EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 8

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<1>
Accession Number
24449733
Authors
Grossgasteiger M. Hien M.D. Graser B. Rauch H. Motsch J. Gondan M.
Rosendal C.
Institution
(Grossgasteiger) Cand.med, Department of Anesthesiology, University of
Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Title
Image quality influences the assessment of left ventricular function: an
intraoperative comparison of five 2-dimensional echocardiographic methods
with real-time 3-dimensional echocardiography as a reference.
Source
Journal of ultrasound in medicine : official journal of the American
Institute of Ultrasound in Medicine. 33 (2) (pp 297-306), 2014. Date of
Publication: Feb 2014.
Abstract
Transesophageal echocardiography has become a standard tool for evaluating
left ventricular function during cardiac surgery. However, the image
quality varies widely between patients and examinations. The aim of this
study was to investigate the influence of the image quality on 5 commonly
used 2-dimensional methods. Transesophageal real-time 3-dimensional
echocardiography (3DE) served as a reference. Left ventricular function
was evaluated in 63 patients with sufficient real-time 3DE image quality.
The image quality was rated using the ratio of the visualized border
divided by the total endocardial border. These ratings were used to
generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%)
image quality. The ejection fraction (EF), end-diastolic volume, and
end-systolic volume were analyzed by the Simpson method of disks (biplane
and monoplane), eyeball method, Teichholz method, and speckle-tracking
method. Furthermore, the fractional area change was determined. Each
correlation with real-time 3DE was evaluated. Correlations of the EF and
volumes, respectively, as determined by long-axis view methods increased
with improving image quality: the Simpson biplane method was found to be
the most accurate method, with good image quality for the EF (r = 0.946)
and volumes (end-diastolic volume, r = 0.962; end-systolic volume, r =
0.989). Correlations of the EF and fractional area change by short-axis
view methods decreased with improving image quality, with the Teichholz EF
found to be most accurate with poor (r = 0.928) in contrast to good (r =
0.699) image quality. With good image quality, the Simpson biplane method
is the most accurate 2-dimensional method for assessing the left
ventricular EF. Short-axis view methods, especially the Teichholz method
yield better correlations with poor image quality. The eyeball method was
unaffected by image quality.

<2>
Accession Number
2014798311
Authors
Libungan B. Hirlekar G. Albertsson P.
Institution
(Libungan, Hirlekar, Albertsson) Department of Cardiology, Sahlgrenska
University Hospital, Bla straket 3, van 1, Gothenburg SE-413 45, Sweden
Title
Coronary angioplasty in octogenarians with emergent coronary syndromes:
Study protocol for a randomized controlled trial.
Source
Trials. 15 (1) , 2014. Article Number: 349. Date of Publication: September
04, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Invasive treatment (coronary angiography and intervention if
feasible) of patients with acute coronary syndrome (ACS) has been shown to
lead to better outcomes than medical therapy alone, but the elderly have
been under-represented in many of the studies. In the elderly, medical
therapy is common in ACS. Fear of complications related to the procedure
and unclear benefit in older patients are common reasons for invasive
procedures being withheld. Our hypothesis is that invasive treatment of
elderly patients with ACS will lead to a better outcome in terms of
survival and quality of life than medical therapy alone, with acceptable
risk. Methods/Design: This multicenter, randomized controlled trial of
patients 80 years of age and over has two parallel treatment arms, a
medical group and an invasive group. In Swedish hospitals, 200 patients
with non-ST elevation myocardial infarction or unstable angina will be
randomized to medical or invasive treatment strategy. The primary outcome
measure is the combined endpoint major adverse cardiac or cerebrovascular
event (MACCE) within one year. Secondary outcome measures include quality
of life, angina, and adverse events such as bleeding. Assessments will be
conducted during hospitalization, at 1 month after allocation, and at 12
months. Discussion: This study seeks to determine the efficacy and safety
of invasive and medical treatment strategies in the elderly with ACS. The
study is currently recruiting. Trial registration: ClinicalTrials.gov
trial identifier: NCT02126202. Registered on 7 January 2014.

<3>
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Accession Number
2014591140
Authors
Borisenko O. Wylie G. Payne J. Bjessmo S. Smith J. Yonan N. Firmin R.
Institution
(Borisenko) Synergus AB, Svardvagen 19, 18233, Danderyd, Stockholm, Sweden
(Wylie) Scottish Extracorporeal Life Support Service, Royal Hospital for
Sick Children, Glasgow, United Kingdom
(Payne) Scottish National Advanced Heart Failure Service, Golden Jubilee
National Hospital, Clydebank, United Kingdom
(Bjessmo) Medical Management Centre, Department of Learning Informatics,
Management and Ethics, Karolinska Institutet, Stockholm, Sweden
(Smith) Paediatric and Neonatal ECMO Service, Freeman Hospital, Newcastle
upon Tyne, United Kingdom
(Yonan) Department of Cardiothoracic Transplant, Wythenshawe Hospital,
Manchester, United Kingdom
(Firmin) Glenfield General Hospital, Leicester, United Kingdom
Title
Thoratec centrimag for temporary treatment of refractory cardiogenic shock
or severe cardiopulmonary insufficiency: A systematic literature review
and meta-analysis of observational studies.
Source
ASAIO Journal. 60 (5) (pp 487-497), 2014. Date of Publication:
September-October 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
The aim of the study was to systematically evaluate effect of CentriMag
heart pump (Thoratec Corporation) as temporary ventricular assist device
(VAD) and part of extracorporeal membrane oxygenation (ECMO) system on
outcomes in patients with cardiac or cardiac-respiratory failure. A
systematic search was conducted in five databases for the period 2003 to
2012. Fifty-three publications with data for 999 patients, supported with
CentriMag, were included. In 72% studies, CentriMag was used as a VAD and
in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days
in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock
group, 8.8 days in post-transplant graft failure and rejection group, and
16.0 days in post-LVAD placement right ventricular failure group. Survival
on support was 82% (95% CI 70-92) for VAD support in precardiotomy
cardiogenic shock indication, 63% (95% CI 46-78) in VAD support in
postcardiac surgery cardiogenic shock indication, 62% (95% CI 46-76) in
VAD support in post-transplant graft rejection or failure indication, and
83% (95% CI 73-92) in VAD support in post-LVAD placement right ventricular
failure indication. CentriMag is an effective technology for temporary
support of patients with cardiac and cardiorespiratory failure. Copyright
2014 by the American Society for Artificial Internal.

<4>
Accession Number
71621505
Authors
Khan I. Singer L. De Perrot M. Granton J. Keshavjee S. Chau C. Kron A.
Johnson S.
Institution
(Khan) Pulmonary Hypertension Programme, University Health Network,
University of Toronto, Toronto, Canada
(Singer) University of Toronto, Toronto, Canada
(De Perrot, Keshavjee) Division of Thoracic Surgery, University Health
Network, University of Toronto, Toronto, Canada
(Granton) Toronto General Hospital, University of Toronto, Toronto, Canada
(Chau) TorontoCanada
(Kron) Toronto Western Hospital, Mount Sinai Hospital, University of
Toronto, Toronto, Canada
(Johnson) Toronto Western Hospital, University Health Network Pulmonary
Hypertension Programme, University of Toronto, Toronto, Canada
Title
Survival after lung transplantation in systemic sclerosis. A systematic
review.
Source
Journal of Rheumatology. Conference: 69th Annual Meeting of the Canadian
Rheumatology Association, CRA 2014 Whistler, BC Canada. Conference Start:
20140224 Conference End: 20140301. Conference Publication: (var.pagings).
41 (7) (pp 1554-1555), 2014. Date of Publication: July 2014.
Publisher
Journal of Rheumatology
Abstract
Objective: Lung transplantation is a life-saving option for systemic
sclerosis (SSc)-associated pulmonary arterial hypertension (PAH) and
interstitial lung disease (SSc-ILD) patients. Yet, there is risk of
post-transplantation mortality. The objective of this study was to
evaluate survival of SSc patients post-lung transplantation. We
secondarily evaluated SSc lung transplant recipient characteristics, and
compared post-lung transplantation survival of SSc patients to non-SSc
patients (idiopathic PAH, and ILD). Methods: A systematic review of
MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials and CINAHL
(all inception to 2012) was performed to identify studies evaluating
post-lung transplant survival in SSc compared to non-SSc patients. Two
reviewers independently abstracted study and survival data using a
standardized form. Results: 226 citations were screened to identify 7
observational studies reporting SSc patients who underwent single lung,
double lung, or heart-lung transplantation. Mean age at transplantations
ranged 46-53 years. SSc post-transplantation survival ranged 69%-91% at
30-days, 69%-85% at 6-months, 59%-93% at 1-year, 49%-80% at 2-years, and
46%-79% at 3-years. ILD post-transplant survival was 80% at 30-days,
80%-90% at 6-months, 59%-83% at 2-years, and 69% at 3-years. IPAH post
transplant survival was 79% at 30-days, 79%-90% at 6-months, and 74%-90%
at 1-year. The reporting of overlapping cohorts potentially including the
same patients precluded meta-analysis. Causes of death in SSc patients,
when reported, included graft failure (n=6), infection (n=8), cardiac
events (n=3), hemorrhagic stroke (n=1), respiratory failure (n=3),
malignancy (n=2), pulmonary hypertension (n=1), complications of
bronchiolitis obliterans syndrome (BOS) (n=1), anesthetic complication
(n=1), and scleroderma renal crisis (n=1). There were no reports of
recurrence of SSc in the lung allograft. Conclusion: SSc survival
post-lung transplantation is very good, and improving with time. The
short-term and intermediate- term survival post-lung transplantation are
similar to IPAH and ILD patients requiring lung transplantation. Future
researchers should delineate the access process for lung transplantation
and report the occurrence of acute rejection, infection, bronchiolitis
obliterans syndrome, renal dysfunction and dialysis, gastroparesis, and
need for tube feeding.

<5>
Accession Number
71621235
Authors
Wong K.K. Alder S.L. Kinnear H.A. Bethune M.D.
Institution
(Wong, Alder, Kinnear, Bethune) IWK Health Centre, Halifax, NS, Canada
Title
Implementation of a simplified pulse oximetry screening program.
Source
Paediatrics and Child Health (Canada). Conference: 91st Annual Conference
of the Canadian Paediatric Society Montreal, QC Canada. Conference Start:
20140625 Conference End: 20140628. Conference Publication: (var.pagings).
19 (6) (pp e94), 2014. Date of Publication: June-July 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: Newborn pulse oximetry screening increases detection of
critical congenital heart disease otherwise missed by antenatal ultrasound
and physical examination. The AAP endorsed a protocol checking oxygen
saturations in the right hand and one foot at >24 h of age, with abnormal
results (<95%) subject to repeat screening. Objectives: We describe our
experience in implementing a simplified protocol at a Canadian tertiary
children's hospital and a referring regional hospital. Design/Methods: We
collected information from the screening program organizers. Results:
Cardiology chose a simplified screening protocol, checking oxygen
saturations in one foot between 24 h and 36 h of age. This was supported
by a meta-analysis indicating no significant differences in sensitivity or
false positive rates compared to checking both foot and right hand
(Thangaratinam, Lancet 2012). A single abnormal saturation (<95%) requires
physician assessment. If the low saturation is confirmed and no other
cause identified, an echocardiogram would be arranged within 24 h
(utilizing telemedicine at the regional hospital). Physicians and nurses
welcomed more ways to improve detection of CHD. Screening was started in
February 2013 in the post partum unit at the tertiary hospital
(approximately 4500 neonatal admissions annually) and in July 2013 at the
regional hospital (approximately 900 annually). As of December 2013, there
have been no positive screens. All cardiac surgery in the region comes to
the tertiary hospital; we are aware of no false negative results.
Education was delivered at a staff meeting followed by individual teaching
as required, and a written protocol was distributed. As nurses were
familiar with pulse oximetry, education focused on teaching the protocol.
Reusable oximetry probes and probe wraps were used. Three dedicated
oximeter machines were adequate for the tertiary unit and one was used at
the regional site. Testing was usually done at bath time. We estimate it
takes 10 minutes to do the screen, clean the probe and document. A
selective chart review showed excellent compliance, but inconsistency in
where results were being documented. Newborns discharged from the birthing
unit and home births were not being screened. Conclusions: Our experience
shows that a pulse oximetry screening program can be readily implemented.
There are areas for improvement in documentation, and we identified groups
to target for screening. We believe the simplified protocol and shifting
the management of abnormal screens to the physician allowed for easier
implementation.

