Results Generated From:
Embase <1980 to 2016 Week 05>
Embase (updates since 2016-01-22)
<1>
Accession Number
2015722542
Authors
Jy W. Gomez-Marin O. Salerno T.A. Panos A.L. Williams D. Horstman L.L. Ahn
Y.S.
Institution
(Jy, Horstman, Ahn) Wallace H Coulter Platelet Laboratory, Miami, FL,
United States
(Gomez-Marin) Division of Hematology and Oncology, Department of Medicine,
Miami, FL, United States
(Jy, Salerno, Panos, Williams) Department of Surgery, Miller School of
Medicine, University of Miami, 1600 NW 10th Ave. R-36A, Miami, FL 33136,
United States
Title
Presurgical levels of circulating cell-derived microparticles discriminate
between patients with and without transfusion in coronary artery bypass
graft surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (1) (pp 305-311),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objectives: Improved understanding of presurgical risk factors for
transfusions will lead to reduction in their number and related
complications. The goal of this study is to identify these factors in
coronary artery bypass graft (CABG) surgery. Methods: Presented herein are
results of analyses of data from an ongoing study of transfusion in CABG
surgery. Of 122 patients, 81 received transfusion (Tx) and 41 did not
(NoTx). In addition to routine tests, presurgical levels of microparticles
from platelets (PMPs), red cells (RMPs), and other lineages were assayed.
Results: The Tx and NoTx groups were similar with respect to most
presurgical variables but differed in distribution of gender, blood type,
diabetes prevalence, activated partial thromboplastin time (aPTT),
hemoglobin (HGB), and microparticle levels. Stepwise multiple logistic
regression was used to evaluate presurgical variables and to develop a
model to assess risk factors for transfusion. CD41+ PMP and CD235+ RMP
levels were found to be the main risk factors for transfusion. The Model's
discriminating ability was assessed using receiver operating
characteristic curve analysis, which showed that the area under the model
curve (+/- standard error) was 0.86 +/- 0.04 (95% confidence interval,
0.77-0.94). According to the model, patients with higher presurgical
levels of circulating CD41+ PMP, CD235a+ RMP, and HGB, as well as a
shorter aPTT, are less likely to receive transfusion(s). Conclusions:
Presurgical levels of CD41+ PMPs and CD235a+ RMPs are the main risk
factors for transfusion in CABG, followed by HGB and aPTT.
<2>
Accession Number
20160053340
Authors
Patel A.J. Daniel G. Naidu B. Bishay E.
Institution
(Patel, Daniel, Naidu, Bishay) Department of Thoracic Surgery, Birmingham
Heartlands Hospital, Heart of England NHS Trust, Bordesley Green East,
Birmingham, West Midlands B9 5SS, United Kingdom
Title
The significance of microvascular invasion after complete resection of
early-stage non-small-cell lung cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 101-105),
2016. Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'in patients with
non-small-cell lung cancer who have undergone complete resection, does the
presence of microvascular invasion (MVI) significantly impact long-term
survival or prognosis?' Altogether, more than 250 papers were found using
the reported search, of which 12 represented the best evidence to answer
the clinical question. Outcome parameters that were used in the assessment
include 5-year overall survival, event-free or recurrence-free survival
(RFS) and incidence of metastatic relapse. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses were tabulated. The majority of the
data collected were retrospective. Meta-analysis of data of over 16 000
patients showed that when considering RFS, MVI positivity was associated
with a significantly reduced period of RFS; pooled hazard ratio estimates
by univariate and multivariate analyses were 3.28 (95% CI 2.14-5.05; P <
0.0001) and 3.98 (95% CI 2.24-7.06; P < 0.0001), respectively. Eight of
the studies showed a significantly worse 5-year survival in the presence
of MVI, whereas a further study found a reduced median survival with MVI.
One study showed no difference, but concurred with five other studies that
MVI was associated with a significantly shorter event-free or RFS.
Multivariate analyses have furthermore demonstrated that MVI positivity
correlates with larger tumour size, an increased risk of distant
metastases, visceral pleural involvement, lymphovascular invasion, higher
tumour grade and nodal status. We conclude that the presence of
microvascular invasion in resected early-stage non-small-cell lung cancer
is a negative prognostic factor.
<3>
Accession Number
20160053335
Authors
Sepehripour A.H. Chaudhry U.A. Suliman A. Kidher E. Sayani N. Ashrafian H.
Harling L. Athanasiou T.
Institution
(Sepehripour, Chaudhry, Suliman, Kidher, Sayani, Ashrafian, Harling,
Athanasiou) Department of Surgery and Cancer, Imperial College London,
QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom
Title
How revascularization on the beating heart with cardiopulmonary bypass
compares to off-pump? A meta-analysis of observational studies.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 63-71), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press
Abstract
Off-pump coronary artery bypass surgery has been a controversial area of
debate and the outcome profile of the technique has been thoroughly
investigated. Scepticism regarding the reported outcomes and the conduct
of the randomized trials comparing this technique with conventional
on-pump coronary artery bypass surgery has been widely voiced, and the
technique of off-pump surgery remains as an infrequently adopted approach
to myocardial revascularization worldwide. Criticisms of the technique are
related to lower rates of complete revascularization and its unknown
long-term consequences, the significant detrimental effects on mortality
and major adverse events when emergency conversion is required, and the
significant lack of long-term survival and morbidity data. The hybrid
technique of myocardial revascularization on the beating heart with the
use of cardiopulmonary bypass may theoretically provide the beneficial
effects of off-pump surgery in terms of myocardial protection and organ
protection, while providing the safety and stability of on-pump surgery to
allow complete revascularization. Large randomized comparison to support
evidence-based choices is currently lacking. In this article, we have
meta-analysed the outcomes of on-pump beating heart surgery in comparison
with off-pump surgery focusing on major adverse cardiovascular and
cerebrovascular adverse events (MACCE) including mortality, stroke and
myocardial infarction and the degree of revascularization and number of
bypass grafts performed. It was demonstrated that the beating heart
on-pump technique allows a significantly higher number of bypass grafts to
be performed, resulting in significantly higher degree of
revascularization. We have also demonstrated a slightly higher rate of
30-day mortality and MACCE with the technique although not at a
statistically significant level. These results should be considered
alongside the population risk profile, where a significantly higher risk
cohort had undergone the beating heart on-pump technique. Long-term
survival and morbidity figures are required to assess the impact of these
findings in the coronary surgery patient population.
