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<1>
Accession Number
2015182067
Authors
Valooran G.J. Nair S.K. Chandrasekharan K.
Institution
(Valooran, Chandrasekharan) Department of Cardiovascular and Thoracic
Surgery, Rajagiri Hospital, India
(Nair) Department of Cardiovascular and Thoracic Surgery, Rajagiri
Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India
Title
Strategies for the coronary surgeon to remain "competitive and
co-operative" in the PCI era.
Source
Indian Heart Journal. 67 (4) (pp 351-358), 2015. Date of Publication: 01
Jul 2015.
Publisher
Elsevier
Abstract
Background The advent of percutaneous intervention has made surgical
treatment of coronary artery disease less favored by patients though the
evidence that supports CABG in certain patient subsets is strong. Methods
Literature review was done using Pubmed, Scopus, Google and Google Scholar
with MeSH terms-coronary artery bypass grafting, internal mammary artery,
drug eluting stent, stroke, myocardial revascularization. Results The
adoption of evolving techniques like anaortic off pump grafting, bilateral
internal mammary artery use, hybrid and minimally invasive coronary
revascularization techniques, intra-operative graft assessment, and heart
team approach can lead to better outcomes following surgery as is
evidenced by recent literature. Conclusions Though the adoptability of the
newer strategies may vary between centers a close coalition between
coronary surgeons and cardiologists would ensure that the management of
coronary artery disease is based on evidence for the benefit of the
patient.

<2>
Accession Number
2015329188
Authors
Du S.-L. Zeng X.-Z. Tian J.-W. Ai J. Wan J. He J.-X.
Institution
(Du, Wan) Department of Thoracic and Cardiovascular Surgery, Nanfang
Hospital of Southern Medical University, 1838 North Guangzhou Avenue,
Guangzhou, Guangdong 510515, China
(Zeng, Tian, Ai) Division of Nephrology, Nanfang Hospital of Southern
Medical University, 1838 North Guangzhou Avenue, Guangzhou, Guangdong
510515, China
(He) First Clinical Medical School, Southern Medical University,
Guangzhou, Guangdong, China
(He) Department of Thoracic Surgery, First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
Title
Advanced oxidation protein products in predicting acute kidney injury
following cardiac surgery.
Source
Biomarkers. 20 (3) (pp 206-211), 2015. Date of Publication: 03 Apr 2015.
Publisher
Taylor and Francis Ltd
Abstract
To test the hypothesis whether serum advanced oxidation protein products
(AOPP) are associated with increased acute kidney injury (AKI) after
cardiopulmonary bypass (CPB) and could serve as a biomarker in this
aspect, we performed a prospective cohort study. Thirty-five (22.3%)
patients developed AKI, and 32 age-and gender-matched patients without AKI
were selected as control. Serum AOPP 1 h after CPB were significantly
higher among AKI patients compared with non-AKI patients (81.8 +/- 18.6
versus 67.4 +/- 12.5 mol/L, p < 0.001), with an area under the
receiver-operating characteristic (ROC) curve of 0.714. An optimal serum
AOPP 1 h after CPB cutoff of 69.9 mol/L had a sensitivity of 74%,
specificity of 63% and a positive predictive value of 68% for predicting
AKI. These results demonstrated that serum AOPP might be an early
biomarker for AKI after CPB.

<3>
Accession Number
2015332491
Authors
Saito S. Isshiki T. Kimura T. Ogawa H. Yokoi H. Nishikawa M. Miyazaki S.
Tanaka Y. Nakamura M.
Institution
(Saito) Division of Cardiology, Shonan Kamakura General Hospital,
Kamakura, Japan
(Isshiki) Ageo Central General Hospital, Ageo, Japan
(Kimura) Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Ogawa) Department of Cardiovascular Medicine, Graduate School of Medical
Sciences, Kumamoto University, Kumamoto, Japan
(Ogawa) National Cerebral Cardiovascular Center, Suita, Japan
(Yokoi) Fukuoka Sanno Hospital, Fukuoka, Japan
(Yokoi) International University of Health Welfare, Ohtawara, Japan
(Nishikawa) Clinical Research Support Center, Mie University Hospital,
Tsu, Japan
(Miyazaki) Division of Cardiology, Department of Medicine, Kinki
University, Osakasayama, Japan
(Tanaka) Clinical Data Biostatistics, Department R and D Division, Daiichi
Sankyo Co Ltd, Tokyo, Japan
(Nakamura) Division of Cardiovascular Medicine, Ohashi Medical Center,
Toho University, Tokyo, Japan
Title
Impact of arterial access route on bleeding complications in japanese
patients undergoing percutaneous coronary intervention - Insight from the
PRASFIT trial.
Source
Circulation Journal. 79 (9) (pp 1928-1937), 2015. Date of Publication: 25
Aug 2015.
Publisher
Japanese Circulation Society
Abstract
Background: Few large-scale studies have examined the relationship between
bleeding events not related to coronary artery bypass grafting (CABG), and
the vascular access route used in acute coronary syndrome (ACS) or in
elective treatment of coronary artery disease (CAD). Methods and Results:
We compared the incidence of bleeding events occurring up to 3 days after
percutaneous coronary intervention (PCI) or loading dose of prasugrel or
clopidogrel in 2 studies of Japanese patients (PRASFITACS, femoral and
radial routes, n=683 and 531; PRASFIT-Elective, femoral and radial routes,
n=135 and 508). Rates of periprocedural bleeding, bleeding not related to
CABG, and puncture site bleeding were consistently lower in the radial
access route group than in the femoral access route group in both studies.
Risk factors for periprocedural bleeding included sex, body weight, age,
and access route in PRASFIT-ACS (femoral access: hazard ratio [HR], 3.739;
95% confidence interval [CI]: 1.727-8.094; radial access: HR, 0.288; 95%
CI: 0.128-0.65), and body weight, age, and access route in
PRASFIT-Elective (femoral access: HR, 12.32; 95% CI 1.282->100; radial
access: HR, 0.125; 95% CI: 0.013-1.205). Conclusions: The incidence of
periprocedural bleeding is lower with a radial access route than with a
femoral access route for PCI in Japanese patients with ACS or those
undergoing elective PCI for CAD.

<4>
Accession Number
2015320444
Authors
Mouton R. Pollock J. Soar J. Mitchell D.C. Rogers C.A.
Institution
(Mouton, Soar) Southmead Hospital, Department Anaesthesia, Bristol BS10
5NB, United Kingdom
(Pollock) University of the West of England, Faculty of Health and Life
Sciences, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, United
Kingdom
(Mitchell) Southmead Hospital, Department Vascular Surgery, Bristol BS10
5NB, United Kingdom
(Rogers) University of Bristol, Clinical Trials and Evaluation Unit,
School of Clinical Sciences, Level 7, Bristol Royal Infirmary, Bristol BS2
8HW, United Kingdom
Title
Remote ischaemic preconditioning versus sham procedure for abdominal
aortic aneurysm repair: An external feasibility randomized controlled
trial.
Source
Trials. 16 (1) , 2015. Article Number: 377. Date of Publication: August
25, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Despite advances in perioperative care, elective abdominal
aorta aneurysm (AAA) repair carries significant morbidity and mortality.
Remote ischaemic preconditioning (RIC) is a physiological phenomenon
whereby a brief episode of ischaemia-reperfusion protects against a
subsequent longer ischaemic insult. Trials in cardiovascular surgery have
shown that RIC can protect patients' organs during surgery. The aim of
this study was to investigate whether RIC could be successfully introduced
in elective AAA repair and to obtain the information needed to design a
multi-centre RCT. Methods: Consecutive patients presenting for elective
AAA repair, using an endovascular (EVAR) or open procedure, in a single
large city hospital in the UK were assessed for trial eligibility.
Patients who consented to participate were randomized to receive RIC
(three cycles of 5 min ischaemia followed by 5 min reperfusion in the
upper arm immediately before surgery) or a sham procedure. Patients were
followed up for 6 months. We assessed eligibility and consent rates, the
logistics of RIC implementation, randomization, blinding, data capture,
patient and staff opinion, and variability and frequency of clinical
outcome measures. Results: Between January 2010 and December 2012, 98
patients were referred for AAA repair, 93 were screened, 85 (91 %) were
eligible, 70 were approached for participation and 69 consented to
participate; 34 were randomized to RIC and 35 to the sham procedure. There
was a greater than expected variation in the complexity of EVAR that
impacted the outcomes. Acute kidney injury occurred in 28 (AKIN 1: 23 %;
AKIN 2: 15 % and AKIN 3: 3 %) and 7 (10 %) had a perioperative myocardial
infarction. Blinding was successful, and interviews with participants and
staff indicated that the procedure was acceptable. There were no adverse
events secondary to the intervention in the 6 months following the
intervention. Conclusions: This study provided essential information for
the planning and design of a multi-centre RCT to assess effectiveness of
RIC for improving clinical outcomes in elective AAA repair. Patient
consent was high, and the RIC intervention was carried out with minimal
disruption to clinical care. The allocation scheme for a definite trial
should take into account both the surgical procedure and its complexity to
avoid confounding the effect of the RIC, as was observed in this study.
Trial registration: Current Controlled Trials ISRCTN19332276(date of
registration: 16 March 2012). The trial protocol is available from the
corresponding author.

