EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015983964
Authors
Liu J. Li M. Lu H. Qiao W. Xi D. Luo T.T. Xiong H. Guo Z.
Institution
(Liu, Li, Lu, Xi, Luo, Xiong, Guo) Division of Cardiology, Nanfang
Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
(Qiao) Department of Gastroenterology, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong 510515, China
Title
Effects of probucol on restenosis after percutaneous coronary intervention
a systematic review and meta-analysis.
Source
PLoS ONE. 10 (4) , 2015. Article Number: e0124021. Date of Publication: 21
Apr 2015.
Publisher
Public Library of Science
Abstract
Background: Restenosis after percutaneous coronary intervention (PCI) is a
remained clinical problem which limits long-term success of PCI. Although
there was recognition that probucol in treating restenosis after
percutaneous transluminal coronary angioplasty, the efficacy of probucol
on restenosis after stent-implantation is controversial. So this
meta-analysis was conducted to investigate the association between
probucol and late restenosis. Methods: Articles were assessed by four
trained investigators, with divergences resolved by consensus. PubMed,
EMBASE, ScienceDirect and the Cochrane Central Register of clinical trials
were searched for pertinent studies. Inclusion criteria were random
allocated to treatment and a comparison of probucol-treated patients and
control patients (not treated with lipid-lowering drug) undergoing PCI.
Results: Fifteen studies with 859 subjects were analyzed. Major outcome,
binary angiographic restenosis defined as >50% stenosis upon follow-up
angiography, was significantly decreased with probucol treatment (RR =
0.59 [0.43, 0.80] among vessels, P = 0.0007; and RR = 0.52 [0.40, 0.68]
among patients, P<0.00001). Probucol also increased the minimal luminal
diameter (SMD = 0.45 [0.30, 0.61], P< 0.00001) and decreased late loss
upon follow-up after 6 months (SMD = -0.41 [-0.60, -0.22], P<0.0001).
Moreover, there was a significantly lower incidence of major adverse
cardiac events (MACE) in the probucol group than control group (RR = 0.69
[0.51, 0.93], P = 0.01). Conclusion: Probucol is more than a
lipid-lowering drug. It is also effective in reducing the risk of
restenosis and incidence of MACE after PCI.

<2>
Accession Number
2015683062
Authors
Deo S.V. Altarabsheh S.E. Shah I.K. Cho Y.H. McGraw M. Sarayyepoglu B.
Medalion B. Markowitz A.H. Park S.J.
Institution
(Deo, Sarayyepoglu, Medalion, Markowitz, Park) Division of Cardiac
Surgery, Harrington Heart and Vascular Institute, Case Medical Center,
University Hospitals, Cleveland, OH, United States
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Shah) Department of Surgery, University of Minnesota,
Minneapolis-St.Paul, MN, United States
(Cho) Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan
School of Medicine, Samsung Hospital, Seoul, South Korea
(McGraw) Health Sciences Library, Case Western Reserve University,
Cleveland, OH, United States
Title
Are two really always better than one? Results, concerns and controversies
in the use of bilateral internal thoracic arteries for coronary artery
bypass grafting in the elderly: A systematic review and meta-analysis.
Source
International Journal of Surgery. 16 (PB) (pp 163-170), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Bilateral internal thoracic artery grafting appears to be
the preferred method to achieve durable long-term coronary artery
revascularization. However, data reporting the benefit of this technique
in the elderly is very conflicting. Method: We performed a systematic
review of available literature (till November 2014) using multiple
databases to identify studies comparing clinical events in patients
undergoing coronary artery bypass grafting using either a single or double
internal thoracic artery in the elderly. While early mortality was the
primary end-point of inclusion, other adverse events compared were sternal
wound infection (deep and superficial), stroke and peri-operative
myocardial infarction. Individual and pooled odd's ratios were calculated
using the Mantel-Haenzel method (random effect model); sensitivity
analysis was performed. Results are presented using 95% confidence
intervals. Result: Nine retrospective studies (4479 BITA, 7733 LITA
patients) fulfilled search criteria. Deep sternal wound infection was
significantly higher after BITA harvest [OR 1.86 (1.3-2.5);
I²=0%; p<0.01]. Early mortality (BITA 3.6% vs SITA 3.1%;
p=0.86), stroke [OR 0.7(0.4-1.1); p=0.1], and peri-operative myocardial
infarction (BITA 4.3% vs SITA 2.3%; p=0.1) were comparable in both
cohorts. Long-term survival favored the BITA cohort in two propensity
matched studies. Conclusion: The incidence of deep sternal wound infection
may be significantly higher after the harvest of both internal thoracic
arteries in the elderly. While other post-operative adverse events are
comparable, data regarding the long-term survival advantage in this cohort
is conflicting. Hence, the use of both internal thoracic arteries in this
age group needs to be invidualized.

<3>
Accession Number
2014896448
Authors
Sa M.P.B.O. Cavalcanti P.E.F. de Andrade Costa Santos H.J. Soares A.F.
Albuquerque Miranda R.G. Araujo M.L. Lima R.C.
Institution
(Sa, Cavalcanti, de Andrade Costa Santos, Soares, Albuquerque Miranda,
Araujo, Lima) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(Sa, Cavalcanti, de Andrade Costa Santos, Soares, Albuquerque Miranda,
Araujo, Lima) University of Pernambuco - UPE, Recife, Brazil
(Sa, Cavalcanti, Lima) Nucleus of Postgraduate and Research in Health
Sciences of Faculty of Medical Sciences, Biological Sciences Inst.
(FCM/ICB), Recife, Brazil
Title
Skeletonized versus pedicled bilateral internal mammary artery grafting:
Outcomes and concerns analyzed through a meta-analytical approach.
Source
International Journal of Surgery. 16 (PB) (pp 146-152), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Ltd
Abstract
Background: It is suggested that the internal thoracic artery (ITA)
harvesting technique influences the incidence of sternal wound infection
(SWI) after coronary artery bypass graft (CABG) surgery when both right
and left ITAs are used. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled bilateral ITA
in terms of SWI after CABG. Methods: We performed a systematic-review
using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles to search for studies that compared
the incidence of SWI after CABG between skeletonized versus pedicled
bilateral ITA until May 2014. The principal summary measures were odds
ratio (OR) with 95% Confidence Interval (CI) and P values (statistically
significant when <0.05). The ORs were combined across studies using
weighted DerSimonian-Laird random effects model. Meta-analysis,
sensitivity analysis and meta-regression were carried out by using the
software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood,
New Jersey). Results: Eight studies involving 2633 patients (1698
skeletonized; 935 pedicled) met the eligibility criteria. There was no
evidence for important heterogeneity of the effects among the studies. The
overall OR (95% CI) of SWI showed statistical significant difference in
favor to skeletonized ITA (random effect model: OR 0.327; 95% CI
0.217-0.492; P<0.001). In sensitivity analysis, the difference in favor to
skeletonized ITA was observed mainly in the presence of diabetes. In
meta-regression, we observed no modulation of the effects. Conclusion:
When both ITAs are used, the skeletonized technique appears to reduce the
incidence of SWI after CABG in comparison to the pedicled technique.

