Results Generated From:
Embase <1980 to 2016 Week 02>
Embase (updates since 2015-12-31)
<1>
Accession Number
26551304
Authors
Rodes-Cabau J. Horlick E. Ibrahim R. Cheema A.N. Labinaz M. Nadeem N.
Osten M. Cote M. Marsal J.R. Rivest D. Marrero A. Houde C.
Institution
(Rodes-Cabau) Department of Cardiology, Quebec Heart and Lung Institute,
Quebec City, Quebec, Canada
(Horlick) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Ibrahim) Department of Cardiology, Montreal Heart Institute, Montreal,
Quebec, Canada
(Cheema) Department of Cardiology, St. Michael's Hospital, Toronto,
Ontario, Canada
(Labinaz) Department of Cardiology, Ottawa Heart Institute, Ottawa,
Ontario, Canada
(Nadeem) Department of Cardiology, Queen Elizabeth II Health Sciences
Centre, Halifax, Nova Scotia, Canada
(Osten) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Cote) Department of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Marsal) Epidemiology Unit of the Cardiology Department, Vall d'Hebron
Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
(Rivest) Department of Neurology, Hotel Dieu de Levis, Quebec City,
Quebec, Canada
(Marrero) Department of Neurology, Centre Hospitalier Universitaire
Georges. L Dumont, Moncton, New Brunswick, Canada
(Houde) Department of Pediatric Cardiology, Centre Hospitalier
Universitaire de Quebec, Quebec City, Quebec, Canada
Title
Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches
After Transcatheter Atrial Septal Defect Closure: The CANOA Randomized
Clinical Trial.
Source
JAMA. 314 (20) (pp 2147-2154), 2015. Date of Publication: 24 Nov 2015.
Abstract
IMPORTANCE: The occurrence of new-onset migraine attacks is a complication
of transcatheter atrial septal defect (ASD) closure. It has been suggested
that clopidogrel may reduce migraine attacks after ASD closure.
OBJECTIVE: To assess the efficacy of clopidogrel, used in addition to
taking aspirin, for the prevention of migraine attacks following ASD
closure.
DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind clinical trial
performed in 6 university hospitals in Canada. Participants were 171
patients with an indication for ASD closure and no history of migraine.
INTERVENTIONS: Patients were randomized (1:1) to receive dual antiplatelet
therapy (aspirin+clopidogrel [the clopidogrel group], n=84) vs single
antiplatelet therapy (aspirin+placebo [the placebo group], n=87) for 3
months following transcatheter ASD closure. The first patient was enrolled
in December 2008, and the last follow-up was completed in February 2015.
MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was the monthly
number of migraine days within the 3 months following ASD closure in the
entire study population. The incidence and severity of new-onset migraine
attacks, as evaluated by the Migraine Disability Assessment questionnaire,
were prespecified secondary end points. A zero-inflated Poisson regression
model was used for data analysis.
RESULTS: The mean (SD) age of the participants was 49 (15) years and 62%
(106) were women. Patients in the clopidogrel group had a reduced mean
(SD) number of monthly migraine days within the 3 months following the
procedure (0.4 [95% CI, 0.07 to 0.69] days) vs the placebo group (1.4 [95%
CI, 0.54 to 2.26] days; difference, -1.02 days [95% CI, -1.94 to -0.10
days]; incident risk ratio [IRR], 0.61 [95% CI, 0.41 to 0.91]; P=.04) and
a lower incidence of migraine attacks following ASD closure (9.5% for the
clopidogrel group vs 21.8% for the placebo group; difference, -12.3% [95%
CI, -23% to -1.6%]; odds ratio [OR], 0.38 [95% CI, 0.15 to 0.89]; P=.03).
