EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014434863
Authors
Jalalian R. Ghafari R. Ghazanfari P.
Institution
(Jalalian, Ghafari, Ghazanfari) Department of Cardiology, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Comparing the therapeutic effects of carvedilol and metoprolol on
prevention of atrial fibrillation after coronary artery bypass surgery, a
double-blind study.
Source
International Cardiovascular Research Journal. 8 (3) (pp 111-115), 2014.
Date of Publication: September 2014.
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: Atrial Fibrillation (AF) is a common complication after open
heart surgery and is frequently associated with increased hospital stay,
complications, and mortality rates. The effect of beta-blockers on
prevention of supraventricular arrhythmias has been confirmed in several
prospective randomized studies. Objectives: This clinical trial aimed to
compare the preventive effects of carvedilol and metoprolol on occurrence
of AF after CABG surgery. Patients and Methods: This prospective,
double-blind, randomized clinical trial was conducted on 150 patients (55
females, 95 males; mean age: 59 + 10 years) who underwent CABG surgery.
The patients with no contraindication for beta-blocker use were randomly
divided into two groups of carvedilol and metoprolol Tartarate (n = 75).
Treatment with beta-blocker was started on the first postoperative day
(metoprolol, 25 mg BD; carvedilol, 6.25 mg, BD) and the dosage was
regulated according to the patients' hemodynamic response. All the
patients were monitored 5 days after the surgery and incidence of AF and
other complications was recorded in both groups. Results: AF was detected
in 18 patients in the carvedilol group and 21 patients in the metoprolol
group (P = 0.577). The results of Fisher Exact test showed no significant
relationship between the type of the drug and the occurrence of AF (P <
0.05). Nevertheless, the prevalence of AF was higher in the renal failure
group. AF was mostly recorded on the second and third days after the
surgery. The results showed an association between old age and higher
occurrence of AF. AF was recorded in 11 patients (14%) in the metoprolol
group and 9 ones (12%) in the carvedilol group, with Left Ventricle
Ejection Fraction (LVEF) being between 35% and 45% (P = 0.587). However,
no significant difference was found between the two groups in this regard.
Conclusions: In the patients with sufficient ejection fraction, no
difference was observed in using carvedilol or metoprolol in prevention of
post-CABG AF. Yet, given the anti-oxidant and anti- inflammatory effects
of carvedilol, it might be more beneficial in comparison to metoprolol,
particularly in the patients with lower ejection fractions or heart
failure.

<2>
Accession Number
2014420837
Authors
Lindman B.R. Stewart W.J. Pibarot P. Hahn R.T. Otto C.M. Xu K. Devereux
R.B. Weissman N.J. Enriquez-Sarano M. Szeto W.Y. Makkar R. Miller D.C.
Lerakis S. Kapadia S. Bowers B. Greason K.L. McAndrew T.C. Lei Y. Leon
M.B. Douglas P.S.
Institution
(Lindman) Washington University School of Medicine, Cardiovascular
Division, Campus-Box 8086, 660 South Euclid Avenue, St. Louis, MO 63110,
United States
(Stewart, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec, QC,
Canada
(Hahn, Leon) Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY, United States
(Otto) University of Washington School of Medicine, Seattle, WA, United
States
(Xu, McAndrew, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Devereux) Weill Medical College, Cornell University, New York, NY, United
States
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Enriquez-Sarano, Greason) Mayo Clinic, Rochester, MN, United States
(Szeto) University of Pennsylvania School of Medicine, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Miller) Stanford University School of Medicine, Stanford, CA, United
States
(Lerakis) Emory University School of Medicine, Atlanta, GA, United States
(Bowers) Medical City Dallas, Dallas, TX, United States
(Lei) Saint Luke's Mid-America Heart Institute, Kansas City, MO, United
States
(Douglas) Duke University Medical Center, Duke Clinical Research
Institute, Durham, NC, United States
Title
Early regression of severe left ventricular hypertrophy after
transcatheter aortic valve replacement is associated with decreased
hospitalizations.
Source
JACC: Cardiovascular Interventions. 7 (6) (pp 662-673), 2014. Date of
Publication: June 2014.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to examine the relationship between left
ventricular mass (LVM) regression and clinical outcomes after
transcatheter aortic valve replacement (TAVR). Background LVM regression
after valve replacement for aortic stenosis is assumed to be a favorable
effect of LV unloading, but its relationship to improved clinical outcomes
is unclear. Methods Of 2,115 patients with symptomatic aortic stenosis at
high surgical risk receiving TAVR in the PARTNER (Placement of Aortic
Transcatheter Valves) randomized trial or continued access registry, 690
had both severe LV hypertrophy (left ventricular mass index [LVMi] 149
g/m² men, 122 g/m² women) at baseline and an LVMi
measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared
for patients with greater than versus lesser than median percentage change
in LVMi between baseline and 30 days using Cox proportional hazard models
to evaluate event rates from 30 to 365 days. Results Compared with
patients with lesser regression, patients with greater LVMi regression had
a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a
lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50,
95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of
rehospitalization specifically for heart failure (7.3% vs. 13.6%, p =
0.01). The association with a lower rate of rehospitalization was
consistent across subgroups and remained significant after multivariable
adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with
greater LVMi regression had lower B-type natriuretic peptide (p = 0.002)
and a trend toward better quality of life (p = 0.06) at 1-year follow-up
than did those with lesser regression. Conclusions In high-risk patients
with severe aortic stenosis and severe LV hypertrophy undergoing TAVR,
those with greater early LVM regression had one-half the rate of
rehospitalization over the subsequent year compared to those with lesser
regression.

<3>
Accession Number
2014423210
Authors
Nairooz R. Sardar P. Amin H. Swaminathan R.V. Kim L.K. Chatterjee S.
Feldman D.N.
Institution
(Nairooz) Department of Cardiology, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Sardar) Department of Medicine, New York Medical College-Metropolitan
Hospital Center, New York, NY, United States
(Amin, Kim) Department of Cardiology, Texas Tech University Health
Sciences Center, El Paso, TX, United States
(Swaminathan, Feldman) Division of Cardiology, Weill Cornell Medical
College, NewYork-Presbyterian Hospital, New York, NY, United States
(Chatterjee) Department of Cardiology, St Luke's Roosevelt Hospital
Center, Columbia University, New York, NY, United States
Title
Meta-analysis of randomized clinical trials comparing Bivalirudin versus
heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing
percutaneous coronary intervention and in patients with ST-segment
elevation myocardial infarction.
Source
American Journal of Cardiology. 114 (2) (pp 250-259), 2014. Date of
Publication: 15 Jul 2014.
Publisher
Elsevier Inc.
Abstract
This study sought to investigate the relative safety and efficacy of
bivalirudin versus heparin plus glycoprotein (GP) IIb/IIIa inhibitors in
patients undergoing percutaneous coronary intervention (PCI) and in those
with ST-segment elevation myocardial infarction (STEMI). The safety of
bivalirudin in PCI, particularly in patients with STEMI, continues to be
debated. We searched the on-line databases for randomized controlled
trials of bivalirudin versus heparin plus GP IIb/IIIa inhibitors. Data on
study design, inclusion and exclusion criteria, sample characteristics,
and clinical outcomes at 30 days were extracted. A total of 19,856 PCI
patients included in 7 randomized trials and 5,820 patients with STEMI
included in 2 randomized trials were separately analyzed. At 30 days,
bivalirudin use in patients undergoing PCI resulted in similar rates of
death, myocardial infarction, repeat revascularization, and stent
thrombosis. In patients with STEMI, bivalirudin use resulted in decreased
cardiac mortality (risk ratio [RR] 0.70, 95% confidence interval [CI] 0.50
to 0.97, p = 0.03) compared with heparin plus GP IIb/IIIa inhibitors but
an increase in definite stent thrombosis at 30 days (RR 1.88, 95% CI 1.09
to 3.24, p = 0.02) driven by an increase in acute stent thrombosis (RR
5.48, 95% CI 2.30 to 13.07, p = 0.0001). Bivalirudin use was associated
with a decrease in Thrombolysis In Myocardial Infarction (TIMI) major (RR
0.58, 95% CI 0.46 to 0.74, p <0.0001) and TIMI minor (RR 0.55, 95% CI 0.48
to 0.63, p <0.0001) bleeding rates in PCI patients as well as in a
subgroup of patients with STEMI. In conclusion, in PCI patients
anticoagulation with bivalirudin results in similar ischemic adverse
events and a reduction in TIMI major and minor bleeding at 30 days
compared with heparin plus GP IIb/IIIa inhibitors. In patients with STEMI,
bivalirudin use is associated with a reduction in TIMI major and minor
bleeding and fewer deaths from cardiac causes but an increase in acute and
30-day definite stent thrombosis. 2014 Elsevier Inc. All rights reserved.

<4>
Accession Number
2014422986
Authors
Bunge J.J.H. Van Osch D. Dieleman J.M. Jacob K.A. Kluin J. Van Dijk D.
Nathoe H.M.
Institution
(Bunge, Van Osch, Jacob, Nathoe) University Medical Center Utrecht,
Department of Cardiology, Mail Stop E03.511, PO Box 85500, 3508 GA
Utrecht, Netherlands
(Dieleman, Jacob, Van Dijk) Departments of Anaesthesiology and Intensive
Care, University Medical Center Utrecht, Utrecht, Netherlands
(Kluin) Departments of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
Title
Dexamethasone for the prevention of postpericardiotomy syndrome: A
DExamethasone for Cardiac Surgery substudy.
Source
American Heart Journal. 168 (1) (pp 126-131.e1), 2014. Date of
Publication: July 2014.
Publisher
Mosby Inc.
Abstract
Background The postpericardiotomy syndrome (PPS) is a common complication
following cardiac surgery. The pathophysiology remains unclear, although
evidence exists that surgical trauma and the use of cardiopulmonary bypass
provoke an immune response leading to PPS. We hypothesized that an
intraoperative dose of dexamethasone decreases the risk of PPS, by
reducing this inflammatory response. Methods We performed a subanalysis of
the DECS study, which is a multicenter, double-blind, placebo-controlled,
randomized trial of 4,494 patients undergoing cardiac surgery with use of
cardiopulmonary bypass. The aim of the DECS study was to investigate
whether a single intraoperative dose of 1 mg/kg dexamethasone reduced the
incidence of a composite of death, myocardial infarction, stroke, renal
failure, or respiratory failure, within 30 days of randomization. In this
substudy, we retrospectively analyzed the occurrence of PPS in 822
patients who were included in the DECS trial and underwent valvular
surgery. Postpericardiotomy syndrome was diagnosed if 2 of 5 listed
symptoms were present: unexplained fever, pleuritic chest pain,
pericardial or pleural rub, new or worsening pericardial or pleural
effusion. All medical charts, x-rays, and echocardiograms were reviewed.
Secondary end point was the occurrence of complicated PPS, defined as PPS
with need for evacuation of pleural effusion, pericardiocentesis, and
tamponade requiring intervention or hospital readmission for PPS. This is
a blinded, single-center, post hoc analysis. Results Postpericardiotomy
syndrome occurred in 119 patients (14.5%). The incidence of PPS after
dexamethasone compared with placebo was 13.5% vs 15.5% (relative risk
0.88, 95% CI 0.63-1.22). For complicated PPS, the incidence was 3.8%
versus 3.2% (relative risk 1.17, 95% CI 0.57-2.41, P =.66), respectively.
Conclusion In patients undergoing valvular cardiac surgery, high-dose
dexamethasone treatment had no protective effect on the occurrence of PPS
or complicated PPS. 2014 Mosby, Inc.

