Results Generated From:
Embase <1980 to 2014 Week 20>
Embase (updates since 2014-05-09)
<1>
Accession Number
2013571761
Authors
Pourmehdi Z. Tabatabaei S. Salimbahrami S. Borzouei S.
Institution
(Pourmehdi) Razi Hospital, Ahwaz University of Medica Sciences, Ahwaz,
Iran, Islamic Republic of
(Tabatabaei) Emam Khomeini Hospital, Ahwaz University of Medical Sciences,
Ahwaz, Iran, Islamic Republic of
(Salimbahrami) Besat Hospital, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
(Borzouei) Shahid beheshti Hospital, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
Title
The efficacy of intrathecal bupivacaine in combination with general
anesthesia versus general anesthesia alone on time to extubation in
patients with Coronary Artery Bypass Graft (CABG) surgery.
Source
Shiraz E Medical Journal. 14 (1) , 2013. Date of Publication: January
2013.
Publisher
Shiraz University of Medical Sciences
Abstract
Objective: we compared the use of intrathecal bupivacaine in combination
with general anesthesia to general anesthesia alone in patients undergoing
coronary artery bypass grafting (CABG) surgery for its impact on time to
extubation. Methodology: In this case control double blind study we
compared 34 patients in Imam Khomeini Hospital, Ahwaz, Iran, from May 2011
to September 2011.The patients were randomly assigned to receive general
anesthesia with prior administration of intrathecal bupivacaine 0.5% at a
dosage of 20 mg (bupivacaine or case group n = 17) or general anesthesia
alone (control group n = 17) according to a simple computer-generated
list. Results: Mean extubation time in bupivacaine group was213.00 + 3.06
(3h and 33m) and in control group was 257.12 + 4.49 minutes (4h and
17m).the difference between two groups was significant(P < 0.05).
Conclusion: Intrathecal bupivacaine offers promise as a useful adjunct in
reducing postoperative time to extubation in coronary artery bypass
grafting (CABG) surgery. 2013, Shiraz E Medical Journal, Shiraz, Iran.
All rights reserved.
<2>
Accession Number
2014299738
Authors
Han Y.-L.
Institution
(Han) Department of Cardiology, General Hospital of Shenyang Command,
Shenyang 110016, China
Title
Contrast-induced acute kidney injury.
Source
Medical Journal of Chinese People's Liberation Army. 39 (4) (pp 255-258),
2014. Date of Publication: 01 Apr 2014.
Publisher
People's Military Medical Press
Abstract
Contrast-induced acute kidney injury (CIAKI), known as the most important
complication after exposure to intravascular iodine based contrast agents,
has attracted increasing attention with the development of cardiac
intervention in recent years. CIAKI is harmful as it increases the risk of
renal failure and death, prolongation of hospitalization time, and
increase in expenditure. Moreover, lack of obvious clinical manifestation
makes CIAKI more easily neglected by clinicians. Preceding risk assessment
and giving prophylactic measures to high risk patients may lower the
incidence of CIAKI. Continuous renal function monitoring after
intervention procedure is helpful to detect CIAKI. Hydration has been
proved to be effective for the prevention of CIAKI. However, the affect of
other medication has not been well evaluated up to now. A multicenter,
randomized and controlled study, performed in union in 53 domestic
hospitals with the same protocol, demonstrated that short-term statin
therapy during perioperative period of invasive cardiovascular procedure
can effectively reduce the incidence of CIAKI. It may give us a new
strategy to prevent CIAKI.
<3>
Accession Number
2014289611
Authors
Capodanno D. Capranzano P. Tamburino C.
Institution
(Capodanno, Capranzano, Tamburino) Cardiology Department, Ferrarotto
Hospital, University of Catania, Via Citelli 6, 95124 Catania, Italy
Title
CABG versus PCI in diabetic patients with multivessel disease after risk
stratification by the SYNTAX score: A pooled analysis of the SYNTAX and
FREEDOM trials.
Source
International Journal of Cardiology. 173 (3) (pp 548-549), 2014. Date of
Publication: 15 May 2014.
Publisher
Elsevier Ireland Ltd
<4>
Accession Number
2014292942
Authors
Okada D.R. Rahmouni H.W. Herrmann H.C. Bavaria J.E. Forfia P.R. Han Y.
Institution
(Okada, Rahmouni, Herrmann, Forfia, Han) Department of Medicine, Perelman
School of Medicine, University of Pennsylvania, 3400 Spruce Street,
Philadelphia 19104-4283, PA, United States
(Bavaria) Department of Surgery, Perelman School of Medicine, University
of Pennsylvania, Philadelphia PA, United States
Title
Assessment of right ventricular function by transthoracic echocardiography
following aortic valve replacement.
Source
Echocardiography. 31 (5) (pp 552-557), 2014. Date of Publication: May
2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is a widely
used clinical measure of right ventricular (RV) systolic performance.
However, postsurgical changes in the pattern of RV contraction may limit
the utility of TAPSE for assessing global RV function. We retrospectively
examined pre- and postoperative TAPSE and RV fractional area change (FAC)
in patients undergoing 3 different types of aortic valve replacement
(AVR). Methods Fifty-two patients enrolled in the Placement of AoRTic
TraNscathetER Valve Trial at our institution were randomized to receive
open AVR or transcatheter AVR (TAVR) by either the transapical or
transfemoral access routes. Thirty-seven of these patients had analyzable
transthoracic echocardiography (TTE) before and after AVR. Using M-mode
echocardiography, TAPSE was measured in the apical four-chamber view.
Using two-dimensional echocardiography, RV FAC was measured in the apical
four-chamber view. Results The mean change in TAPSE was -0.7 + 0.6 cm for
open AVR (P = 0.002), -0.2 + 0.4 cm for transapical TAVR (P = 0.26), and
0.1 + 0.5 cm for transfemoral TAVR (P = 0.64). The mean change in RV FAC
was -1 + 5% for open AVR (P = 0.91), 2 + 4% for transapical TAVR (P =
0.37), and 7 + 10% for transfemoral TAVR (P = 0.07). Conclusions The
normal pattern of RV contraction was unchanged by transapical and
transfemoral TAVR, while open AVR led to a significant decrease in TAPSE
with preserved RV FAC. Thus, RV FAC is a preferable method for assessing
RV function in the postoperative patient. 2013, Wiley Periodicals, Inc.
<5>
Accession Number
2014277319
Authors
Carillo S. Zhang Y. Fay R. Angioi M. Vincent J. Sutradhor S.C. Ahmed A.
Pitt B. Zannad F.