Among patients with migraines, those in the clopidogrel group had
less-severe migraine attacks (zero patients with moderately or severely
disabling migraine attacks vs 37% [7 patients] in the placebo group;
difference, -36.8% [95% CI, -58.5% to -15.2%]; P=.046). There were no
between-group differences in the rate of patients with at least 1 adverse
event (16.7% [14 patients] in the clopidogrel group vs 21.8% [19 patients]
in the placebo group; difference, -5.2% [95% CI, -17% to 6.6%]; P=.44).
CONCLUSIONS AND RELEVANCE: Among patients who underwent transcatheter ASD
closure, the use of clopidogrel and aspirin, compared with aspirin alone,
resulted in a lower monthly frequency of migraine attacks over 3 months.
Further studies are needed to assess generalizability and durability of
this effect.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00799045.
<2>
Accession Number
25835756
Authors
Lam J.Y. Lopushinsky S.R. Ma I.W. Dicke F. Brindle M.E.
Title
Treatment Options for Pediatric Patent Ductus Arteriosus: Systematic
Review and Meta-analysis.
Source
Chest. 148 (3) (pp 784-793), 2015. Date of Publication: 01 Sep 2015.
Abstract
BACKGROUND: Patent ductus arteriosus (PDA) in the nonpremature pediatric
patient is currently treated by surgical ligation or catheter occlusion.
There is no clear superiority of one technique over the other. This
meta-analysis compares the clinical outcomes of the two treatment options
for PDA.
METHODS: We performed a literature search of MEDLINE, Embase, PubMed, and
the Cochrane database of randomized controlled trials (RCTs) that took
place between 1950 and February 2014 and hand-searched references from
included studies. We excluded studies of adult or premature patients and
those without a direct comparison between surgical and catheter-based
treatments of PDAs. Outcomes of interest were reintervention, total
complications, length of stay, and cost.
RESULTS: One thousand three hundred thirty-three manuscripts were
screened. Eight studies fulfilled the inclusion criteria (one RCT and
seven observational studies [N = 1,107]). In pooled observational studies,
there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for
reintervention in the surgical ligation group but insignificantly higher
odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were
no complications reported in the RCT, but surgical ligation was associated
with decreased odds for reintervention and a longer length of stay. Funnel
plots revealed a possible publication bias and a quality review identified
comparability bias.
CONCLUSIONS: Both therapies have comparable outcomes. Reintervention is
more common with catheter-based treatment, but overall complication rates
are not higher and hospital stay is shorter. Our data span > 2 decades and
may not reflect current surgical and catheterization outcomes. Large,
randomized, prospective studies may help determine the optimal treatment
strategy.
<3>
Accession Number
26436963
Authors
Makkar R.R. Fontana G. Jilaihawi H. Chakravarty T. Kofoed K.F. de Backer
O. Asch F.M. Ruiz C.E. Olsen N.T. Trento A. Friedman J. Berman D. Cheng W.
Kashif M. Jelnin V. Kliger C.A. Guo H. Pichard A.D. Weissman N.J. Kapadia
S. Manasse E. Bhatt D.L. Leon M.B. Sondergaard L.
Institution
(Makkar, Fontana, Jilaihawi, Chakravarty, Kofoed, de Backer, Asch, Ruiz,
Olsen, Trento, Friedman, Berman, Cheng, Kashif, Jelnin, Kliger, Guo,
Pichard, Weissman, Kapadia, Manasse, Bhatt, Leon, Sondergaard) From
Cedars-Sinai Heart Institute (R.R.M., H.J., T.C., A.T., J.F., D.B., W.C.,
M.K.) and Cedars-Sinai Medical Center (G.F.) - both in Los Angeles;
Rigshospitalet, University of Copenhagen, Copenhagen (K.F.K., O.B.,
N.T.O., L.S.); MedStar Health Research Institute, Washington, DC (F.M.A.,
A.D.P., N.J.W.); Hackensack University Medical Center and Joseph M.