<5>
Accession Number
2014422978
Authors
Lamas G.A. Boineau R. Goertz C. Mark D.B. Rosenberg Y. Stylianou M. Rozema
T. Nahin R.L. Terry Chappell L. Lindblad L. Lewis E.F. Drisko J. Lee K.L.
Institution
(Lamas) Columbia University, Division of Cardiology, Mount Sinai Medical
Center, 4300 Alton Rd, Miami Beach, FL 33140, United States
(Boineau, Rosenberg, Stylianou) National Heart, Lung, and Blood Institute,
Bethesda, MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Nahin) National Center for Complementary and Alternative Medicine,
Bethesda, MD, United States
(Terry Chappell) Celebration of Health Association, Bluffton, OH, United
States
(Lewis) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Drisko) University of Kansas Medical Center, Kansas City, KS, United
States
(Mark, Lindblad, Lee) Duke Clinical Research Institute, Durham, NC, United
States
Title
EDTA chelation therapy alone and in combination with oral high-dose
multivitamins and minerals for coronary disease: The factorial group
results of the Trial to Assess Chelation Therapy.
Source
American Heart Journal. 168 (1) (pp 37-44.e5), 2014. Date of Publication:
July 2014.
Publisher
Mosby Inc.
Abstract
Background Disodium ethylenediaminetetraacetic acid (EDTA) reduced adverse
cardiac outcomes in a factorial trial also testing oral vitamins. This
report describes the intent-to-treat comparison of the 4 factorial groups
overall and in patients with diabetes. Methods This was a double-blind,
placebo-controlled, 2 x 2 factorial multicenter randomized trial of 1,708
post-myocardial infarction (MI) patients >50 years of age and with
creatinine <2.0 mg/dL randomized to receive 40 EDTA chelation or placebo
infusions plus 6 caplets daily of a 28-component multivitamin-multimineral
mixture or placebo. The primary end point was a composite of total
mortality, MI, stroke, coronary revascularization, or hospitalization for
angina. Results Median age was 65 years, 18% were female, 94% were
Caucasian, 37% were diabetic, 83% had prior coronary revascularization,
and 73% were on statins. Five-year Kaplan-Meier estimates for the primary
end point was 31.9% in the chelation + high-dose vitamin group, 33.7% in
the chelation + placebo vitamin group, 36.6% in the placebo infusion +
active vitamin group, and 40.2% in the placebo infusions + placebo vitamin
group. The reduction in primary end point by double active treatment
compared with double placebo was significant (hazard ratio 0.74, 95% CI
0.57-0.95, P =.016). In patients with diabetes, the primary end point
reduction of double active compared with double placebo was more
pronounced (hazard ratio 0.49, 95% CI 0.33-0.75, P 001). Conclusions In
stable post-MI patients on evidence-based medical therapy, the combination
of oral high-dose vitamins and chelation therapy compared with double
placebo reduced clinically important cardiovascular events to an extent
that was both statistically significant and of potential clinical
relevance. 2014, The Authors.

<6>
Accession Number
2014433601
Authors
Urbanowicz T. Baszynska-Wachowiak H. Ligowski M. Straburzynska-Migaj E.
Misterski M. Jemielity M.
Institution
(Urbanowicz, Ligowski, Misterski, Jemielity) Department of Cardiac Surgery
and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
(Baszynska-Wachowiak, Straburzynska-Migaj) Department of Cardiology,
Poznan University of Medical Sciences, Poznan, Poland
Title
Comparison of conventional tacrolimus versus prolong release formula as
initial therapy in heart transplantation.
Source
Annals of Transplantation. 19 (1) (pp 295-299), 2014. Date of Publication:
2014.
Publisher
Medical Science International
Abstract
Background: A new formulation of tacrolimus that is characterized by
prolonged release has been developed to facilitate treatment and patient
compliance. Initial therapy with prolonged release formula in heart
transplantation is not widely accepted. Material/Methods: We enrolled 19
patients into a randomized analysis divided into 2 groups with different
initial regimens. There were 8 patients with a mean age of 44+13 years
treated by Advagraf, and 11 patients with a mean age of 41+9 years treated
by Prograf. Serum concentration of immunosuppressive drug was followed by
its oral dosage and endomyocardial biopsy results. Arterial hypertension,
kidney function, and incidence of diabetes mellitus were recorded.
Results: There were no perioperative deaths. The risk of acute rejection
within 6 months following surgery was 1 (2%) in the Advagraf group and 1
(1.5%) in the Prograf group. Although the serum tacrolimus results were
comparable between groups, the drug's daily dosages were different after 6
months of therapy (3+1 mg in the Advagraf group and 6+2 mg in the Prograf
group (p<0.05). The low rate of adverse effects throughout the study was
noted. Conclusions: Prolonged-release tacrolimus formula is an efficient
immunosuppressant in heart transplantation. Its initial application after
surgery has low risk of adverse effects with similar results to
conventional formula. Ann Transplant.

<7>
Accession Number
2014425380
Authors
Formanek M.B. Herwaldt L.A. Perencevich E.N. Schweizer M.L.
Institution
(Formanek, Herwaldt, Schweizer) College of Public Health, University of
Iowa, Iowa City, IA, United States
(Formanek, Perencevich, Schweizer) Center for Comprehensive Access and
Delivery Research and Evaluation VA Health Care System, Iowa City, IA,
United States
(Herwaldt, Perencevich, Schweizer) Carver College of Medicine, University
of Iowa, Iowa City, IA, United States
Title
Gentamicin/collagen sponge use may reduce the risk of surgical site
infections for patients undergoing cardiac operations: A meta-analysis.
Source
Surgical Infections. 15 (3) (pp 244-255), 2014. Date of Publication: 01
Jun 2014.
Publisher
Mary Ann Liebert Inc.
Abstract
Objective: A meta-analysis of all published randomized controlled trials
of the effectiveness of gentamicin/collagen sponges for preventing
surgical site infections (SSIs). Background: Despite routine use of
systemic prophylactic antimicrobial agents, SSIs continue to be associated
with substantial morbidity. Results conflict of studies of the efficacy of
gentamicin/collagen sponges for preventing SSIs. However, many of these
studies have assessed sponge use in only a single specific type of
operation. The general effect of sponge use among different types of
operations has not been previously assessed. Methods: The PubMed and
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
databases were searched for articles appearing from 1990 through January
2012 that were related to gentamicin/collagen sponge use and SSIs. Summary
estimates were obtained through a random effects model. After reviewing
714 article abstracts and reviewing 22 articles in detail, we pooled the
odds ratios (OR) for 13 independent study populations (cardiac, n=4;
colorectal, n=4; pilonidal sinus, n=2; hernia, n=2; gastrointestinal, n=1)
in which the association between prophylactic use of gentamicin/collagen
sponges and SSIs was assessed. Results: Pooling of the results of all
studies included in the review in a random effects model showed a
significant protective effect of prophylactic use of gentamicin/collagen
sponges against SSI (pooled OR: 0.66; 95% confidence interval [CI]: 0.45,
0.97; n=13). However, when the data were stratified by type of operation,
a significant protective effect was observed in cardiac procedures (pooled
OR: 0.59; 95% CI: 0.37, 0.96; n=4) but not in colorectal procedures
(pooled OR: 0.74; 95% CI: 0.29-1.92; n=4). Conclusion: Use of
gentamicin/collagen sponges was associated with a reduced risk of SSI
following cardiac operations but not following colorectal procedures.
Mary Ann Liebert, Inc.

<8>
Accession Number
2014438272
Authors
Munir M.S. Wang Z. Alahdab F. Steffen M.W. Erwin P.J. Kullo I.J. Murad
M.H.
Institution
(Munir, Steffen, Murad) Division of Preventive Medicine, Mayo Clinic,
Rochester, MN, United States
(Munir) Hospital Medicine, University of Wisconsin Medical Foundation,
Madison, WI, United States
(Wang, Alahdab) Knowledge and Evaluation Research Unit, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Kullo) Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN,
United States
Title
The association of 9p21-3 locus with coronary atherosclerosis: A
systematic review and meta-analysis.
Source
BMC Medical Genetics. 15 (1) , 2014. Article Number: 66. Date of
Publication: 06 Jun 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Studies suggest that the 9p21-3 locus may influence
susceptibility to myocardial infarction. We performed a systematic review
and meta-analysis to assess whether this locus is associated with severity
of coronary atherosclerosis and adverse clinical outcomes in those with
known coronary disease.Methods: Multiple electronic databases were
searched from inception through August 2012. Studies examining 9p21-3
genotype in patients with known coronary artery disease were included. We
extracted the association of the 9p21-3 locus with measures of severity of
coronary atherosclerosis [number of diseased vessels, Gensini Score, Duke
CAD Prognostic Index (DPI)], angiographic outcomes [change in minimum
lumen diameter ({increment}MLD) and number of new lesions at follow-up],
and key clinical outcomes (all-cause mortality, recurrent myocardial
infarction and the need for coronary revascularization). Relative risks
(RR) and weighted mean difference (WMD) were pooled using the random
effects models.Results: 23 cohorts enrolling 16,860 participants were
analyzed. There was no significant difference between HR and LR genotypes
in terms of all-cause mortality, recurrent myocardial infarction or the
frequency of coronary revascularization. HR genotype was associated with
increased risk of triple vessel disease (RR = 1.34; 95% CI 1.08-1.65; P =
0.01) and increased baseline Gensini Score (WMD = 5.30; 95% CI 0.66-9.93;
P = 0.03). However there was no association with DPI (WMD = 4.00; 95% CI
2.94-10.94; P = 0.26). HR genotype did not predict {increment}MLD or
number of new lesions at follow-up.Conclusions: Patients of coronary
atherosclerosis who carry the high risk genotype of the 9p21-3 allele may
be more likely to have multi-vessel CAD. However the effect of this allele
on CAD progression and disease specific clinical outcomes are not observed
possibly due to diminishing genetic risk following dietary modification
and therapy. 2014 Munir et al.; licensee BioMed Central Ltd.

<9>
Accession Number
2014436812
Authors
Davidson L.J. Luna J. Virmani R. Asscher J.A. Davidson C.J.
Institution
(Davidson, Davidson) Feinberg School of Medicine, 676 N. St. Clair,
Chicago, IL 60611, United States
(Luna) Hospital Almater, Medicina Cardiovascular, Col. Nueva, Mexicali,
BC, Mexico
(Virmani) CV Path Institute Inc., Gaithersburg, MD, United States
(Asscher) Department of Quality and Reliability Engineering, Kinneret
College on the Sea of Galilee, M.P. Emek Hayarden, Israel
Title
First human experience of thermal arterial closure.
Source
Catheterization and Cardiovascular Interventions. 84 (1) (pp 30-36), 2014.
Date of Publication: 01 Jul 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study was designed to evaluate the efficacy and safety of
the CardioDex arterial closure device, which is a novel femoral artery
closure device used following percutaneous cardiac catheterization.
Background: Current devices utilized to achieve hemostasis of the femoral
artery following percutaneous cardiac catheterization include collagen
plug and suture mediated devices, but are associated with significant
vascular complications. The CardioDex closure device utilizes thermal
energy to cause collagen shrinking and swelling and thereby, achieve
hemostasis. Methods: The device was evaluated in a prospective
nonrandomized single-center trial with patients undergoing 6F invasive
cardiac procedures. Femoral artery puncture closure was performed
immediately at completion of the procedure, followed by 3-4 minutes of
manual compression. Time to hemostasis (TTH), time to ambulation (TTA),
and short-term clinical follow-up data were collected. Results: A total of
34 patients including 21 diagnostic and 13 interventional cases were
evaluated. The median TTH was 3 min in diagnostic and 4 min in
interventional cases. TTH was independent of activated clotting time
(ACT). The median TTA was 2.75 hr and 3.37 hr in diagnostic and
interventional groups, respectively. There were no major adverse events
identified at 1 week and 30 day follow up. Conclusions: This first in
human clinical experience with the CardioDex closure device demonstrates
that in the small cohort studied, it is safe and effective in diagnostic
cardiac catheterization and also in interventional cases on mild
anticoagulation (mean ACT = 188 sec). It has the advantage of leaving no
foreign material in the body following use. 2013 Wiley Periodicals, Inc.