Institution
(Carillo, Fay, Zannad) Inserm U961, Cardiology, Centre d'Investigations
Cliniques CIC9501, CHU de Nancy, 2 avenue du Morvan, 54500
Vandoeuvre-Les-Nancy, France
(Zhang, Ahmed) University of Alabama at Birmingham and VA Medical Center,
Birmingham, AL, United States
(Angioi) Clinic Louis-Pasteur, 54270 Essey-Les-Nancy, France
(Vincent, Sutradhor) Pfizer Inc., New York City, NY, United States
(Pitt) University of Michigan, Ann Arbor, MI, United States
Title
Heart failure with systolic dysfunction complicating acute myocardial
infarction - Differential outcomes but similar eplerenone efficacy by
ST-segment or non-ST-segment elevation: A post hoc substudy of the EPHESUS
trial.
Source
Archives of Cardiovascular Diseases. 107 (3) (pp 149-157), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Masson SAS
Abstract
Background Differential outcomes in patients with acute systolic heart
failure (HF) complicating acute myocardial infarction (AMI) and the
efficacy of mineralocorticoid receptor antagonists according to
non-ST-segment and ST-segment elevation myocardial infarction (NSTEMI,
STEMI) status has not been specifically investigated. Methods In the
EPHESUS study, 6632 patients with acute HF and left ventricular ejection
fraction < 40% were randomized 3-14 days post-AMI (median 7.3 + 3.0 days)
to receive eplerenone (n = 3319) or placebo (n = 3313). Among them, 6392
patients with available data on baseline ST-segment status (4634 STEMI;
1758 NSTEMI) were compared using a Cox model analysis stratified according
to quintiles of propensity score (PS), taking into account major baseline
risk factors, including revascularization. Results STEMI and NSTEMI
patients differed significantly across a large variety of baseline
characteristics. During 30 months of follow-up, all-cause death occurred
in 19% and 13% (P < 0.0001), cardiovascular death in 16% and 12% (P <
0.0001), cardiovascular death and hospitalization in 33% and 26% (P <
0.0001) and death from progression of HF in 5% and 3% (P < 0.0001) of
unadjusted NSTEMI and STEMI patients, respectively. After Cox model PS
adjustment without revascularization, NSTEMI status still proved to be a
risk factor for all-cause death, cardiovascular death and death from
progression of HF. After Cox model PS adjustment including
revascularization, none of the outcomes differed between STEMI and NSTEMI
patients. Eplerenone morbidity and mortality benefits were consistent in
the STEMI and NSTEMI subgroups. Conclusion In patients with acute systolic
HF complicating AMI, eplerenone improves outcomes equally in STEMI and
NSTEMI patients. Worse outcomes associated with NSTEMI could be explained
by more co-morbidities, less aggressive therapies and, mainly, less
frequent revascularization. 2014 Elsevier Masson SAS.
<6>
Accession Number
2014279888
Authors
Apostolakis E. Baikoussis N.G. Papakonstantinou N.A.
Institution
(Apostolakis, Baikoussis, Papakonstantinou) Department of Cardiac Surgery,
University of Ioannina, School of Medicine, Ioannina, Greece
Title
The role of myocardial ischaemic preconditioning during beating heart
surgery: Biological aspect and clinical outcome.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 68-71), 2012.
Date of Publication: 2012.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Short periods of ischaemia consecutive to reperfusion periods before a
sustained ischaemic condition, the so-called ischaemic preconditioning
(IP), aim to protect myocardial cells against prolonged ischaemia. IP
appears as a considerable endogenous cardioprotective mechanism decreasing
the infarct size after total occlusion in either experimental models or
humans. Angina periods before an acute coronary syndrome limit the
myocardial infarction being protective for the myocardium. Our report aims
to review the international bibliography of the IP during off-pump
coronary artery bypass grafting. 2011 The Author 2011. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<7>
Accession Number
2014279879
Authors
Rossi M. Gallo A. Joseph De Silva R. Sayeed R.
Institution
(Rossi, Gallo, Joseph De Silva, Sayeed) Department of Cardio-thoracic
Surgery, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
Title
What is the optimal timing for surgery in infective endocarditis with
cerebrovascular complications?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 72-80), 2012.
Date of Publication: 2012.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Neurologic dysfunction complicates the course of 10-40% of left-side
infective endocarditis (IE). In right-sided IE, instead, when systemic
emboli occur, paradoxical embolism should be considered. The spectrum of
neurologic events includes embolic cerebrovascular complication (CVC),
intracranial haemorrhage, ruptured mycotic aneurysm, transient ischaemic
attack (TIA), meningitis, encephalopathy and brain abscess.
Cardiopulmonary bypass might exacerbate neurological deficits due to:
heparinization and secondary cerebral haemorrhage; hypotension and
cerebral oedema in areas of the disrupted blood brain barrier. A best
evidence topic was written according to a structured protocol. The
question addressed was, whether there is an optimal timing for surgery in
IE with CVCs. One hundred papers were found using the reported search
criteria, and out of these 20 papers, provided the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results were tabulated. We found that evidence is conflicting because of
lack of controlled studies. The optimal timing for the valve replacement
depends on the type of neurological complication and the urgency of the
operation. The new 2009 Guidelines on the prevention, diagnosis, and
treatment of infective endocarditis (IE) recommend a multidisciplinary
approach and to wait for 1-2 weeks of antibiotics treatment before
performing cardiac surgery. However, early surgery is indicated in: heart
failure (class 1 B), uncontrolled infection (class 1 B) and prevention of
embolic events (class 1B/C). After a stroke, surgery should not be delayed
as long as coma is absent and cerebral haemorrhage has been excluded by
cranial CT (class IIa level B). After a TIA or a silent cerebral embolism,
surgery is recommended without delay (class 1 level B). In intracranial
haemorrhage (ICH), surgery must be postponed for at least 1 month (class 1
level C). Surgery for prosthetic valve endocarditis (PVE) follows the
general principles outlined for native valve IE. Every patient should have
a repeated head CT scan immediately before the operation to rule out a
preoperative haemorrhagic transformation of a brain infarction. The
presence of a haematoma warrants neurosurgical consultation and
consideration of cerebral angiography to rule out a mycotic aneurysm.
2011 The Author 2011. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.
<8>
Accession Number
2014279875
Authors
El Zayat H. Puskas J.D. Hwang S. Thourani V.H. Lattouf O.M. Kilgo P.
Halkos M.E.
Institution
(El Zayat, Puskas, Thourani, Lattouf, Kilgo, Halkos) Division of
Cardiothoracic Surgery, Emory University School of Medicine, Clinical
Research Unit, Atlanta, GA, United States
(Hwang) Department of Radiology, Emory University School of Medicine,
Atlanta, GA, United States
Title
Avoiding the clamp during off-pump coronary artery bypass reduces cerebral
embolic events: Results of a prospective randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 12-16), 2012.