<4>
Accession Number
20160053316
Authors
Hosseinpour A.-R. Adsuar-Gomez A. Gonzalez-Calle A. Pedrote A. Arana-Rueda
E. Garcia-Riesco L. Arce-Leon A. Jimenez-Velasco A. Borrego-Dominguez J.M.
Ordonez-Fernandez A.
Institution
(Hosseinpour, Adsuar-Gomez, Gonzalez-Calle, Pedrote, Arana-Rueda,
Garcia-Riesco, Arce-Leon, Jimenez-Velasco, Borrego-Dominguez,
Ordonez-Fernandez) Heart Unit, University Hospitals Virgen Del Rocio,
Department of Cardiac Surgery, Avenida Manuel Siurot s/n, Seville 41013,
Spain
Title
A simple surgical technique to prevent atrial reentrant tachycardia in
surgery for congenital heart disease.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 47-52), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press
Abstract
OBJECTIVES To present and test a simple surgical technique that may
prevent atrial reentrant tachycardia following surgery for congenital
heart disease. This arrhythmia is one of the commonest long-term
complications of such a surgery. It may occur many years (even decades)
after the operation. It is usually explained as a late consequence of
right atriotomy, which is an inherent component of many operations for
congenital heart disease. Right atriotomy results in a long scar on the
right atrial myocardium. This scar, as any scar, is a barrier to
electrical conduction, and macro-reentrant circuits may form around it,
causing reentrant tachycardia. However, this mechanism may be
counterchecked and neutralized by our proposed method, which prevents
reentrant circuits around right atriotomy scars. METHODS The proposed
method is implemented after termination of cardiopulmonary bypass and
tying the venous purse-strings. It consists of constructing a
full-thickness suture line on the intact right atrial wall from the
inferior vena cava (IVC) (a natural conduction barrier) to the atriotomy
incision. This suture line is made to cross the venous cannulation sites
if these are on the atrial myocardium (rather than being directly on the
venae cavae). Thus, the IVC, atriotomy and cannulation sites are connected
to each other in series by a full-thickness suture line on the atrial
wall. If this suture line becomes a conduction barrier, it would prevent
reentrant circuits around right atrial scars. This was tested in 13 adults
by electroanatomical mapping. All 13 patients had previously undergone
right atriotomy for atrial septal defect closure: 8 of them with the
addition of the proposed preventive suture line (treatment group) and 5
without (control group). RESULTS In all 13 cases, the atriotomy scar was
identified as a barrier to electrical conduction with electrophysiological
evidence of fibrosis (scarring). In the 8 patients with the proposed
suture line, this had also become a scar and a complete conduction
barrier. In the 5 patients without this suture line, there was free
electrical conduction between the IVC and atriotomy scar. CONCLUSIONS The
proposed suture line becomes a scar and conduction barrier. Therefore, it
would prevent reentrant circuits around atrial scars and their consequent
arrhythmias.
<5>
Accession Number
20160048936
Authors
Wachtell K. Lagerqvist B. Olivecrona G.K. James S.K. Frobert O.
Institution
(Wachtell, Frobert) Department of Cardiology, Orebro University, Orebro,
Sweden
(Wachtell) Section Cardiology Intervention, Department of Cardiology,
Division of Cardiovascular and Pulmonary Diseases, Oslo University
Hospital, Oslo, Norway
(Lagerqvist, James) Department of Medical Sciences, Cardiology, and
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
(Olivecrona) Department of Coronary Heart Disease, Skane University
Hospital, Clinical Sciences Section, Lund University, Lund, Sweden
Title
Novel Trial Designs: Lessons Learned from Thrombus Aspiration During
ST-Segment Elevation Myocardial Infarction in Scandinavia (TASTE) Trial.
Source
Current Cardiology Reports. 18 (1) (pp 1-10), 2016. Article Number: 11.
Date of Publication: 01 Jan 2016.
Publisher
Current Medicine Group LLC 1
Abstract
In ST-elevation myocardial infarction (STEMI), thrombus material is often
present in partial or total coronary occlusion of the coronary vessel.
However, prior to the thrombus aspiration during ST-Segment Elevation
Myocardial Infarction in Scandinavia (TASTE) trial, it remained unclear
whether routine thrombus aspiration during percutaneous coronary
intervention (PCI) treatment of STEMI would result in patients overall
survival benefit. The TASTE trial was a multicenter, prospective,
open-label, randomized, controlled clinical trial. In order to randomize
patients to treatment and collect data, the infrastructure of a clinical
population-based registry was used. Online data collection used the
national comprehensive Swedish Coronary Angiography and Angioplasty
Registry, a part of the SWEDEHEART registry. Monitoring and adjudication
was done as part of the regular registry validation. There was no
separate, dedicated monitoring or adjudication of endpoints. Included were
7244 patients with STEMI with chest pain and time of symptoms to hospital
admission <24 h, in addition to new electrocardiographic ST-segment
elevation or left bundle-branch block. Exclusion criteria were the need
for emergency coronary artery bypass grafting. All-cause mortality at 30
days occurred in 2.8 % of the patients in the thrombus-aspiration group,
as compared with 3.0 % in the PCI-only group (hazard ratio [HR] 0.94, 95 %
confidence interval [CI] 0.72-1.22; p = 0.63). All-cause mortality at 1
year occurred in 5.3 % of the patients in the thrombus-aspiration group,
as compared with 5.6 % in the PCI-only group (HR 0.94, 95 % CI 0.78-1.15;
p = 0.57). No patients were lost to follow-up at 1 year. The incremental
cost for trial execution was approximately US$ 300,000 or $50 per patient.
Routine thrombus aspiration during PCI in patients with STEMI did not
reduce the rate of all-cause mortality at 1 year. It is possible to design
and conduct mega-trial at only small cost compared to a similar-sized
conventional randomized clinical trial.
<6>
Accession Number
20160056766
Authors
Cavender M.A. Gibson C.M. Braunwald E. Wiviott S.D. Murphy S.A. Toda Kato
E. Plotnikov A.N. Amuchastegui M. Oude Ophuis T. van Hessen M. Mega J.L.
Institution
(Cavender, Gibson, Braunwald, Wiviott, Murphy, Toda Kato, Mega) TIMI Study
Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard
Medical School, United States
(Plotnikov) Janssen Research and Development, LLC, United States
(Amuchastegui) Hospital Privado, Centro Medico de Cordoba, Argentina
(Oude Ophuis) Department of Cardiology, Canisius Wilhelmina Ziekenhuis,
Netherlands
(van Hessen) Department of Cardiology, Groene Hart Hospital, Netherlands
Title
The effect of rivaroxaban on myocardial infarction in the ATLAS ACS 2 -
TIMI 51 trial.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (5) (pp 468-474),
2015. Date of Publication: 01 Oct 2015.
Publisher
SAGE Publications Inc.