<4>
Accession Number
2014923163
Authors
Zhu T.-Y. Min X.-P. Zhang H.-B. Meng X.
Institution
(Zhu, Min, Zhang, Meng) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang
District, Beijing 100029, China
Title
Preoperative risk factors for residual tricuspid regurgitation after
isolated left-sided valve surgery: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). 129 (4) (pp 242-249), 2014. Date of Publication:
16 Apr 2014.
Publisher
S. Karger AG
Abstract
Objectives: Residual tricuspid regurgitation (TR) that has developed after
isolated left-sided valve surgery is not uncommon. Indications for
concomitant tricuspid repair at the initial operation have not been well
established. The selection of high-risk preoperative patients is of great
importance in this situation. Methods: Six databases were searched to
access eligible articles reporting potential risk factors for the
development of residual TR. The pooled analysis of risk factors was based
on odds ratios or mean differences with their 95% confidence intervals.
Results: A total of 3,138 patients with 487 residual TR in 11 studies were
analyzed. Of the 14 candidate parameters in our meta-analysis, 10 factors,
i.e. older age, female gender, atrial fibrillation, rheumatic etiology,
mitral valve surgery, previous valve surgery, a long time from onset to
surgery, 2+/3+ TR and enlarged left and right atria, were found to be
significantly associated with the development of residual TR. Conclusions:
Our study highlights the role of the above preoperative risk factors in
the development of residual TR after isolated left-sided valve surgery and
emphasizes the need of further studies to investigate other potential
predictors. Moreover, predictive models or scoring systems for the
identification of patients at a high risk for developing late TR are
urgently needed.

<5>
Accession Number
2015936972
Authors
Azzalini L. Millan X. Ly H.Q. L'Allier P.L. Jolicoeur E.M.
Institution
(Azzalini, Millan, Ly, L'Allier, Jolicoeur) Interventional Cardiology
Division, Department of Medicine, Universite de Montreal, Montreal, QC,
Canada
Title
Direct stenting versus pre-dilation in ST-elevation myocardial infarction:
A systematic review and meta-analysis.
Source
Journal of Interventional Cardiology. 28 (2) (pp 119-131), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives This study aimed at comparing direct stenting (DS) versus
stenting with pre-dilation (SP) in patients with ST-elevation myocardial
infarction (STEMI), using a systematic review and meta-analysis of
published evidence. Background There is conflicting evidence whether
stenting strategy impacts clinical outcomes in patients with STEMI.
Methods We searched EMBASE, MEDLINE, and CENTRAL, from inception to
December 2014. The primary endpoint was mortality. Secondary endpoints
included major adverse cardiac events (MACEs), ST-segment resolution, and
angiographic outcomes. Results A total of 9,331 patients enrolled in 12
studies (3 randomized controlled trials, RCTs; 9 non-randomized studies,
NRSs) were included. DS was associated with lower mortality (OR 0.55;
95%CI: 0.33-0.94; P = 0.03) in NRSs, and overall (OR 0.56; 95%CI:
0.37-0.86; P = 0.008). Mortality was non-significantly reduced in RCTs (OR
0.56; 95%CI: 0.26-1.23; P = 0.15). DS was also associated with lower MACE
rate (OR 0.71; 95%CI 0.60-0.84; P < 0.0001) in NRSs, but not in RCTs (OR
0.99; 95%CI: 0.61-1.60; P = 0.96). ST-segment resolution, no reflow, final
thrombolysis in myocardial infarction (TIMI) flow and final TIMI
myocardial perfusion or blush grade were significantly better with DS in
NRSs, and non-significantly better in RCTs. Conclusions The available
evidence suggests that DS in STEMI might be associated with better
clinical and procedural outcomes, as compared with SP. However, the fact
that RCTs account for the minority of available data and that most of the
available studies poorly reflect current clinical practice, as well as the
existence of publication bias, preclude drawing definitive conclusions.

<6>
Accession Number
2015976414
Authors
Horn P. Stern D. Veulemans V. Heiss C. Zeus T. Merx M.W. Kelm M.
Westenfeld R.
Institution
(Horn, Stern, Veulemans, Heiss, Zeus, Merx, Kelm, Westenfeld) Division of
Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty,
University Duesseldorf, Moorenstr. 5, Dusseldorf D-40225, Germany
(Kelm) Cardiovascular Research Institute Duesseldorf (CARID), University
Duesseldorf, Duesseldorf, Germany
Title
Improved endothelial function and decreased levels of endothelium-derived
microparticles after transcatheter aortic valve implantation.
Source
EuroIntervention. 10 (12) (pp 1456-1463), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: Degenerative aortic valve stenosis (AVS) is independently associated
with endothelial dysfunction and increased levels of circulating
endothelium-derived microparticles (EMPs) as a marker of compromised
endothelial integrity. The aim of this study was to investigate whether
therapy for severe AVS by transcatheter aortic valve implantation (TAVI)
improves endothelial function and decreases EMPs. Methods and results:
Fifty-six patients with indication for TAVI due to symptomatic severe AVS
were prospectively enrolled. Brachial wall shear stress (WSS), endothelial
function and circulating microparticles (MPs) were measured before and
three months following TAVI. Endothelial function was assessed as
flow-mediated dilation (FMD) using ultrasound. MP subpopulations were
discriminated by flow cytometry according to the expression of established
surface antigens: CD31⁺/CD41^-, CD144⁺ and
CD62E⁺ as EMPs and CD41⁺ as platelet-derived MPs
(PMPs). In patients with severe AVS, decreased brachial WSS was an
independent predictor of low FMD. At three-month follow-up after TAVI, WSS
and FMD increased along with decreased levels of EMPs as compared to pre
TAVI. Decrease of CD31⁺/CD41^-, CD144⁺ and
CD62E⁺ EMP levels correlated with the increase of FMD.
Conclusions: Therapy for AVS by TAVI was associated with improved
endothelial function and integrity indicating beneficial effects of TAVI
on systemic arterial function.