Date of Publication: 2012.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The purpose of this study was to determine whether a clampless
facilitating device (CFD) to perform proximal aortocoronary anastomoses
would result in a lower incidence of cerebral embolic events compared with
a partial clamping strategy during off-pump coronary artery bypass
(OPCAB). After epiaortic ultrasound confirmed the mild aortic disease
(Grades I and II), 57 patients were randomly assigned to have proximal
anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD
[Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA).
Solid and gaseous emboli in the middle cerebral arteries were detected
using transcranial Doppler ultrasonography. The mean number of proximal
anastomoses was similar between groups 1.93 + 0.72 (CL) and 1.72 + 0.70
(HS) (P = 0.28). The mean number of gaseous plus solid emboli was greater
in the CL group than the HS group (90.0 + 64.0 vs. 50.8 + 36.6, P = 0.01).
Emboli were fewest in patients undergoing HS anastomoses using the suction
device. The number of intraoperative cerebral emboli was proportional to
the number of proximal anastomoses in the HS groups, but independent of
the number of proximal anastomoses in the CL groups. Among patients with a
low burden of aortic atherosclerosis, partial clamping of the ascending
aorta during OPCAB was associated with more cerebral embolic events
compared with an anastomosis with a CFD. 2011 The Author 2011. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<9>
Accession Number
2014289442
Authors
Whitlock R. Teoh K. Vincent J. Devereaux P.J. Lamy A. Paparella D. Zuo Y.
Sessler D.I. Shah P. Villar J.-C. Karthikeyan G. Urrutia G. Alvezum A.
Zhang X. Abbasi S.H. Zheng H. Quantz M. Yared J.-P. Yu H. Noiseux N. Yusuf
S.
Institution
(Whitlock, Teoh, Vincent, Devereaux, Lamy, Zhang, Yusuf) Population Health
Research Institute, McMaster University/Hamilton Health Sciences,
Hamilton, Canada
(Paparella) University of Bari Aldo Moro, Bari, Italy
(Zuo, Yu) West China Hospital, Sichuan University, Chengdu, China
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Shah) Princess Alexandra Hospital, Woolloongabba, Australia
(Villar) Fundacion Cardio Infantil-Instituto de Cardiologia, Bogota,
Colombia
(Karthikeyan) All India Institute of Medical Sciences, New Delhi, India
(Urrutia) Institut d'Investigacio Biomedica Sant Pau-CIBERESP, Barcelona,
Spain
(Alvezum) Divisao de Pesquisa, Instituto Dante Pazzanese de Cardiologia,
Sao Paulo, Sao Paulo, Brazil
(Abbasi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Zheng) First Teaching Hospital, Xinjiang Medical University, Urumqi,
China
(Quantz) London Health Sciences Centre, London, United Kingdom
(Yared) Cleveland Clinic, Cleveland OH, United States
(Noiseux) Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
Title
Rationale and design of the steroids in cardiac surgery trial.
Source
American Heart Journal. 167 (5) (pp 660-665), 2014. Date of Publication:
May 2014.
Publisher
Mosby Inc.
Abstract
Background Steroids may improve outcomes in high-risk patients undergoing
cardiac surgery with the use of cardiopulmonary bypass (CBP). There is a
need\ for a large randomized controlled trial to clarify the effect of
steroids in such patients. Methods We plan to randomize 7,500 patients
with elevated European System for Cardiac Operative Risk Evaluation who
are undergoing cardiac surgery with the use of CBP to methylprednisolone
or placebo. The first coprimary outcome is 30-day all-cause mortality, and
the most second coprimary outcome is a composite of death, MI, stroke,
renal failure, or respiratory failure within 30 days. Other outcomes
include a composite of MI or mortality at 30 days, new onset atrial
fibrillation, bleeding and transfusion requirements, length of intensive
care unit stay and hospital stay, infection, stroke, wound complications,
gastrointestinal complications, delirium, postoperative insulin use and
peak blood glucose, and all-cause mortality at 6 months. Results As of
October 22, 2013, 7,034 patients have been recruited into SIRS in 82
centers from 18 countries. Patient's mean age is 67.3 years, and 60.4% are
male. The average European System for Cardiac Operative Risk Evaluation is
7.0 with 22.1% having an isolated coronary artery bypass graft procedure,
and 66.1% having a valve procedure. Conclusions SIRS will lead to a better
understanding of the safety and efficacy of prophylactic steroids for
cardiac surgery requiring CBP. 2014 Mosby, Inc.
<10>
Accession Number
2014289576
Authors
Machaalany J. Senechal M. O'Connor K. Abdelaal E. Plourde G. Voisine P.
Rimac G. Tardif M.-A. Costerousse O. Bertrand O.F.
Institution
(Machaalany, Senechal, O'Connor, Abdelaal, Plourde, Rimac, Tardif,
Costerousse, Bertrand) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Department of Cardiology, Quebec Heart-Lung
Institute, 2725 chemin Sainte-Foy, Quebec City, QC G1V 4G5, Canada
(Voisine) Department of Cardiovascular Surgery, Quebec City, QC, Canada
Title
Early and late mortality after repair or replacement in mitral valve
prolapse and functional ischemic mitral regurgitation: A systematic review
and meta-analysis of observational studies.
Source
International Journal of Cardiology. 173 (3) (pp 499-505), 2014. Date of
Publication: 15 May 2014.
Publisher
Elsevier Ireland Ltd
<11>
Accession Number
2014295874
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Rezaeisadrabadi M. Dehghan H.R.