<6>
Accession Number
71621032
Authors
Baric D.
Institution
(Baric) University Hospital Dubrava, Zagreb, Croatia
Title
Remote ischemic preconditioning-from studies to clinical practice.
Source
Heart Surgery Forum. Conference: 2nd Heart Surgery Forum, HSF Meeting
Croatia Split Croatia. Conference Start: 20140514 Conference End:
20140517. Conference Publication: (var.pagings). 17 (2) (pp E107), 2014.
Date of Publication: April 2014.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Remote ischemic preconditioning (RIPC) is a preconditioning of a
non-cardiac organ or tissue that can increase myocardial tolerance to
ischemic-reperfusion injury during the subsequent prolonged ischemia.
Several studies have shown promising results of RIPC usage in cardiac
surgery, but a lot of controversies remain. Our randomized controlled
trial includes 50 patients scheduled for elective surgical aortic valve
replacement. Ischemic-reperfusion injury is assessed by measurement of
biochemical markers of myocardial injury. Hemodynamical parameters are
analyzed to evaluate influence of RIPC on postishemic heart function.
Correlation between RIPC and systemic inflammatory response is evaluated
by comparison of ischemic and inflammatory markers. Preliminary results
will be presented.

<7>
Accession Number
71617738
Authors
Schurmann K.
Institution
(Schurmann) Diagnostic and Interventional Radiology, St.-Johannes-Hospital
Dortmund, Dortmund, Germany
Title
Clinical and imaging assessment of mesenteric ischaemia.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2014 Glasgow
United Kingdom. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 37 (2 SUPPL. 1) (pp S92-S93), 2014.
Date of Publication: September 2014.
Publisher
Springer New York
Abstract
Learning Objectives 1. To define clinical presentation and assessment of
acute and chronic mesenteric ischaemia 2. To learn the different imaging
modalities available for assessment 3. To understand the efficacy of
different imaging modalities Mesenteric ischemia may be considered as an
occlusive disease of the bowel supplying and draining blood vessels. The
occlusion may occur on the arterial or venous side, it may be located in
the proximal or the distal portion of the mesenteric vasculature, and it
may be acute or chronic (1-4). The major bowel supplying vessels are the
celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric
artery. SMA is the most important feeding vessel; the superior mesenteric
and portal vein are the most important draining vessels. Acute mesenteric
ischemia (AMI) is a life-threatening disease requiring prompt diagnosis
and treatment. Symptoms of AMI are usually nonspecific, and there are no
serum parameters reliably indicating or proving AMI (1,4). Timely
diagnosis is based on clinical suspicion and early contrast-enhanced CT
imaging. As a rule of thumb, acute mesenteric ischemia is caused by: *
embolic or thrombotic occlusion of SMA in 70% patients * non-occlusive
mesenteric ischemia (NOMI) in 20% patients * mesenteric vein thrombosis
(MVT) in 10% patients (1-5) Diagnostic imaging If there is clinical
suspicion of occlusive mesenteric ischemia, the diagnostic imaging method
of choice is biphasic multislice CT (MSCT) after an intravenous
administration of contrast agent (4-8). Multiplanar reconstructions are
helpful in establishing and confirming the diagnosis. The arterial phase
is required to detect mesenteric stenosis/occlusion and the venous phase
is required to detect mesenteric vein thrombosis. In a recent
meta-analysis, the sensitivity of MSCT in patients with AMI was found to
be 93% and specificity was 96% (7). Because almost all patients suffering
from mesenteric ischemia present with abdominal pain, abdominal plain
films are frequently obtained in the early phase and also later in the
course of the disease if it is not diagnosed. The findings of plain films
are nonspecific; however, they may reveal other causes of abdominal pain,
particularly, hollow organ perforation (1). If the plain films show signs
of mesenteric ischemia, such as pneumatosis intestinalis or gas in the
portomesenteric circulation, the disease is already far advanced, gangrene
of the bowel has occurred, peritonitis is present, and mortality is
consistently high. Duplex sonography may demonstrate the proximal stenosis
or occlusion of mesenteric vessels with good diagnostic accuracy (9).
However, if findings are nonspecific, results highly depend on the
experience of the investigator, and NOMI is not assessable. Bowel
distention and bowel gas reduce the diagnostic capacity of duplex
sonography. Overall, duplex sonography alone is insufficient in reliably
diagnosing mesenteric ischemia. Reportedly, the diagnostic accuracy of
duplex sonography is improved with the use of contrast agents (10). MR and
MR angiography show vascular mesenteric pathology with high diagnostic
accuracy (6). However, availability of MR is limited, and examination
durations are much longer compared with CT. Due to the severe pressure of
time in diagnosing, MR is not considered an advisable imaging tool in
patients suspected to have AMI (4). In contrast, if chronic mesenteric
ischemia is suspected, MR may be useful (11). Clinical classification of
mesenteric ischemia Mesenteric ischemia may be classified into four
clinical stages according to the onset and severity of symptoms: *
asymptomatic * recurrent postprandial abdominal pain ("angina
abdominalis") * permanent abdominal pain, malabsorption syndrome * sudden
onset of severe abdominal pain persisting for several hours These symptoms
are nonspecific. Chronic or acute marked abdominal pain may also occur
with multiple other nonvascular abdominal diseases, such as gastric or
duodenal ulcer, several forms of bowel inflammation, bowel perforation,
acute biliary or renal colic, contained aortic rupture, and others.
Mesenteric vein thrombosis is not well captured with this classification,
because symptoms due to MVT are mostly even more nonspecific. Stage 1 of
arterial mesenteric ischemia is usually found accidentally with an
abdominal CT or CTA. Treatment is normally not necessary. Chronic
mesenteric ischemia (CMI) Symptoms of stages 2 and 3 are found in patients
suffering from chronic mesenteric ischemia. Abdominal pain mostly begins
at 20-30 min after a meal and persists for 1-3 h (1). Pain frequently
increases over time and may become permanent. Because of fear of eating,
patients complain of marked waste loss. The main cause of CMI is
arteriosclerosis of the major splanchnic arteries. It depends on the
degree of collateralization whether or not the patient develops symptoms
(12). There are variable collaterals between the splanchnic arteries and
variable collaterals of splanchnic arteries to extrasplanchnic vessels,
such as hypogastric and lumbar arteries. In case of poor
collateralization, occlusion of a single mesenteric artery may be
sufficient to render the patient symptomatic, whereas good
collateralization may preserve the patient asymptomatic even if all three
major splanchnic arteries are occluded. As a rule of thumb, it is said
that 2/3 or 3/3 splanchnic arteries have to be occluded before symptoms
occur (1,12). The term "chronic" implies that elective treatment is
possible; however, the chronic state may turn to acute at any time.
Therefore, there is still a dire necessity for treatment. Acute mesenteric
ischemia (AMI) Stage 4 symptoms may indicate life-threatening abdominal
disease requiring urgent diagnosis and treatment. If other differential
diagnoses as mentioned above can be excluded and symptoms persist for
several hours, AMI has to be suspected. Occlusion of the proximal
splanchnic arteries AMI caused by an obstruction of the proximal segments
of the splanchnic arteries occurs mostly due to SMA occlusion that is of
embolic nature in most cases; thrombosis favored by underlying
arteriosclerotic stenosis is observed in 20%-30% cases (13). A typical
patient with AMI is older than 70 years. Among all patients presenting
with an acute abdomen, only 1% have AMI; however, in patients older than
70 years, the rate increases to 10% (14). Important risk factors are
atrial fibrillation, major heart disease (coronary artery disease,
congestive heart failure, and myocardial infarction), peripheral arterial
occlusive disease, and arterial hypertension. Time to treat critical
ischemia of the small bowel is approximately 6 h. Because diagnosis and
treatment are frequently delayed, the lethality of AMI is still between
50%-90% and has not improved during the last decades (1,4). Based on
pathophysiology, the clinical course of acute arterial mesenteric
occlusion is divided into three stages: * initial stage (first 6 h):
characterized by severe griping pains in the bowel, nausea, vomiting,
diarrhea, and vertigo * intermediate stage (7-12 h): relief of symptoms,
tolerable permanent abdominal pain, so-called "deceptive peace," resulting
from necrosis of intramural pain receptors * final stage (>12 h): increase
in symptoms, paralytic ileus, penetrating peritonitis, shock, and death
Nonocclusive mesenteric ischemia (NOMI) NOMI is a special form of acute
mesenteric ischemia that refers to all forms of non-central mesenteric
occlusions (3,4,15). NOMI mainly occurs perioperatively in patients
following a major cardiac or aortic surgery. Different from this group of
patients, NOMI is also observed in patients requiring long-term
hemodialysis (16,17). Etiology is not fully understood. It is assumed that
NOMI is caused by sympathetic dysregulation with spasm of the distal
segments of the mesenteric circulation (1,3). NOMI is observed in 0.5%-1%
of all patients undergoing a heart surgery (18). Mortality being
approximately 50% is at least as high as or even higher than in acute SMA
occlusion (3,4), because symptoms are nonspecific, and they are frequently
diagnosed too late. The typical NOMI patient is older than 50 years and
treated in the intensive care unit. Different from the other forms of
mesenteric ischemia, not CTA but selective arterial DSA of the splanchnic
arteries is the method of choice for diagnosis. Despite advances in
technology, CTA is not yet able to depict the subtle changes in the
periphery of the splanchnic arteries found with NOMI. Moreover, it does
not allow CT for the evaluation of splanchnic blood flow, which is simply
possible with DSA. Beside the criterion time to portal vein filling, the
other two main DSA criteria for the diagnosis of NOMI are vessel
morphology and a reflux of contrast medium into the aorta. Based on these
three criteria, Minko et al developed a scoring system that well
correlated with perioperative mortality (15). Finally, DSA offers the
opportunity to combine diagnosis and therapy by infusing vasodilators via
the catheter in SMA. Mesenteric vein thrombosis (MVT) Different from
arterial mesenteric ischemia, MVT is observed more frequently in younger
patients (<50 years) (2,4). Symptoms and prognosis of the patients vary
considerably depending on the location, extension, and speed of thrombus
formation (2,8,19). Patients with a combination of proximal and distal
mesenteric vein thrombosis are more likely to develop mesenteric
infarction than those with isolated thrombosis of the proximal mesenteric
veins (19). Patients with slowly progressing chronic MVT may be
asymptomatic due to the formation of venous collaterals protecting from
mesenteric necrosis (2). Most patients present with non-specific symptoms,
mainly diffuse abdominal pain that may last for days or even weeks until
the diagnosis is conducted.