<5>
Accession Number
2015321531
Authors
Khan F. Manzoor A. Jamal S.
Institution
(Khan, Manzoor, Jamal) Department of Surgery, Pakistan Air Force Hospital,
Islamabad, Pakistan
Title
Low pressure pneumoperitonium laparoscopic cholecystectomy: A comparison
of intra-operative hemodynamic stability and physiological changes with
standard pressure pneumoperitonium laparoscopic cholecystectomy.
Source
Rawal Medical Journal. 40 (3) (pp 299-303), 2015. Date of Publication: 22
Aug 2015.
Publisher
Pakistan Medical Association
Abstract
Objective: To compare the intra-operative changes in heart rate, mean
arterial blood pressure, oxygen saturation and end-tidal carbon dioxide
volume between patients undergoing low pressure and standard pressure
pneumoperitonium laparoscopic cholecystectomy. Methodology: This
randomized control trial was conducted at department of Surgery, Pakistan
Air Force Hospital, Islamabad, Pakistan from August 2011 to July 2013.
Atotal of 214 patients, who met inclusion criteria, were randomized into
two groups. Pulse rate, mean arterial blood pressure, oxygen saturation
and end-tidal carbon dioxide were measured after anesthesia induction and
at 20, 40 and 60 minutes post-anesthesia induction and at the end of
laparoscopic procedure of the two groups. Results: The operating time in
both groups was comparable. The intra-operative hemodynamic stability and
physiological changes were closer to the pre-operative state in the low
pressure standard pressure pneumoperitonium group. The technical
difficulties were greater in low pressure pneumoperitonium due to the
limited exposure. Post-operative recovery was similar. Conclusion:
Low-pressure pneumoperitonium laparoscopic cholecystectomy is valuable to
reduce the untoward physiologic changes associated with standard pressure
pneumoperitonium, as it minimally alters the physiological parameters
per-operatively. Performing laparoscopic cholecystectomy with low pressure
pneumoperitoneum has potential limitations and its safety has to be
further established. We propose that it is best reserved for patients with
compromised cardiovascular and respiratory functions and the elderly.

<6>
Accession Number
2015315623
Authors
Gabriel J. Klimach S. Lang P. Hildick-Smith D.
Institution
(Gabriel, Klimach) Brighton and Sussex Medical School, BSMS Teaching
Building, University of Sussex, Brighton, East Sussex BN1 9PX, United
Kingdom
(Lang, Hildick-Smith) Sussex Cardiac Centre, Royal Sussex County Hospital,
Brighton and Sussex University Hospitals Trust, Brighton, East Sussex,
United Kingdom
Title
Should computed tomography angiography supersede invasive coronary
angiography for the evaluation of graft patency following coronary artery
bypass graft surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (2) (pp 231-239),
2015. Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Invasive coronary angiography (ICA) has long been the established gold
standard in assessing graft patency following coronary artery bypass graft
(CABG). Over the past decade or so however, improvements in computed
tomography angiography (CTA) technology have allowed its emergence as a
useful clinical tool in graft assessment. The recent introduction of
64-slice and now 128-slice scanners into widespread distribution, and the
development of 320-detector row technology allowing volumetric imaging of
the entire heart at single points in time within one cardiac cycle, has
increased the potential of CTA to supersede ICA in this capacity. This
study sought to examine the evidence surrounding this potential. A best
evidence topic was constructed according to a structured protocol. The
enquiry: In [patients who have undergone coronary artery bypass graft
surgery] is [computed tomography angiography or invasive coronary
angiography] superior in terms of [graft patency assessment, stenosis
detection, radiation exposure and complication rate]? Four hundred and
twenty-four articles were identified from the search strategy. Four
additional articles were identified from references of key articles.
Seventeen articles selected as best evidence were tabulated. The
reliability of CTA as a tool in the detection of graft patency and
stenosis has continued to improve with each successive generation of
multislice technology. The latest 64- and 128-slice CTA techniques are
able to detect graft patency and stenosis with very high sensitivities and
specificities comparable with ICA, while remaining non-invasive procedures
associated with fewer complications (ICA carries a 0.08% risk of
myocardial infarction and 0.7% risk of minor complications in clinically
stable patients). Present limitations of the technology include the
accurate visualization of distal anastomoses and clip artefacts. In
addition, the capacity of diagnostic ICA to be combined simultaneously
with percutaneous coronary interventions is an important advantage and a
further limitation of CTA alone. Recent developments, however, including
the derivation of fractional flow reserve and perfusion assessment from
CTA as functional measures of stenosis severity have given CTA at present
the capacity to become a first-line tool in the assessment of patients
with suspected graft dysfunction. Novel computer-automated diagnostic
software, though currently in infancy, has shown promise in facilitating
and speeding image interpretation. With further improvements in scanning
technologies, CTA is likely to supersede ICA for graft assessment in the
near future.

<7>
Accession Number
2015321341
Authors
Bayat F. Faritous Z. Aghdaei N. Dabbagh A.
Institution
(Bayat) Fellowship in Cardiac Anesthesiology, Alborz University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Faritous, Aghdaei) Fellowship in Cardiac Anesthesiology, Shahid Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Dabbagh) Fellowship in Cardiac Anesthesiology, Anesthesiology Research
Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
A study of the efficacy of furosemide as a prophylaxis of acute renal
failure in coronary artery bypass grafting patients: A clinical trial.
Source
ARYA Atherosclerosis. 11 (3) , 2015. Date of Publication: 2015.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Renal failure is a frequent event after coronary artery bypass
grafting (CABG). Hemodynamic alterations during surgery as well as the
underlying disease are the predisposing factors. We aimed to study
intermittent furosemide therapy in the prevention of renal failure in
patients undergoing CABG. METHODS: In a single-blind randomized controlled
trial, 123 elective CABG patients, 18-75 years, entered the study.
Clearance of creatinine, urea and water were measured. Patients were
randomly assigned into three groups: furosemide in prime (0.3-0.4 mg/kg);
intermittent furosemide during CABG (0.2 mg/kg, if there was a decrease in
urinary excretion) and control (no furosemide). RESULTS: There was a
significant change in serum urea, sodium and fluid balance in
"intermittent furosemide" group; other variables did not change
significantly before or after the operation. Post-operative fluid balance
was significantly higher in "intermittent furosemide" group (2573 +/- 205
ml) compared to control (1574 +/- 155 ml) (P < 0.010); also, fluid balance
was higher in "intermittent furosemide" group (2573 +/- 205 ml) compared
to "furosemide in prime" group (1935 +/- 169 ml) (P < 0.010). CONCLUSION:
The study demonstrated no benefit from intermittent furosemide in elective
CABG compared to furosemide in prime volume or even placebo.

<8>
Accession Number
2015969581
Authors
Nairooz R. Sardar P. Amin H. Chatterjee S. Helmy T. Naidu S.S.
Institution
(Nairooz) Department of Cardiology, University of Arkansas for Medical
Sciences, 4301 West Markham, Slot 532, Little Rock, AR 72205-7199, United
States
(Sardar) Department of Cardiology, University of Utah, Salt Lake City, UT,
United States
(Amin) Department of Medicine, New York Medical College, Metropolitan
Hospital Center, New York City, NY, United States
(Chatterjee) Department of Cardiology, St. Luke's-Roosevelt Hospital
Center, Mount Sinai Health System, New York City, NY, United States
(Helmy) Department of Cardiology, University of Cincinnati, Cincinnati,
OH, United States
(Naidu) Department of Cardiology, Winthrop University Hospital, Mineola,
NY, United States
Title
Short- and long-term outcomes in diabetes patients undergoing percutaneous
coronary intervention with bivalirudin compared with heparin and
glycoprotein IIb/IIIA inhibitors: A meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 86 (3) (pp 364-375),
2015. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Diabetes patients undergoing percutaneous coronary intervention
(PCI) have more complications than nondiabetes patients, including
increased long-term mortality. Use of bivalirudin versus heparin and
glycoprotein IIb/IIIa inhibitors (GPI) in diabetes patients undergoing PCI
and its effect on long-term mortality were evaluated in few randomized
trials, but with conflicting results. Methods We searched the literature
for randomized controlled trials that compared heparin and GPI therapy
with bivalirudin in diabetes patients undergoing PCI. The incidence of
major adverse cardiovascular events (MACE), death from any cause,
myocardial infarction (MI), urgent revascularization, major and minor
bleeding (at 30 days), as well as all-cause mortality at 1 year were
included, and meta-analysis was performed. Results A total of 5,137
patients with diabetes were included in four randomized trials. At 30
days, bivalirudin, compared with heparin and GPI, caused less major
bleeding (odds ratio (OR), 0.68; 95% confidence interval (CI), 0.52-0.89;
P = 0.005) and less minor bleeding (OR, 0.48; 95% CI, 0.41-0.57; P <
0.00001) and similar rates of MACE (OR, 0.87; 95% CI, 0.70-1.08; P =
0.21), MI (OR, 0.87; 95% CI, 0.68-1.10; P = 0.25), and urgent
revascularization (OR, 1.12; 95% CI, 0.76-1.65; P = 0.57). Death from any
cause at 30 day was numerically lower with bivalirudin use but not
statistically significant (OR, 0.72; 95% CI, 0.46-1.13; P = 0.15).
Mortality at 1 year was significantly lower in diabetes patients treated
with bivalirudin compared with heparin and GPI (OR, 0.72; 95% CI,
0.52-0.99; P = 0.04). A secondary analysis suggests that the major
bleeding benefit with bivalirudin may be driven by mandated use of GPI in
heparin arm. Conclusion Among patients with diabetes undergoing PCI,
bivalirudin caused less major and minor bleeding compared with heparin and
GPI, with similar rates of MACE, death, MI, and urgent revascularization
at 30 days, but significantly lower mortality rates at 1 year.