Abstract
Aims: Rivaroxaban reduces cardiovascular death, myocardial infarction
(MI), or stroke in patients following acute coronary syndrome (ACS). We
aimed to characterize the specific effects of rivaroxaban on the size and
type of MI. Methods: The Anti-Xa Therapy to Lower Cardiovascular Events in
Addition to Standard Therapy in Subjects with Acute Coronary
Syndrome-Thrombolysis in Myocardial Infarction 51 (ATLAS ACS 2-TIMI 51)
study randomized 15,526 patients with a recent ACS to rivaroxaban 2.5 mg
BID, rivaroxaban 5 mg BID, or placebo. An independent clinical events
committee adjudicated each MI that occurred during the study and further
classified them based on type. Data are presented as two-year Kaplan-Meier
event rates and hazard ratios (HRs) and 95% confidence intervals (CI).
Results: In total, 665 patients experienced a post-randomization MI. The
majority (n=535, 80.5%) were spontaneous (Type 1) events. Rivaroxaban
reduced spontaneous MI when compared with placebo (4.4% vs 5.7%, HR 0.80,
95% 0.67-0.95, p=0.01), and there were directionally consistent reductions
with both the 2.5 mg BID (4.7% vs 5.7%, HR 0.84, 95% 0.68-1.02, p=0.08)
and 5 mg BID doses (4.1% vs 5.7%, HR 0.77, 95% 0.62-0.94, p=0.01) as
compared with placebo. Rivaroxaban reduced MI with large elevations in
troponin or creatine kinase-MB (CK-MB) fraction (1.8% vs 2.4%, HR 0.73,
95% CI 0.56-0.96, p=0.03) and STEMI events (1.7% vs 2.5%, HR 0.74, 95% CI
0.56-0.99, p=0.04). Conclusions: In patients stabilized and followed after
ACS, the majority of MIs that occur are spontaneous and rivaroxaban
significantly reduced the incidence of these events. Notably, rivaroxaban
reduced MIs with extensive biomarker release and ST-segment elevation.
<7>
Accession Number
20160045629
Authors
Gotberg M. Christiansen E.H. Gudmundsdottir I. Sandhall L. Omerovic E.
James S.K. Erlinge D. Frobert O.
Institution
(Gotberg, Erlinge) Department of Cardiology, Lund University, Skane
University Hospital, Lund 22185, Sweden
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Gudmundsdottir) Department of Cardiology, Reykjavik University Hospital,
Reykjavik, Iceland
(Sandhall) Department of Radiology, Helsingborg County Hospital,
Helsingborg, Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University, Gothenburg,
Sweden
(James) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Frobert) Orebro University, Faculty of Health, Department of Cardiology,
Orebro, Sweden
Title
Instantaneous Wave-Free Ratio versus Fractional Flow Reserve guided
intervention (iFR-SWEDEHEART): Rationale and design of a multicenter,
prospective, registry-based randomized clinical trial.
Source
American Heart Journal. 170 (5) (pp 945-950), 2015. Date of Publication:
2015.
Publisher
Mosby Inc.
Abstract
Background Instantaneous wave-free ratio (iFR) is a new hemodynamic
resting index for assessment of coronary artery stenosis severity. iFR
uses high frequency sampling to calculate a gradient across a coronary
lesion during a period of diastole. The index has been tested against
fractional flow reserve (FFR) and found to have an overall classification
agreement of 80% to 85%. Whether the level of disagreement is clinically
relevant is unknown. Clinical outcome data on iFR are scarce. This study
is a registry-based randomized clinical trial, which is a novel strategy
using health quality registries as on-line platforms for randomization,
case record forms, and follow-up. Design/Methods iFR-SWEDEHEART is a
multicenter, prospective, randomized, controlled, clinical open-label
clinical trial. Two thousand patients with stable angina or acute coronary
syndrome and an indication for physiology-guided assessment of one or more
coronary stenoses will be randomized 1:1 to either iFR- or FFR-guided
intervention. The randomization will be conducted online in the Swedish
web-based system for enhancement and development of evidence-based care in
heart disease evaluated according to recommended therapies (SWEDEHEART)
registry. The trial has a non-inferiority design, with a primary combined
end point of all-cause death, non-fatal myocardial infarction, and
unplanned revascularization at 12 months. End points will be identified
through national registries and undergo central blind adjudication to
ensure data quality. Discussion The iFR-SWEDEHEART trial is an
registry-based randomized clinical trial evaluating the safety and
efficacy of the diagnostic method iFR compared to FFR.
<8>
Accession Number
20160045089
Authors
Aherne T. McHugh S. Kheirelseid E.A. Lee M.J. McCaffrey N. Moneley D.
Leahy A.L. Naughton P.
Institution
(Aherne, McHugh, Kheirelseid, Moneley, Leahy, Naughton) Department of
Vascular Surgery, Beaumont Hospital, Dublin, 9, Ireland
(Lee) Department of Interventional Radiology, Beaumont Hospital, Dublin,
9, Ireland
(McCaffrey) Department of Human and Health Performance, Dublin City
University, Dublin, 9, Ireland
Title
Comparing Supervised Exercise Therapy to Invasive Measures in the
Management of Symptomatic Peripheral Arterial Disease.
Source
Surgery Research and Practice. 2015 (no pagination), 2015. Article Number:
960402. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Peripheral arterial disease (PAD) is associated with considerable
morbidity and mortality. Consensus rightly demands the incorporation of
supervised exercise training (SET) into PAD treatment protocols. However,
the exact role of SET particularly its relationship with intervention
requires further clarification. While supervised exercise is undoubtedly
an excellent tool in the conservative management of mild PAD its use in
more advanced disease as an adjunct to open or endovascular intervention
is not clearly defined. Indeed its use in isolation in this cohort is
incompletely reported. The aim of this review is to clarify the exact role
of SET in the management of symptomatic PAD and in particular to assess
its role in comparison with or as an adjunct to invasive intervention. A
systematic literature search revealed a total 11 randomised studies
inclusive of 969 patients. All studies compared SET and intervention with
monotherapy. Study results suggest that exercise is a complication-free
treatment. Furthermore, it appears to offer significant improvements in
patients walk distances with a combination of both SET and intervention
offering a superior walking outcome to monotherapy in those requiring
invasive measures.