<8>
Accession Number
71616870
Authors
Philip M. Martin H. Robin T. Richard L. Jonathan C. Angela W.
Institution
(Philip, Martin, Robin, Richard, Jonathan, Angela) University of Sydney,
Australia
Title
Chronic kidney disease and risk of stroke: a systematic review and
meta-analysis.
Source
Nephrology. Conference: 14th Asian Pacific Congress of Nephrology Tokyo
Japan. Conference Start: 20140514 Conference End: 20140517. Conference
Publication: (var.pagings). 19 (pp 63), 2014. Date of Publication: May
2014.
Publisher
Blackwell Publishing
Abstract
Introduction: Reduced glomerular filtration rate (GFR) and proteinuria are
associated with increased stroke risk but the consistency and strength of
this relationship is unknown. We estimated the independent and combined
effects of GFR and proteinuria on stroke risk. Methods: Systematic review
and meta-analysis of observational studies and randomised trials using
Meta-analysis Of Observational Studies in Epidemiology and Preferred
Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We
searched MEDLINE and Embase for studies which prospectively measured GFR,
proteinuria or both, and quantified subsequent risk of stroke. Reviewers
abstracted risk (RR) of stroke, synthesized data using a random-effects
model and explored heterogeneity with meta-regression. We assessed study
quality using the Newcastle-Ottawa scale or Cochrane risk of bias tool.
Results: We included 71 studies (1,693,306 participants): 53 cohort
studies (1,537,097 participants) and 18 trials (156,209 participants).
Risk of stroke increased by 39% in people with eGFR <90 ml/min/1.73 m2
(RR1.39, 95%CI1.31 to 1.48) and increased with declining GFR (figure 1).
We estimated stroke risk increased by 7% for every 10% decline in GFR
(RR1.07, 95%CI 1.04 to 1.10). Larger studies (>20,000 participants)
reported smaller risk (RR0.67, 95%CI 0.52 to 0.87) and studies where
participants were undergoing cardiac surgery reported larger risk of
stroke (RR1.42, 95%CI1.15 to 1.60). Considering proteinuria, risk of
stroke increased by 69% when any proteinuria was detectable (RR1.69,
95%CI1.55 to1.84) and rose further as proteinuria increased (figure 1). We
estimated that stroke risk increased by 6% for every 10-fold increase in
the quantity of proteinuria (RR1.06, 95%CI1.02 to 1.11). Studies which
recruited mainly Asian participants reported an almost two-fold risk of
stroke compared to studies recruiting mainly white participants (RR1.93,
95%CI1.19 to 3.13). When GFR and proteinuria were both present, their
combined effects were additive. All of our observations were consistent
across different subtypes of stroke. Conclusions: Risk of stroke increases
with declining GFR and increasing quantities of proteinuria with variation
in the effect of proteinuria by ethnicity. Assessing risk of stroke
requires measurement of both GFR and proteinuria and recognition of
subgroups of people at particular risk. (Figure presented) .

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 12

Results Generated From:
Embase <1980 to 2014 Week 38>
Embase (updates since 2014-09-12)

<1>
Accession Number
24439644
Authors
Bagheri-Nesami M. Shorofi S.A. Zargar N. Sohrabi M. Gholipour-Baradari A.
Khalilian A.
Institution
(Bagheri-Nesami, Shorofi) Department of Medical-Surgical Nursing, School
of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Shorofi) Traditional and Complementary Medicine Research Centre,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zargar) School of Nursing and Midwifery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Sohrabi) Ayatollah Rohani Hospital, Babol University of Medical Science,
Babol, Iran, Islamic Republic of
(Gholipour-Baradari) Department of Anesthesiology, Imam Khomeini Hospital,
Mazandaran University of Medical Science, Sari, Iran, Islamic Republic of
(Khalilian) Department of Biostatistics and Epidemiology, Psychiatry and
Behavioral Sciences Research Centre, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Title
The effects of foot reflexology massage on anxiety in patients following
coronary artery bypass graft surgery: A randomized controlled trial.
Source
Complementary Therapies in Clinical Practice. 20 (1) (pp 42-47), 2014.
Date of Publication: February 2014.
Abstract
Objective: To examine the effects of foot reflexology massage on anxiety
in patients following CABG surgery. Methods: In this randomized controlled
trial, 80 patients who met the inclusion criteria were conveniently
sampled and randomly allocated to the experimental and control groups
after they were matched on age and gender. On the days following surgery,
the experimental group received foot reflexology massage on their left
foot 20mina day for 4 days, while the control group was given a gentle
foot rub with oil for one minute. Anxiety was measured using the
short-form of the Spielberger State-Trait Anxiety Inventory and the Visual
Analogue Scale-Anxiety. Results: Both measurement instruments confirmed a
significant decrease in anxiety following the foot reflexology massage.
Conclusion: The significant decrease in anxiety in the experimental group
following the foot reflexology massage supports the use of this
complementary therapy technique for the relief of anxiety. 2013.

<2>
Accession Number
24547604
Authors
Laursen S.B.
Title
Treatment and prognosis in peptic ulcer bleeding.
Source
Danish medical journal. 61 (1) (pp B4797), 2014. Date of Publication: Jan
2014.
Abstract
Peptic ulcer bleeding is a frequent cause of admission. Despite several
advances in treatment the 30-day mortality seems unchanged at a level
around 11%. Use of risk scoring systems is shown to be advantageous in the
primary assessment of patients presenting with symptoms of peptic ulcer
bleeding. Studies performed outside Denmark have demonstrated that use of
risk scoring systems facilitates identification of low-risk patients
suitable for outpatient management. Nevertheless, these systems have not
been implemented for routine use in Denmark. This is mainly explained by
concerns about the external validity due to considerable inter-country
variation in patients' characteristics. In recent years, transcatheter
arterial embolization (TAE) has become increasingly used for achievement
of hemostasis in patients with peptic ulcer bleeding not responding to
endoscopic therapy. As rebleeding is associated with poor outcome TAE
could, in theory, also be beneficial as a supplementary treatment in
patients with ulcer bleeding responding to endoscopic therapy. This has
not been examined previously. Several studies have concluded that peptic
ulcer bleeding is associated with excess long-term mortality. These
findings are, however, questioned as the studies were based on life-table
analysis, unmatched control groups, or did not perform adequate adjustment
for comorbidity. Treatment with blood transfusion is, among patients
undergoing cardiac bypass surgery, shown to increase the long-term
mortality. Despite frequent use of blood transfusion in treatment of
peptic ulcer bleeding a possible adverse effect of on long-term survival
has not been examined in these patients. The aims of the present thesis
were: 1. To examine which risk scoring system is best at predicting need
of hospital-based intervention, rebleeding, and mortality in patients
presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate
if supplementary transcatheter arterial embolization (STAE) after
successful endoscopic haemostasis improves outcome in patients with PUB
with active bleeding, a non-bleeding visible vessel, or an adherent clot
(Study II) 3. To examine the short- and long-term mortality in PUB
compared to a matched control group including identification of predictive
factors for adverse outcome, identification of underlying causes of death,
and investigation of a possible association between treatment with blood
transfusion and long-term mortality (Study III). Study I was conducted as
a prospective validation study. During a two-year period 831 patients
presenting with upper gastrointestinal haemorrhage were included. The
study demonstrated that the Glasgow Blatchford Score (GBS) was superior to
the other risk scoring systems at predicting need for hospital-based
intervention. The GBS was found to be favourable for the assessment of
Danish patients presenting with symptoms of upper gastrointestinal
haemorrhage. According to the findings of Study 1 implementation of the
GBS at a 1000-bed hospital would be associated with a 90.000 EUR annual
saving through avoidance of admission of patients in very low risk of
needing hospital-based intervention. None of the examined risk scoring
systems were suitable for predicting risk of rebleeding or 30-day
mortality. Study II was designed as a non-blinded, stratified, parallel
group, randomized controlled trial. Patients were randomized in a 1:1
ratio to receive STAE within 24 hours from therapeutic endoscopy or to
continue standard treatment. A total of 105 patients were included. After
adjustment for possible imbalances STAE was associated with a clear trend
of reduced rate of rebleeding (P=.079). Numbers needed to treat in order
to avoid one case of rebleeding was 10. Study III was conducted as a
prospective cohort study. The long-term survival of 455 patients admitted
with peptic ulcer bleeding was compared to an age- and sex-matched control
group consisting of 2224 individuals selected from the same geographical
area. Long-term mortality was adjusted for differences in comorbidity
using the Charlson comorbidity index. The study demonstrated that peptic
ulcer bleeding is associated with long-lasting excess mortality. Age,
recurrent bleeding, and comorbidity were predictors for 30-day mortality.
The underlying cause of 30-day mortality was in the majority of patients
related to comorbidity. The main predictors for long-term mortality were
old age, comorbidity, male sex, severe anaemia and tobacco use. Although
severe anaemia predicted long-term mortality treatment with blood
transfusion was not associated with long-term mortality per se.

<3>
Accession Number
2014580314
Authors
Sarzaeem M. Shayan N.
Institution
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Shayan) Transplantation Research Center, Dr. Shariati Hospital, Tehran,
Iran, Islamic Republic of
Title
Vitamin C in prevention of atrial fibrillation after coronary artery
bypass graft: Double blind randomized clinical trial.
Source
Tehran University Medical Journal. 71 (12) (pp 787-793), 2014. Date of
Publication: 2014.
Abstract
Background: Atrial fibrillation is the most common arrhythmia after
cardiac surgery. Vitamin C as an antioxidant has an important role in
reducing the incidence of postoperative atrial fibrillation. The present
study aimed at administrating vitamin C as a way to reduce the incidence
of post-CABG atrial fibrillation. Methods: In this double-blind, parallel
clinical trial, 170 patients with coronary artery disease who underwent
CABG surgery, by using a table of random numbers are divided into
intervention and control groups to receive placebo or vitamin C. The
clinical and surgical characteristics of the patients in the two groups
were similar. The intervention group received 2 mg of vitamin C
intravenously, the night before surgery. This drug followed by 500 mg,
twice a day for five days after surgery. On the other hand patients in the
control group received placebo (normal saline intravenously). After
operation two groups were compared regarding Important outcomes such as
postoperative arrhythmia, ICU stay and hospital stay. Results: One hundred
eighteen men and fifty two women with a mean age of 59.1+9.8 years were
enrolled in the study in two vitamin C and placebo groups (each consisting
of 85 patients). The incidence of postoperative atrial fibrillation was
12.9% in the vitamin C group and 29.4% in the control group (P=0.009). ICU
stay in the vitamin C group were 2.5+1.4 days versus 3.0+1.6 days in
controls (P=0.035) and hospital stay in the vitamin C group were 6.6+1.5
days versus 8.2+2.3 days in controls (P<0.001). Conclusion: Vitamin C is
relatively safe, inexpensive, well tolerated and has a low complication.
According to the 44% reduction in the incidence of atrial fibrillation in
vitamin C patients undergoing coronary artery bypass grafting surgery,
this drug can be prescribed as a prophylaxis for prevention of post-CABG
atrial fibrillation.