Sanzari Children's Hospital, Hackensack, NJ (C.E.R., V.J.); Lenox Hill
Heart and Vascular Institute of New York (C.A.K.) and Columbia University
Medical Center-New York Presbyterian Hospital (M.B.L.) - both in New York;
St. Jude Medical, Plymouth, MN (H.G., E.M.); Cleveland Clinic, Cleveland
(S.K.); and Brigham and Women's Hospital Heart and Vascular Center and
Harvard Medical School - both in Boston (D.L.B.)
Title
Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves.
Source
The New England journal of medicine. 373 (21) (pp 2015-2024), 2015. Date
of Publication: 19 Nov 2015.
Abstract
BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on
computed tomography (CT) in a patient who had a stroke after transcatheter
aortic-valve replacement (TAVR) during an ongoing clinical trial. This
finding raised a concern about possible subclinical leaflet thrombosis and
prompted further investigation.
METHODS: We analyzed data obtained from 55 patients in a clinical trial of
TAVR and from two single-center registries that included 132 patients who
were undergoing either TAVR or surgical aortic-valve bioprosthesis
implantation. We obtained four-dimensional, volume-rendered CT scans along
with data on anticoagulation and clinical outcomes (including strokes and
transient ischemic attacks [TIAs]).
RESULTS: Reduced leaflet motion was noted on CT in 22 of 55 patients (40%)
in the clinical trial and in 17 of 132 patients (13%) in the two
registries. Reduced leaflet motion was detected among patients with
multiple bioprosthesis types, including transcatheter and surgical
bioprostheses. Therapeutic anticoagulation with warfarin, as compared with
dual antiplatelet therapy, was associated with a decreased incidence of
reduced leaflet motion (0% and 55%, respectively, P=0.01 in the clinical
trial; and 0% and 29%, respectively, P=0.04 in the pooled registries). In
patients who were reevaluated with follow-up CT, restoration of leaflet
motion was noted in all 11 patients who were receiving anticoagulation and
in 1 of 10 patients who were not receiving anticoagulation (P<0.001).
There was no significant difference in the incidence of stroke or TIA
between patients with reduced leaflet motion and those with normal leaflet
motion in the clinical trial (2 of 22 patients and 0 of 33 patients,
respectively; P=0.16), although in the pooled registries, a significant
difference was detected (3 of 17 patients and 1 of 115 patients,
respectively; P=0.007).
CONCLUSIONS: Reduced aortic-valve leaflet motion was shown in patients
with bioprosthetic aortic valves. The condition resolved with therapeutic
anticoagulation. The effect of this finding on clinical outcomes including
stroke needs further investigation. (Funded by St. Jude Medical and
Cedars-Sinai Heart Institute; Portico-IDE ClinicalTrials.gov number,
NCT02000115; SAVORY registry, NCT02426307; and RESOLVE registry,
NCT02318342.).
<4>
Accession Number
25123674
Authors
Sharma V. Deo S.V. Altarabsheh S.E. Cho Y.H. Erwin P.J. Park S.J.
Institution
(Sharma) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
USA ctvsteam@hotmail.com
(Deo) Adventist Wockhardt Heart Institute, Athawalines, Surat, India
Division of Cardiovascular Surgery, University Hospitals, Case Western
Reserve University, Cleveland, OH, USA
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Cho) Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul, South Korea
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
(Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, USA
Title
Comparison of the early haemodynamics of stented pericardial and porcine
aortic valves.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp 4-10), 2015.
Date of Publication: 01 Jan 2015.
