Total documents retrieved: 137
Results Generated From:
Embase <1980 to 2015 Week 08>
Embase (updates since 2015-02-13)
<1>
Accession Number
2014457646
Authors
Daniels L.A. Krol A.D.G. De Graaf M.A. Scholte A.J.H.A. Van't Veer M.B.
Putter H. de Roos A. Schalij M.J. Creutzberg C.L.
Institution
(Daniels, Krol, Creutzberg) Department of Clinical Oncology, Leiden
University Medical Center, Leiden, Netherlands
(De Graaf, Scholte, Schalij) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Van't Veer) Department of Hematology, Leiden University Medical Center,
Leiden, Netherlands
(Putter) Department of Medical Statistics and Bio-informatics, Leiden
University Medical Center, Leiden, Netherlands
(de Roos) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(De Graaf) The Interuniversity Cardiology Institute, Utrecht, Netherlands
Title
Screening for coronary artery disease after mediastinal irradiation in
Hodgkin lymphoma survivors: Phase II study of indication and acceptance.
Source
Annals of Oncology. 25 (6) (pp 1198-1203), 2014. Date of Publication: June
2014.
Publisher
Oxford University Press
Abstract
Background: Cardiovascular diseases are the most common nonmalignant cause
of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal
irradiation. We investigated the role of computed tomographic coronary
angiography (CTA) as a screening tool for coronary artery disease (CAD) in
asymptomatic HL survivors, and related CTA findings to exercise testing
and subsequent interventions. Patients and methods: Patients were eligible
for this phase II study if at least 10 years disease-free and treated with
mediastinal radiotherapy. Screening consisted of electrocardiogram,
exercise testing and CTA. Primary end point was significant CAD (stenosis
>50%) on CTA. CTA screening was considered to be indicated for testing in
a larger population if >6 of 50 CTA scanned patients (12%) would need
revascularization. Screening was evaluated with a questionnaire before and
after screening. Results: Fifty-two patients were included, and 48
patients underwent CTA. Median age was 47 years, time since HL diagnosis
21 years. There were 45 evaluable scans. Significant CAD on CTA was found
in 20% (N = 9), significantly increased compared with the 7% expected
abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N
= 5), significant stenosis was confirmed at coronary angiography, and
revascularization was carried out. Additionally, two patients were treated
with optimal medical therapy. Ninety percent of patients were content with
screening, regardless whether the CTA showed abnormalities. Conclusions:
Prevalence of significant CAD among HL survivors is high, while
asymptomatic even in the presence of life-threatening CAD. This might
justify screening by CTA in asymptomatic HL survivors who had mediastinal
radiotherapy, but needs to be evaluated in a larger cohort. The trial
protocol was approved by the Ethics Committee of the LUMC and registered
with ClinicalTrials.gov, NCT01271127. © The Author 2014. Published by
Oxford University Press on behalf of the European Society for Medical
Oncology. All rights reserved.
<2>
Accession Number
2014430720
Authors
Xu B. Yang Y.-J. Han Y.-L. Lu S.-Z. Li B. Liu Q. Zhu G.-Y. Cui J.-Y. Li L.
Zhao Y.L. Kirtane A.J.
Institution
(Xu, Yang, Zhao) Fu Wai Hospital, National Center for Cardiovascular
Diseases, A167, Beilishi Road, Beijing, 100037, China
(Han) Shenyang Northern Hospital, Shenyang, China
(Lu) An Zhen Hospital of Capital Medical University, Beijing, China
(Li) Shanxi Provincial Cardiovascular Institute, Taiyuan, China
(Liu) Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
(Zhu) Wuhan Asia Heart Hospital, Wuhan, China
(Cui) Beijing Military General Hospital, Beijing, China
(Li) Hospital of Guangxi Medical University, Nanning, China
(Kirtane) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
Title
Validation of residual SYNTAX score with second-generation drug-eluting
stents: One-year results from the prospective multicentre SEEDS study.
Source
EuroIntervention. 10 (1) (pp 65-73), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: The SYNTAX score has been proposed as a valuable tool to
characterise coronary anatomy prospectively based on its complexity. This
study evaluated the prognostic value on adverse outcomes of the residual
SYNTAX score (rSS) in patients with complex lesions treated with an
everolimus-eluting stent (EES). Methods and results: One thousand eight
hundred and fifty-one patients with small vessel (reference diameter >2.75
mm), long lesion (length <25 mm), or multivessel (<2 target vessels)
disease who underwent percutaneous coronary intervention (PCI) with EES in
the prospective SEEDS (A Registry To Evaluate Safety And Effectiveness Of
Everolimus Drug Eluting Stent For Coronary Revascularization) trial were
categorised into low (>6), mid (<6->12) and high (<12) baseline SYNTAX
score (bSS) groups, and into low (=0), mid (<0->5) and high (<5) rSS
groups. Mean bSS and rSS were 10.87+/-7.26 and 2.18+/-3.97, respectively;
64% of patients had complete revascularisation (rSS=0). At 12 months the
primary outcome of ischaemia- driven target vessel failure (TVF, composite
of cardiac death, target vessel myocardial infarction and ischaemia-driven
target vessel revascularisation) was significantly higher in the high bSS
and rSS groups than in the respective lower groups (p>0.01 for both). In
multivariable analysis, rSS was an independent predictor of TVF (hazard
ratio: 1.403, 95% confidence interval: 1.081 to 1.820, p=0.01).
Conclusions: Twelve-month TVF was significantly higher in the highest rSS
group; rSS with a cut-off of 5 might therefore allow the risk
stratification of patients with complex lesions treated with a
second-generation drug-eluting stent (ClinicalTrials.gov identifier: NCT
01157455). © Europa Digital & Publishing 2014.
<3>
Accession Number
2014414940
Authors
Husted S. James S.K. Bach R.G. Becker R.C. Budaj A. Heras M. Himmelmann A.
Horrow J. Katus H.A. Lassila R. Morais J. Nicolau J.C. Steg P.G. Storey
R.F. Wojdyla D. Wallentin L.
Institution
(Husted) Medical Department, Hospital Unit West, GI, Landevej 61, Herning
7400, Denmark
(James, Wallentin) Department of Medical Sciences and Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Bach) Cardiovascular Division, Washington University School of Medicine,
St Louis, MO, United States
(Becker, Wojdyla) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Heras) Cardiology Department, Hospital Clinic, University of Barcelona,
Barcelona, Spain
(Himmelmann) AstraZeneca Research and Development, Molndal, Sweden
(Horrow) AstraZeneca Research and Development, Wilmington, DE, United
States
(Katus) Medizinishe Klinik, Universitatsklinikum Heidelberg, Heidelberg,
Germany
(Lassila) Division of Hematology and Laboratory Services Coagulation
Disorders, Helsinki University Central Hospital, Helsinki, Finland
(Morais) Santo Andre Hospital, Leiria, Portugal
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Steg) INSERM-Unite 698, Paris, France
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
The efficacy of ticagrelor is maintained in women with acute coronary
syndromes participating in the prospective, randomized, PLATelet
inhibition and patient Outcomes (PLATO) trial.
Source
European Heart Journal. 35 (23) (pp 1541-1550), 2014. Date of Publication:
14 Jun 2014.
Publisher
Oxford University Press
Abstract
Aims The aim of this study was to assess the relationship between sex and
clinical outcomes and treatment-related complications in patients with
ST-elevation or non-ST-elevation acute coronary syndromes (ACS) randomized
to treatment with ticagrelor or clopidogrel in the PLATelet inhibition and
patient Outcomes (PLATO) trial. Methods The associations between sex
subgroup and the primary composite outcomes, secondary outcomes, and major
bleeding endpoints as well as interaction of sex subgroup with treatment
effects were analysed using Cox proportional-hazards models. Results Sex
was not significantly associated with the probability of the primary
composite endpoint [adjusted hazard ratio (HR): 1.02 (0.91-1.16)], or
other adverse cardiovascular endpoints. Ticagrelor was similarly more
effective than clopidogrel in reducing rates of the primary endpoint in
women 11.2 vs. 13.2% [adjusted HR: 0.88 (0.74-1.06)] and men 9.4 vs. 11.1%
[adjusted HR: 0.86 (0.76-0.97)] (interaction P-value 0.78), all-cause
death in women 5.8 vs. 6.8% [adjusted HR: 0.90 (0.69-1.16)] and men 4.0
vs. 5.7% [adjusted HR: 0.80 (0.67-0.96)] (interaction P-value 0.49), and
definite stent thrombosis in women 1.2 vs. 1.4% [adjusted HR: 0.71
(0.36-1.38)] and men 1.4 vs. 2.1% [adjusted HR: 0.63 (0.45-0.89)]
(interaction P-value 0.78). The treatments did not differ for
PLATO-defined overall major bleeding complications in women [adjusted HR:
1.01 (0.83-1.23)] or men [adjusted HR: 1.10 (0.98-1.24)]. Sex had no
significant association with these outcomes (interactions P = 0.43-0.88).
Conclusion Female sex is not an independent risk factor for adverse
clinical outcomes in moderate-to-high risk ACS patients. Ticagrelor has a
similar efficacy and safety profile in men and women. © 2014 The
Author 2014. Published by Oxford University Press on behalf of the
European Society of Cardiology.
<4>
Accession Number
2014403367
Authors
Pedersen S.H. Pfisterer M. Kaiser C. Jensen J.S. Alber H. Rickenbacher P.
SOrensen R. Iversen A. Jensen M.T. Wadt K. Galatius S.
Institution
(Pedersen, Jensen, SOrensen, Iversen, Jensen, Wadt, Galatius) Department
of Cardiology P, Gentofte University Hospital, Niels Andersens Vej 65,
DK-2900 Hellerup, Denmark
(Pfisterer, Kaiser) Department of Cardiology, University Hospital, Basel,
Switzerland
(Alber) Department of Cardiology, University Hospital, Innsbruck, Austria
(Rickenbacher) Department of Cardiology, University Hospital Bruderholz,
Bruderholz, Switzerland
Title
Drug-eluting stents and bare metal stents in patients with nste-acs:
2-year outcome from the randomised basketprove trial.
Source
EuroIntervention. 10 (1) (pp 58-64), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: The use of drug-eluting stents (DES) in patients with non-ST-segment
elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet
endorsed in clinical guidelines. Methods and results: This was an a priori
planned post hoc analysis involving 754 NSTE-ACS patients from the
randomised BASKET-PROVE trial (sirolimus-eluting stent vs.
everolimus-eluting stent vs. bare metal stent in large-vessel stenting).
The primary endpoint was the combined two-year rate of cardiovascular
death or non-fatal myocardial infarction (MI). Secondary endpoints were
each component of the primary endpoint, and clinically indicated target
vessel revascularisation (TVR) and stent thrombosis. Compared to patients
with BMS, those treated with SES and EES had a strong trend towards lower
two-year rates of the primary endpoint (HR: 0.31 [CI: 0.11-0.90], p=0.03,
and HR: 0.74 [CI: 0.44-1.24], p=0.25), and of TVR (HR: 0.58 [CI:
0.29-1.15], p=0.12) and (HR: 0.52 [CI: 0.34-0.78], p=0.002). When the SES
and EES groups were combined and compared to BMS, significant reductions
in both cardiovascular death/MI and TVR were found. Conclusions: Compared
with BMS, use of DES in NSTE-ACS patients undergoing stent implantation in
large vessels was associated with a reduction in both TVR and the combined
endpoint consisting of cardiovascular death/MI. Thus, DES use improves
both efficacy and safety. These findings support the use of DES in
NSTE-ACS patients. © Europa Digital & Publishing 2014.
<5>
Accession Number
2014403366
Authors
Minguez J.R.L. Asensio J.M.N. Vecino L.J.D. Sandoval J. Romany S. Romero
P.M. Diaz J.A.F. Portales J.F. Fernandez R.G. Caceres G.M. Herrera A.M.
Manterola F.A.
Institution
(Minguez, Asensio, Vecino, Fernandez, Caceres, Herrera) Hospital
Universitario Infanta Cristina, Adelardo Covarsi n1, 6.D., 06005 Badajoz,
Spain
(Sandoval, Manterola) Hospital Universitario Clinico de San Carlos,
Madrid, Spain
(Romany, Portales) Hospital San Pedro de Alcantara, Caceres, Spain
(Romero) Hospital Puerto Real, Cadiz, Spain
(Diaz) Hospital Universitario Clinica Puerta de Hierro, Madrid, Spain
Title
A prospective randomised study of the paclitaxel-coated balloon catheter
in bifurcated coronary lesions (babilon trial): 24-month clinical and
angiographic results.
Source
EuroIntervention. 10 (1) (pp 50-57), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: Paclitaxel drug-eluting balloons (pDEB) could be an attractive
option to minimise side branch (SB) restenosis in bifurcated coronary
lesions. We compared angiographic and clinical outcomes with pDEB plus
bare metal stent (BMS) versus drug-eluting stents (DES) in de novo
bifurcated lesions. Methods and results: This multicentre randomised trial
included 108 patients. Sequential main branch (MB)/SB dilatation with
pDEB, with provisional T-stenting with BMS in the MB was performed in the
pDEB group, and with everolimus DES in the DES group. The primary endpoint
was late lumen loss (LLL) at nine months. The secondary endpoint was the
incidence of major adverse cardiac events (MACE: death, myocardial
infarction, or target lesion revascularisation). In-segment MB LLL was
0.31+/-0.48 mm in the pDEB group, and 0.16+/-0.38 mm in the DES group
(p=0.15); mean difference was 0.15 mm (upper limit one-sided 95% CI: 0.27
mm; p=0.001; non-inferiority test). LLL in SB was -0.04+/-0.76 mm in the
pDEB group and -0.03+/-0.51 mm in the DES group (p=0.983). MACE and TLR
were higher in the pDEB group (17.3% vs. 7.1%; p=0.105, and 15.4% vs.
3.6%; p=0.045), due to higher MB restenosis (13.5% vs. 1.8%; p=0.027).
Conclusions: pDEB bifurcation pretreatment with BMS implantation in MB
showed greater LLL (ns) and increased incidence of MACE compared to
everolimus DES. Both strategies showed similar results in the SB. ©
Europa Digital & Publishing 2014.
<6>
Accession Number
2014391706
Authors
Cao L. Wang K. Gu T. Du B. Song J.
Institution
(Cao) Department of Intensive Care Unit, Second Affiliated Hospital of
Nantong University, Nantong, China
(Wang) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
College, Xuzhou, China
(Gu, Du, Song) Department of Anesthesiology, Second Affiliated Hospital of
Nantong University, Nantong, China
Title
Association between APOE epsilon 4 allele and postoperative cognitive
dysfunction: A meta-analysis.
Source
International Journal of Neuroscience. 124 (7) (pp 478-485), 2014. Date of
Publication: July 2014.
Publisher
Informa Healthcare
Abstract
Background: Carriers of the apolipoprotein E epsilon 4 allele (APOE4) may
be at increased risk of postoperative cognitive dysfunction (POCD), but
this association has not been reported consistently. We conducted a
meta-analysis to derive a more precise conclusion. Methods: The PubMed,
EBSCO and EMBASE databases were searched for eligible studies published in
English before March 2013. The association between APOE4 and POCD was
expressed by the odds ratio (OR) with 95% confidence interval (CI). Funnel
plots were constructed and publication bias assessed by Egger's test.
Results: Nine studies encompassing 1063 APOE4 carriers and 2983
noncarriers were included. At about 1-week postsurgery, a significant
association between APOE4 and POCD was found (OR 1.83, 95% CI: 1.18-2.85),
but the association was no longer significant after removing one large
study (OR 1.35, 95% CI: 0.92-1.97). Stratified analysis of
cardiac/vascular surgery patients also yielded no significant correlation
(OR 1.62, 95% CI: 0.80-3.28). One to three months postsurgery, neither the
overall analysis (OR 1.56, 95% CI: 0.87-2.81) nor the stratified analysis
of cardiac/vascular surgery patients (OR 3.33, 95% CI: 0.55-20.22)
indicated a significant correlation. APOE4 was also not correlated with
POCD at 1-year postsurgery (OR 1.15, 95% CI: 0.71-1.86). No evidence of
publication bias was revealed by Egger's test. Conclusions: The APOE4
allele was associated with a significantly increased POCD risk about
1-week postsurgery, but the association depended on one large study. No
association was found 1-3 months and 1-year postsurgery. © 2014
Informa Healthcare USA, Inc.
<7>
Accession Number
2014364320
Authors
Gawecka A. Mierzewska-Schmidt M.
Institution
(Gawecka, Mierzewska-Schmidt) Department of Paediatric Anaesthesiology and
Intensive Therapy, Medical University of Warsaw, ul. Marszalkowska 24,
00-576 Warszawa, Poland
Title
Tolerance of, and metabolic effects of, preoperative oral carbohydrate
administration in children - A preliminary report.
Source
Anaesthesiology Intensive Therapy. 46 (2) (pp 61-64), 2014. Date of
Publication: April-June 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
viamedica@viamedica.com.pl)
Abstract
Background: The need for long preoperative fasting has been questioned.
Recent data shows that intake of an oral carbohydrate-containing clear
fluid prior to anaesthesia is safe and may have a positive impact on
recovery and metabolic status and could improve glucose tolerance. Such
solutions are routinely used in adults but not children. The aim of this
study was to evaluate the safety, tolerance and influence of oral
carbohydrate on selected metabolic parameters in children. Methods: With
ethics committee approval and parental informed consent, 20 children, aged
4-17 years, ASA status I or II, scheduled for abdominal or thoracic
surgery were randomised either to Group 1 - receiving a 12.6%
carbohydrate-containing drink (10 mL kg<sup>-1</sup> the evening before
surgery and two hours before anaesthesia), or the control Group 2 -
fasting. Serum glucose and insulin concentration were measured four times:
before and after anaesthesia, in the evening after surgery, and the
following morning. IGF-1 concentration was measured once, before surgery.
Insulin resistance was assessed by the HOMA-IR equation. Results: Oral
carbohydrate solution was well tolerated and no adverse events were noted.
Glucose concentrations were within the normal range in both groups.
Insulin concentration did not show significant differences between groups,
however before surgery it tended to be lower in Group 1. Insulin
resistance after surgery was significantly higher in Group 2 (2.0 vs.
0.62, P = 0.03), also the increase in insulin resistance after operation
was significant only in the control group (P = 0.03). Conclusion: Oral
carbohydrates are safe, well tolerated and do not cause any perioperative
adverse events. They seem to improve postoperative metabolism by
decreasing insulin resistance.
<8>
Accession Number
2014362538
Authors
Benhamed L. Woelffle D.
Institution
(Benhamed, Woelffle) Department of Thoracic and Vascular Surgery,
Valenciennes Hospital, Centre Hospitalier de Valenciennes, Avenue
Desandrouin, 59322 Valenciennes cedex, France
Title
Adjuvant antifungal therapy after pulmonary surgery for aspergilloma: Is
it useful?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 835-837),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether adjuvant
antifungal therapy is useful after pulmonary surgery for aspergilloma. One
hundred and sixteen papers were identified using the search described
below, of which 5 papers presented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. No paper was greater than level-three evidence. One
study compared the outcomes of 72 patients treated for pulmonary
aspergilloma (PA) during a 23-year period. Despite no difference being
found in outcomes, more complications were seen in the surgery-alone
group. Another study included 14 patients treated with amphotericin B
alone or with flucytocine. They found no benefit in the treatment of PA by
systemic antifungal therapy. One retrospective study reported complete
eradication of PA in patients treated with preoperative and postoperative
oral itraconazole. One large cohort study reported their outcomes in 256
patients with PA, divided into two groups: Group A (simple aspergilloma, n
= 96) and Group B (complex aspergilloma, n = 160) after aggressive
surgical treatment and antifungal therapy. They found no difference in the
postoperative morbidity between two groups (P = 0.27). A postoperative
fungal relapse was found in 2 patients. One retrospective study reported
the outcomes and mortality in 61 cases with PA. Thirty-five (60%) patients
were treated with antifungal agents, and 15 (25%) patients were treated
surgically. Many cases did not respond to antifungal therapy. Nineteen
(31%) patients died. We did not find evidence to support the role of
adjuvant antifungal therapy following definitive surgical removal of the
fungus ball in immunocompetent patients; however, randomized control
studies in multiple centres, with new antifungal therapy, are necessary to
confirm these preliminary results. © 2014 The Author 2014. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<9>
Accession Number
2014362535
Authors
Kiessling A.-H. Guo F.W. Gokdemir Y. Thudt M. Reyher C. Scherer M.
Beiras-Fernandez A. Moritz A.
Institution
(Kiessling, Guo, Gokdemir, Thudt, Beiras-Fernandez, Moritz) Department of
Thoracic and Cardiovascular Surgery, Goethe University Hospital Frankfurt
Am Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
(Reyher) Department of Anaesthesiology and Intensive Care, Goethe
University Hospital Frankfurt Am Main, Frankfurt am Main, Germany
(Scherer) Department for Cardiac Surgery, UKM University Clinic, Munster,
Germany
Title
The influence of selective pulmonary perfusion on the inflammatory
response and clinical outcome of patients with chronic obstructive
pulmonary disease undergoing cardiopulmonary bypass.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 732-739),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
OBJECTIVES Patients undergoing cardiac surgery presenting with chronic
obstructive pulmonary disease (COPD) have a higher 30-day mortality risk.
In these patients, pulmonary dysfunction linked to an inflammatory
response is frequent after cardiac operations using cardiopulmonary bypass
(CPB), which causes pulmonary hypoperfusion. We hypothesize that selective
pulmonary perfusion (sPP) of the lungs leads to a reduction of pulmonary
inflammation and a better clinical outcome. METHODS Fifty-nine COPD
patients (forced expiratory volume in 1 s/vital capacity <70%) undergoing
cardiac surgery procedures (coronary artery bypass grafting 64%, valve
14%) were block-randomized to sPP (venous blood, temperature 2degreeC, 4
l) or standard CPB (28/28). The primary end-point of the study was to
evaluate the effect of pulmonary perfusion on gas exchange by measuring
alveolar-arterial oxygen gradient. The surrogate end-points were
inflammatory response, intensive care unit (ICU) stay, time on respirator
(TOR) and major adverse cardiac and cerebrovascular events. A cytokine
assay for interleukin-1beta, IL-6, IL-10, tumour necrosis factor-alpha
(TNF-alpha) and polymorphonuclear elastase was performed with peripheral
blood at different time-points [(t1) pre-CPB, (t2) end of CPB, (t3) 3 h,
(t4) 24 h, (t5) 48 h postoperatively]. Repeated-measure analysis of
variance and non-parametric statistics were used to assess the
between-group and during time differences. RESULTS The two groups proved
comparable for perioperative variables. Serum cytokines were not different
in the two groups throughout the study (P > 0.05 at single time-points),
but as a function of time, the markers of the inflammatory response
increased after CBP (P < 0.05 pre-CPB to 24 h). Clinical end-points were
statistically comparable in both groups, but with a trend towards a
shorter TOR (72 +/- 159 h/106 +/- 193 h) and ICU stay (3.9 +/- 7.2
days/5.5 +/- 9.2 days) in the sPP group despite a slightly longer time on
extracorporeal circulation (120 vs 158 min). CONCLUSIONS These results
indicate a non-significant trend that repeated hypothermic lung perfusion
with venous blood during CPB may have a protective effect on the lungs. A
multicentre study design and larger cohort seem necessary to demonstrate
the benefits of sPP more clearly. © 2014 The Author 2014. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<10>
Accession Number
2014362534
Authors
Wang S. Huang D. Ma Q. Chen X.
Institution
(Wang, Huang, Ma, Chen) Department of Thoracic Surgery, Huashan Hospital,
Fudan University, Shanghai, China
Title
Does ambroxol confer a protective effect on the lungs in patients
undergoing cardiac surgery or having lung resection?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 830-834),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in perioperative care was written according to a
structured protocol. The question addressed was 'Does ambroxol confer a
protective effect on the lung in patients undergoing cardiac surgery or
having lung resection?' A total of 247 papers were found using the
reported search, of which 7 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers were tabulated. Several studies indicate that for patients with
chronic obstructive pulmonary disease (COPD) who undergo cardiac surgery
or upper abdominal surgery, perioperative ambroxol administration is
associated with improved pulmonary function and reduced postoperative
pulmonary complications (PPCs). In patients with pulmonary lobectomy,
large-dose ambroxol treatment (1000 mg/day for 3 days) is correlated with
reduced PPCs (6 vs 19%, P = 0.02), decreased postoperative hospital stay
(5.6 vs 8.1 days, P = 0.02) and lower postoperative cost (2499 vs 5254 , P
= 0.04) compared with low-dose ambroxol treatment. Ambroxol also has a
protective effect on the lungs during extracorporeal bypass, ameliorating
inflammatory reaction and oxygen stress and preserving pulmonary
surfactant. However, there is no evidence for any advantage of reducing
PPCs after extracorporeal circulation. We conclude that perioperative
application of ambroxol, a versatile mucoactive drug, particularly in high
doses, is associated with lower PPCs, especially in high-risk patients
with fundamental lung disease such as COPD. Large doses of ambroxol are
correlated with even lower PPCs after lung resection. We recommend that
routine intravenous ambroxol should be used in large doses in high-risk
patients in the perioperative period to reduce the risk of PPCs. ©
2014 The Author 2014. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.
<11>
Accession Number
2014362528
Authors
Kouvelos G.N. Koutsoumpelis A. Peroulis M. Matsagkas M.
Institution
(Kouvelos, Koutsoumpelis, Peroulis, Matsagkas) Department of Surgery,
Medical School, University of Ioannina, S. Niarchos Avenue, 45110
Ioannina, Greece
Title
In endovascular aneurysm repair cases, when should you consider internal
iliac artery embolization when extending a stent into the external iliac
artery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 821-824),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether internal iliac artery (IIA)
embolization is necessary for achieving the best clinical outcome in all
patients when extension of the stent graft to the external iliac artery is
required. Altogether more than 400 papers were found using the reported
search, of which 5 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. There is a significant gap in the current literature
regarding the subset of patients that may benefit from an IIA embolization
during endovascular aneurysm repair (EVAR) as indications have not been
clearly defined. There are several situations concerning a small number of
patients, that IIA embolization might be beneficial in preventing endoleak
not only to the common iliac artery but also to the aortic aneurysmal sac.
For the majority of patients requiring extension of the stent graft to the
external iliac artery, the current evidence, even retrospective in nature
and reporting on small numbers of patients, shows that IIA embolization
seems to be associated with worse clinical outcome, mostly raising the
risk for new-onset buttock claudication. It seems that not all patients
require embolization, as IIA coverage solely by the stent graft was not
associated with a significant higher rate of type II endoleak in either
study. Furthermore, coil embolization in the largest study so far was
associated with higher procedure and fluoroscopy time and amount of
contrast media, facts that should not be neglected. However the
above-mentioned results should be taken into account with caution, as all
studies were retrospective and reported on small number of patients.
© 2014 The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<12>
Accession Number
2014362519
Authors
Ahmed N. Gollop N.D. Ellis J. Khan O.A.
Institution
(Ahmed) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
(Gollop) Norfolk and Norwich University Hospital, Colney Lane, Norwich,
NR4 7UY Norfolk, United Kingdom
(Ellis) Queen Elizabeth Hospital Norfolk, United Kingdom
(Khan) Department of Upper GI Surgery, St Georges Hospital, London, United
Kingdom
Title
How does elective laparoscopic abdominal aortic aneurysm repair compare to
endovascular aneurysm repair?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 814-820),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in surgery was written according to a structured
protocol. The question addressed was how elective laparoscopic abdominal
aortic aneurysm (AAA) repair compared to endovascular aneurysm repair
(EVAR) in terms of survival. There were 229 papers found using the
reported search, with 8 papers (5 prospective studies, 1 retrospective
study, 1 randomized trial and 1 systematic review) representing the best
evidence to answer the question proposed. Current evidence suggests that
EVAR is the preferred surgical approach for AAA repair, due to shorter
hospital stay and lower perioperative morbidity and mortality rates, as
opposed to an open surgical approach. Despite this, EVAR is subject to a
number of limitations, including device restrictions in patients with
anatomical variations as well as increased risk of future complications
stemming from device implantation. We discuss a key study that showed that
complications in the EVAR group commonly included endoleak type II and
graft thrombosis. More importantly, there were similar rates of
complications between those patients receiving EVAR and those receiving
minimally invasive aortic surgery. The evidence suggests that elective
laparoscopic AAA repair has a favourable safety profile comparable with
that of EVAR, with low conversion rates as well as similar mortality and
morbidity rates. This has been illustrated in several studies. We discuss
a prospective randomized trial of 100 patients, which compared EVAR with
hand-assisted laparoscopic surgery. This study showed no deaths in either
group after the procedure or at follow-up after 12 months, with similar
complication rates between the groups. While the evidence suggests that
EVAR is less invasive, it does not always significantly alter the
postoperative course or length of hospital stay for patients. We conclude
from the evidence available that elective laparoscopic AAA repair may have
a role in those patients who are unsuitable for EVAR. Unfortunately, few
studies exist directly comparing these two techniques, and those that do
are subject to limitations, for example, study population bias, small
sample sizes and a lack of comparison in the literature between the common
AAA repair techniques. © 2014 The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<13>
Accession Number
2014362516
Authors
Talwar S. Kumar M.V. Choudhary S.K. Airan B.
Institution
(Talwar, Kumar, Choudhary, Airan) Cardiothoracic Centre, All India
Institute of Medical Sciences, New Delhi 110029, India
Title
Conventional versus adjustable pulmonary artery banding: Which is
preferable?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 838-841),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'whether conventional
pulmonary artery banding (PAB) or adjustable PAB might be the superior
intervention?' Using the PubMed search, 51 papers were found, of which
seven papers represented the best evidence to answer the clinical
question. We included only those papers that actually compared
conventional PAB with adjustable PAB, and excluded those that studied only
one of these interventions. Four studies qualified (one prospective and
three retrospective) and analysed data in human patients, while three were
experimental studies in animals. The end points in the prospective human
study were death, debanding and follow-up to intracardiac repair. The
three retrospective studies compared the incidence of early deaths,
inotropic support, need for mechanical ventilatory support, reoperations
and intensive care unit and hospital stay. Out of the four studies in
humans, three studies noted a significant reduction in early deaths from
23 to 1.8%, 77 to 0% and 15 to 0% in conventional vs adjustable PAB. Need
for early reoperations reduced from 18 to 3.5% and from 35 to 0% in 2
studies. Similarly, there was a reduction in the ventilatory times and the
intensive care unit and hospital stay. The three experimental animal
studies demonstrated that a much more reliable preparation of the
ventricle was achieved with the use of an adjustable PAB. The results of
all the seven studies led us to conclude that adjustable PAB provides
superior early outcomes; reduces early mortality, need for inotropes and
need for reintervention; and provides equivalent or superior band
gradients when compared to conventional PAB. The use of the adjustable PAB
was found to result in significant haemodynamic improvement by
progressively reducing the pulmonary artery pressures and left-to-right
shunt. The adjustable PAB was found to improve early survival and also
made delayed repair feasible in a better clinical state, with reduced
mortality and morbidity. © 2014 The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<14>
Accession Number
2014362514
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A review with meta-analysis of observational studies for survival
following off-pump coronary artery bypass versus drug-eluting stent
implantation.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 807-813),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
To determine whether off-pump coronary artery bypass (OPCAB) improves
survival over drug-eluting stent (DES) implantation, we performed a review
with meta-analysis of exclusive OPCAB versus DES. Databases including
MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials
were searched through October 2013 using Web-based search engines (PubMed
and OVID). Studies that met the following criteria were considered for
inclusion: the design was a randomized controlled trial or observational
comparative study; the study population was patients with any coronary
artery disease; patients were assigned to OPCAB versus DES and outcomes
included all-cause mortality at >1 years. Our exhaustive search identified
no randomized trial and 10 observational studies of OPCAB versus DES. A
pooled analysis demonstrated no statistically significant difference in
all-cause mortality between OPCAB and DES (hazard ratio, 0.94; 95%
confidence interval, 0.76-1.15; P = 0.55). In general, exclusion of any
single study from the analysis did not substantially alter the overall
result of our analysis. There was no evidence of significant publication
bias. In conclusion, OPCAB may not improve survival over DES despite
greater number of treated vessels in OPCAB than in DES or greater number
of distal anastomosis in OPCAB than that of implanted stents in DES.
© 2014 The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<15>
Accession Number
2014362511
Authors
Cherniavsky A. Kareva Y. Pak I. Rakhmonov S. Pokushalov E. Romanov A.
Karaskov A.
Institution
(Cherniavsky, Kareva, Pak, Rakhmonov) Department of Surgery, Aorta,
Coronary and Peripheral Arteries, Novosibirsk Research Institute of
Circulation Pathology, Stroiteley Street 9, 46, Novosibirsk, Russian
Federation
(Pokushalov, Romanov) Department of Rhythm Disorders of the Heart,
Novosibirsk Research Institute of Circulation Pathology, Novosibirsk,
Russian Federation
(Karaskov) Novosibirsk Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
Title
Assessment of results of surgical treatment for persistent atrial
fibrillation during coronary artery bypass grafting using implantable loop
recorders.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 727-731),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
OBJECTIVES We report our experience with a modified mini-maze procedure
and pulmonary vein isolation using radiofrequency energy for treating
persistent atrial fibrillation during coronary artery bypass grafting
(CABG). METHODS Ninety-five patients with persistent atrial fibrillation
and coronary heart disease underwent open heart surgery combined with
intraoperative irrigated radiofrequency ablation. Patients were randomized
into the following three groups: CABG and irrigated radiofrequency
pulmonary vein isolation (CABG+PVI, n = 31); CABG and an irrigated
radiofrequency modified mini-maze procedure (CABG+MM, n = 30); and
isolated CABG (CABG alone, n = 34). All patients received implantable loop
recorders. RESULTS No reoperation and no hospital mortality were recorded.
Mean follow-up was 14.4 +/- 9.7 months. The implantable loop
recorder-determined freedom from atrial fibrillation was 80% in the
CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone
group. CONCLUSIONS Patients with concomitant atrial fibrillation and
coronary heart disease may benefit from intraoperative ablation to prevent
relapse of arrhythmia. © 2014 The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<16>
Accession Number
2014362509
Authors
Hassouna A. Allam H.
Institution
(Hassouna) Department of Cardiothoracic Surgery, Faculty of Medicine, Ain
Shams University Hospitals, PO Box 93, Elmukattam, 11571 Cairo, Egypt
(Allam) Department of Complementary Medicine, National Research Center,
Giza, Egypt
Title
Limited dose warfarin throughout pregnancy in patients with mechanical
heart valve prosthesis: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (6) (pp 797-806),
2014. Date of Publication: June 2014.
Publisher
Oxford University Press
Abstract
The continuation of warfarin throughout pregnancy in patients with a
mechanical valve prosthesis is a valid anticoagulation regimen, provided
that warfarin dose does not exceed 5 mg/day. Two decades after being
introduced, the efficacy and safety of this regimen merit evaluation. We
performed a systematic review for cases published between January 1991 and
January 2013. We compiled our prospective data on 55 pregnancies and
calculated pooled estimates (95% confidence interval) of adverse foetal
and maternal outcomes. Events were expressed as proportions of total
pregnancies, except embryopathy and maternal death, which were related to
the number of live births and number of patients, respectively. There were
494 eligible pregnancies reported in 11 studies. The rate of embryopathy
was 0.9% (0.4-2.4%) and most of the 13.4% (8.4-24.7%) foetal losses were
due to the 12.8% (7.7-22.7%) rate of spontaneous abortion. No maternal
mortality was encountered (0-1.3%) but 0.6% (0.3-2%) prosthetic valve
thrombosis, 1.8% (1.1-3.6%) total thromboembolic events and 3.4% (2-5.1%)
major maternal bleeding events were recorded. Foetal loss, spontaneous
abortions and foetal embryopathy dropped to 8.1% (2.9-13.7%), 7.3%
(3.1-11.8%) and 0.6% (0.1-2.1%) among the 344 pregnancies (69.6%) observed
in the 6 prospective studies (54.5%). Prosthetic valve thrombosis (0.6%;
01-2%), total thromboembolic (2.3%; 1.2-4.6%) and major bleeding events
(2.9%; 1.8-6%) remained comparable with overall results. Foetal
embryopathy and prosthetic valve thrombosis were not robust on sensitivity
analysis, regardless of the study design. A prospective subgroup of 96
patients (19.4%) received smaller warfarin dose, through targeting a lower
international normalized ratio (INR) between 1.5 and 2.5. The associated
rate of foetal loss (2.1%; 0.5-6.9%) was significantly lower than that
observed in the remaining patients targeting a higher INR between 2.5 and
3.5 (16.1%; 13.1-34.4%). Adverse maternal outcomes were also fewer but
rates remained comparable. Limited dose warfarin throughout pregnancy was
associated with improved foetal outcomes, without jeopardizing maternal
safety. Foetal outcomes were better when patients were followed up
prospectively or receiving smaller warfarin doses through targeting a
lower INR than recommended (1.5-2.5). Large randomized controlled trials
are mandatory to evaluate our findings. © 2014 The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
<17>
Accession Number
2014343201
Authors
Zeb I. Abbas N. Nasir K. Budoff M.J.
Institution
(Zeb, Abbas) Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx,
NY, United States
(Nasir) Center for Prevention and Wellness Research, Baptist Health
Medical Group, Miami Beach, FL, United States
(Nasir) Department of Epidemiology, Robert Stempel College of Public
Health, Florida International University, Miami, FL, United States
(Nasir) Department of Medicine, Herbert Wertheim College of Medicine,
Florida International University, Miami, FL, United States
(Nasir) The Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Baltimore, MD, United States
(Budoff) Los Angeles Biomedical Research Institute at Harbor-UCLA Medical
Center, Torrance, CA 90502, United States
Title
Coronary computed tomography as a cost-effective test strategy for
coronary artery disease assessment - A systematic review.
Source
Atherosclerosis. 234 (2) (pp 426-435), 2014. Date of Publication: June
2014.
Publisher
Elsevier Ireland Ltd
Abstract
Cardiovascular imaging imparts a huge burden on healthcare spending.
Coronary CT angiography (CCTA) may provide a cost effective means of
diagnosing coronary artery disease (CAD) and reducing downstream cost of
testing. We performed a systematic search of literature for randomized
controlled trials or prospective or retrospective non-randomized
comparative studies or case series, decision analytic models and
technology reports in which some or all of the patients underwent CCTA and
looking at the cost effectiveness, comparative effectiveness and
downstream test utilization associated with the use of CCTA. We found 42
articles matching our criteria. CCTA either as first line or as a layering
test may represent a cost effective strategy for initial evaluation of
patients with CAD prevalence of 10%-50% in both near-term and long-term
diagnostic periods. For CAD prevalence >70%, ICA as initial test may
represent cost effective strategy for diagnosis of stable chest pain. CCTA
may represent cost-effective strategy when performed as a layering test to
equivocal initial stress imaging before performing ICA. Use of CCTA is
cost- and time-effective strategy for evaluation of low risk (<30% CAD
prevalence) acute chest pain patients in emergency department and can be
used for safe exclusion of acute coronary syndrome (ACS). Use of coronary
calcium score as an initial test may require further evidence to be deemed
cost-effective strategy. CCTA may represent a cost effective and may be
associated with less downstream testing for diagnosis of stable chest pain
patients in low to intermediate risk patients whereas for low risk acute
chest pain patients, use of CCTA is associated with expedited patient
management, less cost and safe exclusion of ACS. © 2014 Elsevier
Ireland Ltd.