Sedaghat-Hamedani F. Kayvanpour E. Popov A.-F. Liakopoulos O.J.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Rezaeisadrabadi, Dehghan) Yazd
Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Imam Khomeini
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sedaghat-Hamedani, Kayvanpour) Department of Medicine III, University of
Heidelberg, Heidelberg, Germany
(Popov) Department of Thoracic and Cardiovascular Surgery, University of
Gottingen, Gottingen, Germany
(Liakopoulos) Department of Thoracic and Cardiovascular Surgery, West
German Heart Center Essen, University Hospital, Essen, Germany
Title
Antioxidant supplementations for prevention of atrial fibrillation after
cardiac surgery: An updated comprehensive systematic review and
meta-analysis of 23 randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 646-654),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
This systematic review with meta-analysis sought to determine the impact
of antioxidants (N-acetylcysteine [NAC], polyunsaturated fatty acids
[PUFAs] and vitamins) on incidence of postoperative atrial fibrillation
(POAF) and duration of length of hospital stay. Medline, Embase, Elsevier,
Sciences online database and Google Scholar literature search was made for
studies in randomized controlled trials. The effect sizes measured were
odds ratio (OR) for categorical variable and standard mean difference
(SMD) with 95% confidence interval (CI) for calculating differences
between mean values of duration of hospitalization in intervention and
control groups. A value of P < 0.1 for Q-test or I<sup>2</sup> > 50%
indicated significant heterogeneity between the studies. Literature search
of all major databases retrieved 355 studies. After screening, a total of
23 trials were identified that reported outcomes of 4278 patients
undergoing cardiac surgery. Pooled effects estimates on POAF showed a
significant reduction after NAC (OR: 0.56, 95% CI: 0.40-0.77, P < 0.001),
PUFA (OR: 0.84, 95% CI: 0.71-0.99, P = 0.03) and vitamin C treatment (OR:
0.50, 95% CI: 0.27-0.91, P = 0.02). Hospital length of stay was not
reduced after NAC therapy (SMD: 0.082, 95% CI -0.09 to 0.25, P = 0.3), but
could be decreased with PUFA (SMD: -0.185, 95% CI: -0.35 to -0.018, P =
0.03) and vitamin C (SMD: -0.325, 95% CI -0.50 to -0.14, P < 0.01). In
conclusion, perioperative antioxidant supplementations with NAC, PUFA and
vitamin C prevent atrial fibrillation after cardiac surgery. Moreover,
PUFA and vitamin C are capable to reduce hospital stay, whereas NAC lacks
this capacity. The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<12>
Accession Number
2014295869
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of adjusted risk estimates for survival from observational
studies of complete versus incomplete revascularization in patients with
multivessel disease undergoing coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 679-682),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
To determine whether coronary artery bypass grafting (CABG) with complete
revascularization improves survival in patients with multivessel disease
(MVD) over CABG with incomplete revascularization, we performed a
meta-analysis of adjusted (but not unadjusted) risk estimates from
observational studies. Databases including MEDLINE and EMBASE were
searched through October 2013 using Web-based search engines (PubMed,
OVID). Eligible studies were observational studies of complete- versus
incomplete-revascularization CABG enrolling 100 patients with MVD in each
treatment arm and reporting an adjusted hazard ratio for follow-up
mortality. Mixed-effects meta-regression analyses were performed to
determine whether the effects of complete-revascularization CABG on
survival were modulated by the prespecified factors. Fourteen
observational studies enrolling 30 389 patients were identified and
included. A pooled analysis demonstrated a statistically significant 37%
reduction in follow-up mortality with complete- relative to
incomplete-revascularization CABG (hazard ratio, 0.63; 95% confidence
interval, 0.53-0.75; P < 0.00001). Although meta-regression coefficients
were not statistically significant for mean follow-up duration and age and
proportion of men and patients undergoing off-pump CABG, that for
proportion of patients with diabetes was significantly negative (P =
0.03), which would indicate that as patients with diabetes increase,
complete-revascularization CABG is more beneficial for survival. In
conclusion, complete-revascularization CABG appears to improve survival
over incomplete-revascularization CABG in patients with MVD. The Author
2014. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.
<13>
Accession Number
2014295862
Authors
Morcos K. Shaikhrezai K. Kirk A.J.B.
Institution
(Morcos, Shaikhrezai, Kirk) Department of Thoracic Surgery, Golden Jubilee
National Hospital, Agamemnon St., Clydebank G81 4DY, United Kingdom
Title
Is it safe not to drain the pneumonectomy space?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 671-675),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether it is safe not to
position any chest drain into the pneumonectomy space at the conclusion of
the procedure. Altogether 381 relevant studies were identified of which 11
represented the best evidence to answer the question. The author, journal,
date, country of publication, alternative methods of postpneumonectomy
space (PPS) management, complications and relevant outcomes are tabulated.
The majority of studies are on the basis of expert opinion or small
cohorts. Major cohorts, by which the pneumonectomy outcomes have been
examined, demonstrated that the rates of complications related to
pneumonectomy space management such as empyema, bronchopleural fistula,
mediastinal shift and major bleeding requiring reopening are very low. In
a large cohort where 408 patients underwent pneumonectomy the rate of
relevant complications was low and also it was concluded that the PPS
drainage is not necessary. Two separate expert opinions were in agreement
that needle aspiration in the absence of a drainage system is adequate for
the management of PPS and avoiding a mediastinal shift. One small cohort
and one institutional audit directly examined the impact of a drainage
versus no drainage approach in the management of PPS. Although neither
study could show a significant superiority of one method over another,
they recommended adopting a unified institutional protocol for current
departmental practice. They also emphasized that larger cohorts are
required to examine the superiority of different strategies for PPS
management. In a cohort of 291 patients, it was demonstrated that patients
with drainage with underwater seal are more at risk of postpneumonectomy
oedema. A recent review published as a book chapter appraised the relevant
literature in both humans and animals. The authors concluded that the
simplicity of a no-drainage system is notable; however, a balanced
drainage might be recommended for local protocols. We conclude that
although the current evidence is not adequate to examine the different
aforementioned approaches, not draining the pneumonectomy space can be
performed safely. The Author 2014. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.
<14>
Accession Number
2014295858
Authors
Cuthbert G.A. Kirmani B.H. Muir A.D.
Institution
(Cuthbert, Kirmani, Muir) Department of Cardiothoracic Surgery, Liverpool
Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
Title
Should dialysis-dependent patients with upper limb arterio-venous fistulae
undergoing coronary artery bypass grafting avoid having ipsilateral in
situ mammary artery grafts?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 655-660),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether dialysis-dependent
patients with upper limb arterio-venous fistulae (AVFs) undergoing
coronary artery bypass grafting should avoid having ipsilateral in situ
internal mammary artery (IMA) grafts. A literature search performed
yielded 28 peer reviewed articles, of which 21 represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. The papers identified
included 478 patients, of whom 219 had in situ IMA grafts with ipsilateral
upper limb arterio-venous fistulae. There was a substantial variation
between the papers, from single case reports to small retrospective cohort
studies, but no randomized, controlled trials. The largest retrospective
study included 155 patients and followed up for up to 5 years. Methods
used to determine coronary steal included clinical assessment,
electrocardiogram or echocardiographic changes, Doppler ultrasound of
mammary arteries and angiography. The aggregate evidence suggested that 61
of the 219 patients with ipsilateral IMA grafts developed some clinical or
physiological evidence of malperfusion during the use of the AVFs for
dialysis. Comparisons with the contralateral IMA suggested that 27 of the
61 patients suffered similar problems when dialysis was applied. A number
of studies used controls, including in situ right internal mammary artery
(RIMA) flow and patients not on dialysis. In total, 32 patients had their
in situ RIMA flow measurements studied, of which none showed any
statistically significant flow alteration. While further strong evidence
to demonstrate long-term outcomes is required, we recommend the avoidance,
where possible, of ipsilateral in situ IMA grafts in patients with an
upper limb AVF. There is sufficient experimental and anecdotal evidence to
suggest that steal occurs and that in some patients, this has clinical
implications on both morbidity and mortality. In this scenario, the use of
the contralateral mammary is strongly advocated to maximize the patency of
grafts in an already high-risk population. The Author 2014. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<15>
Accession Number
2014295855
Authors
Baidya D.K. Khanna P. Maitra S.