<7>
Accession Number
2015976405
Authors
Tian N.-L. Gami S.-K. Ye F. Zhang J.-J. Liu Z.-Z. Lin S. Ge Z. Shan S.-J.
You W. Chen L. Zhang Y.-J. Mintz G. Chen S.-L.
Institution
(Tian, Gami, Liu, Ge, Chen, Zhang, Chen) Department of Cardiology, Nanjing
First Hospital, Nanjing Medical University, No. 68 Changle Road, Qinhuai
District, Nanjing 210006, China
(Ye, Zhang, Lin, Shan, You) Department of Cardiology, Nanjing Heart
Centre, Nanjing, China
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
Title
Angiographic and clinical comparisons of intravascular ultrasound-versus
angiography-guided drug-eluting stent implantation for patients with
chronic total occlusion lesions: Two-year results from a randomised
AIR-CTO study.
Source
EuroIntervention. 10 (12) (pp 1409-1417), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: This study sought to compare angiographic endpoints at one-year
follow-up after a drug-eluting stent implantation guided by either
intravascular ultrasound (IVUS) or angiography in patients with chronic
total occlusion (CTO) lesions. Methods and results: Patients with at least
one CTO lesion recanalised successfully were randomly assigned to the
IVUS-guided or the angiography-guided group. The use of IVUS for
penetration of the true lumen and optimisation of stent expansion was only
done in the IVUS-guided group. The primary endpoint was in-stent late
lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO
lesions after successful recanalisation were enrolled and followed with
office visits or telephone contact up to 24 months. In-stent LLL in the
IVUS-guided group was significantly lower compared to the
angiography-guided group at one-year follow-up (0.28+/-0.48 mm vs.
0.46+/-0.68 mm, p=0.025), with a significant difference in restenosis of
the "in-true-lumen" stent between the two groups (3.9% vs. 13.7%,
p=0.021). The minimal lumen diameter and minimal stent cross-section area
significantly and negatively correlated with LLL (all p<0.001). The rates
of adverse clinical events were comparable between the IVUS- and
angiography-guided groups at two-year follow-up (21.7% vs. 25.2%,
p=0.641). Conclusions: The IVUS-guided stenting of the CTO lesion was
associated with less LLL and a lower incidence of "in-true-lumen" stent
restenosis. Additional study is required to identify the clinical benefit
of the IVUS-guided procedure for CTO lesions.

<8>
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Accession Number
2014946233
Authors
Kapadia S.R. Tuzcu E.M. Makkar R.R. Svensson L.G. Agarwal S. Kodali S.
Fontana G.P. Webb J.G. Mack M. Thourani V.H. Babaliaros V.C. Herrmann H.C.
Szeto W. Pichard A.D. Williams M.R. Anderson W.N. Akin J.J. Miller D.C.
Smith C.R. Leon M.B.
Institution
(Kapadia, Tuzcu, Svensson, Agarwal) Cleveland Clinic Foundation, J2-3,
9500 Euclid Ave., Cleveland, OH 44195, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Kodali, Williams, Smith, Leon) Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Fontana) Lenox Hill Hospital, New York, NY, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Mack) Baylor Healthcare System, Plano, TX, United States
(Thourani, Babaliaros) Emory University, School of Medicine, Atlanta, GA,
United States
(Herrmann, Szeto) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Anderson, Akin) Edwards Lifesciences, Irvine, CA, United States
(Miller) Stanford University, Stanford, CA, United States
Title
Long-term outcomes of inoperable patients with aortic stenosis randomly
assigned to transcatheter aortic valve replacement or standard therapy.
Source
Circulation. 130 (17) (pp 1483-1492), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The long-term outcomes of transcatheter aortic valve
replacement (TAVR) in inoperable patients with severe aortic stenosis
remain unknown. Methods and Results: In the Placement of Aortic
Transcatheter Valves (PARTNER) study, 358 patients were randomly assigned
to TAVR or standard therapy. We report the 3-year outcomes on these
patients, and the pooled outcomes for all randomly assigned inoperable
patients (n=449) in PARTNER, as well, including the randomized portion of
the continued access study (n=91). The 3-year mortality rate in the TAVR
and standard therapy groups was 54.1% and 80.9%, respectively (P<0.001;
hazard ratio, 0.53; 95% confidence interval, 0.41-0.68; P<0.001). In
survivors, there was significant improvement in New York Heart Association
functional class sustained at 3 years. The cumulative incidence of strokes
at 3-year follow-up was 15.7% in TAVR patients versus 5.5% in patients
undergoing standard therapy (hazard ratio, 2.81; 95% confidence interval,
1.26-6.26; P=0.012); however, the composite of death or strokes was
significantly lower after TAVR versus standard therapy (57.4% versus
80.9%, P<0.001; hazard ratio, 0.60; 95% confidence interval, 0.46-0.77;
P<0.001). Echocardiography showed a sustained increase in aortic valve
area and decrease in transvalvular gradient after TAVR. Analysis of the
449 pooled randomly assigned patients (TAVR, n=220; standard therapy,
n=229) demonstrated significant improvement in all-cause mortality and
functional status during early and 3-year follow-up. The results of the
pooled cohort were similar to the results obtained from the pivotal
PARTNER trial. Conclusions: TAVR resulted in better survival and
functional status in inoperable patients with severe aortic stenosis with
durable hemodynamic benefit on long-term follow-up. However, high residual
mortality, even in successfully treated TAVR patients, highlights the need
for more strategic patient selection.