<9>
Accession Number
2015969578
Authors
Ferrante G. Valgimigli M. Pagnotta P. Presbitero P.
Institution
(Ferrante, Pagnotta, Presbitero) Department of Interventional Cardiology,
Humanitas Clinical and Research Center, Istituto Clinico Humanitas IRCCS,
Via Manzoni, 56, Rozzano, Milan 20089, Italy
(Valgimigli) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
Title
Bivalirudin versus heparin in patients with acute myocardial infarction: A
meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 86 (3) (pp 378-389),
2015. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background The aim of this study was to assess the impact of bivalirudin,
as compared to unfractionated heparin, on clinical outcomes in patients
with ST-segment elevation myocardial infarction (STEMI). Methods A
meta-analysis of randomized trials comparing bivalirudin versus heparin in
patients with STEMI undergoing primary percutaneous coronary intervention
was performed. Three randomised trials enrolling 7,612 patients were
included. Analysis was by intention to treat. Results At 30 days,
bivalirudin, as compared to heparin, was associated with a similar risk of
all-cause mortality (3.03% vs. 3.38%, odds ratio (OR) 0.90, 95% confidence
intervals (CI) [0.63 to 1.29], P = 0.57). Bivalirudin significantly
increased the risk of definite (2.39% vs. 1.06%, OR 2.49, 95% CI [1.30 to
4.76], P = 0.006); definite or probable (2.55% vs. 1.35%, OR 2.26, 95% CI
[1.07 to 4.79], P = 0.03), and acute stent thrombosis (1.69% vs. 0.39%, OR
4.34, 95% CI [2.30 to 8.16], P < 0.001); leading to nonsignificantly
higher reinfarction rates (2.0% vs. 1.31%, OR 1.72, 95% CI [0.89 to 3.35],
P = 0.11), and to a significantly increased risk of ischemia driven
revascularization (2.50% vs. 1.52%, OR 1.80, 95% CI [1.02 to 3.18], P =
0.04) at 30 days. No firm evidence for a reduction in major bleeding
associated with bivalirudin use was found (3.93% vs. 6.39%, OR 0.63, 95%
CI [0.39 to 1.04], P = 0.07). Conclusions In patients with STEMI,
bivalirudin, as compared to heparin, increases the risk of stent
thrombosis and ischemia driven repeat revascularization at 30 days. There
is no strong evidence that bivalirudin significantly reduces major
bleeding at 30 days. Bivalirudin does not have an effect on all-cause
mortality at 30 days.

<10>
Accession Number
2015783787
Authors
Briguori C. Visconti G. Donahue M. Focaccio A. Mitomo S. Kawamoto H.
Nakamura S.
Institution
(Briguori, Visconti, Donahue, Focaccio) Laboratory of Interventional
Cardiology, Department of Cardiology, Clinica Mediterraneac, Via Orazio 2,
Naples 80121, Italy
(Mitomo, Kawamoto, Nakamura) Interventional Cardiology Unit, New Tokyo
Hospital, Chiba, Japan
Title
The STENTYS paclitaxel-eluting stent in the treatment of unprotected
distal left main.
Source
Catheterization and Cardiovascular Interventions. 86 (3) (pp E131-E139),
2015. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Vessel tapering represents an important limitation of the
balloon-expandable drug-eluting stent (DES) in the treatment of distal
unprotected left main coronary artery (ULMCA) lesions. In this study, we
assessed the suitability of the STENTYS DES^(P), a self-apposing
nitinol paclitaxel-eluting stent, for use in the treatment of distal ULMCA
lesions. Methods and Results From February 2012 to September 2013, 75
consecutive patients with tapered (that is a >1 mm difference in the
diameter from the proximal to the distal main vessel) distal ULMCA lesions
were treated with the STENTYS DES^(P) (STENTYS-DES group) at the
Clinica Mediterranea (Naples, Italy). A matched-group of 75 patients
treated with second-generation DES in the same period (Control group) was
selected from the database of New Tokyo Hospital (Chiba, Japan). The
result was assessed by both quantitative coronary angiography and
intravascular ultrasound (IVUS). Although the final balloon diameter was
larger in the Control group (4.51 +/- 0.51 vs. 3.62 +/- 0.49 mm; P <
0.001), the IVUS analysis showed a larger final minimal lumen area in the
STENTYS-DES group than in the Control group (left main: 17.45 +/- 3.45 vs.
14.84 +/- 3.45 mm²; P < 0.001; polygon of confluence: 15.74 +/-
3.28 vs. 12.55 +/- 5.45 mm²; P < 0.002; ostial left anterior
descending artery: 11.73 +/- 1.97 vs. 8.56 +/- 1.80 mm²; P <
0.001). At 12 +/- 5 months, major adverse cardiac events (including death,
myocardial infarction, and repeat revascularization) occurred in seven
patients in both groups. Conclusions This pilot study suggests that the
self-apposing properties of the STENTYS DES^(P) offer a valid
alternative for the treatment of the distal ULMCA lesions.

<11>
Accession Number
2015772637
Authors
Gargiulo G. Sannino A. Capodanno D. Perrino C. Capranzano P. Barbanti M.
Stabile E. Trimarco B. Tamburino C. Esposito G.
Institution
(Gargiulo, Sannino, Perrino, Stabile, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University of Naples, Via Pansini 5, Naples 80131, Italy
(Capodanno, Capranzano, Barbanti, Tamburino) Division of Cardiology,
Ferrarotto Hospital, University of Catania, Catania, Italy
(Capodanno, Capranzano, Tamburino) Excellence Through Newest Advances
(ETNA) Foundation, Catania, Italy
Title
Impact of postoperative acute kidney injury on clinical outcomes after
transcatheter aortic valve implantation: A meta-analysis of 5,971
patients.
Source
Catheterization and Cardiovascular Interventions. 86 (3) (pp 518-527),
2015. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background There is conflicting evidence on the safety and efficacy of
transcatheter aortic valve implantation (TAVI) in patients with
postoperative acute kidney injury (AKI). Therefore, we conducted a
meta-analysis on the impact of AKI on clinical outcomes after TAVI.
Methods and Results Twenty-four studies including 5,971 patients were
analyzed. The mean incidence of AKI in this population was 22.1% +/- 11.2.
Postoperative AKI significantly increased early (odds ratio [OR] 5.09; 95%
confidence interval [CI], 4.03-6.43 and OR 6.14; 95% CI, 3.26-11.55) and
1-year (OR 3.27; 95% CI, 2.42-4.42 and OR 1.93; 95% CI, 1.38-2.71)
all-cause and cardiovascular mortality respectively, but also early
myocardial infarction (OR 3.30; 95% CI, 1.44-7.57), life-threatening
bleeding (OR 2.90; 95% CI, 1.67-5.05), need for transfusion (OR 2.42; 95%
CI, 1.96-2.99), and dialysis (OR 14.35; 95% CI, 6.21-33.20), with a
non-significant increase of stroke (OR 1.66; 95% CI, 0.94-2.95),
hospitalization (mean difference [MD] 1.73; 95% CI, -0.31 to 3.77) and
contrast medium received (MD 4.74; 95% CI, -2.33 to 11.81). Conclusions
Postoperative AKI seems to significantly worsen TAVI prognosis. The
results of the present meta-analysis should be considered
hypothesis-generating and future studies on risk stratification,
prevention, and postoperative management are needed.

<12>
Accession Number
2015315983
Authors
Dehghani M.R. Kasianzadeh M. Rezaei Y. Sepehrvand N.
Institution
(Dehghani, Kasianzadeh) Department of Cardiology, Seyyed-al-Shohada Heart
Center, Urmia University of Medical Sciences, Urmia, Iran, Islamic
Republic of
(Rezaei) Seyyed-al-Shohada Heart Center, Urmia University of Medical
Sciences, 17 Shahrivar Blvd, Urmia 5718749441, Iran, Islamic Republic of
(Sepehrvand) Department of Medicine, Canadian VIGOUR Centre, University of
Alberta, Edmonton, AB, Canada
Title
Atorvastatin Reduces the Incidence of Postoperative Atrial Fibrillation in
Statin-Naive Patients Undergoing Isolated Heart Valve Surgery.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 20 (5) (pp
465-472), 2015. Date of Publication: 18 Sep 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Atorvastatin has been demonstrated to reduce the incidence of
postoperative atrial fibrillation (POAF) in patients undergoing cardiac
surgery, but its effect on isolated heart valve surgery is unknown.
Methods: In a randomized, double-blinded, placebo-controlled trial, 58
patients who underwent isolated heart valve surgery supported by on-pump
cardiopulmonary bypass were randomly assigned to receive either placebo (n
= 29) or 40 mg of atorvastatin once daily starting 3 days preoperatively
and continuing within 5 days postoperatively (n = 29). A continuous
monitoring tool and an electrocardiographic Holter monitoring were used
for detecting the POAF (Clinical Trial Registration:
www.clinicaltrials.gov; Unique Identifier: NTC02084069). Results: The
patients median age was 49 years, and 67% were female. In all, 6 (21%) and
13 (45%) cases of POAF were observed in the atorvastatin and placebo
groups, respectively (P =.050). The duration of AF before re-establishment
of sinus rhythm was significantly lower in the atorvastatin group than in
the placebo group (median of 70 vs 132 minutes, P =.026). The lengths of
intensive care unit and hospital stay were comparable between the groups.
The increase in postoperative white blood cell count was significantly
lower in the atorvastatin group than in the placebo group (median of 1.5
vs 2.3 x 10³/muL, respectively, P =.019). After adjustment, the
atorvastatin treatment was associated with a decrease in the risk of
developing POAF (odds ratio 0.122, 95% confidence interval 0.027-0.548, P
=.006). Conclusion: Perioperative treatment with 40 mg of atorvastatin is
useful to decrease the incidence of POAF in the statin-naive patients
undergoing isolated heart valve surgery.