Abstract
Data comparing the haemodynamic performance of stented pericardial and
porcine aortic valves are conflicting. Hence, we performed a systematic
review and meta-analysis comparing the early haemodynamic parameters of
stented pericardial and porcine valves in patients undergoing isolated
aortic valve replacement. Medline, EMBASE and Web of Science were queried
for English language original publications from 2000 to 2013. Studies
comparing porcine (PoV) and pericardial (PeV) with regard to their
haemodynamic parameters were included in this review. Continuous data were
pooled using the mean difference (MD) or the standardized mean difference
(SMD). A random-effect inverse weighted analysis was conducted; a
P-value<0.05 is considered statistically significant. Results are
presented with 95% confidence intervals. Thirteen studies (1265 PeV
patients and 871 PoV patients) were included in this analysis. The pooled
transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77)
mmHg; P<0.01]. Limiting this analysis to small valves (19 and 21 mm; eight
studies; 714 patients) revealed that the PeV gradients were significantly
lower [MD -4.5 (-5.7 to -3.2); P=0.001]. The corresponding effective
orifice area of PeV was significantly larger than PoV [SMD 0.42
(0.15-0.69); P<0.01]. A sensitivity analysis comprising only randomized
controlled trials did not significantly alter results. When compared with
porcine valves, stented pericardial aortic valves have lower mean
transvalvular gradients early after implant. Even pericardial valves in
smaller sizes (19 and 21 mm) have a better haemodynamic profile when
compared with their counterparts.
<5>
Accession Number
25312529
Authors
Martucci N. Tracey M. La Rocca A. La Manna C. De Luca G. Rocco G.
Institution
(Martucci) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Tracey) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Rocca) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Manna) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(De Luca) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Rocco) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy g.rocco@istitutotumori.na.it
Title
A pilot prospective randomized, controlled trial comparing LigaSureTM
tissue fusion technology with the ForceTriadTM energy platform to the
electrosurgical pencil on rates of atrial fibrillation after pulmonary
lobectomy and mediastinal lymphadenectomy.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp e13-e18),
2015. Date of Publication: 01 Jan 2015.
Abstract
OBJECTIVES: The use of bipolar sealing devices during pulmonary resection
is particularly useful in thoracoscopic surgery. Theoretically, a bipolar
device, which contains the current in a smaller area and completes the
current cycle only through the tissue between the electrodes, may reduce
the proportion of patients experiencing atrial fibrillation compared with
monopolar devices such as the electrosurgical pencil using which the
current completes the cycle through the patient. We investigated the
impact of the LigaSureTM (LS) tissue fusion technology with the
ForceTriadTM energy platform device on the incidence of postoperative
atrial fibrillation and on the reduction of postoperative chest tube
output and hospital length of stay after open pulmonary lobectomy.
METHODS: A pilot prospective randomized, controlled trial comparing LS
tissue fusion technology with the ForceTriadTM energy platform to the
conventional electrosurgical pencil. Overall, 146 patients with resectable
lung cancer were recruited at the Division of Thoracic Surgery of the
Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, between January 2011
and July 2013. Of these, 119 candidates to open lobectomy for
non-small-cell lung cancer were randomized to either LS tissue fusion
technology with the ForceTriadTM energy platform (LS: 57 patients) or
standard haemostatic procedure (standard treatment, ST: 62 patients) for
hilar and mediastinal nodal dissection. The primary end-point was to
compare the incidence of postoperative atrial fibrillation of LS compared
with ST. The secondary end-point was to compare the efficacy of LS
compared with ST in terms of total chest tube drainage, daily chest tube
drainage and chest tube duration.
RESULTS: There was no statistically significant difference between LS and
ST in terms of postoperative atrial fibrillation (P=0.31). However, LS was
associated to significant reduction of duration of both mediastinal nodal
dissection (P=0.017) and the cumulative chest tube drainage (P=0.025).
CONCLUSIONS: The incidence of atrial fibrillation with LS tissue fusion
technology with the ForceTriadTM energy platform is not reduced as
compared with conventional electrosurgical pencil. However, the use of LS
during mediastinal nodal dissection is associated to shorter duration of
lymphadenectomy and duration of chest tube drainage.
<6>
Accession Number
25798568
Authors
Obadia J.-F. Armoiry X. Iung B. Lefevre T. Mewton N. Messika-Zeitoun D.
Cormier B. Berthiller J. Maucort-Boulch D. Boutitie F. Vaz B. Trochu J.-N.
