Results Generated From:
Embase <1980 to 2015 Week 15>
Embase (updates since 2015-04-02)
<1>
Accession Number
2010633388
Authors
De Lemos J. Blazing M. Downs J.R. Gotto A. Clearfield M. Gordon D. Davis
B. Koren M. Dahlof B. Poulter N. Sever P. Knopp R.H. Fellstrom B. Holdaas
H. Jardine A. Schmieder R. Zannad F. Goldbourt U. Kaplinsky E. Colhoun
H.M. Betteridge D.J. Durrington P.N. Hitman G.A. Fuller J. Neil A. Wanner
C. Krane V. Sacks F. Moye L. Pfeffer M. Hawkins C.M. Barter P. Tavazzi L.
Marchioli R. Tognoni G. Franzosi M.G. Maggioni A. Bloomfield H. Robins S.
Pedersen T.R. Ridker P.M. Holman R. Meade T. MacMahon S. Tonkin A. Shaw J.
Serruys P.W. Nakamura H. Knatterud G. Furberg C. Byington R. Murphy M.
Blauw G.J. Packard C. Kjekshus J. Pedersen T. Wilhelmsen L. Braunwald E.
Cannon C. Murphy S. Armitage J. Bowman L. Parish S. Peto R. Sleight P.
Landray M. La Rosa J. Rossouw J. Probstfield J. Shepherd J. Cobbe S.
Macfarlane P. Ford I. Flather M. Kastelein J. Newman C. Shear C. Tobert J.
Varigos J. White H. Yusuf S. Mellies M. McGovern M. Barclay J. Belder R.
Mitchel Y. Musliner T. Ansquer J.-C. Llewellyn M. Bortolini M.
Brandrup-Wognsen G. Bryzinski B. Olsson G. Pears J. De Micco D. Baxter A.
Baigent C. Barnes E.H. Bhala N. Blackwell L. Buck G. Collins R. Emberson
J. Herrington W.G. Holland L.E. Kearney P.M. Keech A. Kirby A. Lewis D.A.
Marschner I. Pollicino C. Reith C. Simes J. Sourjina T.
Institution
(De Lemos, Braunwald, Blazing, Murphy) Phase Z, United States
(Downs, Gotto, Clearfield) AFCAPS/TEXCAPS (AirForce/Texas Coronary
Atherosclerosis Prevention Study), United States
(Holdaas) ALERT (Assessment of Lescol in Transplantation), United States
(Gordon, Davis) ALLHAT (Antihypertensive Lipid Lowering Heart Attack
Trial), United States
(Koren) ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac
Events), United States
(Dahlof, Poulter, Sever) ASCOT (Anglo-Scandinavian Cardiac Outcomes
Trial), United States
(Knopp) ASPEN, United States
(Fellstrom, Holdaas, Jardine, Schmieder, Zannad) AURORA, United States
(Goldbourt, Kaplinsky) BIP (Bezafibrate Infarction Prevention Study),
United States
(Colhoun, Betteridge, Durrington, Hitman, Fuller, Neil) CARDS
(Collaborative Atorvastatin Diabetes Study), United States
(Wanner, Krane) 4D (Die Deutsche Diabetes Dialyse Study), United States
(Sacks, Moye, Pfeffer) CARE (Cholesterol and Recurrent Events Study),
United States
(Barter, Keech) FIELD (Fenofibrate Intervention and Event Lowering in
Diabetes), United States
(Tavazzi, Maggioni) GISSI (Gruppo Italiano per Lo Studio della
Sopravvivenza nell'Infarto Miocardico)-Heart Failure, Italy
(Marchioli, Tognoni, Franzosi, Maggioni) GISSI-Prevention, Italy
(Bloomfield, Robins) HIT (Veteran Administration Low HDL Intervention
Trial), United States
(Collins, Armitage, Keech, Parish, Peto, Sleight) HPS (Heart Protection
Study), United States
(Pedersen) IDEAL (Incremental Decrease in Endpoints Through Aggressive
Lipid-lowering), United States
(Ridker) JUPITER, United States
(Holman) LDS (Lipids in Diabetes Study), United States
(Meade) LEADER (Lower Extremity Arterial Disease Event Reduction Trial),
United States
(Simes, Keech, MacMahon, Marschner, Tonkin, Shaw) LIPID (Long-term
Intervention with Pravastatin in Ischaemic Disease), United States
(Serruys) LIPS (Lescol Intervention Prevention Study), United States
(Nakamura) MEGA (Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese), United States
(Knatterud) Post-CABG (Post- Coronary Artery Bypass Graft Study), United
States
(Furberg, Byington) PPP (Pravastatin Pooling Project), United States
(Macfarlane, Cobbe, Ford, Murphy, Blauw, Packard, Shepherd) PROSPER
(Prospective Study of Pravastatin in the Elderly at Risk), United States
(Kjekshus, Pedersen, Wilhelmsen) 4S (Scandinavian Simvastatin Survival
Study), United States
(Braunwald, Cannon, Murphy) PROVE-IT (Pravastatin or Atorvastatin
Evaluation and Infection Therapy), United States
(Collins, Armitage, Bowman, Parish, Peto, Sleight) SEARCH (Study of
Effectiveness of Additional Reductions in Cholesterol and Homocysteine),