<4>
Accession Number
2014580500
Authors
Sarzaeem M. Shayan N. Bagheri J. Jebelli M. Mandegar M.
Institution
(Sarzaeem, Bagheri, Jebelli, Mandegar) Department of Cardiovascular
Surgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Shayan) Cardiac Surgery and Transplantation Research Center, Dr. Shariati
Hospital, Tehran, Iran, Islamic Republic of
Title
Low dose Colchicine in prevention of atrial fibrillation after coronary
artery bypass graft: A double blind clinical trial.
Source
Tehran University Medical Journal. 72 (3) (pp 147-154), 2014. Date of
Publication: 2014.
Abstract
Background: The occurrence of Atrial Fibrillation (AF) is linked to an
increased inflammatory response after cardiac surgery that is
significantly decreased by anti-inflammatory treatments. The present study
aimed at administrating Colchicine as a way to reduce the incidence of
post- Coronary Artery Bypass Graft (CABG) atrial fibrillation. Methods: In
this double-blind, parallel clinical trial, 216 patients with coronary
artery disease who underwent CABG surgery, by using a table of random
numbers are divided into intervention and control groups to receive
placebo or Colchicine. The clinical and surgical characteristics of the
patients in two groups were similar. The intervention group received 1.0
mg of Colchicine tab, the night before surgery and on the morning of
surgery. This drug followed by 0.5 mg twice a day for five days after
surgery. On the other hand patients in the control group received only
placebo (ineffective pill with similar size to Colchicine). After
operation two groups were compared regarding important outcomes such as
postoperative arrhythmia, ICU stay and hospital stay. The data were
assessed using SPSS software (version 17) and t-test and chi²
statistical tests. Results: One hundred fifty six men and sixty women with
a mean age of 59.9+9.3 years were enrolled in the study in two Colchicine
and placebo groups (each consisting of 108 patients). The incidence of
postoperative atrial fibrillation was 14.8% in the Colchicine group and
30.6% in the control group (P= 0.006). ICU stay in the Colchicine group
were 2.4+1.3 days versus 3.1+1.5 days in controls (P< 0.001) and hospital
stay in the Colchicine group were 6.6+1.5 days versus 8.1+2.0 days in
controls (P< 0.001). Conclusion: Colchicine is an anti-inflammatory
medication and has very few side effects at low doses. According to the
48% reduction in the incidence of atrial fibrillation in Colchicine
patients undergoing coronary artery bypass grafting surgery, this drug can
be prescribed as a prophylaxis for prevention of post-CABG atrial
fibrillation.

<5>
Accession Number
2014796031
Authors
Imazio M. Brucato A. Ferrazzi P. Pullara A. Adler Y. Barosi A. Caforio
A.L. Cemin R. Chirillo F. Comoglio C. Cugola D. Cumetti D. Dyrda O. Ferrua
S. Finkelstein Y. Flocco R. Gandino A. Hoit B. Innocente F. Maestroni S.
Musumeci F. Oh J. Pergolini A. Polizzi V. Ristic A. Simon C. Spodick D.H.
Tarzia V. Trimboli S. Valenti A. Belli R. Gaita F.
Institution
(Imazio, Belli) Department of Cardiology, Maria Vittoria Hospital,
University of Torino, Via Cibrario 72, Torino, Torino 10141, Italy
(Imazio, Pullara, Gaita) University of Torino, Torino, Italy
(Brucato, Ferrazzi, Cugola, Cumetti, Innocente, Maestroni, Simon, Valenti)
Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Pullara, Gaita) AOU Citta Della Salute e Della Scienza di Torino, Torino,
Italy
(Adler) Chaim Sheba Medical Center, Tel Hashomer and Sacker University,
Tel Aviv, Israel
(Barosi, Gandino) Department of Internal Medicine and Cardiac Surgery,
Ospedale Niguarda, Milano, Italy
(Caforio, Tarzia) Department of Cardiological Thoracic and Vascular
Sciences, University of Padova, Padova, Italy
(Cemin) Cardiology Department, Ospedale Regionale San Maurizio, Bolzano,
Italy
(Chirillo) Department of Cardiology and Cardiac Surgery, Ca Foncello
Hospital, Treviso, Italy
(Comoglio, Dyrda, Trimboli) Department of Cardiac Surgery and
Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
(Ferrua) Department of Cardiology, Ospedale degli Infermi, Rivoli, Italy
(Finkelstein) Department of Pediatrics, Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
(Flocco) Cardiac Surgery, Ospedale Mauriziano, Torino, Italy
(Hoit) Case Western Reserve University, Cleveland, OH, United States
(Hoit) University Hospitals Case Medical Center, Cleveland, OH, United
States
(Musumeci, Pergolini, Polizzi) Department of Cardiac Surgery, Ospedale San
Camillo, Roma, Italy
(Oh) Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN,
United States
(Ristic) Department of Cardiology, Belgrade University School of Medicine,
Clinical Centre of Serbia, Belgrade, Serbia
(Spodick) St Vincent Hospital, Worcester, MA, United States
Title
Colchicine for prevention of postpericardiotomy syndrome and postoperative
atrial fibrillation: The COPPS-2 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (10) (pp
1016-1023), 2014. Date of Publication: 10 Sep 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: Postpericardiotomy syndrome, postoperative atrial fibrillation
(AF), and postoperative effusions may be responsible for increased
morbidity and health care costs after cardiac surgery. Postoperative use
of colchicine prevented these complications in a single trial. OBJECTIVE:
To determine the efficacy and safety of perioperative use of oral
colchicine in reducing postpericardiotomy syndrome, postoperative AF, and
postoperative pericardial or pleural effusions. DESIGN, SETTING, AND
PARTICIPANTS: Investigator-initiated, double-blind, placebo-controlled,
randomized clinical trial among 360 consecutive candidates for cardiac
surgery enrolled in 11 Italian centers between March 2012 and March 2014.
At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6
years), 69% were men, and 36% had planned valvular surgery. Main exclusion
criteria were absence of sinus rhythm at enrollment, cardiac
transplantation, and contraindications to colchicine. INTERVENTIONS:
Patients were randomized to receive placebo (n=180) or colchicine (0.5mg
twice daily in patients >70 kg or 0.5 mg once daily in patients <70 kg;
n=180) starting between 48 and 72 hours before surgery and continued for 1
month after surgery. MAIN OUTCOMES AND MEASURES: Occurrence of
postpericardiotomy syndrome within 3 months; main secondary study end
points were postoperative AF and pericardial or pleural effusion. RESULTS:
The primary end point of postpericardiotomy syndrome occurred in 35
patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to
placebo (absolute difference, 10.0%; 95% CI, 1.1%-18.7%; number needed to
treat = 10). There were no significant differences between the colchicine
and placebo groups for the secondary end points of postoperative AF
(colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute
difference, 7.8%; 95% CI, -2.2% to 17.6%) or postoperative
pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo,
106 patients [58.9%]; absolute difference, 1.7%; 95% CI, -8.5% to 11.7%),
although there was a reduction in postoperative AF in the prespecified
on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine,
38/141 patients [27.0%]; absolute difference, 14.2%; 95% CI, 3.3%-24.7%).
Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36
(20.0%) in the colchicine group (absolute difference, 8.3%; 95% CI;
0.76%-15.9%; number needed to harm = 12), but discontinuation rates were
similar. No serious adverse events were observed. CONCLUSIONS AND
RELEVANCE: Among patients undergoing cardiac surgery, perioperative use of
colchicine compared with placebo reduced the incidence of
postpericardiotomy syndrome but not of postoperative AF or postoperative
pericardial/pleural effusion. The increased risk of gastrointestinal
adverse effects reduced the potential benefits of colchicine in this
setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01552187
Copyright 2014 American Medical Association. All rights reserved.

<6>
Accession Number
2014796030
Authors
O'Donoghue M.L. Braunwald E. White H.D. Steen D.P. Lukas M.A. Tarka E.
Steg P.G. Hochman J.S. Bode C. Maggioni A.P. Im K. Shannon J.B. Davies
R.Y. Murphy S.A. Crugnale S.E. Wiviott S.D. Bonaca M.P. Watson D.F. Weaver
W.D. Serruys P.W. Cannon C.P.
Institution
(O'Donoghue, Braunwald, Steen, Im, Murphy, Crugnale, Wiviott, Bonaca,
Cannon) TIMI Study Group, Cardiovascular Division, Brigham AndWomen's
Hospital, 350 Longwood Ave, Boston, MA 02115, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, PA, United States
(Tarka, Davies) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, King of Prussia, PA, United States
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Universite Paris-Diderot, Paris, France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital, United Kingdom
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Maggioni) ANMCO Research Center, Florence, Italy
(Shannon, Watson) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Research Triangle Park, NC, United States
(Weaver) Henry Ford Heart and Vascular Institute, Detroit, MI, United
States
(Serruys) Erasmus University, Thoraxcentrum, Rotterdam, Netherlands
(Serruys) International Center for Circulatory Health, Imperial College,
London, United Kingdom
Title
Effect of darapladib on major coronary events after an acute coronary
syndrome: The SOLID-TIMI 52 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (10) (pp
1006-1015), 2014. Date of Publication: 10 Sep 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: Lipoprotein-associated phospholipase
A₂(Lp-PLA₂) has been hypothesized to be involved in
atherogenesis through pathways related to inflammation. Darapladib is an
oral, selective inhibitor of the Lp-PLA₂enzyme. OBJECTIVE: To
evaluate the efficacy and safety of darapladib in patients after an acute
coronary syndrome (ACS) event. DESIGN, SETTING, AND PARTICIPANTS:
SOLID-TIMI 52was a multinational, double-blind, placebo-controlled trial
that randomized 13 026 participants within 30 days of hospitalization with
an ACS (non-ST-elevation or ST-elevationmyocardial infarction [MI]) at 868
sites in 36 countries. INTERVENTIONS: Patients were randomized to either
once-daily darapladib (160mg) or placebo on a background of
guideline-recommended therapy. Patients were followed up for a median of
2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES
AND MEASURES: The primary end point (major coronary events)was the
composite of coronary heart disease (CHD) death, MI, or urgent coronary
revascularization formyocardial ischemia. Kaplan-Meier event rates are
reported at 3 years. RESULTS: During a median duration of 2.5 years, the
primary end point occurred in 903 patients in the darapladib group and 910
in the placebo group (16.3%vs 15.6%at 3 years; hazard ratio [HR], 1.00
[95%CI, 0.91-1.09]; P = .93). The composite of cardiovascular death, MI,
or stroke occurred in 824 in the darapladib group and 838 in the placebo
group (15.0%vs 15.0%at 3 years; HR, 0.99 [95%CI, 0.90-1.09]; P = .78).
There were no differences between the treatment groups for additional
secondary end points, for individual components of the primary end point,
or in all-cause mortality (371 events in the darapladib group and 395 in
the placebo group [7.3%vs 7.1%at 3 years; HR, 0.94 [95%CI, 0.82-1.08]; P =
.40). Patients were more likely to report an odor-related concern in the
darapladib group vs the placebo group (11.5%vs 2.5%) and also more likely
to report diarrhea (10.6%vs 5.6%). CONCLUSIONS AND RELEVANCE: In patients
who experienced an ACS event, direct inhibition of Lp-PLA₂with
darapladib added to optimal medical therapy and initiated within 30 days
of hospitalization did not reduce the risk of major coronary events. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01000727 Copyright 2014
American Medical Association. All rights reserved.

<7>
Accession Number
2014587165
Authors
Attaran S. Harling L. Ashrafian H. Moscarelli M. Casula R. Anderson J.
Punjabi P. Athanasiou T.
Institution
(Attaran, Moscarelli, Casula, Anderson, Punjabi) Department of
Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London,
United Kingdom
(Harling, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, St Mary's Hospital, South Wharf Road, London, W2
1NY, United Kingdom
Title
Off-pump versus on-pump revascularization in females: A meta-analysis of
observational studies.
Source
Perfusion (United Kingdom). 29 (5) (pp 385-396), 2014. Date of
Publication: September 2014.
Abstract
Background: Coronary revascularization in female patients presents several
challenges, including smaller target vessels and smaller conduits.
Furthermore, late presentation and more co-morbidities than males may
increase complication rates. The aim of this study was to assess whether
off-pump coronary artery bypass (OPCAB) improves outcomes when compared to
on-pump coronary artery bypass (ONCAB) in the female population. Methods:
A systematic literature review identified six observational studies,
incorporating 23313 patients (n=9596 OPCAB, 13717 ONCAB). These were
meta-analyzed using random effects modeling. Heterogeneity, subgroup
analysis, quality scoring and publication bias were assessed. The primary
endpoints were 30-day mortality and major cardiac, respiratory and renal
complications. Secondary endpoints were the number of grafts per patient.
Results: No statistically significant difference was observed in 30-day
mortality between the OPCAB and ONCAB groups (4.8% vs. 0.7%; OR 0.96;
95%CI [0.41, 2.24], p=0.92). Significant inter-study heterogeneity was
also present (I2=94%) and was not explained by study size or quality.
Peri-operative myocardial infarction (OR 0.65; 95%CI [0.51, 0.84],
p=0.0009) was significantly lower with OPCAB without significant
heterogeneity; however, OPCAB did not significantly alter other morbidity
outcomes. OPCAB was associated with a trend towards fewer grafts per
patient than ONCAB. Conclusions: OPCAB is a safe alternative to ONCAB in
the surgical revascularisation of female patients and may reduce
post-operative myocardial infarction (MI). However, this does not
translate into a reduction in 30-day mortality and OPCAB does not
significantly improve other cardiovascular, renal or neurological
outcomes. Late outcome data remains lacking and a well-structured,
randomized trial is required to answer vital questions regarding the
effect of OPCAB on women in the long-term. The Author(s) 2014.