<18>
Accession Number
2014335813
Authors
Mosleh S.M. Bond C.M. Lee A.J. Kiger A. Campbell N.C.
Institution
(Mosleh) Mutah University, Faculty of Nursing, PO BOX (7), Karak, 61710,
Jordan
(Bond, Campbell) Centre of Academic Primary Care, University of Aberdeen,
United Kingdom
(Lee) Division of Applied Health Sciences, University of Aberdeen, United
Kingdom
(Kiger) Centre for Advanced Studies in Nursing, University of Aberdeen,
United Kingdom
Title
Effectiveness of theory-based invitations to improve attendance at cardiac
rehabilitation: A randomized controlled trial.
Source
European Journal of Cardiovascular Nursing. 13 (3) (pp 201-210), 2014.
Date of Publication: June 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: Despite well-established evidence of benefit from cardiac
rehabilitation, typically fewer than 35% of eligible patients attend.
Objective: The purpose of this study was to evaluate whether theory-based
invitations increase attendance at cardiac rehabilitation. Method: The
study was a randomized controlled trial (RCT) with two by two factorial
design. A total of 375 participants with acute myocardial infarction or
coronary revascularization was recruited from medical and surgical cardiac
wards at Aberdeen Royal Infirmary (ARI). They were randomly assigned to
receive either the standard invitation letter or a letter with wording
based on the theory of planned behavior (TPB) and the common sense model
of illness perception, and either a supportive leaflet with motivational
messages or not. The primary outcome was one or more attendances at
cardiac rehabilitation. Results: The theory-based letter increased
attendance at cardiac rehabilitation compared to the standard letter (84%
versus 74%, odds ratio (OR) 2.93, 95% confidence interval (CI) 1.545.56),
independent of age, gender, working status, hypertension, identity and TPB
constructs. The number needed to treat (NNT) was 9 (95% CI 712). The
motivational leaflet had no significant effect on attendance at
rehabilitation (OR 1.02, 95% CI 0.571.83). Conclusions: The use of
theory-based wording in invitation letters is a simple method to improve
attendance at cardiac rehabilitation. Our letter, reproduced in this
paper, could provide a template for practitioners and researchers. ©
2013 The European Society of Cardiology.
<19>
Accession Number
2014318098
Authors
van Buuren S. Hulzebos E.H.J. Valkenet K. Lindeman E. van Meeteren N.L.U.
Institution
(van Buuren, van Meeteren) Netherlands Organisation for Applied Scientific
Research TNO, Leiden, Netherlands
(van Buuren) University of Utrecht, Utrecht, Netherlands
(Hulzebos) Child Development and Exercise Centre, Division of Paediatrics,
University Children's Hospital Utrecht, Utrecht, Netherlands
(Valkenet, Lindeman) Department of Rehabilitation, Nursing Science and
Sport, Rudolf Magnus Institute of Neurosciences, University Medical Centre
Utrecht, Utrecht, Netherlands
Title
Reference chart of inspiratory muscle strength: A new tool to monitor the
effect of pre-operative training.
Source
Physiotherapy (United Kingdom). 100 (2) (pp 128-133), 2014. Date of
Publication: June 2014.
Publisher
Elsevier Ltd
Abstract
Objectives: To develop a reference chart to monitor inspiratory muscle
strength during pre-operative inspiratory muscle training for patients at
high risk of developing postoperative pulmonary complications awaiting
coronary artery bypass graft (CABG) surgery. Design: Secondary data
analysis using patients from the intervention arm of a randomised clinical
trial. Setting: University medical centre. Participants: Patients at high
risk of developing postoperative pulmonary complications awaiting CABG
surgery. Interventions: Patients performed inspiratory muscle training
seven times per week for at least 2 weeks before surgery. Main outcome
measures: Maximal inspiratory muscle strength. Results: A new reference
chart was produced using a non-linear time trend model with a normal error
structure. Conclusions: The chart is a novel tool for monitoring the
progress of inspiratory muscle training for physiotherapy practice. Wider
use of this chart is recommended. © 2013 Chartered Society of
Physiotherapy.
<20>
Accession Number
2014247016
Authors
Corley A. Sharpe N. Caruana L.R. Spooner A.J. Fraser J.F.
Institution
(Corley, Sharpe, Caruana, Spooner, Fraser) Critical Care Research Group,
The Prince Charles Hospital, University of Queensland, Brisbane, QLD,
Australia
Title
Lung volume changes during cleaning of closed endotracheal suction
catheters: A randomized crossover study using electrical impedance
tomography.
Source
Respiratory Care. 59 (4) (pp 497-503), 2014. Date of Publication: April
2014.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Airway suctioning in mechanically ventilated patients is
required to maintain airway patency. Closed suction catheters (CSCs)
minimize lung volume loss during suctioning but require cleaning
post-suction. Despite their widespread use, there is no published evidence
examining lung volumes during CSC cleaning. The study objectives were to
quantify lung volume changes during CSC cleaning and to determine whether
these changes were preventable using a CSC with a valve in situ between
the airway and catheter cleaning chamber. METHODS: This prospective
randomized crossover study was conducted in a metropolitan tertiary ICU.
Ten patients mechanically ventilated via volume-controlled synchronized
intermittent mandatory ventilation (SIMV-VC) and requiring manual
hyperinflation (MHI) were included in this study. CSC cleaning was
performed using 2 different brands of CSC (one with a valve [Ballard Trach
Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex
Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were
performed during both SIMV-VC and MHI. Lung volume change was measured via
impedance change using electrical impedance tomography. A mixed model was
used to compare the estimated means. RESULTS: During cleaning of the
valveless CSC, significant decreases in lung impedance occurred during MHI
(-2563 impedance units, 95% CI 2213-2913, P <.001), and significant
increases in lung impedance occurred during SIMV (762 impedance units, 95%
CI 452-1072, P <.001). In contrast, cleaning of the CSC with a valve in
situ resulted in non-significant lung volume changes and maintenance of
normal ventilation during MHI and SIMV-VC, respectively (188 impedance
units, 95% CI _136 to 511, P =.22; and 22 impedance units, 95% CI -342 to
299, P =.89). CONCLUSIONS: When there is no valve between the airway and
suction catheter, cleaning of the CSC results in significant derangements
in lung volume. Therefore, the presence of such a valve should be
considered essential in preserving lung volumes and uninterrupted
ventilation in mechanically ventilated patients. © 2014 Daedalus
Enterprises.
<21>
Accession Number
2014100054
Authors
Yu X.-Y. Wang Y. Zhong H. Dou Q.-L. Song Y.-L. Wen H.
Institution
(Yu, Wang, Zhong, Dou, Song) Department of Critical Care Medicine, First
Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
(Wen) Xinjiang Key Lab of Echinococcosis, First Affiliated Hospital of
Xinjiang Medical University, No. 1 Liyu Shan Road, Urumqi, Xinjiang,
830054, China
Title
Diagnostic value of serum procalcitonin in solid organ transplant
recipients: A systematic review and meta-analysis.
Source
Transplantation Proceedings. 46 (1) (pp 26-32), 2014. Date of Publication:
January-February 2014.
Publisher
Elsevier USA
Abstract
Purpose To perform a systematic review and meta-analysis to define the
role of procalcitonin (PCT) in identifying infectious complication in
organ transplant recipients. Methods We searched EMBASE, MEDLINE, the
Cochrane database, and reference lists of relevant articles, with no
language restrictions, published from inception through May 2013. We
selected original research that reported the diagnostic performance of PCT
alone or when compared with other biomarkers to diagnose infectious
complication among organ transplant recipients. We summarized test
performance characteristics with the use of forest plots, hierarchical
summary receiver operating characteristic curves, and bivariate
random-effects models. Results We found 7 qualifying studies (studying
1226 episodes of suspected infection with 186 confirmed infectious
episodes) from 4 countries. The patients were lung, kidney, liver, and
heart transplant recipients. Bivariate pooled sensitivity, specificity,
positive likelihood ratios, and negative likelihood ratios for
identification of bacterial infections in patients after transplantation
were 85% (95% confidence interval [CI], 75%-92%), 81% (95% CI, 72%-88%),
4.41 (95% CI, 2.86-6.81), and 0.18 (95% CI, 0.10-0.33), respectively. Of
the 4 studies that reported the experience of liver transplant patients,
the pooled sensitivity, specificity, positive likelihood ratios, and
negative likelihood ratios were 90% (95% CI, 75%-97%), 85% (95% CI,
77%-91%), 6.12 (95% CI, 3.79-9.88), and 0.11 (95% CI, 0.04-0.32),
respectively. There was no evidence of significant heterogeneity.
Conclusion The existing literature suggests reasonable sensitivity and
specificity for the PCT test in identifying infection complications among
patients undergoing solid organ transplantation. Given the imperfect
sensitivity and specificity of the PCT test, medical decisions should be
based on both PCT test results and clinical findings. © 2014 by
Elsevier Inc. All rights reserved.
<22>
Accession Number
2014393102
Authors
Liu Y. Davari-Farid S. Arora P. Porhomayon J. Nader N.D.
Institution
(Liu, Davari-Farid, Arora, Porhomayon, Nader) SUNY at Buffalo, VA Western
NY Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, United States
Title
Early versus late initiation of renal replacement therapy in critically
ill patients with acute kidney injury after cardiac surgery: A systematic
review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 557-563),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To investigate the impact of early versus late renal replacement
therapy (RRT) on mortality in patients with acute kidney injury (AKI)
after cardiac surgery. Design Meta-analysis of 9 retrospective cohort
studies and 2 randomized clinical trials extracted from the Medline engine
from 1950 to 2013. Setting University medical school. Participants 841
Patients. Interventions None. Measurements and Main Results A total of 841
patients were studied. Pooled estimates of the odds ratio with 95%
confidence interval using a random-effect model were conducted as well as
the heterogeneity, publication bias, and sensitivity analysis. Primary
outcome was 28-day mortality, and secondary outcome was the intensive care
unit (ICU) length of stay. The 28-days mortality rate was lower in the
early RRT group (OR = 0.29, 95% CI, 0.16-0.52, p<0.0001, NNT = 5).
Heterogeneity was high (I2 = 56%), and publication bias was low. Secondary
outcome suggested 3.9 (1.5-6.3) days shorter ICU stay in the early RRT
group, p<0.0001, with extremely high heterogeneity (I<sup>2</sup> = 99%),
and low publication bias. Specifically, studies before 2000 and studies
with mortality less than 50% in the late RRT group reported significantly
higher odds ratio and mean difference than overall value favoring early
RRT. Conclusion Early initiation of RRT for patients with AKI after
cardiac surgery revealed lower 28-days mortality and shorter ICU length of
stay. However, this was based on 11 studies of various qualities with very
high heterogeneity of results. Defining treatment guidelines needs further
research with a larger and better database. © 2014 Elsevier Inc. All
rights reserved.
<23>
Accession Number
2014393106
Authors
Aronson S. Levy J.H. Lumb P.D. Fontes M. Wang Y. Crothers T.A. Sulham K.A.
Navetta M.S.
Institution
(Aronson, Levy, Fontes) Department of Anesthesiology, Duke University
Medical Center, 3094, 101 Baker House, Duke South, Durham, NC 27710,
United States
(Lumb) Department of Anesthesiology, Keck School of Medicine, University
of Southern California, Los Angeles, CA, United States
(Wang, Crothers, Sulham, Navetta) Medicines Company, Parsippany, NJ,
United States
Title
Impact of perioperative blood pressure variability on health resource
utilization after cardiac surgery: An analysis of the ECLIPSE trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 579-585),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To examine the impact of blood pressure control on hospital
health resource utilization using data from the ECLIPSE trials. Design
Post-hoc analysis of data from 3 prospective, open-label, randomized
clinical trials (ECLIPSE trials). Setting Sixty-one medical centers in the
United States. Participants Patients 18 years or older undergoing cardiac
surgery. Interventions Clevidipine was compared with nitroglycerin, sodium
nitroprusside, and nicardipine. Measurements and Main Results The ECLIPSE
trials included 3 individual randomized open-label studies comparing
clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood
pressure control was assessed as the integral of the cumulative area under
the curve (AUC) outside specified systolic blood pressure ranges, such
that lower AUC represents less variability. This analysis examined surgery
duration, time to extubation, as well as intensive care unit (ICU) and
hospital length of stay (LOS) in patients with AUC<10 mmHgxmin/h compared
to patients with AUC>10 mmHgxmin/h. One thousand four hundred ten patients
were included for analysis; 736 patients (52%) had an AUC<10 mmHgxmin/h,
and 674 (48%) had an AUC>10 mmHgxmin/h. The duration of surgery and ICU
LOS were similar between groups. Time to extubation and postoperative LOS
were both significantly shorter (p = 0.05 and p<0.0001, respectively) in
patients with AUC<10. Multivariate analysis demonstrates AUC<10 was
significantly and independently associated with decreased time to
extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard
ratio 1.221, p = 0.0006). Conclusions Based on data derived from the
ECLIPSE studies, increased perioperative BP variability is associated with
delayed time to extubation and increased postoperative LOS. © 2014
Elsevier Inc.
<24>
Accession Number
2014393066
Authors
Zeng J. He W. Qu Z. Tang Y. Zhou Q. Zhang B.
Institution
(Zeng, Zhang) Department of Anesthesia of Cardiovascular Institute, First
Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
(He) Department of Cardiothoracic Surgery, Nanchong Central Hospital,
Second Clinical College of North Sichuan Medical College, Nanchong,
Sichuan, China
(Qu, Tang) Department of Neurology, First Affiliated Hospital, Guangxi
Medical University, Nanning, Guangxi, China
(Zhou) Department of Cardiology, First Affiliated Hospital, Guangxi
Medical University, Nanning, Guangxi, China
Title
Cold blood versus crystalloid cardioplegia for myocardial protection in
adult cardiac surgery: A meta-analysis of randomized controlled studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 674-681),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective The purpose of this article was to systematically review
randomized controlled trials in which cold blood cardioplegia was compared
with cold crystalloid cardioplegia for cardiac surgery. Design Correlation
studies were searched independently in the EMBASE, MEDLINE and Cochrane
library databases. The primary endpoints of interest were spontaneous
sinus rhythm (SSR) after declamping, perioperative myocardial infarction
(MI) and mortality (within 30 days). Setting A hospital. Participants
Randomized controlled trials. Intervention A meta-analysis of 12 studies.
Measurements and Main Results The 12 included trials recruited a total of
2866 participants; 1357 patients received cold crystalloid cardioplegia,
and 1509 patients received cold blood cardioplegia. The pooled analysis
showed no significant difference favoring either cold crystalloid
cardioplegia or cold blood cardioplegia in terms of spontaneous sinus
rhythm (SSR) after declamping (789/1028 [76.75%] v 773/1025 [75.41%],
relative risk (RR) = 0.92 [0.76, 1.13], p = 0.43 with 6 studies included),
mortality (within 30 days) (20/1335 [1.50%] v 24/1469 [1.63%], relative
risk (RR) = 1.09 [0.62, 1.91], p = 0.77 with 11 studies included), atrial
fibrillation (AF) (329/1043 [31.54%] v 365/1040 [35.10%], RR =0.90 [0.80,
1.01], p = 0.08 with 6 studies included) or stroke (45/1114 [4.04%] v
20/1240 [1.61%], RR = 2.18 [0.69, 6.93], p = 0.19 with 4 studies
included). The aggregate data showed that the incidence of perioperative
myocardial infarction was lower in patients who received cold blood
cardioplegia (CB) (32/1310 [2.44%] v 17/1434 [1.19%], RR = 2.30 [1.33,
3.98], p = 0.003 with 11 studies included). Conclusions Cold blood
cardioplegia reduced perioperative myocardial infarction when compared
with cold crystalloid cardioplegia. No differences in the overall
incidence rates of spontaneous sinus rhythm, mortality (within 30 days),
atrial fibrillation or stroke were observed. © 2014 Published by
Elsevier Inc.
<25>
Accession Number
2014448896
Authors
Rushton P.R.P. Grevitt M.P.
Institution
(Rushton, Grevitt) Centre for Spinal Studies and Surgery, Queen's Medical
Centre, Derby Road, Nottingham NG7 2UH, United Kingdom
Title
Do vertebral derotation techniques offer better outcomes compared to
traditional methods in the surgical treatment of adolescent idiopathic
scoliosis?.
Source
European Spine Journal. 23 (6) (pp 1166-1176), 2014. Date of Publication:
June 2014.
Publisher
Springer Verlag
Abstract
Purpose: In recent years, authors have described novel derotation
techniques for surgery in adolescent idiopathic scoliosis. These methods
include direct vertebral body derotation (DVD) and vertebral coplanar
alignment (VCA). By improved derotation it is hoped that there is further
reduction in rib hump prominence and corresponding improvement in
patients' quality of life. This paper aims to evaluate studies reporting
outcomes from DVD and VCA techniques to assess if these methods lead to
superior radiographic vertebral derotation, rib hump correction on surface
measurements or patient-reported outcomes compared to traditional
derotation manoeuvres using similar instrumentation. Method: Literature
review. Results: Fifteen reports were identified. Most comparative studies
represent class three or four data. DVD and VCA techniques have been shown
to reduce apical vertebral rotation by 37-63 %. Few studies compare
DVD/VCA techniques with traditional methods. Most DVD/VCA reports with
pedicle screw instrumentation have reported superior radiographic
derotation on CT compared with conventional techniques. Despite this the
majority of studies have found similar corrections of rib hump
measurements between DVD/VCA techniques and cantilever or global
derotation methods. There is no evidence that DVD/VCA techniques allow
greater correction of significant rib hump deformity without an adjuvant
thoracoplasty. No studies to date have used patient-reported outcomes
prospectively or demonstrated clinically meaningful differences
retrospectively between DVD/VCA and conventional techniques. Conclusions:
There is little evidence to recommend the widespread adoption of DVD/VCA
techniques. Whilst there is some weak evidence to suggest that novel
techniques may improve radiographic measures, there is little to suggest
that they offer patients improved correction of clinical rib hump or
quality of life compared to established techniques. Further well-designed
prospective studies are needed in this area. © 2014 Springer-Verlag.
<26>
Accession Number
2014393077
Authors
Baysal A. Yanartas M. Dogukan M. Gundogus N. Kocak T. Koksal C.
Institution
(Baysal, Kocak) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu
High Speciality Training and Research Hospital, Istanbul, Turkey
(Yanartas, Koksal) Cardiovascular Surgery Clinic, Kartal Kosuyolu High
Speciality Training and Research Hospital, Istanbul, Turkey
(Dogukan) Anesthesiology and Reanimation Clinic, Adiyaman University
Training and Research Hospital, Adiyaman, Turkey
(Gundogus) Clinic of Anesthesiology and Reanimation, Sanliurfa Training
and Research Hospital, Sanliurfa, Turkey
Title
Levosimendan improves renal outcome in cardiac surgery: A randomized
trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 586-594),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective The effect of levosimendan on renal function in patients with
low ejection fraction undergoing mitral valve surgery was investigated.
Design A prospective, double-blinded, randomized clinical trial. Setting
Tertiary teaching and research hospital. Participants Of a total of 147
patients, 128 patients completed the study. In the levosimendan group (n =
64), levosimendan was administered in addition to standard inotropic
support; whereas, in the control group (n = 64), only standard inotropic
support was given. Interventions In the levosimendan group, a loading dose
of levosimendan (6 mug/kg) was administered after removal of the aortic
cross-clamp, followed by an infusion (0.1 mug/kg/min) in addition to
standard inotropic therapy for 24 hours. In the control group, only
standard inotropic therapy was administered. Preoperative characteristics,
serum creatinine (sCr) levels, and estimated glomerular filtration rate
(eGFR) were determined preoperatively, on postoperative days 1, 3, and 10.
Independent risk factors for renal replacement therapy (RRT) requirement
were investigated with stepwise multivariate logistic regression analysis.
Measurements and Main Results The primary endpoint was the effect of
levosimendan on postoperative renal clearance (sCr and eGFR). The
secondary endpoint was the effect of levosimendan on clinical outcomes
(length of intensive care unit and hospital stays, need for RRT).
Preoperative characteristics and eGFR were similar between the groups
(p>0.05). On postoperative days 1 and 3, sCr values were lower and eGFR
values were higher in the levosimendan group in comparison with the
control group (p = 0.0001, p = 0.009, respectively). Six patients (9.4%)
in the levosimendan group and 10 patients (15.6%) in the control group
required RRT therapy (p = 0.284). Independent risk factors for need of RRT
include preoperative sCr value between 1.2 to 2.09 mg/dL and>2.1 mg/dL (p<
0.05). Conclusions Perioperative treatment with levosimendan in addition
to standard inotropic therapy in patients with a low ejection fraction
undergoing mitral valve surgery improved immediate postoperative renal
function and reduced need for RRT. © 2014 Elsevier Inc.
<27>
[Use Link to view the full text]
Accession Number
2014234913
Authors
Couturier R. Rubatti M. Credico C. Louvain-Quintard V. Anerkian V. Doubine
S. Vasse M. Grassin-Delyle S.
Institution
(Couturier, Rubatti, Credico, Anerkian) Departement d'Anesthesie, Centre
Chirurgical Marie Lannelongue, 133 avenue de la Resistance, 92350 Le
Plessis Robinson, France
(Louvain-Quintard, Doubine) Laboratoire d'Hemostase, Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson, France
(Vasse) Service de Biologie Clinique, Hopital Foch, Suresnes, France
(Grassin-Delyle) Laboratoire de Pharmacologie, UPRES EA220, Hopital Foch,
Suresnes, France
(Grassin-Delyle) Laboratoire de Pharmacologie - Toxicologie, Hopital
Raymond Poincare, AP-HP, Garches, France
Title
Continuous or discontinuous tranexamic acid effectively inhibits
fibrinolysis in children undergoing cardiac surgery with cardiopulmonary
bypass.
Source
Blood Coagulation and Fibrinolysis. 25 (3) (pp 259-265), 2014. Date of
Publication: April 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Tranexamic acid is given continuously or discontinuously as an
anti-fibrinolytic therapy during cardiac surgery, but the effects on
fibrinolysis parameters remain poorly investigated. We sought to assess
the effects of continuous and discontinuous tranexamic acid on
fibrinolysis parameters in children undergoing cardiac surgery with
cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat
surgery by sternotomy with CPB for congenital heart disease were
randomized to receive either continuous or discontinuous tranexamic acid.
Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA),
tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and
fibrin monomers were measured and compared to values obtained from
children who did not receive tranexamic acid. Tranexamic acid inhibited
the CPB-induced increase in D-dimers, with a similar potency between
continuous and discontinuous regimens. Time courses for tPA, fibrin
monomers, and fibrinogen were also similar for both regimen, and there was
a significant difference in tPA-PAI1 complex concentrations at the end of
surgery, which may be related to a significantly higher tranexamic acid
concentration. Continuous and discontinuous regimen are suitable for an
effective inhibition of fibrinolysis in children undergoing cardiac
surgery with CPB, but the continuous regimen was previously shown to be
more effective to maintain stable tranexamic acid concentrations. ©
2014 Wolters Kluwer Health Lippincott Williams & Wilkins.
<28>
Accession Number
2014342867
Authors
Baik J.S. Oh A.-Y. Cho C.W. Shin H.-J. Han S.H. Ryu J.H.
Institution
(Baik, Oh, Cho, Shin, Han, Ryu) Department of Anesthesiology and Pain
Medicine, Seoul National University Bundang Hospital, Seongnam-si,
Gyeonggi-do, South Korea
Title
Thoracic paravertebral block for nephrectomy: A randomized, controlled,
observer-blinded study.
Source
Pain Medicine (United States). 15 (5) (pp 850-856), 2014. Date of
Publication: May 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Objective: This study evaluated whether adding a preoperative single
thoracic paravertebral block (TPVB) to intravenous patient-controlled
analgesia (IV PCA) would improve postoperative analgesia compared with
using IV PCA alone in patients undergoing nephrectomy. Design:
Prospective, randomized, controlled, observer-blinded trial. Setting:
University hospital. Subjects: Thirty-four adult patients undergoing
elective open nephrectomy. Methods: The patients were randomized to
receive a TPVB plus IV PCA (group T) or IV PCA alone (group C). A single
18-mL injection of 0.75% ropivacaine was administered preoperatively under
ultrasound guidance; fentanyl was used for IV PCA. Each patient's
postoperative pain score based on a verbal numerical rating scale,
postoperative fentanyl consumption, inspiratory volume by incentive
spirometry, and complications were evaluated at 1, 3, 6, 12, and 24 hours
after surgery. Changes in heart rate (HR), systolic arterial pressure
(SAP), and mean arterial pressure (MAP) were evaluated following skin
incision. Results: The postoperative pain score and fentanyl consumption
were significantly lower in group T than in group C at all time points up
to 24 hours after surgery. The postoperative inspiratory volumes were not
significantly different. The changes in HR were similar, while the
increases in SAP and MAP after skin incision were lower in group T than in
group C. Conclusions: A preoperative single TPVB improved postoperative
analgesia by reducing the postoperative pain score and fentanyl
consumption in patients undergoing nephrectomy. © 2014 American
Academy of Pain Medicine.
<29>
Accession Number
2014393072
Authors
Desebbe O. Faulcon C. Henaine R. Tran L. Koffel C. Delannoy B. Lehot J.-J.
Bastien O. Maucort-Boulch D.
Institution
(Desebbe, Faulcon, Koffel, Delannoy, Bastien) Department of Anesthesiology
and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1
University, Lyon, France
(Desebbe, Bastien) Laboratory EA4169, Louis Pradel Hospital, Claude
Bernard Lyon 1 University, Lyon, France
(Henaine) Department of Anesthesiology and Perioperative Care, University
of California, Irvine, CA, United States
(Tran) Department of Surgery, Louis Pradel Hospital, Claude Bernard Lyon 1
University, Lyon, France
(Lehot) Department of Anesthesiology and Intensive Care, Wertheimer Pierre
Hospital, Claude Bernard Lyon 1 University, Lyon, France
(Maucort-Boulch) Hospices Civils de Lyon, Universite Lyon i, Laboratoire
Biostatistique Sante, Pierre-Benite, France
Title
Tissue hemoglobin monitoring is unable to follow variations of arterial
hemoglobin during transitions from pulsatile to constant flow in cardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 668-673),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To test whether the variations of tissue hemoglobin
concentration (DELTA<sub>T</sub>Hb) measured by the FORE-SIGHT cerebral
oximeter can accurately detect changes in arterial hemoglobin
concentration (DELTA<sub>A</sub>Hb) before, during, and after
cardiopulmonary bypass. Design A prospective clinical study. Setting
Cardiac surgery operating room. Participants Thirty patients scheduled for
cardiac surgery. Interventions Tissue hemoglobin concentration
(<sub>T</sub>Hb) was recorded continuously via 2 sensors applied on the
forehead and connected to the cerebral oximeter. Arterial hemoglobin
concentration (<sub>A</sub>Hb) was measured in a hematology analyzer
laboratory. Hemodynamic and respiratory parameters as well as
epidemiologic data also were noted. Data were collected at 3 perioperative
times: After induction of anesthesia, 10 minutes after cardioplegia, and
at the end of the surgery. Measurements and Main Results Ninety pairs of
data were collected. The coefficient of linear regression between
DELTA<sub>T</sub>Hb and DELTA<sub>A</sub>Hb was 0.4 (p<0.001). After
exclusion of Hb variations<5%, the trending ability of <sub>T</sub>Hb to
predict DELTA<sub>A</sub>Hb was 87%. However, the Bland and Altman plot
graph for <sub>T</sub>Hb and <sub>A</sub>Hb showed major limits of
agreement (2.4 times the standard deviation). Central venous pressure and
carbon dioxide tension were linked independently and positively with
<sub>T</sub>Hb (p = 0.03). Conclusions Continuous monitoring of
<sub>T</sub>Hb cannot accurately track variations of <sub>A</sub>Hb during
the transition from pulsatile to continuous flow and vice versa in cardiac
surgery. Local hemodynamic factors such as PaCO<sub>2</sub> and
vasodilation significantly impact <sub>T</sub>Hb. In this setting,
<sub>T</sub>Hb monitoring should not be used to guide eventual blood
transfusion management. © 2014 Elsevier Inc.
<30>
Accession Number
2014737798
Authors
Lavi S. Bainbridge D. D'Alfonso S. Diamantouros P. Syed J. Jablonsky G.
Lavi R.
Institution
(Lavi, Bainbridge, Diamantouros, Syed, Jablonsky, Lavi) Division of
Cardiology, University of Western Ontario, 339 Windermere Road, London, ON
N6A 5A5, Canada
(Lavi, Bainbridge, D'Alfonso, Diamantouros, Syed, Jablonsky, Lavi) London
Health Sciences Centre, London, ON, Canada
Title
Sevoflurane in acute myocardial infarction: A pilot randomized study.
Source
American Heart Journal. 168 (5) (pp 776-783), 2014. Date of Publication:
01 Nov 2014.
Publisher
Mosby Inc.
Abstract
Methods: We randomized 50 patients presenting with a first acute
ST-elevation MI treated by primary PCI within 6 hours from symptom onset
to sedation with sevoflurane inhalation or standard sedation (control).
Coronary flow at the end of PCI was assessed by corrected Thrombolysis In
Myocardial Infarction frame count. Myocardial reperfusion was assessed by
ST-segment resolution 60 minutes post-PCI. Infarct size was assessed by
release of creatinine kinase (CK) and troponin T.
Results: There was no difference in the primary end point: troponin T or
CK release adjusted to the area at risk, between groups. However, among
patients with anterior MI, there was a trend toward lower CK (P =.05) and
nonsignificant decrease in troponin (P =.11) levels in the sevoflurane
group. Corrected Thrombolysis In Myocardial Infarction frame count was
12.3 +/- 1.5 in the sevoflurane group and 15.6 +/- 9.1 in the control
group (P =.16). There was more ST resolution in patients treated by
sevoflurane 80.7% +/- 25.8% versus 56.6% +/- 35.7% (P =.01). Sevoflurane
had no significant adverse effect during administration.
Conclusions: Sevoflurane administration during primary PCI did not reduce
infarct size. There was a trend toward a reduction in infarct size among
patients with anterior MI. Sevoflurane administration was associated with
improvement in ST-segment resolution.
Background: Experimental evidence suggests that the inhalational
anesthetic sevoflurane has a cardioprotective effect. Our objective was to
determine if sedation with sevoflurane will reduce infarct size in
patients with acute myocardial infarction (MI) who are treated with
primary percutaneous coronary intervention (PCI).
<31>
Accession Number
2014393069
Authors
Sethi B.S. Chauhan S. Bisoi A.K. Kapoor P.M. Kiran U. Rajput R.S.
Institution
(Sethi, Chauhan, Kapoor, Kiran, Rajput) Department of Cardiac Anaesthesia,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029,
India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Title
Comparison of a waxy maize and a potato starch-based balanced hydroxyethyl
starch for priming in patients undergoing coronary artery bypass grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 690-697),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective Concerns have been raised about differences in the safety
profile of potato- versus waxy maize-derived hydroxyethyl starch (HES).
The objective of this study was to compare 2 HES solutions derived from 2
different source materials (potato versus waxy maize) for their
dose-related effects on hemostasis and organ function when used to prime
the cardiopulmonary bypass circuit (CPB). Design A prospective,
randomized, controlled study. Setting Tertiary care center. Participants
Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB.
Interventions For priming the CPB circuit, the HES<sub>P</sub>RL group
received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500
mL of Ringer's lactate; the HES<sub>P</sub> group received 1,500 mL of
potato-derived balanced 6% HES 130/0.42; the HES <sub>M</sub>RL group
received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with
500 mL of Ringer's lactate, and the HES<sub>M</sub> group received 1500 mL
of waxy maize-derived balanced 6% HES 130/0.4. Measurements and Main
Results There were no significant differences in 24-hour mediastinal
drainage, rate of re-exploration, blood product usage, coagulation
parameters, and measures of pulmonary, renal, and hepatic function with
respect to plant source of HES, when equivalent doses were used. Sonoclot
activated clotting time (SonACT) was significantly higher and clot rate
(CR) significantly lower at end of surgery (T<sub>1</sub>) and 24 hours
after surgery (T<sub>2</sub>) in the HES<sub>P</sub> and HES<sub>M</sub>
groups compared with the HES<sub>P</sub>RL and HES<sub>M</sub>RL groups.
Compared with baseline, CR and platelet function were significantly lower
at T<sub>1</sub>, PaO<sub>2</sub>/F<sub>I</sub>O <sub>2</sub> ratio
decreased significantly at T<sub>1</sub> and T<sub>2,</sub> and serum
bilirubin and transaminases increased significantly at T<sub>2</sub> in
all 4 groups. Conclusions There was no significant difference in
cumulative 24-hour mediastinal drainage when potato-derived balanced 6%
HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to
prime the CPB circuit in patients undergoing CABG. In equal doses, both
starches exerted the same effect on blood coagulation and pulmonary,
renal, and hepatic function. © 2014 Elsevier Inc.
<32>
Accession Number
2014393062
Authors
Yang L. Wang G. Du Y. Ji B. Zheng Z.
Institution
(Yang, Wang, Du) Department of Anesthesiology, Fuwai Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Ji) Department of Cardiopulmonary Bypass, Fuwai Hospital, Chinese Academy
of Medical Sciences, Beijing, China
(Zheng) Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
Title
Remote ischemic preconditioning reduces cardiac troponin i release in
cardiac surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 682-689),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether remote ischemic preconditioning (RIPC)
reduces myocardial injury, mortality, morbidity, and resource utilization
in cardiac surgery. Design Meta-analysis of controlled clinical trials.
The primary outcome was cardiac troponin I (cTnI) concentrations.
Secondary outcomes included cardiac troponin T (cTnT) concentrations,
myocardial infarction, stroke, renal failure requiring hemodialysis,
atrial fibrillation, inotropic score, mechanical ventilation time, length
of intensive care unit stay, length of hospital stay, and death. Setting
University hospitals. Patients Adult and pediatric patients undergoing
cardiac surgery, including coronary artery bypass grafting, valve
procedures, and correction of congenital cardiac anomalies. Interventions
Remote ischemic preconditioning through limb ischemia. Measurements and
Main Results Nineteen randomized trials involving 1,235 patients were
included in the meta-analysis. The cTnI concentrations at 6 (or 4-8) hours
postoperatively and the total cTnI released after surgery showed a
statistically significant reduction in the RIPC group compared with a
control group (weighted mean difference [WMD] -2.03 ug/L, 95% confidence
interval [CI] -3.25 to -0.82 ug/L, p = 0.001; WMD -65.74 ug/L*h, 95% CI
-107.88 to -23.61 ug/L*h, p = 0.002, respectively). There were no
differences in mortality, morbidity, and resource utilization between
groups. Conclusions Current evidence suggests that RIPC reduces cardiac
troponin I release in patients undergoing cardiac surgery. The clinical
significance of these observations merits further investigation. ©
2014 Elsevier Inc.
<33>
[Use Link to view the full text]
Accession Number
2013745463
Authors
Chatterjee S. Nerella N. Chakravarty S. Shani J.
Institution
(Chatterjee, Nerella, Shani) Department of Medicine, Maimonides Medical
Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
(Chakravarty) Department of Medicine, Division of Cardiology, University
of Connecticut School of Medicine, Farmington, CT, United States
Title
Angioplasty alone versus angioplasty and stenting for subclavian artery
stenosis-;A systematic review and meta-analysis.
Source
American Journal of Therapeutics. 20 (5) (pp 520-523), 2013. Date of
Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Subclavian artery stenosis has long been treated with great success with
bypass surgery. Percutaneous intervention, often used in combination with
stent placement, has come into vogue for the past few years as a safe and
effective therapeutic modality. This study aimed to compare angioplasty
alone with angioplasty followed by stent placement by combining available
data. The objective of this study was to perform a review of the available
literature to compare the efficacy of percutaneous transluminal
angioplasty (PTA) alone with PTA followed by stent placement for proximal
subclavian artery stenosis. Successful recanalization was defined as
patency at the end of 1 year, and reocclusions and restenoses were noted
as events for the purpose of pooling the data. The authors searched the
Specialized Register and the Cochrane Central Register of Controlled
Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, and CINAHL
databases for relevant trials/studies comparing PTA and PTA with stenting.
Review authors independently assessed the methodological quality of
studies (focusing on the adequacy of the randomization process, allocation
concealment, blinding, completeness of follow-up, and intention-to-treat
analysis) and selected studies for inclusion. All retrospective
observational studies were also included in the analysis in the absence of
doubleblinded randomized trials for increasing sample size. All analyses
were done using RevMan 5.0. Odds ratio was calculated using
Mantel-Haenszel test with a fixed effect model. All included studies were
assessed by all authors for potential sources of bias. Eight studies were
included in the analysis having 544 participants. Stenting after PTA was
significantly superior to angioplasty alone for treatment of subclavian
artery stenosis and maintenance of patency at 1 year, as indicated by
absence of events (P 5 0.004; 95% confidence interval, odds ratio 2.37
[1.32-4.26]) without significant complication rates for either procedure.
There is evidence in favor of stent placement after angioplasty for
successful recanalization of stenosed subclavian arteries and long-term
maintenance of patency without significant increase in risk for major
complications in subjects. © 2013 Lippincott Williams & Wilkins.
<34>
[Use Link to view the full text]
Accession Number
2014970691
Authors
Bailey M. McGuinness S. Haase M. Haase-Fielitz A. Parke R. Hodgson C.L.
Forbes A. Bagshaw S.M. Bellomo R.
Institution
(Bailey, Hodgson, Forbes, Bellomo) Department of Epidemiology and
Preventive Medicine, Australian and New Zealand Intensive Care Research
Center, Monash University, 99 Commercial Road, Melbourne 3181, Australia
(McGuinness, Parke) Cardiothoracic and Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension,
Diabetes, and Endocrinology, Otto-von-Guericke-University Magdeburg,
Magdeburg, Germany
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AB, Canada
Title
Sodium bicarbonate and renal function after cardiac surgery: A
prospectively planned individual patient meta-analysis.
Source
Anesthesiology. 122 (2) (pp 294-306), 2015. Date of Publication: 02 Feb
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND:: The effect of urinary alkalinization in cardiac surgery
patients at risk of acute kidney injury (AKI) is controversial and trial
findings conflicting. Accordingly, the authors performed a prospectively
planned individual patient data meta-analysis of the double-blind
randomized trials in this field. METHODS:: The authors studied 877
patients from three double-blind, randomized controlled trials enrolled to
receive either 24 h of intravenous infusion of sodium bicarbonate or
sodium chloride. The primary outcome measure was a postoperative increase
in serum creatinine concentration of greater than 25% or 0.5 mg/dl (> 44
muM/L) within the first five postoperative days. Secondary outcomes
included the raw change in serum creatinine, greater than 50% and greater
than 100% rises in serum creatinine, developing AKI (Acute Kidney Injury
Network criteria), initiation of renal replacement therapy, morbidity, and
mortality. RESULTS:: Patients were similar in demographics, comorbidities,
and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P
< 0.001) and urine pH (P < 0.001). There were no differences in the
development of the primary outcome (Bicarbonate 45% [39-51%] vs. Saline
42% [36-48%], P = 0.29). This result remained unchanged when controlling
for study and covariates (odds ratio [OR], 99% confidence interval [CI]:
Bicarbonate vs. Control, 1.11 [0.77-1.60], P = 0.45). There was, however,
a significant study-adjusted benefit in elective coronary artery bypass
surgery patients in terms of renal replacement therapy (Bicarbonate vs.