United States
(Baigent, Baxter, Collins, Landray) SHARP (Study of Heart and Renal
Protection), United States
(La Rosa) TNT (Testing New Targets), United States
(Rossouw, Probstfield) WHI (Women's Health Initiative), United States
(Shepherd, Cobbe, Macfarlane, Ford) WOSCOPS (West of Scotland Coronary
Prevention Study), United Kingdom
(Mellies, McGovern, Barclay, Belder) Bristol-Myers Squibb, United States
(Mitchel, Musliner) Merck, United States
(Ansquer) Laboratoires Fournier, United States
(Llewellyn) Bayer, United States
(Bortolini) Novartis Pharma, United States
(Brandrup-Wognsen, Bryzinski, Olsson, Pears) AstraZeneca, United States
(De Micco) Pfizer, United States
Title
Efficacy and safety of more intensive lowering of LDL cholesterol: A
meta-analysis of data from 170 000 participants in 26 randomised trials.
Source
The Lancet. 376 (9753) (pp 1670-1681), 2010. Date of Publication: 13 Nov
2010.
Publisher
Lancet Publishing Group
Abstract
Lowering of LDL cholesterol with standard statin regimens reduces the risk
of occlusive vascular events in a wide range of individuals. We aimed to
assess the safety and efficacy of more intensive lowering of LDL
cholesterol with statin therapy. We undertook meta-analyses of individual
participant data from randomised trials involving at least 1000
participants and at least 2 years' treatment duration of more versus less
intensive statin regimens (five trials; 39 612 individuals; median
follow-up 51 years) and of statin versus control (21 trials; 129 526
individuals; median follow-up 48 years). For each type of trial, we
calculated not only the average risk reduction, but also the average risk
reduction per 10 mmol/L LDL cholesterol reduction at 1 year after
randomisation. In the trials of more versus less intensive statin therapy,
the weighted mean further reduction in LDL cholesterol at 1 year was 051
mmol/L. Compared with less intensive regimens, more intensive regimens
produced a highly significant 15 (95 CI 11-18; p<00001) further reduction
in major vascular events, consisting of separately significant reductions
in coronary death or non-fatal myocardial infarction of 13 (95 CI 7-19;
p<00001), in coronary revascularisation of 19 (95 CI 15-24; p<00001), and
in ischaemic stroke of 16 (95 CI 5-26; p=0005). Per 10 mmol/L reduction in
LDL cholesterol, these further reductions in risk were similar to the
proportional reductions in the trials of statin versus control. When both
types of trial were combined, similar proportional reductions in major
vascular events per 10 mmol/L LDL cholesterol reduction were found in all
types of patient studied (rate ratio [RR] 078, 95 CI 076-080; p<00001),
including those with LDL cholesterol lower than 2 mmol/L on the less
intensive or control regimen. Across all 26 trials, all-cause mortality
was reduced by 10 per 10 mmol/L LDL reduction (RR 090, 95 CI 087-093;
p<00001), largely reflecting significant reductions in deaths due to
coronary heart disease (RR 080, 99 CI 074-087; p<00001) and other cardiac
causes (RR 089, 99 CI 081-098; p=0002), with no significant effect on
deaths due to stroke (RR 096, 95 CI 084-109; p=05) or other vascular
causes (RR 098, 99 CI 081-118; p=08). No significant effects were observed
on deaths due to cancer or other non-vascular causes (RR 097, 95 CI
092-103; p=03) or on cancer incidence (RR 100, 95 CI 096- 104; p=09), even
at low LDL cholesterol concentrations. Further reductions in LDL
cholesterol safely produce definite further reductions in the incidence of
heart attack, of revascularisation, and of ischaemic stroke, with each 10
mmol/L reduction reducing the annual rate of these major vascular events
by just over a fifth. There was no evidence of any threshold within the
cholesterol range studied, suggesting that reduction of LDL cholesterol by
2-3 mmol/L would reduce risk by about 40-50. UK Medical Research Council,
British Heart Foundation, European Community Biomed Programme, Australian
National Health and Medical Research Council, and National Heart
Foundation.