<9>
Accession Number
2015936864
Authors
Abe N. Kashima Y. Izawa A. Motoki H. Ebisawa S. Miyashita Y. Imamura H.
Ikeda U.
Institution
(Abe, Kashima, Izawa, Motoki, Miyashita, Imamura, Ikeda) Department of
Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1
Asahi, Matsumoto, Nagano 390-0802, Japan
(Ebisawa) Department of Emergency and Intensive Care Medicine, Shinshu
University School of Medicine, Nagano, Japan
Title
A 2-year follow-up of oxidative stress levels in patients with ST-segment
elevation myocardial infarction: A subanalysis of the ALPS-AMI study.
Source
Angiology. 66 (3) (pp 271-277), 2014. Date of Publication: 2014.
Publisher
SAGE Publications Inc.
Abstract
We sought to determine whether serial measurements of oxidative stress
levels could serve as a predictive marker for cardiovascular (CV) events
in patients with ST-segment elevation myocardial infarction (STEMI).
Biological antioxidant potential (BAP) levels were measured at admission
and at 6, 12, and 24 months in 69 patients with STEMI. The CV events
abruptly increased 6 to 10 months after successful percutaneous coronary
intervention in patients with STEMI, and the 6-month BAP levels were
significantly lower in patients with CV events (2456 mumol/L
[interquartile range: 2237-2615 mumol/L]) than in those without (2849
mumol/L [2575-2987 mumol/L], P <.001). A decreased 6-month BAP level was
an independent and significant predictor of long-term CV events (hazard
ratio = 2.45; 95% confidence intervals 1.10-5.78; P =.04). Our findings
suggest that serial changes in antioxidant capacity, assessed by BAP
levels, may serve as a predictive marker for CV events after STEMI.

<10>
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Accession Number
2015938170
Authors
Wong K. Phelan R. Kalso E. Galvin I. Goldstein D. Raja S. Gilron I.
Institution
(Wong, Phelan, Goldstein, Gilron) Department of Anesthesiology and
Perioperative Medicine, Queen's University, Kingston General Hospital, 76
Stuart Street, Victory 2,Kingston, ON K7L2V7, Canada
(Kalso) Department of Anaesthesia Intensive Care Medicine, Emergency
Medicine and Pain Medicine, Helsinki University Central Hospital,
Helsinki, Finland
(Raja) Department of Anesthesiology and Critical Care Medicine, School of
Medicine, Johns Hopkins University, Baltimore MD, United States
(Galvin) Departments of Anesthesiology and Perioperative Medicine and
Biomedical and Molecular Sciences, Queen's University, Kingston, ON,
Canada
Title
Antidepressant drugs for prevention of acute and chronic postsurgical pain
early evidence and recommended future directions.
Source
Anesthesiology. 121 (3) (pp 591-608), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: This review evaluates trials of antidepressants for acute and
chronic postsurgical pain. Methods: Trials were systematically identified
using predefined inclusion and exclusion criteria. Extracted data included
the following: pain at rest and with movement, adverse effects, and other
outcomes. Results: Fifteen studies (985 participants) of early
postoperative pain evaluated amitriptyline (three trials), bicifadine (two
trials), desipramine (three trials), duloxetine (one trial), fluoxetine
(one trial), fluradoline (one trial), tryptophan (four trials), and
venlafaxine (one trial). Three studies (565 participants) of chronic
postoperative pain prevention evaluated duloxetine (one trial),
escitalopram (one trial), and venlafaxine (one trial). Heterogeneity
because of differences in drug, dosing regimen, outcomes, and/or surgical
procedure precluded any meta-analyses. Superiority to placebo was reported
in 8 of 15 trials for early pain reduction and 1 of 3 trials for chronic
pain reduction. The majority of positive trials did not report sufficient
data to estimate treatment effect sizes. Many studies had inadequate size,
safety evaluation/reporting, procedure specificity, and movement-evoked
pain assessment. Conclusions: There is currently insufficient evidence to
support the clinical use of antidepressants-beyond controlled
investigations- for treatment of acute, or prevention of chronic,
postoperative pain. Multiple positive trials suggest the therapeutic
potential of antidepressants, which need to be replicated. Other nontrial
evidence suggests potential safety concerns of perioperative
antidepressant use. Future studies are needed to better define the
risk-benefit ratio of antidepressants in postoperative pain management.
Higher-quality trials should optimize dosing, timing and duration of
antidepressant treatment, trial size, patient selection, safety evaluation
and reporting, procedure specificity, and assessment of movement-evoked
pain relevant to postoperative functional recovery.

<11>
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Accession Number
2015938169
Authors
Dardashti A. Ederoth P. Algotsson L. Bronden B. Grins E. Larsson M.
Nozohoor S. Zinko G. Bjursten H.
Institution
(Dardashti, Ederoth, Algotsson, Bronden, Grins, Larsson, Nozohoor, Zinko,
Bjursten) Department of Cardiothoracic Surgery Anesthesiology, and
Intensive Care, Lund University, Skane University Hospital, Lund, Sweden
(Dardashti) Division of Anesthesia and Intensive Care, Department of
Clinical Sciences, Lund University, Lund SE-22185, Sweden
Title
Erythropoietin and protection of renal function in cardiac surgery (the
EPRICS trial).
Source
Anesthesiology. 121 (3) (pp 582-590), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: To date, there are no known methods for preventing acute
kidney injury after cardiac surgery. Increasing evidence suggests that
erythropoietin has renal antiapoptotic and tissue protective effects.
However, recent human studies have shown conflicting results. The authors
aimed to study the effect of a single high-dose erythropoietin
preoperatively on renal function after coronary artery bypass grafting in
patients with preoperative impaired renal function. Methods: This
single-center, randomized, double-blind, placebo-controlled study included
75 patients scheduled for coronary artery bypass grafting with preexisting
renal impairment estimated glomerular filtration rate based on p-cystatin
C (<60 and >15 ml/min). The patients either received a single high-dose
erythropoietin (400 IU/kg) or placebo preoperatively. The primary endpoint
was renal protection evaluated by p-cystatin C at the third postoperative
day compared to the preoperative values. Incidence of acute kidney injury
and other renal biomarker changes were among secondary endpoints. Results:
There was no statistically significant difference on the third
postoperative day for relative p-cystatin C level changes from baseline
between the groups, 131 +/- 31% (mean +/- SD) for the study group and 125
+/- 24% for the control group (P = 0.31; 95% CI, -0.6 to 20% for the
difference). There were no statistically significant differences in other
renal biomarkers or measures between the groups (p-neutrophil
gelatinase-associated lipocalin, p-creatinine, p-urea, and estimated
glomerular filtration rate). There were no other differences in outcome
variables between the groups. Conclusion: Intravenous administration of a
single high-dose (400 IU/kg) erythropoietin did not have a renal
protective effect on patients with reduced kidney function undergoing
coronary artery bypass surgery.