Control, OR: 0.38 [99% CI: 0.25-0.58], P < 0.0001) and the development of
an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR:
0.45 [99% CI: 0.43-0.48], P < 0.0001). CONCLUSIONS:: Urinary
alkalinization using sodium bicarbonate infusion is not associated with an
overall lower incidence of AKI; however, it reduces severe AKI and need
for renal replacement therapy in elective coronary artery bypass patients.
<35>
Accession Number
2014788537
Authors
Gallagher S.M. Jones D.A. Kapur A. Wragg A. Harwood S.M. Mathur R.
Archbold R.A. Uppal R. Yaqoob M.M.
Institution
(Gallagher, Jones, Kapur, Wragg, Archbold) Department of Cardiology, Barts
Health NHS Trust, London, United Kingdom
(Gallagher, Jones, Kapur, Harwood, Mathur, Uppal, Yaqoob) William Harvey
Research Institute, Queen Mary University, London, United Kingdom
(Gallagher, Jones, Kapur, Wragg, Archbold, Uppal, Yaqoob) NIHR
Cardiovascular Biomedical Research Unit, London Chest Hospital, London,
United Kingdom
(Uppal) Department of Cardiothoracic Surgery, Barts Health NHS Trust,
London, United Kingdom
(Yaqoob) Department of Nephrology, Barts Health NHS Trust, London, United
Kingdom
Title
Remote ischemic preconditioning has a neutral effect on the incidence of
kidney injury after coronary artery bypass graft surgery.
Source
Kidney International. 87 (2) (pp 473-481), 2015. Date of Publication: 03
Feb 2015.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Acute kidney injury (AKI) is a frequent complication of cardiac surgery
and usually occurs in patients with preexisting chronic kidney disease
(CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal
ischemia-reperfusion injury associated with cardiac surgery and may be a
preventive strategy for postsurgical AKI. We undertook a randomized
controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated
glomerular filtration rate under 60 ml/min per 1.73 m 2) undergoing
coronary artery bypass graft (CABG) surgery. Forty-three patients each
were randomized to receive standard care with or without RIPC consisting
of three 5-minute cycles of forearm ischemia followed by reperfusion. The
primary end point was the development of AKI defined as an increase in
serum creatinine concentration over 0.3 mg/dl within 48 h of surgery.
Secondary end points included a comparison between the study and control
groups of several serum biomarkers of renal injury including cystatin-C,
neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18
(IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury
molecule-1 measured at 6, 12, and 24 h after CABG, and the 72-h serum
troponin T concentration area under the curve as a marker of myocardial
injury. Clinical and operative characteristics were similar between the
preconditioned and control groups. AKI developed in 12 patients in both
groups within 48 h of CABG. There were no significant differences between
the two groups in the concentrations of any of the serum or urinary
biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by
forearm ischemia-reperfusion had no effect on the frequency of AKI after
CABG in patients with CKD.
<36>
Accession Number
2014954272
Authors
Bove T. Zangrillo A. Guarracino F. Alvaro G. Persi B. Maglioni E. Galdieri
N. Comis M. Caramelli F. Pasero D.C. Pala G. Renzini M. Conte M.
Paternoster G. Martinez B. Pinelli F. Frontini M. Zucchetti M.C.
Pappalardo F. Amantea B. Camata A. Pisano A. Verdecchia C. Dal Checco E.
Cariello C. Faita L. Baldassarri R. Scandroglio A.M. Saleh O. Lembo R.
Calabro M.G. Bellomo R. Landoni G.
Institution
(Bove, Zangrillo, Pappalardo, Scandroglio, Saleh, Lembo, Calabro, Landoni)
IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132,
Italy
(Guarracino, Cariello, Baldassarri) University Hospital of Pisa, Pisa,
Italy
(Alvaro, Amantea, Faita) Mater Domini Hospital, Catanzaro, Italy
(Persi, Camata) Ospedale Civile Ca' Foncello di Treviso, Treviso, Italy
(Maglioni) Siena Hospital, Siena, Italy
(Galdieri, Pisano) A. O. R. N. dei Colli, Monaldi Hospital, Napoli, Italy
(Comis, Verdecchia) Mauriziano Hospital, Turin, Italy
(Caramelli, Dal Checco) S. Orsola-Malpighi University Hospital, Bologna,
Italy
(Pasero) Citta Della Salute e Della Scienza Hospital, University of Turin,
Turin, Italy
(Pala) Ospedale Civile SS Annunziata, Sassari, Italy
(Renzini) Ospedale Santa Maria Della Misericordia, Perugia, Italy
(Conte) Maria Cecilia Hospital-GVM Care and Research, Cotignola and Citta
di Lecce Hospital, Lecce, Italy
(Paternoster) A. O. Regionale San Carlo, Potenza, Italy
(Martinez) Santa Maria Della Misericordia University Hospital of Udine,
Udine, Italy
(Pinelli) Careggi University Hospital, Florence, Italy
(Frontini) A. O. Spedali Civili di Brescia, Brescia, Italy
(Zucchetti) A. O. Ospedali Riuniti Papardo-Piemonte, Messina, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, School of Public Health and Preventive Medicine,
Melbourne, VIC, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Effect of fenoldopam on use of renal replacement therapy among patients
with acute kidney injury after cardiac surgery: A randomized clinical
trial.
Source
JAMA - Journal of the American Medical Association. 312 (21) (pp
2244-2253), 2014. Date of Publication: 03 Dec 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: No effective pharmaceutical agents have yet been identified to
treat acute kidney injury after cardiac surgery. OBJECTIVE: To determine
whether fenoldopam reduces the need for renal replacement therapy in
critically ill cardiac surgery patients with acute kidney injury. DESIGN,
SETTING, AND PARTICIPANTS: Multicenter, randomized, double-blind,
placebo-controlled, parallel-group study from March 2008 to April 2013 in
19 cardiovascular intensive care units in Italy. We randomly assigned 667
patients admitted to intensive care units after cardiac surgery with early
acute kidney injury (>50% increase of serum creatinine level from baseline
or oliguria for >6 hours) to receive fenoldopam (338 patients) or placebo
(329 patients). We used a computer-generated permuted block randomization
sequence for treatment allocation. All patients completed their follow-up
30 days after surgery, and data were analyzed according to the
intention-to-treat principle. INTERVENTIONS: Continuous infusion of
fenoldopam or placebo for up to 4 days with a starting dose of 0.1
mug/kg/min (range, 0.025-0.3 mug/kg/min). MAIN OUTCOMES AND MEASURES: The
primary end point was the rate of renal replacement therapy. Secondary end
points included mortality (intensive care unit and 30-day mortality) and
the rate of hypotension during study drug infusion. RESULTS: The study was
stopped for futility as recommended by the safety committee after a
planned interim analysis. Sixty-nine of 338 patients (20%) allocated to
the fenoldopam group and 60 of 329 patients (18%) allocated to the placebo
group received renal replacement therapy (P = .47). Mortality at 30 days
was 78 of 338 (23%) in the fenoldopam group and 74 of 329 (22%) in the
placebo group (P = .86). Hypotension occurred in 85 (26%) patients in the
fenoldopam group and in 49 (15%) patients in the placebo group (P = .001).
CONCLUSIONS AND RELEVANCE: Among patients with acute kidney injury after
cardiac surgery, fenoldopam infusion, compared with placebo, did not
reduce the need for renal replacement therapy or risk of 30-day mortality
but was associated with an increased rate of hypotension. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT00621790.
<37>
[Use Link to view the full text]
Accession Number
2014950147
Authors
Akeju O. Westover M.B. Pavone K.J. Sampson A.L. Hartnack K.E. Brown E.N.
Purdon P.L.
Institution
(Akeju, Pavone, Sampson, Hartnack, Brown, Purdon) Department of
Anesthesia, Critical Care, and Pain Medicine, Massachusetts General
Hospital, 149 13th Street, Rm 4005, Boston, MS 02129, United States
(Westover) Department of Neurology, Massachusetts General Hospital,
Boston, MS, United States
(Akeju, Brown, Purdon) Harvard Medical School, Boston, MS, United States
(Westover, Brown, Purdon) Department of Brain and Cognitive Science,
Massachusetts Institute of Technology, Cambridge, MS, United States
(Brown) Harvard-Massachusetts Institute of Technology Division of Health
Sciences and Technology, Massachusetts Institute of Technology, Cambridge,
MS, United States
(Brown) Institute for Medical Engineering and Sciences, Massachusetts
Institute of Technology, Cambridge, United States
Title
Effects of sevoflurane and propofol on frontal electroencephalogram power
and coherence.
Source
Anesthesiology. 121 (5) (pp 990-998), 2014. Date of Publication: 04 Nov
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The neural mechanisms of anesthetic vapors have not been
studied in depth. However, modeling and experimental studies on the
intravenous anesthetic propofol indicate that potentiation of
?-Aminobutyric acid receptors leads to a state of thalamocortical
synchrony, observed as coherent frontal alpha oscillations, associated
with unconsciousness. Sevoflurane, an ether derivative, also potentiates
?-Aminobutyric acid receptors. However, in humans, sevoflurane-induced
coherent frontal alpha oscillations have not been well detailed.
Methods: To study the electroencephalogram dynamics induced by
sevoflurane, the authors identified age- and sex-matched patients in which
sevoflurane (n = 30) or propofol (n = 30) was used as the sole agent for
maintenance of general anesthesia during routine surgery. The authors
compared the electroencephalogram signatures of sevoflurane with that of
propofol using time-varying spectral and coherence methods.
Results: Sevoflurane general anesthesia is characterized by alpha
oscillations with maximum power and coherence at approximately 10 Hz,
(mean +/- SD; peak power, 4.3 +/- 3.5 dB; peak coherence, 0.73 +/- 0.1).
These alpha oscillations are similar to those observed during propofol
general anesthesia, which also has maximum power and coherence at
approximately 10 Hz (peak power, 2.1 +/- 4.3 dB; peak coherence, 0.71 +/-
0.1). However, sevoflurane also exhibited a distinct theta coherence
signature (peak frequency, 4.9 +/- 0.6 Hz; peak coherence, 0.58 +/- 0.1).
Slow oscillations were observed in both cases, with no significant
difference in power or coherence.
Conclusions: The study results indicate that sevoflurane, like propofol,
induces coherent frontal alpha oscillations and slow oscillations in
humans to sustain the anesthesia-induced unconscious state. These results
suggest a shared molecular and systems-level mechanism for the unconscious
state induced by these drugs. © 2014, the American Society of
Anesthesiologists, Inc.
<38>
Accession Number
2014733582
Authors
Phan K. Xie A. Di Eusanio M. Yan T.D.
Institution
(Phan, Xie, Di Eusanio, Yan) Collaborative Research (CORE) Group,
Macquarie University, 2 Technology Pl, Sydney, NSW 2109, Australia
(Di Eusanio) Cardiovascular Surgery Department, Sant'Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW, Australia
Title
A meta-analysis of minimally invasive versus conventional sternotomy for
aortic valve replacement.
Source
Annals of Thoracic Surgery. 98 (4) (pp 1499-1511), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Elsevier USA
Abstract
Minimally invasive aortic valve replacement (AVR) is increasingly used as
an alternative to conventional AVR, despite limited randomized evidence
available. To assess the evidence base, a systematic search identified 50
comparative studies with a total of 12,786 patients. A meta-analysis
demonstrated that minimally invasive AVR is associated with reduced
transfusion incidence, intensive care stay, hospitalization, and renal
failure, and has a mortality rate that is comparable to conventional AVR.
The evidence quality was mostly very low. Given the inadequate statistical
power and heterogeneity of available studies, prospective randomized
trials are needed to assess the benefits and risks of minimally invasive
AVR approaches.
<39>
Accession Number
2014857744
Authors
Varenhorst C. Alstrom U. Braun O.O. Storey R.F. Mahaffey K.W. Bertilsson
M. Cannon C.P. Scirica B.M. Himmelmann A. James S.K. Wallentin L. Held C.
Institution
(Varenhorst, James, Wallentin, Held) Department of Medical Sciences,
Cardiology, Uppsala University, Uppsala, Sweden
(Varenhorst, Bertilsson, James, Wallentin, Held) Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Alstrom) Department of Cardiac and Thoracic Anaesthesia and Surgery,
Uppsala University, Uppsala, Sweden
(Braun) Department of Cardiology, Lund University, Lund, Sweden
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Mahaffey) Department of Medicine, Stanford University, Stanford, CA,
United States
(Cannon, Scirica) TIMI Study Group, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Himmelmann) AstraZeneca R and D, Molndal, Sweden
Title
Causes of mortality with ticagrelor compared with clopidogrel in acute
coronary syndromes.
Source
Heart. 100 (22) (pp 1762-1769), 2014. Date of Publication: 01 Nov 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: To describe specific causes of death and evaluate whether
bleeding events and infection contributed to mortality in all
ticagrelor-treated and clopidogrel-treated patients with acute coronary
syndromes. Methods: In the PLATelet inhibition and patient Outcomes
(PLATO) trial, ticagrelor signi ficantly reduced rates of vascular and
total death compared with clopidogrel. In the 905 patients who died
postenrolment in the PLATO trial (n=18 624), reviewers, blinded to study
treatment, subclassified direct causes of death and evaluated whether
infection or bleeding events contributed to fatal events. Results: Among
vascular deaths, there were significantly fewer sudden deaths (63 (0.7%)
vs 98 (1.1%), p<0.01) but no significant difference in deaths caused by
acute myocardial infarction (179 (1.9%) vs 194 (2.1%), p=0.43) or heart
failure (31 (0.3%) vs 42 (0.5%), p=0.20) with ticagrelor compared with
clopidogrel. For non-vascular deaths, there was no difference between
treatments in deaths directly caused by infection. Although, patients
treated with ticagrelor were at lower risk for death where infection was
either a direct cause or contributed to death (51 (0.5%) vs 76 (0.8%), HR
0.67 (0.47 to 0.95), p<0.05) but not for bleeding (42 (0.5%) vs 42 (0.5%),
HR 0.99 (0.65 to 1.53), p=0.98). Conclusions: In this post hoc analysis,
ticagrelor compared with clopidogrel reduced total and cardiovascular
mortality, which appeared to be mainly mediated by a reduction in sudden
death. Importantly, bleeding causing or contributing to death did not
differ between treatments. Clinical trial registration number NCT00391872
(http://www.clinicaltrial.gov).
<40>
Accession Number
2014842899
Authors
Madhavan M.V. Genereux P. Kirtane A.J. Xu K. Witzenbichler B. Mehran R.
Stone G.W.
Institution
(Madhavan, Genereux, Kirtane, Stone) Department of Medicine, Columbia
University Medical Center, New York-Presbyterian Hospital, New York, NY,
United States
(Genereux, Kirtane, Xu, Mehran, Stone) Cardiovascular Research Foundation,
New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Title
Postprocedural anticoagulation for specific therapeutic indications after
revascularization for ST-segment elevation myocardial infarction (from the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction Trial).
Source
American Journal of Cardiology. 114 (9) (pp 1322-1328), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Elsevier Inc.
Abstract
Postprocedural anticoagulation (AC) after primary percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
may be administered for a number of specific therapeutic indications (e.g.
atrial fibrillation or left ventricular thrombus). However, the safety and
effectiveness of such post-PCI AC for specific indications are not well
defined. Thus, we sought to study outcomes after postprocedural AC for
specific indications in patients undergoing primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial. Patients who underwent primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial were grouped according to whether they received specific
indication AC. Adverse outcomes were assessed using propensity-adjusted
multivariate analyses. After excluding patients who received post-PCI AC
solely for routine prophylaxis, 410 patients (16.6%) received
postprocedural AC for specific indications and 2,063 patients (83.4%)
received no post-PCI AC. After propensity adjustment, use of
postprocedural AC for specific indications was associated with higher
rates of cardiac mortality, reinfarction, stent thrombosis, and major
bleeding at 30 days compared with patients who received no AC post-PCI. In
conclusion, in this large prospective study, use of postprocedural AC for
specific indications after primary PCI for STEMI was independently
associated with early rates of adverse ischemic and hemorrhagic outcomes.
Post-PCI AC for specific indications was also associated with worse
outcomes from 30 days to 3 years. Further studies are warranted to
determine the optimal use of postprocedural AC after primary PCI in STEMI.
<41>
Accession Number
2014842889
Authors
Giordana F. D'Ascenzo F. Nijhoff F. Moretti C. D'Amico M. Biondi Zoccai G.
Sinning J.M. Nickenig G. Van Mieghem N.M. Chieffo A. Dumonteil N. Tchetche
D. Barbash I.M. Waksman R. D'Onofrio A. Lefevre T. Pilgrim T. Amabile N.
Codner P. Kornowski R. Yong Z.Y. Baan J. Colombo A. Latib A. Salizzoni S.
Omede P. Conrotto F. La Torre M. Marra S. Rinaldi M. Gaita F.
Institution
(Giordana, D'Ascenzo, Moretti, D'Amico, Omede, Conrotto, Marra, Gaita)
Division of Cardiology, Department of Internal Medicine, University of
Turin, Turin, Italy
(Salizzoni, La Torre, Rinaldi) Division of Cardio-Surgery, Cardiovascular
and Thoracic Department, University of Turin, Turin, Italy
(Nijhoff) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Sinning, Nickenig) Medizinische Klinik und Poliklinik II, Innere Medizin,
Universitatsklinikum, Bonn, Germany
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
(Chieffo) Division of Metabolic and Cardiovascular Sciences, San Raffaele
Scientific Institute, Milan, Italy
(Dumonteil) Pole Cardiovasculaire et Metabolique, Hopital Rangueil,
Toulouse, France
(Tchetche) Department of General and Interventional Cardiology, Clinique
Pasteur, Toulouse, France
(Barbash, Waksman) Interventional Cardiology, Division of Cardiology,
Washington Hospital Center, Washington, DC, United States
(D'Onofrio) Division of Cardiac Surgery, University of Padova, Padova,
Italy
(Lefevre) Institut Cardiovasculaire Paris Sud, Institut Hospitalier
Jacques Cartier, Massy, France
(Pilgrim) Department of Cardiology, Swiss Cardiovascular Center, Bern
University Hospital, Bern, Switzerland
(Amabile) Department of Cardiology, Centre Marie Lannelongue, Le
Plessis-Robinson, France
(Codner, Kornowski) Division of Cardiology, Beilinson Hospital, Rabin
Medical Center, Petach-Tikva, Israel
(Codner, Kornowski) Tel-Aviv University, Sackler Faculty of Medicine,
Tel-Aviv, Israel
(Yong, Baan) Department of Cardiology and Cardio-Thoracic Surgery,
Academic Medical Center-University of Amsterdam, Amsterdam, Netherlands
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Meta-analysis of predictors of all-cause mortality after transcatheter
aortic valve implantation.
Source
American Journal of Cardiology. 114 (9) (pp 1447-1455), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Elsevier Inc.
Abstract
The aim of this study was to identify predictors of 30-day and midterm
mortality after transcatheter aortic valve implantation (TAVI) by means of
a systemic review. TAVI was demonstrated to be safe and efficacious in
patients with severe aortic stenosis. An accurate estimation of procedural
risk of these patients represents an actual challenge. The PubMed and
Cochrane Collaboration databases were systematically searched for studies
reporting on the incidence and independent predictors of 30-day and
midterm mortality. Adverse events were pooled with random effect, whereas
independent predictors are reported as odds ratios (ORs) with 95%
confidence intervals (CIs). A total of 25 studies with 8,874 patients were
included (median age 82.5 +/- 1.5 years, 54.6% women). At 30 days, 7.5% of
patients (n = 663) died. At midterm follow-up (median 365 days,
interquartile range 267 to 365 days), the cumulative mortality rate was
21.6% (n = 1,917). Acute kidney injury (AKI) stage >2 (OR 18.0, 95% CI 6.3
to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI
2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6
to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR
5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of
30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI
stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction
<30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial
infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of
midterm mortality. In conclusion, in this large meta-analysis of patients
undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI
were the strongest independent predictors of both 30-day and 1-year
mortality. These findings may contribute to a better understanding of the
risk assessment process of patients undergoing TAVI.
<42>
Accession Number
2014838629
Authors
Al-Atassi T. Toeg H. Malas T. Lam B.-K.
Institution
(Al-Atassi, Toeg, Malas, Lam) Division of Cardiac Surgery, University of
Ottawa Heart Institute, Ottawa, ON, Canada
Title
Mapping and ablation of autonomic ganglia in prevention of postoperative
atrial fibrillation in coronary surgery: Maappafs atrial fibrillation
randomized controlled pilot study.
Source
Canadian Journal of Cardiology. 30 (10) (pp 1202-1207), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) remains common after
coronary artery bypass grafting (CABG). Limited efforts to intervene on
cardiac autonomic ganglionic plexi (AGP) during surgery show mixed
results. In this pilot study, we evaluated the safety and feasibility of
map-guided ablation of AGPs during isolated CABG in the prevention of
POAF. Methods: In this pilot study, patients undergoing isolated CABG were
randomized into an intervention group (mapping and ablation of AGP [AGP+]
group), and a control group (no mapping and ablation [AGP-] group). Using
high-frequency stimulation, active AGPs were identified and ablated
intraoperatively using radiofrequency. Continuous rhythm monitoring, serum
electrolytes, postoperative medications, and postoperative complications
were recorded until discharge. Results: Randomization of 47 patients (24
AGP+ and 23 AGP-) resulted in similar baseline characteristics, past
medical history, and preoperative medication use. The intervention added a
median of 14 minutes to the operative time. The incidence of POAF, mean
time inPOAF, and median length of stay in hospital were: AGP+ 21% vs AGP-
30%; AGP+ 298 minutes vs AGP- 514 minutes; AGP+ 5 days vs AGP- 6 days;
respectively). Postoperative complications, medication use, and daily
serum electrolyte profiles were similar in both groups. Conclusions: This
pilot study demonstrated the safety and feasibility of mapping and
ablation of AGP during CABG with minimal added operative time. Results
further suggest a potentially clinically significant effect on POAF. A
multicentre trial is warranted.
<43>
Accession Number
2014362753
Authors
Long G.H. Cooper A.J.M. Wareham N.J. Griffin S.J. Simmons R.K.
Institution
(Long, Cooper, Wareham, Griffin, Simmons) MRC Epidemiology Unit,
University of Cambridge, School of Clinical Medicine, Cambridge, United
Kingdom
Title
Healthy behavior change and cardiovascularoutcomes innewly diagnosed type
2 diabetic patients: A cohort analysis of the addition-cambridge study.
Source
Diabetes Care. 37 (6) (pp 1712-1720), 2014. Date of Publication: June
2014.
Publisher
American Diabetes Association Inc.
Abstract
OBJECTIVE To examine whether improvements in health behaviors are
associated with reduced risk of cardiovascular disease (CVD) in
individuals with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND
METHODS Population-based prospective cohort study of 867 newly diagnosed
diabetic patients aged between 40 and 69 years from the treatment phase of
the ADDITION-Cambridge study. Because the results for all analyses were
similar by trial arm, data were pooled, and results were presented for the
whole cohort. Participants were identified via population-based stepwise
screening between 2002 and 2006, and underwent assessment of physical
activity (European Prospective Investigation into Cancer-Norfolk Physical
Activity Questionnaire), diet (plasma vitamin C and self-report), and
alcohol consumption (self-report) at baseline and 1 year. A composite
primary CVD outcome was examined, comprised of cardiovascular mortality,
nonfatal myocardial infarction, nonfatal stroke, and revascularization.
RESULTS After a median (interquartile range) follow-up period of 5.0 years
(1.3 years), 6% of the cohort experienced a CVD event (12.2 per 1,000
person-years; 95% CI 9.3- 15.9). CVD risk was inversely related to the
number of positive health behaviors changed in the year after diabetes
diagnosis. The relative risk for primary CVD event in individuals who did
not change any health behavior compared with those who adopted three/four
healthy behaviors was 4.17 (95% CI 1.02-17.09), adjusting for age, sex,
study group, social class, occupation, and prescription of
cardioprotective medication (P for trend = 0.005). CONCLUSIONS CVD risk
was inversely associated with the number of healthy behavior changes
adopted in the year after the diagnosis of diabetes. Interventions that
promote early achievement of these goals in patients with newly diagnosed
diabetes could help reduce the burden of diabetes-related morbidity and
mortality. © 2014 by the American Diabetes Association.
<44>
Accession Number
2014358690
Authors
Zhang X.-D. Gu J. Jiang W.-F. Zhao L. Zhou L. Wang Y.-L. Liu Y.-G. Liu X.
Institution
(Zhang, Gu, Jiang, Zhao, Zhou, Wang, Liu, Liu) Department of Cardiology,
Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241
West Huaihai Road, Shanghai 200030, China
Title
Optimal rhythm-control strategy for recurrent atrial tachycardia after
catheter ablation of persistent atrial fibrillation: A randomized clinical
trial.
Source
European Heart Journal. 35 (20) (pp 1327-1334), 2014. Date of Publication:
21 May 2014.
Publisher
Oxford University Press
Abstract
Aim: Although catheter ablation (CA) has replaced antiarrhythmic drugs
(AAD) as first-line treatment in selected patients with atrial
fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT)
after AF ablation remains unclear. This parallel randomized controlled
study compared CA vs. AAD for recurrent AT after persistent AF ablation.
Methods and results: Two-hundred and one patients (aged 59.1 +/- 10.9
years, 68.7% male) with recurrent AT after persistent AF ablation were
enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment.
Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa,
including AT and AF) at 24-month follow-up. Composite secondary endpoints
comprised procedural complications, long-term morbidity and improvement in
quality of life (QoL). On an intention-to-treat basis, the CA group had a
higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001).
Adjusted Cox regression analysis showed a significant treatment effect
with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There
was a higher proportion of periprocedural complications in the CA group
(7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group
(10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for
CA. Conclusions: This study demonstrates superiority of CA over AAD for
recurrent AT after persistent AF ablation with regard to SR maintenance,
long-term safety and QoL improvement. However, CA use might be limited by
a higher risk for periprocedural complications. © The Author 2014.
<45>
Accession Number
2014355323
Authors
Mahdanian A.A. Rej S. Bacon S.L. Ozdin D. Lavoie K.L. Looper K.
Institution
(Mahdanian, Rej, Ozdin, Looper) McGill University, Jewish General
Hospital, Department of Psychiatry, 1033 Pine Avenue West Montreal,
Montreal, QC H3A 1A1, Canada
(Mahdanian, Bacon, Lavoie) Hopital du Sacre-Coeur de Montreal, Montreal
Behavioural Medicine Centre, Montreal, Canada
(Mahdanian) McGill University Health Centre, Department of Surgery, Cedars
Clinic, Montreal, Canada
(Bacon) Concordia University, Department of Exercise Sciences, Montreal,
Canada
(Lavoie) University of Quebec at Montreal (UQAM), Department of
Psychology, Montreal, Canada
Title
Serotonergic antidepressants and perioperative bleeding risk: A systematic
review.
Source
Expert Opinion on Drug Safety. 13 (6) (pp 695-704), 2014. Date of
Publication: June 2014.
Publisher
Informa Healthcare
Abstract
Introduction: Serotonergic antidepressants (SAds) are known to increase
bleeding events, with a number of recent studies investigating this risk
in surgical settings. Our main objective was to synthesize the current
evidence to evaluate the clinical importance of SAd-related bleeding risk
in the perioperative period. Methods: A systematic review of MEDLINE,
Embase and PsychINFO until November 2013 was conducted in compliance with
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
statement. We examined the risk of perioperative bleeding adverse events
in SAd users in comparison to controls. Results: A total of 13 relevant
studies were identified across a broad variety of surgical procedures.
SAds were associated with an increased risk of perioperative bleeding
(odds ratios [ORs] = 1.21-4.14) and blood transfusions (ORs = 0.93-3.71).
Conclusions: SAds are associated with increased perioperative bleeding
events, particularly abnormal bleeding and blood transfusions. From a
clinical perspective, the potential bleeding risks of SAds in surgical
settings need to be carefully weighed against their psychiatric benefits.
Future research will need to investigate potential strategies to mitigate
SAd-related bleeding risk in the surgical context. © Informa UK, Ltd.
<46>
Accession Number
2014322244
Authors
Kang S.-H. Park K.W. Kang D.-Y. Lim W.-H. Park K.T. Han J.-K. Kang H.-J.
Koo B.-K. Oh B.-H. Park Y.-B. Kandzari D.E. Cohen D.J. Hwang S.-S. Kim
H.-S.
Institution
(Kang, Park, Kang, Lim, Park, Han, Kang, Koo, Oh, Park, Kim) Department of
Internal Medicine and Cardiovascular Center, Seoul National University
Hospital, 28 Yeongeon-Dong, Chongno-gu, Seoul 110-744, South Korea
(Kandzari) Piedmont Heart Institute, Altanta, GA, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Hwang) Department of Social and Preventive Medicine, Inha University
School of Medicine, Incheon, South Korea
Title
Biodegradable-polymer drug-eluting stents vs. bare metal stents vs.
durable-polymer drug-eluting stents: A systematic review and Bayesian
approach network meta-analysis.
Source
European Heart Journal. 35 (17) (pp 1147-1158), 2014. Date of Publication:
May 2014.
Publisher
Oxford University Press
Abstract
Background The aim of this study was to compare the safety and efficacy of
biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents
(BMS), and durable-polymer DES in patients undergoing coronary
revascularization, we performed a systematic review and network
meta-analysis using a Bayesian framework. Methods and results Study stents
included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor
zotarolimus-eluting (ZES-E), cobalt-chromium everolimus-eluting
(CoCr-EES), platinium-chromium everolimus-eluting (PtCr-EES), resolute
zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES).
After a systematic electronic search, 113 trials with 90 584 patients were
selected. The principal endpoint was definite or probable stent thrombosis
(ST) defined according to the Academic Research Consortium within 1 year.
Results Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95%
credible interval (CrI), 0.33-0.90], SES (OR, 0.53; 95% CrI, 0.38-0.73),
CoCr-EES (OR, 0.34; 95% CrI, 0.23-0.52), and PtCr-EES (OR, 0.31; 95% CrI,
0.10-0.90) were all superior to BMS in terms of definite or probable ST
within 1 year. Cobalt-chromium everolimus-eluting stents demonstrated the
lowest risk of ST of all stents at all times after stent implantation.
Biodegradable polymer-biolimus-eluting stents was associated with a higher
risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI,
1.04-2.98). All DES reduced the need for repeat revascularization, and all
but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions All DESs but PES and ZES-E were superior to BMS in terms of ST
within 1 year. Cobalt-chromium everolimus-eluting stents was safer than
any DES even including BP-BES. Our results suggest that not only the
biodegradability of polymer, but the optimal combination of stent alloy,
design, strut thickness, polymer, and drug all combined determine the
safety of DES. © The Author 2014.
<47>
Accession Number
2014295874
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Rezaeisadrabadi M. Dehghan H.R.
Sedaghat-Hamedani F. Kayvanpour E. Popov A.-F. Liakopoulos O.J.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Rezaeisadrabadi, Dehghan) Yazd
Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Imam Khomeini
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sedaghat-Hamedani, Kayvanpour) Department of Medicine III, University of
Heidelberg, Heidelberg, Germany
(Popov) Department of Thoracic and Cardiovascular Surgery, University of
Gottingen, Gottingen, Germany
(Liakopoulos) Department of Thoracic and Cardiovascular Surgery, West
German Heart Center Essen, University Hospital, Essen, Germany
Title
Antioxidant supplementations for prevention of atrial fibrillation after
cardiac surgery: An updated comprehensive systematic review and
meta-analysis of 23 randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 646-654),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
This systematic review with meta-analysis sought to determine the impact
of antioxidants (N-acetylcysteine [NAC], polyunsaturated fatty acids
[PUFAs] and vitamins) on incidence of postoperative atrial fibrillation
(POAF) and duration of length of hospital stay. Medline, Embase, Elsevier,
Sciences online database and Google Scholar literature search was made for
studies in randomized controlled trials. The effect sizes measured were
odds ratio (OR) for categorical variable and standard mean difference
(SMD) with 95% confidence interval (CI) for calculating differences
between mean values of duration of hospitalization in intervention and
control groups. A value of P < 0.1 for Q-test or I<sup>2</sup> > 50%
indicated significant heterogeneity between the studies. Literature search
of all major databases retrieved 355 studies. After screening, a total of
23 trials were identified that reported outcomes of 4278 patients
undergoing cardiac surgery. Pooled effects estimates on POAF showed a
significant reduction after NAC (OR: 0.56, 95% CI: 0.40-0.77, P < 0.001),
PUFA (OR: 0.84, 95% CI: 0.71-0.99, P = 0.03) and vitamin C treatment (OR:
0.50, 95% CI: 0.27-0.91, P = 0.02). Hospital length of stay was not
reduced after NAC therapy (SMD: 0.082, 95% CI -0.09 to 0.25, P = 0.3), but
could be decreased with PUFA (SMD: -0.185, 95% CI: -0.35 to -0.018, P =
0.03) and vitamin C (SMD: -0.325, 95% CI -0.50 to -0.14, P < 0.01). In
conclusion, perioperative antioxidant supplementations with NAC, PUFA and
vitamin C prevent atrial fibrillation after cardiac surgery. Moreover,
PUFA and vitamin C are capable to reduce hospital stay, whereas NAC lacks
this capacity. © The Author 2014. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.
<48>
Accession Number
2014295869
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of adjusted risk estimates for survival from observational
studies of complete versus incomplete revascularization in patients with
multivessel disease undergoing coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 679-682),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
To determine whether coronary artery bypass grafting (CABG) with complete
revascularization improves survival in patients with multivessel disease
(MVD) over CABG with incomplete revascularization, we performed a
meta-analysis of adjusted (but not unadjusted) risk estimates from
observational studies. Databases including MEDLINE and EMBASE were
searched through October 2013 using Web-based search engines (PubMed,
OVID). Eligible studies were observational studies of complete- versus
incomplete-revascularization CABG enrolling 100 patients with MVD in each
treatment arm and reporting an adjusted hazard ratio for follow-up
mortality. Mixed-effects meta-regression analyses were performed to
determine whether the effects of complete-revascularization CABG on
survival were modulated by the prespecified factors. Fourteen
observational studies enrolling 30 389 patients were identified and
included. A pooled analysis demonstrated a statistically significant 37%
reduction in follow-up mortality with complete- relative to
incomplete-revascularization CABG (hazard ratio, 0.63; 95% confidence
interval, 0.53-0.75; P < 0.00001). Although meta-regression coefficients
were not statistically significant for mean follow-up duration and age and
proportion of men and patients undergoing off-pump CABG, that for
proportion of patients with diabetes was significantly negative (P =
0.03), which would indicate that as patients with diabetes increase,
complete-revascularization CABG is more beneficial for survival. In
conclusion, complete-revascularization CABG appears to improve survival
over incomplete-revascularization CABG in patients with MVD. © The
Author 2014. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<49>
Accession Number
2014295862
Authors
Morcos K. Shaikhrezai K. Kirk A.J.B.
Institution
(Morcos, Shaikhrezai, Kirk) Department of Thoracic Surgery, Golden Jubilee
National Hospital, Agamemnon St., Clydebank G81 4DY, United Kingdom
Title
Is it safe not to drain the pneumonectomy space?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 671-675),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether it is safe not to
position any chest drain into the pneumonectomy space at the conclusion of
the procedure. Altogether 381 relevant studies were identified of which 11
represented the best evidence to answer the question. The author, journal,
date, country of publication, alternative methods of postpneumonectomy
space (PPS) management, complications and relevant outcomes are tabulated.
The majority of studies are on the basis of expert opinion or small
cohorts. Major cohorts, by which the pneumonectomy outcomes have been
examined, demonstrated that the rates of complications related to
pneumonectomy space management such as empyema, bronchopleural fistula,
mediastinal shift and major bleeding requiring reopening are very low. In
a large cohort where 408 patients underwent pneumonectomy the rate of
relevant complications was low and also it was concluded that the PPS
drainage is not necessary. Two separate expert opinions were in agreement
that needle aspiration in the absence of a drainage system is adequate for
the management of PPS and avoiding a mediastinal shift. One small cohort
and one institutional audit directly examined the impact of a drainage
versus no drainage approach in the management of PPS. Although neither
study could show a significant superiority of one method over another,
they recommended adopting a unified institutional protocol for current
departmental practice. They also emphasized that larger cohorts are
required to examine the superiority of different strategies for PPS
management. In a cohort of 291 patients, it was demonstrated that patients
with drainage with underwater seal are more at risk of postpneumonectomy
oedema. A recent review published as a book chapter appraised the relevant
literature in both humans and animals. The authors concluded that the
simplicity of a no-drainage system is notable; however, a balanced
drainage might be recommended for local protocols. We conclude that
although the current evidence is not adequate to examine the different
aforementioned approaches, not draining the pneumonectomy space can be
performed safely. © The Author 2014. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.
<50>
Accession Number
2014295858
Authors
Cuthbert G.A. Kirmani B.H. Muir A.D.
Institution
(Cuthbert, Kirmani, Muir) Department of Cardiothoracic Surgery, Liverpool
Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
Title
Should dialysis-dependent patients with upper limb arterio-venous fistulae
undergoing coronary artery bypass grafting avoid having ipsilateral in
situ mammary artery grafts?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 655-660),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether dialysis-dependent
patients with upper limb arterio-venous fistulae (AVFs) undergoing
coronary artery bypass grafting should avoid having ipsilateral in situ
internal mammary artery (IMA) grafts. A literature search performed
yielded 28 peer reviewed articles, of which 21 represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. The papers identified
included 478 patients, of whom 219 had in situ IMA grafts with ipsilateral
upper limb arterio-venous fistulae. There was a substantial variation
between the papers, from single case reports to small retrospective cohort
studies, but no randomized, controlled trials. The largest retrospective
study included 155 patients and followed up for up to 5 years. Methods
used to determine coronary steal included clinical assessment,
electrocardiogram or echocardiographic changes, Doppler ultrasound of
mammary arteries and angiography. The aggregate evidence suggested that 61
of the 219 patients with ipsilateral IMA grafts developed some clinical or
physiological evidence of malperfusion during the use of the AVFs for
dialysis. Comparisons with the contralateral IMA suggested that 27 of the
61 patients suffered similar problems when dialysis was applied. A number
of studies used controls, including in situ right internal mammary artery
(RIMA) flow and patients not on dialysis. In total, 32 patients had their
in situ RIMA flow measurements studied, of which none showed any
statistically significant flow alteration. While further strong evidence
to demonstrate long-term outcomes is required, we recommend the avoidance,
where possible, of ipsilateral in situ IMA grafts in patients with an
upper limb AVF. There is sufficient experimental and anecdotal evidence to
suggest that steal occurs and that in some patients, this has clinical
implications on both morbidity and mortality. In this scenario, the use of
the contralateral mammary is strongly advocated to maximize the patency of
grafts in an already high-risk population. © The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
<51>
Accession Number
2014295851
Authors
Dunne M.J. Abah U. Scarci M.