<9>
Accession Number
2015901335
Authors
Zimarino M. Ricci F. Romanello M. Di Nicola M. Corazzini A. De Caterina R.
Institution
(Zimarino, Ricci, Romanello, Corazzini, De Caterina) Institute of
Cardiology, Center of Excellence on Aging, G, d'Annunzio University, C/o
Ospedale SS. Annunziata, Via dei Vestini, Chieti 66013, Italy
(Di Nicola) Laboratory of Biostatistics, Department of Experimental and
Clinical Science, G, d'Annunzio University, Chieti, Italy
Title
Complete myocardial revascularization confers a larger clinical benefit
when performed with state-of-the-art techniques in high-risk patients with
multivessel coronary artery disease: A meta-analysis of randomized and
observational studies.
Source
Catheterization and Cardiovascular Interventions. 87 (1) (pp 3-12), 2016.
Date of Publication: 01 Jan 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To test whether a strategy of complete revascularization (CR)
as compared with incomplete myocardial revascularization (IR) - both
performed with current "state-of-the-art" percutaneous coronary
interventions (PCI) or coronary artery bypass graft (CABG) - would provide
a clinical benefit in patients with multivessel coronary artery disease
(MVCAD). Background The "optimal" extent of myocardial revascularization
remains to be determined. Methods: We performed a meta-analysis of studies
reporting on clinical outcomes of MVCAD patients treated with CR and IR,
with extensive (>80%) use of stents for PCI or arterial conduits in CABG.
Relative risk (RR) and 95% confidence intervals (CIs) for all-cause
mortality were assessed as primary endpoint, myocardial infarction (MI)
and repeat revascularization as secondary endpoints. Results A total of 28
studies were identified, including 83,695 patients with 4.7 +/- 4.3 years
of follow-up. Compared with IR, CR was associated with reduced mortality
(RR: 0.73; 95% CI 0.66-0.81) both after CABG (RR: 0.76; 95% CI 0.63-0.90)
and PCI (RR: 0.73; 95% CI 0.64-0.82). The risks of MI (RR: 0.74; 95% CI
0.64-0.85) and repeat revascularization (RR: 0.77; 95% CI 0.66-0.88) were
also lower after CR as compared with IR. Metaregression showed a
significant RR reduction of MI associated with more recent publication (P
= 0.021) and increasing prevalence of diabetes (P = 0.033). Conclusions In
MVCAD, as compared with IR, CR confers a clinical benefit that seems
larger in cohorts of patients enrolled in more recent studies and with a
higher prevalence of diabetes.
<10>
Accession Number
2015781579
Authors
Goswami N.J. Smalling R.G. Sinha S. Gammon R.S. Ramaiah V.G.
Institution
(Goswami) Interventional Cardiology, St. John's - Prairie Heart,
Springfield, IL, United States
(Smalling) Interventional Cardiology, Christi Hospital, Pittsburg, KS,
United States
(Sinha) Interventional Cardiology, Fairfield Medical Center, Lancaster,
OH, United States
(Gammon) Interventional Cardiology, Austin Heart, Austin, TX, United
States
(Ramaiah) Vascular Surgery, Arizona Heart Institute, Phoenix, AZ, United
States
Title
Comparison of the boomerang wire vascular access management system versus
manual compression alone during percutaneous diagnostic and interventional
cardiovascular procedures: The boomerangTM wire vascular access management
trial II.
Source
Catheterization and Cardiovascular Interventions. 87 (1) (pp 75-81), 2016.
Date of Publication: 01 Jan 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To evaluate the use of the BoomerangTM Wire as an adjunct to
manual compression (MC) in patients requiring diagnostic (Dx) or
interventional (Ix) percutaneous procedures. Background MC remains the
standard of care for closure of femoral artery access sites. Adjunctive
use of a device to facilitate closure, reduce time to hemostasis (TTH) and
ambulation (TTA) without increasing complication rates could reduce costs
and hospital resource demands. Methods The BoomerangTM Trial was a
prospective, multicenter, randomized, controlled trial comparing use of
the BoomerangTM wire, (Cardiva Medical, Sunnyvale, CA) in conjunction with
MC versus MC alone to achieve hemostasis in Dx and Ix patients undergoing
percutaneous procedures requiring femoral artery access. Endpoints
included TTH, TTA, major, and minor access-site related complications.
Subjects were randomized 3:1, Boomerang versus MC. Results No minor or
major device-related adverse events were reported. Nondevice related
complication rates were 3 (0.9%) in the Boomerang arm (n = 327) and 1
(0.8%) in MC arm (n = 123). Mean TTH for Boomerang vs. MC was 11.2 +/- 4.3
vs. 23.2 +/- 11 min for Dx (P < 0.0001) and 13.9 +/- 5.4 vs. 38.4 +/- 57.3
min for Ix patients (P < 0.0001). Mean TTA for Boomerang vs. MC was 3.3
+/- 3.0 vs. 4.5 +/- 2.0 hr (P < 0.0001)for Dx and 5.4 +/- 3.3 vs. 6.8 +/-
3.2 hr (P < 0.0001) for Ix patients. Conclusions BoomerangTM use, in
conjunction with MC, was associated with low rates of complications and
demonstrated that BoomerangTM as an adjunct to MC can significantly
decrease TTH and TTA after both Dx and Ix procedures.
<11>
Accession Number
20160012957
Authors
Mahler S.A. Riley R.F. Russell G.B. Hiestand B.C. Hoekstra J.W. Lefebvre
C.W. Nicks B.A. Cline D.M. Askew K.L. Bringolf J. Elliott S.B. Herrington
D.M. Burke G.L. Miller C.D.
Institution
(Mahler, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Bringolf,
Elliott, Miller) Department of Emergency Medicine, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Riley, Herrington) Department of Internal Medicine, Division of
Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Russell, Burke) Division of Public Health Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Title
Adherence to an accelerated diagnostic protocol for chest pain: Secondary
analysis of the HEART pathway randomized trial.