<10>
Accession Number
2014434123
Authors
Zhang H. Wang Z.W. Wu H.B. Hu X.P. Zhou Z. Xu P.
Institution
(Zhang, Wang, Wu, Hu, Zhou, Xu) Department of Cardiothoracic Surgery,
Renmin Hospital, Wuhan University, 99 Ziyang Road, 430060 Wuhan, Hubei
Province, China
Title
Radial artery graft vs. saphenous vein graft for coronary artery bypass
surgery. Which conduit offers better efficacy?.
Source
Herz. 39 (4) (pp 458-465), 2014. Date of Publication: June 2014.
Publisher
Urban und Vogel GmbH
Abstract
Objectives. Coronary artery bypass grafting (CABG) is the best therapeutic
option for multivessel coronary artery diseases. The internal thoracic
artery is usually used for the left anterior descending coronary artery.
However, it is still not clear what the best conduit is for non-left
anterior descending coronary arteries. This research sought to assess the
efficacy of the radial artery versus the saphenous vein in this context.
Methods. A systematic literature search was performed for randomized
clinical trials (RCT) published in MEDLINE, EMBASE, and the Cochrane
Library. RCTs reporting angiographic comparisons and clinical events of
the radial artery versus the saphenous vein were included. Results. Six
trials (1,860 participants, 1,188 radial artery grafts, 1,178 saphenous
vein grafts) were included in this review. The radial artery was
associated with a significantly lower incidence of graft failure (p<0.05)
and of repeat coronary operation (p<0.05). There was no significant trend
toward decreased cardiac death and myocardial infarction with the use of a
radial artery (p>0.05; p>0.05). As determined by the GRADE method, the
evidence quality was low for repeat operation and very low for other
variables. Conclusion. The radial artery can be weakly recommended as a
selective conduit but cannot always be considered better than the
saphenous vein. 2013 Urban & Vogel.

<11>
Accession Number
2014436163
Authors
Mbuagbaw L. Forlemu-Kamwa D. Chu A. Thabane L. Dillenberg R.
Institution
(Mbuagbaw, Thabane) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
(Mbuagbaw, Thabane) Biostatistics Unit, Father Sean o'Sullivan Research
Centre, St. Joseph's Healthcare, Hamilton, ON, Canada
(Mbuagbaw) Centre for Development of Best Practices in Health, Yaounde
Central Hospital, Yaounde, Cameroon
(Forlemu-Kamwa) Faculty of Health Sciences, McMaster University, Hamilton,
ON, Canada
(Chu) Michael G DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Thabane, Dillenberg) Departments of Paediatrics and Anaesthesia, McMaster
University, Hamilton, ON, Canada
(Thabane) Centre for Evaluation of Medicines, St. Joseph's Healthcare,
Hamilton, ON, Canada
(Thabane) Population Health Research Institute, Hamilton Health Sciences,
Hamilton, ON, Canada
Title
Outcomes after corrective surgery for congenital dextro-transposition of
the great arteries using the arterial switch technique: A protocol for a
scoping systematic review.
Source
BMJ Open. 4 (6) , 2014. Article Number: e005123. Date of Publication:
2014.
Publisher
BMJ Publishing Group
Abstract
Introduction: Dextro-transposition of the great arteries (d-TGA) is a
life-threatening congenital health defect that requires rapid surgery. The
most widely used approach is the arterial switch operation (ASO) developed
by Jatene in the 1970s. The first set of children who received this
intervention are now adults. The objective of this scoping review of the
literature was to document the short-term (less than 1 year), medium-term
(1-20 years) and long-term (more than 20 years) outcomes in children who
underwent the ASO. Our primary income is survival, but we will explore
other secondary surgical, cardiovascular, reproductive and quality-of-life
outcomes. Methods and analyses: Using a systematic scoping review
approach, we will conduct a systematic search of the published literature
for experimental and observational studies published on children who
received the ASO intervention for classic d-TGA. We will search MEDLINE,
Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied
Health Literature (CINAHL) and Literatura Latino Americana em Ciencias da
Saude (LILACS) from 1973 (date of the first successful ASO) to February
2014. Identified articles will be screened in duplicate and full text for
selected articles will be retrieved. Data extraction will be carried out
in duplicate. Discrepancies will be resolved by consensus or by consulting
a third author. Where possible, proportions will be pooled using the
inverse variance method. Our findings will be reported according to the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) and Meta-analysis Of Observational studies in Epidemiology
(MOOSE) guidelines. Ethics and dissemination: The results of this paper
will be disseminated as peer-reviewed publications, at conferences and at
clinical rounds. Our findings may answer important questions for surgeons
who perform the ASO intervention and for clinicians who take care of
patients after surgery and throughout their lifespans. Trial Registration
number: Prospero/CRD42014007590.

<12>
Accession Number
2014434398
Authors
Yin Y. Zhang Y. Zhao X.
Institution
(Yin, Zhao) Cardiovascular Disease Research Center, Xinqiao Hospital,
Third Military Medical University, Chongqing, China
(Zhang) Evidence Based Medicine and Clinic Epidemiology Center, Third
Military Medical University, Chongqing, China
Title
Safety and efficacy of biodegradable drug-eluting vs. Bare metal stents: A
meta-analysis from randomized trials.
Source
PLoS ONE. 9 (6) , 2014. Article Number: e99648. Date of Publication: 19
Jun 2014.
Publisher
Public Library of Science
Abstract
Background: Biodegradable polymeric coatings have been proposed as a
promising strategy to enhance biocompatibility and improve the delayed
healing in the vessel. However, the efficacy and safety of biodegradable
polymer drug-eluting stents (BP-DES) vs. bare metal stents (BMS) are
unknown. The aim of this study was to perform a meta-analysis of
randomized controlled trials (RCTs) comparing the outcomes of BP-DES vs.
BMS. Methods and Results: PubMed, Embase, and Cochrane Central Register of
Controlled Trials (CENTRAL) were searched for randomized clinical trials,
until December 2013, that compared any of approved BP-DES and BMS.
Efficacy endpoints were target-vessel revascularization (TVR),
target-lesion revascularization (TLR) and in-stent late loss (ISLL).
Safety endpoints were death, myocardial infarction (MI), definite stent
thrombosis (DST). The meta-analysis included 7 RCTs with 2,409 patients.
As compared with BMS, there was a significantly reduced TVR (OR [95% CI] =
0.37 [0.28-0.50]), ISLL (OR [95% CI] = -0.41 [-0.48-0.34]) and TLR (OR
[95% CI] = 0.38 [0.27-0.52]) in BP-DES patients. However, there were no
difference for safety outcomes between BP-DES and BMS. Conclusions: BP-DES
is more effective in reducing ISLL, TVR and TLR, as safe as standard BMS
with regard to death, ST and MI. Further large RCTs with long-term
follow-up are warranted to better define the relative merits of BP-DES.
2014 Yin et al.

<13>
Accession Number
2014432865
Authors
Schricker T. Sato H. Beaudry T. Codere T. Hatzakorzian R. Pruessner J.C.
Institution
(Schricker, Codere, Hatzakorzian) Department of Anesthesia, Faculty of
Medicine, McGill University, Montreal, QC, Canada
(Sato) Department of Anesthesiology, Yamanashi University, Yamanashi,
Japan
(Beaudry, Pruessner) Department of Psychiatry, Faculty of Medicine, McGill
University, Montreal, QC, Canada
Title
Intraoperative maintenance of normoglycemia with insulin and glucose
preserves verbal learning after cardiac surgery.
Source
PLoS ONE. 9 (6) , 2014. Article Number: e99661. Date of Publication: 18
Jun 2014.
Publisher
Public Library of Science
Abstract
Objective: The hyperglycemic response to surgery may be a risk factor for
cognitive dysfunction. We hypothesize that strict maintenance of
normoglycemia during cardiac surgery preserves postoperative cognitive
function. Methods: As part of a larger randomized, single-blind,
interventional efficacy study on the effects of hyperinsulinemic glucose
control in cardiac surgery (NCT00524472), consenting patients were
randomly assigned to receive combined administration of insulin and
glucose, titrated to preserve normoglycemia (3.5-6.1 mmol L ^-1;
experimental group), or standard metabolic care (blood glucose 3.5-10 mmol
L^-1; control group), during open heart surgery. The patients'
cognitive function was assessed during three home visits, approximately
two weeks before the operation, and two months and seven months after
surgery. The following tests were performed: Rey Auditory Verbal Learning
Task (RAVLT for verbal learning and memory), Digit Span Task (working
memory), Trail Making A & B (visuomotor tracking and attention), and the
Word Pair Task (implicit memory). Questionnaires measuring specific traits
known to affect cognitive performance, such as self-esteem, depression,
chronic stress and social support, were also administered. The primary
outcome was to assess the effect of hyperinsulinemic-normoglycemic clamp
therapy versus standard therapy on specific cognitive parameters in
patients receiving normoglycemic clamp, or standard metabolic care.
Results: Twenty-six patients completed the study with 14 patients in the
normoglycemia and 12 patients in the control group. Multiple analysis of
covariance (MANCOVA) for the RAVLT showed a significant effect for the
interaction of group by visit (F = 4.07, p = 0.035), and group by visit by
recall (F = 2.21, p = 0.04). The differences occurred at the second and
third visit. MANCOVA for the digit span task, trail making and word pair
association test showed no significant effect. Conclusions: Preserving
intraoperative normoglycemia by intravenous insulin and glucose may
prevent the impairment of memory function, both short and long-term, after
cardiac surgery. 2014 Schricker et al.

<14>
Accession Number
2014432608
Authors
Windecker S. Stortecky S. Stefanini G.G. DaCosta B.R. Rutjes A.W. Di Nisio
M. Siletta M.G. Maione A. Alfonso F. Clemmensen P.M. Collet J.-P. Cremer
J. Falk V. Filippatos G. Hamm C. Head S. Kappetein A.P. Kastrati A. Knuuti
J. Landmesser U. Laufer G. Neumann F.-J. Richter D. Schauerte P. Uva M.S.
Taggart D.P. Torracca L. Valgimigli M. Wijns W. Witkowski A. Kolh P. Juni
P.
Institution
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Department of Cardiology, University Hospital Bern, Bern
University Hospital, 3010 Bern, Switzerland
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Title
Revascularisation versus medical treatment in patients with stable
coronary artery disease: Network meta-analysis.
Source
BMJ (Online). 348 , 2014. Article Number: g3859. Date of Publication: 23
Jun 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: To investigate whether revascularisation improves prognosis
compared with medical treatment among patients with stable coronary artery
disease. Design: Bayesian network meta-analyses to combine direct within
trial comparisons between treatments with indirect evidence from other
trials while maintaining randomisation. Eligibility criteria for selecting
studies: A strategy of initial medical treatment compared with
revascularisation by coronary artery bypass grafting or Food and Drug
Administration approved techniques for percutaneous revascularization:
balloon angioplasty, bare metal stent, early generation paclitaxel eluting
stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent,
and new generation everolimus eluting stent, and zotarolimus eluting
(Resolute) stent among patients with stable coronary artery disease. Data
sources: Medline and Embase from 1980 to 2013 for randomised trials
comparing medical treatment with revascularisation. Main outcome measure:
All cause mortality. Results: 100 trials in 93 553 patients with 262 090
patient years of follow-up were included. Coronary artery bypass grafting
was associated with a survival benefit (rate ratio 0.80, 95% credibility
interval 0.70 to 0.91) compared with medical treatment. New generation
drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus
(Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to
1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug
eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to
1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with
improved survival compared with medical treatment. Coronary artery bypass
grafting reduced the risk of myocardial infarction compared with medical
treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a
trend towards a reduced risk of myocardial infarction (0.75, 0.55 to
1.01). The risk of subsequent revascularisation was noticeably reduced by
coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new
generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to
0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting
stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24
to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69,
0.59 to 0.81) compared with medical treatment. Conclusion: Among patients
with stable coronary artery disease, coronary artery bypass grafting
reduces the risk of death, myocardial infarction, and subsequent
revascularisation compared with medical treatment. All stent based
coronary revascularisation technologies reduce the need for
revascularisation to a variable degree. Our results provide evidence for
improved survival with new generation drug eluting stents but no other
percutaneous revascularisation technology compared with medical treatment.