<12>
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Accession Number
2015938162
Authors
Ottens T.H. Sauer A.-M.C. Peelen L.M. De Groot W.J. Buijsrogge M.P. Bredee
J.J. Buhre W.F. Dieleman J.M. Van Dijk D. Van Herwerden L.A. Kalkman C.J.
Van Klarenbosch J. Moons K.G. Nathoe H.M. Numan S.C. Roes K.C. Slooter
A.J. Nierich A.P. Ennem J.J. Rosseel P.M. Van Der Meer N.J. Van Der Maaten
J.M. Cernak V. Hofland J. Van Thiel R.J. Diephuis J.C. Schepp R.M. Haenen
J. De Lange F. Boer C. De Jong J.R. Tijssen J.G.
Institution
(Ottens, Sauer, Dieleman, Kalkman) Department of Anesthesiology,
University Medical Center, P.O. Box 85500, Utrecht 3508 GA, Netherlands
(Peelen) Department of Epidemiology, Julius Center for Epidemiology and
Primary Care, Utrecht, Netherlands
(Buijsrogge) Department of Cardiothoracic Surgery, University Medical
Center, Utrecht, Netherlands
(Van Dijk) University Medical Center, Intensive Care Medicine, Utrecht,
Netherlands
(Nierich) Department of Anesthesiology, Isala Clinics, Zwolle, Netherlands
(De Groot) Department of Anesthesiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Nathoe) Department of Cardiology, University Medical, Utrecht,
Netherlands
(Ottens, Sauer, Bredee, Buhre, Dieleman, Van Dijk, Van Herwerden, Kalkman,
Van Klarenbosch, Moons, Nathoe, Numan, Roes, Slooter) University Medical
Center, Utrecht, Netherlands
(Nierich, Ennem) Isala Klinieken, Zwolle, Netherlands
(Rosseel, Van Der Meer) Amphia Ziekenhuis, Breda, Netherlands
(Van Der Maaten, Cernak) University Medical Center, Groningen, Netherlands
(Hofland, Van Thiel) Erasmus University Medical Center, Rotterdam,
Netherlands
(Diephuis) Medisch Spectrum Twente, EnschedeNetherlands
(Schepp, Haenen, De Lange) Medical Center, Leeuwarden, Netherlands
(Boer, De Jong) Vrije Universiteit Medical Center, Amsterdam, Netherlands
(Tijssen) Academic Medical Center, Amsterdam, Netherlands
Title
Effects of dexamethasone on cognitive decline after cardiac surgery a
randomized clinical trial.
Source
Anesthesiology. 121 (3) (pp 492-500), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac surgery can be complicated by postoperative cognitive
decline (POCD), which is characterized by impaired memory function and
intellectual ability. The systemic inflammatory response that is induced
by major surgery and cardiopulmonary bypass may play an important role in
the etiology of POCD. Prophylactic corticosteroids to attenuate the
inflammatory response may therefore reduce the risk of POCD. The authors
investigated the effect of intraoperative high-dose dexamethasone on the
incidence of POCD at 1 month and 12 months after cardiac surgery. Methods:
This multicenter, randomized, double-blind, placebo-controlled trial is a
preplanned substudy of the DExamethasone for Cardiac Surgery trial. A
total of 291 adult patients undergoing cardiac surgery with
cardiopulmonary bypass were recruited in three hospitals and randomized to
receive dexamethasone 1 mg/kg (n = 145) or placebo (n = 146). The main
outcome measures were incidence of POCD at 1- And 12-month follow-up,
defined as a decline in neuropsychological test performance beyond natural
variability, as measured in a control group. Results: At 1-month
follow-up, 19 of 140 patients in the dexamethasone group (13.6%) and 10 of
138 patients in the placebo group (7.2%) fulfilled the diagnostic criteria
for POCD (relative risk, 1.87; 95% CI, 0.90 to 3.88; P = 0.09). At
12-month follow-up, 8 of 115 patients in the dexamethasone group (7.0%)
and 4 of 114 patients (3.5%) in the placebo group had POCD (relative risk,
1.98; 95% CI, 0.61 to 6.40; P = 0.24). Conclusion: Intraoperative
high-dose dexamethasone did not reduce the risk of POCD after cardiac
surgery.

<13>
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Accession Number
2015934240
Authors
Curley G.F. Shehata N. Mazer C.D. Hare G.M.T. Friedrich J.O.
Institution
(Curley, Mazer) Department of Anesthesia and Critical Care, Li Ka Shing
Knowledge Institute, University of Toronto, 30 Bond Street, Toronto, ON
M5B 1W8, Canada
(Shehata) Department of Medicine and Laboratory Medicine and Pathobiology,
Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON,
Canada
(Hare) Department of Anesthesia, Li Ka Shing Knowledge Institute,
University of Toronto, Toronto, ON, Canada
(Friedrich) Department of Critical Care and Medicine, Li Ka Shing
Knowledge Institute, University of Toronto, Toronto, ON, Canada
Title
Transfusion triggers for guiding RBC transfusion for cardiovascular
surgery: A systematic review and meta-analysis.
Source
Critical Care Medicine. 42 (12) (pp 2611-2624), 2014. Date of Publication:
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Restrictive red cell transfusion is recommended to minimize
risk associated with exposure to allogeneic blood. However, perioperative
anemia is an independent risk factor for adverse outcomes after
cardiovascular surgery. The purpose of this systematic review and
meta-analysis is to determine whether perioperative restrictive
transfusion thresholds are associated with inferior clinical outcomes in
randomized trials of cardiovascular surgery patients. Data Sources: The
Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from
inception to October 2013; reference lists of published guidelines,
reviews, and associated articles, as well as conference proceedings. No
language restrictions were applied. Study Selection: We included
controlled trials in which adult patients undergoing cardiac or vascular
surgery were randomized to different transfusion thresholds, described as
a hemoglobin or hematocrit level below which RBCs were transfused. Data
Extraction: Two authors independently extracted data from included trials.
We pooled risk ratios of dichotomous outcomes and mean differences of
continuous outcomes across trials using random-effects models. Data
Synthesis: Seven studies (enrolling 1,262 participants) met inclusion
criteria with restrictive and liberal transfusion thresholds most commonly
differing by a hemoglobin of 1 g/dL or hematocrit of 6-7%, resulting in
decreased transfusions by 0.71 units of RBCs (95% CI, 0.31-1.09, p =
0.0002) without an associated change in adverse events: mortality (risk
ratio, 1.12; 95% CI, 0.65-1.95; p = 0.60), myocardial infarction (risk
ratio, 0.94; 95% CI, 0.30-2.99; p = 0.92), stroke (risk ratio, 1.15; 95%
CI, 0.57-2.32; p = 0.70), acute renal failure (risk ratio, 0.98; 95% CI,
0.64-1.49; p = 0.91), infections (risk ratio, 1.23; 95% CI, 0.85-1.78; p =
0.27), or length of stay. There was no betweentrial heterogeneity for any
pooled analysis. Including four pediatric trials (456 participants) and 10
trials utilizing only intraoperative acute normovolemic hemodilution (872
participants) did not substantially change the results except that unlike
the transfusion threshold trials, the hemodilution trials did not reduce
the proportion of patients transfused (interaction p = 0.01). Conclusions:
Further randomized controlled trials are necessary to determine the
optimal transfusion strategy for patients undergoing cardiovascular
surgery.