Institution
(Baidya, Khanna, Maitra) Department of Anaesthesiology and Intensive Care,
All India Institute of Medical Sciences, F 35/2 Third Floor, Gautam Nagar,
New Delhi-49, India
Title
Analgesic efficacy and safety of thoracic paravertebral and epidural
analgesia for thoracic surgery: A systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 626-636),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Though once considered the gold standard, epidural anaesthesia has
complications that may be significant and include hypotension, urinary
retention, partial or patchy block and, in rare cases, devastating
neurological injuries also. Paravertebral block (PVB) is an alternative
technique for unilateral surgical procedures like thoracotomy, which may
offer similar analgesic effectiveness and a more favourable side-effect
profile than epidural analgesia. This systematic review and meta-analysis
of published randomized clinical trials aims to compare thoracic
paravertebral with thoracic epidural analgesia (TEA) in thoracotomy for
lung surgery. Five hundred and forty-one patients from 12 clinical trials
have been included in this systematic review and meta-analysis. We found
that visual analogue scale (VAS) scores at rest and during
activity/coughing at 4-8, 24 and 48 h postoperatively were similar in both
the PVB and TEA groups. Considering studies not included in the previous
meta-analysis, a VAS score on activity at 48 h is significantly better in
the PVB group (mean difference 0.40 cm; 95% confidence interval [95% CI]
0.77, 0.02; Mantel-Haenszel (M-H) fixed). Hypotension (odds ratio 0.13;
95% CI 0.06, 0.31; M-H fixed) and urinary retention are more common in the
epidural analgesia group. So, we conclude that thoracic PVB may be as
effective as thoracic epidural analgesia for post-thoracotomy pain relief
and is also associated with fewer complications. The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
<16>
Accession Number
2014295851
Authors
Dunne M.J. Abah U. Scarci M.
Institution
(Dunne, Abah, Scarci) Department of Cardiac Surgery, Papworth Hospital,
Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Frailty assessment in thoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 667-670),
2014. Date of Publication: May 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in thoracic surgery was performed according to a
structured protocol. The question addressed was the role of frailty scores
in predicting outcomes of patients undergoing thoracic surgery.
Seventy-one papers were found using the reported search, of which three
studies and one conference abstract represented the best evidence to
answer the clinical question. The authors, journal date, country of
publication, patient group, study type, relevant outcomes and results are
tabulated. Despite an extensive literature search, few studies were
identified which addressed the clinical dilemma posed, all of which were
retrospective observational series. A study analysed 971 434 patients
across a wide range of surgical specialties, 4648 of which were classified
as thoracic. A statistically significant relationship was demonstrated
between increasing frailty and higher rates of postoperative complications
and mortality (P < 0.0001). Another study reported a similar association
between modified frailty index (mFI) scores and postoperative outcomes in
patients undergoing lobectomies. Morbidity increased uniformly with mFI
and multivariant analysis found an mFI of >0.27 (P = 0.002) to be an
independent predictor of mortality. Another paper demonstrated higher
rates of major postoperative complications and increased mortality (P <
0.001) in patients with higher preoperative dependency. A study examined
geriatric frailty assessment tools for the prediction of postoperative
outcomes in patients over 70 undergoing thoracic surgery for neoplasms.
The Geriatric Depression Screen, Mini Mental State Examination, Fatigue
Inventory, Eastern Co-Operative Oncology Group Performance Scale and
Instrumental Activities of Daily Living were used as a means of
determining preoperative frailty. Their conclusion supported the
conclusions drawn from the larger studies that a single frailty measure
alone did not predict an increase in morbidity or mortality, but in
combination several measures may have a role in predicting postoperative
outcomes. The clinical bottom line is that there is a paucity of evidence
to either fully support or fully refute the use of preoperative frailty
scoring as a reliable means of predicting morbidity and mortality in
thoracic surgery. The evidence presented does however indicate the
potentially important clinical role that frailty scores may have in the
future. The Author 2014. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<17>
Accession Number
2014276936
Authors
Mao S. Huang S.
Institution
(Mao, Huang) Department of Nephrology, Nanjing Children's Hospital,
Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu Province,
210008, China
Title
Statins use and the risk of acute kidney injury: A meta-analysis.
Source
Renal Failure. 36 (4) (pp 651-657), 2014. Date of Publication: May 2014.
Publisher
Informa Healthcare
Abstract
The association between statins use and the risk of acute kidney injury
(AKI) remains elusive. We aimed to evaluate the association of statins use
with AKI risk by performing a meta-analysis. Twenty-one studies were
included in our meta-analysis by searching electronic databases according
to predefined criteria. No significant association between statins use and
AKI risk was observed in overall populations, Caucasians, Asians, and
patients undergoing cardiac and elective surgery (p=0.816, 0.981, 0.18,
0.709, and 0.122). Statins use decreased the risk of contrast-induced AKI
(CIN) (p=0.005) and increased AKI risk in patients with community acquired
pneumonia (CAP) (p=0.006). Meta-regression analyses showed almost no
impact on the pooled ORs of age and study length for overall populations.
Exclusion of any single study had little impact on the pooled ORs. In
conclusion, statins use is not associated with the risk of AKI in overall
populations, Caucasians, Asians, and patients undergoing cardiac and
elective surgery. Statins use decreases the risk of CIN and may increase
the risk of AKI in CAP patients. 2014 Informa Healthcare USA, Inc. All
rights reserved: reproduction in whole or part not permitted.
<18>
Accession Number
2014278739
Authors
Staikou C. Stavroulakis E. Karmaniolou I.
Institution
(Staikou, Stavroulakis) Department of Anaesthesia, Aretaieio University
Hospital, Athens, Greece
(Karmaniolou) Department of Anaesthesia, Royal National Orthopaedic
Hospital, G-Stanmore, United Kingdom
Title
A narrative review of peri-operative management of patients with
thalassaemia.
Source
Anaesthesia. 69 (5) (pp 494-510), 2014. Date of Publication: May 2014.
Publisher
Blackwell Publishing Ltd
Abstract
In thalassaemic patients, multiple organ systems may be affected by the
disease, blood transfusion, iron overload and chelating therapy. Patients
may develop cardiomyopathy, pulmonary hypertension or heart failure
requiring pre-operative echocardiography or cardiac catheterisation.
