wang G. Liu R. Chen G. Li L. Yang X.
Institution
(Gong, Liu, Yang) Department of Surgery, China
(Zhou, Wang, Wang, Li) Department of Anesthesiology, China
(Sun) Department of Extracorporeal Circulation, China
(Chen) Department of Internal Medicine, China
(Gong, Zhou, Wang, Sun, Wang, Liu, Chen, Li, Yang) State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical, China
Title
Female and off-pump patients may have better cardiac function preservation
effect of Sevoflurane compared with Propofol: The result of a
meta-analysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress International
Heart Forum 2013 Beijing China. Conference Start: 20130808 Conference End:
20130811. Conference Publication: (var.pagings). 126 (pp 121), 2013. Date
of Publication: September 2013.
Publisher
S. Karger AG
Abstract
Objective: We sought to perform a systematic review and metaanalysis to
compare propofol and sevoflurane on cardioprotective effects and explore
potential relevant factors for patients undergoing coronary artery bypass
grafting (CABG). Methods: The MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials were searched for relevant randomized
controlled trials (RCTs) published in English from their inception up to
Nov. 1, 2012. Data on cardiac index (CI), mean arterial pressure (MAP),
central venous pressure (CVP), pulmonary capillary wedge pressures (PCWP),
systemic vascular resistance index (SVRI), troponin I level (cTnI),
mechanical ventilation time, postoperative inotropic requirement, length
of stay (LOS) in intensive care unit (ICU) and hospital stay,
postoperative complications, major adverse cardiovascular and
cerebrovascular events (MACCE) were analyzed. Result: Seventeen studies of
1253 patients were included out of 1 010 retrieved citations. Sevoflurane
group had higher post-bypass CI (WMD,-0.55, 95% CI:-0.63 to-0.47), less
postoperative inotropic requirement (RR, 2.08, 95% CI: 1.72 to 2.51),
higher CVP (WMD, 0.45; 95% CI, 0.1 to 0.79; P = 0.011) and PCWP (WMD,
0.85; 95% CI, 0.32 to 1.37; P = 0.002). Univariate meta-regression
analysis suggested the major sources of significant heterogeneity for CI
were male proportion (coefficient =-0.018; P = 0.091; adjusted
R<sup>2</sup> = 30.47%) and CPB application (coefficient =-0.413; P =
0.06; adjusted R<sup>2</sup> = 42.51%). Conclusion: Sevoflurane was
associated with higher post-bypass CI and less postoperative inotropic
drug requirement. The cardiac function preservation effects of sevoflurane
were more pronounced among female and off-pump patients in CABG.
<32>
Accession Number
71316354
Authors
Zhou C. Li L.
Institution
(Zhou, Li) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, Beijing 100037, China
Title
Ischemic preconditioning offers cardioprotection in coronary artery bypass
graft: A metaanalysis of 10 randomized controlled trials.
Source
Cardiology (Switzerland). Conference: China Heart Congress International
Heart Forum 2013 Beijing China. Conference Start: 20130808 Conference End:
20130811. Conference Publication: (var.pagings). 126 (pp 98), 2013. Date
of Publication: September 2013.
Publisher
S. Karger AG
Abstract
Background: Result from clinical trials on cardioprotection by ischemic
preconditioning (IPC) for patients undergoing coronary artery bypass graft
(CABG) are mixed. The aim of this meta-analysis was to evaluate the effect
of IPC on the postoperative biomarkers of myocardial injury in surgical
revascularization. Methods: A systematic search was performed in PubMed,
EMBase, and Cochrane Library (up to Mar. 2013). Randomized controlled
trials (RCT) about IPC reporting postoperative myocardial biomarkers (CKMB
or troponin) levels in CABG were included. Standardized mean difference
(SMD) was used to pool the different types of biomarkers. Random-effect
model was used in the pooled analysis in case of significant heterogeneity
(I<sup>2</sup> > 50%). 'Trim and fill ' method was used in case of
significant publication bias (Begg's or Egger's test, P < 0.05). Meta
regression analyses were used to explore the potential sources of
significant heterogeneity (I<sup>2</sup> > 50%) including mean age, mean
male proportion, mean bypass time, and baseline left ventricular ejection
fraction (LVEF). Result: Ten trials included 13 comparisons with 429 study
subjects in which 215 ones were preconditioned were selected and
identified. Aorta was majorly used for the conditioning protocols which
were 1-2 cycles of 2-5 min occlusion/2-5 min reflow. The mean age ranged
from 57.0 to 65.0 years and male proportion from 62.5% to 93.0%. The mean
bypass time varied from 71.0 to 126.0 min. The baseline LVEF was 40.7% to
71.5%. Troponin levels were reported in 9 trials. Compared with controls,
IPC significantly reduced postoperative biomarkers of myocardial injury
(SMD =-1.25; 95% Confidence Interval,-2.25 to-0.24; P = 0.0151;
heterogeneity test: I<sup>2</sup> = 94.5%; ). Significant publication bias
was observed (Begg's test, P = 0.028; Egger's test, P = 0.191). However,
this effect size remained unchanged after 'trim and fill ' method was
performed. Meta-regression analysis revealed that the major sources of
significant heterogeneity was baseline LVEF (regression coefficient > 0, P
< 0.05, adjust R<sup>2</sup> = 52%). Conclusion: Available data from this
meta-analysis suggests that IPC may conferred cardioprotective potential
by reducing postoperative biomarkers of injury for patients undergoing
coronary bypass surgery. This effect may be more pronounced in patients
with low baseline LVEF.