<13>
Accession Number
2015309242
Authors
Abdel-Wahab M. Neumann F.-J. Mehilli J. Frerker C. Richardt D. Landt M.
Jose J. Toelg R. Kuck K.-H. Massberg S. Robinson D.R. El-Mawardy M.
Richardt G.
Institution
(Abdel-Wahab, Landt, Jose, Toelg, El-Mawardy, Richardt) Heart Center,
Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities
of Kiel, Lubeck and Hamburg, Am Kurpark 1, Bad Segeberg 23795, Germany
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Mehilli, Massberg) Munich University Clinic, Munich, Germany
(Frerker, Kuck) Cardiology Department, Asklepios Clinic St. Georg,
Hamburg, Germany
(Richardt) Cardiosurgery Department, Lubeck University Hospital, Lubeck,
Germany
(Robinson) Mathematics Department, University of Sussex, Brighton, United
Kingdom
Title
1-year outcomes after transcatheter aortic valve replacement with
balloon-expandable versus self-expandable valves: Results from the CHOICE
randomized clinical trial.
Source
Journal of the American College of Cardiology. 66 (7) (pp 791-800), 2015.
Date of Publication: 18 Aug 2015.
Publisher
Elsevier USA
Abstract
Background The use of a balloon-expandable transcatheter heart valve
previously resulted in a greater rate of device success compared with a
self-expandable transcatheter heart valve. Objectives The aim of this
study was to evaluate clinical and echocardiographic outcome data at
longer term follow-up. Methods The investigator-initiated trial randomized
241 high-risk patients with symptomatic severe aortic stenosis and anatomy
suitable for treatment with both balloon- and self-expandable
transcatheter heart valves to transfemoral transcatheter aortic valve
replacement with either device. Patients were followed-up for 1 year, with
assessment of clinical outcomes and echocardiographic evaluation of valve
function. Results At 1 year, the rates of death of any cause (17.4% vs.
12.8%; relative risk [RR]: 1.35; 95% confidence interval [CI]: 0.73 to
2.50; p = 0.37) and of cardiovascular causes (12.4% vs. 9.4%; RR: 1.32;
95% CI: 0.63 to 2.75; p = 0.54) were not statistically significantly
different in the balloon- and self-expandable groups, respectively. The
frequencies of all strokes (9.1% vs. 3.4%; RR: 2.66; 95% CI: 0.87 to 8.12;
p = 0.11) and repeat hospitalization for heart failure (7.4% vs. 12.8%;
RR: 0.58; 95% CI: 0.26 to 1.27; p = 0.19) did not statistically
significantly differ between the 2 groups. Elevated transvalvular
gradients during follow-up were observed in 4 patients in the
balloon-expandable group (3.4% vs. 0%; p = 0.12); all were resolved with
anticoagulant therapy, suggesting a thrombotic etiology. More than mild
paravalvular regurgitation was more frequent in the self-expandable group
(1.1% vs. 12.1%; p = 0.005). Conclusions Despite the higher device success
rate with the balloon-expandable valve, 1-year follow-up of patients in
CHOICE (Randomized Comparison of Transcatheter Heart Valves in High Risk
Patients With Severe Aortic Stenosis: Medtronic CoreValve Versus Edwards
SAPIEN XT Trial), with limited statistical power, revealed clinical
outcomes after transfemoral transcatheter aortic valve replacement with
both balloon- and self-expandable prostheses that were not statistically
significantly different. (A Comparison of Transcatheter Heart Valves in
High Risk Patients With Severe Aortic Stenosis: The CHOICE Trial;
NCT01645202)

<14>
[Use Link to view the full text]
Accession Number
2015315477
Authors
Malik V. Subramanian A. Hote M. Kiran U.
Institution
(Malik, Subramanian, Kiran) Departments of Cardiac Anesthesiology, All
India Institute of Medical Sciences, New Delhi 110029, India
(Hote) Cardiothoracic and Vascular Surgery, All India Institute of Medical
Sciences, New Delhi, India
Title
Effect of Levosimendan on Diastolic Function in Patients Undergoing
Coronary Artery Bypass Grafting: A Comparative Study.
Source
Journal of Cardiovascular Pharmacology. 66 (2) (pp 141-147), 2015. Date of
Publication: 21 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
To compare the efficacy of levosimendan with nitroglycerin in patients
with isolated diastolic dysfunction undergoing coronary artery bypass
grafting. Procedure: Thirty patients with isolated diastolic dysfunction
undergoing on-pump coronary artery bypass grafting were randomized into 2
groups receiving levosimendan or nitroglycerin infusion. The infusion was
started before sternotomy and continued in the postoperative period.
Perioperatively, diastolic function was serially evaluated at 3 different
time points using echocardiography. N-terminal fragment of
pro-B-natriuretic peptide (NT-proBNP) levels were measured in both the
groups. Results: There was a significant improvement in diastolic function
as measured by isovolumic relaxation time (P=0.0001, P=0.001) and
deceleration time (P=0.0001, P=0.0001) in the levosimendan group from the
baseline in patients with impaired relaxation. Similarly, tissue Doppler
imaging also revealed an improvement from the baseline in patients with a
pseudonormal pattern (P = 0.018, P = 0.001). Furthermore, there was a
significant improvement in the above parameters when compared with the
nitroglycerin group. The NT-proBNP levels also demonstrated a similar
pattern between the 2 groups (P = 0.03, P = 0.02) when levosimendan was
compared with nitroglycerin in patients with a pseudonormal pattern on
echocardiography. Conclusions: Levosimendan is superior to nitroglycerin
in improving diastolic function irrespective of coronary
revascularization.

<15>
Accession Number
2015310713
Authors
Vrooman B. Kapural L. Sarwar S. Mascha E.J. Mihaljevic T. Gillinov M. Qavi
S. Sessler D.I.
Institution
(Vrooman) Department of Pain Management, Cleveland Clinic, Cleveland, OH,
United States
(Kapural) Carolinas Pain Institute at Brookstown, Wake Forest University,
School of Medicine, Winston-Salem, NC, United States
(Sarwar) Department of Family Medicine, University Hospitals of Cleveland,
Cleveland, OH, United States
(Mascha) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Mascha, Sessler) Department of Outcomes Research, Cleveland Clinic,
Cleveland, OH, United States
(Mihaljevic, Gillinov) Department of Cardiothoracic Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Qavi) Resident, Anesthesiology Institute, Cleveland Clinic, Cleveland,
OH, United States
Title
Lidocaine 5% Patch for Treatment of Acute Pain After Robotic Cardiac
Surgery and Prevention of Persistent Incisional Pain: A Randomized,
Placebo-Controlled, Double-Blind Trial.
Source
Pain Medicine (United States). 16 (8) (pp 1610-1621), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: To test the hypotheses that lidocaine 5% patches decrease the
severity of acute pain and incidence of persistent incisional pain after
robotic cardiac valve surgery. Design: A randomized, placebo-controlled,
double-blind trial. Setting: Tertiary care academic medical center.
Subjects: Patients having robotic cardiac valve surgery. Methods: Patients
having robotic cardiac valve surgery were randomly assigned to 5%
lidocaine patches or identical-appearing placebo patches. Patches were
applied around each incision 12 hours/day until pain resolved, or for 6
months. Supplemental opioid was provided by patient-controlled analgesia
or orally. Pain was initially evaluated with a Visual Analog Scale, and
subsequently by telephone with a Verbal Response Scale and the Pain
Disability Index (our primary outcome) after 1 week, 1 month, 3 months,
and 6 months. Global Perceived Effect, a measure of patient satisfaction,
was simultaneously recorded. Repeated-measures analysis of variance and
generalized estimating equations were our primary statistical tools.
Results: Acute pain scores and opioid use were low, as was the incidence
of persistent pain. Lidocaine 5% patches did not influence any measure of
acute or persistent incisional pain. Estimated difference (95% CI) in mean
Pain Disability Index for Lidocaine patch minus placebo was -2.5 (95% CI
-7.1, 2.1), P=0.28. Conclusions: Lidocaine 5% patches did not reduce acute
or persistent pain in patients having robotic thoracic surgery, though
pain scores were low in both treatment groups. Clinicians should choose
alternative analgesic approaches in these patients.