Institution
(Dunne, Abah, Scarci) Department of Cardiac Surgery, Papworth Hospital,
Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Frailty assessment in thoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (5) (pp 667-670),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was performed according to a
structured protocol. The question addressed was the role of frailty scores
in predicting outcomes of patients undergoing thoracic surgery.
Seventy-one papers were found using the reported search, of which three
studies and one conference abstract represented the best evidence to
answer the clinical question. The authors, journal date, country of
publication, patient group, study type, relevant outcomes and results are
tabulated. Despite an extensive literature search, few studies were
identified which addressed the clinical dilemma posed, all of which were
retrospective observational series. A study analysed 971 434 patients
across a wide range of surgical specialties, 4648 of which were classified
as thoracic. A statistically significant relationship was demonstrated
between increasing frailty and higher rates of postoperative complications
and mortality (P < 0.0001). Another study reported a similar association
between modified frailty index (mFI) scores and postoperative outcomes in
patients undergoing lobectomies. Morbidity increased uniformly with mFI
and multivariant analysis found an mFI of >0.27 (P = 0.002) to be an
independent predictor of mortality. Another paper demonstrated higher
rates of major postoperative complications and increased mortality (P <
0.001) in patients with higher preoperative dependency. A study examined
geriatric frailty assessment tools for the prediction of postoperative
outcomes in patients over 70 undergoing thoracic surgery for neoplasms.
The Geriatric Depression Screen, Mini Mental State Examination, Fatigue
Inventory, Eastern Co-Operative Oncology Group Performance Scale and
Instrumental Activities of Daily Living were used as a means of
determining preoperative frailty. Their conclusion supported the
conclusions drawn from the larger studies that a single frailty measure
alone did not predict an increase in morbidity or mortality, but in
combination several measures may have a role in predicting postoperative
outcomes. The clinical bottom line is that there is a paucity of evidence
to either fully support or fully refute the use of preoperative frailty
scoring as a reliable means of predicting morbidity and mortality in
thoracic surgery. The evidence presented does however indicate the
potentially important clinical role that frailty scores may have in the
future. © The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<52>
Accession Number
2014284793
Authors
Liu C. Wang J. Yiu D. Liu K.
Institution
(Liu, Yiu, Liu) Hebei Medical University, Hebei Medical University,
Shijiazhuang, China
(Liu) Department of Pharmacology, Hebei Medical University, Shijiazhuang,
China
(Wang) Hebei Northern Institute, Hebei Northern Institute, Zhangjiakou,
China
Title
The efficacy of glucocorticoids for the prevention of atrial fibrillation,
or length of intensive care unite or hospital stay after cardiac surgery:
A meta-analysis.
Source
Cardiovascular Therapeutics. 32 (3) (pp 89-96), 2014. Date of Publication:
June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Summary: Aims: cardiopulmonary bypass and cardiac surgery are associated
with a significant systemic inflammatory response that has been suggested
playing a causative role in the development of perioperative atrial
fibrillation (POAF). The goal of this meta-analysis was to determine the
efficacy of glucocorticoid prophylaxis in preventing POAF, or length of
intensive care unite (ICU) or hospital stay. Methods: A systematic
electronic database literature search of Cochrane controlled trials
register (2013, issue 4) and MEDLINE (1966 to April, 2013) was conducted
using specific search terms for all relevant articles. Including criteria
were: randomized controlled clinical trials, participants were adults (>18
years of age) undergoing cardiac surgery, evaluated glucocorticoid
prophylaxis in cardiac surgery with adequately reported data on incidence
of POAF, or length of ICU or hospital stay. Results: Forty-two randomized
controlled trials involving 7621 participants were included in the
meta-analysis. Overall, glucocorticoids prophylaxis significantly lowered
participants' risk of developing POAF (Relative Risk [RR] 0.77; 95%
confidence interval [CI] 0.66-0.90), P < 0.01), reduced length of ICU stay
by 0.25 day (95% CI -0.40 to -0.10, P < 0.01). Glucocorticoid prophylaxis
in cardiac surgery was not associated with increased all-cause of
infection (RR 0.68; 95% CI 0.58-0.78, P < 0.01) and mortality (RR 0.75;
95% CI 0.52-1.08, P = 0.12). Conclusions: Pooled evidence suggests that
glucocorticoid prophylaxis may reduce the incidence of POAF. The
beneficial effect on POAF is associated with reduced length of ICU and
hospital stay, and infection rate. © 2014 John Wiley & Sons Ltd.
<53>
Accession Number
2014276936
Authors
Mao S. Huang S.
Institution
(Mao, Huang) Department of Nephrology, Nanjing Children's Hospital,
Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu Province,
210008, China
Title
Statins use and the risk of acute kidney injury: A meta-analysis.
Source
Renal Failure. 36 (4) (pp 651-657), 2014. Date of Publication: May 2014.
Publisher
Informa Healthcare
Abstract
The association between statins use and the risk of acute kidney injury
(AKI) remains elusive. We aimed to evaluate the association of statins use
with AKI risk by performing a meta-analysis. Twenty-one studies were
included in our meta-analysis by searching electronic databases according
to predefined criteria. No significant association between statins use and
AKI risk was observed in overall populations, Caucasians, Asians, and
patients undergoing cardiac and elective surgery (p=0.816, 0.981, 0.18,
0.709, and 0.122). Statins use decreased the risk of contrast-induced AKI
(CIN) (p=0.005) and increased AKI risk in patients with community acquired
pneumonia (CAP) (p=0.006). Meta-regression analyses showed almost no
impact on the pooled ORs of age and study length for overall populations.
Exclusion of any single study had little impact on the pooled ORs. In
conclusion, statins use is not associated with the risk of AKI in overall
populations, Caucasians, Asians, and patients undergoing cardiac and
elective surgery. Statins use decreases the risk of CIN and may increase
the risk of AKI in CAP patients. © 2014 Informa Healthcare USA, Inc.
All rights reserved: reproduction in whole or part not permitted.
<54>
Accession Number
2014245931
Authors
Pandit A. Aryal M.R. Pandit A.A. Jalota L. Hakim F.A. Mookadam F. Lee H.R.
Tleyjeh I.M.
Institution
(Pandit, Pandit, Hakim, Mookadam, Lee) Division of Cardiovascular
Diseases, Mayo Clinic, Scottsdale, AZ, United States
(Aryal, Jalota) Department of Internal Medicine, Reading Hospital, West
Reading, PA, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, King Fahad Medical City, Riyadh, Saudi
Arabia
(Tleyjeh) College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
Title
Cangrelor versus clopidogrel in percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
EuroIntervention. 9 (11) (pp 1350-1358), 2014. Date of Publication: March
2014.
Publisher
EuroPCR
Abstract
Aims: Cangrelor is a new antiplatelet agent that has been used in
percutaneous coronary intervention (PCI) with mixed results. We aimed to
review the evidence on the efficacy of cangrelor in comparison to
clopidogrel in reducing ischaemic endpoints at 48 hours in patients
undergoing PCI in large randomised trials. Methods and results: In three
large clinical trials involving 25,107 participants, the risk of the
primary composite efficacy endpoint of death, MI and ischaemia-driven
revascularisation at 48 hours, (pooled OR 0.94; 95% CI: 0.77-1.14, p=0.51,
I<sup>2</sup>=68%), death from all cause (pooled OR 0.72, 95% CI:
0.36-1.43, p=0.34, I<sup>2</sup>=52%), myocardial infarction (pooled OR
0.94, 95% CI: 0.77-1.14, p=0.51, I<sup>2</sup>=68%) was not significantly
different between cangrelor and clopidogrel. Likewise, severe or
life-threatening bleeding was similar between cangrelor and clopidogrel
(pooled OR 1.21, 95% CI: 0.70-2.12, p=0.50, I<sup>2</sup>=0%). The risk of
stent thrombosis (pooled OR 0.59, 95% CI: 0.43-0.81, p=0.001,
I<sup>2</sup>=0%), Q-wave myocardial infarction (pooled OR 0.53, 95% CI:
0.30-0.92, p=0.02, I <sup>2</sup>=0%) and ischaemia-driven
revascularisation (pooled OR 0.71, 95% CI: 0.52-0.98, p=0.04,
I<sup>2</sup>=0%) was lower in the cangrelor group. Conclusions: Based on
this meta-analysis, we did not find any difference in the risk of the
primary composite efficacy endpoint of all-cause death, ischaemia-driven
revascularisation, and myocardial infarction at 48 hours between cangrelor
and clopidogrel use. Given that cangrelor was associated with a lower risk
of stent thrombosis, ischaemia-driven revascularisation and Q-wave
myocardial infarction compared to clopidogrel, cangrelor can be considered
as a suitable alternative during PCI. © Europa Digital & Publishing
2014. All rights reserved.
<55>
Accession Number
2014242095
Authors
Wang X. Zhang G. Jiang X. Zhu H. Lu Z. Xu L.
Institution
(Wang, Jiang, Zhu, Lu, Xu) Department of Cardiology, Renmin Hospital of
Wuhan University, China
(Zhang) Department of Cardiology, Zhongnan Hospital of Wuhan University,
China
Title
Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality
and cardiovascular events among patients undergoing angiography or cardiac
revascularization: A meta-analysis of observational studies.
Source
Atherosclerosis. 234 (1) (pp 206-213), 2014. Date of Publication: May
2014.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: The aim of this study was to investigate whether neutrophil to
lymphocyte ratio (NLR) was an independent predictor for all-cause
mortality or cardiovascular events in patients undergoing angiography or
cardiac revascularization with observational studies by meta-analysis.
Methods: Pubmed and Embase were searched without language restrictions for
cohort studies published prior to November 2013. Citations were
independently screened by 2 authors, and those meeting the inclusion
criteria defined a priori were retained. Data on authors, year of
publication, location, target participant, comparison of NLR, outcome
assessment, number of event and sample size, duration and statistical
adjustments were abstracted. Results: Eight studies were identified that
reported on all-cause mortality and five studies were identified that
reported on cardiovascular events. The pooled relative risk (RR) of
all-cause mortality was 2.33 (95% CI 1.88-2.88) and the RR of
cardiovascular events was 1.89 (95% CI 1.42, 2.52) comparing the highest
with the lowest category of NLR. Conclusions: The meta-analysis indicates
that NLR is a predictor of all-cause mortality and cardiovascular events.
Further well-designed trials are warranted to confirm this association.
© 2014 Elsevier Ireland Ltd.
<56>
Accession Number
2014214754
Authors
Mrozinski P. Lango R. Biedrzycka A. Kowalik M.M. Pawlaczyk R. Rogowski J.
Institution
(Mrozinski, Lango, Biedrzycka, Kowalik) Department of Cardiac
Anaesthesiology, Medical University of Gdansk, ul. Debinki 7, 80-211
Gdansk, Poland
(Pawlaczyk, Rogowski) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Poland
Title
Comparison of haemodynamics and myocardial injury markers under desflurane
vs propofol anaesthesia for off-pump coronary surgery. A prospective
randomised trial.
Source
Anaesthesiology Intensive Therapy. 46 (1) (pp 4-13), 2014. Date of
Publication: January-March 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
viamedica@viamedica.com.pl)
Abstract
Background: Several studies have highlighted that volatile anaesthetics
improve myocardial protection in cardiopulmonary bypass coronary surgery.
However, the haemodynamic effect of desflurane in off-pump coronary
surgery has not been clarified yet. Our study hypothesis was that
desflurane-fentanyl anaesthesia could decrease myocardial injury markers
and improve haemodynamics compared to propofol-fentanyl in patients
undergoing off-pump coronary surgery. Methods: Design: Prospective
randomised open-label study. Sixty elective patients with left ventricular
ejection fraction above 30% received either desflurane (group D, n = 32)
or propofol (group P, n = 28), in addition to fentanyl and vecuronium
bromide anaesthesia for off-pump coronary surgery. Assessment of
haemodynamic function included thermodilution continuous cardiac output
and right ventricular end diastolic volume. Results: No significant
differences in cardiac output, stroke volume and mean arterial pressure
were noted between groups. The only observed difference in haemodynamic
profile was that group D demonstrated improved stability, expressed as
left ventricular stroke work index (LVSWI). Decrease in LVSWI after
performing distal anastomoses was smaller in D compared to P (median
value: -14.3 and -19.8 [g m m <sup>-2</sup> beat<sup>-1</sup>]),
respectively (P = 0.029). Oxygen uptake index (VO<sub>2</sub>I) and oxygen
extraction ratio (OER) after skin incision were lower in D, while blood
lactate concentration was slightly higher after surgery in D compared to
P. The groups did not differ with respect to CK-MB and troponin I
concentration. Conclusions: This study demonstrated no difference between
desflurane and propofol anaesthesia for off-pump coronary surgery in major
haemodynamic parameters, as well as in myocardial injury markers and the
long-term outcome. However, the study indicated that desflurane might
accelerate recovery of myocardial contractility, as assessed by LVSWI.
Lower oxygen uptake and elevated lactate under desflurane anaesthesia
indicated a discrete shift towards anaerobic metabolism. Clinical trial
registration information: NCT00528515 (http://www.clinicaltrials.gov/
ct2/show/NCT00528515?term= NCT00528515&rank = 1).
<57>
Accession Number
2014210292
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of large randomized trials for mid-term major cardio- and
cerebrovascular events following off-pump versus on-pump coronary artery
bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 522-524),
2014. Date of Publication: April 2014.
Publisher
Oxford University Press
Abstract
To determine whether off-pump coronary artery bypass grafting (CABG)
increases mid-term major adverse cardiovascular (and cerebrovascular)
events MACCE over on-pump CABG, we performed a meta-analysis of exclusive
large randomized controlled trials (RCTs). Databases including MEDLINE,
EMBASE and the Cochrane Central Register of Controlled Trials were
searched through October 2013 using Web-based search engines (PubMed and
OVID). Eligible studies were RCTs of off-pump vs on-pump CABG enrolling
>100 patients in each procedure and reporting MACCE at the time of >1 year
follow-up. Mixed-effects meta-regression analyses were performed to
determine whether the effects of off-pump CABG on MACCE were modulated by
the prespecified factors. Eight RCTs enrolling 10 954 patients were
identified and included. A pooled analysis demonstrated no statistically
significant difference in off-pump and on-pump CABG (hazard ratio, 1.10;
95% confidence interval, 0.93-1.29; P = 0.27). In general, exclusion of
any single study from the analysis did not substantially alter the overall
result of our analysis. There was no evidence of significant publication
bias. Meta-regression coefficients were not statistically significant for
mean age, proportion of men and that of diabetes. In conclusion, off-pump
CABG appears not to increase mid-term MACCE over on-pump CABG. © The
Author 2013.
<58>
Accession Number
2014210289
Authors
Sastry P. Tocock A. Coonar A.S.
Institution
(Sastry, Tocock, Coonar) Department of Cardiothoracic Surgery, Papworth
Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Adrenalectomy for isolated metastasis from operable non-small-cell lung
cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 495-497),
2014. Date of Publication: April 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'in [patients with
isolated adrenal metastasis from operable/operated non-small cell lung
cancer] is [adrenalectomy] superior [to chemo/radiotherapy alone for
achieving long-term survival]?' Altogether >160 papers were found using
the reported search, of which 3 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. We conclude that the body of
evidence is small, retrospective and not formally controlled. As such
interpretation is limited by selection bias in assignment of patients.
These limitations notwithstanding, surgical resection is associated with
prolonged survival for patients with isolated adrenal metastasis from
non-small cell lung cancer (NSCLC). Patient selection is probably
critical. Factors that are important are: otherwise early tumour, node
(TN) status of the lung primary and R0 resection, long disease-free
interval and confidence that there are no other sites of metastasis.
Patients with ipsilateral adrenal metastasis may derive the greatest
survival benefit from adrenalectomy, since spread to the ipsilateral gland
may occur via direct lymphatic channels in the retroperitoneum.
Involvement of the contralateral adrenal may signify haematogenous spread
and therefore, a more aggressive process. Adrenalectomy must be
accompanied by regional lymph node clearance to reduce the chance of
further spread from the adrenal itself. © The Author 2013.
<59>
Accession Number
2014210288
Authors
Ogutu P. Werner R. Oertel F. Beyer M.
Institution
(Ogutu, Oertel, Beyer) Department of Cardiothoracic Surgery, Klinikum
Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
(Werner) Department of Cardiovascular Surgery, Herz-Neuro-Zentrum
Bodensee, Kreuzlingen, Switzerland
Title
Should patients with asymptomatic significant carotid stenosis undergo
simultaneous carotid and cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 511-518),
2014. Date of Publication: April 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiovascular surgery was written according to a
structured protocol. The question addressed was whether patients with
severe asymptomatic carotid and coronary artery diseases should undergo
simultaneous carotid endarterectomy (CEA) and coronary artery bypass
grafting (CABG). A total of 624 papers were found using the reported
search, of which 20 represent the best evidence to answer the clinical
question. The author, journal, date and country of publication, patient
group studied, study type, relevant outcomes, results and study results of
these papers are tabulated. Previous cohort studies showed mixed results,
while advocating for the necessity of a randomized controlled trial (RCT).
A recent RCT showed that patients undergoing prophylactic or simultaneous
CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1-3
months after CABG (7.7%), without significant perioperative mortality
difference. This study included patients with unilateral severe (>70%)
asymptomatic carotid stenosis requiring CABG. An earlier partly randomized
trial also showed better outcomes for patients undergoing simultaneous
procedures (P = 0.045). Interestingly, systematic reviews previously
failed to show compelling evidence supporting prophylactic CEA. This could
be partly due to the fact that these reviews collectively analyse
different cohort qualities. Neurological studies have, however, shown
reduced cognitive and phonetic quality and function in patients with
unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one
RCTs comparing lone carotid artery stenting (CAS) and CEA informed the
American Heart Association guidelines, which declared CAS comparable with
CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the
risk of death/stroke for CAS alone is double that for CEA alone in the
acute phase following onset of symptoms, while CEA alone is associated
with a doubled risk of myocardial infarction. There is, however, no
significant difference for combined 30-day risk of death/stroke/myocardial
infarction. Outcomes of hybrid or simultaneous CAS/CABG procedures show
comparable results, albeit from rather small cohorts. While current
evidence leans towards simultaneous CEA/CABG, the emergence of hybrid
operating theatres in various institutions may allow larger cohorts with
subsequent significant data on simultaneous CAS/CABG. A randomized
controlled trial comparing both approaches would be crucial in informing
future updates of existing guidelines. © The Author 2013.
<60>
Accession Number
2014210286
Authors
Zakkar M. Kanagasabay R. Hunt I.
Institution
(Zakkar, Kanagasabay, Hunt) Department of Cardiothoracic, St. George's
Hospital, Blackshaw Road, SW17 0QT London, United Kingdom
Title
No evidence that manual closure of the bronchial stump has a lower failure
rate than mechanical stapler closure following anatomical lung resection.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 488-493),
2014. Date of Publication: April 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether manual closure of
the bronchial stump is safer with lower failure rates than mechanical
closure using a stapling device following anatomical lung resection. One
hundred and twenty-nine papers were identified using the search below.
Eight papers presented the best evidence to answer the clinical question
as they included sufficient number of patients to reach conclusions
regarding the issues of interest for this review. Complications,
complication rates and operation time were included in the assessment. The
author, journal, date and country of publication, patient group studied,
study type, relevant outcomes, results and study weaknesses of the papers
are tabulated. When looking at manual vs mechanical staples, it was noted
that stapler failure can occur in around 4% of cases. The rate of
bronchopleural fistula (BPF) development varied more in patients who
underwent manual closure (1.5-12.5%) than in patients who underwent
mechanical closure (1-5.7%). Although most of the studies reviewed showed
no statistical differences between manual and mechanical closure in terms
of BPF development, one study, however, showed that manual closure was
significantly associated with lower numbers of postoperative BPF, while
another study showed that mechanical closure is significantly associated
with lower incidence of BPF. When looking at the role of the learning
curve and training opportunities, it seems that the surgeon's inexperience
when using mechanical staples can contribute to BPF development. A
surgeon's experience can play a major role in the prevention of BPF
development in patients having manual closure. Manual closure can provide
a cheap and reliable technique when compared with costs incurred from
using staplers, it is applicable in all situations and can be taught to
surgeons in training with an acceptable risk. However, there is a lack of
evidence to suggest that manual closure is better than mechanical stapler
closure following anatomical lung resection. © The Author 2013.
<61>
Accession Number
2014206726
Authors
Monk-Hansen T. Dall C.H. Christensen S.B. Snoer M. Gustafsson F. Rasmusen
H. Prescott E.
Institution
(Monk-Hansen, Dall, Snoer, Rasmusen, Prescott) Department of Cardiology,
Bispebjerg University Hospital, Bispebjerg Bakke 23, byg. 67, 2400
Kobenhavn NV, Denmark
(Christensen, Gustafsson) Department of Cardiology, Rigshospitalet
University Hospital, Copenhagen, Denmark
Title
Interval training does not modulate diastolic function in heart transplant
recipients.
Source
Scandinavian Cardiovascular Journal. 48 (2) (pp 91-98), 2014. Date of
Publication: April 2014.
Publisher
Informa Healthcare
Abstract
Objectives. This study investigates the effect of aerobic interval
training on diastolic function at rest and during exercise in stable heart
transplant (HTx) recipients. Design. Twenty-three stable HTx recipients
(74% males, mean age 50 +/- 14.9 years) were recruited to a training
programme. Intervention was 8 weeks intensive training or control in a
randomized controlled design. Results. At baseline, participants had
normal or mild diastolic dysfunction at rest. During exercise, mean E/e'
increased from 9.0 (+/- 2.8) to 12.8 (+/- 7.7) (p = 0.09), E/A increased
from 2.1 (+/- 0.6) to 2.6 (+/- 0.7) (p = 0.02), and deceleration time
decreased by over 50 ms, all markers of increased filling pressure. There
were no correlations between diastolic function and VO2peak at baseline.
After intervention VO2peak increased from 23.9 (+/- 4.5) to 28.3(+/- 6)
ml/kg/min in the training group (difference between groups p = 0.0018). No
consistent pattern of improvement in diastolic function at rest or during
exercise was seen. Conclusion. The study does not support a role of
diastolic dysfunction in the limited exercise capacity of HTx recipients
and suggests that in these patients peripheral factors are of greater
importance. © 2014 Informa Healthcare.
<62>
Accession Number
2014203365
Authors
Bertolaccini L. Viti A. Cavallo A. Terzi A.
Institution
(Bertolaccini, Viti, Cavallo, Terzi) Division of Thoracic Surgery, S.
Croce e Carle Hospital, Cuneo, Italy
Title
Results of Li-Tho trial: A prospective randomized study on effectiveness
of ligasure in lung resections.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 693-698), 2014.
Article Number: ezt445. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVE: The role of electro-thermal bipolar tissue sealing system
(LigaSure. (LS); Covidien, Inc., CO, USA) in thoracic surgery is still
undefined. Reports of its use are still limited. The objective of the
trial was to evaluate the cost and benefits of LS in major lung resection
surgery. METHODS: A randomized blinded study of a consecutive series of
100 patients undergoing lobectomy was undertaken. After muscle-sparing
thoracotomy and classification of lung fissures according to Craig-Walker,
patients with fissure Grade 2-4 were randomized to Stapler group or LS
group fissure completion. Recorded parameters were analysed for
differences in selected intraoperative and postoperative outcomes.
Statistical analysis was performed with the bootstrap method. Pearson's
chi<sup>2</sup> test and Fisher's exact test were used to calculate
probability value for dichotomous variables comparison. Cost-benefit
evaluation was performed using Pareto optimal analysis. RESULTS: There
were no significant differences between groups, regarding demographic and
baseline characteristics. No patient was withdrawn from the study; no
adverse effect was recorded. There was no mortality or major complications
in both groups. There were no statistically significant differences as to
operative time or morbidity between patients in the LS group compared with
the Stapler group. In the LS group, there was a not statistically
significant increase of postoperative air leaks in the first 24
postoperative hours, while a statistically significant increase of
drainage amount was observed in the LS group. No statistically significant
difference in hospital length of stay was observed. Overall, the LS group
had a favourable multi-criteria analysis of cost/benefit ratio with a good
'Pareto optimum'. CONCLUSIONS: LS is a safe device for thoracic surgery
and can be a valid alternative to Staplers. In this setting, LS allows
functional lung tissue preservation. As to costs, LS seems equivalent to
Staplers. © The Author 2013. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<63>
Accession Number
2014203356
Authors
Bertholdt S. Latal B. Liamlahi R. Pretre R. Scheer I. Goetti R. Dave H.
Bernet V. Schmitz A. Von rhein M. Knirsch W. Sennhauser F.H. Plecko B.R.
Kretschmar O. Batinic K. Dimitropoulos A. Kellenberger C. Makki M. Hug
M.I. Burki C. Weiss M. Hagmann C.
Institution
(Bertholdt, Liamlahi, Knirsch) Pediatric Cardiology, University Children's
Hospital, Zurich, Switzerland
(Latal, Von rhein) Child Development Center, University Children's
Hospital, Zurich, Switzerland
(Pretre, Dave) Congenital Cardiovascular Surgery, University Children's
Hospital, Zurich, Switzerland
(Scheer, Goetti) Diagnostic Imaging, University Children's Hospital,
Zurich, Switzerland
(Bernet) Pediatric Intensive Care and Neonatology, University Children's
Hospital, Zurich, Switzerland
(Schmitz) Anaesthesia, University Children's Hospital, Zurich, Switzerland
(Sennhauser) University Children's Hospital, Pediatrics, Zurich,
Switzerland
(Hagmann) University Hospital Zurich, Neonatology, Switzerland
Title
Cerebral lesions on magnetic resonance imaging correlate with preoperative
neurological status in neonates undergoing cardiopulmonary bypass surgery.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 625-632), 2014.
Article Number: ezt422. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: To determine the prevalence, spectrum and course of cerebral
lesions in neonates with congenital heart disease (CHD) undergoing full
flow cardiopulmonary bypass (CPB) surgery using magnetic resonance imaging
(MRI) and to examine the correlation between cerebral lesions and clinical
neurological abnormalities. Methods: Prospective cohort study of neonates
with d-transposition of the great arteries (n = 22), univentricular heart
malformation with hypoplastic aortic arch (n = 6) and aortic arch
obstructions (n = 2) undergoing CPB. Neonates underwent cerebral MRI and
blinded standardized neurological examination before (median day 6) and
after surgery (day 13). The MRI findings were compared with those of 20
healthy controls. Results: Preoperative cerebral lesions were present in 7
of 30 patients (23%) with isolated mild or moderate white matter injury
(WMI) (n = 4), isolated small cerebral stroke (n = 1) and combined WMI and
stroke (n = 2). None of the healthy controls had cerebral lesions on MRI.
CHD neonates with preoperative cerebral lesions had more neurological
abnormalities (P = 0.01) than neonates without cerebral lesions. Low
arterial oxygen saturation (P = 0.03) was a risk factor for preoperative
cerebral lesions, while balloon atrioseptostomy (P = 0.19) was not. After
surgery, preoperative cerebral lesions persisted in 5 of 7 neonates, and 2
neonates (7%) showed signs of additional WMI in their postoperative MRI.
Conclusions: In neonates with severe CHD, WMI was the predominant
preoperative finding, while cerebral strokes were less frequent. New
postoperative lesions were rare. Preoperative neurological abnormalities
correlated with the presence of cerebral lesions on MRI. © The Author
2013. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.
<64>
Accession Number
2014200995
Authors
Lupi A. Rognoni A. Secco G.G. Lazzero M. Nardi F. Fattori R. Bongo A.S.
Agostoni P. Sheiban I.
Institution
(Lupi, Rognoni, Lazzero, Nardi, Bongo) Hospital Cardiology, Maggiore della
Carita Hospital, Novara, Italy
(Secco) Department of Clinical and Experimental Medicine, University of
Eastern Piedmont, Maggiore della Carita Hospital, Novara, Italy
(Secco, Fattori) Division of Interventional Cardiology, Ospedali Riuniti
Marche Nord, Pesaro, Italy
(Agostoni) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Sheiban) Interventional Cardiology, Division of Cardiology, University of
Turin, Turin, Italy
Title
Biodegradable versus durable polymer drug eluting stents in coronary
artery disease: Insights from a meta-analysis of 5834 patients.
Source
European Journal of Preventive Cardiology. 21 (4) (pp 411-424), 2014. Date
of Publication: April 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: Biodegradable polymer drug eluting stents (BP-DES) have been
developed to overcome the limitations of first generation durable polymer
DES (DP-DES) but the clinical results of different BP-DES are not
consistent. We performed a meta-analysis to compare the outcomes of BP-DES
and DP-DES in the treatment of coronary artery disease (CAD). Methods and
results: Online databases including MEDLINE were searched for studies
comparing BP-DES and DP-DES for obstructive CAD that reported rates for
overall mortality, myocardial infarction (MI), late stent thrombosis
(LST), target lesion revascularization (TLR) and late lumen loss (LLL)
with a follow-up of >6 months. Ten studies (5834 patients) with a 1-year
median follow-up were included in the meta-analysis. When comparing
patients treated with DP-DES and BP-DES those treated with BP-DES had
lower LLL (in-stent: weighted mean difference (WMD) -0.10 mm, 95% CI=-0.17
to -0.03 mm, 0.004; in-segment: WMD >0.06 mm, 95% CI=-0.10 to -0.01 mm,
0.01) with lower TLR rates (OR 0.67, 95% CI=-0.47 to 0.98, 0.04). However,
BP-DES did not improve mortality (OR 0.97, 95% CI=-0.73 to 1.29, 0.83), MI
(OR 1.13, 95% CI=-0.87 to 1.46, 0.36) or LST rates (OR 0.64, 95% CI=-0.36
to 1.16, 0.14). A pre-specified subgroup analysis of Biolimus BP-DES
confirmed significant LLL reduction without differences in other clinical
endpoints. Meta-regression analysis demonstrated a strong significant
inverse correlation between LLL and reference coronary diameter (p
<0.001). Conclusions: Our present meta-analysis showed that BP-DES when
compared with DP-DES significantly reduced LLL and TVR but without clear
benefits on mortality, MI and LST rates. (Clinicaltrials.gov identifier:
NCT01466634). © The European Society of Cardiology 2012.
<65>
Accession Number
2014197290
Authors
Abdel-Wahab M. Comberg T. Buttner H.J. El-Mawardy M. Chatani K. Gick M.
Geist V. Richardt G. Neumann F.-J.
Institution
(Abdel-Wahab, El-Mawardy, Chatani, Geist, Richardt) Cardiology Department,
Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Comberg, Buttner, Gick, Neumann) Cardiology Department, University Heart
Center Bad Krozingen, Bad Krozingen, Germany
Title
Aortic regurgitation after transcatheter aortic valve implantation with
balloon- and self-expandable prostheses: A pooled analysis from a 2-center
experience.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 284-292), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to assess aortic regurgitation (AR) after
transcatheter aortic valve implantation (TAVI) with the self-expandable
Medtronic CoreValve (MCV) (Medtronic Inc., Minneapolis, Minnesota) versus
balloon-expandable Edwards Sapien XT valve (ESV) (Edwards Lifesciences,
Irvine, California). Background: AR after TAVI has been associated with
poor survival, but limited data exist comparing MCV with ESV. Methods: We
pooled the prospective TAVI databases of 2 German centers. The primary
endpoint was more-than-mild post-TAVI AR assessed by echocardiography. We
also assessed device success and survival within 1 year. Endpoints were
adjudicated according to the Valve Academic Research Consortium criteria
and analyzed by unadjusted and propensity-score-adjusted models. Results:
A total of 394 patients were included, 276 treated with MCV and 118 with
ESV. More-than-mild AR was significantly higher with MCV than with ESV
(12.7% vs. 2.6%, p = 0.002). This difference remained significant after
propensity adjustment (adjusted odds ratio [OR]: 4.59, 95% confidence
interval [CI]: 1.03 to 20.44). The occurrence of any degree of AR was also
higher with MCV (71.6% vs. 56.9%, p = 0.004). Device success was mainly
influenced by the occurrence of AR and was consequently higher with ESV
(95.8% vs. 86.6%, p = 0.007), but this was not significant after
propensity adjustment (adjusted OR: 0.34, 95% CI: 0.11 to 1.03, p = 0.06).
At 1 year, survival was comparable between both valve types (83.8% MCV vs.
88.2% ESV, p = 0.42), but was significantly worse in patients with
more-than-mild AR (69.8% vs. 87.4%, p = 0.004) and in those with device
failure (65.6% vs. 87.4%, p < 0.001). Conclusions: More-than-mild AR after
TAVI was more frequent with MCV than with ESV. This finding deserves
consideration, as more-than-mild AR was associated with higher mortality
at 1 year. © 2014 by the American College of Cardiology Foundation.
<66>
Accession Number
2014292854
Authors
Kormi I. Alfakry H. Tervahartiala T. Pussinen P.J. Sinisalo J. Sorsa T.
Institution
(Kormi) Oral and Maxillofacial Department, Oulu University Hospital, Oulu,
Finland
(Kormi, Alfakry, Tervahartiala, Pussinen, Sorsa) Institute of Dentistry,
University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
(Sorsa) Department of Oral and Maxillofacial Diseases, Helsinki University
Central Hospital, Helsinki, Finland
(Sinisalo) Division of Cardiology, Department of Medicine, Helsinki
University Central Hospital, Helsinki, Finland
Title
The effect of prolonged systemic doxycycline therapy on serum tissue
degrading proteinases in coronary bypass patients: A randomized,
double-masked, placebo-controlled clinical trial.
Source
Inflammation Research. 63 (5) (pp 329-334), 2014. Date of Publication: May
2014.
Publisher
Birkhauser Verlag AG
Abstract
Objective: Serum matrix metalloproteinases (MMP-8, MMP-7) and their
regulators may be associated with the risk of incident cardiovascular
disease events. Doxycycline can be used as matrix metalloproteinase (MMP)
inhibitor independent of its antimicrobial activity. We aimed to
investigate serum inflammatory biomarkers during 4 months of doxycycline
therapy in coronary bypass patients. Materials and methods: Thirty-one
non-smoking men who had previous coronary bypass surgery were randomly
assigned to receive placebo or 100 mg doxycycline daily for 4 months.
Serum samples were collected at baseline before the treatment, and at 2,
4, and 10 months. Serum levels of MMP-7, tissue inhibitor of matrix
metalloproteinase (TIMP)-1, myeloperoxidase, and neutrophil elastase were
analyzed with enzyme-linked immunosorbent assay, MMP-8 by
immunofluorometric assay, and C-reactive protein by rate nephelometry.
Results: At baseline, no significant differences existed between the two
groups. Serum levels of MMP-8, MMP-7, and MMP-8/TIMP-1 were and remained
lower (p = 0.034, p = 0.041, and NS) in the doxycycline group relative to
the placebo group at 4 months of follow-up. Conclusions: Doxycycline
decreases the systemic inflammatory burden in patients with myocardial
infarction and especially down-regulates MMP-7, MMP-8, and MMP-8/TIMP-1.
Doxycycline might prevent or reduce the risk of secondary myocardial
infarctions by providing a systemic anti-proteolytic and -inflammatory
shield. © 2013 Springer.
<67>
Accession Number
2013788582
Authors
Kekecs Z. Jakubovits E. Varga K. Gombos K.
Institution
(Kekecs) Eotvos Lorand University, Faculty of Education and Psychology,
Affective Psychology Department, Budapest, Hungary
(Jakubovits) Semmelweis University, Faculty of Health Scienses, Hungary
(Varga) Eotvos Lorand University, Faculty of Education and Psychology,
Affective Psychology Department, Hungary
(Gombos) Szent Janos Korhaz es Eszak-budai Egyesitett Korhazak,
Ophthalmology, Hungary
Title
Effects of patient education and therapeutic suggestions on cataract
surgery patients: A randomized controlled clinical trial.
Source
Patient Education and Counseling. 94 (1) (pp 116-122), 2014. Date of
Publication: January 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: This paper describes a randomized controlled single blind study
testing the effects of a patient education intervention combined with
positive therapeutic suggestions on anxiety for cataract surgery patients.
Methods: 84 patients participated in the study. Physiological and
behavioral indicators of anxiety were compared between a regularly treated
control and an intervention group receiving an audio CD containing
information, relaxation, and positive imagery. Results: We found that the
intervention group was calmer throughout the four measurement points of
the study (p = .004; d= 0.71) and they were more cooperative (p = .01; d=
0.60) during the operation. The groups did not differ in sleep quality
before the day of the operation, heart rate during the procedure, and
subjective Well-being. Conclusion: Findings indicate that preoperative
information combined with positive suggestions and anxiety management
techniques might reduce patient anxiety in the perioperative period of
cataract surgery, but further research is needed to investigate the
benefits of such interventions and to uncover the underlying mechanisms.
Practice implications: Patient education interventions providing
additional anxiety management techniques are recommended for use prior to
cataract surgery. © 2013 Elsevier Ireland Ltd.
<68>
Accession Number
2014344793
Authors
El Sabbagh A. Patel V.G. Jeroudi O.M. Michael T.T. Alomar M.E. Mogabgab O.
Fuh E. Roesle M. Rangan B.V. Abdullah S. Hastings J.L. Grodin J. Kumbhani
D.J. Alexopoulos D. Fasseas P. Banerjee S. Brilakis E.S.
Institution
(El Sabbagh, Patel, Jeroudi, Michael, Alomar, Mogabgab, Fuh, Roesle,
Rangan, Abdullah, Hastings, Grodin, Kumbhani, Banerjee, Brilakis) VA North
Texas Health Care System, University of Texas Southwestern Medical School,
Dallas, TX, United States
(Alexopoulos) University of Patras, Patras, Greece
(Fasseas) Medical College of Wisconsin, Milwaukee, WI, United States
Title
Angiographic success and procedural complications in patients undergoing
retrograde percutaneous coronary chronic total occlusion interventions: A
weighted meta-analysis of 3482 patients from 26 studies.