<2>
Accession Number
2015866980
Authors
Mikus E. Grattoni C. Fiore F. Conte M. Coppola R. Chierchia S. Bosi S.
Jori M.C. Castriota F. Del Giglio M.
Institution
(Mikus, Del Giglio) Department of Cardiothoracic and Vascular Surgery,
Maria Cecilia Hospital, GVM Care and Research, Via Corriera 1, Cotignola
RA 48010, Italy
(Grattoni, Castriota) Interventional Cardio-Angiology, Maria Cecilia
Hospital, GVM Care and Research, Cotignola, RA, Italy
(Fiore) Intensive Care Unit, Anthea Hospital, GVM Care and Research, Bari,
Italy
(Conte) Intensive Care Unit, Maria Cecilia Hospital, GVM Care and
Research, Cotignola, RA, Italy
(Coppola, Chierchia) Department of Cardiothoracic and Vascular Surgery,
ICLAS, Rapallo, GE, Italy
(Bosi) Department of Cardiology, Maria Cecilia Hospital, GVM Care and
Research, Cotignola, RA, Italy
(Jori) Clinical Research Unit, ES Health Science Foundation, Cotignola,
RA, Italy
Title
Hybrid coronary artery revascularization: Initial experience of a single
centre.
Source
European Heart Journal, Supplement. 17 (pp A38-A42), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Oxford University Press
Abstract
Current guidelines recommend coronary bypass grafting (CABG) as the
treatment of choice for patients with triple vessel and left main disease,
although the growing use of drug-eluting stents (DES) has significantly
reduced the rate of restenosis and extended the use of percutaneous
coronary interventions (PCIs). Hybrid coronary revascularization (HCR)
integrates the positive features of both PCI and CABG. We present
preliminary results of a prospective study designed to verify the
selection of candidates for treatment with hybrid approach. Between
September 2011 and August 2014, 42 patients [(M = 37 (88.1%); mean age
68.6 +/- 10.3 years, range 53-90] were selected to receive a complete (all
lesions of main vessels treated) coronary revascularization with a hybrid
approach at our Institution. Age-creatinine-ejection-fraction score was
high (>1.277) in 16 (38%) patients, median 1.2 (0.77; 2.89). All patients
underwent off-pump single-vessel revascularization (left internal thoracic
artery to the left anterior descending coronary artery) using a
left-anterior small thoracotomy and percutaneous coronary angioplasty.
Eighteen patients (42.8%) underwent a simultaneous hybrid approach.
Drug-eluting stents were used to treat 49 lesions, were also implanted 6
(7.6%) bioabsorbable stents. Procedural success was obtained in 41 (97.6%)
patients. No conversion to full sternotomy and no blood transfusions were
necessary during surgery. Median ventilation time was 7.7 (3-33) h and
median hospital length of stay was 6 days (3-14). All patients were alive
at discharge. Our early experience with HCR shows encouraging results.
Randomized studies on a larger series with a longer follow-up are
required.
<3>
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Accession Number
2014747565
Authors
Sia J. Nammas W. Niemela M. Airaksinen J.K.E. Lalmand J. Laine M.
Tedjokusumo P. Nyman K. Biancari F. Karjalainen P.P.
Institution
(Sia) Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
(Nammas, Karjalainen) Heart Center, Satakunta Central Hospital, Department
of Cardiology, Sairaalantie 3, Pori FIN-28100, Finland
(Niemela) Department of Internal Medicine, Division of Cardiology,
University of Oulu, Oulu, Finland
(Airaksinen) Department of Medicine, Turku University Hospital, Turku,
Finland
(Lalmand) Department of Cardiology, CHU de Charleroi, Charleroi, Belgium
(Laine) Helsinki University Hospital, Helsinki, Finland
(Tedjokusumo) Department of Cardiology and Vascular Medicine, Dr. Hasan
Sadikin Hospital, Bandung, Indonesia
(Nyman) Department of Cardiology, Jyvaskyla Central Hospital, Jyvaskyla,
Finland
(Biancari) Division of Cardiothoracic and Vascular Surgery, Department of
Surgery, University of Oulu, Oulu, Finland
Title
Gender-based analysis of randomized comparison of bioactive versus
everolimus-eluting stents in acute coronary syndrome.