<15>
Accession Number
2014430068
Authors
Saito S. Isshiki T. Kimura T. Ogawa H. Yokoi H. Nanto S. Takayama M.
Kitagawa K. Nishikawa M. Miyazaki S. Nakamura M.
Institution
(Saito) Division of Cardiology, Shonan Kamakura General Hospital,
Kamakura, Japan
(Isshiki) Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
(Kimura) Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Ogawa) Department of Cardiovascular Medicine, Graduate School of Medical
Sciences, Kumamoto University, Kumamoto, Japan
(Ogawa) National Cerebral and Cardiovascular Center, Suita, Japan
(Yokoi) Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka,
Japan
(Yokoi) International University of Health and Welfare, Ohtawara, Japan
(Nanto) Department of Advanced Cardiovascular Therapeutics, Graduate
School of Medicine, Osaka University, Suita, Japan
(Takayama) Sakakibara Heart Institute, Tokyo, Japan
(Kitagawa) Department of Neurology, Graduate School of Medicine, Osaka
University, Suita, Japan
(Nishikawa) Institute of Human Research Promotion and Drug Development,
Mie University, Tsu, Japan
(Miyazaki) Division of Cardiology, Department of Medicine, Kinki
University, Osakasayama, Japan
(Nakamura) Division of Cardiovascular Medicine, Ohashi Medical Center,
Toho University, Tokyo, Japan
Title
Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel
in Japanese patients with acute coronary syndrome - The PRASFIT-ACS study
-.
Source
Circulation Journal. 78 (7) (pp 1684-1692), 2014. Date of Publication:
2014.
Publisher
Japanese Circulation Society
Abstract
Background: Prasugrel is an antiplatelet agent that shows more prompt,
potent, and consistent platelet inhibition than clopidogrel. The objective
of this study was to confirm the efficacy and safety of prasugrel at
loading/maintenance doses of 20/3.75 mg. Methods and Results: Japanese
patients (n=1,363) with acute coronary syndrome undergoing percutaneous
coronary intervention were randomized to either prasugrel (20/3.75 mg) or
clopidogrel (300/75 mg), both in combination with aspirin (81-330 mg for
the first dose and 81-100 mg/day thereafter), for 24-48 weeks. The primary
efficacy endpoint was the incidence of major adverse cardiovascular events
(MACE) at 24 weeks, defined as a composite of cardiovascular death,
nonfatal myocardial infarction, and nonfatal ischemic stroke. We compared
the incidence of MACE between the 2 groups using point estimates. Safety
outcomes included the incidence of bleeding events until 2 weeks after the
last dose. The incidence of MACE at 24 weeks was 9.4% in the prasugrel
group and 11.8% in the clopidogrel group (risk reduction 23%, hazard ratio
0.77, 95% confidence interval 0.56-1.07). The incidence of non-coronary
artery bypass graft-related major bleeding was similar in both groups
(1.9% vs. 2.2%). Conclusions: Prasugrel 20/3.75 mg was associated with a
low incidence of ischemic events, similar to the results of TRITON-TIMI
38, and with a low risk of clinically serious bleeding in Japanese ACS
patients.

<16>
Accession Number
2014422698
Authors
Cornu C. Dufays C. Gaillard S. Gueyffier F. Redonnet M. Sebbag L.
Roussoulieres A. Gleissner C.A. Groetzner J. Lehmkuhl H.B. Potena L.
Gullestad L. Cantarovich M. Boissonnat P.
Institution
(Cornu, Dufays, Gaillard, Gueyffier) INSERM, CIC201, Hopital Louis Pradel,
28 Avenue du Doyen Lepine, F-69677 Bron, France
(Cornu, Dufays, Gaillard, Gueyffier) CHU Lyon, Service de Pharmacologie
Clinique, Lyon, France
(Cornu, Dufays, Gaillard, Gueyffier) Universite de Lyon, UMR 5558, Lyon,
France
(Cornu, Dufays, Gaillard, Gueyffier) Hospices Civils de Lyon, Hopital
Louis Pradel, Bron cedex, France
(Redonnet) Departement de Chirurgie Cardiaque, Hopital Charles Nicolle,
Universite de Rouen, Rouen, France
(Sebbag, Roussoulieres, Boissonnat) Hospices Civils de Lyon, Hopital Louis
Pradel, Pole Medico-chirurgical de Transplantation Cardiaque Adulte, Bron
cedex, France
(Gleissner) Department of Cardiology, Angiology and Pneumonology,
University of Heidelberg, Heidelberg, Germany
(Groetzner) Department of Cardiac Surgery, Ludwig-Maximilians-University
Grosshadern, Munich, Germany
(Lehmkuhl) Deutsches Herzzentrum Berlin, Berlin, Germany
(Potena) Dipartimento Cardiovascolare, Policlinico S. Orsola-Malpighi,
Bologna, Italy
(Gullestad) Department of Cardiology, Oslo University Hospital,
Rikshospitalet Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
(Cantarovich) Department of Medicine, McGill University Health Center,
Royal Victoria Hospital, Montreal QC, Canada
Title
Impact of the reduction of calcineurin inhibitors on renal function in
heart transplant patients: A systematic review and meta-analysis.
Source
British Journal of Clinical Pharmacology. 78 (1) (pp 24-32), 2014. Date of
Publication: July 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Aims Calcineurin inhibitors (CNIs) taken after heart transplantation lead
to excellent short-term outcomes, but long-term use may cause chronic
nephrotoxicity. Our aim was to identify, appraise, select and analyse all
high-quality research evidence relevant to the question of the clinical
impact of CNI-sparing strategies in heart transplant patients. Methods We
carried out a systematic review and meta-analysis of randomized controlled
trials on CNI reduction in heart transplant recipients. Primary outcomes
were kidney function and acute rejection after 1 year. Secondary outcomes
included graft loss, all-cause mortality and adverse events. Results Eight
open-label studies were included, with 723 patients (four tested de novo
CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor
reduction did not improve creatinine clearance at 12 months 5.46 [-1.17,
12.03] P-=-0.32 I ²-=-65.4%. Acute rejection at 12 months
(55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates
(55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI
groups. There was significant benefit on creatinine clearance in patients
with impaired renal function at 6 months [+12.23 (+5.26, +18.82)
ml-min^-1, P = 0.0003] and at 12 months 4.63 [-4.55, 13.82]
P-=-0.32 I²-=-75%. Conclusions This meta-analysis did not
demonstrate a favourable effect of CNI reduction on kidney function, but
there was no increase in acute rejection. To provide a better analysis of
the influence of CNI reduction patterns and associated treatments, a
meta-analysis of individual patient data should be performed. 2013 The
British Pharmacological Society.

<17>
Accession Number
2014423105
Authors
Dulfer K. Duppen N. Kuipers I.M. Schokking M. Van Domburg R.T. Verhulst
F.C. Helbing W.A. Utens E.M.W.J.
Institution
(Dulfer, Utens) Department of Child and Adolescent Psychiatry/Psychology,
Erasmus Medical Center, Sophia Children's Hospital, P.O. Box 2060, 3000
CB, Rotterdam, Netherlands
(Duppen, Helbing) Department of Paediatrics, Erasmus Medical Center,
Sophia Children's Hospital, Rotterdam, Netherlands
(Kuipers) Department of Pediatric Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Schokking) Department of Pediatric Cardiology, Radboud University,
Nijmegen Medical Centre, Nijmegen, Netherlands
(Van Domburg) Department of Cardiology-Thoraxcenter, Erasmus Medical
Center, Rotterdam, Netherlands
(Verhulst) Erasmus MC-Sophia Children's Hospital, Department of Child and
Adolescent Psychiatry/Psychology, P.O. Box 2060, 3000 CB, Rotterdam,
Netherlands
Title
Aerobic exercise influences quality of life of children and youngsters
with congenital heart disease: A randomized controlled trial.
Source
Journal of Adolescent Health. 55 (1) (pp 65-72), 2014. Date of
Publication: July 2014.
Publisher
Elsevier USA
Abstract
Purpose To evaluate effects of an exercise program on health-related
quality of life (HRQoL) in children and adolescents with tetralogy of
Fallot (ToF) or a Fontan circulation. Methods Stratified, randomized,
controlled intervention study conducted in five participating centers of
pediatric cardiology in The Netherlands. In total, 93 patients, aged 10-25
years, with surgical repair for tetralogy of Fallot or with a Fontan
circulation for single-ventricle physiology were included. They were
randomly allocated with a ratio of 2:1 to: (1) a 12-week period with an
exercise program for 3 times per week or (2) to a control group.
Randomization was stratified by age, gender, and cardiac diagnosis. At
baseline and follow-up after 12 weeks, all participants completed
Web-based age-appropriate HRQoL questionnaires. Primary analyses involved
change in HRQoL during follow-up. Secondary analyses concerned influence
of cardiac diagnosis and comparison with normative data. Results
Forty-eight (86%) and 32 (86%) patients in the exercise-group and
control-group respectively completed all questionnaires at baseline and
follow-up. Compared with the control-group, children, aged 10-15 years, in
the exercise-group improved significantly on self-reported cognitive
functioning, p <.05, r =.30, and parent-reported social functioning, p
<.05, r =.30. Youngsters aged 16-25 years did not change their HRQoL.
Cardiac diagnosis had no influence on pre/post changes. Children and
youngsters in this study reported comparable or better HRQoL than norm
groups. Conclusions Participation in an exercise program improved HRQoL of
children with ToF or a Fontan circulation, especially in those with low
baseline QoL. 2014 Society for Adolescent Health and Medicine. All rights
reserved.

<18>
Accession Number
2014430729
Authors
Park K.W. Kang S.-H. Kang H.-J. Koo B.-K. Park B.-E. Cha K.S. Rhew J.Y.
Jeon H.-K. Shin E.-S. Oh J.H. Jeong M.-H. Kim S. Hwang K.-K. Yoon J.-H.
Lee S.Y. Park T.-H. Moon K.W. Kwon H.-M. Hur S.-H. Ryu J.-K. Lee B.-R.
Park Y.W. Chae I.-H. Kim H.-S.
Institution
(Park, Kang, Kang, Koo, Kim) Department of Internal Medicine,
Cardiovascular Center, Seoul National University Hospital, 101 Daehakro,
Jongro Gu, Seoul 110-744, South Korea
(Park) Dankook University Hospital, Cheonan, South Korea
(Cha) Busan National University Hospital, Busan, South Korea
(Rhew) Presbyterian Medical Center, Jeonju, South Korea
(Jeon) Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea
(Shin) Ulsan University Hospital, Ulsan, South Korea
(Oh) Samsung Changwon Hospital, Changwon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Kim) Boramae Medical Center, Seoul, South Korea
(Hwang) Chungbuk National University Hospital, Cheongju, South Korea
(Yoon) Wonju Christian Hospital, Wonju, South Korea
(Lee) Inje University, Ilsan Paik Hospital, Goyang, South Korea
(Park) Dong-A Medical Center, Busan, South Korea
(Moon) St. Vincent's Hospital, Suwon, South Korea
(Kwon) Gangnam Severance Hospital, Seoul, South Korea
(Hur) Keimyung University, Dongsan Medical Center, Daegu, South Korea
(Ryu) Daegu Catholic University Medical Center, Daegu, South Korea
(Lee) Daegu Fatima Hospital, Daegu, South Korea
(Park) Gyeongsang National University Hospital, Jinju, South Korea
(Chae) Seoul National University, Bundang Hospital, Seongnam, South Korea
Title
A randomized comparison of platinum chromium-based everolimus-eluting
stents versus cobalt chromium-based zotarolimus-eluting stents in
all-comers receiving percutaneous coronary intervention: HOST-ASSURE
noninferiority trial.
Source
Journal of the American College of Cardiology. 63 (25 PART A) (pp
2805-2816), 2014. Date of Publication: 01 Jul 2014.
Publisher
Elsevier USA
Abstract
Objectives This study sought to test whether the newly developed platinum
chromium (PtCr)-based everolimus-eluting stent (EES) is noninferior to the
cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers
receiving percutaneous coronary intervention (PCI). Background PtCr
provides improved radial strength, conformability, and visibility compared
with the CoCr alloy, but PtCr-based stents have not been tested in a wide
range of patients receiving PCI. Also, recent case series have raised the
issue of longitudinal stent deformation (LSD) with newer drug-eluting
stents. Methods We randomly assigned 3,755 all-comers receiving PCI to
PtCr-EES or CoCr-ZES. The primary outcome was target lesion failure (TLF)
at 1-year post-PCI, defined as the composite of cardiac death, nonfatal
target vessel-related myocardial infarction, and ischemia-driven target
lesion revascularization. Post-hoc angiographic analysis was performed to
qualitatively and quantitatively analyze LSD. Results At 1 year, TLF
occurred in 2.9% and 2.9% of the population in the PtCr-EES and CoCr-ZES
groups, respectively (superiority p = 0.98, noninferiority p = 0.0247).
There were no significant differences in the individual components of TLF
as well as the patient-oriented clinical outcome. Of 5,010 stents
analyzed, LSD occurred in 0.2% and 0% in the PtCr-EES and CoCr-ZES groups,
respectively (p = 0.104). There was no significant difference in
post-deployment stent length ratio between the 2 stents (p = 0.352).
Conclusions At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers
receiving PCI. Although LSD was observed only in PtCr-EES, both the stent
length ratio and the frequency of LSD were not significantly different
between the 2 stent types, and PtCr-EES was not associated with adverse
clinical outcomes. (Harmonizing Optimal Strategy for Treatment of Coronary
Artery Stenosis-SAfety & EffectiveneSS of Drug-ElUting Stents &
Anti-platelet REgimen [HOST-ASSURE]; NCT01267734). 2014 by the American
College of Cardiology Foundation. Published by Elsevier Inc.