<8>
Accession Number
2014578246
Authors
Shan L. Saxena A. McMahon R.
Institution
(Shan) Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Melbourne, VIC, Australia
(Saxena, McMahon) Cardiology Unit, South Eastern Sydney and Illawarra
Health Network, Wollongong, NSW 2500, Australia
Title
A systematic review on the quality of life benefits after percutaneous
coronary intervention in the elderly.
Source
Cardiology (Switzerland). 129 (1) (pp 46-54), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Aims: Percutaneous coronary intervention (PCI) is being increasingly
performed on elderly patients with acceptable peri-procedural outcomes and
long-term survival. We aim to systematically review the health-related
quality of life (HRQOL) following PCI in the elderly which is an important
measure of procedural success. Methods: A systematic review of clinical
studies before September 2012 was performed to identify HRQOL in the
elderly after PCI. Strict inclusion and exclusion criteria were applied.
Quality appraisal of each study was also performed using pre-defined
criteria. HRQOL results were synthesised through a narrative review with
full tabulation of results of all included studies. Results: Elderly
patients have significant improvements in cardiovascular well-being. Early
HRQOL appears improved from baseline, but recovery in physical health may
be slower than in younger patients. HRQOL is comparable to an age-matched
general population and younger patients undergoing PCI. Conservative
management is not able to offer the same HRQOL benefits. Coronary artery
bypass graft surgery may be superior to PCI in the very elderly.
Significant heterogeneity and bias exists. Lack of appropriate data
precluded meta-analysis. Conclusion: HRQOL after PCI in the elderly can
improve for at least 1 year across a broad range of health domains, and is
comparable to an age-matched general population and younger patients
undergoing PCI. Given a limited number of articles and patients included,
more prospective studies are needed to better identify the benefits for
elderly patients. 2014 S. Karger AG, Basel.

<9>
Accession Number
2014581391
Authors
Nielsen L.H. Ortner N. Norgaard B.L. Achenbach S. Leipsic J. Abdulla J.
Institution
(Nielsen) Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25,
Vejle 7100, Denmark
(Ortner, Abdulla) Division of Cardiology, Department of Medicine, Glostrup
University Hospital, Glostrup, Denmark
(Norgaard) Department of Cardiology B, Aarhus University Hospital Skejby,
Aarhus N, Denmark
(Achenbach) Department of Cardiology, University of Erlangen, Erlangen,
Germany
(Leipsic) Department of Medical Imaging, St. Paul's Hospital, Vancouver,
BC, Canada
Title
The diagnostic accuracy and outcomes after coronary computed tomography
angiography vs. conventional functional testing in patients with stable
angina pectoris: A systematic review andmeta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 15 (9) (pp 961-971), 2014.
Date of Publication: September 2014.
Abstract
Aims To systematically reviewand perform a meta-analysis of the diagnostic
accuracy and post-test outcomes of conventional exercise
electrocardiography (XECG) and single-photon emission computed tomography
(SPECT) compared with coronary computed tomography angiography (coronary
CTA) in patients suspected of stable coronary artery disease (CAD).
Methods and results We systematically searched for studies published from
January 2002 to February 2013 examining the diagnostic accuracy (defined
as at least >50% luminal obstruction on invasive coronary angiography) and
outcomes of coronary CTA (>16 slice) in comparison with XECG and SPECT.
The search revealed 11 eligible studies (N = 1575) comparing the
diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary
CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence
interval (95% CI)] to identify significant CAD was 98% (93-99%) for
coronary CTAvs. 67% (54- 78%) (P< 0.001) for XECG and 99% (96-100%) vs.
73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary
CTA was 82% (63-93%) vs. 46% (30-64%) (P< 0.001) for XECG and 71% (60-80%)
vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream
test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38
(1.33-1.43, P< 0.001), for revascularization 2.63 (2.50-2.77, P< 0.001),
for non-fatal myocardial infarction 0.53 (0.39-0.72, P< 0.001), and for
all-cause mortality 1.01 (0.87-1.18, P = 0.87). Conclusion The up-front
diagnostic performance of coronary CTA is higher than of XECG and SPECT.
When compared with XECG/ SPECT testing, coronary CTA testing is associated
with increased DTU and coronary revascularization. The Author 2014.

<10>
Accession Number
71613975
Authors
Valero A. Westerhout K. Van De Wetering G. Perez-Alcantara F. Azpeitia A.
Najib M.
Institution
(Valero) Hospital Clinic Universitari Barcelona, Barcelona, Spain
(Westerhout) Pharmerit Europe, Rotterdam, Netherlands
(Van De Wetering, Perez-Alcantara) Oblikue Consulting, S.L., Barcelona,
Spain
(Azpeitia) Stallergenes Iberica, S.A., Barcelona, Spain
(Najib) Stallergenes S.A., Antony, France
Title
Impact of allergen immunotherapy on quality of life and healthcare costs
in patients with grass pollen-induced allergic rhinitis in Spain.
Source
Allergy: European Journal of Allergy and Clinical Immunology. Conference:
33rd Congress of the European Academy of Allergy and Clinical Immunology
Copenhagen Denmark. Conference Start: 20140607 Conference End: 20140611.
Conference Publication: (var.pagings). 69 (pp 611), 2014. Date of
Publication: September 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: A health economic assessment, reflective of Spanish clinical
practice, was conducted to determine the relative impact of treatment with
Oralair, Grazax, Pangramin, Pollinex Quattro, and symptomatic drug
treatment (SDT) on clinical effects and healthcare costs in patients with
grass pollen-induced allergic rhinitis. Methods: The effects of 3 years of
drug treatment on quality-adjusted life-years (QALYs) and associated costs
were assessed using a health economic Markov model with a 9-year time
horizon. Symptom score data were extracted, and the relative efficacy on
QALYs was assessed through a network meta-analysis (i.e. indirect
comparison) of 3-year, placebo-controlled, clinical trial data. Patient
symptom scores were translated into the impact on quality of life by means
of published sources. Costs associated with drug treatment and other
healthcare resources were calculated. The incremental costs and QALYs
gained for Oralair relative to Grazax, Pangramin, Pollinex Quattro and SDT
were generated accordingly. The uncertainty around the model outcomes was
determined by means of sensitivity analyses. Results: The base case
analysis over 9 years estimates an incremental cost-effectiveness ratio of
9517 per QALY, 9703 per QALY, and 6931 per QALY for Oralair relative to
SDT, Pollinex Quattro , and Pangramin, respectively. Meanwhile, Oralair
was predicted to result in more QALYs and considerable cost savings
relative to Grazax. The sensitivity analyses suggest that results were
mostly driven by drug-specific SMD values, duration of the pollen season,
and inputs for immunotherapy discontinuation. Conclusion: Oralair is
cost-effective relative to Grazax, Pangramin, Pollinex Quattro and SDT in
a health economic assessment of Spanish clinical practice. Findings are
confirmed by extensive sensitivity analyses.

<11>
Accession Number
71608609
Authors
Wagner G. Urbanschitz L. Vock P. Lamm G. Rimpfl T. Mayr H. Moertl D.
Institution
(Wagner, Urbanschitz, Vock, Lamm, Rimpfl, Mayr, Moertl) Landesklinikum St.
Polten, 3. Medizinische Abteilung, Medizinische Universitat Wien, Austria
Title
The St. Poelten experience of percutaneous transcatheter aortic-valve
implantation (TAVI) for severe aortic stenosis: Descriptive comparison to
results from the PARTNER trial.
Source
Wiener Klinische Wochenschrift. Conference: Jahrestagung 2014 der
Osterreichischen Kardiologischen Gesellschaft Salzburg Austria. Conference
Start: 20140528 Conference End: 20140531. Conference Publication:
(var.pagings). 126 (2 SUPPL. 1) (pp S124), 2014. Date of Publication: May
2014.
Publisher
Springer Wien
Abstract
Background: Symptomatic aortic valve stenosis, the most common valve
disease in adults, is associated with a high mortality of up to 50 % per
year. Surgical valve replacement is the treatment of choice in symptomatic
patients. However, more than 30 % of these patients do not undergo surgery
due to high surgical risk. Recently, percutaneous transcatheter aortic
valve implantation (TAVI) has been established as a non-surgical treatment
option for patients with symptomatic aortic valve stenosis at high
surgical risk and is used in our center since 2008. The short- and
long-term mortality benefit of TAVI compared to conservative therapy has
been clearly demonstrated in the randomized, controlled PARTNER-trial arm
B. However, clinical trial data do not always reflect everyday clinical
practice and the outcome of such interventions should also be evaluated in
"real world" patients aside clinical trials. We therefore performed a
retrospective analysis of all TAVI implantations in our center and
descriptively compared their outcome to data from the PARTNER trial arm B.
Methods: In this retrospective, single-center, mono-cohort study all
patients undergoing TAVI at the Department of Internal Medicine III
(Cardiology and Emergency Medicine), Landesklinikum St. Poelten from
01/2008 to 12/2013 were included. Endpoints were all-cause death after 30
days and one year. Baseline characteristics and outcome were descriptively
compared to the TAVI cohort of the PARTNER trial arm B (PTB: n = 179).
Results: Among a total of 279 patients (62 % female [PTB: 54 %], mean age
82 + 6yrs [PTB: 83 + 9yrs],) 183 (66 %) received a selfexpandable
Medtronic CoreValve (176 transfemoral, 7 transsubclavian approach) and 96
(34 %) a balloon expandable Edwards Sapien valve (all transfemoral).
Procedural success rate was 96 %. The logistic EuroSCORE was 19.7 + 11.4 %
(PTB: 26.4 + 17.2 %). Thirty-day and one-year all-cause mortality (n =
185, patients with completed one year follow-up) were 8.6 % (PTB: 5.0 %)
and 29.7 % (PTB: 30.7 %), respectively. Conclusion: Even in our real-world
population in a non-academic environment, TAVI outcome measures with
respect to mortality are comparable with randomized controlled trial data.
This suggests that the benefit for patients known from clinical TAVI
trials might be transferable into clinical practice.