Source
Journal of Cardiovascular Medicine. 16 (3) (pp 197-203), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Aims: The randomized comparison of titanium-nitrideoxidecoated bioactive
stent with everolimus-eluting stent in acute coronary syndrome (BASE-ACS)
trial demonstrated an outcome of the titanium-nitride-oxide coated
bioactive stents (BASs) that was statistically noninferior to that of the
everolimus-eluting stents (EESs) at 12-month follow-up, in patients
presenting with acute coronary syndrome (ACS) who underwent early
percutaneous coronary intervention. We performed a post-hoc gender-based
analysis of the BASE-ACS trial at 24-month follow-up. Methods: A total of
827 patients (198 women) with ACS were randomly assigned to receive either
BAS or EES. The primary endpoint was a composite of cardiac death,
nonfatal myocardial infarction (MI), or ischemia-driven target lesion
revascularization. Results: Women were older, and more likely to have
diabetes and hypertension compared with men (P<0.05 for all). Moreover,
women had significantly smaller reference vessel diameter and stent
diameter (P<0.05 for all). At 24-month follow-up, the cumulative incidence
of the primary endpoint was similar between the two sex subgroups (15.2
versus 11.0%, for women versus men, respectively, P=0.13). However, the
rate of nonfatal MI was significantly higher in women compared with men
(8.6 versus 3.8%, respectively, P=0.007). After propensity score-adjusted
analysis, there was a trend toward more nonfatal MI among women (8.6
versus 4.0%, respectively, P=0.08). Moreover, among male patients, those
assigned to BAS had significantly lower nonfatal MI compared with those
assigned to EES (P=0.027). However, among patients assigned to EES, female
patients had a significantly higher rate of nonfatal MI compared with men
(P=0.02). Conclusion: In the current post-hoc gender-based analysis of the
BASE-ACS trial, the 24-month outcome of patients undergoing percutaneous
coronary intervention for ACS was slightly worse in women, compared with
men, as reflected by a trend toward more nonfatal MI events after
propensity score-adjusted analysis.
<4>
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Accession Number
2015868314
Authors
Bagai A. Wang Y. Wang T.Y. Curtis J.P. Gurm H.S. Shah B. Cheema A.N.
Peterson E.D. Saucedo J.F. Granger C.B. Roe M.T. Bhatt D.L. McNamara R.L.
Alexander K.P.
Institution
(Bagai, Cheema) Terrence Donnelly Heart Center, Department of Medicine,
University of Toronto, Toronto, ON, Canada
(Wang, Curtis, McNamara) Section of Cardiovascular Medicine, Department of
Internal Medicine, Yale University School of Medicine, New Haven, CT,
United States
(Wang, Peterson, Granger, Roe, Alexander) Duke Clinical Research
Institute, Durham, NC, United States
(Gurm) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, United States
(Shah) New York University School of Medicine, United States
(Saucedo) NorthShore University Health System, Evanston, IL, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
Title
In-hospital switching between clopidogrel and prasugrel among patients
with acute myocardial infarction treated with percutaneous coronary
intervention: Insights into contemporary practice from the national
cardiovascular data registry.
Source
Circulation: Cardiovascular Interventions. 7 (4) (pp 585-593), 2014. Date
of Publication: 01 Aug 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Although randomized clinical trials have compared clopidogrel
with higher potency ADP receptor inhibitors (ADPris) among patients with
myocardial infarction, little is known about the frequency and factors
associated with switching between ADPris in clinical practice. Methods and
Results-We studied 47 040 patients with myocardial infarction treated with
percutaneous coronary intervention, who received either clopidogrel or
prasugrel within 24 hours of admission at 361 US hospitals from July 2009
to June 2011 using the merged Acute Coronary Treatment and Intervention
Outcomes Network Registry-Get With the Guidelines and CathPCI Registry
database. Hierarchical logistic regression modeling was used to determine
factors independently associated with in-hospital ADPri switching. Among
40 531 patients treated initially in-hospital with clopidogrel, 2125
(5.2%) were discharged on prasugrel; this frequency steadily increased
from 0% to 7% during the study period. Among 6509 patients treated
initially in-hospital with prasugrel, 751 (11.5%) were discharged on
clopidogrel. The frequency of this switch increased from 6% to 18% during
the first 2 quarters of the study period and decreased to 9% by the end.