<16>
Accession Number
2015315025
Authors
Cao A.-H. Wang J. Gao H.-Q. Zhang P. Qiu J.
Institution
(Cao, Wang, Gao, Zhang, Qiu) Department of Geriatrics, Shandong University
Qilu Hospital, 107 Wenhua Xi Road, Jinan, Shandong, China
(Cao, Wang, Gao, Qiu) Shandong Provincial Key Laboratory of Cardiovascular
Proteomics, 107 Wenhua Xi Road, Jinan, Shandong, China
Title
Beneficial clinical effects of grape seed proanthocyanidin extract on the
progression of carotid atherosclerotic plaques.
Source
Journal of Geriatric Cardiology. 12 (4) (pp 417-423), 2015. Date of
Publication: 2015.
Publisher
Science Press
Abstract
Background Atherosclerotic plaques indicate the occurrence of ischemia
events and it is a difficult task for clinical physicians. Grape seed
proanthocyanidin extract (GSPE) has been reported to exert an
antiatherogenic effect by inducing regression of atherosclerotic plaques
in animal experimental studies. In this study, the antiatherogenic effect
of GSPE has been investigated in clinical use. Methods Consecutive 287
patients diagnosed with asymptomatic carotid plaques or abnormal plaque
free carotid intima-media thickness (CIMT) were randomly assigned to the
GSPE group (n = 146) or control group (n = 141). The patients in the GSPE
group received GSPE 200 mg per day orally, while patients in the control
group were only enrolled in a lifestyle intervention program. Carotid
ultrasound examination was performed at baseline and 6, 12, 24 months
during follow-up. Mean maximum CIMT (MMCIMT), plaque score, echogenicity
of plaques and ischemic vascular events were recorded. Results As
anticipated, after treatment, GSPE resulted in significant reduction in
MMCIMT progression (4.2% decrease after six months, 4.9% decrease after 12
months and 5.8% decrease after 24 months) and plaque score (10.9% decrease
after six months, 24.1% decrease after 12 months and 33.1% decrease after
24 months) for the primary outcome, while MMCIMT and plaque score were
stable and even increased with the time going on in control group. The
number of plaques and unstable plaques also decreased after treatment of
GSPE. Furthermore, the carotid plaque can disappear after treatment with
GSPE. The incidence rate for transitory ischemic attack (TIA), arterial
revascularization procedure, and hospital readmission for unstable angina
in GSPE group were statistically significant lower (P = 0.02, 0.08, 0.002,
respectively) compared with the control group. Conclusions GSPE inhibited
the progression of MMCIMT and reduced carotid plaque size in GSPE treated
patients, and with extended treatment, the superior efficacy on MMCIMT and
carotid plaque occurred. Furthermore, the GSPE group showed lower rates of
clinical vascular events.

<17>
[Use Link to view the full text]
Accession Number
2015312011
Authors
Lee J.M. Hwang D. Park J. Kim K.-J. Ahn C. Koo B.-K.
Institution
(Lee, Hwang, Park, Kim, Koo) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro,
Chongno-gu, Seoul 110-744, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
(Koo) Institute of Aging, Seoul National University, South Korea
Title
Percutaneous coronary intervention at centers with and without on-site
surgical backup: An updated meta-analysis of 23 studies.
Source
Circulation. 132 (5) (pp 388-401), 2015. Date of Publication: 04 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Emergency coronary artery bypass grafting for unsuccessful
percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate
the current safety and outcomes of primary PCI and nonprimary PCI at
centers with and without on-site surgical backup. Methods and Results - We
performed an updated systematic review and meta-analysis by using
mixed-effects models. We included 23 high-quality studies that compared
clinical outcomes and complication rates of 1 101 123 patients after PCI
at centers with or without on-site surgery. For primary PCI for
ST-segment-elevation myocardial infarction (133 574 patients), all-cause
mortality (without on-site surgery versus with on-site surgery: observed
rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence
interval, 0.91-1.07; P=0.729; I²=3.4%) or emergency coronary
artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR,
0.76; 95% confidence interval, 0.56-1.01; P=0.062; I²=42.5%)
did not differ by presence of on-site surgery. For nonprimary PCI (967 549
patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled
OR, 1.15; 95% confidence interval, 0.94-1.41; P=0.172;
I²=67.5%) and emergency coronary artery bypass grafting rates
(observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence
interval, 0.62-2.13; P=0.669; I²=81.7%) were not significantly
different. PCI complication rates (cardiogenic shock, stroke, aortic
dissection, tamponade, recurrent infarction) also did not differ by
on-site surgical capability. Cumulative meta-analysis of nonprimary PCI
showed a temporal decrease of the effect size (OR) for all-cause mortality
after 2007. Conclusions - Clinical outcomes and complication rates of PCI
at centers without on-site surgery did not differ from those with on-site
surgery, for both primary and nonprimary PCI. Temporal trends indicated
improving clinical outcomes in nonprimary PCI at centers without on-site
surgery.

<18>
Accession Number
2015183359
Authors
Jensen L.O. Thayssen P. Maeng M. Ravkilde J. Hansen H.S. Jensen S.E.
Botker H.E. Berencsi K. Lassen J.F. Christiansen E.Ho.
Institution
(Jensen, Thayssen, Hansen) Department of Cardiology, Odense University
Hospital, Sdr Boulevard 29, Odense C 5000, Denmark
(Maeng, Botker, Lassen, Christiansen) Department of Cardiology, Aarhus
University Hospital, Skejby Hospital, Aarhus, Denmark
(Ravkilde, Jensen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Berencsi) Department of Clinical Epidemiolog, Aarhus University, Aarhus,
Denmark
Title
Randomized comparison of a sirolimus-eluting Orsiro stent with a
biolimus-eluting Nobori stent in patients treated with percutaneous
coronary intervention: Rationale and study design of the Scandinavian
Organization for Randomized Trials with Clinical Outcome VII trial.
Source
American Heart Journal. 170 (2) (pp 210-215), 2015. Date of Publication:
01 Aug 2015.
Publisher
Mosby Inc.
Abstract
Background Third-generation coronary drug-eluting stents (DES) with
biodegradable polymers have been designed to improve safety and efficacy.
We designed a large scale registry-based randomized clinical trial to
compare 2 third-generation DES: a thin strut, cobalt-chromium DES with
silicon carbide-coating releasing sirolimus from a biodegradable polymer
(O-SES, Orsiro; Biotronik, Bulach, Switzerland) with the stainless steel
biodegradable polymer biolimus-eluting Nobori stents (N-BES, Nobori;
Terumo, Tokyo, Japan) in an all-comer patient population. Design The
multicenter SORT OUT VII trial (NCT01879358) randomly assigned 2,530
patients to treatment with biodegradable polymer O-SES or biodegradable
polymer N-BES at 3 sites in Western Denmark. Patients were eligible, if
they were >18 years old; had chronic stable coronary artery disease or
acute coronary syndromes; and >1 coronary lesion with >50% diameter
stenosis, requiring treatment with a DES. The primary end point target
lesion failure is a composite of cardiac death, myocardial infarction (not
related to other than index lesion), or target lesion revascularization
within 12 months. Clinically, driven event detection based on Danish
registries will be used. An event rate of 6.5% is assumed in each stent
group. With a sample size of 1,157 patients in each treatment arm, a
2-group large-sample normal approximation test of proportions with a
1-sided 5% significance level will have 90% power to detect noninferiority
of the O-SES compared with the N-BES with a predetermined noninferiority
margin of 3.0%. Conclusion The SORT OUT VII trial will determine whether
the biodegradable polymers O-SES is noninferior to the N-BES with respect
to driven event.

<19>
Accession Number
2015062944
Authors
Pancholy S.B. Palamaner Subash Shantha G. Romagnoli E. Kedev S. Bernat I.
Rao S.V. Jolly S. Bertrand O.F. Patel T.M.
Institution
(Pancholy) Wright Center for Graduate Medical Education, Commonwealth
Medical College, Scranton, PA, United States
(Palamaner Subash Shantha) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Romagnoli) Interventional Cardiology Unit, Ospedale Belcolle, Viterbo,
Italy
(Kedev) University Clinic of Cardiology, Skopje, United States
(Bernat) University Hospital, Faculty of Medicine, Pilsen, Czech Republic
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Jolly) Population Health Research Institute, Hamilton, ON, Canada
(Bertrand) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Patel) Apex Heart Institute, Ahmedabad, India
Title
Impact of access site choice on outcomes of patients with cardiogenic
shock undergoing percutaneous coronary intervention: A systematic review
and meta-analysis.
Source
American Heart Journal. 170 (2) (pp 353-361.e6), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Mosby Inc.
Abstract
Background The benefit of transradial access (TRA) in patients with
cardiogenic shock (CS) is uncertain. We sought to determine the benefits
of TRA in patients with CS undergoing coronary angiography/intervention.
Methods MEDLINE, Embase, Cochrane Central, and electronic databases were
searched for studies that assessed the following: (1) patients with CS who
underwent percutaneous coronary intervention (PCI) and (2) the association
between choice of arterial access, 30-day all-cause mortality, and 30-day
major adverse cardiac and cerebral events (MACCEs) using random-effects
model. Results From 3,652 retrieved citations, 8 studies involving 8,131
patients with CS undergoing PCI (via TRA: 2,321 patients, via TFA: 5,810
patients) were included. Transradial access was associated with
significantly reduced risk for all-cause mortality (unadjusted: risk ratio
[RR] 0.60, 95% CI 0.52-0.71, P <.001, I² = 29%, 8 included
studies; adjusted: RR 0.55, 95% CI 0.46-0.65, P <.001, I² = 0%,
6 included studies) and MACCE (unadjusted: RR 0.68, 95% CI 0.63-0.73, P
<.001, I² = 0%, 6 included studies; adjusted: RR 0.63, 95% CI
0.52-0.75, P <.001, I² = 0%, 4 included studies) at 30 days
when compared with TFA. Conclusions Transradial access is associated with
reduced mortality and MACCE at 30 days in patients with CS undergoing PCI.
Considering the possible influence of selection bias on the effect
estimate in our analysis, randomized controlled trials are needed to
better assess this association.