Source
International Journal of Cardiology. 174 (2) (pp 243-248), 2014. Date of
Publication: 15 Jun 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background The efficacy and safety profile of retrograde chronic total
occlusion (CTO) percutaneous coronary intervention (PCI) has received
limited study. We sought to perform a weighted meta-analysis of the
success and complication rates of retrograde CTO PCI. Methods We conducted
a meta-analysis of 26 studies published between 2006 and April 2013
reporting in-hospital outcomes of retrograde CTO PCI. Data on procedural
success, frequency of death, emergent coronary artery bypass graft surgery
(CABG), stroke, myocardial infarction (MI), perforation, tamponade, stent
thrombosis, major vascular or bleeding events, contrast nephropathy, and
radiation skin injury were collected. Results A total of 26 studies with
3482 patients and 3493 target CTO lesions were included. Primary
retrograde CTO PCI was attempted in 52.4%. Pooled estimates of outcomes
were as follows: procedural success 83.3% [95% confidence interval (CI):
79.0% to 87.7%]; death 0.7% (95% CI: 0.5% to 1.2%); urgent CABG 0.7% (95%
CI: 0.4% to 1.2%); tamponade 1.4% (95% CI: 1.0% to 2.2%); collateral
perforation 6.9% (95% CI: 4.6% to 10.4%); coronary perforation 4.3% (95%
CI: 1.2% to 15.4%); donor vessel dissection 2% (95% CI: 0.9% to 4.5%);
stroke 0.5% (95% CI: 0.2% to 1.0%); MI 3.1% (95% CI: 0.2% to 5.0%); Q wave
MI 0.6% (95% CI: 0.4% to 1.1%); vascular access complications 2% (95% CI:
0.9% to 4.5%); contrast nephropathy 1.8% (95% CI: 0.8% to 3.7%); and wire
fracture and equipment entrapment 1.2% (95% CI: 0.6% to 2.5%). Conclusions
Retrograde CTO PCI is associated with high procedural success rate and
acceptable risk for procedural complications. © 2014 Elsevier Ireland
Ltd. All rights reserved.
<69>
Accession Number
2014344659
Authors
Escarcega R.O. Magalhaes M.A. Lipinski M.J. Baker N.C. Minha S. Torguson
R. Waksman R.
Institution
(Escarcega, Magalhaes, Lipinski, Baker, Minha, Torguson, Waksman) MedStar
Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010,
United States
Title
Mortality in patients requiring pacemaker implantation following
transcatheter aortic valve replacement: Insights from a systematic review
and meta-analysis.
Source
International Journal of Cardiology. 174 (1) (pp 207-208), 2014. Date of
Publication: 01 Jun 2014.
Publisher
Elsevier Ireland Ltd
<70>
Accession Number
2014289611
Authors
Capodanno D. Capranzano P. Tamburino C.
Institution
(Capodanno, Capranzano, Tamburino) Cardiology Department, Ferrarotto
Hospital, University of Catania, Via Citelli 6, 95124 Catania, Italy
Title
CABG versus PCI in diabetic patients with multivessel disease after risk
stratification by the SYNTAX score: A pooled analysis of the SYNTAX and
FREEDOM trials.
Source
International Journal of Cardiology. 173 (3) (pp 548-549), 2014. Date of
Publication: 15 May 2014.
Publisher
Elsevier Ireland Ltd
<71>
Accession Number
2014258710
Authors
Campo G. Punzetti S. Malagu M. Ferrari R. Valgimigli M.
Institution
(Campo, Punzetti, Malagu, Ferrari) Cardiovascular Institute, Azienda
Ospedaliero-Universitaria S. Anna, Ferrara, Italy
(Campo, Ferrari) LTTA Center, Ferrara, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care and Research, E.S. Health
Science Foundation, Cotignola, Italy
(Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Two-year outcomes after first- or second-generation drug-eluting stent
implantation in patients with in-stent restenosis. A PRODIGY trial
substudy.
Source
International Journal of Cardiology. 173 (2) (pp 343-345), 2014. Date of
Publication: 01 May 2014.
Publisher
Elsevier Ireland Ltd
<72>
Accession Number
2014289576
Authors
Machaalany J. Senechal M. O'Connor K. Abdelaal E. Plourde G. Voisine P.
Rimac G. Tardif M.-A. Costerousse O. Bertrand O.F.
Institution
(Machaalany, Senechal, O'Connor, Abdelaal, Plourde, Rimac, Tardif,
Costerousse, Bertrand) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Department of Cardiology, Quebec Heart-Lung
Institute, 2725 chemin Sainte-Foy, Quebec City, QC G1V 4G5, Canada
(Voisine) Department of Cardiovascular Surgery, Quebec City, QC, Canada
Title
Early and late mortality after repair or replacement in mitral valve
prolapse and functional ischemic mitral regurgitation: A systematic review
and meta-analysis of observational studies.
Source
International Journal of Cardiology. 173 (3) (pp 499-505), 2014. Date of
Publication: 15 May 2014.
Publisher
Elsevier Ireland Ltd
<73>
Accession Number
2014264662
Authors
Robertson J.O. Ebrahimi R. Lansky A.J. Mehran R. Stone G.W. Lincoff A.M.
Institution
(Robertson, Lincoff) Department of Cardiovascular Medicine/F25, Cleveland
Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
(Ebrahimi) University of California Los Angeles, Greater Los Angeles VA
Medical Center, Los Angeles, CA, United States
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Mehran) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Mehran, Stone) Cardiovascular Research Foundation, New York, NY, United
States
(Stone) Columbia University Medical Center, New York, NY, United States
Title
Impact of cigarette smoking on extent of coronary artery disease and
prognosis of patients with non-ST-segment elevation acute coronary
syndromes: An analysis from the ACUITY trial (acute catheterization and
urgent intervention triage strategy).
Source
JACC: Cardiovascular Interventions. 7 (4) (pp 372-379), 2014. Date of
Publication: April 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to evaluate the short- and long-term
outcomes for smokers with non-ST-segment elevation acute coronary
syndromes (NSTE-ACS). Background: Smoking has been associated with the
"paradox" of reduced mortality after acute myocardial infarction (MI).
This is thought to be due to favorable baseline characteristics and less
diffuse coronary artery disease (CAD) among smokers. Methods: In the
ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy)
trial, 13,819 patients (29.1% smokers) with moderate- to high-risk
NSTE-ACS underwent angiography and, if indicated, revascularization.
Results: Smokers were significantly younger and had fewer comorbidities
than nonsmokers. Incidence of death and MI were comparable at 30 days,
although smokers had significantly reduced risks of 30-day major bleeding
(hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.67 to 0.96; p =
0.016) and 1-year mortality (HR: 0.797, 95% CI: 0.65 to 0.97; p = 0.027).
After correction for baseline and clinical differences, smoking was no
longer predictive of major bleeding (odds ratio: 1.06, 95% CI: 0.86 to
1.32; p = 0.56) and was associated with higher 1-year mortality (HR: 1.37,
95% CI: 1.07 to 1.7; p = 0.013). This pattern of reversed risk after
multivariable correction held true for those smokers requiring
percutaneous coronary intervention. Core laboratory angiographic analysis
showed that smokers and nonsmokers were comparable in terms of the extent
of CAD, Thrombolysis In Myocardial Infarction flow, myocardial blush, and
the presence of thrombi. Conclusions: In contrast to the paradox
previously described in ST-segment elevation MI, our analysis finds
smoking to be an independent predictor of higher 1-year mortality in
patients presenting with NSTE-ACS, and our angiographic study demonstrates
CAD in smokers that is comparable to that in nonsmokers but evident ~1
decade earlier. (Acute Catheterization and Urgent Intervention Triage
Strategy [ACUITY]; NCT00093158). © 2014 by the American College of
Cardiology Foundation.
<74>
Accession Number
2014277319
Authors
Carillo S. Zhang Y. Fay R. Angioi M. Vincent J. Sutradhor S.C. Ahmed A.
Pitt B. Zannad F.
Institution
(Carillo, Fay, Zannad) Inserm U961, Cardiology, Centre d'Investigations
Cliniques CIC9501, CHU de Nancy, 2 avenue du Morvan, 54500
Vandoeuvre-Les-Nancy, France
(Zhang, Ahmed) University of Alabama at Birmingham and VA Medical Center,
Birmingham, AL, United States
(Angioi) Clinic Louis-Pasteur, 54270 Essey-Les-Nancy, France
(Vincent, Sutradhor) Pfizer Inc., New York City, NY, United States
(Pitt) University of Michigan, Ann Arbor, MI, United States
Title
Heart failure with systolic dysfunction complicating acute myocardial
infarction - Differential outcomes but similar eplerenone efficacy by
ST-segment or non-ST-segment elevation: A post hoc substudy of the EPHESUS
trial.
Source
Archives of Cardiovascular Diseases. 107 (3) (pp 149-157), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France. E-mail: infos@masson.fr)
Abstract
Background Differential outcomes in patients with acute systolic heart
failure (HF) complicating acute myocardial infarction (AMI) and the
efficacy of mineralocorticoid receptor antagonists according to
non-ST-segment and ST-segment elevation myocardial infarction (NSTEMI,
STEMI) status has not been specifically investigated. Methods In the
EPHESUS study, 6632 patients with acute HF and left ventricular ejection
fraction < 40% were randomized 3-14 days post-AMI (median 7.3 +/- 3.0
days) to receive eplerenone (n = 3319) or placebo (n = 3313). Among them,
6392 patients with available data on baseline ST-segment status (4634
STEMI; 1758 NSTEMI) were compared using a Cox model analysis stratified
according to quintiles of propensity score (PS), taking into account major
baseline risk factors, including revascularization. Results STEMI and
NSTEMI patients differed significantly across a large variety of baseline
characteristics. During 30 months of follow-up, all-cause death occurred
in 19% and 13% (P < 0.0001), cardiovascular death in 16% and 12% (P <
0.0001), cardiovascular death and hospitalization in 33% and 26% (P <
0.0001) and death from progression of HF in 5% and 3% (P < 0.0001) of
unadjusted NSTEMI and STEMI patients, respectively. After Cox model PS
adjustment without revascularization, NSTEMI status still proved to be a
risk factor for all-cause death, cardiovascular death and death from
progression of HF. After Cox model PS adjustment including
revascularization, none of the outcomes differed between STEMI and NSTEMI
patients. Eplerenone morbidity and mortality benefits were consistent in
the STEMI and NSTEMI subgroups. Conclusion In patients with acute systolic
HF complicating AMI, eplerenone improves outcomes equally in STEMI and
NSTEMI patients. Worse outcomes associated with NSTEMI could be explained
by more co-morbidities, less aggressive therapies and, mainly, less
frequent revascularization. © 2014 Elsevier Masson SAS.
<75>
Accession Number
2014333030
Authors
Rashidi A. Fisher S.I.
Institution
(Rashidi) Division of Oncology, Washington University School of Medicine,
St. Louis, MO, United States
(Fisher) Pathology Sciences Medical Group/Sentara Laboratory Services,
Norfolk, VA, United States
Title
Acute myeloid leukemia following solid organ transplantation: Entity or
novelty?.
Source
European Journal of Haematology. 92 (6) (pp 459-466), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Due to the rarity of the disease, the characteristics of acute myeloid
leukemia following solid organ transplantation (post-transplant AML;
PT-AML) are unclear; furthermore, it is not known for certain whether
PT-AML is a separate entity or not. We provide a systematic review of all
previously reported cases of PT-AML in the English literature (n = 51).
45% of cases occurred after renal transplantation, and 72% were males. The
median age at diagnosis of AML was 50 yr, with a median transplant-to-AML
interval of 3.8 yr and a rapid decline in incidence after 5 yr. 26% of
patients were asymptomatic at the time of presentation, and 42% were
pancytopenic. M0/M1/M2, M3, M4/M5, and M6/M7 subtypes comprised 17%, 25%,
39%, and 19% of all cases, respectively. 36% of patients had unfavorable
cytogenetic risk disease. The median overall survival was only 3 months.
We observed several transplant-specific features: (i) The
transplant-to-AML interval follows two very different patterns between
renal vs. liver transplant patients. (ii) All 4 cases of donor cell
leukemia occurred after liver transplant. (iii) Unfavorable risk disease
was marginally significantly more common among renal compared with liver
transplant patients (P = 0.057). Our results suggest that PT-AML is a
separate entity with distinct characteristics, which need to be
investigated further in future research. Heavy post-transplant
immunosuppression likely plays a key role in the pathogenesis of PT-AML.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
<76>
Accession Number
2014197285
Authors
Jang J.-S. Song Y.-J. Kang W. Jin H.-Y. Seo J.-S. Yang T.-H. Kim D.-K. Cho
K.-I. Kim B.-H. Park Y.H. Je H.-G. Kim D.-S.
Institution
(Jang, Song, Kang, Jin, Seo, Yang, Kim, Kim) Department of Cardiology,
Busan Paik Hospital, University of Inje College of Medicine, Busan, South
Korea
(Cho) Department of Cardiology, Kosin University Medical Center, Busan,
South Korea
(Kim) Department of Cardiology, Pusan National University Hospital, Busan,
South Korea
(Park, Je) Department of Cardiology and Cardiovascular Surgery, Pusan
National University Yangsan Hospital, Yangsan, South Korea
Title
Intravascular ultrasound-guided implantation of drug-eluting stents to
improve outcome: A meta-analysis.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 233-243), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to systematically review and perform
a meta-analysis of randomized trials and observational studies of
intravascular ultrasound (IVUS)-guided versus angiography-guided
implantation of drug-eluting stents (DES). Background: Although studies in
the bare-metal stents era suggested that there were clinical benefits to
IVUS guidance, it is still controversial whether percutaneous coronary
intervention (PCI) with DES guided by IVUS leads to better clinical
outcomes. Methods: Relevant studies published through March 31, 2013, were
searched for and identified in the electronic databases. Summary estimates
were obtained using a random-effects model. Results: From 138 initial
citations, 3 randomized trials and 12 observational studies with 24,849
patients (11,793 IVUS-guided and 13,056 angiography-guided) were included
in this study. Comparison of IVUS- versus angiography-guided PCI disclosed
odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence
interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also
associated with significantly lower rates of all-cause mortality (OR:
0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57;
95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR:
0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95%
CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched
studies demonstrated similar results in terms of clinical outcomes, but
not repeat revascularization. Conclusions: IVUS-guided DES implantation is
associated with significantly lower rates of adverse clinical events
compared with angiography guidance. Further study is needed to clarify
which subgroups of subjects with IVUS guidance will have greater benefit.
© 2014 by the American College of Cardiology Foundation.
<77>
Accession Number
2014245320
Authors
Aryal M.R. Hakim F.A. Giri S. Ghimire S. Pandit A. Bhandari Y. Acharya
Y.P. Pradhan R.
Institution
(Aryal) Department of Internal Medicine, Reading Health System, West
Reading, PA, United States
(Hakim, Pandit) Division of Cardiovascular Diseases, Department of
Medicine, Mayo Clinic, Scottsdale, AZ, United States
(Giri) Division of Internal Medicine, University of Tennessee, Health
Science Center, Memphis, TN, United States
(Ghimire, Acharya) Division of Internal Medicine, Tribhuvan University
Teaching Hospital, Kathmandu, Nepal
(Bhandari) Department of Nursing, Alvernia University, Reading, PA, United
States
(Pradhan) Regional Heart Doctors, Rapid City Regional Hospital, Rapid
City, SD, United States
Title
Right atrial appendage aneurysm: A systematic review.
Source
Echocardiography. 31 (4) (pp 534-539), 2014. Date of Publication: April
2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Right atrial appendage aneurysm (RAAA) is rare with fewer than
20 cases reported in the literature. We sought to systematically review
the published cases of RAAA in terms of demographics, clinical
characteristics, treatment, complications, and outcome. Methodology
Electronic search for case reports, case series, and related articles
published until July 2013 was carried out and clinical data were extracted
and analyzed. Results Seventeen cases of RAAA were identified with equal
sex distribution and commonly presenting in the third decades of life.
Dyspnea and palpitation were the most common clinical presentations.
Echocardiography was the most common diagnostic modality. The mean size of
aneurysm was 8.83 +/- 4.84 x 6.05 +/- 2.99 cm. Most of the patients were
treated medically with close follow-up. The mean follow-up period was 10
months. Atrial tachyarrhythmias and heart failure were the most common
complications. Conclusion Right atrial appendage aneurysm although rare
may be associated with significant morbidity. Surgical resection is
indicated in symptomatic patients. © 2014, Wiley Periodicals, Inc.
<78>
Accession Number
2014123993
Authors
Rogers P.A. Daye J. Huang H. Blaustein A. Virani S. Alam M. Kumar A.
Paniagua D. Kar B. Bozkurt B. Ballantyne C.M. Deswal A. Jneid H.
Institution
(Rogers, Daye, Huang, Blaustein, Virani, Alam, Kumar, Paniagua, Kar,
Bozkurt, Ballantyne, Deswal, Jneid) Division of Cardiology, Department of
Medicine, Baylor College of Medicine, Houston, TX, United States
(Blaustein, Virani, Paniagua, Kar, Bozkurt, Deswal, Jneid) Michael E.
Debakey VA Medical Center, Houston, TX, United States
Title
Revascularization improves mortality in elderly patients with acute
myocardial infarction complicated by cardiogenic shock.
Source
International Journal of Cardiology. 172 (1) (pp 239-241), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Ireland Ltd
<79>
Accession Number
2014747485
Authors
Osnabrugge R.L. Speir A.M. Head S.J. Jones P.G. Ailawadi G. Fonner C.E.
Fonner E. Kappetein A.P. Rich J.B.
Institution
(Osnabrugge, Head, Kappetein) Department of Cardio-Thoracic Surgery,
Erasmus University Medical Center, Rotterdam, Netherlands
(Speir) Inova Heart and Vascular Institute, Fairfax, VA, United States
(Jones) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Ailawadi) Department of Thoracic and Cardiovascular Surgery, University
of Virginia Health System, Charlottesville, VA, United States
(Fonner) ARMUS Corporation, San Mateo, CA, United States
(Fonner, Fonner) Virginia Cardiac Surgery Quality Initiative, Falls
Church, VA, United States
(Rich) Sentara Heart Hospital, 600 Gresham Dr, Ste 8600, Norfolk, VA
23507, United States
Title
Prediction of costs and length of stay in coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 98 (4) (pp 1286-1293), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Elsevier USA
Abstract
Background. Although more than 200,000 bypass operationsare performed in
the United States annually, fewdata exist on the predictors of costs and
resource use forthis procedure. Questions related to clinical
outcomes,costs, and resource use in coronary artery bypass grafting(CABG)
were addressed.
Methods. In a multiinstitutional statewide database,patient level data
from 42,839 patients undergoingisolated CABG were combined with cost data.
Afteradjustment for cost-to-charge ratios and inflation, the associationof
length of stay and costs with the Societyof Thoracic Surgeons-Predicted
Risk of Mortality (STSPROM)was analyzed. Patients were randomly
dividedinto development (60%) and validation (40%) cohorts.Regression
models were developed to analyze the impactof patient characteristics,
comorbidities, and adverseevents on postoperative length of stay and total
costs.
Results. Postoperative length of stay and total directcosts for CABG
averaged 6.9 days and $38,847. Length ofstay and costs increased from 5.4
days and $33,275 in thelowest-risk decile (mean STS-PROM of 0.6%) to 13.8
daysand $69,122 in the highest-risk decile (mean STS-PROM19%). Compared
with adverse events, patient characteristicshad little impact on length of
stay and costs.on validation, the models that combined preoperativeand
postoperative variables explained variance better(R2[0.51 for length of
stay; R2[0.47 for costs) and werebetter calibrated than the preoperative
models (R2 [ 0.10for length of stay; R2 [ 0.14 for costs).
Conclusions. The STS-PROM and preoperative regressionmodels are useful for
preoperative prediction of costsand length of stay for groups of patients,
case-mixadjustment in hospital benchmarking, and pay for
performancemeasures. The combined preoperative andpostoperative models
identify incremental costs andlength of stay associated with adverse
events and are moresuitable for prioritizing quality improvement efforts.
<80>
Accession Number
2014731352
Authors
Schwalm J.D.R. Wijeysundera H.C. Tu J.V. Guo H. Kingsbury K.J. Natarajan
M.K.
Institution
(Schwalm, Natarajan) McMaster University, Hamilton Health
Sciences/Population Health Research Institute, Hamilton, ON, Canada
(Wijeysundera, Tu) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Wijeysundera, Tu, Guo) Institute for Clinical Evaluative Sciences,
Toronto, ON, Canada
(Kingsbury) Cardiac Care Network, Toronto, ON, Canada
Title
Influence of coronary anatomy and SYNTAX score on the variations in
revascularization strategies for patients with multivessel disease.
Source
Canadian Journal of Cardiology. 30 (10) (pp 1155-1161), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: The Variation in Revascularization Practice in Ontario (VRPO)
project helped describe variations in revascularization across Ontario.
Coronary anatomy was the most important predictor of revascularization
strategy. We conducted a novel angiographic substudy of the VRPO cohort
to: (1) validate "real-world" coronary angiographic reporting in the
province of Ontario; and (2) understand the relationship between
variability in revascularization and coronary anatomy complexity. Methods:
Seventeen hundred eighty-seven angiograms from 17 cardiac centres were
randomly sampled from the VRPO cohort. The core lab assessment involved
blinded interpretation of each angiographic film. A comparison of
agreement in coronary anatomy and treatment strategy between abstracted
chart data from the VRPO study and blinded film review was undertaken.
Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac
Surgery (SYNTAX) scores were calculated for all patients with multivessel
disease. Results: The weighted kappa statistic for coronary anatomy was
0.75 (95% confidence interval, 0.72-0.77), suggesting substantial
agreement between abstracted chart data and blinded film review. The
weighted kappa for revascularization strategy was 0.51 (95% confidence
interval, 0.47-0.54) suggesting only moderate agreement. There were no
significant differences in the mean/median SYNTAX scores across all 4
percutaneous coronary intervention: coronary artery bypass graft (CABG)
groups. Conclusions: Abstracted chart data in the VRPO project provides a
valid assessment of coronary anatomy and furthermore serves as validation
of "real-world" coronary angiographic reporting in the province of
Ontario. The uniform distribution of coronary complexity across centres in
Ontario, with respect to the SYNTAX score, suggests the variation of
percutaneous coronary intervention: CABG ratio is not related to a
difference in coronary anatomy complexity across sites, but rather a
difference in management strategies for the same anatomy.
<81>
Accession Number
2014364114
Authors
Mathews S.B. Arnold S.E. Epperson C.N.
Institution
(Mathews, Arnold, Epperson) Department of Psychiatry, University of
Pennsylvania School of Medicine, 3535 Market St., Philadelphia, PA 19104,
United States
(Mathews, Epperson) Penn Center for Women's Behavioral Wellness,
University of Pennsylvania, Philadelphia, PA, United States
(Arnold, Epperson) Department of Obstetrics and Gynecology, University of
Pennsylvania School of Medicine, Philadelphia, PA, United States
Title
Hospitalization and cognitive decline: Can the nature of the relationship
be deciphered?.
Source
American Journal of Geriatric Psychiatry. 22 (5) (pp 465-480), 2014. Date
of Publication: May 2014.
Publisher
Elsevier
Abstract
Background: Evidence for a relationship between hospitalization and
incident cognitive decline exists mainly in the literature focusing on
critical care hospitalization. Recent studies, however, have also found an
association between noncritical care hospitalization and the development
of cognitive decline. Objective: This article will review the literature
pertaining to hospitalization and cognitive decline, including
hospitalizations for both critical and noncritical care, and in medical
and surgical patients. The article will also explore the various factors
that have been implicated in the development of cognitive decline and
dementia. Methods: Review of the literature was completed using PubMed and
Medline search programs. Results: Several articles supporting evidence for
the association between hospitalization and cognitive decline are
available. Evidence for potential mediating factors also does exist.
Conclusions: There is evidence to support an association between
hospitalization and development of cognitive decline. Factors that could
mediate this association include, but may not be limited to, delirium,
medications, stress, and depression. There is a need for further research
in this area in order to better understand the underlying pathophysiology
involved in the development of cognitive decline and dementia and to
determine if preventive measures might be beneficial in decreasing risk
for cognitive decline for patients who are hospitalized © 2014
American Association for Geriatric Psychiatry.
<82>
[Use Link to view the full text]
Accession Number
2014336595
Authors
Singh M. Singh P. Grewal P. Kovacs D. Molnar J. Arora R. Khosla S.
Institution
(Singh, Singh, Grewal, Kovacs, Molnar, Arora, Khosla) Department of
Cardiology, Chicago Medical School, 3333, Green Bay Road, North Chicago,
IL 60068, United States
Title
Clinical outcomes after percutaneous coronary intervention in patients
with mild versus moderate renal insufficiency at 30-day and 1-year
follow-up.
Source
American Journal of Therapeutics. 21 (3) (pp 184-192), 2014. Date of
Publication: May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Percutaneous coronary intervention (PCI) is a standard of care in the
management of coronary artery disease in patients with renal insufficiency
(RI). However, outcomes of PCI in these patients remain suboptimal with
high cardiovascular morbidity and mortality. The studies comparing target
vessel revascularization (TVR) after PCI in patients with mild and
moderate RI have shown conflicting results. Hence, a meta-Analysis of
these studies comparing 30-day and 1-year outcomes after PCI was
performed. A systematic review of literature revealed 5 studies involving
16,262 patients. Based on the creatinine clearance (CrCl), patients were
divided into 2 groups (mild RI, CrCl > 60 mL/min and moderate RI, CrCl of
30-60 mL/min). End points extracted were all-cause mortality, TVR,
myocardial infarction, and major adverse cardiac events at 30-day and
1-year follow-up. Combined relative risks (RR) across all the studies and
95% confidence intervals (CIs) were computed. A 2-sided alpha error of
<0.05 was considered statistically significant. Both groups had similar
baseline characteristics. Rate of TVR at 30 days was significantly lower
in the mild RI group than in the moderate RI group (RR, 1.45; 95% CI,
1.04-2.02; P < 0.05). However, rate of TVR at 1-year follow-up was similar
in both groups (RR, 1.02; 95% CI, 0.94-1.11; P, nonsignificant). Incidence
of all-cause mortality, TVR, myocardial infarction, and major adverse
cardiac events remained higher in the moderate RI group both at 30-day and
1-year follow-up (P < 0.05 for all outcomes). Patients with moderate RI
have higher morbidity and mortality at 30 days and 1 year after PCI
compared with patients with mild RI. However, there is no difference in
the incidence of TVR after PCI at 1 year between the 2 groups. © 2013
Lippincott Williams & Wilkins.
<83>
Accession Number
2013672823
Authors
Villani A.M. Crotty M. Cleland L.G. James M.J. Fraser R.J. Cobiac L.
Miller M.D.
Institution
(Villani, Cobiac, Miller) Department of Nutrition and Dietetics, School of
Medicine, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
(Crotty) Department of Rehabilitation and Aged Care, School of Medicine,
Flinders University, Adelaide, SA, Australia
(Cleland, James) Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA,
Australia
(Fraser) Flinders Clinical Effectiveness, School of Medicine, Flinders
University, Adelaide, SA, Australia
Title
Fish oil administration in older adults with cardiovascular disease or
cardiovascular risk factors: Is there potential for adverse events? A
systematic review of the literature.
Source
International Journal of Cardiology. 168 (4) (pp 4371-4375), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd
<84>
Accession Number
2014438584
Authors
Jensen K. Ringsted C. Hansen H.J. Petersen R.H. Konge L.
Institution
(Jensen, Hansen, Petersen) Department of Cardiothoracic Surgery,
University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100
Copenhagen, Denmark
(Ringsted) Wilson Centre, University of Toronto, University Health
Network, Toronto, ON, Canada
(Konge) Centre for Clinical Education, University of Copenhagen,
Copenhagen, Denmark
Title
Simulation-based training for thoracoscopic lobectomy: A randomized
controlled trial: Virtual-reality versus black-box simulation.
Source
Surgical Endoscopy and Other Interventional Techniques. 28 (6) (pp
1821-1829), 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
Background: Video-assisted thoracic surgery is gradually replacing
conventional open thoracotomy as the method of choice for the treatment of
early-stage non-small cell lung cancers, and thoracic surgical trainees
must learn and master this technique. Simulation-based training could help
trainees overcome the first part of the learning curve, but no
virtual-reality simulators for thoracoscopy are commercially available.
This study aimed to investigate whether training on a laparoscopic
simulator enables trainees to perform a thoracoscopic lobectomy. Methods:
Twenty-eight surgical residents were randomized to either virtual-reality
training on a nephrectomy module or traditional black-box simulator
training. After a retention period they performed a thoracoscopic
lobectomy on a porcine model and their performance was scored using a
previously validated assessment tool. Results: The groups did not differ
in age or gender. All participants were able to complete the lobectomy.
The performance of the black-box group was significantly faster during the
test scenario than the virtual-reality group: 26.6 min (SD 6.7 min) versus
32.7 min (SD 7.5 min). No difference existed between the two groups when
comparing bleeding and anatomical and non-anatomical errors. Conclusion:
Simulation-based training and targeted instructions enabled the trainees
to perform a simulated thoracoscopic lobectomy. Traditional black-box
training was more effective than virtual-reality laparoscopy training.
Thus, a dedicated simulator for thoracoscopy should be available before
establishing systematic virtual-reality training programs for trainees in
thoracic surgery. © 2014 Springer Science+Business Media.
<85>
Accession Number
2015636070
Authors
Giaquinta S. Michaels M.G. McCullers J.A. Wang L. Fonnesbeck C. O'Shea A.
Green M. Halasa N.B.
Institution
(Giaquinta, O'Shea, Halasa) Pediatrics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Michaels, Green) Pediatrics, Children's Hospital of Pittsburgh,
Pittsburgh, PA, United States
(McCullers) Pediatrics, St. Jude Children's Research Hospital, Memphis,
TN, United States
(McCullers) Pediatrics, University of Tennessee, Health Sciences Center,
Memphis, TN, United States
(Wang, Fonnesbeck) Biostatistics, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
Randomized, double-blind comparison of standard-dose vs. high-dose
trivalent inactivated influenza vaccine in pediatric solid organ
transplant patients.
Source
Pediatric Transplantation. 19 (2) (pp 219-228), 2014. Date of Publication:
01 Mar 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Children who have undergone SOT mount a lower immune response after
vaccination with TIV compared to healthy controls. HD or SD TIV in
pediatric SOT was given to subjects 3-17 yr and at least six months
post-transplant. Subjects were randomized 2:1 to receive either the HD (60
mug) or the SD (15 mug) TIV. Local and systemic reactions were solicited
after each vaccination, and immune responses were measured before and
after each vaccination. Thirty-eight subjects were enrolled. Mean age was
11.25 yr; 68% male, 45% renal, 26% heart, 21% liver, 5% lung, and 5%
intestinal. Twenty-three subjects were given HD and 15 SD TIV. The median
time since transplant receipt was 2.2 yr. No severe AEs or rejection was
attributed to vaccination. The HD group reported more tenderness and local
reactions, fatigue, and body ache when compared to the SD cohort, but
these were considered mild and resolved within three days. Subjects in the
HD group demonstrated a higher percentage of four-fold titer rise to H3N2
compared to the SD group. HD influenza vaccine was well tolerated and may
have increased immunogenicity. A phase 2 trial is needed to confirm.
<86>
Accession Number
2014746686
Authors
Ohtaki Y. Shimizu K.
Institution
(Ohtaki, Shimizu) Department of Thoracic and Visceral Organ Surgery, Gunma
University Graduate School of Medicine, Maebashi, Gunma, Japan
Title
Anatomical thoracoscopic segmentectomy for lung cancer.
Source
General Thoracic and Cardiovascular Surgery. 62 (10) (pp 586-593), 2014.
Date of Publication: 04 Oct 2014.
Publisher
Springer-Verlag Tokyo
Abstract
Minimally invasive surgery for lung cancer has seen considerable progress.
A segmentectomy is less invasive than a lobectomy as it preserves lung
parenchyma. The preservation of pulmonary function can reduce
complications. The combination of a thoracoscopic approach with a
segmentectomy should be less invasive, and retrospective studies have
shown that the thoracoscopic approach is safe and feasible due to the
lower postoperative mortality and complication rates as compared to an
open thoracotomy. The validity of a segmentectomy for
ground-glass-opacity-type lung cancer has been demonstrated, and it has
also been evaluated for small, predominantly solid, lung cancers. Two
prospective studies of segmentectomy versus lobectomy for <2-cm
non-small-cell lung cancer are now underway (CALGB 140503 and
JCOG0802/WJTOG4607L) and should clarify the role of segmentectomy.
Regarding thoracoscopic segmentectomy, few retrospective studies have
reported the oncological outcome for lung cancer and there is inadequate
evidence regarding the long-term oncological outcome, although the
perioperative complication rate and duration of hospital stay seem to be
non-inferior to those of an open approach. For preoperative simulation,
three-dimensional multidetector computed tomography (3D-CT) is essential
for performing an atypical thoracoscopic segmentectomy safely.
Preoperative 3D-CT angiography and bronchography (3D-CTAB) enable accurate
identification of the venous branches in the affected segment and the
intersegmental vein. This review describes the surgical and oncological
outcomes, utility of 3D-CTAB, and surgical techniques and procedure used
for a thoracoscopic segmentectomy.
<87>
Accession Number
2014925423
Authors
Xu L. Hu Z. Shen J. Mcquillan P.M.
Institution
(Xu) Department of Anesthesiology, The Second Affiliated Hospital of
Zhejiang Chinese Medical University, Hangzhou, China
(Hu) Department of Anesthesiology, The Children's Hospital, School of
Medicine, Zhejiang University, Hangzhou, China
(Shen) Department of Anesthesiology, The Second Affiliated Hospital,
School of Medicine, Zhejiang University, Hangzhou, China
(Mcquillan) Penn State Hershey Medical Center, Penn State College of
Medicine, Hershey, PA, United States
Title
Does dexmedetomidine have a cardiac protective effect during non-cardiac
surgery? A randomised controlled trial.
Source
Clinical and Experimental Pharmacology and Physiology. 41 (11) (pp
879-883), 2014. Date of Publication: 01 Nov 2014.
Publisher
Blackwell Publishing
Abstract
Summary: This study was designed to determine the effects of
dexmedetomidine on perioperative myocardial injury by observing peripheral
circulatory changes in response to tracheal intubation and extubation,
myocardial enzyme levels, myocardial ischaemia improvements,
cardiovascular adverse events and cytokines in patients with coronary
heart disease (CHD) undergoing non-cardiac surgery. This study was a
prospective, randomized, double-blind trial. Eighty patients having CHD
were scheduled for elective hip-replacement surgery and randomly allocated
to receive a loading dose of 1 mug/kg dexmedetomidine followed by a 0.2
mug/kg per h infusion (Dex group; n = 40) or normal saline (control group;
n = 40). Systolic blood pressure, diastolic blood pressure, mean arterial
pressure, heart rate, rate-pressure product and changes in ST-T segment on
the electrocardiogram were recorded every 5 min during surgery. Serum
creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), glycogen
phosphorylase BB (GP-BB), interleukin (IL)-6 and tumour necrosis factor
(TNF)-alpha protein levels were determined preoperatively, at the end of
surgery and 12 and 24 h after surgery. The improvement rate of myocardial
ischaemia was higher in the Dex than control group (87.5% vs 32.5%,
respectively; P < 0.05). In addition, the Dex group had lower serum CK-MB,
IL-6, cTnI and GP-BB concentrations than the control group (P < 0.05).
There was no significance difference in TNF-alpha between the two groups
(P > 0.05). Dexmedetomidine can reduce myocardial injury and cytokine
levels in patients with CHD undergoing non-cardiac surgery.
<88>
[Use Link to view the full text]
Accession Number
2014723398
Authors
Van Hemelrijck J. Levien L.J. Veeckman L. Pitman A. Zafirelis Z. Standa T.
Institution
(Van Hemelrijck, Veeckman) Department of Anesthesiology, Clinical
Research, Universitaire Ziekenhuizen Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Levien) Department of Vascular Surgery, Milpark Hospital, Parktown,
Johannesburg, South Africa
(Pitman) Independent Biostatistics Consultant, Peabody, MA, United States
(Zafirelis) Independent Consultant, Needham, MA, United States
(Standa) Department of Anesthesiology, University Hospital, Eppendorf,
Hamburg, Germany
Title
A safety and efficacy evaluation of hemoglobin-based oxygen carrier
HBOC-201 in a randomized, multicenter red blood cell controlled trial in
noncardiac surgery patients.
Source
Anesthesia and Analgesia. 119 (4) (pp 766-776), 2014. Date of Publication:
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We present the results of a previously unpublished
hemoglobin-based oxygen carrier (HBOC) study conducted in 1998-1999.
Methods: In a multicenter, randomized, single-blind, comparative study of
HBOC-201 versus allogeneic red blood cell (RBC) transfusions, no-cardiac
surgery patients received HBOC-201 to a maximum of 7 units (n = 83) or
RBCs (n = 77). Patients could be switched to RBCs for safety or any other
reason. The efficacy end points were elimination and/or reduction of
allogeneic RBC transfusions for 28 days.
Results: The proportion of patients in the HBOC-201 group that avoided RBC
transfusion was 0.427 (95% confidence interval, 0.321-0.533). Subjects in
the HBOC-201 group received on average 3.2 units of RBCs versus 4.4 units
in the control arm (P = 0.004). Seventy-nine (95.2%) subjects in the
HBOC-201 group and 72 (93.5%) in the RBC group experienced adverse events
(AEs), judged to be associated with study treatment in 59 (71.1%) and 18
(23.4%) subjects, respectively. Thirty-day mortality, 5 (6.0%) vs 4 (5.2%)
patients (P = 1.00), incidence of serious AEs, 24 (28.9%) vs 20 (26.0%) (P
= 0.73), or time to intensive care unit (log-rank P = 0.15) or hospital
discharge (log-rank P = 0.53) were similar for the HBOC-201 and RBC
groups, respectively.
Conclusions: Up to 7 units of HBOC-201 infused over the course of 6 days
resulted in RBC transfusion avoidance in 43% of patients. There were no
notable differences in mortality and serious AEs incidence. The use of
HBOC-201 was associated with a notable excess of nonserious AEs.
<89>
Accession Number
2014296255
Authors
Malhotra A. Garg P. Bishnoi A.K. Pendro V. Sharma P. Upadhyay M. Gandhi S.
Institution
(Malhotra, Garg, Bishnoi, Sharma, Upadhyay, Gandhi) Department of
Cardiothoracic and Vascular Surgery, U. N. Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
(Pendro) Department of General Surgery, Gandhi Medical College, Bhopal,
Madhya Pradesh, India
Title
Is steel wire closure of sternotomy better than polyester suture closure?.
Source
Asian Cardiovascular and Thoracic Annals. 22 (4) (pp 409-415), 2014. Date
of Publication: May 2014.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Median sternotomy is the preferred approach for open heart
surgeries. The sternotomy incision is predominantly closed with either
steel wire or polyester suture. The type of material used is primarily
based on the surgeon's choice, and both materials achieve a good result.
No prospective clinical study has been undertaken to evaluate differences
in the incidence of wound infection and the degree of pain associated with
both techniques. Patients and methods: Our randomized controlled
double-blind study included 200 adults undergoing single-valve
replacement. The technique of surgery, apart from the material used for
sternal closure, was the same in both groups. Postoperatively, patients
were analyzed for wound infection and wound pain based on the ASEPSIS
score and Numeric Pain Rating Score, respectively. Results: The polyester
suture group had a significantly higher mean ASEPSIS score, indicating a
higher incidence of wound infection, and more late wound complications.
The polyester suture group also had a significantly higher mean pain
score. The steel wire group had significantly higher mediastinal drain
output in the first 48 h after surgery. Conclusion: The use of polyester
suture for sternal closure in adult patients results in increased wound
infection, wound pain, and late wound complications, but lower mediastinal
drain output. © The Author(s) 2013 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.