Source
Academic Emergency Medicine. 23 (1) (pp 70-77), 2016. Date of Publication:
01 Jan 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives Accelerated diagnostic protocols (ADPs), such as the HEART
Pathway, are gaining popularity in emergency departments (EDs) as tools
used to risk stratify patients with acute chest pain. However, provider
nonadherence may threaten the safety and effectiveness of ADPs. The
objective of this study was to determine the frequency and impact of ADP
nonadherence. Methods A secondary analysis of participants enrolled in the
HEART Pathway RCT was conducted. This trial enrolled 282 adult ED patients
with symptoms concerning for acute coronary syndrome without ST-elevation
on electrocardiogram. Patients randomized to the HEART Pathway (N = 141)
were included in this analysis. Outcomes included index visit disposition,
nonadherence, and major adverse cardiac events (MACEs) at 30 days. MACE
was defined as death, myocardial infarction, or revascularization.
Nonadherence was defined as: 1) undertesting - discharging a high-risk
patient from the ED without objective testing (stress testing or coronary
angiography) or 2) overtesting - admitting or obtaining objective testing
on a low-risk patient. Results Nonadherence to the HEART Pathway occurred
in 28 of 141 patients (20%, 95% confidence interval [CI] = 14% to 27%).
Overtesting occurred in 19 of 141 patients (13.5%, 95% CI = 8% to 19%) and
undertesting in nine of 141 patients (6%, 95% CI = 3% to 12%). None of
these 28 patients suffered MACE. The net effect of nonadherence was 10
additional admissions among patients identified as low-risk and
appropriate for early discharge (absolute decrease in discharge rate of
7%, 95% CI = 3% to 13%). Conclusions Real-time use of the HEART Pathway
resulted in a nonadherence rate of 20%, mostly due to overtesting. None of
these patients had MACE within 30 days. Nonadherence decreased the
discharge rate, attenuating the HEART Pathway's impact on health care use.
<12>
Accession Number
20151062897
Authors
Weisz G. Genereux P. Iniguez A. Zurakowski A. Shechter M. Alexander K.P.
Dressler O. Osmukhina A. James S. Ohman E.M. Ben-Yehuda O. Farzaneh-Far R.
Stone G.W.
Institution
(Weisz) Department of Cardiology, Shaare Zedek Medical Center, Jerusalem
91031, Israel
(Weisz) New York Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Weisz, Genereux, Dressler, Ben-Yehuda, Stone) Hopital du Sacre-Coeur de
Montreal, Universite de Montreal, Montreal, QC, Canada
(Genereux) Hospital de Meixoeiro, Vigo, Spain
(Iniguez) American Heart of Poland SA, Katowice, Poland
(Zurakowski) Chaim Sheba Medical Center, Tel Hashomer, Israel
(Shechter) Duke Clinical Research Institute, Duke University, Durham, NC,
United States
(Alexander, Ohman) Gilead Sciences, Foster City, CA, United States
(Osmukhina, James, Farzaneh-Far) Department of Medical Sciences,
Cardiology, Uppsala University, Uppsala, Sweden
Title
Ranolazine in patients with incomplete revascularisation after
percutaneous coronary intervention (RIVER-PCI): A multicentre, randomised,
double-blind, placebo-controlled trial.
Source
The Lancet. 387 (10014) (pp 136-145), 2016. Date of Publication: 09 Jan
2016.
Publisher
Lancet Publishing Group
Abstract
Background Incomplete revascularisation is common after percutaneous
coronary intervention and is associated with increased mortality and
adverse cardiovascular events. We aimed to assess whether adjunctive
anti-ischaemic pharmacotherapy with ranolazine would improve the prognosis
of patients with incomplete revascularisation after percutaneous coronary
intervention. Methods We performed this multicentre, randomised,
parallel-group, double-blind, placebo-controlled, event-driven trial at
245 centres in 15 countries in Europe, Israel, Russia, and the USA.
Patients (aged <18 years) with a history of chronic angina with incomplete
revascularisation after percutaneous coronary intervention (defined as one
or more lesions with <50% diameter stenosis in a coronary artery <2 mm
diameter) were randomly assigned (1:1), via an interactive web-based block
randomisation system (block sizes of ten), to receive either twice-daily
oral ranolazine 1000 mg or matching placebo. Randomisation was stratified
by diabetes history (presence vs absence) and acute coronary syndrome
presentation (acute coronary syndrome vs non-acute coronary syndrome).
Study investigators, including all research teams, and patients were
masked to treatment allocation. The primary endpoint was time to first
occurrence of ischaemia-driven revascularisation or ischaemia-driven
hospitalisation without revascularisation. Analysis was by intention to
treat. This study is registered at ClinicalTrials.gov, number NCT01442038.
Findings Between Nov 3, 2011, and May 27, 2013, we randomly assigned 2651
patients to receive ranolazine (n=1332) or placebo (n=1319); 2604 (98%)
patients comprised the full analysis set. After a median follow-up of 643
days (IQR 575-758), the composite primary endpoint occurred in 345 (26%)
patients assigned to ranolazine and 364 (28%) patients assigned to placebo
(hazard ratio 0.95, 95% CI 0.82-1.10; p=0.48). Incidence of
ischaemia-driven revascularisation and ischaemia-driven hospitalisation
did not differ significantly between groups. 189 (14%) patients in the
ranolazine group and 137 (11%) patients in the placebo group discontinued
study drug because of an adverse event (p=0.04). Interpretation Ranolazine
did not reduce the composite rate of ischaemia-driven revascularisation or
hospitalisation without revascularisation in patients with a history of
chronic angina who had incomplete revascularisation after percutaneous
coronary intervention. Further studies are warranted to establish whether
other treatment could be effective in improving the prognosis of high-risk
patients in this population. Funding Gilead Sciences, Menarini.
<13>
Accession Number
20160039271
Authors
Gu W.-J. Wu X.-D. Wang F. Ma Z.-L. Gu X.-P.
Institution
(Gu, Ma, Gu) Department of Anesthesiology, Drum Tower Hospital, Medical
College of Nanjing University, 321 Zhongshan Road, Nanjing 210008, China
(Wu) Department of Orthopaedic Surgery, First Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Wang) Department of Anesthesiology, General Hospital of Jinan Military
Command, Jinan, China
Title
Ultrasound guidance facilitates radial artery catheterization: A
meta-Analysis with trial sequential analysis of randomized controlled
trials.
Source
Chest. 149 (1) (pp 166-179), 2016. Date of Publication: January 2016.