<14>
Accession Number
2015967519
Authors
Li J. Liu W.-L. Yi X. Feng G.-K. Lu Z. Jiang X.-J. Li X.-Y.
Institution
(Li, Liu, Yi, Feng, Lu, Jiang, Li) Department of Cardiology, Renmin
Hospital of Wuhan University, Wuhan, Hubei 430060, China
Title
Paclitaxel-coated balloons for the treatment of patients with in-stent
restenosis: A meta-analysis of angiographic and clinical data.
Source
Experimental and Therapeutic Medicine. 9 (6) (pp 2285-2292), 2015. Date of
Publication: 2015.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
Paclitaxel-coated balloons (PCBs) have become attractive alternative
treatment options for patients with in-stent restenosis (ISR); however,
the safety and efficacy of PCBs in comparison with those of conventional
therapies are less well defined. The aim of this meta-analysis was to
systematically review the efficacy and safety of PCBs for patients with
ISR using comparisons with control groups. Electronic databases, such as
MEDLINE, Embase and the Cochrane Central Register of Controlled Trials,
were searched, and eligible studies that compared PCBs with uncoated
balloons (UCBs) or drug-eluting stents (DESs) in patients with ISR were
considered. Subgroup analyses were performed with different control
groups. Nine studies (1,488 patients, 1,608 lesions) were included in the
meta-analysis. Compared with patients who underwent UCB angioplasty, those
who underwent PCB angioplasty exhibited a clear superiority in late lumen
loss (LLL) [weighted mean difference (WMD), -0.46; 95% confidence interval
(CI), (-0.59)-(-0.34); P<0.00001] and major adverse cardiac events (MACEs)
[odds ratio (OR), 0.21; 95% CI, 0.13-0.33; P<0.00001]. The OR for
myocardial infarction (MI) (OR, 0.46; 95% CI, 0.15-1.47; P=0.19) did not
reach statistical significance. PCBs were associated with similar outcomes
when compared with DESs with regard to LLL (WMD, -0.04; 95% CI,
-0.18-0.10; P=0.57), MACEs (OR, 0.74; 95% CI, 0.36-1.53; P=0.42) and the
ORs for all endpoints, including total mortality, target lesion
revascularization, MI, stent thrombosis and binary restenosis, and no
statistically significant differences were found. This meta-analysis
showed that PCBs are associated with superior outcomes when compared with
UCBs in the management of ISR, and are at least as efficacious and as well
tolerated as DESs.

<15>
[Use Link to view the full text]
Accession Number
2014945337
Authors
Peng Y. Fu X. Li W. Geng W. Xing K. Ru L. Sun J. Zhao Y.
Institution
(Peng, Fu, Li, Geng, Xing) Department of Cardiology, Second Hospital of
Hebei, Medical University, 215 Heping West Road, Shijiazhuang, Hebei
050000, China
(Ru, Sun, Zhao) Department of Cardiology, Bethune International Peace
Hospital, Hebei, China
Title
Effect of intracoronary anisodamine and diltiazem administration during
primary percutaneous coronary intervention in acute myocardial infarction.
Source
Coronary Artery Disease. 25 (8) (pp 645-652), 2014. Date of Publication:
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The aim of this study was to examine the role of intracoronary
anisodamine and diltiazem administration performed before stenting on the
immediate angiographic and clinical outcome in patients with ST-elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI). Methods: STEMI patients during primary PCI were
randomized to two bolus injections of intracoronary anisodamine (1mg/5 ml)
and diltiazem (2 mg/5 ml) (COM group, n =54) or saline (5 ml) and
diltiazem (2 mg/5 ml) (diltiazem group, n =54) before stenting. The
primary endpoint was the incidence of no/slow reflow [thrombolysis in
myocardial infarction (TIMI) flow grade <2] immediately after stenting.
TIMI myocardial perfusion grade and corrected TIMI frame count were
assessed. The secondary endpoints were major adverse cardiac events
including death, nonfatal myocardial infarction, and target vessel
revascularization. Results: The percent of TIMI flow grade 3 was found to
be higher in the COM group than in the diltiazem group (92.6 vs. 75.9%,
P=0.032). The percent of TIMI myocardial perfusion grade 3 was 46.3% in
the diltiazem group and improved in the COM group (68.5%, P=0.032).
Corrected TIMI frame count was significantly lower in the COM group than
in the diltiazem group (P< 0.0001). The COM group showed low incidences of
bradyarrhythmia and rapid arrhythmia (7.4 vs. 24.1% and 3.7 vs. 18.5%,
respectively, P=0.032, P =0.029). In addition, there were no significant
differences in the secondary outcome measures. Conclusion: Intracoronary
anisodamine and diltiazem administration before stenting improved the
angiographic results and prevented reperfusion arrhythmia in patients with
STEMI undergoing PCI. Coron Artery Dis 25:645-652