<19>
Accession Number
2014430720
Authors
Xu B. Yang Y.-J. Han Y.-L. Lu S.-Z. Li B. Liu Q. Zhu G.-Y. Cui J.-Y. Li L.
Zhao Y.L. Kirtane A.J.
Institution
(Xu, Yang, Zhao) Fu Wai Hospital, National Center for Cardiovascular
Diseases, A167, Beilishi Road, Beijing, 100037, China
(Han) Shenyang Northern Hospital, Shenyang, China
(Lu) An Zhen Hospital of Capital Medical University, Beijing, China
(Li) Shanxi Provincial Cardiovascular Institute, Taiyuan, China
(Liu) Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
(Zhu) Wuhan Asia Heart Hospital, Wuhan, China
(Cui) Beijing Military General Hospital, Beijing, China
(Li) Hospital of Guangxi Medical University, Nanning, China
(Kirtane) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
Title
Validation of residual SYNTAX score with second-generation drug-eluting
stents: One-year results from the prospective multicentre SEEDS study.
Source
EuroIntervention. 10 (1) (pp 65-73), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: The SYNTAX score has been proposed as a valuable tool to
characterise coronary anatomy prospectively based on its complexity. This
study evaluated the prognostic value on adverse outcomes of the residual
SYNTAX score (rSS) in patients with complex lesions treated with an
everolimus-eluting stent (EES). Methods and results: One thousand eight
hundred and fifty-one patients with small vessel (reference diameter >2.75
mm), long lesion (length <25 mm), or multivessel (<2 target vessels)
disease who underwent percutaneous coronary intervention (PCI) with EES in
the prospective SEEDS (A Registry To Evaluate Safety And Effectiveness Of
Everolimus Drug Eluting Stent For Coronary Revascularization) trial were
categorised into low (>6), mid (<6->12) and high (<12) baseline SYNTAX
score (bSS) groups, and into low (=0), mid (<0->5) and high (<5) rSS
groups. Mean bSS and rSS were 10.87+7.26 and 2.18+3.97, respectively; 64%
of patients had complete revascularisation (rSS=0). At 12 months the
primary outcome of ischaemia- driven target vessel failure (TVF, composite
of cardiac death, target vessel myocardial infarction and ischaemia-driven
target vessel revascularisation) was significantly higher in the high bSS
and rSS groups than in the respective lower groups (p>0.01 for both). In
multivariable analysis, rSS was an independent predictor of TVF (hazard
ratio: 1.403, 95% confidence interval: 1.081 to 1.820, p=0.01).
Conclusions: Twelve-month TVF was significantly higher in the highest rSS
group; rSS with a cut-off of 5 might therefore allow the risk
stratification of patients with complex lesions treated with a
second-generation drug-eluting stent (ClinicalTrials.gov identifier: NCT
01157455). Europa Digital & Publishing 2014.

<20>
Accession Number
2014424690
Authors
Sa M.P.B.D.O. Ferraz P.E. Escobar R.R. Nunes E.O. Lustosa P. Vasconcelos
F.P. Lima R.C.
Institution
(Sa, Ferraz, Escobar, Nunes, Lustosa, Vasconcelos, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Sa, Ferraz, Escobar, Nunes, Lustosa, Vasconcelos, Lima) University of
Pernambuco - UPE, Recife, Brazil
(Sa, Ferraz, Escobar, Lima) Nucleus of Postgraduate and Research in Health
Sciences, Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
Title
Patency of skeletonized versus pedicled internal thoracic artery in
coronary bypass graft surgery: A systematic review, meta-analysis and
meta-regression.
Source
International Journal of Surgery. 12 (7) (pp 666-672), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ltd
Abstract
Background: It is suggested that the skeletonization harvesting technique
influences the patency rates of internal thoracic artery (ITA) after
coronary artery bypass graft (CABG) surgery in comparison to conventional
(pedicled) harvesting. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled ITA in terms
of patency after CABG. Methods: We performed a systematic-review using
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles to search for studies that performed
angiographic evaluation within the first two years after CABG between
these two groups until December 2013. The principal summary measures were
odds ratio (OR) with 95% Confidence Interval (CI) and P values
(statistically significant when <0.05). The OR's were combined across
studies using weighted DerSimonian-Laird random effects model and weighted
Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and
meta-regression were completed using the software Comprehensive
Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey). Results:
Five studies involving 1764 evaluated conduits (1145 skeletonized; 619
pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of effects among the studies. The overall OR (95%
CI) for graft occlusion showed no statistical significant difference
between groups (fixed effect model: OR 1.351, 95% CI 0.408 to 4.471, P =
0.801; random effect model: OR 1.351, 95% CI 0.408 to 4.471, P = 0.801).
In sensitivity analysis, no difference regarding to left or right ITA was
also observed. In meta-regression, we observed no statistically
significant coefficients for graft occlusion and proportion of female,
diabetics, renal failure, age, off-pump surgery or urgency, which means
that the effect is not modulated by these factors. Conclusion: In terms of
patency, skeletonized ITA appears to be non-inferior in comparison to
pedicled ITA after CABG. 2014 Surgical Associates Ltd.

<21>
Accession Number
2014426560
Authors
Lu D. Nie X. Wan J. He S. Du S. Zhang Z. Wang Z. Wang W.
Institution
(Lu, Wan, He, Du, Zhang, Wang, Wang) Department of Cardiovascular and
Thoracic Surgery, Nanfang Hospital, Southern Medical University, 1838 N,
Guangzhou Avenue, Guangzhou 510515, China
(Nie) Department of Neurology, Nanfang Hospital, Southern Medical
University, Guangzhou 510515, China
Title
Is off-pump coronary artery bypass grafting superior to drug-eluting
stents for the treatment of coronary artery disease? A meta-analysis of
randomized and nonrandomized studies.
Source
International Journal of Cardiology. 174 (3) (pp 640-653), 2014. Date of
Publication: 01 Jul 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background As drug-eluting stent (DES) has almost overcome the
disadvantage of frequent restenosis, off-pump coronary artery bypass
grafting (OPCAB) has been introduced to avoid complications of
cardiopulmonary bypass. However, which approach may promise better
outcomes for patients with coronary artery disease remains controversial.
Methods Three databases were searched. The outcomes of interest were major
adverse cardiac and cerebrovascular events (MACCE), all-cause death,
target vessel revascularization (TVR), repeat revascularization (RRV),
myocardial infarction (MI), and cerebrovascular events (CVE). The relative
risk (RR) was calculated as the summary statistic. Results 11,452 patients
from 22 studies were included, of which 4949 patients underwent OPCAB and
6503 patients received DES. The cumulative rates of MACCE (RR [95% CI] =
0.43 [0.34, 0.54], P < 0.00001), all-cause death (RR [95% CI] = 0.56
[0.33, 0.96], P = 0.03), TVR (RR [95% CI] = 0.33 [0.21, 0.53], P <
0.00001), RRV (RR [95% CI] = 0.22 [0.11, 0.42], P < 0.00001) and MI (RR
[95% CI] = 0.13 [0.05, 0.29], P < 0.00001) at 3 years were all lower in
OPCAB group. The incidences of in-hospital death (RR [95% CI] = 1.31
[0.81, 2.13], P = 0.27) and MI (RR [95% CI] = 1.03 [0.60, 1.78], P = 0.92)
were not different between groups, but the rate of in-hospital CVE was
lower (RR [95% CI] = 2.6355 [1.0033, 6.9228], P = 0.05) in DES group.
Conclusions OPCAB presents better long-term outcomes of MACCE, all-cause
mortality, TVR, RRV and MI but uncertain outcome of postoperative CVE
without influencing the incidences of in-hospital death and MI. 2014
Elsevier Ireland Ltd.

<22>
Accession Number
2014426551
Authors
Stabile E. Pucciarelli A. Cota L. Sorropago G. Tesorio T. Salemme L.
Popusoi G. Ambrosini V. Cioppa A. Agrusta M. Catapano D. Moscariello C.
Trimarco B. Esposito G. Rubino P.
Institution
(Stabile, Trimarco, Esposito) Department of Advanced Biomedical Sciences,
University of Napoli Federico II, Via S. Pansini 5, 80131 Napoli, Italy
(Pucciarelli, Cota, Sorropago, Tesorio, Salemme, Popusoi, Ambrosini,
Cioppa, Rubino) Laboratory of Invasive Cardiology, Clinica Montevergine,
Mercogliano, Italy
(Agrusta) Coronary Care Unit, Clinica Montevergine, Mercogliano, Italy
(Catapano, Moscariello) Intensive Care Unit, Clinica Montevergine,
Mercogliano, Italy
Title
SAT-TAVI (single antiplatelet therapy for TAVI) study: A pilot randomized
study comparing double to single antiplatelet therapy for transcatheter
aortic valve implantation.
Source
International Journal of Cardiology. 174 (3) (pp 624-627), 2014. Date of
Publication: 01 Jul 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background Common clinical practice recommends dual antiplatelet therapy
(DAPT) for transcatheter aortic valve implantation (TAVI). The aim of the
study was to evaluate, in a double blind randomized study, the safety of
TAVI, with adjunctive pharmacotherapy consisting of single antiplatelet
therapy. Methods and results From April 2010 to April 2011, 120
consecutive patients, undergoing TAVI, have been enrolled in the study.
Patients were randomly assigned to DAPT group (aspirin and clopidogrel 75
mg/qd or ticlopidine 500 mg/bid) or ASA group (aspirin only). TAVI device
was the Sapien XT-Novaflex Delivery System (Edwards Lifesciences, Inc.).
All patients were followed up to 6 months. Device success was achieved in
100% of patients. No difference in the VARC combined 30 day safety
endpoint, all cause and cardiovascular mortality was observed. At 30 days
vascular complications were reduced in the ASA group (p < 0.05). No
differences in the clinical status were detected between the groups up to
6 months. Conclusions This study suggests that TAVI procedures can be
performed without DAPT without increasing the morbidity and mortality.
These findings, if confirmed in a larger multicenter randomized trial,
will no longer support the use of DAPT for TAVI. 2014 Elsevier Ireland
Ltd.