<90>
Accession Number
2014281904
Authors
Rivosecchi R.M. Rice M.J. Smithburger P.L. Buckley M.S. Coons J.C.
Kane-Gill S.L.
Institution
(Rivosecchi) University of Pittsburgh Medical Center, Presbyterian Campus,
Pittsburgh, PA, United States
(Rice) University of Florida, College of Medicine, Gainesville, FL, United
States
(Smithburger, Coons, Kane-Gill) University of Pittsburgh, School of
Pharmacy, Pittsburgh, PA, United States
(Buckley) Banner Health Good Samaritan Medical Center, Pheonix, AZ, United
States
Title
An evidence based systematic review of remifentanil associated
opioid-induced hyperalgesia.
Source
Expert Opinion on Drug Safety. 13 (5) (pp 587-603), 2014. Date of
Publication: May 2014.
Publisher
Informa Healthcare
Abstract
Introduction: Therapeutic opioid use continues to grow, with greater than
a fivefold increase in usage of fentanyl-based products over a 10-year
period. Opioids are known for their side-effect profile, including
bradycardia and respiratory depression; questions remain, however,
regarding lesser known side effects such as opioid-induced hyperalgesia
(OIH). Areas covered: A systematic review of published literature
addressing remifentanil OIH in the surgical setting was completed. A
search was conducted of PubMed, Embase and Ovid from 1946 until June 2013.
Inclusion criteria consisted of age > 18 years, humans, full-text articles
and English language. A total of 35 unique articles were included. Sixteen
articles reported outcomes that supported remifentanil OIH and 6 that
refuted and 22 were focused on prevention. Expert opinion: There is
conflicting evidence regarding the existence of remifentanil OIH. Outcomes
evaluating measures of hyperalgesia frequently conclude that remifentanil
OIH exists, while those evaluating opioid consumption do not. Therefore,
remifentanil does induce a degree of hyperalgesia, but we do not believe
that it reaches a level of clinical significance that requires prevention.
If a significant concern for the development of remifentanil OIH is
suspected, we suggest using the least possible effective dose of
remifentanil as the primary prevention strategy. © 2014 Informa UK,
Ltd.
<91>
Accession Number
2014261959
Authors
Mardani M. Farshidpour M. Nekoonam M. Varahram F. Najafizadeh K. Mohammadi
N. Sharifkashani B. Gachkar L. Farokhzad B. Droudinia A. Javanmard P.
Tabarsi P.
Institution
(Mardani, Nekoonam, Gachkar) Iranian Infectious Disease Research Center,
NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Farshidpour, Mohammadi, Farokhzad, Droudinia, Javanmard, Tabarsi)
Clinical TB and Epidemiology Research Center, NRITLD, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Varahram, Najafizadeh, Sharifkashani) Transplantation Research Center,
NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Performance of QuantiFERON TB Gold test compared with the tuberculin skin
test for detecting latent tuberculosis infection in lung and heart
transplant candidates.
Source
Experimental and Clinical Transplantation. 12 (2) (pp 129-132), 2014. Date
of Publication: April 2014.
Publisher
Baskent University (26 Austin Avenue,Baglica Kampusu, P.O. Box 337,Ankara
06530, Turkey)
Abstract
Objectives: Evaluation for latent tuberculosis infection is advised before
organ transplant. The interferon-gamma release assay has been shown to be
more specific than the tuberculin skin test for screening for latent
tuberculosis infection. We compared the tuberculin skin test and
QuantiFERON-TB Gold In-Tube test for screening for latent tuberculosis
infection and agreement between the tests in heart and lung transplant
recipients before transplant. Materials and Methods: Fifty-five adult
patients who had been evaluated for heart and lung transplant between
September 2011 and September 2012 at Masih Daneshvari Hospital in Iran
were prospectively enrolled. We performed the tuberculin skin test and
QuantiFERON-TB Gold In-Tube test. Results: Of the 55 patients, 3 (5%) had
positive tuberculin skin test results, and 11 (20%) had positive
QuantiFERON-TB Gold In-Tube test results. Agreement between the tuberculin
skin test and QuantiFERON-TB Gold In-Tube test was fair (Kappa=0.061; 95%
CI: - 0.185-0.307) (P =.56). Conclusions: The positivity for
QuantiFERON-TB Gold In-Tube test was greater than the positivity for the
tuberculin skin test, and QuantiFERON-TB Gold In-Tube test more accurately
determined the risk for latent tuberculosis infection. However, a further
longitudinal study is necessary to verify that the QFT-G test would
predict developing tuberculosis after heart and lung transplant. ©
Baskent University 2014 Printed in Turkey. All Rights Reserved.
<92>
Accession Number
2014253091
Authors
Hosbond S.E. Diederichsen A.C.P. Pedersen L. Rasmussen L.M. Munkholm H.
Gerke O. Poulsen T.S. Mickley H.
Institution
(Hosbond, Diederichsen, Poulsen, Mickley) Department of Cardiology, Odense
University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
(Hosbond, Diederichsen, Mickley) OPEN (Odense Patient Data Explorative
Network), Odense University Hospital, Odense, Denmark
(Pedersen, Rasmussen) Department of Biochemistry and Pharmacology, Odense
University Hospital, Odense, Denmark
(Diederichsen, Rasmussen) Centre for Individualized Medicine of Arterial
Diseases, Odense University Hospital, Odense, Denmark
(Munkholm) Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
(Gerke) Department of Nuclear Medicine, University of Southern Denmark,
Odense University Hospital, Denmark
Title
Lipocalin-type prostaglandin D synthase is not a biomarker of
atherosclerotic manifestations.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. 74 (3) (pp
219-227), 2014. Date of Publication: April 2014.
Publisher
Informa Healthcare
Abstract
Objective. Over the last decades Lipocalin-type prostaglandin D synthase
(L-PGDS), Osteoprotegerin (OPG), Osteopontin (OPN) and Pregnancy
associated plasma protein A (PAPP-A) have been reported to be associated
with coronary artery disease, and L-PGDS has been proposed as a potential
new diagnostic tool in the setting of stable coronary artery disease. We
set out to investigate if measurement of concentrations of these
biomarkers could be used to differentiate between four groups of
individuals with different atherosclerotic manifestations. Methods. A
total of 120 individuals from four equal gender- and age-matched groups
were studied: (i) no previous cardiovascular disease (CVD) and no coronary
calcifications [CAC-negative group], (ii) no previous CVD but evidence of
severe coronary calcifications [CAC-positive group], (iii) acute coronary
syndrome [ACS-group], and (iv) clinical stable patients with CVD, who were
referred for cardiovascular surgery [CVD-group]. Concentrations of L-PGDS,
OPG, OPN and PAPP-A were analyzed and compared between the four groups.
Results. We did not find any significant differences in L-PGDS
concentrations between the four groups (p = 0.32). OPG concentrations
differed significantly (p = 0.003), with the highest concentration
observed in ACS patients. Considering OPN (p = 0.12) and PAPP-A (p = 0.53)
their concentrations between groups did not differ significantly.
Conclusion. The main message from this study is the observation that
L-PGDS based on a single blood test appears to be less valuable than
previously proposed in identification of patients with coronary artery
disease. However, ACS patients have higher OPG concentrations than
patients with different manifestations of stable atherosclerosis. Neither
OPN nor PAPP-A concentrations differed between groups. © 2014 Informa
Healthcare.
<93>
[Use Link to view the full text]
Accession Number
2014219732
Authors
Dagres N. Iliodromitis E.K. Lekakis J.P. Simitsis P. Karatzas D. Rallidis
L.S. Simeonidou E. Anastasiou-Nana M.
Institution
(Dagres, Iliodromitis, Lekakis, Simitsis, Karatzas, Rallidis, Simeonidou,
Anastasiou-Nana) Second Cardiology Department, Attikon University
Hospital, University of Athens, Athens, Greece
Title
Ranolazine for the prevention or treatment of atrial fibrillation: A
systematic review.
Source
Journal of Cardiovascular Medicine. 15 (3) (pp 254-259), 2014. Date of
Publication: March 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
The use of currently available antiarrhythmic drugs for atrial
fibrillation is limited by their moderate efficacy and the considerable
proarrhythmic risk. Ranolazine, an antianginal agent, has been reported to
possess antiarrhythmic properties, resulting in a reduction of
supraventricular and ventricular arrhythmias. We performed a systematic
review of the clinical studies reporting the outcome of patients treated
with ranolazine for the prevention or treatment of atrial fibrillation in
various clinical settings. We searched PubMed and abstracts of major
conferences for clinical studies using ranolazine, either alone or in
combination with other antiarrhythmic agents for the prevention or
treatment of atrial fibrillation. Ten relevant records were identified.
These included both randomized trials and retrospective cohort studies
concerning the use of ranolazine in different clinical settings;
prevention of atrial fibrillation in patients with acute coronary
syndrome, prevention as well as conversion of postoperative atrial
fibrillation after coronary artery bypass grafting, conversion of
recent-onset atrial fibrillation, sinus rhythm maintenance in
drug-resistant recurrent atrial fibrillation and facilitation of
electrical cardioversion in cardioversion-resistant patients. A
beneficial, mostly modest effect of ranolazine was homogeneously reported
in all clinical settings. There were no substantial proarrhythmic effects.
No meta-analysis could be performed because for most of the clinical
scenarios, there was only one study investigating the effect of
ranolazine. Except for one large randomized trial, all the other studies
were either relatively small randomized studies or retrospective cohort
analyses, which in several cases lacked a control group. This systematic
review indicates a modest beneficial effect of ranolazine administered for
the prevention or treatment of atrial fibrillation across several clinical
settings without substantial proarrhythmic risk. © 2014 Italian
Federation of Cardiology.
<94>
Accession Number
2014209108
Authors
De Luca G. Schaffer A. Verdoia M. Suryapranata H.
Institution
(De Luca, Schaffer, Verdoia) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting
stents in diabetic patients with multivessel coronary artery disease.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 24 (4) (pp 344-354),
2014. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
Background and aim: Clinical trials have reported lower mortality and
repeated revascularization rate in diabetic patients treated with coronary
artery bypass grafting (CABG) as compared to percutaneous
revascularization. However, these studies were conducted in the era of
bare-metal stents. Therefore, we performed a meta-analysis to compare CABG
to PCI with drug-eluting stents (DES) in diabetic patients with
multivessel and/or left main disease. Methods and results: The literature
was scanned by formal search of electronic databases (Medline, EMBASE, and
Cochrane databases), and major international scientific session abstracts
from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4
randomized and 10 non-randomized) trials were finally included, with a
total of 7072 patients. Up to 5 years follow-up, CABG was associated with
a reduction in mortality (7.3% vs 10.4%, OR[95%CI]=0.65[0.55-0.77],
p<0.0001; phet=0.00001), with similar results in both RCTs
(OR[95%CI]=0.64[0.50-0.82], p=0.0005) and NRCTs
(OR[95%CI]=0.75[0.6-0.94)], p=0.01) (p int=0.93). A significant
relationship was observed between risk profile and benefits in mortality
with CABG (p<0.001). CABG reduced target vessel revascularization (TVR;
5.2% vs 15.7%, OR[95%CI]=0.30[0.25-0.36], p<0.00001, p het=0.02), with a
relationship between risk profile and the benefits from CABG as compared
to DES (p<0.0001). CABG was associated with a lower rate of MACCE (14.9%
vs 22.9%, OR[95%CI]=0.59[0.51-0.67], p<0.00001, p het<0.00001) but higher
risk of CVA (3.6% vs 1.4%, OR[95%CI]=2.34[1.63-3.35], p<0.00001, p
het=0.71). Conclusions: The present meta-analysis demonstrates that among
diabetic patients with multivessel disease and/or left main disease, CABG
provides benefits in mortality and TVR, especially in high-risk patients
but it is counterbalanced by a higher risk of stroke. Future trials are
certainly needed in the era of new DES and improved antiplatelet
therapies. © 2013 Elsevier B.V.
<95>
[Use Link to view the full text]
Accession Number
2014256035
Authors
Verdoia M. Schaffer A. Barbieri L. Cassetti E. Piccolo R. Galasso G.
Marino P. Sinigaglia F. De Luca G.
Institution
(Verdoia, Schaffer, Barbieri, Cassetti, Marino, De Luca) Division of
Cardiology, Azienda Ospedaliera-Universitaria maggiore della Carita,
Eastern Piedmont University, C.so Mazzini 18, Novara 28100, Italy
(Piccolo, Galasso) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(Sinigaglia) Department of Translational Medicine, Centro di Biotecnologie
per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University,
Novara, Italy
Title
Benefits from new ADP antagonists as compared with clopidogrel in patients
with stable angina or acute coronary syndrome undergoing invasive
management: A meta-analysis of randomized trials.
Source
Journal of Cardiovascular Pharmacology. 63 (4) (pp 339-350), 2014. Date of
Publication: April 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Aims: New P2Y12 receptor inhibitors have provided new and more potent
antiplatelet strategies, although raising several concerns on possible
increase of bleedings. The aim of current meta-analysis was to evaluate
the efficacy and safety of new adenosine diphosphate (ADP) receptor
antagonists as compared with clopidogrel in elective or ACS patients
managed invasively. Methods and Results: Literature archives (Pubmed,
EMBASE, Cochrane) and main scientific sessions abstracts were scanned for
randomized trials comparing new ADP antagonists with clopidogrel in
patients with acute coronary syndromes or stable angina. Primary endpoint
was mortality. Secondary endpoints were: (1) nonfatal myocardial
infarction (MI), (2) recurrent ischemia symptoms or ischemia-driven
revascularization (RI/IDR), (3) stent thrombosis (ST), and (4) safety
endpoints, defined as for TIMI major bleeding criteria. A total of 8
randomized clinical trials were finally included, for a total population
of 67,851 patients. Mean follow-up was 7.6 months, ranging from 48 hours
to 30 months. New ADP antagonists significantly reduced mortality {3.1%
vs. 3.6%, odds ratio [OR] [95% confidence interval (CI)], 0.86
[0.79-0.94], P = 0.0008, Phet = 0.18}, with greater impact of oral drugs.
Similar benefits were found for MI [6.1% vs. 7%; OR (95% CI)
(random-effect model) = 0.88 (0.79-0.98), P = 0.01, Phet = 0.02], RI [2.7%
vs. 3.1%; OR (95% CI) = 0.85 (0.77-0.93), P = 0.0005, Phet = 0.09], or ST
[1.1% vs. 1.7%; OR (95% CI) = 0.60 (0.51-0.71), P < 0.00001, Phet = 0.13].
By meta-regression analysis, no relationship was observed between benefits
in mortality, new MI, RI, and ST with new ADP antagonists and patients'
risk profile [beta (95% CI) =-0.01 [-0.30 to 0.27], P = 0.94; beta (95%
CI) =-0.05 [-1.49 to 1.43], P = 0.96); beta (95% CI) = 0.19 (-0.18 to
0.57), P = 0.31, and beta (95% CI) =-0.08 (-0.86 to 0.70), P = 0.84,
respectively]. CONCLUSIONS: Present meta-analysis shows that the new ADP
antagonists prasugrel, ticagrelor, and cangrelor are associated to
significant reduction of mortality, reinfarction, RI, and ST respect to
clopidogrel alone, without significant increase in bleeding complications.
© 2013 by Lippincott Williams & Wilkins.
<96>
Accession Number
2014221546
Authors
Tait A.R. Voepel-Lewis T. Chetcuti S.J. Brennan-Martinez C. Levine R.
Institution
(Tait, Voepel-Lewis) Department of Anesthesiology, University of Michigan
Health System, Ann Arbor, MI, United States
(Chetcuti, Brennan-Martinez) Department of Cardiology, University of
Michigan Health System, Ann Arbor, MI, United States
(Tait) Center for Bioethics and Social Sciences in Medicine, University of
Michigan, United States
(Levine) Emergency Care Center, Jackson Memorial Hospital, Miami, FL,
United States
(Levine) ArchieMD, Inc., Boca Raton, FL, United States
Title
Enhancing patient understanding of medical procedures: Evaluation of an
interactive multimedia program with in-line exercises.
Source
International Journal of Medical Informatics. 83 (5) (pp 376-384), 2014.
Date of Publication: May 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Standard print and verbal information provided to patients
undergoing treatments are often difficult to understand and may impair
their ability to be truly informed.This study examined the effect of an
interactive multimedia informational program with in-line exercises and
corrected feedback on patients' real-time understanding of their cardiac
catheterization procedure. Methods: 151 adult patients scheduled for
diagnostic cardiac catheterization were randomized to receive information
about their procedure using either the standard institutional verbal and
written information (SI) or an interactive iPad-based informational
program (IPI). Subject understanding was evaluated using semi-structured
interviews at baseline, immediately following catheterization, and 2 weeks
after the procedure. In addition, for those randomized to the IPI, the
ability to respond correctly to several in-line exercises was recorded.
Subjects' perceptions of, and preferences for the information delivery
were also elicited. Results: Subjects randomized to the IPI program had
significantly better understanding following the intervention compared
with those randomized to the SI group (8.3. +/-. 2.4 vs 7.4. +/-. 2.5,
respectively, 0-12 scale where 12. = complete understanding, P<. 0.05).
First-time correct responses to the in-line exercises ranged from 24.3% to
100%. Subjects reported that the in-line exercises were very helpful (9.1.
+/-. 1.7, 0-10 scale, where 10. = extremely helpful) and the iPad program
very easy to use (9.0. +/-. 1.6, 0-10 scale, where 10. = extremely easy)
suggesting good clinical utility. Discussion: Results demonstrated the
ability of an interactive multimedia program to enhance patients'
understanding of their medical procedure. Importantly, the incorporation
of in-line exercises permitted identification of knowledge deficits,
provided corrected feedback, and confirmed the patients' understanding of
treatment information in real-time when consent was sought. © 2014
Elsevier Ireland Ltd.
<97>
Accession Number
2014621889
Authors
Kupelian V. Araujo A.B. Wittert G.A. McKinlay J.B.
Institution
(Kupelian, Araujo, McKinlay) New England Research Institutes, Inc., 480
Pleasant St., Watertown, MA 02472, United States
(Wittert) Department of Medicine, University of Adelaide, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Araujo) Eli Lilly and Co., Indianapolis, IN, United States
Title
Association of moderate to severe lower urinary tract symptoms with
incident type 2 diabetes and heart disease.
Source
Journal of Urology. 193 (2) (pp 581-586), 2015. Date of Publication: 01
Feb 2015.
Publisher
Elsevier Inc.
Abstract
Purpose Increasing evidence suggests a possible link between lower urinary
tract symptoms and chronic illnesses. We determined whether lower urinary
tract symptoms are associated with incident type 2 diabetes and heart
disease in a population based study. Materials and Methods BACH is a
population based epidemiological survey of urological symptoms. A
multistage, stratified, cluster sample design was used to obtain a random
sample of 4,144 men and women 30 to 79 years old at baseline. Median
followup was 4.8 years between baseline (2002 to 2005) and followup (2006
to 2010). Type 2 diabetes and heart disease were assessed by self-report.
Lower urinary tract symptoms were assessed by the AUA-SI, and voiding and
storage subscores. Logistic regression was used to estimate the OR and 95%
CI, and adjust for potential confounders. Results In participants with a
body mass index of 30 kg/m<sup>2</sup> or greater the adjusted ORs for
incident heart disease were 1.89 (95% CI 1.05, 3.39) for AUA-SI 8 or
greater and 2.32 (95% CI 1.33, 4.05) for a storage score of 4 or greater.
In participants with abdominal obesity the adjusted ORs for incident type
2 diabetes were 2.06 (95% CI 1.19, 3.55) for AUA-SI 8 or greater and 1.81
(95% CI 1.04, 3.15) for a storage score of 4 or greater. Lower urinary
tract symptoms (AUA-SI 8 or greater) were also predictive of type 2
diabetes in men and women younger than 50 years (adjusted OR 2.37, 95% CI
1.18, 4.80). Conclusions Longitudinal results of BACH suggest that lower
urinary tract symptoms are a marker of increased risk for type 2 diabetes
and heart disease in obese men and women. The increased risk in younger
men and women suggests that lower urinary tract symptoms may be an
indicator of impending disease.
<98>
Accession Number
2014740136
Authors
Afshani N. Schulein S. Biccard B.M. Thomas J.M.
Institution
(Afshani) Department of Anaesthetics, University of Cape Town, Groote
Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
(Schulein) Department of Anesthetics, Toronto General Hospital, University
of Toronto, Toronto, Canada
(Schulein) McMaster University, ON, Canada
(Biccard) Perioperative Research Group, Department of Anaesthetics,
University of Kwazulu-Natal, Durban, South Africa
(Thomas) Department of Anaesthetics, Red Cross War Memorial Children's
Hospital, Cape Town, South Africa
Title
Clinical utility of B-type natriuretic peptide (NP) in pediatric cardiac
surgery - A systematic review.
Source
Paediatric Anaesthesia. 25 (2) (pp 115-126), 2014. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background NP is a biomarker that has been used in the diagnosis,
management, and prognostication of a number of cardiovascular disorders in
the pediatric population. The physiological role of this hormone is to
allow the myocardium to adapt to stress or strain imposed by a volume
and/or pressure load. Objective The aim of this study was to determine the
utility of preoperative and postoperative NP to predict outcome in
pediatric patients undergoing cardiac surgery for structural congenital
heart disease. Method We conducted a systematic review by searching three
electronic databases using the search terms 'paediatric' or 'pediatric'
and 'B-type natriuretic peptide'. Twenty peer-reviewed papers were
included in the study. Results Preoperative NP levels were associated with
the severity of cardiac failure in several studies. Preoperative NPs also
correlated with early postoperative outcome measures such as duration of
cardiopulmonary bypass, duration of mechanical ventilation, presence of
low cardiac output syndrome, length of stay in the intensive care unit and
in one study, death. Early (within 24 h) postoperative NPs showed a
stronger correlation than preoperative NPs to early postoperative adverse
events. Conclusion NPs provide a simple, noninvasive and complementary
tool to echocardiography that can be used to assist clinicians in the
assessment and management of pediatric patients with congenital heart
disease in the perioperative period.
<99>
Accession Number
24739515
Authors
Fan G.-H. Xu C.-Y.
Institution
(Fan) Department of Cardiology, Wuhan General Hospital of Guangzhou
Military Command, 627 Wuluo Road, Wuhan, China. fanguanghui59@163.com
Title
Efficacy of N-acetylcysteine in preventing atrial fibrillation after
cardiac surgery: a meta-analysis of published randomized controlled
trials.
Source
BMC cardiovascular disorders. 14 (pp 52), 2014. Date of Publication:
2014.
Abstract
BACKGROUND: Atrial fibrillation is a common complication after cardiac
surgery. The aim of this study is to evaluate whether N-acetylcysteine
(NAC) could prevent postoperative atrial fibrillation (POAF).
METHODS: PubMed, Embase and Cochrane Center Register of Controlled Trials
were searched from the date of their inception to 1 July 2013 for relevant
randomized controlled trials (RCTs), in which NAC was compared with
controls for adult patients undergoing cardiac surgery. Outcome measures
comprised the incidence of POAF, all-cause mortality, length of intensive
care unit (ICU) stay, hospital length of stay, and the incidence of
cerebrovascular events. The meta-analysis was performed with the
fixed-effect model or random-effect model according to the heterogeneity.
RESULTS: We retrieved ten studies enrolling a total of 1026 patients.
Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to
0.77; P<0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93;
P=0.03) compared with controls, but failed to reduce the stay in ICU and
overall stay in hospital. No difference in the incidence of
cerebrovascular events was observed.
CONCLUSIONS: Prophylactic use of NAC could reduce the incidence of POAF
and all-cause mortality in adult patients undergoing cardiac surgery.
However, larger RCTs evaluating these and other postoperative complication
endpoints are needed.
<100>
Accession Number
24507744
Authors
Widimsky P.
Institution
(Osmancik) Cardiocenter, Department of Cardiology, 3rd Faculty of
Medicine, Charles University and University Hospital Kralovske Vinohrady
Prague, Czech Republic. Electronic address:
(Budera) Cardiocenter, Department of Cardiac Surgery, 3rd Faculty of
Medicine, Charles University and University Hospital Kralovske Vinohrady
Prague, Czech Republic
(Straka) Cardiocenter, Department of Cardiac Surgery, 3rd Faculty of
Medicine, Charles University and University Hospital Kralovske Vinohrady
Prague, Czech Republic
(Widimsky) Cardiocenter, Department of Cardiology, 3rd Faculty of
Medicine, Charles University and University Hospital Kralovske Vinohrady
Prague, Czech Republic
Title
Predictors of complete arrhythmia free survival in patients undergoing
surgical ablation for atrial fibrillation. PRAGUE-12 randomized study
sub-analysis.
Source
International journal of cardiology. 172 (2) (pp 419-422), 2014. Date of
Publication: 15 Mar 2014.
Abstract
BACKGROUND: Surgical ablation (SA) is commonly used in atrial fibrillation
(AF) patients undergoing cardiac surgery. However, its effect has been
established in few randomized studies. To assess the complete atrial
fibrillation free (AF-free) survival in randomized study assessing the
effects of additional concomitant SA of AF in patients primarily indicated
for other cardiac surgery.
METHODS: The PRAGUE-12 study was a prospective randomized study comparing
the effect of adding SA to other cardiac surgery. We examined the data
from the PRAGUE-12 trial and grouped patients according to complete
AF-free survival. All patients had regular check-ups at 3, 6, 9 months,
some of them with Holter recordings, and a final check-up at 12 months
with Holter recording.
RESULTS: One hundred ninety-four patients were analyzed; 104 originally
randomized to surgery with adding SA (SA group) and 90 without it (non-SA
group). Complete AF-free status was found in 46 patients from the SA group
(44.2%) and 25 patients (27.8%) from the non-SA group (p<0.05). In a
multivariate logistic regression, the SA group was associated with a
greater chance for complete AF-free survival (OR 1.87, p<0.05). In the
multivariate analysis of the SA group, history of myocardial infarction
(OR 0.2, p<0.05) and a higher EuroSCORE (OR 0.9, p 0.05) were
independently associated with a lower probability of AF-free survival.
CONCLUSION: Complete AF-free survival following SA was present in almost
one half of patients. Patients with a history of myocardial infarction and
higher EuroSCOREs were less likely to benefit from an add-on SA procedure.
<101>
Accession Number
24497345
Authors
Stamm C.
Institution
(Nasseri) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Ebell) Pediatric Bone Marrow Transplant Program, Charite,
Universitatsmedizin Berlin, Berlin 10117, Germany
(Dandel) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Kukucka) Department of Anesthesiology, Deutsches Herzzentrum Berlin,
Berlin 13353, Germany
(Gebker) Department of Internal Medicine/Cardiology, Deutsches Herzzentrum
Berlin, Berlin 13353, Germany
(Doltra) Department of Internal Medicine/Cardiology, Deutsches Herzzentrum
Berlin, Berlin 13353, Germany
(Knosalla) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Choi) Berlin-Brandenburg Center for Regenerative Therapies, Berlin 13353,
Germany
(Hetzer) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Stamm) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
Berlin-Brandenburg Center for Regenerative Therapies, Berlin 13353,
Germany stamm@dhzb.de
Title
Autologous CD133+ bone marrow cells and bypass grafting for regeneration
of ischaemic myocardium: the Cardio133 trial.
Source
European heart journal. 35 (19) (pp 1263-1274), 2014. Date of Publication:
14 May 2014.
Abstract
AIMS: Intra-myocardial transplantation of CD133(+) bone marrow stem cells
(BMC) yielded promising results in clinical pilot trials. We now performed
the double-blinded, randomized, placebo-controlled CARDIO133 trial to
determine its impact on left ventricular (LV) function and clinical
symptoms.
METHODS AND RESULTS: Sixty patients with chronic ischaemic heart disease
and impaired LV function (left ventricular ejection fraction, LVEF <35%)
were randomized to undergo either coronary artery bypass grafting (CABG)
and injection of CD133(+) BMC in the non-transmural, hypokinetic infarct
border zone (CD133), or CABG and placebo injection (placebo).
Pre-operative LVEF was 27 +/- 6% in CD133 patients and 26 +/- 6% in
placebo patients. Outcome was assessed after 6 months, and the primary
endpoint was LVEF measured by cardiac magnetic resonance imaging (MRI) at
rest. The incidence of adverse events was similar in both groups. There
was no difference in 6-min walking distance, Minnesota Living with Heart
Failure score, or Canadian Cardiovascular Society (CCS) class between
groups at follow-up, and New York Heart Association class improved more in
the placebo group (P = 0.004). By cardiac MRI, LVEF at 6 months was 33 +/-
8% in the placebo group and 31 +/- 7% in verum patients (P = 0.3), with an
average inter-group difference of -2.1% (95% CI -6.3 to 2.1). Systolic or
diastolic LV dimensions at 6 months were not different, either. In the
CD133 group, myocardial perfusion at rest recovered in more LV segments
than in the placebo group (9 vs. 2%, P < 0.001). Scar mass decreased by
2.2 +/- 5 g in CD133(+) patients (P = 0.05), but was unchanged in the
placebo group (0.3 +/- 4 g, P = 0.7; inter-group difference in change = 2
g (95% CI -1.1 to 5)). By speckle-tracking echocardiography, cell-treated
patients showed a better recovery of regional wall motion when the target
area was posterior.
CONCLUSION: Although there may be some improvements in scar size and
regional perfusion, intra-myocardial injection of CD133(+) BMC has no
effect on global LV function and clinical symptoms. Improvements in
regional myocardial function are only detectable in patients with
posterior infarction, probably because the interventricular septum after
anterior infarction is not accessible by trans-epicardial injection.
CLINICAL TRIAL REGISTRATION: This trial was registered at
http://www.clinicaltrials.gov under NCT00462774.
<102>
Accession Number
25001071
Authors
Amos T. Stein D.J. Ipser J.C.
Institution
(Amos, Stein, Ipser) Department of Psychiatry and Mental Health,
University of Cape Town, Education Centre, Valkenberg Hospital, Private
Bage X1, Observatory, Cape Town, South Africa, 7925
Title
Pharmacological interventions for preventing post-traumatic stress
disorder (PTSD).
Source
The Cochrane database of systematic reviews. 7 (pp CD006239), 2014. Date
of Publication: 2014.
Abstract
BACKGROUND: Post-traumatic stress disorder (PTSD) is a debilitating
disorder which, after a sufficient delay, may be diagnosed amongst
individuals who respond with intense fear, helplessness or horror to
traumatic events. There is some evidence that the use of pharmacological
interventions immediately after exposure to trauma may reduce the risk of
developing of PTSD.
OBJECTIVES: To assess the effects of pharmacological interventions for the
prevention of PTSD in adults following exposure to a traumatic event.
SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis
Controlled Trials Register (CCDANCTR-Studies and CCDANCTR-References) (to
14 February 2014). This register contains relevant reports of randomised
controlled trials from the following bibliographic databases: CENTRAL (all
years); EMBASE (1974 to date); MEDLINE (1950 to date) and PsycINFO (1967
to date). We identified unpublished trials by searching the National
Institute of Health (NIH) Reporter, the metaRegister of Controlled Trials
database (mRCT) and the WHO International Clinical Trials Registry
Platform (to December 2013). We scanned the reference lists of articles
for additional studies. We placed no constraints on language and setting.
SELECTION CRITERIA: We restricted studies to randomised controlled trials
(RCTs) of pharmacological interventions compared with placebo for the
prevention of PTSD in adults.
DATA COLLECTION AND ANALYSIS: Two authors (TA and JI) independently
assessed trials for eligibility and inclusion based on the review
selection criteria. We independently extracted sample, methodological,
outcome and 'Risk of bias' data, as well as the number of side effects,
from each trial and entered these into a customised data extraction form.
We contacted investigators for missing information. We calculated summary
statistics for continuous and dichotomous variables (if provided). We did
not undertake subgroup analyses due to the small number of included
studies.
MAIN RESULTS: We included nine short-term RCTs (duration 12 weeks or less)
in the analysis (345 participants; age range 18 to 76 years). Participants
were exposed to a variety of traumas, ranging from assault, traffic
accidents and work accidents to cardiac surgery and septic shock. Seven
studies were conducted at single centres. The seven RCTs included four
hydrocortisone studies, three propranolol studies (of which one study had
a third arm investigating gabapentin), and single trials of escitalopram
and temazepam. Outcome assessment measures included the
Clinician-Administered PTSD Scale (CAPS), the 36-Item Short-Form Health
Survey (SF-36) and the Center for Epidemiological Studies - Depression
Scale (CES-D).In four trials with 165 participants there was moderate
quality evidence for the efficacy of hydrocortisone in preventing the
onset of PTSD (risk ratio (RR) 0.17; 95% confidence interval (CI) 0.05 to
0.56; P value = 0.004), indicating that between seven and 13 patients
would need to be treated with this agent in order to prevent the onset of
PTSD in one patient. There was low quality evidence for preventing the
onset of PTSD in three trials with 118 participants treated with
propranolol (RR 0.62; 95% CI 0.24 to 1.59; P value = 0.32). Drop-outs due
to treatment-emergent side effects, where reported, were low for all of
the agents tested. Three of the four RCTs of hydrocortisone reported that
medication was more effective than placebo in reducing PTSD symptoms after
a median of 4.5 months after the event. None of the single trials of
escitalopram, temazepam and gabapentin demonstrated evidence that
medication was superior to placebo in preventing the onset of PTSD.Seven
of the included RCTs were at a high risk of bias. Differential drop-outs
between groups undermined the results of three studies, while one study
failed to describe how the allocation of medication was concealed. Other
forms of bias that might have influenced study results included possible
confounding through group differences in concurrent medication and
termination of the study based on treatment response.
AUTHORS' CONCLUSIONS: There is moderate quality evidence for the efficacy
of hydrocortisone for the prevention of PTSD development in adults. We
found no evidence to support the efficacy of propranolol, escitalopram,
temazepam and gabapentin in preventing PTSD onset. The findings, however,
are based on a few small studies with multiple limitations. Further
research is necessary in order to determine the efficacy of
pharmacotherapy in preventing PTSD and to identify potential moderators of
treatment effect.
<103>
Accession Number
24053433
Authors
Kuiper A.N. Trof R.J. Groeneveld A.B.
Institution
(Kuiper) Departments of Intensive Care, VU University Medical Centre,
Amsterdam, The Netherlands.
Title
Mixed venous O2 saturation and fluid responsiveness after cardiac or major
vascular surgery.
Source
Journal of cardiothoracic surgery. 8 (pp 189), 2013. Date of Publication:
2013.
Abstract
It is unclear if and how SvO2 can serve as an indicator of fluid
responsiveness in patients after cardiac or major vascular surgery. This
was a substudy of a randomized single-blinded clinical trial reported
earlier on critically ill patients with clinical hypovolemia after cardiac
or major vascular surgery. Colloid fluid loading was done for 90 min,
guided by changes in pulmonary artery occlusion pressure (PAOP) or central
venous pressure (CVP). Fluid responsiveness was defined as >15% increase
in cardiac index (CI). Hemodynamics, including transpulmonary
dilution-derived global end-diastolic volume index (GEDVI) and global
ejection fraction (GEF), were measured and blood samples taken. Whereas
baseline SvO2 (>70% in 68% of patients) did not differ, the SvO2 increased
in patients responding to fluid loading (>15% in CI in n = 26) versus
those not responding (n = 11; P = 0.03). The increase in GEDVI was also
greater in responders (P = 0.005). The area under the receiver operating
characteristic curve for fluid responsiveness of changes in SvO2 was 0.73
(P = 0.007), with an optimal cutoff of 2%, and of those in GEDVI 0.82 (P <
0.001), while the areas did not differ. However, the value of SvO2
increases to reflect CI increases with fluid loading was greatest when GEF
was <20% (in 53% of patients). An increase in SvO2 >2%, irrespective of a
relatively high baseline value, can thus be used as a monitor of fluid
responsiveness in clinically hypovolemic patients after cardiac or major
vascular surgery, particularly in those with systolic cardiac dysfunction.
Fluid responsiveness concurs with increased tissue O2 delivery.
<104>
Accession Number
23691266
Authors
Haghjooy Javanmard S. Ziaei A. Ziaei S. Ziaei E. Mirmohammad-Sadeghi M.
Institution
(Haghjooy Javanmard) Department of Physiology, Physiology Research Centre,
Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan
73461-8174, Iran.
Title
The effect of preoperative melatonin on nuclear erythroid 2-related factor
2 activation in patients undergoing coronary artery bypass grafting
surgery.
Source
Oxidative medicine and cellular longevity. 2013 (pp 676829), 2013. Date
of Publication: 2013.
Abstract
During and after coronary artery bypass grafting (CABG), oxidative stress
occurs. Finding an effective way to improve antioxidant response is
important in CABG surgery. It has been shown that patients with coronary
heart disease have a low Melatonin production rate. The present study
aimed to investigate the effects of Melatoninon nuclear erythroid
2-related factor 2(Nrf2) activity in patients undergoing CABG surgery.
Thirty volunteers undergoing CABG were randomized to receive 10 mg oral
Melatonin (Melatonin group, n = 15) or placebo (placebo group, n = 15)
before sleeping for 1 month before surgery. The activated Nrf2 was
measured twice by DNA-based ELISA method in the nuclear extract of
peripheral blood mononuclear cells of patients before aortic clumps and 45
minutes after CABG operation. Melatonin administration was associated with
a significant increase in both plasma levels of Melatonin and Nrf2
concentration in Melatonin group compared to placebo group, respectively
(15.2 +/- 4.6 pmol/L, 0.28 +/- 0.01 versus 1.1 +/- 0.59 pmol/L, 0.20 +/-
0.07, P < 0.05). The findings of the present study provide preliminary
data suggesting that Melatonin may play a significant role in the
potentiation of the antioxidant defense and attenuate cellular damages
resulting from CABG surgery via theNrf2 pathway.
<105>
Accession Number
2015730932
Authors
De Frutos F. Gea A. Hernandez-Estefania R. Rabago G.
Institution
(De Frutos, Hernandez-Estefania, Rabago) Department of Cardiovascular
Surgery, Clinica-University of Navarra, Pamplona, Spain
(Gea) Department of Preventive Medicine and Public Health, University of
Navarra, Pamplona, Spain
Title
Prophylactic treatment with coenzyme Q10 in patients undergoing cardiac
surgery: Could an antioxidant reduce complications? A systematic review
and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (2) (pp 254-259),
2015. Date of Publication: 01 Feb 2015.
Publisher
Oxford University Press
Abstract
Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have
beneficial effects in patients undergoing cardiac surgery with
cardiopulmonary bypass. There is no clear evidence about its clinical
effects or a systematic review published yet. We aimed to conduct a
systematic review and meta-analysis of the literature to elucidate the
role of coenzyme Q10 in preventing complications in patients undergoing
cardiac surgery with cardiopulmonary bypass. We searched the PubMed
Database using the following keywords: Coenzyme Q10, ubiquinone,
ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were
systematically retrieved, selected, assessed and summarized for this
review. We performed separate meta-analyses for different outcomes
(inotropic drug requirements after surgery, incidence of ventricular
arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and
hospital stay), estimating pooled odds ratios (ORs) or mean differences of
the association of CoQ10 administration with the risk of these outcomes.