<16>
Accession Number
2015935124
Authors
Jacob M. Fellahi J.-L. Chappell D. Kurz A.
Institution
(Jacob) Department of Anesthesiology, Surgical Intensive Care Medicine and
Pain Therapy, Harlaching Hospital, Munich Municipal Hospital Group,
Munich, Germany
(Fellahi) Department of Anesthesiology and Critical Care, Hopital
Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon,
28 avenue du Doyen Lepine, Lyon Cedex, Bron 69677, France
(Fellahi) Faculte de Medecine Lyon Est, Universite Lyon 1, Lyon 69008,
France
(Chappell) Department of Anesthesiology, University Hospital of Munich,
Nussbaumstrasse 20, Munich 80336, Germany
(Kurz) Department of General Anesthesiology, Cleveland Clinic Main Campus,
9500 Euclid Avenue, Cleveland, OH 44195, United States
Title
The impact of hydroxyethyl starches in cardiac surgery: A meta-analysis.
Source
Critical Care. 18 (6) , 2014. Article Number: 656. Date of Publication:
01,12,2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Recent studies in septic patients showed that adverse
effects of hydroxyethyl starches (HESs) possibly outweigh their benefits
in severely impaired physiological haemostasis. It remains unclear whether
this also applies to patient populations that are less vulnerable. In this
meta-analysis, we evaluated the impact of various HES generations on
safety and efficacy endpoints in patients undergoing cardiac surgery.
Methods: We searched the PubMed, Embase and Cochrane Central Register of
Controlled Trials databases for randomised controlled trials (RCTs) in the
English or German language comparing the use of HES to any other colloid
or crystalloid during open heart surgery. Results: Blood loss and
transfusion requirements were higher for older starches with mean
molecular weights more than 200 kDa compared to other volume substitutes.
In contrast, this effect was not observed with latest-generation
tetrastarches (130/0.4), which performed even better when compared to
albumin (blood loss of tetrastarch versus albumin: standardised mean
difference (SMD), -0.34; 95% CI, -0.63, -0.05; P = 0.02; versus gelatin:
SMD, -0.06; 95% CI, -0.20, 0.08; P = 0.39; versus crystalloids: SMD,
-0.05; 95% CI, -0.20, 0.10; P = 0.54). Similar results were found for
transfusion needs. Lengths of stay in the intensive care unit or hospital
were significantly shorter with tetrastarches compared to gelatin
(intensive care unit: SMD, -0.10; 95% CI, -0.15, -0.05; P = 0.0002) and
crystalloids (hospital: SMD, -0.52; 95% CI, -0.90, -0.14; P = 0.007).
Conclusions: In this meta-analysis of RCTs, we could not identify safety
issues with tetrastarches compared with other colloid or crystalloid
solutions in terms of blood loss, transfusion requirements or hospital
length of stay in patients undergoing cardiac surgery. The safety data on
coagulation with older starches raise some issues that need to be
addressed in future trials.

<17>
[Use Link to view the full text]
Accession Number
2015932667
Authors
Jimenez-Quevedo P. Gonzalez-Ferrer J.J. Sabate M. Garcia-Moll X.
Delgado-Bolton R. Llorente L. Bernardo E. Ortega-Pozzi A.
Hernandez-Antolin R. Alfonso F. Gonzalo N. Escaned J. Banuelos C. Regueiro
A. Marin P. Fernandez-Ortiz A. Das Neves B. Del Trigo M. Fernandez C.
Tejerina T. Redondo S. Garcia E. Macaya C.
Institution
(Jimenez-Quevedo, Gonzalez-Ferrer, Llorente, Bernardo, Ortega-Pozzi,
Hernandez-Antolin, Alfonso, Gonzalo, Escaned, Banuelos, Fernandez-Ortiz,
Das Neves, Del Trigo, Garcia, Macaya) Cardiology and Hematology
Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
(Sabate, Regueiro, Marin) Cardiology and Hematology Department, Hospital
Clinic, IDIBAPS, Barcelona, Spain
(Garcia-Moll) Cardiology Department, Hospital Sant Pau, Barcelona, Spain
(Delgado-Bolton) Department of Radiology and Nuclear Medicine, San Pedro
Hospital and Centre for Biomedical Research of la Rioja (CIBIR),
Logrono-(La-Rioja), Spain
(Delgado-Bolton) Institute Focuscan, Madrid, Spain
(Fernandez) Statistic Department, Hospital Clinico San Carlos, Madrid,
Spain
(Tejerina, Redondo) Pharmacology Department, Complutense University,
Madrid, Spain
Title
Selected CD133⁺ progenitor cells to promote angiogenesis in
patients with refractory angina final results of the PROGENITOR randomized
trial.
Source
Circulation Research. 115 (11) (pp 950-960), 2014. Date of Publication:
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Rationale: Refractory angina constitutes a clinical problem. Objective:
The aim of this study was to assess the safety and the feasibility of
transendocardial injection of CD133⁺ cells to foster
angiogenesis in patients with refractory angina. Methods and Results: In
this randomized, double-blinded, multicenter controlled trial, eligible
patients were treated with granulocyte colony-stimulating factor,
underwent an apheresis and electromechanical mapping, and were randomized
to receive treatment with CD133⁺ cells or no treatment. The
primary end point was the safety of transendocardial injection of
CD133⁺ cells, as measured by the occurrence of major adverse
cardiac and cerebrovascular event at 6 months. Secondary end points
analyzed the efficacy. Twenty-eight patients were included (n=19
treatment; n=9 control). At 6 months, 1 patient in each group had
ventricular fibrillation and 1 patient in each group died. One patient
(treatment group) had a cardiac tamponade during mapping. There were no
significant differences between groups with respect to efficacy
parameters; however, the comparison within groups showed a significant
improvement in the number of angina episodes per month (median absolute
difference,-8.5 [95% confidence interval,-15.0 to-4.0]) and in angina
functional class in the treatment arm but not in the control group. At 6
months, only 1 simple-photon emission computed tomography (SPECT)
parameter: summed score improved significantly in the treatment group at
rest and at stress (median absolute difference,-1.0 [95% confidence
interval,-1.9 to-0.1]) but not in the control arm. Conclusions: Our
findings support feasibility and safety of transendocardial injection of
CD133⁺ cells in patients with refractory angina. The promising
clinical results and favorable data observed in SPECT summed score may set
up the basis to test the efficacy of cell therapy in a larger randomized
trial.