<12>
Accession Number
71608536
Authors
Blessberger H. Kammler J. Domanovits H. Schlager O. Wildner B. Azar D.
Schillinger M. Wiesbauer F. Steinwender C.
Institution
(Blessberger, Kammler, Domanovits, Schlager, Wildner, Azar, Schillinger,
Wiesbauer, Steinwender) I. Medizinische Abteilung mit Kardiologie, AKH
Linz, Universitatsklinik fur Notfallmedizin, Universitatsklinik fur Innere
Medizin II, Baden, Germany
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
Wiener Klinische Wochenschrift. Conference: Jahrestagung 2014 der
Osterreichischen Kardiologischen Gesellschaft Salzburg Austria. Conference
Start: 20140528 Conference End: 20140531. Conference Publication:
(var.pagings). 126 (2 SUPPL. 1) (pp S89-S90), 2014. Date of Publication:
May 2014.
Publisher
Springer Wien
Abstract
Background: Randomized controlled trials (RCTs) yielded conflicting
results regarding the ability of beta-blockers (BB) to influence
perioperative cardiovascular morbidity and mortality. Methods: We
conducted a meta-analysis by searching the following databases from the
date of their inception until June 2013: MEDLINE, EMBASE, CENTRAL, Biosis
Previews, CAB Abstracts, CINAHL, Derwent Drug File, Science Citation Index
Expanded, Life Sciences Collection, Global Health and PASCAL. We included
RCTs if their participants were randomized into a BB group or a control
group (either standard care or placebo). Surgery (any type) had to be
performed under general anaesthesia in all or at least in a significant
proportion of patients. Subgroup analyses for various potential effect
modifiers were performed. Results: We included 89 RCTs with 19211
participants. Outcomes were evaluated separately for cardiac (CS) and non
cardiac surgery (NCS). In CS (53 trials) BBs did not influence all-cause
mortality (ACM) (RR 0.73, 95 % CI: 0.35 - 1.52, p = 0.40) or the incidence
of acute myocardial infarction (AMI) (RR 1.04, 95 % CI: 0.71 - 1.51, p =
0.85). BBs did not affect the incidence of cerebrovascular events (CVE)
(RR 1.52, 95 % CI: 0.58 - 4.02, p = 0.40), whereas a protective effect
against ventricular (VA) (RR 0.37, 95 % CI: 0.24 - 0.58, p < 0.0001, NNT:
29) and supraventricular arrhythmias (SVA) could be shown (RR 0.46, 95 %
CI: 0.37 - 0.56, p < 0.00001, NNT: 6). Hypotension (HY) (RR1.54, 95 % CI:
0.67 - 3.51, p = 0.31), bradycardia (BR) (RR 1.61, 95 % CI: 0.97 - 2.66, p
= 0.06) and congestive heart failure (CHF) (RR 0.22, 95 % CI: 0.04 - 1.34,
p = 0.10) were not increased with the use of beta-blockers. BBs reduced
length of hospital stay (LOS) on average by 0.54 days (95 % CI: - 0.90 to
- 0.19, p = 0.003). In NCS (36 trials) BBs overall did not influence ACM
(RR 1.24, 95 % CI: 0.99 - 1.54, p = 0.06). However, restricting the
meta-analysis to low risk of bias studies revealed an increase of ACM with
BBs (RR 1.26, 95 % CI: 1.02 - 1.57, p = 0.04, NNH: 185). BBs exhibited a
significant protective effect in the prevention of AMI (RR 0.73, 95 % CI:
0.61 - 0.87, p = 0.0005, NNT: 71) and SVAs (RR 0.72, 95 % CI: 0.56 - 0.92,
p = 0.008, NNT: 111). However, adverse events such as HY (1.49, 95 % CI:
1.37 - 1.62, p < 0.00001, NNH: 16) or BR (RR 2.30, 95 % CI: 1.58 - 3.37, p
< 0.0001, NNH: 17) were significantly increased by BB treatment. Risk for
CVEs was overall not influenced by BBs (RR 1.59, 95 % CI: 0.93 - 2.71, p =
0.09). Restricting the meta-analysis to low risk of bias studies again
revealed an increase of CVEs with the use of BBs (RR 2.09, 95 % CI: 1.14 -
3.82, p = 0.02, NNH: 255). VAs (RR 0.64, 95 % CI: 0.30 - 1.33, p = 0.23),
CHF (RR 1.17, 95 % CI: 0.93 - 1.47, p = 0.18) as well as LOS (mean
difference - 0.27 days, 95 % CI: - 1.29 to 0.75, p = 0.60) were not
affected by BB treatment. Discussion: According to our findings the
perioperative application of BBs still plays a pivotal role in CS, as they
can substantially reduce the high burden of SVAs and VAs in the aftermath
of surgery and reduce oxygen consumption in patients diagnosed with
coronary heart disease. The role of BBs in preventing AMI and potentially
causing CVE, HY, BR or death in this setting is still unclear. In NCS
evidence indicates a reduction of SVAs and AMIs, whereas data from low
risk of bias trials points to an increase in ACM and the incidence of CVEs
with the use of BBs. As the quality of evidence is still low to moderate,
more evidence is needed to draw a definite conclusion.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 12

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<1>
Accession Number
23911209
Authors
Harilall Y. Adam J.K. Biccard B.M. Reddi A.
Institution
(Harilall, Reddi) Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli
Central Hospital, KZN, South Africa.
(Adam) Department of Biomedical and Clinical Technology, Durban University
of Technology, South Africa. Electronic address:
(Biccard) College of Health Sciences, University of Kwazulu Natal, South
Africa; Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital,
South Africa.
Title
The effect of optimising cerebral tissue oxygen saturation on markers of
neurological injury during coronary artery bypass graft surgery.
Source
Heart, lung & circulation. 23 (1) (pp 68-74), 2014. Date of Publication:
Jan 2014.
Abstract
Surgical revascularisation of the coronary arteries is a cornerstone of
cardiothoracic surgery. Advanced age and the incidence of preoperative
co-morbidity in patients presenting for coronary artery bypass graft
surgery increases the potential for stroke and other perioperative
outcomes. It is hypothesised that by using interventions during cardiac
surgery to improve cerebral oxygenation, the risk of patients enduring
adverse neurological outcomes would be reduced. Forty patients (mean age
55.3, standard deviation 9.74 and range from 39 to 72 years) undergoing
on-pump coronary artery bypass graft surgery were recruited at Inkosi
Albert Luthuli Central Hospital, South Africa. Patients were randomised
into a control group (n=20) and interventional group (n=20).
Intraoperative regional cerebral oxygen saturation (rSO2) monitoring with
active display and Murkin treatment intervention protocol was administered
for the interventional group. Arterial blood samples for the measurement
of serum S100B were taken pre and postoperatively. An enzyme immunoassay
(ELISA) was used for the quantitative and comparative measurement of human
S100B concentrations for both groups. A prioritised intraoperative
management protocol to maintain rSO2 values above 75% of the baseline
threshold during cardiopulmonary bypass was followed. There was a highly
significant difference in the change in S100B concentrations post surgery
between the interventional (37.3picograms per millilitre) and control
groups (139.3pg/ml). The control group showed a significantly higher
increase in S100B concentration over time than the intervention group
(p<0.001). There was a significant difference in cerebral desaturation
time (p<0.001) between the groups. The mean desaturation time for the
control group was 63.85min as compared to 24.7min in the interventional
group. Cerebral desaturation occurred predominantly during aortic cross
clamping, distal anastomosis of coronary arteries and aortic cross clamp
release. Predictors of cerebral oxygen desaturation included, partial
pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean
arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen
saturation (SpO2). Monitoring brain oxygen saturation during on-pump CABG
together with an effective treatment protocol to deal with cerebral
desaturation must be advocated. Copyright 2013. Published by Elsevier
B.V.

<2>
Accession Number
2014571101
Authors
Pin T.W.
Institution
(Pin) Department of Rehabilitation Science, Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong
Title
Psychometric properties of 2-minute walk test: A systematic review.
Source
Archives of Physical Medicine and Rehabilitation. 95 (9) (pp 1759-1775),
2014. Date of Publication: September 2014.
Abstract
Objective To systematically review the psychometric evidence on the
2-minute walk test (2MWT). Data Sources Electronic searches of databases
including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO,
EMBASE, the Cochrane Library, and DARE were done until February 2014 using
a combination of subject headings and free texts. Study Selection Studies
were included if psychometric properties of the 2MWT were (1) evaluated;
(2) written as full reports; and (3) published in English language
peer-reviewed journals. Data Extraction A modified consensus-based
standard for the selection of health measurement instruments checklist was
used to rate the methodological quality of the included studies. A quality
assessment for statistical outcomes was used to assess the measurement
properties of the 2MWT. Data Synthesis Best-evidence synthesis was
collated from 25 studies of 14 patient groups. Only 1 study was found that
examined the 2MWT in the pediatric population. The testing procedures of
the 2MWT varied across the included studies. Reliability, validity
(construct and criterion), and responsiveness of the 2MWT also varied
across different patient groups. Moderate to strong evidence was found for
reliability, convergent validity, discriminative validity, and
responsiveness of the 2MWT in frail elderly patients. Moderate to strong
evidence for reliability, convergent validity, and responsiveness was
found in adults with lower limb amputations. Moderate to strong evidence
for validity (convergent and discriminative) was found in adults who
received rehabilitation after hip fractures or cardiac surgery. Limited
evidence for the psychometric properties of the 2MWT was found in other
population groups because of methodological flaws. Conclusions There is
inadequate breadth and depth of psychometric evidence of the 2MWT for
clinical and research purposes - specifically, minimal clinically
important changes and responsiveness. More good-quality studies are
needed, especially in the pediatric population. Consensus on standardized
testing procedures of the 2MWT is also required. 2014 by the American
Congress of Rehabilitation Medicine.

<3>
Accession Number
2014571057
Authors
Pilgrim T. Roffi M. Tuller D. Muller O. Vuilliomenet A. Cook S. Weilenmann
D. Kaiser C. Jamshidi P. Heg D. Juni P. Windecker S.
Institution
(Pilgrim, Windecker) Department of Cardiology, Swiss Cardiovascular
Center, University Hospital, 3010 Bern, Switzerland
(Roffi) Department of Cardiology, University Hospital, Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Heg, Juni) Institute of Social and Preventive Medicine, Clinical Trials
Unit, Bern University Hospital, Bern, Switzerland
Title
Randomized comparison of biodegradable polymer sirolimus-eluting stents
versus durable polymer everolimus-eluting stents for percutaneous coronary
revascularization: Rationale and design of the BIOSCIENCE trial.
Source
American Heart Journal. 168 (3) (pp 256-261), 2014. Date of Publication:
September 2014.
Abstract
Background Biodegradable polymers for release of antiproliferative drugs
from metallic drug-eluting stents aim to improve long-term vascular
healing and efficacy. We designed a large scale clinical trial to compare
a novel thin strut, cobalt-chromium drug-eluting stent with silicon
carbide-coating releasing sirolimus from a biodegradable polymer (O-SES,
Orsiro; Biotronik, Bulach, Switzerland) with the durable polymer-based
Xience Prime/Xpedition everolimus-eluting stent (EES) (Xience
Prime/Xpedition stent, Abbott Vascular, IL) in an all-comers patient
population. Design The multicenter BIOSCIENCE trial (NCT01443104) randomly
assigned 2,119 patients to treatment with biodegradable polymer
sirolimus-eluting stents (SES) or durable polymer EES at 9 sites in
Switzerland. Patients with chronic stable coronary artery disease or acute
coronary syndromes, including non-ST-elevation and ST-elevation myocardial
infarction, were eligible for the trial if they had at least 1 lesion with
a diameter stenosis >50% appropriate for coronary stent implantation. The
primary end point target lesion failure (TLF) is a composite of cardiac
death, target vessel myocardial infarction, and clinically driven target
lesion revascularization within 12 months. Assuming a TLF rate of 8% at 12
months in both treatment arms and accepting 3.5% as a margin for
noninferiority, inclusion of 2,060 patients would provide more than 80%
power to detect noninferiority of the biodegradable polymer SES compared
with the durable polymer EES at a 1-sided type I error of 0.05. Clinical
follow-up will be continued through 5 years. Conclusion The BIOSCIENCE
trial will determine whether the biodegradable polymer SES is noninferior
to the durable polymer EES with respect to TLF. 2014 Mosby, Inc.