Eight clinical trials met our inclusion criteria. Patients with CoQ10
treatment were significantly less likely to require inotropic drugs after
surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to
develop ventricular arrhythmias after surgery [OR (95% CI) 0.05
(0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac
index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)],
hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and
incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since
none of the clinical trials included in this review report any adverse
effects associated to CoQ10 administration, and coenzyme Q10 has been
demonstrated to be safe even at much higher doses in other studies, we
conclude that CoQ10 should be considered as a prophylactic treatment for
preventing complications in patients undergoing cardiac surgery with
cardiopulmonary bypass. However, better quality randomized, controlled
trials are needed to clarify the role of CoQ10 in patients undergoing
cardiac surgery with cardiopulmonary bypass.
<106>
Accession Number
2015730931
Authors
Bettex D.A. Wanner P.M. Bosshart M. Balmer C. Knirsch W. Dave H. Dillier
C. Burki C. Hug M. Seifert B. Spahn D.R. Beck-Schimmer B.
Institution
(Bettex, Spahn, Beck-Schimmer) Department of Anaesthesiology, University
Hospital Zurich, Zurich, Switzerland
(Bettex, Dillier, Burki) Department of Anaesthesiology, University
Children's Hospital Zurich, Zurich, Switzerland
(Wanner) Department of Internal Medicine, Cantonal Hospital Baden, Baden,
Switzerland
(Bosshart) Department of Anaesthesiology, Hirslanden Clinic, Zurich,
Switzerland
(Balmer, Knirsch) Department of Cardiology, University Children's Hospital
Zurich, Zurich, Switzerland
(Dave) Department of Cardiac Surgery, University Children's Hospital
Zurich, Zurich, Switzerland
(Hug) Department of Intensive Care Medicine, University Children's
Hospital Zurich, Zurich, Switzerland
(Seifert) Division of Biostatistics, University Zurich, Institute for
Social and Preventive Medicine, Zurich, Switzerland
Title
Role of sevoflurane in organ protection during cardiac surgery in
children: A randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (2) (pp 157-165),
2015. Date of Publication: 01 Feb 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES The protective effects of volatile anaesthetics against
ischaemia-reperfusion injury have been shown in vitro, but clinical
studies have yielded variable results. We hypothesized that, in children,
sevoflurane provides superior cardioprotection after cardiac surgery on
cardiopulmonary bypass (CPB) compared with totally intravenous anaesthesia
(TIVA). METHODS In this randomized controlled, single-centre study, 60
children with cyanotic and acyanotic heart defects undergoing elective
cardiac surgery under CPB (RACHS-1 1-3) were randomized to sevoflurane or
TIVA (midazolam <6 months of age, propofol >6 months of age). The primary
end-point was the postoperative peak cardiac troponin I/T (cTnI/T).
Perioperative cardiac function (as determined by brain-type natriuretic
peptide, echocardiography and postoperative vasopressor/inotrope
requirements), short-term clinical outcomes (duration of intubation,
intensive care unit and hospital length of stay), postoperative
inflammatory profile, and pulmonary, renal and liver function were defined
as secondary end-points. Analysis of variance was used for statistical
analysis. RESULTS There was no statistically significant difference in
postoperative peak troponin values or any of the secondary end-points. In
the subgroup of acyanotic patients under 6 months, sevoflurane led to
significantly lower postoperative troponin levels compared with midazolam
[reduction of 54% (95% confidence interval 29-71%, P = 0.002)], without
any differences in secondary outcome parameters. CONCLUSIONS Sevoflurane
did not provide superior myocardial protection in our general paediatric
cardiac surgical population. In children under 6 months, however,
sevoflurane might be beneficial in comparison with midazolam. The
conditioning effects of sevoflurane in specific paediatric subgroups need
to be further investigated.
<107>
Accession Number
2015730913
Authors
Balkanay O.O. Goksedef D. Omeroglu S.N. Ipek G.
Institution
(Balkanay) Department of Cardiovascular Surgery, Manisa State Hospital,
Manisa, Turkey
(Goksedef, Omeroglu, Ipek) Department of Cardiovascular Surgery,
Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Title
The dose-related effects of Dexmedetomidine on renal functions and serum
neutrophil gelatinase-associated lipocalin values after coronary artery
bypass grafting: A randomized, triple-blind, placebo-controlled study.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (2) (pp 209-214),
2015. Date of Publication: 01 Feb 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Acute kidney failure after coronary artery bypass grafting
(CABG) is a serious complication that increases morbidity and mortality
rates. Early detection and prevention of this complication are very
important. A novel biomarker named neutrophil gelatinase-associated
lipocalin (NGAL) can play an important role in early diagnosis of acute
kidney injury. Recent studies on the favourable effects of Dexmedetomidine
on cardiac surgery have been published. The aim of this study is to
investigate whether there is a dose-dependent positive effect of
Dexmedetomidine on neutrophil gelatinase-associated lipocalin levels and
renal functions when used after CABG. METHODS Our randomized,
triple-blinded, placebo-controlled study was conducted among 295 patients
scheduled for CABG surgery between August 2009 and March 2011 in a
tertiary cardiac and vascular surgery clinic. A total of 90 consecutive
patients who met inclusion criteria were randomized and divided into three
groups. The first group received a placebo. The second and the third
groups received 4 and 8 mug/cc concentration of the Dexmedetomidine
infusion, respectively. Infusion rates were regulated to obtain sedation
with a Ramsey sedation score of 2 or 3. Patients were regrouped according
to the total Dexmedetomidine dose. Statistical analyses of variables
including serum neutrophil gelatinase-associated lipocalin values and
conventional renal function tests were made for all six possibilities
before the blind was broken. RESULTS Results of conventional renal
function tests were not significantly different. However, neutrophil
gelatinase-associated lipocalin levels for the first postoperative day for
placebo, low-dose and high-dose Dexmedetomidine groups were 176.8 +/-
145.9, 97.7 +/- 63.4 and 67.3 +/- 10.9 ng/ml, respectively. These values
were significantly different among the groups (P <0.001). CONCLUSIONS In
our study, we found that Dexmedetomidine infusion for sedation after CABG
under cardiopulmonary bypass can be useful in the prevention of kidney
injury. Conventional renal function tests, including blood urea nitrogen,
serum creatinine, urine output and creatinine clearance rate measurements
typically may not detect the development of acute kidney dysfunction in
the first 48-h postoperative period. Differences were detected in renal
function in the early postoperative period and the development of acute
kidney injury, as determined by measurements of blood NGAL levels, was
significant and dose-dependent.
<108>
Accession Number
2015660063
Authors
Ielasi A. Brugaletta S. Silvestro A. Cequier A. Iniguez A. Serra A.
Hernandez-Antolin R. Mainar V. Valgimigli M. Den Heijer P. Bethencourt A.
Vazquez N. Serruys P. Sabate M. Tespili M.
Institution
(Ielasi, Silvestro, Tespili) Hospital Bolognini Seriate, Bergamo, Italy
(Brugaletta, Sabate) University Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
(Cequier) Heart Institute, University Hospital of Bellvitge, Barcelona,
Spain
(Cequier) University Hospital of Bellvitge (IDIBELL), Barcelona, Spain
(Iniguez) Hospital Do Meixoeiro, Vigo, Spain
(Serra) University Hospital of Sant Pau, Barcelona, Spain
(Hernandez-Antolin) University Hospital San Carlos, Madrid, Spain
(Mainar) Hospital General of Alicante, Alicante, Spain
(Valgimigli) University Hospital Ferrara, Ferrara, Italy
(Den Heijer) Amphia Ziekenhuis, Breda, Netherlands
(Bethencourt) Hospital Son Dureta, Palma de Mallorca, Spain
(Vazquez) Hospital Juan Canalejo, A Coruna, Spain
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
Title
Everolimus-eluting stent versus bare-metal stent in elderly (> 75 years)
versus non-elderly (< 75 years) patients with ST-elevation myocardial
infarction undergoing primary percutaneous coronary intervention: Insights
from the examination trial.
Source
International Journal of Cardiology. 179 (pp 73-78), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The elderly (> 75 years) constitute a high-risk subset of
patients who continue to have a poorer prognosis than non-elderly (< 75
years). Whether the effects of everolimus-eluting stent (EES) in
ST-segment elevation myocardial infarction (STEMI) are independent of age
has not been reported. We investigated the outcomes following primary PCI
(PPCI) with bare-metal stent (BMS) or EES in elderly vs. non-elderly STEMI
patients. Methods The EXAMINATION trial randomized 1498 STEMI patients to
BMS or EES. The primary patient-oriented endpoint (POCE) was the combined
of all-cause death, any-recurrent myocardial infarction (MI) and
any-revascularization at 1-year. The secondary endpoint included the
device-oriented combined (DOCE) of cardiac death, target-vessel MI and
target-lesion revascularization. These endpoints and their components were
compared between elderly and non-elderly. Results Among patients enrolled
in the trial, 245 (16.3%) were elderly, allocated to BMS (n = 132) or EES
(n = 113), while the remaining 1253 (83.7%) were non-elderly, allocated to
BMS (n = 615) or EES (n = 638). At 1-year, both the POCE and DOCE were
observed more frequently in elderly vs. non-elderly group (24.5% vs.
10.5%, p < 0.001 and 15.9% vs. 5.1%, p < 0.001). Whereas in non-elderly,
both POCE and DOCE were lower in EES vs. BMS (12.4% vs. 8.8%, p = 0.03 and
6.7% vs. 3.6%, p = 0.01), no differences were found in elderly, with a
tendency for interaction between age and stent type for POCE (p = 0.05).
On multivariate analysis age > 75 years was an independent predictor of
POCE (HR 2.19 [95%CI 1.59-3.01], p < 0.0001) and DOCE (HR 2.42 [95%CI
1.60-3.7], p < 0.001) at 1-year. Conclusions In STEMI patients undergoing
PPCI, advanced age (> 75 years) is associated with worse outcomes. The
beneficial effects of EES over BMS tended to be age-dependent.
<109>
Accession Number
2015660003
Authors
Mamuti W. Ablimit A. Kelimu W. Rao F. Jiamali A. Zhang W. Pei X. Zhang F.
Institution
(Mamuti, Ablimit, Kelimu, Rao, Jiamali, Zhang, Pei) Department of
Cardiology, Kashgar Prefecture Second People's Hospital, Kashi, Xinjiang
844000, China
(Zhang) Department of Cardiology, Zhongshan Hospital, Fudan University,
180 Fenglin Road, Shanghai 200032, China
Title
Comparison of drug-eluting balloon versus drug-eluting stent in patients
with in-stent restenosis: Insight from randomized controlled trials.
Source
International Journal of Cardiology. 179 (pp 424-429), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Backgrounds In-stent restenosis (ISR) remains an important issue even in
the current drug-eluting stent (DES) era. We performed a meta-analysis to
assess the clinical efficacy and safety of drug-eluting balloon (DEB) as
compared with DES for the treatment of ISR. Methods The published
literature was scanned by formal searches of electronic databases from
January 2005 to February 2014. All randomized controlled trials were
eligible for inclusion if they compared DEB with DES in patients with ISR.
Results Prespecified criteria were met by 4 trials involving 803 patients.
There was no significant difference in the primary endpoint (12-month
major adverse cardiac events) between the 2 groups (risk ratio [RR] 1.04,
P = 0.80). The incidence of death (RR 0.81, P = 0.62), myocardial
infarction (RR 0.66, P = 0.29), and target lesion revascularization (RR
1.35, P = 0.12) in the DEB group was also similar to those in the DES
group. Conclusions This meta-analysis showed that DEB was associated with
comparable clinical outcomes to DES for the treatment of ISR. DEB might be
the preferred interventional strategy for patients with ISR by obviating
the need of additional stent layer.
<110>
Accession Number
2015659949
Authors
Phan K. Wong S. Phan S. Yan T.D.
Institution
(Phan, Wong, Phan, Yan) Collaborative Research (CORE) Group, Macquarie
University, 2 Technology Place, Sydney, Australia
Title
Early outcomes of isolated transcatheter aortic valve implantation versus
combined with percutaneous coronary intervention.
Source
International Journal of Cardiology. 179 (pp 258-261), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
<111>
Accession Number
2015660036
Authors
Sardar P. Chatterjee S. Giri J. Alfonso F. Helmy T. Ledley G.S. Magalhaes
M.A. Mukherjee D. Waksman R.
Institution
(Sardar, Mukherjee) Texas Tech University Health Sciences Center, Paul L.
Foster School of Medicine, El Paso, TX, United States
(Chatterjee) St Luke's-Roosevelt Hospital Center of the Mount Sinai Health
System, New York, NY, United States
(Giri) Hospital of the University of Pennsylvania, Cardiovascular Medicine
Division, Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104,
United States
(Alfonso) Cardiac Department, Hospital Universitario de la Princesa,
Universidad Autonoma de Madrid, c/ Diego de Leon 62, Madrid 28006, Spain
(Helmy) College of Medicine, University of Cincinnati, 231 Albert Sabine
Way, Cincinnati, OH, United States
(Ledley) Drexel University College of Medicine, Philadelphia, PA, United
States
(Magalhaes, Waksman) Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
Title
Intervention strategies for multi-vessel disease in patients with
ST-segment elevation myocardial infarction: A meta-analysis of randomized
trials.
Source
International Journal of Cardiology. 179 (pp 225-227), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
<112>
Accession Number
2015660029
Authors
Phan K. Wong S. Wang N. Phan S. Yan T.D.
Institution
(Phan, Wang, Phan, Yan) Collaborative Research (CORE) Group, Macquarie
University, 2 Technology Place, Sydney, Australia
(Phan, Yan) Sydney Medical School, University of Sydney, Sydney, Australia
(Wong) Gosford Hospital, Gosford, Australia
Title
Hybrid coronary revascularization versus coronary artery bypass surgery:
Systematic review and meta-analysis.
Source
International Journal of Cardiology. 179 (pp 484-488), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
<113>
Accession Number
2014909954
Authors
Moretti C. D'Ascenzo F. Quadri G. Omede P. Montefusco A. Taha S. Cerrato
E. Colaci C. Chen S.-L. Biondi-Zoccai G. Gaita F.
Institution
(Moretti, D'Ascenzo, Quadri, Omede, Montefusco, Taha, Cerrato, Colaci,
Gaita) Division of Cardiology, Department of Internal Medicine, University
of Turin, Italy
(Chen) Nanjing Medical University, Nanjing, China
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, Rome,
Italy
Title
Management of multivessel coronary disease in STEMI patients: A systematic
review and meta-analysis.
Source
International Journal of Cardiology. 179 (pp 552-557), 2015. Date of
Publication: 20 Jan 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background Appropriate management for patients with multivessel coronary
disease presenting with ST segment Elevation Myocardial Infarction (STEMI)
remains to be defined. Methods and results Medline and Cochrane Library
were searched for randomized controlled trials (RCTs) or observational
studies adjusted with multivariate analysis, reporting about STEMI
patients with multivessel coronary disease treated with either a culprit
only or complete revascularization strategy, excluding patients in
cardiogenic shock. Prespecified analysis was performed according to the
strategy of complete revascularization, either during the same procedure
of primary percutaneous coronary intervention (PCI) or during the index
hospitalization. MACE (a composite and mutually exclusive end point of
death or myocardial infarction or revascularization) at follow-up of at
least one year was the primary end point. 9 studies with 4686 patients
compared culprit only versus complete PCI performed during the primary
PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27],
I<sup>2</sup> = 0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03],
I<sup>2</sup> = 0%). No significant difference was found for the
components of the primary outcome, apart from a reduction in repeated
revascularization for patients undergoing complete PCI during the STEMI
procedure (OR 0.62 [0.39, 0.98], I<sup>2</sup> = 0%). 6 studies (1 RCT)
with 5855 patients compared culprit only lesions versus complete PCI
performed during index hospitalization. 90 day risk of MACE did not differ
nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I<sup>2</sup> = 0%), with a
similar reduction in repeated revascularization (0.60 [0.40, 0.90],
I<sup>2</sup> = 0%). Conclusions Complete revascularization performed
during primary PCI or index hospitalizations for patients presenting with
STEMI appears safe at short term follow-up and offers a reduction in
repeated revascularization at one year.
<114>
Accession Number
2015727320
Authors
Little A.G. Lerut A.E. Harpole D.H. Hofstetter W.L. Mitchell J.D. Altorki
N.K. Krasna M.J.
Institution
(Little, Lerut, Harpole, Hofstetter, Mitchell, Altorki, Krasna) Department
of Surgery, University of Arizona, Tucson, Arizona; Department of Thoracic
Surgery, University Hospital Leuven, Leuven, Belgium; Department of
Surgery, Duke University Medical Center, Durham, North Carolina; M.D.
Anderson Cancer Center, University of Texas, Houston, Texas; Division of
Cardiothoracic Surgery, University of Colorado Denver School of Medicine,
Aurora, Colorado; Weill Cornell Medical College, New York, New York;
Jersey Shore University Medical Center, Neptune, New Jersey
Title
The Society of Thoracic Surgeons practice guidelines on the role of
multimodality treatment for cancer of the esophagus and gastroesophageal
junction.
Source
Annals of Thoracic Surgery. 98 (5) (pp 1880-1885), 2014. Date of
Publication: 2014.
Publisher
Elsevier USA
Abstract
1. Class I Recommendation: Patients with potentially curable, locally
advanced esophageal cancer should be cared for in a multidisciplinary
setting. (Level of Evidence B) 2. Class I Recommendation: Restaging
studies after neoadjuvant therapy are recommended before resection to rule
out interval development of distant metastatic disease. (Level of Evidence
B) 3. Class IIA Recommendation: Endoscopic ultrasound restaging for
residual local (mural) disease is inaccurate and can be omitted. (Level of
Evidence B) 4. Class IIA Recommendation: A positron emission tomography
scan is recommended for restaging after neoadjuvant therapy to detect
interval development of distant metastatic disease. (Level of Evidence B)
5. Class III Recommendation: Radiotherapy as monotherapy before resection
is not recommended. (Level of Evidence A) 6. Class IIA recommendation:
Neoadjuvant platinumbased doublet chemotherapy alone is beneficial before
resection for patients with locally advanced esophageal adenocarcinoma.
(Level of Evidence A) 7. Class IIA Recommendation: Neoadjuvant
chemoradiation therapy should be used for locally advanced squamous cell
cancer and either neoadjuvant chemotherapy or chemoradiation therapy for
locally advanced adenocarcinoma; multimodality therapy has advantages over
surgical resection alone. (Level of Evidence A) 8. Class I Recommendation:
After neoadjuvant therapy, patients without metastatic disease, in whom
surgical resection can be safely performed, should receive esophageal
resection. (Level of Evidence A) 9. Class IIA Recommendation: Patients
with adenocarcinoma who have not received neoadjuvant therapy should be
considered for adjuvant chemoradiotherapy if the pathologic specimen
reveals regional lymph node disease. (Level of Evidence B).
<115>
Accession Number
2015727339
Authors
Bolotin G. Huber C.H. Shani L. Mohr F.W. Carrel T.P. Borger M.A. Falk V.
Taggart D. Nir R.-R. Englberger L. Seeburger J. Caliskan E. Starck C.T.
Institution
(Bolotin, Huber, Shani, Mohr, Carrel, Borger, Falk, Taggart, Nir,
Englberger, Seeburger, Caliskan, Starck) Department of Cardiac Surgery,
Rambam Health Care Campus, and Faculty of Medicine, Technion-Israel
Institute of Technology, Haifa, Israel; University Clinic for
Cardiovascular Surgery Inselspital, Bern, Switzerland; Heart Center
Leipzig, University of Leipzig, Leipzig, Germany; University Hospital
Zurich, Zurich, Switzerland; and University of Oxford, Oxford, United
Kingdom
Title
Novel emboli protection system during cardiac surgery: A multi-center,
randomized, clinical trial.
Source
Annals of Thoracic Surgery. 98 (5) (pp 1627-1633), 2014. Date of
Publication: 2014.
Publisher
Elsevier USA
Abstract
Background. Stroke is a major cause of morbidity and mortality during
open-heart surgery. Up to 60% of intraoperative cerebral events are emboli
induced. This randomized, controlled, multicenter trial is the first human
study evaluating the safety and efficacy of a novel aortic cannula
producing simultaneous forward flow and backward suction for extracting
solid and gaseous emboli from the ascending aorta and aortic arch upon
their intraoperative release. Methods. Sixty-six patients (25 females; 68
+/- 10 years) undergoing elective aortic valve replacement surgery, with
or without coronary artery bypass graft surgery, were randomized to the
use of the CardioGard (CardioGard Medical, Or-Yehuda, Israel) Emboli
Protection cannula ("treatment") or a standard ("control") aortic cannula.
The primary endpoint was the volume of new brain lesions measured by
diffusion-weighted magnetic resonance imaging (DW-MRI), performed
preoperatively and postoperatively. Device safety was investigated by
comparisons of complications rate, namely neurologic events, stroke, renal
insufficiency and death. Results. Of 66 patients (34 in the treatment
group), 51 completed the presurgery and postsurgery MRI (27 in the
treatment group). The volume of new brain lesion for the treatment group
was (mean +/- standard error of the mean) 44.00 +/- 64.00 versus 126.56
+/- 28.74 mm<sup>3</sup> in the control group ( p = 0.004). Of the
treatment group, 41% demonstrated new postoperative lesions versus 66% in
the control group ( p = 0.03). The complication rate was comparable in
both groups. Conclusions. The CardioGard cannula is safe and efficient in
use during open-heart surgery. Efficacy was demonstrated by the removal of
a substantial amount of emboli, a significant reduction in the volume of
new brain lesions, and the percentage of patients experiencing new brain
lesions.
<116>
Accession Number
2015722956
Authors
Ari H. Kivac E. Ari S. Emlek N. Cetinkaya S. Celiloglu N. Yasar Sarigul O.
Aydin C. Akkaya M. Koca V. Bozat T. Gurdogan M.
Institution
(Ari, Kivac, Ari, Emlek, Cetinkaya, Celiloglu, Yasar Sarigul, Aydin,
Akkaya, Koca, Bozat) Dept. of Cardiology, Bursa Postgraduate Hospital,
Bursa, Turkey
(Gurdogan) Dept. of Cardiology, Pasabahce State Hospital, Istanbul, Turkey
Title
The REDUCED(A RandomisED stUdy Comparing standard systemic anticoagulation
thErapy to low Dose intracoronary anticoagulation therapy for elective
percutaneous coronary intervention) trial. A novel pharmacologic regime
for elective percutaneous coronary intervention.
Source
Acta Cardiologica. 69 (6) (pp 619-627), 2014. Date of Publication: 2014.
Publisher
Acta Cardiologica (Weldadigheidsstraat 49, Leuven B-3000, Belgium)
Abstract
Aim: This study tried to determine the efficacy and safety of low-dose
intracoronary unfractionated heparin (UFH) in elective percutaneous
coronary intervention (PCI). Methods: Two-hundred patients who underwent
elective PCI of an uncomplicated lesion were included into the study. The
patients were assigned to either a control group (70-100 IU/kg intravenous
UFH) or a low-dose intracoronary UFH (1,000 IU intracoronary UFH) group.
Results: At 30 days, the primary end point (composite of death, myocardial
infarction, or urgent target vessel revascularization) was similar in both
groups [intracoronary UFH group, 1.0%; control group, 2.0%; odds ratio;
0.49 (95% CI: 0.04 - 5.54), P = 0.56]. Post-procedural myocardial injury
(according to CK-MB, P = 0.91; according to Tn I, P = 0.81) and bleeding
events (based on TIMI criteria, P = 0.33; based on STEEPLE criteria, P =
0.20) were similar in the control and intracoronary groups. The primary
end point at 6 months was also similar between the two groups (P = 0.33).
Moreover, the health care cost at 30 days of follow-up was lower in the
intracoronary group than in the control group (1,016 +/- 54 $/patient vs
1,110 +/- 102 $/patient, P < 0.001). Conclusion: This pilot study suggests
that elective PCI could be safely performed with low-dose intracoronary
UFH in the treatment of uncomplicated lesions and at a lower cost as
compared to standard systemic anticoagulation. These results should be
confirmed by further studies.
<117>
Accession Number
2015724750
Authors
Genereux P. Cohen D.J. Williams M.R. Mack M. Kodali S.K. Svensson L.G.
Kirtane A.J. Xu K. McAndrew T.C. Makkar R. Smith C.R. Leon M.B.
Institution
(Genereux, Williams, Kodali, Kirtane, Smith, Leon) Columbia University
Medical Center, New York-Presbyterian Hospital, 161 Fort Washington
Avenue, 6th Floor, New York, NY 10032, United States
(Genereux, Kodali, Kirtane, Xu, McAndrew, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Mack) Baylor Healthcare System, Plano, TX, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
Title
Bleeding complications after surgical aortic valve replacement compared
with transcatheter aortic valve replacement: Insights from the PARTNER I
trial (Placement of Aortic Transcatheter Valve).
Source
Journal of the American College of Cardiology. 63 (11) (pp 1100-1109),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives: This study sought to identify the incidence, predictors, and
prognostic impact of bleeding complications (BC) after surgical aortic
valve replacement (SAVR) compared with transcatheter aortic valve
replacement (TAVR). Background: Bleeding complications after SAVR and TAVR
are frequent and may be associated with an unfavorable prognosis. Methods:
In the randomized controlled PARTNER (Placement of Aortic Transcatheter
Valve) I trial, 657 patients from cohort A (operable high risk) were
randomly assigned to SAVR or TAVR (transfemoral [TF] if iliofemoral access
was suitable or transapical [TA] if not) and received the designated
treatment. First-generation Edwards SAPIEN valves and delivery systems
(Edwards Lifesciences, Irvine, California) were used for TAVR, through a
22- or 24-F sheath. The 30-day rates of major BC (modified Valve Academic
Research Consortium definitions), predictors of BC, and their association
with 1-year mortality were assessed. Results: A total of 71 (22.7%), 27
(11.3%), and 9 (8.8%) patients had major BC within 30 days of the
procedure after SAVR, TF-TAVR, and TA-TAVR, respectively (p < 0.0001).
SAVR was associated with a significantly higher 30-day rate of transfusion
(17.9%) than either TF-TAVR (7.1%) or TA-TAVR (4.8%; p < 0.0001).
Independent predictors of major BC were the occurrence of major vascular
complications and use of intraprocedural hemodynamic support among TF-TAVR
patients, severe procedural complications requiring conversion to open
surgery among TA-TAVR patients, and the presence of low hemoglobin at
baseline among SAVR patients. Major BC was identified as the strongest
independent predictor of 1-year mortality among the full cohort. However,
risk-adjusted analyses demonstrated a significant interaction between BC
and treatment strategy with respect to mortality, suggesting that BC after
SAVR have a greater impact on prognosis than after TAVR. Conclusions:
Among high-risk aortic stenosis patients enrolled in the PARTNER I
randomized trial, BC were more common after SAVR than after TAVR and were
also associated with a worse long-term prognosis. (THE PARTNER TRIAL:
Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
<118>
Accession Number
2015724739
Authors
El Aidi H. Adams A. Moons K.G.M. Den Ruijter H.M. Mali W.P.Th.M.
Doevendans P.A. Nagel E. Schalla S. Bots M.L. Leiner T.
Institution
(El Aidi, Doevendans) Department of Cardiology, University Medical Center
Utrecht, Heidelberglaan 100, P.O. Box 85500 HP E01.132, Utrecht 3508 GA,
Netherlands
(El Aidi, Adams, Mali, Leiner) Department of Radiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Moons, Den Ruijter, Bots) Julius Center of Health Sciences and Primary
Care, University Medical Center Utrecht, Utrecht, Netherlands
(Den Ruijter) Laboratory of Experimental Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Nagel) Division of Imaging Sciences and Biomedical Engineering, St.
Thomas' Hospital, London, United Kingdom
(Schalla) Department of Cardiology, Maastricht University Medical Center,
Maastricht, Netherlands
Title
Cardiac magnetic resonance imaging findings and the risk of cardiovascular
events in patients with recent myocardial infarction or suspected or known
coronary artery disease: A systematic review of prognostic studies.
Source
Journal of the American College of Cardiology. 63 (11) (pp 1031-1045),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
The goal of this study was to review the prognostic value of cardiac
magnetic resonance (CMR) imaging findings for future cardiovascular events
in patients with a recent myocardial infarction (MI) and patients with
suspected or known coronary artery disease (CAD). Although the diagnostic
value of CMR findings is established, the independent prognostic
association with future cardiovascular events remains largely unclear.
Studies published by February 2013, identified by systematic MEDLINE and
EMBASE searches, were reviewed for associations between CMR findings (left
ventricular ejection fraction [LVEF], wall motion abnormalities [WMA],
abnormal myocardial perfusion, microvascular obstruction, late gadolinium
enhancement, edema, and intramyocardial hemorrhage) and hard events
(all-cause mortality, cardiac death, cardiac transplantation, and MI) or
major adverse cardiovascular events (MACE) (hard events and other
cardiovascular events defined by the authors of the evaluated papers).
Fifty-six studies (n = 25,497) were evaluated. For patients with recent
MI, too few patients were evaluated to establish associations between CMR
findings and hard events. LVEF (range of adjusted hazard ratios [HRs]:
1.03 to 1.05 per % decrease) was independently associated with MACE. In
patients with suspected or known CAD, WMA (adjusted HRs: 1.87 to 2.99),
inducible perfusion defects (adjusted HRs: 3.02 to 7.77), LVEF (adjusted
HRs: 0.72 to 0.82 per 10% increase), and infarction (adjusted HRs: 2.82 to
9.43) were independently associated with hard events, and the presence of
inducible perfusion defects was associated with MACE (adjusted HRs: 1.76
to 3.21). The independent predictor of future cardiovascular events for
patients with a recent MI was LVEF, and the predictors for patients with
suspected or known CAD were WMA, inducible perfusion defects, LVEF, and
presence of infarction.
<119>
Accession Number
2014706818
Authors
Ariyaratne T.V. Ademi Z. Yap C.-H. Billah B. Rosenfeldt F. Yan B.P. Reid
C.M.
Institution
(Ariyaratne, Ademi, Yap, Billah, Reid) Centre of Cardiovascular Research
and Education in Therapeutics (CCRE), Department of Epidemiology and
Preventive Medicine (DEPM), Monash University, 99 Commercial Rd,
Melbourne, VIC 3004, Australia
(Ademi) Melbourne Epi Centre, Department of Medicine, University of
Melbourne, Parkville, VIC, Australia
(Yap) Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
(Rosenfeldt) Cardiac Surgical Research Unit, Department of Cardiothoracic
Surgery, Monash University, Melbourne, VIC, Australia
(Yan) Division of Cardiology, Department of Medicine and Therapeutics,
Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Prolonged effectiveness of coronary artery bypass surgery versus
drug-eluting stents in diabetics with multi-vessel disease: An updated
systematic review and meta-analysis.
Source
International Journal of Cardiology. 176 (2) (pp 346-353), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Currently, the appropriateness of percutaneous coronary
intervention (PCI) using drug-eluting stents (DES) versus coronary artery
bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel
disease (MVD) is uncertain due to limited evidence from few randomised
controlled trials (RCTs). We aimed to compare the clinical effectiveness
of CABG versus PCI-DES in DM-MVD patients using an evidence-based
approach. Methods: A systematic review and meta-analyses were conducted to
compare the risk of all-cause mortality, myocardial infarction (MI),
repeat revascularisation, cerebrovascular events (CVE), and major adverse
cardiac or cerebrovascular events (MACCE). Results: A total of 1,837 and
3,052DM-MVD patientswere pooled fromfour RCTs (FREEDOM, SYNTAX,VA CARDS,
and CARDia) and five non-randomised studies. At mean follow-up of 3 years,
CABG comparedwith PCI-DES was associated with a lower risk of all-cause
mortality and MI in RCTs. By contrast, no significant differences were
observed in the mean 3.5-year risk of all-cause mortality and MI in
non-randomised trials. However, the risk of repeat revascularisations
following PCI-DES compared with CABG was 2.3 (95% CI = 1.8-2.8) and 3.0
(2.3- 4.2)-folds higher in RCTs and non-randomised trials, respectively.
Accordingly, the risk of MACCE at 3 years following CABG compared with
PCI-DES was lower in both RCTs and non-randomised trials [0.65 (:
0.55-0.77); and 0.77 (0.60-0.98), respectively]. Conclusions: Based on our
pooled results, we recommend CABG compared with PCI-DES for patients with
DM-MVD. Although non-randomised trials suggest no additional survival-,
MI-, and CVE- benefit from CABG over PCI-DES, these results should be
interpreted with care.
<120>
Accession Number
2014744320
Authors
Yousef A. Simard T. Pourdjabbar A. Webb J. So D. Chong A.-Y. Glover C. Le
May M. Hibbert B. Labinaz M.
Institution
(Yousef, Simard, Pourdjabbar, So, Chong, Glover, Le May, Hibbert, Labinaz)
Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin
Street, Ottawa, ON K1Y 4W7, Canada
(Webb) Division of Cardiology, St. Paul's Hospital, University of British
Columbia, Vancouver, BC, Canada
Title
Performance of transcatheter aortic valve implantation in patients with
bicuspid aortic valve: Systematic review.
Source
International Journal of Cardiology. 176 (2) (pp 562-564), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ireland Ltd
<121>
Accession Number
2015714912
Authors
Zhang B.-C. Wang C. Li W.-H. Li D.-Y.
Institution
(Zhang, Wang, Li, Li) Department of Cardiology, The Affiliated Hospital of
Xuzhou Medical College, Xuzhou, Jiangsu, China
Title
Clinical outcome of drug-eluting versus bare-metal stents in patients with
calcified coronary lesions: A meta-analysis.
Source
Internal Medicine Journal. 45 (2) (pp 203-211), 2015. Date of Publication:
01 Feb 2015.
Publisher
Blackwell Publishing
Abstract
Background: The relative safety and efficacy of drug-eluting stents (DES)
versus bare-metal stents (BMS) in patients with calcified coronary lesions
is still debated. Aims: To evaluate clinical outcome of DES versus BMS in
patients with calcified coronary lesions using a meta-analysis of the
current literature. Methods: We performed a systematic literature search
using Medline, Embase, Cochrane and several other databases. Randomised
controlled trials, prospective and retrospective cohort studies with a
mean follow-up period >6 months were included. Primary efficacy was target
lesions revascularisation (TLR) and primary end-point for safety was stent
thrombosis. Secondary end-points were cardiac death and recurrent
myocardial infarction (MI). Results: Five trials were included in the
meta-analysis, including 2440 patients (1230 in the DES group, 1210 in the
BMS group). TLR was significantly lower in patients treated with DES as
compared with patients treated with BMS (8.5% vs 16.0%; odds ratio (OR) =
0.50; 95% confidence interval (CI) 0.38-0.65; P < 0.00001). There were no
significant differences in the incidence of stent thrombosis (0.9% vs
0.3%; OR = 2.01; 95% CI 0.34-11.88; P = 0.44), cardiac death (3.3% vs
4.2%; OR = 0.81; 95% CI 0.50-1.30; P = 0.38) and recurrent MI (5.0% vs
5.2%; OR = 0.99; 95% CI, 0.66-1.49; P = 0.97) between the two groups.
Subgroup analysis by the sample size and follow-up duration showed that
the associations were similar between DES versus BMS. Conclusions: DES
significantly reduces TLR rates as compared with BMS in patients with
calcified coronary lesions, with non-significant differences in terms of
stent thrombosis, cardiac death and MI.
<122>
Accession Number
2014869153
Authors
Thalji N.M. Suri R.M. Michelena H.I. Greason K.L. Dearani J.A. Daly R.C.
Joyce L.D. Stulak J.M. Burkhart H.M. Li Z. Schaff H.V.
Institution
(Thalji, Suri, Greason, Dearani, Daly, Joyce, Stulak, Burkhart, Schaff)
Division of Cardiovascular Surgery, Mayo Clinic, College of Medicine, 200
First St, SW, Rochester, MN, United States
(Michelena) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MI, United States
(Li) Department of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MI, United States
Title
Do differences in early hemodynamic performance of current generation
biologic aortic valves predict outcomes 1 year following surgery?.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (1) (pp 163-173),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objective: Small early postoperative hemodynamic differences were noted in
a randomized comparison of 3 current-generation bioprosthetic aortic
valves. Whether these differences persist and influence clinical outcomes
1 year following implantation is unknown. Methods: Three hundred adults
with severe aortic stenosis undergoing valve replacement were randomized
to receive the Epic (St Jude, St Paul, Minn) (n = 99), Magna (Edwards
LifeSciences Inc, Irvine, Calif) (n = 100), or Mitroflow (Sorin Biomedica
Spa, Saluggio, Italy) (n = 101) bioprostheses. Hemodynamic valve
performance was examined by echocardiography at 1 year, and clinical
outcomes were assessed in 241 patients (79 Epic, 77 Magna, and 85
Mitroflow; P = .437). Results: Mean age was 75 +/- 8 years and 164 were
men (68%). Between dismissal and 1 year there were 9 deaths (3.7%) (Epic:
3.7%, Magna: 5.0%, and Mitroflow: 2.3%; P = .654), 6 episodes of heart
failure (2.5%) (Epic: 1.3%, Magna: 1.3%, and Mitroflow: 5.8%; P = .265),
27 instances of atrial fibrillation/flutter (11.2%) (Epic: 8.1%, Magna:
11.0%, and Mitroflow: 7.9%; P = .577) and no strokes/transient ischemic
attacks. One-year echocardiography demonstrated small hemodynamic
differences between Epic, Magna, and Mitroflow bioprostheses in mean
gradient (15.2 +/- 5.5, 12.3 +/- 4.3, and 16.2 +/- 5.7 mm Hg,
respectively; P<.001) and indexed aortic valve area (0.93 +/- 0.28, 1.04
+/- 0.28, and 0.96 +/- -0.26 cm<sup>2</sup>/m<sup>2</sup>, respectively; P
= .015). Several early trends persisted when stratifying data by
echocardiographic annulus diameter, universal annulus size, and implant
size, particularly with annular size >23 mm. Overall left ventricular mass
index regression between dismissal and 1 year was -16.5 +/- 28.1 g/m2, and
was similar among groups (P = .262). There were no aortic valve
reoperations. Conclusions: Despite midterm persistence of small
hemodynamic differences amongst current-generation porcine and pericardial
aortic valves, our prospective randomized comparison reveals that clinical
outcomes and mass regression are equivalent between devices at 1 year.
These encouraging trends must continue to be assessed during longitudinal
follow-up.
<123>
Accession Number
2015718648
Authors
Bhargava S. Tamaskar A. Chakravarty N. Shende S. Shidhaye R.V.
Institution
(Bhargava, Tamaskar, Chakravarty, Shende, Shidhaye) Department of
Anesthesiology and Critical Care, L.N. Medical College, J.K. Hospital,
Kolar Road, Bhopal 462042, India
Title
Comparative study of thoracic epidural fentanyl with sufentanil for
postoperative pain relief in thoracic surgery.