Switching clopidogrel to prasugrel was associated with high-risk
angiographic characteristics (thrombotic, long, and bifurcating lesions),
reinfarction in-hospital, and private health insurance coverage. Older
age, previous cerebrovascular event, in-hospital coronary artery bypass
grafting, in-hospital bleeding, and warfarin use at discharge were
associated with switching prasugrel to clopidogrel.
Conclusions-Clopidogrel and prasugrel are not uncommonly switched
in-hospital in patients with myocardial infarction undergoing percutaneous
coronary intervention. In contemporary US practice, in addition to risk
for bleeding and recurrent ischemic events, medical drug coverage is a
major determinant of ADPri selection.
<5>
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Accession Number
2015868306
Authors
Bangalore S. Toklu B. Feit F.
Institution
(Bangalore, Feit) Division of Cardiology, New York University School of
Medicine, New York, NY 10016, United States
(Toklu) Division of Cardiology, Virginia Commonwealth University,
Richmond, United States
Title
Outcomes with coronary artery bypass graft surgery versus percutaneous
coronary intervention for patients with diabetes mellitus: Can newer
generation drug-eluting stents bridge the gap?.
Source
Circulation: Cardiovascular Interventions. 7 (4) (pp 518-525), 2014. Date
of Publication: 01 Aug 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Coronary artery bypass graft surgery (CABG) compared with
percutaneous coronary intervention (PCI) reduces mortality in patients
with diabetes mellitus. However, prior trials compared CABG with balloon
angioplasty or older generation stents, and it is not known if the gap
between CABG and PCI can be reduced by newer generation drugeluting
stents. Methods and Results-PUBMED/EMBASE/CENTRAL search for randomized
trials comparing mode of revascularization in patients with diabetes
mellitus. Primary outcome was all-cause mortality. Secondary outcomes were
myocardial infarction, repeat revascularization, and stroke. Mixed
treatment comparison analyses were performed using a randomeffects Poisson
regression model. Sixty-eight randomized trials that enrolled 24 015
diabetic patients with a total of 71 595 patient-years of follow-up
satisfied our inclusion criteria. When compared with CABG (reference rate
ratio [RR]=1.0), PCI with paclitaxel-eluting stent (RR=1.57 [1.15-2.19])
or sirolimus-eluting stent (RR=1.43 [1.06-1.97]) was associated with an
increase in mortality. However, PCI with cobalt-chromium
everolimus-eluting stent (RR=1.11 [0.67-1.84]) was not associated with a
statistically significant increase in mortality. When compared with CABG,
there was excess repeat revascularization with PCI, which progressively
declined from plain old balloon angioplasty (341% increase) to bare metal
stent (218% increase) to paclitaxel-eluting stent (81% increase) and to
sirolimus-eluting stent (47% increase). However, for PCI with
cobalt-chromium everolimus-eluting stent (RR=1.31 [0.74-2.29]), the excess
repeat revascularization was not statistically significant although the
point estimate favored CABG. CABG was associated with numerically higher
stroke. Conclusions-In patients with diabetes mellitus, evidence from
indirect comparison shows similar mortality between CABG and PCI using
cobalt-chromium everolimus-eluting stent. CABG was associated with
numerically excess stroke and PCI with cobalt-chromium everolimus-eluting
stent with numerically increased repeat revascularization. This hypothesis
needs to be tested in future trials.
<6>
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Accession Number
2014963194
Authors
Mu J.L. Lee A. Joynt G.M.
Institution
(Mu, Lee, Joynt) Department of Anaesthesia and Intensive Care, Chinese
University of Hong Kong, Shatin, Hong Kong
Title
Pharmacologic agents for the prevention and treatment of delirium in
patients undergoing cardiac surgery: Systematic review and metaanalysis.