Publisher
American College of Chest Physicians
Abstract
BACKGROUND: Potential benefits and possible risks associated with
ultrasound guidance compared with traditional palpation for radial artery
catheterization are not fully understood. METHODS: We searched PubMed,
Embase, and the Cochrane Library through July 2015 to identify randomized
controlled trials that evaluated ultrasound guidance compared with
traditional palpation for radial artery catheterization. Primary outcome
was first-Attempt failure. Secondary outcomes included mean attempts to
success, mean time to success, and hematoma complications. A
random-effects model was used to estimate relative risks (RRs) with 95%
CIs. RESULTS: Twelve trials used dynamic two-dimensional (2-D) ultrasound
guidance (N = 1,992) and two used Doppler ultrasound guidance (N = 666).
Compared with traditional palpation, dynamic 2-D ultrasound guidance was
associated with a reduced first-Attempt failure (RR, 0.68; 95% CI,
0.52-0.87). Trial sequential analysis showed that the cumulative z curve
crossed the trial sequential monitoring boundary for benefit establishing
sufficient and conclusive evidence. Dynamic 2-D ultrasound guidance
further reduced mean attempts to success, mean time to success, and
hematoma complications. No evidence of publication bias was detected.
Compared with traditional palpation, Doppler ultrasound guidance had no
benefit on first-Attempt failure (RR, 1.00; 95% CI, 0.87-1.15), which was
confirmed by trial sequential analysis as the cumulative z curve entered
the futility area. CONCLUSIONS: The use of dynamic 2-D ultrasound guidance
for radial artery catheterization decreases first-Attempt failure, mean
attempts to success, mean time to success, and the occurrence of hematoma
complications. Dynamic 2-D ultrasound guidance is recommended as an
adjunct to aid radial arterial catheterization.
<14>
Accession Number
20151003675
Authors
Kizilirmak F. Gunes H.M. Demir G.G. Gokdeniz T. Guler E. Cakal B. Omaygenc
M.O. Yilmaz F. Savur U. Barutcu I.
Institution
(Kizilirmak, Gunes, Demir, Gokdeniz, Guler, Cakal, Omaygenc, Savur,
Barutcu) Cardiology Department, Medipol University Hospital, TEM Avrupa
Otoyolu Goztepe Cikisi No: 1 Bagcilar, Istanbul 34214, Turkey
(Yilmaz) Kartal Kosuyolu Research and Education Hospital, Istanbul
University, Istanbul, Turkey
Title
Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable
Angina Pectoris Undergoing Percutaneous Coronary Intervention.
Source
Cardiovascular Drugs and Therapy. 29 (6) (pp 519-526), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Springer New York LLC
Abstract
Background: In this study, we aimed to investigate the impact of
prophylactic intracoronary adenosine administered during percutaneous
coronary intervention (PCI) due to unstable angina pectoris on myonecrosis
by measuring post-procedural levels of cardiac troponin I (cTnI) and
creatine kinase-myocardial band (CK-MB). Methods: A total of 122 patients
with unstable angina undergoing PCI were included in this single-center,
double-blind, randomized study. The patients were randomly allocated to
adenosine and placebo groups. In the adenosine group, a single-dose of
intracoronary adenosine (100 mug for the right coronary artery and 150 mug
for the left coronary artery) was administered. Primary endpoint was
post-PCI myonecrosis, which was defined as abnormal levels of
periprocedural cTnI. Secondary endpoints were defined as elevated cTnI
levels [5 x upper limit of normal (ULN)], abnormal CK-MB levels,
angiographic coronary flow measured by Thrombolysis In Myocardial
Infarction (TIMI) frame count (TFC), the cumulative incidence of
in-hospital death and in-hospital urgent target vessel revascularization
(TVR). Results: Clinical and angiographic characteristics of both
adenosine (61 patients, 61 +/- 9 years) and placebo (61 patients, 59 +/-
10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal
cTnI levels in the adenosine group were significantly lower than the
placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 x ULN (21 % vs. 31 %, p:
0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in
both groups. Post-procedural TFCs in the adenosine group were
significantly lower than the placebo group (24 +/- 4 vs. 27 +/- 5, p:
0.004). In-hospital events including death and urgent TVR were not
observed in either group. Conclusion: Intracoronary administration of
single-dose adenosine in patients with unstable angina undergoing PCI is
associated with decreased periprocedural myonecrosis and improved coronary
blood flow.
<15>
Accession Number
20160046396
Authors
Hsieh W.C. Chen P.C. Corciova F.-C. Tinica G.
Institution
(Hsieh, Chen, Corciova, Tinica) Department of Cardiovascular Surgery,
Institute of Cardiovascular Diseases "Prof Dr. George IM Georgescu", Iasi,
Romania
(Hsieh, Chen, Corciova, Tinica) Grigore T. Popa" University of Medicine
and Pharmacy, Iasi, Romania
Title
Liver dysfunction as an important predicting risk factor in patients
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 8 (11) (pp
20712-20721), 2015. Date of Publication: 30 Nov 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Liver function is not considered as a risk factor by current risk scores,
such as EUROSCORE II or STSScore for cardiac surgery. The aim of this
study was to review the role of liver dysfunction, classified by the
Child- Turcotte-Pugh classification or model for end-stage liver disease
scores, as a risk factor for mortality and morbidity of patients following
cardiac surgery. The Pubmed referencing library was searched. The rates of
mortality and morbidity were calculated using SPSS software. The mortality
rates in patients of Child class A, Child class B, and Child class C were
pairwise compared respectively. A total of 22 reports including 939
patients from eight countries were reviewed. The mortality rate of
patients increased in accordance with increased CTP classification. The
lowest mortality rate was recorded in Child class A patients, followed by
Child class B patients and the highest mortality rate was observed in
Child class C patients. The mean complication rate ranged from 3.82% to
22.15%. Child class C patients should be considered unacceptable for
cardiovascular surgery. As two studies revealed, patients with a higher
MELD score had significantly higher mortality rates. Liver function should
be viewed as an important risk factor for cardiovascular surgery, based on
its strong association with mortality and morbidity.
<16>
Accession Number
20160035252
Authors
Zhao J. Wang C. Hu Z.
Institution
(Zhao, Hu) Department of Orthopedic Surgery, First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Wang) Department of Clinical Laboratory, Children's Hospital of Chongqing
Medical University, Chongqing, China
Title
Efficacy and Safety of Bisphosphonates for Osteoporosis or Osteopenia in
Cardiac Transplant Patients: A Meta-Analysis.
Source
Transplantation Proceedings. 47 (10) (pp 2957-2964), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Elsevier USA
Abstract
Background After cardiac transplantation (CTP), the loss of bone mass is
accelerated and there is an increased risk for bone fractures.