<23>
Accession Number
2014424525
Authors
Uribe L.G. Cortes J.A. Granados C.E. Montoya J.G.
Institution
(Uribe, Montoya) Department of Medicine, Division of Infectious Diseases
and Geographic Medicine, Stanford University School of Medicine, Stanford,
CA, United States
(Uribe, Cortes, Granados) Department of Internal Medicine, School of
Medicine, Universidad Nacional de Colombia, Bogota, Colombia
(Uribe) Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia
Title
Antifungal prophylaxis following heart transplantation: Systematic review.
Source
Mycoses. 57 (7) (pp 429-436), 2014. Date of Publication: July 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Patients with heart transplantation have a high incidence of infectious
complications, especially fungal infections. The aim of the systematic
review was to determine the best pharmacological strategy to prevent
fungal infections among patients with heart transplant. We searched the
PubMed and Embase databases for studies reporting the effectivenesss of
pharmacologic strategies to prevent fungal infections in adult patient
with a heart transplant. Our search yielded five studies (1176 patients),
four of them with historical controls. Two studies used inhaled
amphotericin B deoxycholate, three used itraconazole and one used targeted
echinocandin. All studies showed significant reduction in the prophylaxis
arm. Different products, doses and outcomes were noted. There is a highly
probable benefit of prophylaxis use, however, better studies with
standardised doses and comparators should be performed. 2014 Blackwell
Verlag GmbH.

<24>
Accession Number
71512374
Title
37th Annual Scientific Sessions of the Society for Cardiovascular
Angiography and Interventions', SCAI 2014.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 , 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
The proceedings contain 350 papers. The topics discussed include: acute
coronary syndromes, myocardial infarction, thrombectomy and vulnerable
plaque; cyclocreatine phosphate is an effective cardioprotective agent
against ischemic injury; sheath size correlation to future radial artery
occlusion (RAO); impact of chronic lung disease on outcomes of patients
with inferior myocardial infarction at risk of right ventricular
infarction; primary percutaneous coronary intervention of infarct related
artery only versus complete revascularization in ST segment elevation
myocardial infarction: meta-analysis of 756 patients; underutilization of
invasive cardiac procedures and increased mortality in chronic kidney
disease patients with acute myocardial infarction in the united states;
safety and efficacy of the radial approach for emergency PCI in acute
myocardial infarction; and comparison between clopidogrel and ticagrelor
in patients treated with primary angioplasty after out-of-hospital cardiac
arrest.

<25>
Accession Number
71512371
Authors
Loomba R. Gupta N. Aggarwal S. Ismail I. Agarwal A. Kaushik M. Alla V.
Arora R.
Institution
(Loomba, Gupta) Medical College of Wisconsin, United States
(Aggarwal, Ismail, Arora) Chicago Medical School, Rosalind Franklin
University, United States
(Agarwal) ACS, Aurora Sinai/St. Luke's Med Ctrs, Univ Wisconsin, Sch Med
and Public Health, United States
(Kaushik, Alla) Creighton University, Cardiac Center, United States
Title
Transradial versus transfemoral approach for coronary artery bypass graft
angiography and intervention: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S245-S246), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Few studies have compared transradial and transfemoral access
for cardiac catheterization in patients who had previously undergone
coronary artery bypass grafting and the results have been variable. We
aimed to perform a meta-analysis of the published studies. Methods: 2
authors independently searched for studies using Pubmed, Embase and
Cochrane databases. Search terms used were "transradial", "transfemoral",
"coronary artery bypass graft" and their various combinations. Studies
were included in the analysis if they reported the desired outcomes and
were in English language. References of included studies were reviewed to
search for additional studies. Full texts of eligible studies were
downloaded and data was extracted. Studies were evaluated for quality by
two authors independently. Statistical analysis was performed using the
Revman software. Cochrane's Q statistics were calculated and used to
determine the heterogeneity of included studies for each end point. The
fixed-effects model was used for analysis of end points that were
homogenous and the random-effects model was used for analysis of end
points that were heterogeneous. P<0.05 was considered significant. Forest
plots were drawn. Results: Results: 1 randomized trial and 6 nonrandomized
studies were included for final analysis. There was a significant decrease
in number of vascular complications by using transradial approach compared
to transfemoral approach (odds ratio 0.33; 95% CI 0.16 to 0.72; p=0.005).
No significant differences were found when comparing transradial versus
transfemoral approach for contrast volume (mean differ- (Figure presented)
ence 1.67; 95% CI -22.76 to 25.49; p=0.89), fluoroscopy time (mean
difference 51.75; 95% CI -66.83 to 170.34; p=0.39), procedural time (mean
difference 231.98; 95% CI -84.39 to 548.36; p=0.15), procedural success
(OR 0.87; 95% CI 0.43 to 1.73; p=0.68), and in-hospital mortality (OR
0.50; 95% CI 0.13 to 1.92; p=0.31). Contrast volume, fluoroscopy time and
procedural time demonstrated significant heterogeneity. Conclusion:
Transradial approach was associated with less vascular complications
compared to transfemoral approach for patients with previous bypass
surgery, although the fluoroscopy time, contrast doses and mortality were
not different between the two groups. More randomized controlled trials
are needed to support or refute these findings.

<26>
Accession Number
71512353
Authors
Bavishi C. Ghatak A. Cardoso R. Macon C. O'Neill B. Shah N. Singh V.
Alfonso C.E. Ferreira A. Cohen M.G. Heldman A.W. O'Neill W. De Marchena E.
Mitrani R.
Institution
(Bavishi) St. Luke's Roosevelt Hospital Center, United States
(Ghatak, Cardoso, Macon, Singh, Alfonso, Ferreira, Cohen, Heldman, De
Marchena, Mitrani) University of Miami, United States
(O'Neill) Temple University, United States
(Shah) Staten Island University Hospital, United States
(O'Neill) Henry Ford Hospital, United States
Title
30-Day incidence of new pacemaker insertion between transfemoral and
transapical accesses in transcatheter aortic valve replacement (TAVR)
using edwards sapien valve: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S230-S231), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Transcathter Aortic Valve Replacement (TAVR) has been
validated as safe and effective procedure for treatment of patients with
severe aortic stenosis (AS) considered in-operable or high risk for
surgical aortic valve replacement. High degree conduction abnormality
occurs as a complication after TAVR, however data comparing the incidence
of these complications between the transfemoral and transapical approaches
is limited. Methods: Pubmed and Scopus databases were systematically
searched for patients undergoing TAVR with Edwards-Sapien valve. We
included studies that evaluated the transfemoral and transapical access in
TAVR procedures and reported the primary outcome of 30-day incidence of
new pacemaker insertion. We excluded studies that did not stratify
outcomes by access routes. In studies with overlapping populations, only
the study with the greater number of patients was included. Data was
extracted by two different authors. The statistical analysis was performed
according to Cochrane Collaboration guidelines. Pooled effect estimates
were calculated with random effects models. Because of known clinical and
methodological heterogeneity of the studies, DerSimonian and Laird
random-effects model was used to calculate the relative risk of two
approaches for the defined complications. Heterogeneity was assessed with
Higgins and Thompson I2 statistic, with I2 <25% considered as low
heterogeneity. All analyses were performed using STATA 11.2 (Stata Corp.,
College Station, Texas). Results: Fifteen studies met all inclusion
criteria. A total of 2,987 patients were included, of which 1,591 (53.3%
(mean age 82.5 years, 47.6% males) had transfemoral TAVR and 1396 (46.7%
(mean age 81.5years, 47.5% males) had transapical TAVR. As illustrated in
figure, new pacemaker implantation was significantly lower in patients
undergoing Edwards-Sapien valve via the transfemoral access as compared to
those via transapical access (TF= 5.7% vs TA= 7.7%, p=0.03) . In the
pooled data there was a trend towards lower risk of new pacemaker
insertion with transfemoral access as compared to the transapical approach
(RR 0.78; 95% CI: 0.58-1.03, p=0.077). Conclusion: In our meta-analysis
comparing a large number of patients undergoing TAVR, transfemoral access
tends to be associated (Figure presented) with reduced incidence of 30-day
pacemaker insertion when compared to the transapical technique.

<27>
Accession Number
71512350
Authors
Ghatak A. Cardoso R. Bavishi C. Macon C. O'Neill B. Shah N. Singh V.
Badheka A. Ansari M. Alfonso C.E. Ferreira A. Cohen M.G. Heldman A.W.
Williams D. O'Neill W. De Marchena E.
Institution
(Ghatak, Cardoso, Macon, Singh, Ansari, Alfonso, Ferreira, Cohen, Heldman,
Williams, De Marchena) University Of Miami, United States
(Bavishi) St. Luke's Roosevelt Hospital Center, United States
(O'Neill) Temple University, United States
(Shah) Staten Island University Hospital, United States
(Badheka) Wayne State University, United States
(O'Neill) Henry Ford Hospital, United States
Title
Comparison of 30-day mortality for transfemoral and transapical approaches
to transcatheter aortic valve replacement (TAVR): A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S227-S228), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Both transfemoral (TF) and transapical (TA) approaches to
Transcatheter Aortic Valve Replacement (TAVR) are used for patients with
severe aortic stenosis (AS). To compare these two commonly done procedures
we performed an updated meta-analysis of 30- day mortality for patients
receiving Edwards-Sapien TAVR via TF and TA approaches. (Figure presented)
Methods: Pubmed and Scopus databases were systematically searched for
trials reporting TAVR with the Edwards-Sapien valve. We included studies
that evaluated TF as well as TA access and reported 30-day mortality. We
excluded studies that did not stratify outcomes by access routes. In
studies with overlapping populations, only the study with the greater
number of patients was included. Data was extracted by two different
authors from each study. The statistical analysis was performed according
to Cochrane Collaboration guidelines. Pooled effect estimates were
calculated with random effects models. Because of known clinical and
methodological heterogeneity of the studies, DerSimonian and Laird
random-effects model was used to calculate the relative risk of two
approaches for the defined complications. Heterogeneity was assessed with
Higgins and Thompson I2 statistic, with I2 <25% considered as low
heterogeneity. All analyses were performed using STATA 11.2 (Stata Corp.,
College Station, Texas). Results: Nineteen studies met all inclusion
criteria. A total of 6,427 patients were included, of which 3,819 (59.4%)
had TF TAVR. The 30- day mortality was significantly lower with TF (5.31%)
than with TA (10.5%) with a pooled relative risk of 0.59; 95% CI
0.45-0.77, p<0.001 (Figure 1). Conclusion: Because patient characteristics
determine procedural strategies, the two groups are not matched.
Nonetheless, in this metaanalysis comparing TF and TA approaches in a
large number of patients undergoing TAVR, the TF approach was associated
with significantly lower 30-day mortality.

<28>
Accession Number
71512349
Authors
Panchal H. Ladia V. Amin P. Bhatheja S. Ramu V. Patel B. Paul T.
Institution
(Panchal, Ladia, Amin, Bhatheja, Ramu, Patel, Paul) ETSU/MSHA, United
States
Title
Incidence of permanent pacemaker placement following transcatheter aoritc
valve implantation using edwards valve for severe aortic stenosis: A
meta-analysis of transfemoral versus transapical approach.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S226-S227), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: The objective of this meta-analysis is to compare the
incidence of permanent pacemaker placement in the management of procedural
complication between transfemoral and transapical approaches of
transcather aortic valve implantation (TF-TAVI and TA-TAVI) using Edwards
valve. Methods: PubMed database was searched through May 2013. Fourteen
studies (n=2890) comparing TF-TAVI (n=1427) and TA-TAVI (n=1463)
procedures using Edwards valve were included. End points were baseline
logistic EuroSCORE and incidence of permanent pacemaker placement. The
mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI)
was computed and p<0.05 was considered as a level of significance.
Results: The studies were homogeneous for the desired outcome (p=1.0). The
baseline logistic EuroSCORE was significantly higher in TA-TAVI group
compared to TF-TAVI group (MD: 3.9, CI: 3.5-4.3, p<0.00001). There was no
significant difference in the incidence of permanent pacemaker placement
between TF-TAVI and TA-TAVI (5.3% vs. 6.6%, OR: 1.2, CI: 0.9-1.7, p=0.19).
Conclusion: The results of our meta-analysis of fourteen studies with 2890
patients demonstrate that despite high risk patients in TA-TAVI group,
Edwards valve implantation with TAVI procedure using TF and TA approaches
are equally safe for procedural complications requiring permanent
pacemaker placement.