Source
Critical Care Medicine. 43 (1) (pp 194-204), 2015. Date of Publication: 01
Jan 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Postcardiac surgery delirium is associated with increased
risks of morbidity, cognitive decline, poor health-related quality of life
and mortality, and higher healthcare costs. We performed a systematic
review of randomized controlled trials to examine the effect of
pharmacologic agents for the prevention and the treatment of delirium
after cardiac surgery. Data Sources: Electronic search on PubMed, Medline,
Embase, Cochrane Central Register of Controlled Trials, ISI Web of
Science, and CINAHL up to December 2013. Study Selection: Randomized
controlled trials of pharmacologic agents used for the prevention and the
treatment of delirium after emergency or elective cardiac surgery in
adults. Data Extraction: We extracted data on patient population,
pharmacologic agents, delirium characteristics, rescue treatment, length
of stays in the ICU and hospital, and mortality. For each trial, we
assessed the risk of bias domains and rated the quality of evidence using
the Grading of Recommendations Assessment, Development and Evaluation
approach. Data Synthesis: Of the 13 studies (10 prevention and three
treatment) involving 5,848 patients, one multicentered randomized
controlled trial on prophylactic dexamethasone made up 77% of the total
sample size. The use of pharmacologic agents (dexamethasone, rivastigmine,
risperidone, ketamine, dexmedetomidine, propofol, and clonidine) reduced
the risk of delirium (relative risk, 0.57; 95% CI, 0.40-0.80) with quality
of evidence rated as moderate. There was high quality of evidence for no
increased risk of mortality (relative risk, 0.89; 95% CI, 0.57-1.38)
associated with the use of prophylactic pharmacologic agents. Metaanalysis
of treatment trials was not undertaken because of high heterogeneity. In
two small trials (total number of patients = 133), haloperidol did not
appear to be effective in treating delirium. Conclusions: Moderate to
high-quality evidence supports the use of pharmacologic agents for the
prevention of delirium, but results are based largely on one randomized
controlled trial. The evidence for treating postcardiac surgery delirium
with pharmacologic agents is inconclusive.
<7>
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Accession Number
2014952925
Authors
Zaal I.J. Devlin J.W. Peelen L.M. Slooter A.J.C.
Institution
(Zaal, Peelen, Slooter) Department of Intensive Care Medicine, University
Medical Center Utrecht, Utrecht, Netherlands
(Devlin) School of Pharmacy, Northeastern University, Boston, MA, United
States
(Peelen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Title
A systematic review of risk factors for delirium in the ICU.
Source
Critical Care Medicine. 43 (1) (pp 40-47), 2015. Date of Publication: 01
Jan 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Although numerous risk factors for delirium in the ICU have
been proposed, the strength of evidence supporting each risk factor
remains unclear. This study systematically identifies risk factors for
delirium in critically ill adults where current evidence is strongest.
Data Sources: CINAHL, EMBASE, MEDLINE, the Cochrane Central Register for
Controlled Trials, and the Cochrane Database of Systematic Reviews. Study
Selection: Studies published from 2000 to February 2013 that evaluated
critically ill adults, not undergoing cardiac surgery, for delirium, and
used either multivariable analysis or randomization to evaluate variables
as potential risk factors for delirium. Data Extraction: Data were
abstracted in duplicate, and quality was scored using Scottish
Intercollegiate Guidelines Network checklists (i.e., high, acceptable, and
low). Using a best-evidence synthesis each variable was evaluated using 3
criteria: the number of studies investigating it, the quality of these
studies, and whether the direction of association was consistent across
the studies. Strengths of association were not summarized. Strength of
evidence was defined as strong (consistent findings in >2 high quality
studies), moderate (consistent findings in 1 high quality study and >1
acceptable quality studies), inconclusive (inconsistent findings or 1 high
quality study or consistent findings in only acceptable quality/low
quality studies) or no evidence available. Data Synthesis: Among 33
studies included, 70% were high quality. There was strong evidence that
age, dementia, hypertension, pre-ICU emergency surgery or trauma, Acute
Physiology and Chronic Health Evaluation II score, mechanical ventilation,
metabolic acidosis, delirium on the prior day, and coma are risk factors
for delirium, that gender is not associated with delirium, and that use of
dexmedetomidine is associated with a lower delirium prevalence. There is
moderate evidence that multiple organ failure is a risk factor for
delirium. Conclusions: Only 11 putative risk factors for delirium are
supported by either strong or moderate level of evidence. These factors
should be considered when designing delirium prevention strategies or
controlling for confounding in future etiologic studies.
<8>
Accession Number
2015871744
Authors
Chen C. Zhao Z.-G. Liao Y.-B. Peng Y. Meng Q.-T. Chai H. Li Q. Luo X.-L.
Liu W. Zhang C. Chen M. Huang D.-J.