Bisphosphonates are commonly used for preventing loss of bone mass after
CTP. However, no systematic evaluation of the treatment efficacy of
bisphosphonates after CTP has been reported. The aim of this meta-analysis
was to assess the effectiveness and safety of bisphosphonates for
osteoporosis or osteopenia after CTP. Methods An electronic database
search including Medline, Embase, and the Cochrane Central Register of
Controlled Trials was conducted to identify studies up to March 2015. We
included randomized controlled trials (RCTs) and nonrandomized prospective
comparative studies that were concerned with bisphosphonates for
osteoporosis after CTP. Statistical analyses were conducted with the use
of Review Manager 5.1.6. Results Three RCTs and 3 nonrandomized
prospective studies involving 425 participants were included. Eight and 12
months after CTP, compared with the control groups, vertebral bone mineral
density (BMD) in patients treated with bisphosphonates was ~0.06
g/cm<sup>2</sup> higher than in control patients (weighted mean difference
[WMD], 0.06 g/cm<sup>2</sup>; 95% CI, 0.03-0.08 g/cm<sup>2</sup>; P
<.0001). The loss of femoral neck BMD was 0.03 g/cm<sup>2</sup> lower in
patients treated with bisphosphonates than in control patients; however,
this difference was not statistically significant (WMD, 0.03
g/cm<sup>2</sup>; 95% CI, 0-0.05 g/cm<sup>2</sup>; P =.06). No
bisphosphonate treatment-related serious adverse reactions were found in
the patients. Conclusions In the early stage after CTP, bisphosphonates
effectively reduced the loss of bone mass, especially in vertebral BMD.
<17>
Accession Number
20160035234
Authors
Qiu Y. Wang X. Fan J. Rao Z. Lu Y. Lin T.
Institution
(Qiu, Wang, Rao, Lu, Lin) Department of Urology, Research Institute of
Urology, Organ Transplantation Center, West China Hospital, Sichuan
University, Number 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Qiu, Wang, Rao, Lu, Lin) Institute of Urology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
(Qiu, Wang, Rao, Lu, Lin) Organ Transplantation Center, West China
Hospital, Sichuan University, Chengdu, Sichuan, China
(Fan) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Conversion from Calcineurin Inhibitors to Mammalian Target-of-Rapamycin
Inhibitors in Heart Transplant Recipients: A Meta-Analysis of Randomized
Controlled Trials.
Source
Transplantation Proceedings. 47 (10) (pp 2952-2956), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Elsevier USA
Abstract
Objective Conversion from calcineurin inhibitors (CNIs) to mammalian
target-of-rapamycin inhibitors (mTORi) was systematically evaluated in
heart transplant recipients (HTRs) for the first time. Methods MEDLINE
(PUBMED), EMBASE, Cochrane Library, and clinical trial registries were
searched comprehensively. After screening for eligibility, the randomized
controlled trials (RCTs) comparing continuation of CNI with conversion to
mTORi therapy underwent review, quality assessment, and data extraction.
Outcomes analyzed including creatinine clearance, serum creatinine level,
rejection, adverse effects, and triglyceride levels were expressed as mean
differences (MDs) or as risk ratios (RRs) with 95% confidence intervals
(CIs). Results This is the first systematic review evaluating converting
from CNI to mTORi therapy in HTRs. A total of 4 RCTs (231 HTRs, 117 vs
114) were included in our analysis. Patients converted to mTORi had a
higher creatinine clearance (MD, 19.31; 95% CI [11.16, 27.46]; P <.00001)
and lower serum creatinine levels (MD, -0.15; 95% CI [-0.25, -0.05]; P
=.002). Patients converted to mTORi had a significantly higher occurrence
of adverse effects, which included skin diseases, gastrointestinal side
effects, bone marrow suppression, and infections. There was no significant
difference between the 2 groups regarding graft rejection and triglyceride
levels (RR, 2.61; 95% CI [0.08, 81.25]; P =.58; MD, 22.89; 95% CI [-21.86,
67.63]; P =.32). Conclusions Conversion from CNI to mTORi therapy may
improve the renal function in HTRs, but the patients may suffer from a
high incidence of mTORi-associated adverse events. Therefore, conversion
to mTORi must be carefully assessed for the benefits and risks.
<18>
Accession Number
20160038232
Authors
Protogerou C. Fleeman N. Dwan K. Richardson M. Dundar Y. Hagger M.S.
Institution
(Protogerou) Institute of Psychology Health and Society, Department of
Health Services Research, University of Liverpool, Eleanor Rathbone
Building, 74 Bedford Street South, Liverpool L69 7ZQ, United Kingdom
(Fleeman, Dwan) Liverpool Reviews and Implementation Group, University of
Liverpool, United Kingdom
(Richardson) Liverpool Reviews and Implementation Group, Department of
Biostatistics, University of Liverpool, United Kingdom
(Dundar) Mersey Care NHS Trust, Department of Health Services Research,
University of Liverpool, United Kingdom
(Hagger) Health Psychology and Behavioural Medicine Research Group, School
of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin
University, Perth, Australia
(Protogerou) Department of Psychology, University of Cape Town, Rondebosch
7701, South Africa
Title
Moderators of the effect of psychological interventions on depression and
anxiety in cardiac surgery patients: A systematic review and
meta-analysis.
Source
Behaviour Research and Therapy. 73 (pp 151-164), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Cardiac surgery patients may be provided with psychological interventions
to counteract depression and anxiety associated with surgical procedures.
This systematic review and meta-analysis investigated whether intervention
efficacy was impacted by type of cardiac procedure/cardiac event; control
condition content; intervention duration; intervention timing; facilitator
type; and risk of bias. MEDLINE, EMBASE, and PsycINFO were searched for
randomized controlled trials comparing anxiety and depression outcomes,
pre and post psychological and cardiac interventions. Twenty-four studies
met the inclusion criteria for the systematic review (. N = 2718) and 16
of those were meta-analysed (. N = 1928). Depression and anxiety outcomes
were reduced more in interventions that lasted longer, were delivered
post-surgery, and by trained health professionals. Depression (but not
anxiety) was reduced more when the experimental intervention was compared
to an 'alternative' intervention, and when the intervention was delivered
to coronary artery bypass graft patients. Anxiety (but not depression) was
decreased more when interventions were delivered to implantable
cardioverter defibrillator patients, and were of 'high' or 'unclear' risk
of bias. In addition to estimating efficacy, future work in this domain
needs to take into account the moderating effects of intervention, sample,
and study characteristics.