Restrictive lung dysfunction is commonly encountered, especially in
patients with splenomegaly. Haemoglobin level should be optimised
pre-operatively and maintained at adequate levels with transfusion and
blood-saving strategies. Susceptibility to infections should be managed
with broad-spectrum antibiotics. Thromboembolic events due to
hypercoagulability should be prevented by simple measures, such as
graduated compression stockings, intermittent pneumatic compression and
early mobilisation, and possibly anticoagulant drugs. When general
anaesthesia is administered, the risk of difficult intubation due to
oro-facial malformation should be considered. Cardiovascular depression
due to negative inotropic and vasodilating effects of general anaesthesia
should be minimised. Neuraxial techniques may also be challenging due to
spinal skeletal abnormalities and extramedullary haemopoiesis. A
multidisciplinary pre-operative approach, clinical optimisation and a
carefully planned strategy are mandatory. 2014 The Association of
Anaesthetists of Great Britain and Ireland.
<19>
Accession Number
2014284138
Authors
Wang H.-S. Wang Z.-W. Yin Z.-T.
Institution
(Wang, Wang, Yin) Department of Cardiovascular Surgery, Shenyang Northern
Hospital, Shenyang, Liaoning Province, China
Title
Carvedilol for prevention of atrial fibrillation after cardiac surgery: A
meta-analysis.
Source
PLoS ONE. 9 (4) , 2014. Article Number: e94005. Date of Publication: 04
Apr 2014.
Publisher
Public Library of Science
Abstract
Background: Postoperative atrial fibrillation (POAF) remains the most
common complication after cardiac surgery. Current guidelines recommend
beta-blockers to prevent POAF. Carvedilol is a non-selective
beta-adrenergic blocker with anti-inflammatory, antioxidant, and multiple
cationic channel blocking properties. These unique properties of
carvedilol have generated interest in its use as a prophylaxis for POAF.
Objective: To investigate the efficacy of carvedilol in preventing POAF.
Methods: PubMed from the inception to September 2013 was searched for
studies assessing the effect of carvedilol on POAF occurrence. Pooled
relative risk (RR) with 95% confidence interval (CI) was calculated using
random- or fixed-effect models when appropriate. Six comparative trials
(three randomized controlled trials and three nonrandomized controlled
trials) including 765 participants met the inclusion criteria. Results:
Carvedilol was associated with a significant reduction in POAF (relative
risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64, p<0.001).
Subgroup analyses yielded similar results. In a subgroup analysis,
carvedilol appeared to be superior to metoprolol for the prevention of
POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001). No evidence of heterogeneity
was observed. Conclusions: In conclusion, carvedilol may effectively
reduce the incidence of POAF in patients undergoing cardiac surgery. It
appeared to be superior to metoprolol. A large-scale, well-designed
randomized controlled trial is needed to conclusively answer the question
regarding the utility of carvedilol in the prevention of POAF. 2014 Wang
et al.
<20>
Accession Number
2014280885
Authors
Taniwaki M. Stefanini G.G. Silber S. Richardt G. Vranckx P. Serruys P.W.
Buszman P.E. Kelbaek H. Windecker S.
Institution
(Taniwaki, Stefanini, Windecker) Department of Cardiology, Swiss
Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse,
3010 Bern, Switzerland
(Silber) Kardiologische Praxis und Praxisklinik, Munich, Germany
(Richardt) Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Hasselt, Belgium
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Kelbaek) Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen,
Denmark
Title
4-year clinical outcomes and predictors of repeat revascularization in
patients treated with new-generation drug-eluting stents: A report from
the resolute all-comers trial (A Randomized Comparison of a
Zotarolimus-Eluting Stent with an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention).
Source
Journal of the American College of Cardiology. 63 (16) (pp 1617-1625),
2014. Date of Publication: 29 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives The aim of the study was to investigate 4-year outcomes and
predictors of repeat revascularization in patients treated with the
Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Minneapolis,
Minnesota) and XIENCE V everolimus-eluting stent (EES) (Abbott Vascular,
Abbott Park, Illinois) in the RESOLUTE (A Randomized Comparison of a
Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention) All-Comers trial. Background Data on
long-term outcomes of new-generation drug-eluting stents are limited, and
predictors of repeat revascularization due to restenosis and/or
progression of disease are largely unknown. Methods Patients were randomly
assigned to treatment with the R-ZES (n = 1,140) or the EES (n = 1,152).
We assessed pre-specified safety and efficacy outcomes at 4 years
including target lesion failure and stent thrombosis. Predictors of
revascularization at 4 years were identified by Cox regression analysis.
Results At 4 years, the rates of target lesion failure (15.2% vs. 14.6%, p
= 0.68), cardiac death (5.4% vs. 4.7%, p = 0.44), and target vessel
myocardial infarction (5.3% vs. 5.4%, p = 1.00), clinically-indicated
target lesion revascularization (TLR) (7.0% vs. 6.5%, p = 0.62), and
definite/probable stent thrombosis (2.3% vs. 1.6%, p = 0.23) were similar
with the R-ZES and EES. Independent predictors of TLR were age,
insulin-treated diabetes, SYNTAX (Synergy between PCI with Taxus and
Cardiac Surgery) score, treatment of saphenous vein grafts, ostial
lesions, and in-stent restenosis. Independent predictors of any
revascularization were age, diabetes, previous percutaneous coronary
intervention, absence of ST-segment elevation myocardial infarction,
smaller reference vessel diameter, SYNTAX score, and treatment of left
anterior descending, right coronary artery, saphenous vein grafts, ostial
lesions, or in-stent restenosis. Conclusions R-ZES and EES demonstrated
similar safety and efficacy throughout 4 years. TLR represented less than
one-half of all repeat revascularization procedures. Patient- and
lesion-related factors predicting the risk of TLR and any
revascularization showed considerable overlap. (A Randomized Comparison of
a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention [RESOLUTE-AC]; NCT00617084). 2014 by
the American College of Cardiology Foundation.
<21>
Accession Number
2014290159
Authors
Ge Y.-Z. Wu R. Lu T.-Z. Jia R.-P. Li M.-H. Gao X.-F. Jiang X.-M. Zhu X.-B.
Li L.-P. Tan S.-J. Song Q. Li W.-C. Zhu J.-G.