<4>
Accession Number
2014568351
Authors
Ren X. Liu W. Peng Y. Li Q. Chai H. Zhao Z.-G. Meng Q.-T. Chen C. Zhang C.
Luo X.-L. Chen M. Huang D.-J.
Institution
(Ren, Liu, Peng, Li, Chai, Zhao, Meng, Chen, Zhang, Luo, Chen, Huang)
Department of Cardiology, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
Title
Percutaneous coronary intervention compared with coronary artery bypass
graft in coronary artery disease patients with chronic kidney disease: A
systematic review and meta-analysis.
Source
Renal Failure. 36 (8) (pp 1177-1186), 2014. Date of Publication: September
2014.
Publisher
Informa Healthcare
Abstract
Previous reports of percutaneous coronary intervention versus coronary
artery bypass graft outcomes in coronary artery disease patients with
chronic kidney disease (CKD) were inconsistent. We evaluated the optimal
revascularization strategy for CKD patients. We searched Pub Med, EMBASE,
and the Cochrane Central Register of Controlled Trials and scanned the
references of relevant articles and reviews. All studies that compared
relevant clinical outcomes between percutaneous coronary intervention and
coronary artery bypass graft in CKD patients were selected. We defined
short-term and long-term all-cause mortality as primary outcome, and
long-term incidences of myocardial infarction and revascularization as
secondary outcomes. A total of 2235 citations were retrieved, and 31
studies involving 99,054 patients, with 55,383 receiving percutaneous
coronary intervention and 43,671 receiving coronary artery bypass graft,
were included. In subgroup analyses of dialysis patients receiving
percutaneous coronary intervention with stents versus coronary artery
bypass graft, CKD patients with multivessel coronary disease, and CKD
patients receiving drug-eluting stent versus coronary artery bypass graft,
the pooled outcomes revealed that percutaneous coronary intervention
possessed lower short-term mortality, but higher late revascularization
risk. No significant differences in long-term mortality were observed
between the two strategies in these subgroup analyses. In conclusion, in
some specific clinical circumstances, CKD patients receiving percutaneous
coronary intervention possessed lower short-term all-cause mortality, but
higher long-term revascularization risk, than coronary artery bypass
graft; long-term all-cause mortality was not different between the two
strategies. 2014 Informa Healthcare USA, Inc. All rights reserved.

<5>
Accession Number
2014568016
Authors
Canale L. Mick S. Nair R. Mihaljevic T. Bonatti J.
Institution
(Canale, Mick) Cleveland Clinic, Heart and Vascular Institute, 9500 Euclid
Avenue, J 4-133, Cleveland, OH 44195, United States
(Nair, Mihaljevic, Bonatti) Cleveland Clinic Abu Dhabi, Abu Dhabi, United
Arab Emirates
Title
Atrial fibrillation after robotic cardiac surgery.
Source
Journal of Atrial Fibrillation. 7 (1) (pp 99-103), 2014. Date of
Publication: June-July 2014.
Publisher
CardioFront LLC
Abstract
Atrial fibrillation is one of the commonest complications after cardiac
surgery and it is associated with considerable morbidity and increase in
mortality. Recently, robotic approach to many heart operations has become
feasible and reproducible. We here investigate and review the incidence of
atrial fibrillation after robotic cardiac surgery. We found that its
incidence is overall low and less than in conventional heart surgery.

<6>
Accession Number
2014566237
Authors
Saito S. Valdes-Chavarri M. Richardt G. Moreno R. Romo A.I. Barbato E.
Carrie D. Ando K. Merkely B. Kornowski R. Eltchaninoff H. James S. Wijns
W.
Institution
(Saito) Shonan Kamakura General Hospital, Kanagawa, Japan
(Valdes-Chavarri) Hospital Universitaria V. Arrixaca, Murcia, Spain
(Richardt) Segeberger Kliniken GmbH, Bad Segeberg, Germany
(Moreno) Hospital la Paz, Madrid, Spain
(Romo) Hospital Meixoeiro Galaria, Vigo, Spain
(Barbato, Wijns) Cardiovascular Centre Aalst, OLV Hospital, Aalst, Belgium
(Carrie) CHU Toulouse Rangeuil, Toulouse, France
(Ando) Kokura Memorial Hospital, Fukuoka, Japan
(Merkely) Semmelweis University Hospital, Budapest, Hungary
(Kornowski) Rabin Medical Centre, Petach-Tikva, Israel
(Eltchaninoff) CHUCharles Nicolle Rouen, Rouen, France
(James) Uppsala Akademiska Sjukhus, Uppsala, Sweden
(Wijns) Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 165, 9301
Aalst, Belgium
Title
A randomized, prospective, intercontinental evaluation of a bioresorbable
polymer sirolimus-eluting coronary stent system: The CENTURY II (Clinical
Evaluation of New Terumo Drug-Eluting Coronary Stent System in the
Treatment of Patients with Coronary Artery Disease) trial.
Source
European Heart Journal. 35 (30) (pp 2021-2031), 2014. Date of Publication:
07 Aug 2014.
Publisher
Oxford University Press
Abstract
Aim: The aim of this study was to establish safety and efficacy of a new
sirolimus-eluting stent with bioresorbable polymer, Ultimaster (BP-SES).
Sirolimus-eluting stent with bioresorbable polymer was compared with
everolimus-eluting, permanent polymer, Xience stent (PP-EES) in the frame
of a CENTURY II clinical trial designed to make global clinical data
compliant with regulatory requirements in Europe and Japan. Methods and
results: The CENTURY II is a prospective, multicentre, randomized (1: 1),
single blind, controlled, non-inferiority clinical trial conducted at 58
study sites in Japan, Europe, and Korea. A total of 1123 patients
requiring a percutaneous coronary intervention (PCI) procedure, with
implantation of drug-eluting stent (DES), were enrolled [total population
(TP)]. Randomization of patients was stratified for the subset of patients
matching requirements for DES in Japan (Cohort JR, n = 722). Baseline
patient demographic and angiographic characteristics were similar in both
study arms, with minimal differences between the TP and Cohort JR. The
primary endpoint, freedom from target lesion failure (TLF) at 9 months -
TLF [composite of cardiac death, target-vessel-related myocardial
infarction (MI) and target lesion revascularization] - was 95.6% with
BP-SES and 95.1% with PP-EES (P_{non-inferiority}<0.0001).
Composite of cardiac death and MI rate was 2.9 and 3.8% (P = 0.40) and
target vessel revascularization was 4.5% with BP-SES and 4.2% with PP-EES
(P = 0.77). The stent thrombosis rate was 0.9% in both arms. InCohort JR,
freedom fromTLFwas 95.9 and 94.6% (P _{non-inferiority} < 0.0005)
with BP-SES and PP-EES, respectively. Conclusion: The new bioresorbable
polymer sirolimus-eluting stent showed safety and efficacy profiles
similar to durable polymer everolimus-eluting stent at 9-month follow-up.
The Author 2014.

<7>
Accession Number
2014569984
Authors
Washam J.B. Dolor R.J. Jones W.S. Halim S.A. Hasselblad V. Mayer S.B.
Heidenfelder B.L. Melloni C.
Institution
(Washam) Duke Heart Center, Duke University Medical Center, DUMC 3943,
Durham, NC 27710, United States
(Dolor, Jones, Halim, Hasselblad, Heidenfelder, Melloni) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Mayer) Division of Endocrinology and Metabolism, Department of Medicine,
Virginia Commonwealth University, Richmond, VA, United States
Title
Dual antiplatelet therapy with or without oral anticoagulation in the
postdischarge management of acute coronary syndrome patients with an
indication for long term anticoagulation: A systematic review.
Source
Journal of Thrombosis and Thrombolysis. 38 (3) (pp 285-298), 2014. Date of
Publication: October 2014.
Publisher
Kluwer Academic Publishers
Abstract
Currently, there is a lack of consensus among guidelines for the
postdischarge treatment of patients presenting with acute coronary
syndrome (ACS) who have a long-term indication for anticoagulation. We
conducted a systematic review comparing the safety and effectiveness of
dual antiplatelet therapy (DAPT) and triple therapy (TT; defined as DAPT
plus an oral anticoagulant) in patients with ACS and a long-term
indication for anticoagulation. We searched for clinical studies in
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews published
between January 1995 and September 2013. Each investigator screened and
abstracted data, assessed applicability and quality, and graded the
strength of evidence. Meta-analysis of direct comparison was performed
when outcomes and follow-up periods were comparable. Fourteen
observational studies were identified that contained comparative
effectiveness data on DAPT versus TT. No difference in the odds of
mortality (OR 1.04, 95 % CI 0.59-1.83) or stroke (OR 1.01, 95 % CI
0.38-2.67) at 1-5 years was found between TT and DAPT. Major bleeding at
1-5 years (OR 1.46, 95 % CI 1.07-2.00) and nonfatal MI at 1-5 years (OR
1.85, 95 % CI 1.13-3.02) occurred more frequently in patients receiving
TT. The results of this systematic review demonstrate that treatment with
TT was associated with increased rates of nonfatal MI and major bleeding
when compared with treatment with DAPT in the postdischarge management of
ACS patients with an indication for oral anticoagulation. Until results of
ongoing randomized trials assessing antithrombotic therapies define
optimal management strategies, the current analysis suggests using caution
when prescribing TT to these patients. 2014 Springer Science+Business
Media.

<8>
Accession Number
2014566099
Authors
Harskamp R.E. Alexander J.H. Schulte P.J. Brophy C.M. Mack M.J. Peterson
E.D. Williams J.B. Gibson C.M. Califf R.M. Kouchoukos N.T. Harrington R.A.
Ferguson Jr. T.B. Lopes R.D.
Institution
(Harskamp, Alexander, Schulte, Peterson, Williams, Lopes) Department of
Medicine, Duke Clinical Research Institute, Duke University, 2400 Pratt
St, Durham, NC 27705, United States
(Harskamp) Heart Center, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Brophy) Division of Vascular Surgery, Vanderbilt University, Nashville,
TN, United States
(Mack) Cardiopulmonary Research Science and Technology Institute, Dallas,
TX, United States
(Gibson) PERFUSE Angiographic Laboratory, Boston, MA, United States
(Califf) Department of Medicine, Duke Translational Medicine Institute,
Duke University, Durham, NC, United States
(Kouchoukos) Heart Center, Missouri Baptist Medical Center, St Louis, MO,
United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Ferguson Jr.) Department of Cardiovascular Sciences, East Carolina
University, Greenville, NC, United States
Title
Vein graft preservation solutions, patency, and outcomes after coronary
artery bypass graft surgery: Follow-up from PREVENT IV randomized clinical
trail.
Source
JAMA Surgery. 149 (8) (pp 798-805), 2014. Date of Publication: August
2014.
Publisher
American Medical Association
Abstract
IMPORTANCE In vitro and animal model data suggest that intraoperative
preservation solutions may influence endothelial function and vein graft
failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical
studies to validate these findings are lacking. OBJECTIVE To evaluate the
effect of vein graft preservation solutions on VGF and clinical outcomes
in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS
Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection
IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind,
placebo-controlled trial that enrolled 3014 patients at 107 US sites from
August 1, 2002, through October 22, 2003, were used. Eligibility criteria
for the trial included CABG surgery for coronary artery disease with at
least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in
saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES
One-year angiographic VGF and 5-year rates of death, myocardial
infarction, and subsequent revascularization. RESULTS Most patients had
grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%])
and buffered saline (507 [16.8%]). Baseline characteristics were similar
among groups. One-year VGF rates were much lower in the buffered saline
group than in the saline group (patient-level odds ratio [OR], 0.59
[95%CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95%CI, 0.49-0.79; P <
.001]) or the blood group (patient-level OR, 0.62 [95%CI, 0.46-0.83; P =
.001]; graft-level OR, 0.63 [95%CI, 0.48-0.81; P < .001]). Use of buffered
saline solution also tended to be associated with a lower 5-year risk for
death,myocardial infarction, or subsequent revascularization compared with
saline (hazard ratio, 0.81 [95%CI, 0.64-1.02; P = .08]) and blood (0.81
[0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients
undergoing CABG whose vein grafts were preserved in a buffered saline
solution had lower VGF rates and trends toward better long-term clinical
outcomes compared with patients whose grafts were preserved in saline-or
blood-based solutions. Copyright 2014 American Medical Association. All
rights reserved.