<20>
Accession Number
2015053268
Authors
Gao X.-F. Chen Y. Fan Z.-G. Jiang X.-M. Wang Z.-M. Li B. Mao W.-X. Zhang
J.-J. Chen S.-L.
Institution
(Gao, Fan, Jiang, Wang, Li, Mao, Zhang, Chen) Department of Cardiology,
Nanjing First Hospital, Nanjing Medical University, Nanjing, China
(Chen) Department of Neurology, Drum Tower Hospital, Nanjing Medical
University, Nanjing, China
(Gao, Zhang, Chen) Department of Cardiology, Nanjing Heart Center,
Nanjing, China
Title
Antithrombotic Regimens for Patients Taking Oral Anticoagulation after
Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9185
Patients.
Source
Clinical Cardiology. 38 (8) (pp 499-509), 2015. Date of Publication: 01
Aug 2015.
Publisher
John Wiley and Sons Inc.
Abstract
The optimal antithrombotic regimen remains controversial in patients
taking oral anticoagulation (OAC) undergoing coronary stenting. This study
sought to compare efficacy and safety outcomes of triple therapy (OAC,
aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or
OAC) in these patients. We hypothesize OAC plus clopidogrel could be the
optimal regimen for patients with indications for OAC receiving stent
implantation. Medline, the Cochrane Library, and other Internet sources
were searched for clinical trials comparing the efficacy and safety of
triple vs dual therapy for patients taking OAC after coronary stenting.
Sixteen eligible trials including 9185 patients were identified. The risks
of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence
interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95%
CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI:
0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P
= 0.75) were similar between triple and dual therapy. Compared with dual
therapy, triple therapy was associated with a reduced risk of ischemic
stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major
bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR:
1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were
similar ischemic stroke and major bleeding outcomes between triple therapy
and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel
was associated with similar efficacy and safety outcomes compared with
triple therapy. Triple therapy could be replaced by OAC plus clopidogrel
without any concern about additional risk of thrombotic events.

<21>
Accession Number
2015784144
Authors
Sun B. Wang J. Bo L. Zang Y. Gu H. Li J. Qian B.
Institution
(Sun, Zang, Gu, Qian) Department of Transfusion Medicine, Changhai
Hospital, Second Military Medical University, 168 Changhai Road, Shanghai
200433, China
(Wang) Jiangsu Key Laboratory of Anesthesiology and Jiangsu Key Laboratory
of Anesthesia and Analgesia Application Technology, Xuzhou Medical
College, Xuzhou, Jiangsu, China
(Bo, Li) Department of Anesthesiology, Changhai Hospital, Second Military
Medical University, Shanghai, China
Title
Effects of volatile vs. propofol-based intravenous anesthetics on the
alveolar inflammatory responses to one-lung ventilation: a meta-analysis
of randomized controlled trials.
Source
Journal of Anesthesia. 29 (4) (pp 570-579), 2015. Date of Publication: 22
Aug 2015.
Publisher
Springer-Verlag Tokyo
Abstract
Objective: The aim of this meta-analysis is to compare the potential
effects of inhalation anesthetics with total intravenous anesthetics on
alveolar cytokine expression and lung-related clinical outcomes in
patients undergoing one-lung ventilation (OLV) for thoracic surgery.
Methods: We retrieved the PubMed, EMBASE, and the Cochrane Library
respectively to identify randomized controlled trials comparing different
anesthetics (volatile anesthetics vs. intravenous anesthetics) on the
pulmonary inflammatory response to OLV. The primary outcomes were the
levels of alveolar concentrations of inflammatory cytokines. Results:
Eight randomized controlled trials that included 365 patients were
screened. Overall, there were significant differences in the concentration
of alveolar inflammatory mediators between volatile group and intravenous
group, in which volatile group had lower levels of TNF-alpha (SMD -1.51;
95 % CI -2.15 to -0.87; p < 0.001), IL-6 (SMD -0.70; 95 % CI -0.99 to
-0.41; p < 0.001) and IL-8 (SMD -1.32; 95 % CI -2.20 to -0.45; p = 0.003).
The overall number of pulmonary complications in the volatile group was
smaller (RR 0.42; 95 % CI 0.23-0.77; p = 0.005) and patients in that group
had significantly abridged hospitalization stay (WMD -3.59 days; 95 % CI
-5.70 to -1.48 days; p = 0.001). Conclusions: Inhalation anesthetics might
be preferable in patients undergoing OLV for thoracic surgery and their
protective effects might work via attenuating inflammatory responses.

<22>
Accession Number
2015707352
Authors
Sezai A. Soma M. Nakata K.-I. Osaka S. Ishii Y. Yaoita H. Hata H. Shiono
M.
Institution
(Sezai, Nakata, Osaka, Ishii, Yaoita, Hata, Shiono) Department of
Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
(Soma) Department of General Medicine, Nihon University School of
Medicine, Tokyo, Japan
Title
Comparison of febuxostat and allopurinol for hyperuricemia in cardiac
surgery patients with chronic kidney disease (NU-FLASH trial for CKD).
Source
Journal of Cardiology. 66 (4) (pp 298-303), 2015. Date of Publication: 01
Oct 2015.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The NU-FLASH trial demonstrated that febuxostat was more
effective for hyperuricemia than allopurinol. This time, we compared these
medications in patients with chronic kidney disease (CKD) from the
NU-FLASH trial. Methods and results: In the NU-FLASH trial, 141 cardiac
surgery patients with hyperuricemia were randomized to a febuxostat group
or an allopurinol group. This study analyzed 109 patients with an
estimated glomerular filtration rate (eGFR) <60mL/min/1.73m²,
and also analyzed 87 patients with stage 3 CKD. The primary endpoint was
the serum uric acid level. Secondary endpoints included serum creatinine,
urinary albumin, cystatin-C, oxidized low-density lipoprotein,
eicosapentaenoic acid/arachidonic acid ratio, total cholesterol,
triglycerides, low-density lipoprotein, high-density lipoprotein, and
high-sensitivity C-reactive protein.Among patients with an
eGFR<60mL/min/1.73m², uric acid levels were significantly lower
in the febuxostat group than the allopurinol group from 1 month of
treatment onward. The serum creatinine, urinary albumin, cystatin-C,
oxidized low-density lipoprotein, eicosapentaenoic acid/arachidonic acid
ratio, and high-sensitivity C-reactive protein were also significantly
lower in the febuxostat group. Similar results were obtained in the
patients with stage 3 CKD. Conclusion: In cardiac surgery patients with
renal dysfunction, febuxostat reduced uric acid earlier than allopurinol,
had a stronger renoprotective effect than allopurinol, and also had
superior antioxidant and anti-inflammatory effects.

<23>
Accession Number
2015703373
Authors
Karaman Y. Abud B. Tekgul Z.T. Cakmak M. Yildiz M. Gonullu M.
Institution
(Karaman, Cakmak, Yildiz, Gonullu) Department of Anaesthesiology and
Reanimation, Izmir Tepecik Research and Training Hospital, Izmir, Turkey
(Abud) Department of Cardiovascular Surgery, Izmir Tepecik Research and
Training Hospital, Izmir, Turkey
(Tekgul) Department of Anesthesiology and Reanimation, Izmir Bozyaka
Research and Training Hospital, Saim Cikrikci St. No:59, Bozyaka,
Karabaglar, Izmir 35170, Turkey
Title
Effects of dexmedetomidine and propofol on sedation in patients after
coronary artery bypass graft surgery in a fast-track recovery room
setting.
Source
Journal of Anesthesia. 29 (4) (pp 522-528), 2015. Date of Publication: 22
Aug 2015.
Publisher
Springer-Verlag Tokyo
Abstract
Purpose: We aim to compare the effects of propofol and dexmedetomidine
infusions on extubation times, hemodynamic and respiratory functions,
complication rates and patient satisfaction scores in patients undergoing
coronary artery bypass graft (CABG) surgery using a fast-track anesthesia
regimen for early extubation. Methods: We enrolled 64 patients who
underwent CABG surgery. Dexmedetomidine (min 0.2 micro&#32;g/kg/h-max 1.0
micro&#32;g/kg/h) and propofol (min 1.0 mg/kg/h-max 3.0 mg/kg/h) infusion
doses were titrated to give bispectral index values between 60 and 90 and
a Ramsay sedation score (RSS) between 3 and 4. Postoperative extubation
times, patient satisfaction and postoperative adverse events were
recorded. Results: The mean times to extubation were 265.94 +/- 43.1 min
for the dexmedetomidine group and 322.52 +/- 39.2 min for the propofol
group (P < 0.001). In all recordings, RSS median values for the propofol
group were significantly lower than the dexmedetomidine group (P < 0.05).
There were no differences in the incidence of postoperative adverse events
between the dexmedetomidine and propofol groups. There was a statistically
significant difference between patient satisfaction median values of the
two groups-7 (5-9) and 9 (7-10) (min-max) for the propofol and
dexmedetomidine groups, respectively (P < 0.001). Conclusion: Our results
show that dexmedetomidine can easily be preferred over propofol in
fast-track cardiac anesthesia due to its significant advantages of shorter
extubation time and higher postoperative patient satisfaction scores.

<24>
Accession Number
2015318585
Authors
Coyan G.N. Reeder K.M. Vacek J.L.
Institution
(Coyan, Vacek) University of Kansas Medical Center, Kansas City, KS,
United States
(Reeder) Goldfard School of Nursing at Barnes-Jewish College, St. Louis,
MO, United States
(Vacek) Mid-America Cardiology, Kansas City, KS, United States
Title
Diet and exercise interventions following coronary artery bypass graft
surgery: A review and call to action.
Source
Physician and Sportsmedicine. 42 (2) (pp 119-129), 2014. Date of
Publication: 2014.
Publisher
Taylor and Francis Ltd.
Abstract
Coronary artery bypass graft (CABG) surgery has been used for the
treatment of coronary artery disease (CAD) for approximately 50 years, and
has been performed on millions of people globally. However, little is
known about the impact of diet and exercise on long-term outcomes of
patients who have undergone CABG surgery. Although clinical practice
guidelines on the management of this patient population have been
available for approximately 2 decades, evidence regarding secondary
prevention behavioral interventions, lifestyle modifications and
self-management to slow the progressive decline of CAD, reduce cardiac
hospitalizations, and prevent reoperation remains virtually absent from
the literature. Diet and exercise are modifiable factors that affect
secondary CAD risk. This article reviews the relevant current literature
on long-term diet and exercise outcomes in patients who underwent CABG.
The limited available literature shows the positive impacts of exercise on
psychosocial well-being and physical fitness. Current evidence indicates
diet and exercise interventions are effective in the short-term, but
effects fade over time. Potential age and sex differences were found
across the reviewed studies; however, further research is needed with more
rigorous designs to replicate and confirm findings, and to define optimal
management regimens and cost-effective prevention strategies.