Institution
(Ge, Wu, Lu, Jia, Li, Tan, Song, Li, Zhu) Center for Renal
Transplantation, Nanjing First Hospital, Nanjing Medical University,
Nanjing, China
(Ge, Wu, Lu, Jia, Li, Tan, Song, Li, Zhu) Department of Urology, Nanjing
First Hospital, Nanjing Medical University, Nanjing, China
(Gao, Jiang) Department of Cardiology, Nanjing First Hospital, Nanjing
Medical University, Nanjing, China
(Zhu) Department of General Surgery, Nanjing First Hospital, Nanjing
Medical University, Nanjing, China
(Li) Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing
Medical University, Nanjing, China
Title
Combined effects of TGFB1 +869 T/C and +915 G/C polymorphisms on acute
rejection risk in solid organ transplant recipients: A systematic review
and meta-analysis.
Source
PLoS ONE. 9 (4) , 2014. Article Number: e93938. Date of Publication: 04
Apr 2014.
Publisher
Public Library of Science
Abstract
Background: Transforming growth factor-beta 1(TGF-beta1) is involved in
the development of acute rejection (AR) episodes in solid organ transplant
recipients; and a number of studies have been conducted to investigate the
combined effects of human TGF-beta1 gene (TGFB1) +869 T/C and +915 G/C
polymorphisms on AR risk. However, the results obtained are inconclusive.
Methods: Eligible studies that investigated the haplotypic association
between TGFB1 +869 T/C and +915 G/C polymorphisms and AR risk were
comprehensively searched in the PUBMED, EMBASE, China National Knowledge
Infrastructure, and Wanfang Database. Statistical analyses were performed
by using STATA 12.0 and Review Manager 5.0. Results: Fourteen eligible
studies with 565 AR cases and 1219 non-AR cases were included. Overall, a
significantly decreased risk was detected in patients carried with
intermediate producer (IP) haplotypes (T/C G/C, T/T G/C, and C/C G/G)
and/or low producer (LP) haplotypes (C/C G/C, C/C C/C, T/T C/C, and T/C
C/C) compared with high producer (HP) haplotypes (T/T G/G and T/C G/G; IP
vs. HP: OR = 0.75, 95% CI, 0.58-0.96, P <sub>heterogeneity</sub> = 0.238;
IP/LP vs. HP: OR = 0.77, 95% CI, 0.61-0.98, P <sub>heterogeneity</sub> =
0.144). In addition, subgroup analysis by transplant types demonstrated a
similar association in patients receiving heart transplant (IP vs. HP: OR
= 0.32, 95% CI, 0.14-0.73, P <sub>heterogeneity</sub> = 0.790; IP/LP vs.
HP: OR = 0.41, 95% CI, 0.20-0.85, P <sub>heterogeneity</sub> = 0.320).
Conclusions: The current meta-analysis and systematic review indicated
that recipient TGFB1 HP haplotypes were significantly associated with an
increased risk for AR in solid organ transplant recipients, particularly
patients receiving cardiac allograft. 2014 Ge et al.
<22>
Accession Number
71447321
Authors
Filion K.B. Dell'Aniello S. Eberg M. Renoux C. Daskalopoulou S.S. Suissa
S.
Institution
(Filion, Dell'Aniello, Eberg, Renoux, Suissa) Lady Davis Institute, Jewish
General Hosp, Montreal, Canada
(Daskalopoulou) McGill Univ Health Cntr, Montreal, Canada
Title
Varenicline and the risk of adverse cardiovascular events: A
population-based cohort study.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Nutrition, Physical Activity, and Metabolism 2014 Scientific
Sessions San Francisco, CA United States. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 129 ,
2014. Date of Publication: 25 Mar 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Clinical trial results suggest that varenicline is the most
efficacious smoking cessation therapy. However, its cardiovascular safety
is controversial, with recent meta-analyses providing conflicting results.
Our objective was to compare the effect of varenicline to that of
bupropion on the risk of cardiovascular events. Methods: We conducted a
population-based cohort study of new users of varenicline or bupropion
using data extracted from the UK's Clinical Practice Research Datalink
(CPRD) and Hospital Episode Statistics. Our primary endpoint was a
composite of myocardial infarction, coronary revascularization, stroke,
and all-cause mortality. An 'as-treated' analysis with a Cox proportional
hazards model was used, with patients censored 7 days after the end of
their last prescription or upon switching smoking cessation drugs. In
secondary analyses, we compared varenicline and bupropion to nicotine
replacement therapy (NRT) in pairwise comparisons. All analyses used
high-dimensional propensity scores to adjust for potential confounding.
Results: Our primary cohort included 90,522 varenicline users and 12,640
bupropion users. The mean age was 44 years, and 48% were men. The mean
treatment duration was 45 days. A total of 128 events occurred among
varenicline users, and 15 occurred among bupropion users. Although
estimates suggest that varenicline may modestly increase the risk of
cardiovascular events compared to bupropion, they were accompanied by wide
95% CIs (Table). Both varenicline and bupropion users had significantly
lower risks of cardiovascular events than NRT users (Table). Conclusions:
While we cannot exclude a modestly increased risk of cardiovascular events
with varenicline relative to bupropion, such events remain rare, and both
varenicline and bupropion are associated with a decreased risk of
cardiovascular events compared with NRT. The long-term benefits obtained
due to the increased smoking abstinence with varenicline likely outweigh
any increased cardiovascular risk.
<23>
Accession Number
71447314
Authors
DuBroff R. Lad V. Murray-Krezan C.
Institution
(DuBroff, Murray-Krezan) Univ of New Mexico, Albuquerque, NM, United
States
(Lad) Ayurvedic Institute, Albuquerque, NM, United States
Title
Ayurveda improves arterial stiffness and cardiometabolic risk in coronary
patients: A prospective pilot study.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Nutrition, Physical Activity, and Metabolism 2014 Scientific
Sessions San Francisco, CA United States. Conference Start: 20140318
Conference End: 20140321. Conference Publication: (var.pagings). 129 ,
2014. Date of Publication: 25 Mar 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Ayurveda is the ancient East Indian holistic approach to
health that includes yoga, meditation, breathing exercises, medicinal
herbs, and other practices. Although it has been practiced for nearly 5000
years there is little objective data regarding its efficacy in coronary
disease. Hypothesis: Can the addition of Ayurveda to usual care improve
markers and risk factors of cardiovascular disease? Methods: Twenty-six
volunteers with a history of prior myocardial infarction, coronary bypass
surgery, or coronary angioplasty/stent were recruited from the University
of New Mexico cardiology clinics. Each patient underwent consultation with
a single Ayurvedic specialist and received personalized instruction in
daily yoga, meditation, breathing, medicinal herbs, and a caloric
unrestricted Ayurvedic diet. Standardized measurements of arterial
stiffness (pulse wave velocity) and cardiometabolic risk factors were
obtained at baseline and after 90 days of therapy. Results: Nineteen
patients, mean age 71.6 years, completed the study, six dropped out and
one was lost to follow up. Among hypertensive patients (n=15), 60% (9 of
15) had either a >10 mm Hg drop in systolic blood pressure (n=4) or
required a reduction in anti-hypertensive medications due to persistent
systolic blood pressure < 110 mm Hg (n=5). Statistical analysis was
performed using the paired student's t test. Conclusion: This pilot study
suggests that short term Ayurvedic therapy improves arterial stiffness and
many cardiometabolic risk factors in patients with coronary artery
disease. These findings support the need for a randomized controlled trial
to further study the effects of Ayurveda on cardiovascular disease.