<29>
Accession Number
71512348
Authors
Macon C. Ghatak A. Bavishi C. Cardoso R. O'Neill B. Shah N. Singh V.
Badheka A. Alfonso C.E. Williams D. Carrillo R. Ferreira A. Heldman A.W.
Cohen M.G. O'Neill W. De Marchena E.
Institution
(Macon, Ghatak, Cardoso, Singh, Alfonso, Williams, Carrillo, Ferreira,
Heldman, Cohen, De Marchena) University Of Miami, United States
(Bavishi) St. Luke's Roosevelt Hospital Center, United States
(O'Neill) Temple University, United States
(Shah) Staten Island University Hospital, United States
(Badheka) Wayne State University, United States
(O'Neill) Henry Ford Hospital, United States
Title
Meta-analysis comparing in-hospital and 1 year mortality between
transfemoral and transapical accesses in transcatheter aortic valve
replacement using edward-sapien valve.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S224-S226), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Trancatheter Aortic Valve Replacement (TAVR) has been shown to
reduce mortality in patients with severe symptomatic aortic stenosis
deemed high risk or in-operable for surgical aortic valve replacement. The
transapical (TA) approach is an alternate access for TAVR in patients with
significantly diseased or unsuitable iliofemoral arteries. We performed a
meta-analysis to compare the in-hospital and 1 year mortality between the
two approaches using Edward-Sapien Valve. Methods: We performed a
comprehensive systematic search of Pubmed and Scopus databases for
patients undergoing TAVR. Only studies comparing TF vs TA approaches using
the Edwards SAPIEN aortic valves and reporting primary endpoints of
in-hospital and 1 year all cause mortality were included. Studies were
excluded that did not stratify outcomes based on access route. Studies
with overlapping populations were excluded. Two different authors
extracted and validated the data. The statistical analysis was performed
according to Cochrane Collaboration guidelines. Pooled effect estimates
were calculated with random effects models. Because of known clinical and
methodological heterogeneity of the studies DerSimonian and Laird
random-effects model was used to calculate the relative risk of two
approaches for the defined complications . Heterogeneity was assessed with
Higgins and Thompson I2 statistic, with I2 <25% considered as low
heterogeneity. All analyses were performed using STATA 11.2 (Stata Corp.,
College Station, Texas). Results: A total of 8 studies including 6,810
patients (TF= 4,177; TA= 2633) for in-hospital mortality and 10 studies
including 1,914 patients (TF=964; TA=950) for 1 year mortality met our
inclusion criteria. The cumulative incidence of in-hospital mortality post
TAVR was non-significantly different between the two approaches (TF=5.3%
vs TA=7.8%) with pooled relative risk of 1.11 (95% CI 0.59 to 2.08,
p=0.738). However at 1 year the cumulative incidence of all cause
mortality was significantly different between the two approaches (TF=17.2%
vs TA=24.2%) with a significantly lower risk (RR 0.68, 95% CI 0.56 to
0.84, p<0.001) in the transfemoral arm. Conclusion: The transapical and
transfemoral approaches are associated with similar risk of in-hospital
mortality however there is a significant increased mortality at one year
in patients undergoing TAVR with Edward Sapien valve via the transapical
approach. (Figure presented) .

<30>
Accession Number
71512345
Authors
Alam M. Bandeali S. Hira R. Mac-Edo F. Virani S. Jneid H. Ahmad W.
Siddiqui K. Lakkis N. Rosengart T.
Institution
(Alam, Bandeali, Hira, Mac-Edo, Virani, Jneid, Lakkis, Rosengart) Baylor
College of Medicine, United States
(Ahmad) Nishtar Medical College, Pakistan
(Siddiqui) UPMC, United States
Title
Low flow low gradient aortic stenosis: Survival implications of surgical
or percutaneous aortic valve replacement compared to medical therapy.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S223), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Low-Flow Low-Gradient (LF-LG) aortic stenosis remains a rare
clinical entity with limited data on outcomes after surgical (SAVR) or
trans-catheter aortic valve (TAVR) replacement. This high risk cohort of
patient has traditionally been deemed to be inoperable. The relative
impact of SAVR vs. TAVR in this patient population compared to medical
therapy alone is not well known. We conducted a meta-analysis of all the
studies comparing all-cause mortality after aortic valve replacement in
LF-LG AS in comparison to medical therapy alone to assess the impact of
SAVR and TAVR on overall survival. Methods: A thorough PubMed
(time-unlimited till 01/01/2014) search revealed 5 studies comparing
TAVR/SAVR outcomes in LF-LG aortic stenosis (mean gradient <40mmHg; stroke
volume index <35ml/ m2). Primary clinical endpoint was all-cause mortality
at 2 year followup. Odds ratio (OR) and confidence interval (CI) were
estimated using the random effects model. Main analysis compared 24 month
all-cause mortality in patients with SAVR/TAVR vs. medical therapy. An
indirect comparison of SAVR vs. TAVR on 24 month all-cause mortality was
performed using Chi-square test for subgroup differences. Results: A total
of 607 patients (SAVR/TAVR 263; medical therapy 344) were included in the
analysis. Baseline characteristics of these patients in valve replacement
and medical therapy arms were comparable. At 2-year follow-up, SAVR/TAVR
was associated with lower allcause mortality (24.3% vs. 55.8%; OR 0.23;
95% CI 0.15 - 0.36). This corresponds to an absolute risk reduction of
31.5% and a Number Needed to Treat 3.55 to save one life. The relative
impact of SAVR vs. TAVR on all-cause mortality revealed no difference in
24 month clinical outcomes (p=0.96). However, number of patients in TAVR
arm compared to medical therapy was small and reported as a subgroup study
from PARTNER 1(B) cohort of patients. Conclusion: Patients with LF-LG
aortic stenosis experience very high 2-year mortality in the absence of
valve replacement. Valve replacement with surgical or trans-catheter
approach results in improved 2-year survival (NNT=3.6). A heart team
approach for individualized managmenet of these critical patients can
result in prolonged survival.

<31>
Accession Number
71512344
Authors
Cardoso R. Ghatak A. Bavishi C. Macon C. O'Neill B. Shah N. Singh V.
Badheka A. Alfonso C.E. Ferreira A. Cohen M.G. Heldman A.W. Williams D.
O'Neill W. De Marchena E.
Institution
(Cardoso, Ghatak, Macon, Singh, Alfonso, Ferreira, Cohen, Heldman,
Williams, De Marchena) University of Miami, United States
(Bavishi) St. Luke's Roosevelt Hospital Center, United States
(O'Neill) Temple University, United States
(Shah) Staten Island University Hospital, United States
(Badheka) Wayne State University, United States
(O'Neill) Henry Ford Hospital, United States
Title
Thirty-day stroke incidence after transcatheter aortic valve replacement:
A meta-analysis comparing access routes by valve academic research
consortium criteria.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S221-S223), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Transcatheter Aortic Valve Replacement (TAVR) has been
accepted as an alternative in the treatment of severe aortic stenosis.
Stroke is a known complication of TAVR procedures. We performed a
meta-analysis to compare the incidence of 30 day stroke in patients
undergoing TAVR via the transapical and the transfemoral route. We
stratified the studies based on the recently published standardized valve
academic research consortium (VARC) definition of stroke. Methods: We
searched Pubmed and Scopus databases for clinical studies with
Edwards-Sapien valve TAVR procedures. We included studies that reported
the primary outcome of 30-day stroke incidence in a direct comparison
between transfemoral and transapical access routes. In overlapping study
populations, we included the study with a greater patient population. Two
authors independently extracted the data. Cochrane Collaboration
guidelines for systematic reviews were followed. Statistical analysis was
performed with STATA 11.2 (Stata Corp., College Station, Texas). We
calculated pooled effect relative risk estimates between the two
approaches with random effects (DerSimonian and Laird) models due to
methodological and clinical heterogeneity of studies. Higgins and Thompson
I2 statistic was used to assess heterogeneity and I2 <25% was considered
as low heterogeneity. Results: Sixteen studies met all inclusion criteria.
A total of 3,027 patients were included, of which 1,601 (52.9%) underwent
transfemoral TAVR. As illustrated in figure 1, the 30-day incidence of
stroke was higher in the transapical group (4.3%) as compared to the
transfemoral approach (3.8%), with no statistically significant difference
in the pooled relative risk (RR 0.93; 95% CI 0.64-1.33; p=0.679). Only 4
studies used the VARC stroke definitions in their outcomes. These studies
had a total of 790 patients, including 403 (51%) who had transfemoral
procedures. Similarly to the overall study population, after using
standardized VARC definition no statistically significant difference was
found in 30- day stroke incidence between the transfemoral (4.5%) and
transapical (5.2%) access with comparable pooled relative risk (RR 1.01;
95% CI 0.52-1.97; p=0.975; figure 2). Conclusion: In out meta-analysis we
found no significant difference in the 30-day stroke incidence between
transfemoral and transapical TAVR procedures using the Edwards- Sapien
valve. These results are sustained after VARC standardized definitions are
applied. (Figure presented) .

<32>
Accession Number
71512341
Authors
Millan X. Skaf S. Joseph L. Noble S. Sia Y. Tzikas A. Asgar A. Ibrahim R.
Jolicoeur M.
Institution
(Millan, Skaf, Asgar, Ibrahim, Jolicoeur) Montreal Heart Institute, Canada
(Joseph) McGill University, Health Center, Canada
(Noble) University of Geneva, Switzerland
(Sia) Centre Hospitalier de l'Universite de Montreal, Canada
(Tzikas) Interbalkan European Medical Center, Greece
Title
Systematic review and meta-analysis on transcatheter paravalvular leak
reduction.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S219-S220), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Significant paravalvular leak (PVL) following prosthetic valve
replacement can result in intractable congestive heart failure and
hemolytic anemia. Since repeat surgery is only possible in a minority of
patients, transcatheter reduction of PVL is emerging as an alternative
option, but its safety and efficacy remain uncertain. This study sought to
assess whether a successful transcatheter PVL reduction is associated with
an improvement in heart failure functional class or hemolytic anemia.
Methods: We identified 9 clinical studies totalling 269 patients comparing
successful and failed transcatheter PVL reductions. A successful (Table
presented) procedure was defined as the delivery of a reduction device
free of mechanical prosthesis interference and resulting in at least one
grade regurgitation reduction. A Bayesian hierarchical meta-analysis was
performed using as primary endpoint the combined occurrence of improvement
in New York Heart Association (NYHA) functional class or hemolytic anemia.
Mortality and the need for repeat surgery were used as secondary
endpoints. Results: A successful transcatheter PVL reduction is associated
with a superior improvement in heart failure functional class or hemolytic
anemia compared to a failed intervention (OR=7.63, 95% credible interval
[CrI] from 1.32 to 52.33). A trend toward fewer repeated surgeries was
also observed with successful PVL reductions (OR=0.22, 95% CrI from 0.04
to 1.12). Due to small sample sizes, the effect between PVL reduction and
mortality could not be accurately estimated (OR=0.58, 95% CrI from 0.06 to
4.27). Conclusion: A successful transcatheter PVL reduction is associated
with favourable clinical outcomes, including an improvement in congestive
heart failure functional class and hemolytic anemia.