<25>
Accession Number
71989578
Authors
McGuinness S. Parke R.L. Bellomo R. Van Haren F.
Institution
(McGuinness, Parke) Auckland District Health Board, Auckland, New Zealand
(Bellomo) University of Melbourne, Melbourne, Australia
(Van Haren) Canberra Hospital, Canberra, Australia
Title
Sodium bicarbonate infusion to reduce cardiac surgery associated acute
kidney injury; a phase II multi-centre, double-blind, randomized
controlled trial.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2012 San
Francisco, CA United States. Conference Start: 20120518 Conference End:
20120523. Conference Publication: (var.pagings). 185 , 2012. Date of
Publication: 2012.
Publisher
American Thoracic Society
Abstract
RATIONALE Cardiac surgery associated acute kidney injury (CSA-AKI) occurs
in up to 50% of patients and is associated with increased mortality and
morbidity. A previous 100 patient pilot study suggested that prophylactic
peri-operative infusions of sodium bicarbonate could reduce the incidence
of CSA-AKI and thus could have a beneficial effect on patient outcomes.
Before embarking on a large phase III trial of this treatment we completed
a multi-centre phase II trial. METHODS Between February 2009 and June 2011
427 patients scheduled for cardiac surgery using cardiopulmonary bypass
were enrolled. All patients had pre-operative and/or peri-operative risk
factors for the development of CSA-AKI (table1). Patients received an
infusion of either sodium bicarbonate or placebo (sodium chloride),
commencing at the start of anaesthesia, in a dose of 0.5mEq/Kg/hr for the
first hour then 0.2mEq/kg/hr for 23hrs. The primary study outcome was the
number of patients who developed CSA-AKI, defined as an increase in
creatinine of at least 25% from baseline to peak value within the first 5
post-operative days. Secondary outcomes included acid-base status, length
of mechanical ventilation, ICU and hospital length of stay (LOS) and
mortality. RESULTS 215 patients were randomized to receive sodium
bicarbonate and 212 to receive sodium chloride. Treating clinicians and
study personnel were blinded to the allocation. There were no significant
differences in the baseline characteristics of the two groups. There were
significant differences in both the plasma and urinary pH between the
groups (table2). Overall 44% of patients developed CSA-AKI by the above
definition; however there was no significant difference between the groups
(Bicarbonate group 45%, Saline group 44%). There was no significant
difference in ventilation hours (22.9hrs (mean): Bicarbonate 20.8, Saline
24.9), ICU LOS (2.25days (mean): Bicarbonate 2.23, Saline 2.28) or
hospital LOS (13.1days (mean); Bicarbonate 13.4, Saline 12.8). Overall ICU
mortality was 2.8% (Bicarbonate 3.3%, Saline 2.4%) and 90 Day mortality
3.3% (Bicarbonate 3.7%, Saline 2.8%). CONCLUSIONS This study demonstrates
that, using the criteria described, we are able to select a sub-group of
cardiac surgical patients at high risk of developing CSA-AKI. Although the
bicarbonate infusion produced an increase in the pH of both blood and
urine this did not result in a decrease in the incidence of CSA-AKI. On
this basis we cannot recommend the use of peri-operative infusions of
sodium bicarbonate to reduce CSA-AKI in these patients and do not believe
further investigation of this therapy is justified. (Table Presented).

<26>
Accession Number
71989138
Authors
Konishi S. Arita M. Ishida T.
Institution
(Konishi, Arita, Ishida) Kurashiki Central Hospital, Kurashiki City, Japan
Title
%FVC, %DLCO, and, composite physiologic index at baseline could be the
predictors of the efficacy of pirfenidone in patients with idiopathic
pulmonary fibrosis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2012 San
Francisco, CA United States. Conference Start: 20120518 Conference End:
20120523. Conference Publication: (var.pagings). 185 , 2012. Date of
Publication: 2012.
Publisher
American Thoracic Society
Abstract
RATIONALE: Two of the three phase randomized controlled trial (Taniguchi
study and CAPACITY study 004) suggested that pirfenidone ameliorated
disease progression in terms of vital capacity (VC) and forced vital
capacity(FVC) in patients with idiopathic pulmonary fibrosis (IPF).
However, the methodologies to predict the response of this drug are under
analysis. METHODS: Our objective was to confirm the efficacy of
pirfenidone and identify baseline pulmonary function test (PFT) and
composite physiologic index (CPI) as predictors of the response of
pirfenidone in patients with IPF retrospectively. The evaluated patients
who were 57-84 years old had a clinical and radiological diagnosis of IPF
based on an official ATS/ERS/JRS/ALAT statement published in 2011. We
diagnosed 12 patients as Usual Interstitial Pneumonea (UIP) (2 of them
were pathologically diagnosed by Video assisted thoracic surgery) and 8
patients as possible UIP. We started the treatment of pirfenidone from
2009 and discontinued the treatment when the patient showed deterioration
in 5% of %FVC in 6 months, acute exacerbations, or, had severe side
effects. RESULTS: 11 of 20 patients were tolerated for more than 6 months,
and, 8 patients who were tolerated for a year, showed mean 48ml increase
in VC. We discontinued pirfenidone in 5 patients because of the side
effect of loss of appetite. There were no significant differences between
UIP and possible UIP in the response of pirfenidone. But, the effects of
pirfenidone was better in case that the baseline %FVC, or, %DLCO was
higher (p<0.05), or that the baseline CPI was lower (p<0.05). CONCLUSION:
In our study, less progressed disease as indicated by baseline %FVC,
%DLCO, and CPI was more responsive to pirfenidone. In IPF, the
quantitation of disease severity using PFT is often confounded by
emphysema. The baseline CPI may be new predictor of the efficacy of
pirfenidone in IPF patients.

<27>
Accession Number
71986007
Authors
Scott M.J. Kellie S.P. Burke A.M. Burke M. Wiemken T.L. Cavallazzi R.S.
Saad M.
Institution
(Scott, Kellie, Burke, Burke, Wiemken, Cavallazzi, Saad) University of
Louisville, Louisville, KY, United States
Title
Examination of care of medical ICU patients admitted to medical ICU unit
versus medical patients admitted to other ICU units at the university of
louisville hospital.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2012 San
Francisco, CA United States. Conference Start: 20120518 Conference End:
20120523. Conference Publication: (var.pagings). 185 , 2012. Date of
Publication: 2012.
Publisher
American Thoracic Society
Abstract
Rationale Current practices regarding staffing and organization of the
Intensive Care Unit (ICU) have been investigated. Admission time,
multidisciplinary teams, physician and nursing staffing, and even patient
bed visibility have been examined. To our knowledge, no systematic review
has examined placement of patients in specialized critical care units. We
propose that admission to a specialty intensive care unit designed for a
particular patient population (i.e. medical) will result in decreased
mortality and length of stay (LOS) for a medical patient compared with a
medical patient admitted to a unit designated for another type of
specialty intensive care (i.e. surgical). Methods A retrospective review
of existing mortality data from the hospital's database identified
patients admitted to the Medical Intensive Care Unit (MICU) team. Next,
the location of admission was identified (i.e. medical ICU, surgical ICU,
cardiac ICU, and neurosurgical ICU). MICU team patients admitted to other
care units were compared with MICU patients admitted to the medical ICU
unit. The database provided mortality, expected mortality, length of stay,
and expected length of stay. The logistic model used a risk score that
incorporated all patient refined diagnosis related group (APR-DRG),
severity of illness category, admission status, race, age, sex, admission
source, socioeconomic status, and 29 specific co-morbidities defined by
the Agency for Healthcare Research and Quality (AHRQ). For the mortality
analyses, a Poisson regression model with robust error variance calculated
adjusted risk ratios. For LOS, a Cox proportional-hazards regression model
calculated the adjusted Hazard Ratios. P-values of <0.05 were significant.
Results The Risk Ratio of patient placement on mortality from 2008-2011
was 0.87 (95% CI: 0.74-1.04, P=0.115). Though not statistically
significant, there is a trend for non MICU units having a 15% increase in
mortality over the MICU unit. The hazard ratio for patient placement on
length of hospital stay from 2008-2011 was 1.14 (95% CI: 1.03-1.26,
P=0.01). LOS is significantly less in MICU unit versus patients in other
units during the 4 years. The MICU location had a 14% increased chance of
patients being discharged versus other units. Conclusions Our data showed
a statistically significant decrease in LOS in the MICU location versus
patients in other units. This poses potential clinical and financial
implications. Shorter stays are better for both the patient and the
hospital. Although mortality failed to reach statistical significance, it
represents an interesting trend that should be examined on a larger scale.