<18>
Accession Number
2015965073
Authors
Harvey E. Fisher S.A. Doree C. Taggart D.P. Martin-Rendon E.
Institution
(Harvey, Fisher, Doree, Martin-Rendon) Nuffield Division of Clinical
Laboratory Sciences, Radcliffe Department of Medicine, NHS Blood and
Transplant, Oxford, United Kingdom
(Taggart) Nuffield Department of Surgical Sciences, NHS Blood and
Transplant, Oxford, United Kingdom
(Harvey, Martin-Rendon) University of Oxford, Oxford, United Kingdom
(Harvey, Martin-Rendon) Stem Cell Research Laboratory, NHS Blood and
Transplant, Oxford, United Kingdom
(Fisher, Doree) Systematic Review Initiative, NHS Blood and Transplant,
Oxford, United Kingdom
Title
Current evidence of the efficacy of cell-based therapies in heart failure.
Source
Circulation Journal. 79 (2) (pp 229-236), 2015. Date of Publication: 16
Jan 2015.
Publisher
Japanese Circulation Society
Abstract
Heart failure (HF) is the major cause of mortality worldwide. For more
than a decade, cell-based therapies have been developed as treatment for
heart disease as an alternative to current therapies. Trials and
systematic reviews have assessed the safety and efficacy of cell therapies
in a diverse number of participants and clinical settings. The present
study collated and synthesized evidence from all systematic reviews
related to cell-based therapies and HF. A total of 11 systematic reviews
were identified through searches of electronic databases up to June 2014.
We set out to answer 2 key questions on the efficacy of cell therapies in
HF: (1) What is the overall effect of cell therapies on primary outcomes
such as left ventricular ejection fraction (LVEF) and mortality? (2) How
important is it to define the clinical setting and length of follow-up
when assessing cell therapies and HF? There seems to be enough evidence to
suggest that cell therapies have a moderate, long-lasting effect on LVEF,
but the reduction on the risk of mortality observed by some systematic
reviews needs to be confirmed in larger, statistically powered clinical
trials. Additionally, and in order to strengthen conclusions, it is
important to assess clinical evidence for defined clinical settings and to
standardize the length of follow-up when comparing outcome data across
several trials and systematic reviews.

<19>
Accession Number
2015964956
Authors
Le Page S. Bejan-Angoulvant T. Angoulvant D. Prunier F.
Institution
(Le Page, Prunier) Service de Cardiologie, CHU Angers, Remodelage et
Thrombose, EA 3860 Cardioprotection, L'UNAM Universite, Universite
d'Angers, Angers Cedex 9 49933, France
(Bejan-Angoulvant) Service de Pharmacologie, CHRU de Tours, CNRS GICC UMR
U7292, Universite Francois-Rabelais de Tours, Tours, France
(Angoulvant) Service de Cardiologie, CHRU de Tours, Federation
Hospitalo-Universitaires << SUPPORT >>, EA 4245 Cellules dendritiques
Immuno-modulation et Greffes, Universite Francois-Rabelais de Tours,
Tours, France
Title
Remote ischemic conditioning and cardioprotection: a systematic review and
meta-analysis of randomized clinical trials.
Source
Basic Research in Cardiology. 110 (2) , 2015. Date of Publication: 2015.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Remote ischemic conditioning (RIC) represents an innovative
cardioprotective method that has been investigated in numerous clinical
studies providing miscellaneous results. This systematic review and
meta-analysis sought to assess RIC-induced effects on myocardial injury
biomarkers and clinical outcomes in clinical situations at risk of
myocardial ischemia/reperfusion damage. PubMed and Cochrane databases were
searched for randomized clinical trials testing any RIC protocol versus a
control in a situation or procedure at risk of cardiac
ischemia/reperfusion damage, including coronary angioplasty and cardiac or
major vascular surgery. Data were collected from publications reporting
biological markers of myocardial injury or clinical events, including
major adverse cardiovascular and cerebral events (MACCE), all-cause
mortality, myocardial infarction incidence, and repeat revascularization.
Standardized mean difference (SMD) (continuous outcomes) and odds ratios
(OR) (dichotomous outcomes) were compared between groups. Heterogeneity
was investigated by means of meta-analysis regression. A total of 53
articles (44 studies) were identified by the search, with 5,317 patients
included in the systematic meta-analysis. RIC significantly reduced
troponin area under curve (AUC) (SMD -0.27, 95 % confidence interval (CI):
[-0.36, -0.18]; p < 0.01) and troponin peak (SMD: -0.22, 95 % CI: [-0.30,
-0.15]; p < 0.01). The same reduction was observed with creatine kinase MB
(CK-MB) AUC and peak. Long-term MACCE and all-cause mortality were
significantly lower in the RIC group (OR: 0.42, 95 % CI [0.28, 0.64]; p <
0.01 vs. OR: 0.27, 95 % CI [0.13, 0.58]; p < 0.01, respectively), as was
myocardial infarction incidence (OR: 0.54, 95 % CI [0.40, 0.73]; p <
0.01). We observed no difference regarding repeat revascularization. RIC
appears to be an effective method for reducing ischemia/reperfusion
myocardial injury, and our findings suggest that it may reduce long-term
clinical events.

<20>
Accession Number
2015962672
Authors
Wang J. Gu C. Gao M. Yu W. Yu Y.
Institution
(Wang, Gu, Gao, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Mitral valve replacement therapy causes higher 30-day postoperative
mortality than mitral valvuloplasty in patients with severe ischemic
mitral regurgitation: A meta-analysis of 12 studies.
Source
International Journal of Cardiology. 185 (pp 304-307), 2015. Date of
Publication: 15 Apr 2015.
Publisher
Elsevier Ireland Ltd

<21>
Accession Number
2015963230
Authors
Wang J. Gu C. Gao M. Yu W. Li H. Zhang F. Yu Y.
Institution
(Wang, Gu, Gao, Yu, Li, Zhang, Yu) Department of Cardiac Surgery, Beijing
An Zhen Hospital, Capital Medical University, Beijing 100029, China
Title
Comparison of the incidence of postoperative neurologic complications
after on-pump versus off-pump coronary artery bypass grafting in high-risk
patients: A meta-analysis of 11 studies.
Source
International Journal of Cardiology. 185 (pp 195-197), 2015. Date of
Publication: 15 Apr 2015.
Publisher
Elsevier Ireland Ltd