<19>
Accession Number
72164852
Authors
D'Souza R.D. Ostro J. Malinowski A. Silversides C. Murphy K.E. Sermer M.
Shah P.S. Shehata N.
Institution
(D'Souza, Ostro, Malinowski, Silversides, Murphy, Sermer, Shah, Shehata)
Mount Sinai Hospital, Toronto, ON, Canada
Title
Anticoagulation for pregnant women with mechanical heart valves: A
systematic review and meta-analysis.
Source
American Journal of Obstetrics and Gynecology. Conference: 36th Annual
Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting
Atlanta, GA United States. Conference Start: 20160201 Conference End:
20160206. Conference Publication: (var.pagings). 214 (1 SUPPL. 1) (pp
S351), 2016. Date of Publication: January 2016.
Publisher
Mosby Inc.
Abstract
OBJECTIVE: To compare maternal and fetal outcomes associated with the use
of three methods of anticoagulation in pregnant women with mechanical
heart valves (MHVs): Vitamin-K antagonists (VKA), therapeutic heparin and
combination therapy (first trimester heparin followed by VKA). STUDY
DESIGN: A systematic review was conducted using MEDLINE, EMBASE, and
CENTRAL from inception till April 30, 2015. Article selection and data
extraction was performed in duplicate. Risk of bias was assessed using a
modified Newcastle-Ottawa Quality Assessment Scale for cohort studies.
Pooled incidence rates (95% confidence interval [CI]) were calculated for
outcomes that included maternal death, thromboembolic complications
(TECs), live births and congenital anomalies. RESULTS: Of the 1650
articles retrieved, 46 were included in the meta-analysis. Incidences of
maternal mortality and TECs were [9/1000 (4-14/1000) and 21/1000
(13-28/1000)] with VKA, 31/ 1000 (7-54/1000) and 93/1000 (51-134/1000)
with heparin and 20/ 1000 (8-31/1000) and 58/1000 (38-77/1000) with
combination treatment respectively. Live-birth rates were 715/1000
(642-788/ 1000), 854/1000 (760-948/1000) and 799/1000 (743-856/1000).
Congenital anomaly rates were 35/1000 (21-49/1000), 14/1000 (3-25/1000)
and 37/1000 (7-67/1000). Lowering International Normalised Ratio (INR)
targets to 1.5-2.5 resulted in higher live births [840/1000
(731-948/1000)], higher maternal mortality [24/1000 (9-40/1000)] and did
not lower congenital anomalies [42/1000 (17-66/1000)]. VKA doses < 5mg/day
were associated with higher live births than with doses >5mg/day [875/1000
(800- 949/1000) vs. 398/1000 (285-511/1000)], but congenital anomalies
occurred at these doses [22/1000 (5-39/1000)]. Low molecular weight
heparin (LMWH) use was associated with the highest live births [920/1000
(861-980/1000)]. CONCLUSION: In pregnant women with MHVs, VKA is
associated with low maternal complication rates and lowest live-birth
rates. LMWH is associated with highest live-birth rates and may be a
suitable alternative. Lowering INR targets to reduce the dose of warfarin
needs further investigation.
<20>
Accession Number
25727522
Authors
Kadda O. Kotanidou A. Manginas A. Stavridis G. Nanas S. Panagiotakos D.B.
Institution
(Kadda) Department of Critical Care, School of Medicine, University of
Athens, Athens, Greece
(Kotanidou) Department of Critical Care, School of Medicine, University of
Athens, Athens, Greece
(Manginas) Department of Cardiology, Mediterraneo Hospital, Athens, Greece
(Stavridis) Department of Cardiac Surgery, Onassis Cardiac Surgery Center,
Athens, Greece
(Nanas) Department of Critical Care, School of Medicine, University of
Athens, Athens, Greece
(Panagiotakos) Department of Nutrition and Dietetics, School of Health
Science and Education, Harokopio University, Athens, Greece
Title
Lifestyle intervention and one-year prognosis of patients following open
heart surgery: a randomised clinical trial.
Source
Journal of clinical nursing. 24 (11-12) (pp 1611-1621), 2015. Date of
Publication: 01 Jun 2015.
Abstract
AIMS AND OBJECTIVES: To evaluate the one-year prognosis of a lifestyle
counselling intervention (diet, smoking cessation and exercise) among
patients who had open heart surgery.
BACKGROUND: Cardiovascular disease is the leading cause of morbidity
worldwide in both developing and developed countries. Lifestyle
modification plays an important role for patients who are at a high risk
of developing cardiovascular disease and for those with an established
cardiovascular disease.
DESIGN: Randomised, nonblind and lifestyle counselling intervention study
with a one-year follow-up.
METHODS: A randomised, nonblind intervention study was performed on 500
patients who had open heart surgery. After hospital discharge, 250
patients (intervention group) were randomly allocated lifestyle
counselling according to the recent guidelines provided by the European
Society of Cardiology (European Journal Preventive Cardiology, 19, 2012,
585). The remaining 250 patients (control group) received the regular
instructions. Primary end-point was the development of a cardiovascular
disease (nonfatal event) during the first year; secondary end-points
included fatal events, smoking abstinence, dietary habits and a physical
activity evaluation.
RESULTS: According to the primary end-point, the odds of having a nonfatal
cardiovascular disease event are 0.56-times (95%CI 0.28, 0.96, p = 0.03)
lower for the intervention group compared to the control group. One-year
after surgery, it was found that participants in the intervention group
were 1.96-times (95%CI 1.31, 2.93, p < 0.001) more likely to achieve
dietary recommendations, 3.32-times (95%CI 2.24, 4.91, p < 0.001) more
likely to achieve physical activity recommendations and 1.34-times (95%CI
1.15, 1.56, p < 0.001) more likely to return to work.
CONCLUSION: Lifestyle counselling intervention following open heart
surgery can improve health outcomes and reduce the risk of a new cardiac
event. Health care services must recommend and organise well-structured
cardiac rehabilitation programmes adjusted to the patient's needs.
RELEVANCE TO CLINICAL PRACTICE: A well-structured cardiac rehabilitation
programme adjusted to the patient's profile is a safe and cost-effective
way to improve patients' outcome.
<21>
Accession Number
25841244
Authors
Bouchard D.
Title
Coronary artery bypass graft surgery provides clinically important
quality-of-life improvements over medical therapy in patients with
ischaemic left ventricular dysfunction.
Source
Evidence-based medicine. 20 (3) (pp 107), 2015. Date of Publication: 01
Jun 2015.