<28>
Accession Number
71984925
Authors
Khan I.Y. Singer L.G. Granton J.T. Keshavjee S. Chau C. Kron A. Johnson
S.R.
Institution
(Khan, Kron) Pulmonary Hypertension Program, University Health Network,
University of Toronto, Toronto, ON, Canada
(Singer) Division of Respirology, University of Toronto, Toronto Lung
Transplant Program, Toronto, ON, Canada
(Granton) Division of Respirology and Toronto Lung Transplant Program,
University Health Network, University of Toronto, Toronto, ON, Canada
(Keshavjee) Division of Thoracic Surgery, University Health Network,
University of Toronto, Toronto, ON, Canada
(Chau) Division of Rheumatology, Mount Sinai Hospital, University of
Toronto, Toronto, ON, Canada
(Johnson) Toronto Scleroderma Program, Toronto Western Hospital,
University of Toronto, Toronto, ON, Canada
Title
Survival after lung transplantation in systemic sclerosis. A systematic
review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2013 Philadelphia,
PA United States. Conference Start: 20130517 Conference End: 20130522.
Conference Publication: (var.pagings). 187 , 2013. Date of Publication:
2013.
Publisher
American Thoracic Society
Abstract
Rationale. Lung transplantation is a life-saving option for systemic
sclerosis (SSc)-associated pulmonary arterial hypertension (PAH) and
interstitial lung disease (SSc-ILD) patients. Yet, there is considerable
risk of post-transplantation mortality. The objective of this study was to
evaluate survival of SSc patients post-lung transplantation. We
secondarily evaluated SSc lung transplant recipient characteristics, and
compared post-lung transplantation survival of SSc patients to non-SSc
patients (idiopathic PAH, and ILD). Methods. A systematic review of
MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials and CINAHL
(all inception to 2012) was performed to identify studies evaluating
post-lung transplant survival in SSc compared to non-SSc patients. Two
reviewers independently abstracted study and survival data using a
standardized form. Results. Two hundred twenty-six citations were screened
to identify 7 observational studies reporting SSc patients who underwent
single lung, double lung, or heart-lung transplantation. Five studies
report outcomes in US centers, 1 study reports outcomes in 1 center in
Canada, and 1 study reports outcomes in 1 center in Israel. Mean age at
transplantations ranged 46-53 years. SSc post-transplantation survival
ranged 69%-91% at 30-days, 69%-85% at 6-months, 59%-93% at 1-year, 49%-80%
at 2-years, and 46%-79% at 3-years. ILD post-transplant survival was 80%
at 30-days, 80%-90% at 6-months, 59%-83% at 2-years, and 69% at 3-years.
IPAH post transplant survival was 79% at 30-days, 79%-90% at 6-months, and
74%-90% at 1-year. The reporting of overlapping cohorts potentially
including the same patients precluded meta-analysis. Causes of death in
SSc patients, when reported, included graft failure (n=6), infection
(n=8), cardiac events (n=3), hemorrhagic stroke (n=1), respiratory failure
(n=3), malignancy (n=2), pulmonary hypertension (n=1), complications of
bronchiolitis obliterans syndrome (BOS) (n=1), anesthetic complication
(n=1), and scleroderma renal crisis (n=1). There were no reports of
recurrence of SSc in the lung allograft. Conclusion. SSc survival
post-lung transplantation is very good, and improving with time. The
short-term and intermediate-term survival post-lung transplantation are
similar to IPAH and ILD patients requiring lung transplantation. Future
researchers should delineate the access process for lung transplantation
and report the occurrence of acute rejection, infection, bronchiolitis
obliterans syndrome, renal dysfunction and dialysis, gastroparesis, and
need for tube feeding. The occurrence of these co-morbidities likely
impact survival and the quality of life post transplantation.

<29>
Accession Number
71983088
Authors
Govindan S. Chopra V. Flanders S.A. Iwashyna T.J.
Institution
(Govindan, Chopra, Flanders, Iwashyna) University of Michigan, Ann Arbor,
MI, United States
Title
The effect of early mobilization on outcomes following sepsis in non-icu
patients: A systematic review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2013 Philadelphia,
PA United States. Conference Start: 20130517 Conference End: 20130522.
Conference Publication: (var.pagings). 187 , 2013. Date of Publication:
2013.
Publisher
American Thoracic Society
Abstract
BACKGROUND: Sepsis is among the most common reasons for hospitalization
and mortality in the United States, and it is associated with increased
disability and cognitive impairments, leading to significant long-term
morbidity. While most randomized controlled trials in severe sepsis have
emphasized patients with septic shock, a majority of patients do not reach
this point and are therefore understudied. Early mobilization and physical
therapy interventions are associated with improved outcomes in diverse
populations: surgical, cardiac, stroke, and mechanically-ventilated
patients. However, whether this association exists in patients with sepsis
is not well-established, particularly in patients who do not develop
respiratory failure requiring mechanical ventilation and ICU-level care.
In order to correct this deficit, we performed a systematic review of the
literature to understand whether early mobilization has been associated
with improved sepsis outcomes. METHODS: With the assistance of a research
librarian, we performed serial literature searches for English articles in
multiple databases (Figure 1). The search strategy combined outcomes
(length of stay, mortality, cost) with early mobilization across all
patient populations. In the original pre-specified screen, studies were
included if they involved human participants with a primary diagnosis of
sepsis (including severe sepsis or septic shock), utilized an intervention
that consisted of early mobilization, and reported clinical outcomes. In a
supplementary review, the criteria were expanded to include studies that
reported outcomes of a physical-therapy based intervention in patients
with any primary infectious cause for admission. Of note, studies only
involving ICU or post-surgical patients were excluded. RESULTS: 814
studies were identified in the initial search. Of the citations
identified, none focused specifically on patient populations with a
diagnosis of sepsis, severe sepsis, or septic shock. When expanding the
criterion to include patients with any infectious pathology, only 1 study
was eligible for inclusion (Figure 1). In this study, decreases in cost
and length of stay were realized in patients with community-acquired
pneumonia who received early mobilization versus those that did not (Table
1). CONCLUSION: Despite a large evidence-base supporting the importance of
early mobilization in a variety of disease states, there is a striking
paucity of data regarding the role of such interventions among patients
with sepsis. Future research dedicated to understanding whether early
mobilization can mitigate the long-lasting effects of sepsis, and how such
a program may be designed, is necessary. (Figure Presented).

<30>
Accession Number
71981504
Authors
Obeidat M. Hao K. Bosse Y. Nickle D. Postma D. Laviolette M. Sandford A.
Daley D. Brandsma C.-A. Van Den Berge M. Vessey R. Opiteck G. Timens W.
Sin D. Pare P.
Institution
(Obeidat, Sandford, Daley, Sin, Pare) University of British Columbia,
James Hogg Research Centre, St. Paul's Hospital, Vancouver, BC, Canada
(Hao) Mount Sinai School of Medicine, New York, NY, United States
(Bosse, Laviolette) Laval University, Quebec, Canada
(Nickle) Merck Research Laboratories, Boston, United States
(Postma, Van Den Berge) UMCG, GRIAC Research Institute, University of
Groningen, Groningen, Netherlands
(Brandsma, Timens) University of Groningen, University Medical Center
Groningen, GRIAC Research Institute, Groningen, Netherlands
(Vessey, Opiteck) Merck and Co. Inc., NJ, United States
Title
Integration of lung function genome-wide association results with lung
specific expression quantitative trait loci.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2013 Philadelphia,
PA United States. Conference Start: 20130517 Conference End: 20130522.
Conference Publication: (var.pagings). 187 , 2013. Date of Publication:
2013.
Publisher
American Thoracic Society
Abstract
Background: Three large scale meta-analyses for lung function measures in
the general population were published in the last two years, which
identified a large number of SNPs with impressive statistical
associations. However, the exact mechanisms underlying these associations
are not fully understood. By determining which of the lung function
related polymorphisms also influence the level of mRNA in the lungs we
will gain more insights into mechanisms and pathways affecting lung
function. Aim: To identify SNPs in lung function GWAS that are associated
with mRNA levels (eQTLs) in lungs. Methods: The lung eQTLs were derived
from genome-wide genotyping and gene expression analysis of ~1,100 lung
tissue samples which were obtained at the time of thoracic surgery. The
study identified ~470,000 SNPs related to the level of gene expression in
cis and ~17,000 SNPs in trans, at 10% FDR. The SpiroMeta and CHARGE
consortia have made available the top 2000 SNPs associated with forced
expiratory volume in one second (FEV₁); a lung function measure
that can be reduced both by airway obstruction and lung fibrosis, and its
ratio to Forced Vital Capacity (FEV₁/FVC), a specific measure
of large airway obstruction. We undertook an integration of these 4000
SNPs with the lung specific eQTL database SNPs at a 10% FDR. Results: From
the CHARGE study associations with FEV₁, 1293 SNPs were
associated with cis eQTL and 976 trans eQTL, and for the
FEV₁/FVC associated variants, 809 were associated with cis eQTL
and 236 with trans eQTL. For SpiroMeta associations' results for
FEV₁, 594 SNPs were associated with cis eQTL and 54 with trans
eQTL, and among the FEV₁/FVC associated variants, 578 SNPs were
associated with cis eQTL and 91 SNPs with trans eQTL. 48 eQTLs overlapped
between SpiroMeta and CHARGE for FEV₁ and an equal number (48
eQTLs) for FEV₁/FVC, and 7 eQTLs were common to both consortia
associations' with FEV₁ and FEV₁/FVC. (Table
Presented) Ongoing work is aimed at identifying the pathways involved and
future work will focus on prioritizing a number of genes for functional
characterisations. Conclusion: A large number of lung function associated
SNPs act as lung specific eQTLs for either FEV₁ or
FEV₁/FVC in the two conosrtia studied, Additionally 7 eSNPs
were overlapping in the two cohorts and affected both FEV₁ and
FEV₁/FVC. These data suggest that the identified gene variants
influence lung function by modulating gene expression levels in lungs,
differentially affecting FEV₁ and FEV₁/FVC.