Institution
(Chen, Zhao, Liao, Peng, Meng, Chai, Li, Luo, Liu, Zhang, Chen, Huang)
Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Title
Impact of renal dysfunction on mid-term outcome after transcatheter aortic
valve implantation: A systematic review and meta-analysis.
Source
PLoS ONE. 10 (3) , 2015. Article Number: e0119817. Date of Publication: 20
Mar 2015.
Publisher
Public Library of Science
Abstract
Background There is conflicting evidence regarding the impact of
preexisting renal dysfunction (RD) on mid-term outcomes after
transcatheter aortic valve implantation (TAVI) in patients with
symptomatic aortic stenosis (AS). Methods and results Forty-seven articles
representing 32,131 patients with AS undergoing a TAVI procedure were
included in this systematic review and meta-analysis. Pooled analyses were
performed with both univariate and multivariate models, using a fixed or
random effects method when appropriate. Compared with patients with normal
renal function, mid-term mortality was significantly higher in patients
with preexisting RD, as defined by the author (univariate hazard ratio
[HR]: 1.69; 95% confidence interval [CI]: 1.50-1.90; multivariate HR:
1.47; 95% CI: 1.17 -1.84), baseline estimated glomerular filtration rate
(eGFR) (univariate HR: 1.65; 95% CI: 1.47-1.86; multivariate HR: 1.46; 95%
CI: 1.24- 1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48
-1.92; multivariate HR: 1.65; 95% CI: 1.36-1.99). Advanced stage of
chronic kidney disease (CKD stage 3-5) was strongly related to bleeding
(univariate HR in CKD stage 3: 1.30, 95% CI: 1.13-1.49; in CKD stage 4:
1.30, 95% CI: 1.04-1.62), acute kidney injure (AKI) (univariate HR in CKD
stage 3: 1.28, 95% CI: 1.03-1.59; in CKD stage 4: 2.27, 95% CI:
1.74-2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI:
1.52-7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57,
95% CI: 1.26-1.95; in CKD stage 4: 2.77, 95% CI: 2.06 -3.72; in CKD stage
5: 2.64, 95% CI: 1.91-3.65) compared with CKD stage 1+2. Patients with CKD
stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI:
1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99)
compared with those with CKD stage 3. A per unit decrease in serum
creatinine was also associated with a higher mortality at mid-term
follow-up (univariate HR: 1.24, 95% CI: 1.18-1.30; multivariate HR: 1.19,
95% CI: 1.08-1.30). Conclusions Preexisting RD was associated with
increased mid-term mortality after TAVI. Patients with CKD stage 4 had
significantly higher incidences of peri-procedural complications and a
poorer prognosis, a finding that should be factored into the clinical
decision-making process regarding these patients.
<9>
Accession Number
2015862664
Authors
Park S.-J. Ahn J.-M. Kim Y.-H. Park D.-W. Yun S.-C. Lee J.-Y. Kang S.-J.
Lee S.-W. Lee C.W. Park S.-W. Choo S.J. Chung C.H. Lee J.W. Cohen D.J.
Yeung A.C. Hur S.H. Seung K.B. Ahn T.H. Kwon H.M. Lim D.-S. Rha S.-W.
Jeong M.-H. Lee B.-K. Tresukosol D. Fu G.S. Ong T.K.
Institution
(Park, Ahn, Kim, Park, Lee, Kang, Lee, Lee, Park, Choo, Chung, Lee) Heart
Institute, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong,
Songpa-gu, Seoul 138-736, South Korea
(Yun) Division of Biostatistics, South Korea
(Seung) Center for Medical Research and Information, University of Ulsan
College of Medicine, St. Mary's Hospital, South Korea
(Kwon) Gangnam Severance Hospital, South Korea
(Lim) Korea University Anam, South Korea
(Rha) Guro Hospital Seoul, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Ahn) Gachon University Gil Hospital, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Cohen) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Yeung) Stanford University School of Medicine, Palo Alto, United States
(Tresukosol) Siriraj Hospital, Bangkok, Thailand
(Fu) Sir Run Run Shaw Hospital, Hangzhou, China
(Ong) Sarawak General Hospital, Kuching, Malaysia
Title
Trial of everolimus-eluting stents or bypass surgery for coronary disease.