Source
Anaesthesia, Pain and Intensive Care. 18 (3) (pp 260-264), 2015. Date of
Publication: 01 Jul 2014.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Objectives: Both fentanyl and sufentanil have been used, either alone or
with local anesthetics, for thoracic epidural analgesia. This study was
undertaken to compare quality and safety of thoracic epidural fentanyl and
thoracic epidural sufentanil for providing postoperative analgesia for 48
hours after thoracic surgery. Methodology: In a prospective randomized,
controlled study, 70 patients age group between 20-60 years, of either
gender, scheduled for routine thoracic surgery were randomly distributed
into two groups of 35 patients each. Postoperatively, fentanyl 50 mug in
Group-F and sufentanil 20 mug in Group-S, diluted in 10 ml of normal
saline was injected in the thoracic epidural space (between T6 - T8)
through the catheter and then repeated 6 hourly. Pain intensity score,
onset of analgesia, number of top-ups required and overall patient
satisfaction score were recorded. Results: Mean onset of analgesia was
10.31 +/- 1.5 min with sufentanil group as against 14.23 +/- 1.2 min with
fentanyl group. Pain Intensity (PPI) score < 1 was observed in 78.21%
observations belonging to sufentanil group and in 50 % observations
belonging to fentanyl group. Twenty five patients (71.4%) from sufentanil
group and 30 patients (85.7%) from fentanyl group required rescue
analgesia. The patient's feedback on pain relief was graded as very good
or good by 78.5% of the patients in Group-S and 69% patients in Group-F.
Conclusion: Though both drugs are equally safe, sufentanil is faster
acting, more potent and efficient analgesic than fentanyl when used for
postoperative pain relief in thoracic surgeries via thoracic epidural
approach.
<124>
Accession Number
2015722542
Authors
Jy W. Gomez-Marin O. Salerno T.A. Panos A.L. Williams D. Horstman L.L. Ahn
Y.S.
Institution
(Jy, Horstman, Ahn) Wallace H Coulter Platelet Laboratory, Miami, FL,
United States
(Gomez-Marin) Division of Hematology and Oncology, Department of Medicine,
Miami, FL, United States
(Jy, Salerno, Panos, Williams) Department of Surgery, Miller School of
Medicine, University of Miami, 1600 NW 10th Ave. R-36A, Miami, FL 33136,
United States
Title
Presurgical levels of circulating cell-derived microparticles discriminate
between patients with and without transfusion in coronary artery bypass
graft surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (1) (pp 305-311),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objectives: Improved understanding of presurgical risk factors for
transfusions will lead to reduction in their number and related
complications. The goal of this study is to identify these factors in
coronary artery bypass graft (CABG) surgery. Methods: Presented herein are
results of analyses of data from an ongoing study of transfusion in CABG
surgery. Of 122 patients, 81 received transfusion (Tx) and 41 did not
(NoTx). In addition to routine tests, presurgical levels of microparticles
from platelets (PMPs), red cells (RMPs), and other lineages were assayed.
Results: The Tx and NoTx groups were similar with respect to most
presurgical variables but differed in distribution of gender, blood type,
diabetes prevalence, activated partial thromboplastin time (aPTT),
hemoglobin (HGB), and microparticle levels. Stepwise multiple logistic
regression was used to evaluate presurgical variables and to develop a
model to assess risk factors for transfusion. CD41<sup>+</sup> PMP and
CD235<sup>+</sup> RMP levels were found to be the main risk factors for
transfusion. The Model's discriminating ability was assessed using
receiver operating characteristic curve analysis, which showed that the
area under the model curve (+/- standard error) was 0.86 +/- 0.04 (95%
confidence interval, 0.77-0.94). According to the model, patients with
higher presurgical levels of circulating CD41<sup>+</sup> PMP,
CD235a<sup>+</sup> RMP, and HGB, as well as a shorter aPTT, are less
likely to receive transfusion(s). Conclusions: Presurgical levels of
CD41<sup>+</sup> PMPs and CD235a<sup>+</sup> RMPs are the main risk
factors for transfusion in CABG, followed by HGB and aPTT.
<125>
Accession Number
2014873710
Authors
Ryerson L.M. Mackie A.S. Atallah J. Joffe A.R. Rebeyka I.M. Ross D.B.
Adatia I.
Institution
(Ryerson, Mackie, Joffe, Adatia) Department of Pediatrics, AB, Canada
(Atallah, Rebeyka, Ross) Department of Surgery, University of Alberta,
Edmonton, AB, Canada
(Ryerson) Stollery Children's Hospital, 3A3.19 WMC, 8440 112th St,
Edmonton, AB T6G 2B7, Canada
Title
Prophylactic peritoneal dialysis catheter does not decrease time to
achieve a negative fluid balance after the Norwood procedure: A randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (1) (pp 222-228),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objective: Infants and children who undergo cardiopulmonary bypass and
cardiac surgery are at risk of postoperative fluid overload. Peritoneal
dialysis catheter (PDC) and peritoneal dialysis are reported to be
effective means of postoperative fluid management. We sought to test the
hypothesis that PDC insertion in the operating room at the time of Norwood
palliation would decrease the time to achieve a negative fluid balance in
a group of neonates with hypoplastic left heart syndrome. Methods: A
single center randomized controlled trial was performed. We randomized
neonates with hypoplastic left heart syndrome to prophylactic PDC, with or
without dialysis, or standard care (ie, no PDC). Results: Twenty-two
neonates were included; 10 were randomized to PDC and 12 were randomized
to standard care. The mean time to first postoperative negative fluid
balance was 2.70 +/- 1.06 days for the prophylactic PDC group and 2.67 +/-
0.65 days for the standard care group (P = .93). There was no difference
between the 2 groups in time to lactate < 2 mmol/L, maximum
vasoactive-inotrope score on postoperative days 2 to 5, time to sternal
closure, time to first extubation, modified clinical outcome score, or
hospital length of stay. Twenty-one patients (95%) survived to hospital
discharge. Four patients randomized to prophylactic PDC had 1 or more
serious adverse events compared with no patients in the standard care
group (P = .03). Conclusions: Prophylactic PDC, with or without dialysis,
did not decrease the time to achieve a negative fluid balance after the
Norwood procedure, did not alter physiological variables postoperatively,
and was associated with more severe adverse events.
<126>
Accession Number
2015721759
Authors
Verheye S. Jolicoeur E.M. Behan M.W. Pettersson T. Sainsbury P. Hill J.
Vrolix M. Agostoni P. Engstrom T. Labinaz M. De Silva R. Schwartz M.
Meyten N. Uren N.G. Doucet S. Tanguay J.-F. Lindsay S. Henry T.D. White
C.J. Edelman E.R. Banai S.
Institution
(Verheye, Meyten) Antwerp Cardiovascular Center, Ziekenhuis Netwerk
Antwerpen Middelheim, Antwerp, United States
(Vrolix) Ziekenhuis Oost-Limburg Hospital, Genk, Belgium
(Jolicoeur, Doucet, Tanguay) Montreal Heart Institute, Montreal, Canada
(Labinaz) Ottawa Heart Institute, Ottawa, Canada
(Schwartz) Neovasc, Richmond, BC, Canada
(Behan, Uren) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Sainsbury, Lindsay) Bradford Royal Infirmary, Bradford, United Kingdom
(Hill) Kings College Hospital, United Kingdom
(De Silva) National Heart and Lung Institute, Imperial College London,
Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
(Pettersson) Kristianstad Central Hospital, Kristianstad, Sweden
(Agostoni) University Medical Center Utrecht, Utrecht, Netherlands
(Engstrom) Rigshospitalet, Copenhagen, United States
(Henry) Cedars-Sinai Medical Center, Los Angeles, United States
(White) John Ochsner Heart and Vascular Institute, University of
Queensland, Ochsner Clinical School, New Orleans, United States
(Edelman) Institute for Medical Engineering and Science, Massachusetts
Institute of Technology, Cambridge, MA, United States
(Edelman) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Banai) Tel Aviv Medical Center, Tel Aviv University, Medical School, 6
Weizman St., Tel Aviv 64239, Israel
Title
Efficacy of a device to narrow the coronary sinus in refractory Angina.
Source
New England Journal of Medicine. 372 (6) (pp 519-527), 2015. Date of
Publication: 05 Feb 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Many patients with coronary artery disease who are not
candidates for revascularization have refractory angina despite standard
medical therapy. The balloonexpandable, stainless steel, hourglass-shaped,
coronary-sinus reducing device creates a focal narrowing and increases
pressure in the coronary sinus, thus redistributing blood into ischemic
myocardium. METHODS: We randomly assigned 104 patients with Canadian
Cardiovascular Society (CCS) class III or IV angina (on a scale from I to
IV, with higher classes indicating greater limitations on physical
activity owing to angina) and myocardial ischemia, who were not candidates
for revascularization, to implantation of the device (treatment group) or
to a sham procedure (control group). The primary end point was the
proportion of patients with an improvement of at least two CCS angina
classes at 6 months. RESULTS: A total of 35% of the patients in the
treatment group (18 of 52 patients), as compared with 15% of those in the
control group (8 of 52), had an improvement of at least two CCS angina
classes at 6 months (P=0.02). The device was also associated with
improvement of at least one CCS angina class in 71% of the patients in the
treatment group (37 of 52 patients), as compared with 42% of those in the
control group (22 of 52) (P = 0.003). Quality of life as assessed with the
use of the Seattle Angina Questionnaire was significantly improved in the
treatment group, as compared with the control group (improvement on a
100-point scale, 17.6 vs. 7.6 points; P = 0.03). There were no significant
between-group differences in improvement in exercise time or in the mean
change in the wall-motion index as assessed by means of dobutamine
echocardiography. At 6 months, 1 patient in the treatment group had had a
myocardial infarction; in the control group, 1 patient had died and 3 had
had a myocardial infarction. CONCLUSIONS: In this small clinical trial,
implantation of the coronary-sinus reducing device was associated with
significant improvement in symptoms and quality of life in patients with
refractory angina who were not candidates for revascularization.
<127>
Accession Number
2015718959
Authors
Abdelaal E. Plourde G. Machaalany J. Arsenault J. Rimac G. Dery J.-P.
Barbeau G. Larose E. De Larochelliere R. Nguyen C.M. Allende R. Ribeiro H.
Costerousse O. Mongrain R. Bertrand O.F.
Institution
(Abdelaal, Plourde, Machaalany, Arsenault, Rimac, Dery, Barbeau, Larose,
De Larochelliere, Nguyen, Allende, Ribeiro, Costerousse, Bertrand) Quebec
Heart-Lung Institute, Laval University, Quebec City, QC, Canada
(Mongrain, Bertrand) Department of Mechanical Engineering, McGill
University, Montreal, QC, Canada
Title
Effectiveness of low rate fluoroscopy at reducing operator and patient
radiation dose during transradial coronary angiography and interventions.
Source
JACC: Cardiovascular Interventions. 7 (5) (pp 567-574), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to determine the efficacy of low rate
fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction
of operator and patient radiation dose during diagnostic coronary
angiography (DCA) and percutaneous coronary intervention (PCI) via the
transradial approach (TRA). Background TRA for cardiac catheterization is
potentially associated with increased radiation exposure. Low rate
fluoroscopy has the potential to reduce radiation exposure. Methods
Patients undergoing TRA diagnostic angiography +/- ad-hoc PCI were
randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure.
Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed
dose per pulse of 40 nGy. Primary endpoints were operator radiation dose
(measured with dosimeter attached to the left side of the thyroid shield
in muSievert [muSv]), patient radiation dose (expressed as dose-area
product in Gycm<sup>2</sup>), and fluoroscopy time. Results From October
1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent
DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with
15 FPS was associated with a significant reduction in operator dose (30%
relative reduction [RR], p < 0.0001); and in patient's dose-area product
(19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared
with 15 FPS was associated with significant reduction in operator dose
during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011).
Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with
substantial reduction in patients' dose-area product during DCA (26% RR; p
= 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar
in 7.5 FPS and 15 FPS groups for DCA (3.4 +/- 2.0 min vs. 4.0 +/- 4.7 min;
p = 0.42) and PCI (11.9 +/- 8.4 min vs. 13.3 +/- 9.7 min; p = 0.57),
respectively. Conclusions Fluoroscopy at 7.5 FPS, compared with 15 FPS, is
a simple and effective method in reducing operator and patient radiation
dose during TRA DCA and PCI.
<128>
Accession Number
2015718957
Authors
Al Ali J. Franck C. Filion K.B. Eisenberg M.J.
Institution
(Al Ali) Division of Cardiology, McGill University Health Center,
Montreal, QC, Canada
(Franck, Filion, Eisenberg) Center for Clinical Epidemiology, Lady Davis
Institute for Medical Research, Jewish General Hospital, Montreal, QC,
Canada
(Filion) Division of Clinical Epidemiology, McGill University, Montreal,
QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with first-generation drug-eluting stents: A meta-analysis of
randomized controlled trials.
Source
JACC: Cardiovascular Interventions. 7 (5) (pp 497-506), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to compare the efficacy of coronary artery
bypass graft surgery (CABG) to that of percutaneous coronary intervention
(PCI) with first-generation drug-eluting stents among patients with
multivessel disease (MVD), unprotected left main (LM) disease, and
single-vessel proximal left anterior descending (LAD) disease. Background
The efficacy and safety of CABG versus PCI with drug-eluting stents in
patient subgroups remains controversial. Methods We systematically
searched Cardiosource, Circulation, Clinicaltrials.gov, the Cochrane
Library, EMBASE, and Medline for articles published through June 2013 for
randomized controlled trials comparing CABG with PCI. Primary endpoints
included mortality, myocardial infarction, revascularization, and stroke.
Data were meta-analyzed with random-effects models. Results We identified
7 randomized controlled trials (N = 5,835): 2 of MVD (n = 2,410, 100%
diabetic), 2 of LM disease (n = 1,206, 29.0% diabetic), 1 of 3-vessel or
LM disease (n = 1,900, 25.5% diabetic), and 2 of single-vessel proximal
LAD disease (n = 319, 36.3% diabetic). In MVD patients, CABG reduced the
risk of mortality (risk ratio [RR]: 0.70, 95% confidence interval [CI]:
0.57 to 0.87), myocardial infarction (RR: 0.47, 95% CI: 0.36 to 0.61), and
repeat revascularization (RR: 0.36, 95% CI: 0.24 to 0.52), but increased
stroke risk (RR: 1.72, 95% CI: 1.02 to 2.90). In patients with LM disease,
CABG reduced revascularization risk (RR: 0.60, 95% CI: 0.46 to 0.78) and
increased stroke risk (RR: 2.89, 95% CI: 1.15 to 7.27). Data for patients
with single-vessel proximal LAD disease were inconclusive. Conclusions
CABG is more efficacious than is PCI with first-generation drug-eluting
stents in patients with LM and MVD, at the cost of increased rates of
stroke. No conclusion can be drawn for patients with single-vessel
proximal LAD disease.
<129>
Accession Number
2015717325
Authors
Jang J.-S. Song Y.-J. Kang W. Jin H.-Y. Seo J.-S. Yang T.-H. Kim D.-K. Cho
K.-I. Kim B.-H. Park Y.H. Je H.-G. Kim D.-S.
Institution
(Jang, Song, Kang, Jin, Seo, Yang, Kim, Kim) Department of Cardiology,
Busan Paik Hospital, University of Inje College of Medicine, Busan, South
Korea
(Cho) Department of Cardiology, Kosin University Medical Center, Busan,
South Korea
(Kim) Department of Cardiology, Pusan National University Hospital, Busan,
South Korea
(Park, Je) Department of Cardiology and Cardiovascular Surgery, Pusan
National University Yangsan Hospital, Yangsan, South Korea
Title
Intravascular ultrasound-guided implantation of drug-eluting stents to
improve outcome: A meta-analysis.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 233-243), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this study was to systematically review and perform
a meta-analysis of randomized trials and observational studies of
intravascular ultrasound (IVUS)-guided versus angiography-guided
implantation of drug-eluting stents (DES). Background Although studies in
the bare-metal stents era suggested that there were clinical benefits to
IVUS guidance, it is still controversial whether percutaneous coronary
intervention (PCI) with DES guided by IVUS leads to better clinical
outcomes. Methods Relevant studies published through March 31, 2013, were
searched for and identified in the electronic databases. Summary estimates
were obtained using a random-effects model. Results From 138 initial
citations, 3 randomized trials and 12 observational studies with 24,849
patients (11,793 IVUS-guided and 13,056 angiography-guided) were included
in this study. Comparison of IVUS- versus angiography-guided PCI disclosed
odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence
interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also
associated with significantly lower rates of all-cause mortality (OR:
0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57;
95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR:
0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95%
CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched
studies demonstrated similar results in terms of clinical outcomes, but
not repeat revascularization. Conclusions IVUS-guided DES implantation is
associated with significantly lower rates of adverse clinical events
compared with angiography guidance. Further study is needed to clarify
which subgroups of subjects with IVUS guidance will have greater benefit.
<130>
Accession Number
2015723256
Authors
Gomez-Outes A. Suarez-Gea M.L. Lecumberri R. Terleira-Fernandez A.I.
Vargas-Castrillon E.
Institution
(Gomez-Outes, Suarez-Gea) Division of Pharmacology and Clinical
Evaluation, Medicines for Human Use, Spanish Agency for Medicines and
Medical Devices (AEMPS), Madrid, Spain
(Lecumberri) Department of Hematology, University Clinic of Navarra,
Pamplona, Spain
(Terleira-Fernandez, Vargas-Castrillon) Department of Clinical
Pharmacology, Hospital Clinico, Madrid, Spain
(Terleira-Fernandez, Vargas-Castrillon) Department of Pharmacology,
Universidad Complutense, Madrid, Spain
Title
Specific antidotes in development for reversal of novel anticoagulants: A
review.
Source
Recent Patents on Cardiovascular Drug Discovery. 9 (1) (pp 2-10), 2014.
Date of Publication: 01 Dec 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
In the last decade, several direct oral anticoagulants (DOAC; dabigatran,
rivaroxaban, apixaban, edoxaban) have been marketed for prophylaxis and/or
treatment of thromboembolism without having specific antidotes available
for their reversal. Current management of bleeding associated to DOAC
includes the removal of all antithrombotic medications and supportive
care. Non-specific procoagulant agents (prothrombin complex concentrates
and activated factor VIIa) have been used in case of serious bleeding.
Currently, some specific antidotes for the DOAC are under development.
Idarucizumab (BI 655075; Boehringer Ingelheim) is a fragment of an
antibody (Fab), which is a specific antidote to the oral direct thrombin
inhibitor dabigatran. Andexanet alfa (r-Antidote, PRT064445; Portola
Pharmaceuticals) is a truncated form of enzymatically inactive factor Xa,
which binds and reverses the anticoagulant action of the factor Xa
inhibitors (e.g.: rivaroxaban, apixaban and edoxaban). Aripazine (PER-977,
ciraparantag; Perosphere Inc.) is a synthetic small molecule (~500 Da)
that reverses oral dabigatran, apixaban, rivaroxaban, as well as
subcutaneous fondaparinux and LMWH in vivo. These antidotes could provide
an alternative for management of life-threatening bleeding events
occurring with the above-mentioned anticoagulants. In addition, the
specific antidote anivamersen (RB007; Regado Biosciences Inc.) is an RNA
aptamer in clinical development to reverse the anticoagulant effect of the
parenteral factor IXa inhibitor pegnivacogin, which is also in
development. This anticoagulant-antidote pair may provide an alternative
in situations in which a fast onset and offset of anticoagulation is
needed, like in patients undergoing cardiac surgery with extracorporeal
circulation, as an alternative to the heparin/protamine pair. This patent
review includes a description of the pharmacological characteristics of
the novel specific antidotes, the available results from completed
non-clinical and clinical studies and the description of ongoing clinical
trials with the new compounds.
<131>
Accession Number
2015717405
Authors
Sabate M. Raber L. Heg D. Brugaletta S. Kelbaek H. Cequier A. Ostojic M.
Iniguez A. Tuller D. Serra A. Baumbach A. Von Birgelen C.
Hernandez-Antolin R. Roffi M. Mainar V. Valgimigli M. Serruys P.W. Juni P.
Windecker S.
Institution
(Sabate, Brugaletta) University Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
(Raber, Windecker) Swiss Cardiovascular Center, Bern University Hospital,
Bern, Switzerland
(Heg, Juni) Department of Clinical Research, Institute of Social and
Preventive Medicine, University of Bern, Bern, Switzerland
(Kelbaek) Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen,
Denmark
(Cequier) University Hospital of Bellvitge, Barcelona, Spain
(Ostojic) Clinical Center of Serbia, Belgrade, Serbia
(Iniguez) Hospital Do Meixoeiro, Vigo, Spain
(Tuller) Cardiology Department, Triemlispital, Zurich, Switzerland
(Serra) University Hospital of Sant Pau, Barcelona, Spain
(Baumbach) Bristol Heart Institute, Bristol, United Kingdom
(Von Birgelen) Thoraxcentrum Twente, Twente University, Enschede,
Netherlands
(Hernandez-Antolin) University Hospital San Carlos, Madrid, Spain
(Roffi) Cardiocentro, Lugano, Switzerland
(Mainar) Hospital General of Alicante, Alicante, Spain
(Valgimigli) University Hospital Ferrara, Ferrara, Italy
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
Title
Comparison of newer-generation drug-eluting with bare-metal stents in
patients with acute st-segment elevation myocardial infarction: A pooled
analysis of the EXAMINATION (clinical evaluation of the xience-V stent in
acute myocardial INfArcTION) and COMFORTABLE-AMI (comparison of biolimus
eluted from an erodible stent coating with bare metal stents in acute
ST-elevation myocardial infarction) trials.
Source
JACC: Cardiovascular Interventions. 7 (1) (pp 55-63), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to study the efficacy and safety of
newer-generation drug-eluting stents (DES) compared with bare-metal stents
(BMS) in an appropriately powered population of patients with ST-segment
elevation myocardial infarction (STEMI). Background Among patients with
STEMI, early generation DES improved efficacy but not safety compared with
BMS. Newer-generation DES, everolimus-eluting stents, and biolimus
A9-eluting stents, have been shown to improve clinical outcomes compared
with early generation DES. Methods Individual patient data for 2,665 STEMI
patients enrolled in 2 large-scale randomized clinical trials comparing
newer-generation DES with BMS were pooled: 1,326 patients received a
newer-generation DES (everolimus-eluting stent or biolimus A9-eluting
stent), whereas the remaining 1,329 patients received a BMS.
Random-effects models were used to assess differences between the 2 groups
for the device-oriented composite endpoint of cardiac death, target-vessel
reinfarction, and target-lesion revascularization and the patient-oriented
composite endpoint of all-cause death, any infarction, and any
revascularization at 1 year. Results Newer-generation DES substantially
reduce the risk of the device-oriented composite endpoint compared with
BMS at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]:
0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented
composite endpoint was lower with newer-generation DES than BMS (RR: 0.78;
95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation
DES were driven by both a lower risk of repeat revascularization of the
target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p < 0.0001) and a lower
risk of target-vessel infarction (RR: 0.36; 95% CI: 0.14 to 0.92; p =
0.03). Newer-generation DES also reduced the risk of definite stent
thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMS.
Conclusions Among patients with STEMI, newer-generation DES improve safety
and efficacy compared with BMS throughout 1 year. It remains to be
determined whether the differences in favor of newer-generation DES are
sustained during long-term follow-up.
<132>
Accession Number
2015717361
Authors
Brooks W.H. Jones M.R. Gisler P. McClure R.R. Coleman T.C. Breathitt L.
Spear C.
Institution
(Brooks, Jones, Gisler, Coleman, Breathitt, Spear) Baptist Health
Lexington, Neurosurgical Associates, 1780 Nicholasville Road, Lexington,
KY 40503, United States
(McClure) Department of Cardiology, University of Kentucky, Lexington, KY,
United States
Title
Carotid angioplasty with stenting versus endarterectomy: 10-year
randomized trial in a community hospital.
Source
JACC: Cardiovascular Interventions. 7 (2) (pp 163-168), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives This single-center, randomized, clinical trial was designed to
determine the 10-year comparative efficacy and durability of carotid
angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in
preventing ipsilateral ischemic stroke in symptomatic and asymptomatic
patients with high-grade carotid artery stenosis. Background Modern
clinical trials with short-term follow-up indicate CAS and CEA are
equivalent in reducing the risk for ipsilateral ischemic stroke secondary
to carotid stenosis. A paucity of data exists regarding long-term
outcomes. Methods Patients of all surgical risks with symptomatic and
asymptomatic carotid stenosis (>70%) were randomly selected for CEA or CAS
and followed a minimum of 10 years. Results Long-term follow-up was
achieved in 173 patients (91%). Eighty-seven (50.2%) died within this
period, most commonly of nonvascular causes. No difference in the risk of
stroke ipsilateral to the treated artery was noted among treatment groups
(p > 0.05). Restenosis determined by sequential ultrasound was assessed
only in the CAS group (3.3%) and remained asymptomatic. The combined risk
of fatal or nonfatal heart attack over the 10-year period was highest in
individuals with symptomatic versus asymptomatic stenosis (27.5% vs.
11.0%; hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.298 to
4.146, p = 0.005) and was higher in all patients treated with CEA (HR:
2.27, 95% CI: 1.35 to 3.816, p = 0.002). Conclusions Long-term protection
against ipsilateral stroke provided by CAS and CEA did not differ in this
trial. The 10-year risk of fatal/nonfatal myocardial infarction was
highest in all patients harboring symptomatic carotid stenosis at
enrollment. The risk of fatal/nonfatal heart attack was significantly more
prevalent in those symptomatic or asymptomatic patients randomized to CEA.
<133>
Accession Number
2015714170
Authors
Panchal H.B. Ladia V. Amin P. Patel P. Veeranki S.P. Albalbissi K. Paul T.
Institution
(Panchal, Ladia, Amin, Albalbissi, Paul) Department of Internal Medicine,
East Tennessee State University, Johnson City, TN, United States
(Patel) Department of Pathology, University of Tennessee, Knoxville, TN,
United States
(Veeranki) Division of Epidemiology, Department of Preventive Medicine and
Community Health, University of Texas Medical Brach, Galveston, TX, United
States
Title
A meta-analysis of mortality and major adverse cardiovascular and
cerebrovascular events in patients undergoing transfemoral versus
transapical transcatheter aortic valve implantation using edwards valve
for severe aortic stenosis.
Source
American Journal of Cardiology. 114 (12) (pp 1882-1890), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
The purpose of this meta-analysis was to compare 1 year mortality and
major adverse cardiovascular and cerebrovascular events between
transfemoral (TF) transcatheter aortic valve implantation (TAVI) and
transapical (TA) TAVI performed using Edwards valves. PubMed, Embase, and
the Cochrane Center Register of Controlled Trials were searched for
studies published from January 2000 through March 2014. Seventeen studies
met the inclusion criteria and were included in the analysis. This
meta-analysis included total of 2,978 patients with severe aortic stenosis
not eligible for traditional surgical procedures who underwent TF TAVI (n
= 1,465) or TA TAVI (n = 1,513). End points were in-hospital, 30-day, and
1-year all-cause mortality, stroke, myocardial infarction, major bleeding,
and major vascular complications. Odds ratios (ORs) with 95% confidence
interval (CIs) were computed, and p values <0.05 were considered to
indicate statistical significance. The studies were homogenous for all
outcomes except 1-year mortality. There was no significant difference
between the TF and TA TAVI groups for 1-year mortality (OR 0.64, 95% CI
0.34 to 1.2, p = 0.16), incidence of stroke (OR 1.14, 95% CI 0.76 to 1.71,
p = 0.52), incidence of myocardial infarction (OR 0.62, 95% CI 0.23 to
1.7, p = 0.35), and incidence of bleeding events (OR 0.76, 95% CI 0.51 to
1.14, p = 0.19). Thirty-day all-cause mortality was significantly less
with TF TAVI compared with TA TAVI (OR 0.59, 95% CI 0.45 to 0.76, p
<0.0001). Major vascular events were significantly higher in the TF TAVI
group compared with the TA TAVI group (OR 4.33, 95% CI 3.14 to 5.97, p
<0.00001). In conclusion, the results of this meta-analysis of 2,978
patients revealed that TA TAVI had similar 1-year major adverse
cardiovascular and cerebrovascular events, fewer major vascular
complications, but higher 30-day mortality compared with TF TAVI. In
patients with contraindications to TF TAVI, TA TAVI is a reasonable
option, although further randomized trials are warranted for evaluating
long-term clinical outcomes between TF and TA TAVI.
<134>
Accession Number
2014747739
Authors
Alfredsson J. Clayton T. Damman P. Fox K.A.A. Fredriksson M. Lagerqvist B.
Wallentin L. De Winter R.J. Swahn E.
Institution
(Alfredsson, Fredriksson, Swahn) Department of Medicine and Health
Sciences, Faculty of Health Sciences, Linkoping University, Linkoping SE
581 85, Sweden
(Clayton) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Damman, De Winter) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Fox) Cardiovascular Research, Department of Medical and Radiological
Sciences, Royal Infirmary, Edinburgh, United Kingdom
(Lagerqvist, Wallentin) Department of Cardiology, Cardiothoracic Centre,
University Hospital, Uppsala, Sweden
Title
Impact of an invasive strategy on 5 years outcome in men and women with
non-ST-segment elevation acute coronary syndromes.
Source
American Heart Journal. 168 (4) (pp 522-529), 2014. Date of Publication:
01 Oct 2014.
Publisher
Mosby Inc.
Abstract
Background A routine invasive (RI) strategy in non-ST-segment elevation
acute coronary syndromes (NSTE ACS) has been associated with better
outcome compared with a selective invasive (SI) strategy in men, but
results in women have yielded disparate results. The aim of this study was
to assess gender differences in long-term outcome with an SI compared with
an RI strategy in NSTE ACS. Methods Individual patient data were obtained
from the FRISC II trial, ICTUS trial, and RITA 3 trial for a collaborative
meta-analysis. Results Men treated with an RI strategy had significantly
lower rate of the primary outcome 5-year cardiovascular (CV)
death/myocardial infarction (MI) compared with men treated with an SI
strategy (15.6% vs 19.8%, P =.001); risk-adjusted hazards ratio (HR) 0.73
(95% CI 0.63-0.86). In contrast, there was little impact of an RI compared
with an SI strategy on the primary outcome among women (16.5% vs 15.1%, P
=.324); risk-adjusted HR 1.13 (95% CI 0.89-1.43), interaction P =.01. For
the individual components of the primary outcome, a similar pattern was
seen with lower rate of MI (adjusted HR 0.69, 95% CI 0.57-0.83) and CV
death (adjusted HR 0.71, 95% CI 0.56-0.89) in men but without obvious
difference in women in MI (adjusted HR 1.13, 95% CI 0.85-1.50) or CV death
(adjusted HR 0.97, 95% CI 0.68-1.39). Conclusions In this meta-analysis
comparing an SI and RI strategy, benefit from an RI strategy during
long-term follow-up was confirmed in men. Conversely, in women, there was
no evidence of benefit.
<135>
Accession Number
2014729268
Authors
Jones W.S. Tricoci P. Huang Z. Moliterno D.J. Harrington R.A. Sinnaeve
P.R. Strony J. Van De Werf F. White H.D. Held C. Armstrong P.W. Aylward
P.E. Chen E. Patel M.R. Mahaffey K.W.
Institution
(Jones, Tricoci, Huang, Patel) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Moliterno) Gill Heart Institute, Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(Harrington, Mahaffey) Department of Medicine, Stanford University,
Stanford, CA, United States
(Sinnaeve, Van De Werf) Department of Cardiology, University of Leuven,
Leuven, Belgium
(Strony) Merck and Co, Whitehouse Station, NJ, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Held) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(Armstrong) Division of Cardiology, University of Alberta, Edmonton,
Canada
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
(Chen) Global Clinical Development, Bayer HealthCare Pharmaceuticals Inc,
Whippany, NJ, United States
Title
Vorapaxar in patients with peripheral artery disease and acute coronary
syndrome: Insights from Thrombin Receptor Antagonist for Clinical Event
Reduction in Acute Coronary Syndrome (TRACER).
Source
American Heart Journal. 168 (4) (pp 588-596), 2014. Date of Publication:
01 Oct 2014.
Publisher
Mosby Inc.
Abstract
Background In the TRACER trial, vorapaxar, a protease-activated receptor-1
antagonist, plus standard care in non-ST-segment elevation acute coronary
syndrome (NSTE ACS) patients did not significantly reduce the primary
composite end point but reduced a key secondary end point and
significantly increased bleeding. History of peripheral artery disease
(PAD) was a risk-enrichment inclusion criterion. We investigated the
efficacy and safety of vorapaxar in NSTE ACS patients with documented PAD.
Methods TRACER was a double-blind, randomized trial comparing vorapaxar
with placebo in 12,944 patients with NSTE ACS. Results In total, 936
(7.2%) patients had a history of PAD. Ischemic events occurred more
frequently among patients with PAD (25.3%) versus no PAD (12.2%, P <.001),
and Global Use of Strategies to Open Occluded Coronary Arteries
moderate/severe bleeding was more common in PAD (9.1%) versus no PAD
(5.0%, P =.004). Similar rates of the composite end point (cardiovascular
death, myocardial infarction, or stroke) occurred in patients with PAD
treated with vorapaxar and placebo (21.7% vs 24.8%, P interaction =.787).
Patients with PAD treated with vorapaxar, when compared with placebo, also
had a numerical reduction in peripheral revascularization procedures (8.1%
vs 9.0%, P =.158) and a lower extremity amputation rate (0.9% vs 1.5%, P
=.107). Vorapaxar increased Global Use of Strategies to Open Occluded
Coronary Arteries moderate/severe bleeding similarly in patients with PAD
(hazard ratio 1.47, 95% CI 0.89-2.45) and without (hazard ratio 1.48, 95%
CI 1.22-1.79; P interaction =.921). Conclusions Patients with NSTE ACS and
PAD were at increased risk for ischemic events. Lower rates of ischemic
end points, peripheral revascularization, and amputation with vorapaxar
did not reach statistical significance but warrant further investigation.
Vorapaxar increased bleeding in both patients with and without PAD at a
similar magnitude of risk.
<136>
Accession Number
71775653
Authors
Karmali S. Reyes A. Barnett S. Davies K. Moonesinghe R. John J. Haddad F.
Ackland G.
Institution
(Karmali, Reyes, Barnett, Moonesinghe) Centre for Anaesthesia, University
College London Hospital NHS Trust, Oswestry, United Kingdom
(Davies, John) Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS
Foundation Trust, Oswestry, United Kingdom
(Haddad) University College London Hospital NHS Trust, United Kingdom
(Ackland) Centre for Cardiovascular and Metabolic Neuroscience, University
College London, United Kingdom
Title
Frailty and postoperative morbidity following elective orthopaedic
surgery.
Source
Anaesthesia. Conference: Association of Anaesthetists of Great Britain and
Ireland, AAGBI WSM 2015 London United Kingdom. Conference Start: 20150114
Conference End: 20150116. Conference Publication: (var.pagings). 70 (pp
30), 2015. Date of Publication: January 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Frailty has emerged as an important measure of morbidity and mortality in
the general population [1]. The relationship between frailty and
postoperative outcomes remains unclear. This is partly due to lack of
reference to population norms. Our recent systematic review concluded that
more robust studies are required to establish whether objectively defining
frailty by measuring handgrip strength (HGS) preoperatively is associated
with poorer postoperative outcomes [2]. We hypothesized that abnormal HGS
would be associated with morbidity and prolonged length of hospital stay.
Methods This was a pilot sub-study of the POM-X (Post Operative
Morbidity-Vagus) study conducted in two centres (University College London
Hospital and Robert Jones and Agnes Hospital). After approval from the
Research and Ethics Committee and with informed consent, we measured left
and right HGS (noting hand dominance) using a calibrated dynamometer
(Jamar), in elective orthopaedic patients preoperatively and on
postoperative days (POD) three, five, seven and fourteen. HGS was defined
as normal or low, according to published population norms referenced to
age and gender. Postoperative morbidity, defined by the Postoperative
Morbidity Survey (POMS [3]), was recorded by observers blinded to HGS on
POD three, five, seven and fourteen. Absolute risk reduction (ARR) in
POMS-defined morbidity on POD three and five was the primary outcome. Time
to become morbidity free (TTMF) and length of stay (LOS) were also
compared between normal and low HGS (Cox regression, adjusting for gender,
hospital, operation, HGS, diabetes, cardiovascular disease and trial
intervention). Serial changes in HGS were also analyzed. Results
Preoperative HGS values within the population norm were recorded in 21/79
patients. Normal HGS was not associated with age, gender or hand
dominance. Normal HGS was not associated with reduced morbidity within 5
days postoperatively (ARR -19% (95% CI -43 to 6); p = 0.14). Unadjusted
LOS for normal HGS patients (Fig. 1) was not shorter (Hazard ratio: 1.23
(95% CI 0.73-2.1); p = 0.32). TTMF (p = 0.48) and LOS (p = 0.42) were not
associated with normal preoperative HGS. (Figure Presented) Discussion
Using population norms to define HGS in preoperative patients, we found no
evidence to support the hypothesis that low HGS is associated with
postoperative morbidity in this pilot study. We suggest that HGS - in the
absence of referencing to population norms - has been erroneously
associated with poorer surgical outcomes.
<137>
Accession Number
71778139
Authors
Sacco S. Ornello R. Ripa P. Pistoia F. Carolei A.
Institution
(Sacco) Department of Applied Clinical Sciences and Biotechnology,
University of L'Aquila, L'AQUILA, Italy
(Ornello, Ripa, Pistoia, Carolei) Department of Biotechnological and
Applied Clinical Sciences, University of L'Aquila, L'AQUILA, Italy
Title
EHMTI-0392. Migraine and risk of ischemic heart disease: A systematic
review and meta-analysis of observational studies.
Source
Journal of Headache and Pain. Conference: 4th European Headache and
Migraine Trust International Congress, EHMTIC 2014 Copenhagen Denmark.
Conference Start: 20140918 Conference End: 20140921. Conference
Publication: (var.pagings). 15 , 2014. Date of Publication: 18 Sep 2014.
Publisher
Springer-Verlag Italia s.r.l.
Abstract
Background: Several studies have assessed the possible increased risk of
ischemic heart diseases in migraineurs, drawing different conclusions.
Aim: To define and update the issue of the association between migraine
and ischemic heart disease we performed a systematic review and
metaanalysis of the available observational studies. Methods: Electronic
databases were systematically searched up to April 2014 for observational
studies dealing with the risk of any form of ischemic heart disease in
subjects with migraine. Results: Out of 3,348 records, we identified 15
studies which were included in the meta-analysis. The pooled analysis
indicated an increased risk of myocardial infarction (pooled adjusted
effect estimate 1.33, 95% CI 1.08-1.64; P=0.007) and of angina (pooled
adjusted effect estimate 1.29, 95% CI 1.17-1.43; P<0.0001) in subjects
with any migraine compared to non-migraineurs (Figure 1); subjects with
migraine with aura had an increased risk of myocardial infarction and of
angina (Figure 2). At variance, the pooled analysis did not indicate an
increased risk of ischemic heart disease or of coronary revascularization
procedures in subjects with any migraine compared to non-migraineurs
(Figure 1). Conclusions: Based on our data indicating an association of
migraine with myocardial infarction and angina and on previous data
showing an association of migraine, and particularly migraine with aura,
with an increased risk for stroke, migraine can be appropriately
considered an overall risk factor for cardiovascular diseases.