<33>
Accession Number
71512337
Authors
Aggarwal S. Gupta N. Loomba R. Shah P. Agarwal A. Kaushik M. Alla V. Arora
R.
Institution
(Aggarwal, Arora) Chicago Medical School, Rosalind Franklin University,
United States
(Gupta, Loomba) Medical College of Wisconsin, United States
(Shah) Advocate Illinois Masonic Medical Center, United States
(Agarwal) ACS, Aurora Sinai/St. Luke's Med Ctrs, Univ Wisconsin, Sch Med
and Public Health, United States
(Kaushik, Alla) Creighton University, School of Medicine, United States
Title
Multidetector computed tomography versus 2-dimensional transesophageal
echocardiography for transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S216-S217), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is frequently
been used in high surgical risk severe aortic stenosis patients.
Appropriate sizing of the TAVR annular ring is crucial to prevent
paravalvular aortic regurgitation (PAR). Multiple studies have been done
comparing the use of conventional 2-D transesophageal echocardiography
(TEE) versus multidetector computed tomography (MDCT) for appropriate
sizing, on the PAR outcomes after TAVR. We aimed to perform a
meta-analysis of the published studies. Methods: Two authors independently
searched Pubmed, Embase and Cochrane databases using the search terms
"multidetector computed tomography", "transesophageal echocardiography",
"transcatheter aortic valve replacement", "paravalvular aortic
regurgitation" and their various combinations. Studies were included in
the analysis if they reported the desired outcomes and were in English
language. References of included studies were also reviewed to search for
additional studies. Full texts of eligible studies were downloaded and
data was extracted. Statistical analysis was performed using the Revman
software. Cochrane's Q statistics were calculated and used to determine
the heterogeneity of included studies for each end point. The
fixed-effects model was used for analysis of homogenous end points, and
the random-effects model for heterogeneous end points. Forest plots were
drawn. P<0.05 was considered significant. Results: Four studies were
included for final analysis. As compared to TEE based annular ring sizing,
MDCT was associated with a significant decrease in greater than[AA1] mild
PAR (odds ratio (OR) 0.42; 95% CI 0.28 to 0.63; p<0.0001) and severe PAR
(OR 0.41; 95% CI (Figure presented) 0.17 to 0.96; p=0.04). No significant
differences were found in rates of annular rupture (OR 0.96; 95% CI 0.25
to 3.72; p=0.95), no PAR (OR 1.43; 95% CI 0.98 to 2.08; p=0.06), mild PAR
(OR 1.21; 95% CI 0.85 to 1.73; p=0.28), need for pacemaker implantation
(OR 1.00; 95% CI 0.58 to 1.73; p=0.99) and procedural mortality (OR 0.99;
95% CI 0.23 to 4.26; p=0.99). Heterogeneity analysis showed none of the
endpoints had significant heterogeneity. Conclusion: MDCT based annular
ring sizing was associated with significant decreases in more than mild
and severe paravalvular aortic regurgitation after TAVR, when compared to
2D TEE.

<34>
Accession Number
71512200
Authors
Nasim S.
Institution
(Nasim) Aga Khan University, Pakistan
Title
Does percutaneous coronary intervention in octogenerian a viable option?
Prospective cohort study from developing country.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S120-S121), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Ischemic heart disease affects more than 25% of persons older
than 65 years of age in the United States. Indo-Asian population has one
of the highest susceptibilities to Coronary artery disease making it the
leading cause of death. Octogenarians, defined as people aged>80 years are
a unique group of people, characterized by the multitude of risk factors
and high prevalence of comorbid illnesses present at the time of
intervention. In addition, they present more often with acute coronary
syndromes, atypical symptoms and non diagnostic ECGs delaying the referral
for coronary revascularization. Presence of associated illnesses also
increases the chances of procedure-related complications. Most
interventional studies focus on patients 50-65 years and hence scientific
evidence regarding the interventional treatment of the elderly is lacking.
A few large randomized control trials and meta-analyses have examined the
appropriateness of interventions in patients younger than 80 years, but it
cannot be asserted with clarity that as to whether this data can be
extrapolated to the octogenarians worldwide. As per the Census of 1998,
about 4% of Pakistani population is sixty five years and older. This
figure is expected to rise to 10.4% by 2030. Pakistan, a developing
country is facing an alarming epidemic of coronary artery disease (CAD),
with one in four adults having CAD.As the population living with coronary
artery disease ages, revascularization procedures in this group are likely
to increase in prevalence. Unfortunately, octogenarians, although being
the fastest growing cohort, are yet underrepresented in clinical
revascularization trials. There is no available data from Pakistan on the
outcome of PCIs in the octogenarian subset of population voicing the
inevitable need to address it. The purpose of our study was to investigate
the outcomes and complications of contemporary percutaneous coronary
interventions in octogenarians at a tertiary care Centre in Karachi,
Pakistan Methods: Prospective cohort study design Study Duration: Jan 2000
to December 2007 Study population: The cohort is a voluntary, patients
admitted for PCI,at the Aga Khan Hospital. Sample size: Using comparison
of two independent percentages of in hospital complication of PCI in
octogenarian and young patients with 5% level of significance and power of
80% required sample size for octogenarian came out to be 171 subjects.
Study outcome: Complications and in hospital outcomes were collected by
charts review. All vascular access complications were confirmed by
ultrasound or radiographic studies. The development of cardiogenic shock
was defined as systolic blood pressure <90 mm Hg and the need for
intravenous inotropes or mechanical support devices to maintain adequate
tissue perfusion. Acute renal failure (ARF) was defined as an increase in
serum creatinine of at least 25% within 72 hours following angioplasty
Primary end point was In- Hospital mortality, procedural success and posts
PCI complications in octogenarians as compare to younger cohort. Secondary
endpoint was in hospital major adverse events (MACE) among the study
participants. The study protocol was approved by the ethics committee in
the hospital. Written informed consent was obtained in all patients before
including their information. Data collection methods Patients were
explained about the study and verbal informed consent was taken the data
pertaining to PCI. Demographic, clinical, and procedural characteristics
of consecutive patients undergoing PCI were recorded using standardized
definitions for all fields till the required sample was obtained. The
study population consisted of 1517 patients undergoing PCI from Jan 2000
to December 2007 enrolled in the Aga Khan Hospital PCI Registry.
Octogenarians (aged 80 years; n=171) were compared with patients <80 years
of age (n=966). Statistical Analysis Continuous variables were expressed
as mean+SD, and categorical data expressed as percentages. Continuous
variables were compared using Student's t tests or ANOVA. Categorical
variables were compared using Fisher exact or 2 tests as appropriate. All
calculated P-values were two-sided and P-values <0.05 were considered
statistically significant. All statistical analysis was performed using
SPSS Version. 16.0 for Windows (SPSS, Chicago, IL).univariate and
multivariate analysis was done and odd ratio were calculated for
independent predictor of in hospital complication in octogenarians
Results: total 1517 PCI's, 12% (n =171) were performed in octogenarians
(mean age 82+2 years) and 88% (n =1346) were in young cohort, mean age
52+9 years. Octogenarians were more likely female (30% vs. 20%, P=0.03)
and had more co morbidities, including hypertension (68% vs. 50%, p=
0.001), peripheral vascular disease (4% vs. 0.6%, P<0.05), cerebral
vascular disease (6% vs. 1.5%, P<0.001), prior PCI (17% vs. 12, p= 0.01),
prior CABG (15% vs. 8%, p,0.05) and chronic obstructive airway disease (8%
vs. 2%, P=0.01). Octogenarians were presented for emergency PCI (28% vs.
48%, P=0.02). presented with cardiogenic shock (14% vs. 4.7%, P<0.01),
More octogenarics needed IABP (18% vs. 8%, p= 0.001) and multivessel PCI
(35% vs. 22%, p=0.04 The octogenarian cohort had a greater number of left
main stem (7% vs. 2%, P =0.001) and were more likely to have multi-vessel
disease (46% vs. 30%, P<0.001). More lesions in octogenarians were high
risk (27% vs. 12%, p= 0.02). Lesions treated were more complex (54.0% vs.
48.9%, P=0.02).The angiographic success rate in the two groups was not
significantly different (PCI success was 93 and 96% p=NS), similarly,
there was no statistically significant difference seen for percentage of
angiographic complications. Post PCI complication only vascular
complications were more 5 vs 1.5% with OR 2.1 with 95%C.I of (1.7 -4) with
p value of 0.003., it may be contributed to increase use of 53%
octogenarians received GPiIIb/IIIa inhibitors vs. 43% with p value of
0.005 a contributing factor in vascular complications.No statistically
significant difference in rates of MI, stroke, renal failure and
congestive cardiac failure, perforation and dissection. In-hospital
mortality was 1.5 times higher in octogenarians (4% vs. 2%, odds ratio
(OR) 1.3, 95% CI 0f 1.6-4 p value 0.006).Major adverse events were not
different in two cohorts 5% vs. 3% with p value of 0.006 .Post PCI
complications in octogenarians except vascular and increased trend of
death rate was seen. The death rate was high 4 vs. 2.5% with OR of 1.0
with p value of 0.006 . Median hospital stay was also longer compared to
the younger controls (6 days vs. 4 days, p= 0.03).Univariate predictors of
In-hospital mortality in octogenarians, univariate analysis identified
four risk factors for in-hospital mortality: STEMI (P=0.02), LVEF <35%
(P<0.001), development of cardiogenic shock (P<0.001) and prior CABG
(p=0.02). Conclusion: Octogenarians constitute a major part of population
in Pakistan. This study proves that coronary intervention in this age
group has a procedural success rate comparable to the younger cohort of
subjects. In-hospital and long-term complications were highly influenced
by multiple comorbid illnesses present in this group. Additionally, most
of percutaneous interventions done in octogenarians in our study were
under emergency presentations, with cardiogenic shock being the most
noteworthy. This too led to a higher complication rate among the
octogenarics. Henceforth, an earlier invasive intervention along with
vigilant patient selection is needed for a successful outcome.

<35>
Accession Number
71512030
Authors
Krishnamoorthy P. Garg J. Chatterjee S. Ahmad H.
Institution
(Krishnamoorthy) Englewood Hospital and Medical Center, Valhalla, NY,
United States
(Garg, Ahmad) Westchester Medical Center, New York Medical College,
Valhalla, NY, United States
(Chatterjee) St. Lukes Roosevelt Hospital, Valhalla, NY, United States
Title
Primary percutaneous coronary intervention of infarct related artery only
versus complete revascularization in ST segment elevation myocardial
infarction: Meta-analysis of 756 patients.
Source
Catheterization and Cardiovascular Interventions. Conference: 37th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI 2014 Las Vegas, NV United States. Conference Start:
20140528 Conference End: 20140531. Conference Publication: (var.pagings).
83 (pp S4), 2014. Date of Publication: 01 May 2014.
Publisher
Wiley-Liss Inc.
Abstract
Background: Primary percutaneous coronary intervention (PCI) is the
treatment of choice for acute ST-segment elevation myocardial infarction
(STEMI). However these patients frequently have multi-vessel obstructive
coronary artery disease (CAD) that may be associated with poor clinical
outcomes. Current guidelines recommend revascularization of the infarct
related artery (IRA) only unless there is hemodynamic compromise or
refractory angina. We hoped to determine benefits of complete
revascularization (CR) over IRA revascularization only during primary PCI
for STEMI. Methods: A systematic literature search was performed using
PubMed, Embase and MELDINE to identify trials evaluating IRA only versus
CR during primary PCI for STEMI patients. Primary outcome of interest was
major adverse cardiac events (MACE), which is a composite of cardiac
death, non-cardiac deaths, nonfatal MI, refractory angina and
revascularization (PCI or coronary artery bypass grafting). Results: Five
randomized controlled trials (RCTs) were identified and four trials with
similar comparable groups, with a total of 756 patients were included for
analysis. MACE was reduced in the CR group compared to IRA only (OR 0.33,
95% CI 0.24-0.45, p=0.000) driven primarily by significantly reduced
revascularization (OR 0.33, 95% CI 0.21-0.52, p<0.001) and non-fatal MI
(OR 0.36, 95% CI 0.18-0.72, p=0.004). Statistical heterogeneity was
negligible (I2=0.8%, p=0.38). There was no difference in cardiac deaths
(OR 0.52, 95% CI 0.25-1.10, p=0.08) or non-cardiac deaths (OR1.19, 95% CI
0.47-2.99, p=0.72).- Conclusion: Our study demonstrates that complete
revascularization (CR) with multi vessel PCI is superior to infarct
related artery (IRA) revascularization only and is associated with a
statistically significant reduction of revascularization rates and
non-fatal MI. (Figure Presented).