Source
New England Journal of Medicine. 372 (13) (pp 1204-1212), 2015. Date of
Publication: 26 Mar 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Most trials comparing percutaneous coronary intervention (PCI)
with coronaryartery bypass grafting (CABG) have not made use of
second-generation drug-eluting stents. METHODS: We conducted a randomized
noninferiority trial at 27 centers in East Asia. We planned to randomly
assign 1776 patients with multivessel coronary artery disease to PCI with
everolimus-eluting stents or to CABG. The primary end point was a
composite of death, myocardial infarction, or target-vessel
revascularization at 2 years after randomization. Event rates during
longer-term follow-up were also compared between groups. RESULTS: After
the enrollment of 880 patients (438 patients randomly assigned to the PCI
group and 442 randomly assigned to the CABG group), the study was
terminated early owing to slow enrollment. At 2 years, the primary end
point had occurred in 11.0% of the patients in the PCI group and in 7.9%
of those in the CABG group (absolute risk difference, 3.1 percentage
points; 95% confidence interval [CI], -0.8 to 6.9; P = 0.32 for
noninferiority). At longer-term follow-up (median, 4.6 years), the primary
end point had occurred in 15.3% of the patients in the PCI group and in
10.6% of those in the CABG group (hazard ratio, 1.47; 95% CI, 1.01 to
2.13; P = 0.04). No significant differences were seen between the two
groups in the occurrence of a composite safety end point of death,
myocardial infarction, or stroke. However, the rates of any repeat
revascularization and spontaneous myocardial infarction were significantly
higher after PCI than after CABG. CONCLUSIONS: Among patients with
multivessel coronary artery disease, the rate of major adverse
cardiovascular events was higher among those who had undergone PCI with
the use of everolimus-eluting stents than among those who had undergone
CABG.
<10>
Accession Number
2015876485
Authors
Golestaneh L. Lindsey K. Malhotra P. Kargoli F. Farkas E. Barner H. Qazi
R. Schmidt A. Rauchman M. Al-Aly Z. Johnson R. Martin K. Dagher P.
Friedman A. El-Achkar T.M.
Institution
(Golestaneh, Malhotra, Kargoli) Montefiore Medical Center, Albert Einstein
Medical Center, 3411 Wayne Ave, Suite 5H, Bronx, NY 10467, United States
(Lindsey, Farkas, Barner, Qazi, Schmidt, Rauchman, Johnson, Martin) St
Louis University Hospital, St Louis, MO 63110, United States
(Al-Aly) VA St Louis Health Care System, St Louis, MO 63106, United States
(Dagher, Friedman, El-Achkar) IU Health University Hospital, Indianapolis,
IN 46202, United States
Title
Acute kidney injury after cardiac surgery: is minocycline protective?.
Source
Journal of Nephrology. 28 (2) (pp 193-199), 2015. Date of Publication: 01
Apr 2015.
Publisher
Springer New York LLC
Abstract
Background and objectives: Acute kidney injury (AKI) after cardiac bypass
surgery (CABG) is common and carries a significant association with
morbidity and mortality. Since minocycline therapy attenuates kidney
injury in animal models of AKI, we tested its effects in patients
undergoing CABG. Design, setting, participants and measurements: This is a
randomized, double-blinded, placebo-controlled, multi-center study. We
screened high risk patients who were scheduled to undergo CABG in two
medical centers between Jan 2008 and June 2011. 40 patients were
randomized and 19 patients in each group completed the study. Minocycline
prophylaxis was given twice daily, at least for four doses prior to CABG.
Primary outcome was defined as AKI [0.3 mg/dl increase in creatinine (Cr)]
within 5 days after surgery. Daily serum Cr for 5 days, various clinical
and hemodynamic measures and length of stay were recorded. Results: The
two groups had similar baseline and intra-operative characteristics. The
primary outcome occurred in 52.6 % of patients in the minocycline group as
compared to 36.8 % of patients in the placebo group (p = 0.51). Peak Cr
was 1.6 +/- 0.7 vs. 1.5 +/- 0.7 mg/dl (p = 0.45) in minocycline and
placebo groups, respectively. Death at 30 days occurred in 0 vs. 10.5 % in
the minocycline and placebo groups, respectively (p = 0.48). There were no
differences in post-operative length of stay, and cardiovascular events
between the two groups. There was a trend towards lower diastolic
pulmonary artery pressure [16.8 +/- 4.7 vs. 20.7 +/- 6.6 mmHg (p = 0.059)]
and central venous pressure [11.8 +/- 4.3 vs. 14.6 +/- 5.6 mmHg (p =
0.13)] in the minocycline group compared to placebo on the first day after
surgery. Conclusions: Minocycline did not protect against AKI post-CABG.
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