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<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.