<24>
Accession Number
71446467
Authors
Boom D.T. Rijkenberg S. Kreder S. Sechterberger M.K. Bosman R.J. Van Der
Voort P.H.J.
Institution
(Boom, Rijkenberg, Kreder, Sechterberger, Bosman, Van Der Voort) Onze
Lieve Vrouwe Gasthuis, Intensive Care, Amsterdam, Netherlands
Title
The safety and efficacy of a subcutaneous continuous glucose monitoring
compared to point of care measurement in critically ill patients: A rct.
Source
Intensive Care Medicine. Conference: 26th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2013 Paris France. Conference
Start: 20131005 Conference End: 20131009. Conference Publication:
(var.pagings). 39 (pp S362), 2013. Date of Publication: October 2013.
Publisher
Springer Verlag
Abstract
Introduction. Hyperglycaemia, hypoglycaemia and glucose variability are
associated with adverse outcome of critically ill patients. Using a
continuous glucose monitoring (CGM) system these disturbances in glucose
regulation might be reduced. The reliability and accuracy of CGM using
subcutaneous measurements has been studied in critically ill patients
before. OBJECTIVES. The present study aims to determine whether the
clinical use of subcutaneous CGM is safe, effective and feasible in
critically ill patients. METHODS. In an open labeled randomized controlled
trial patients were assigned to glucose regulation using a subcutaneous
CGM system (FreeStyle Navigator-) or frequent point of care measurements
(POCM) using Accu-Chek- (Roche) for 5 days or until ICU discharge. Blinded
arterial blood glucose measurements were performed on standard times in
both groups. Patients with POCM also had subcutaneous CGM but these data
were blinded. Data from CGM or POCM were entered in the same computerized
glucose regulation protocol which prescribed the insulin dose and the time
of next data entering. RESULTS. 178 Patients were included. Median APACHE
IV was 0.32 (IQR 0.55) and 92 % were mechanically ventilated. 13 % were
complicated cardiac surgery patients, the others medical patients. From 15
patients CGM data were lost for technical reasons therefore 163 were
analysed. Study duration was median 70 h (IQR 99) in the CGM patients and
60 h (IQR 89) in POCM patients (p = 0.91). We analyzed 2,844 glucose
measurements, of which 1,358 were paired CGM-POCM. The time in target
range (5-9 mmol/l) was median 57.5 h (IQR 74.4) in CGM patients and median
34.9 h (IQR 62.7) in POCM group (p = 0.043). The incidence of severe
hypoglycemia (below 2.2 mmol/l) or severe hyperglycaemia (above 25 mmol/l)
was similar in both groups (p = 0.54 resp p = 0.09) as well as the glucose
variability in terms of mean absolute glucose change per hour (MAG). The
total number of blood samples per patient was 25 for CGMS and 41 for POCM
(p = 0.001). Hospital and ICU length of stay and mortality did not show
any significant differences. CONCLUSIONS. Glucose monitoring using a
subcutaneous device was safe in terms of hypoglycaemia incidence and
resulted in significantly more time in target range than the use of a
point of care blood measurement. In addition, the number of blood samples
was reduced.
<25>
Accession Number
71438483
Authors
Boom D.T. Rijkenberg S. Kreder S. Sechterberger M.K. Van Der Voort P.H.J.
Institution
(Boom, Rijkenberg, Kreder, Van Der Voort) Intensive Care, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Sechterberger) Internal Medicine, Academic Medical Centre, Amsterdam,
Netherlands
Title
The safety and efficacy of a subcutaneous continuous glucose monitoring
system compared to point of care measurement in critically ill patients: A
randomised controlled trial.
Source
Diabetologia. Conference: 49th Annual Meeting of the European Association
for the Study of Diabetes, EASD 2013 Barcelona Spain. Conference Start:
20130923 Conference End: 20130927. Conference Publication: (var.pagings).
56 (pp S31), 2013. Date of Publication: September 2013.
Publisher
Springer Verlag
Abstract
Background and aims: Hyperglycaemia, hypoglycaemia and glucose variability
are associated with adverse outcome of critically ill patients. Using a
continuous glucose monitoring (CGM) system might reduce these disturbances
in glucose regulation. The reliability and accuracy of CGM using
subcutaneous measurements has been studied in critically ill patients
before. The present study aims to determine whether the clinical use of
subcutaneous CGM is safe, effective and feasible in critically ill
patients. Materials and methods: In an open labeled randomized controlled
trial patients were assigned to glucose regulation using a subcutaneous
CGM system (FreeStyle Navigator) or frequent point of care measurements
(POCM) using Accu-Chek (Roche) for 5 days or until ICU discharge. Blinded
arterial blood glucose measurements were performed on standard times in
both groups. Patients with POCM also had subcutaneous CGM but these data
were blinded. Data from CGM or POCM were entered in the same computerized
glucose regulation protocol which prescribed the insulin dose and the time
of next data entering. Results: 178 Patients were included. Median APACHE
IV was 0.32 (IQR 0.55) and 92% were mechanically ventilated. 13% were
complicated cardiac surgery patients, the others medical patients. From 15
patients CGM data were lost for technical reasons, therefore 163 were
analysed. The median study duration was 70 hrs (IQR 99) in the CGM
patients and 60 hrs (IQR 89) in POCM patients (p=0.91). We analyzed 2844
glucose measurements, of which 1358 were paired CGM-POCM. The median time
in target range (5-9 mmol/l) was 57.5 hrs (IQR 74.4) in CGM patients and
34.9 hrs (IQR 62.7) in POCM group (p=0.043). The incidence of severe
hypoglycaemia (below 2.2 mmol/l) or severe hyperglycaemia (above 25
mmol/l) was similar in both groups (p=0.54 and 0.09) as well as the
glucose variability in terms of mean absolute glucose change per hour
(MAG). The total number of blood samples per patient was 25 for CGMS and
41 for POCM (p=0.001). Hospital and ICU length of stay and mortality did
not show any significant differences. Conclusion: Glucose monitoring using
a subcutaneous device was safe in terms of hypoglycaemia incidence and
resulted in significantly more time in target range than the use of a
point of care blood measurement. In addition, the number of blood samples
was reduced.
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