<9>
Accession Number
2014702098
Authors
Mailhot T. Cossette S. Bourbonnais A. Cote J. Denault A. Cote M.-C.
Lamarche Y. Guertin M.-C.
Institution
(Mailhot, Cossette, Bourbonnais, Cote') Faculty of Nursing, University of
Montreal, C.P. 6128 succ. Centre-ville, Montreal, QC H3C 3J7, Canada
(Mailhot, Cossette) Montreal Heart Institute Research Center S-2490, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Bourbonnais) Centre de recherche de l'Institut Universitaire de
Ge'riatrie de Montre'al, 4545 chemin Queen-Mary, Montre'al, QC H3W 1W4,
Canada
(Bourbonnais) Centre Ge'ratrique Maimonides Donald Berman, 5795 Caldwell
ave, Montreal, QC H4W 1W3, Canada
(Cote') Centre de Recherche du Centre Hospitalier de l'Universite' de
Montre'al, 900 Saint-Denis Street, Montreal, QC H2X 0A9, Canada
(Denault) Department of Anesthesiology, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Cote') Department of Psychosomatics, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Guertin) Montreal Health Innovations Coordinating Center, 4100 Molson
street suite 400, Montre'al, QC H1Y 3N1, Canada
Title
Evaluation of a nurse mentoring intervention to family caregivers in the
management of delirium after cardiac surgery (MENTOR_D): A study protocol
for a randomized controlled pilot trial.
Source
Trials. 15 (1) , 2014. Article Number: 306. Date of Publication: July 30,
2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Despite the use of evidence-based preventive measures,
delirium affects about 40% of patients following cardiac surgery with the
potential for serious clinical complications and anxiety for caregivers.
There is some evidence that family involvement as a core component of
delirium management may be beneficial since familiarity helps patients
stay in contact with reality, however, this merits further investigation.
There is also currently a gap in the scientific literature regarding
objective indicators that could enhance early detection and monitoring of
delirium. Therefore, this randomized pilot trial examines the
acceptability, feasibility, and preliminary efficacy of an experimental
nursing intervention to help family caregivers manage post-cardiac surgery
delirium in their relatives. It also explores the validity of a new and
innovative measure that has potential as an indicator for
delirium.Methods/Design: In this two-group randomized pilot study (n =
30), the control group will receive usual care and the intervention group
will receive the experimental intervention aimed at reducing delirium
severity. The intervention nurse's objective will be to foster the family
caregiver's self-efficacy in behaving in a supportive manner during
delirium episodes. Data will be collected from standard delirium
assessment scales and a novel measure of delirium, i.e., cerebral oximetry
obtained using near infrared spectroscopy, as well as medical records and
participants' responses to questionnaires.Discussion: New strategies for
early detection, monitoring, and management of delirium are needed in
order to improve outcomes for both patients and families. The present
article exposes feasibility issues based on the first few months of the
empirical phase of the study that may be useful to the scientific
community interested in improving the care of patients with delirium.
Another potentially important contribution is in the exploration of
cerebral oximetry, a promising measure as an objective indicator for early
detection and continuous monitoring of delirium. The proposed pilot study
will build towards a larger trial with the potential to improve knowledge
about delirium management and monitoring.

<10>
Accession Number
2014563451
Authors
Rauch B. Riemer T. Schwaab B. Schneider S. Diller F. Gohlke H. Schiele R.
Katus H. Gitt A. Senges J.
Institution
(Rauch) Zentrum fur Ambulante Rehabilitation, Klinikum der Stadt
Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Germany
(Riemer, Schneider, Diller, Senges) Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Schwaab) Curschmann Klinik, Timmendorfer Strand, Germany
(Gohlke) Herzzentrum Bad Krozingen, Bad Krozingen, Germany
(Schiele) Klinikum Friedrichshafen, Friedrichshafen, Germany
(Katus) Klinikum der Universitat Heidelberg, Heidelberg, Germany
(Gitt) Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
Title
Short-term comprehensive cardiac rehabilitation after AMI is associated
with reduced 1-year mortality: Results from the OMEGA study.
Source
European Journal of Preventive Cardiology. 21 (9) (pp 1060-1069), 2014.
Date of Publication: September 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: The prognostic effect of early, comprehensive short-term
cardiac rehabilitation on top of current, guideline- adjusted treatment of
acute myocardial infarction has not sufficiently been evaluated. Design:
Prospective cohort study. Methods: Within the OMEGA study population, the
clinical course of 3560 patients still alive 3 months after acute
myocardial infarction were evaluated by comparing patients who had
attended to cardiac rehabilitation (70.6%) with those who did not. Total
mortality and major adverse cerebrovascular and cardiovascular events, as
well as non-fatal events, were evaluated within the time period of 4-12
months after hospital admission for acute myocardial infarction. The
effect of cardiac rehabilitation on clinical events was estimated by using
the propensity score method to adjust for confounding parameters in
multivariate analysis. Results: Patients participating in cardiac
rehabilitation were younger, more often had acute revascularization, less
often experienced non-ST-elevation myocardial infarction, and less often
had a history of diabetes or cardiovascular events. Total mortality (OR
0.46, 95% CI 0.27-0.77) and major adverse cerebrovascular and
cardiovascular events (OR 0.53, 95% CI 0.38-0.75) were significantly lower
in the rehabilitation group. Subgroup analysis including major clinical
characteristics also revealed significantly reduced rates of total death
and major adverse cerebrovascular and cardiovascular events in the
rehabilitation group. Conclusions: Attendance to early, comprehensive
short-term cardiac rehabilitation programmes on top of current
guideline-adjusted treatment of acute myocardial infarction is associated
with a significantly improved 1-year prognosis. 2013 The European Society
of Cardiology.

<11>
Accession Number
2014562902
Authors
Tackett S.M. Sugarman R. Kreuwel H.T.C. Alvarez P. Nasso G.
Institution
(Tackett, Kreuwel) Baxter Healthcare Corporation, Westlake Village, CA,
United States
(Sugarman, Alvarez) Evidera, Lexington, MA, United States
(Nasso) Department of Cardiac Surgery, Anthea Hospital, GVM Care and
Research, Bari, Italy
Title
Hospital economic impact from hemostatic matrix usage in cardiac surgery.
Source
Journal of Medical Economics. 17 (9) (pp 670-676), 2014. Date of
Publication: September 2014.
Publisher
Informa Healthcare
Abstract
Objective: Improved health outcomes can result in economic savings for
hospitals and payers. While effectiveness of topical hemostatic agents in
cardiac surgery has been demonstrated, evaluations of their economic
benefit are limited. This study quantifies the cost consequences to
hospitals, based on clinical outcomes, from using a flowable hemostatic
matrix vs non-flowable topical hemostatic agents in cardiac surgery.
Research design and methods: Applying clinical outcomes from a prospective
randomized clinical trial, a cost consequence framework was utilized to
model the economic impact of comparator groups. From that study, clinical
outcomes were obtained and analyzed for a flowable hemostatic matrix
(FLOSEAL, Baxter Healthcare Corporation) vs non-flowable topical hemostats
(SURGICEL Nu-Knit, Ethicon-Johnson & Johnson; GELFOAM, Pfizer). Costing
analyses focused on the following outcomes: complications, blood
transfusions, surgical revisions, and operating room (OR) time. Cardiac
surgery costs were analyzed and expressed in 2012 US dollars based on
available literature searches and US data. Comparator group variability in
cost consequences (i.e., cost savings) was calculated based on annualized
impact and scenario testing. Results: Results suggest that if a flowable
hemostatic matrix (rather than a non-flowable hemostat) was utilized
exclusively in 600 mixed cardiac surgeries annually, a hospital could
improve patient outcomes by a reduction of 33 major complications, 76
minor complications, 54 surgical revisions, 194 transfusions, and 242 h of
OR time. These outcomes correspond to a net annualized cost consequence
savings of $5.38 million, with complication avoidance as the largest
contributor. Conclusions: This cost consequence framework and supportive
modeling was used to evaluate the hospital economic impact of outcomes
resulting from the usage of various hemostatic agents. These analyses
support that cost savings can be achieved from routine use of a flowable
hemostatic matrix, rather than a non-flowable topical hemostat, in cardiac
surgery. 2014 Informa UK Ltd.

<12>
Accession Number
71607044
Authors
Boitor M. Martorella G. Arbour C. Michaud C. Gelinas C.
Institution
(Boitor, Martorella, Arbour, Gelinas) Ingram School of Nursing, McGill
University, Montreal, Canada
(Martorella) Faculty of Nursing, Universite de Montreal, Montreal, Canada
(Martorella, Arbour, Michaud, Gelinas) Quebec Nursing Interventions
Research Network (RRISIQ), McGill University, Montreal, Canada
(Arbour, Gelinas) Alan Edwards Centre for Research on Pain, McGill
University, Montreal, Canada
(Michaud) School of Nursing, Universite de Sherbrooke, Sherbrooke, Canada
(Gelinas) Centre for Nursing Research and Lady Davis Institute, Jewish
General Hospital, Montreal, QC, Canada
Title
Evaluation of the preliminary effectiveness of hand-massage therapy on
postoperative pain of cardiac surgery adults in the intensive care unit.
Source
Pain Research and Management. Conference: 35th Annual Scientific Meeting
of the Canadian Pain Society Quebec City, QC Canada. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
19 (3) (pp e64), 2014. Date of Publication: May-June 2014.
Publisher
Pulsus Group Inc.
Abstract
AIM: This study aimed to evaluate the preliminary effectiveness of hand
massage on postoperative pain in the ICU. METHODS: A pilot randomized
controlled trial (RCT) was conducted with 40 adult ICU patients post
cardiac surgery. Patients were randomized to either experimental (EG)
(n=21) or control group (CG) (n=19). The EG received a 15 min hand-massage
with lavender cream followed by a 30 min rest period. The CG had the cream
applied to their hands without massage followed by the rest period. All
participants received at least two interventions (massage or control), and
12 of them, a third one from a trained nurse within the first 24 h
postoperative period. Pain variables (0 to 10 intensity, 0 to 8
Critical-Care Pain Observation Tool for behaviors) were collected before
and after each intervention. Participants were also interviewed within 24
h post-ICU discharge with the Brief Pain Inventory (BPI). RESULTS: A trend
towards significance for the second intervention (P=0.088), and a
treatment effect for the third intervention (F[2, 20]=6.30; P=0.008) were
found for the EG who reported a greater decrease in pain intensity
post-massage. Significantly less pain behaviors (ie, lower CPOT scores)
post-massage were found for the EG for the first intervention (Mann
Whitney=83.5; P=0.047). No significant results were obtained using the
BPI. CONCLUSIONS: This pilot RCT showed promising results supporting
potential benefits of hand-massage as a non-pharmacological intervention
for pain management in postoperative ICU patients. A larger RCT is
warranted to further explore its effects on pain, but until then, this
low-cost intervention can be safely administered.