Vahanian A.
Institution
(Obadia, Armoiry, Iung, Lefevre, Mewton, Messika-Zeitoun, Cormier,
Berthiller, Maucort-Boulch, Boutitie, Vaz, Trochu, Vahanian) Service de
Chirurgie Cardiothoracique et Transplantation, Hopital Cardiothoracique
Louis Pradel, Lyon-Bron, France
Title
The MITRA-FR study: design and rationale of a randomised study of
percutaneous mitral valve repair compared with optimal medical management
alone for severe secondary mitral regurgitation.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
10 (11) (pp 1354-1360), 2015. Date of Publication: 01 Mar 2015.
Abstract
AIMS: Percutaneous mitral valve repair (pMVR) is a new therapeutic option
for mitral valve regurgitation. Positive preliminary results in
non-randomised studies have been published supporting the use of the
MitraClip system in patients with secondary mitral regurgitation (MR) and
poor left ventricular (LV) function contraindicated to surgery. The aim of
the MITRA-FR study is to provide a higher level of evidence for the
efficacy of the MitraClip device in this setting.
METHODS AND RESULTS: The MITRA-FR study is a national, multicentre,
investigator-initiated, open-label, randomised trial to evaluate the
benefits and safety of pMVR using the MitraClip system plus optimal
medical therapy (OMT) compared with OMT alone (control) in patients with
severe symptomatic secondary MR contraindicated to surgical repair. The
trial aims to enrol 144 MitraClip-treated subjects and 144 control (OMT
alone) patients. The primary endpoint is a composite of all-cause
mortality and unplanned hospitalisations for heart failure at 12 months
after randomisation
CONCLUSIONS: MITRA-FR is a randomised controlled national trial designed
to evaluate the performance of pMVR in comparison to OMT in patients with
severe symptomatic secondary MR contraindicated to cardiac surgery.
<7>
Accession Number
2015381157
Authors
Weber B. Bersch-Ferreira A.C. Torreglosa C.R. Ross-Fernandes M.B. Da Silva
J.T. Galante A.P. De Sousa Lara E. Costa R.P. Soares R.M. Biasi Cavalcanti
A. Berwanger O.
Institution
(Weber, Bersch-Ferreira, Torreglosa, Ross-Fernandes, Da Silva, Galante, De
Sousa Lara, Costa, Soares, Biasi Cavalcanti, Berwanger) Research
Institute, Hospital do Coracao (IP-HCor), Rua Abilio Soares 250, 11th
floor, Sao Paulo, SP, Brazil
Title
The Brazilian Cardioprotective Nutritional Program to reduce events and
risk factors in secondary prevention for cardiovascular disease: study
protocol (The BALANCE Program Trial).
Source
American Heart Journal. 171 (1) (pp 73-81.e2), 2016. Date of Publication:
01 Jan 2016.
Publisher
Mosby Inc.
Abstract
This article reports the rationale for the Brazilian Cardioprotective
Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter,
nationwide, randomized, concealed, controlled trial was designed to
investigate the effects of the BALANCE Program in reducing cardiovascular
events. The BALANCE Program consists of a prescribed diet guided by
nutritional content recommendations from Brazilian national guidelines
using a unique nutritional education strategy, which includes suggestions
of affordable foods. In addition, the Program focuses on intensive
follow-up through one-on-one visits, group sessions, and phone calls. In
this trial, participants 45 years or older with any evidence of
established cardiovascular disease will be randomized to the BALANCE or
control groups. Those in the BALANCE group will receive the afore
mentioned program interventions, while controls will be given generic
advice on how to follow a low-fat, low-energy, low-sodium, and
low-cholesterol diet, with a view to achieving Brazilian nutritional
guideline recommendations. The primary outcome is a composite of death
(any cause), cardiac arrest, acute myocardial infarction, stroke,
myocardial revascularization, amputation for peripheral arterial disease,
or hospitalization for unstable angina. A total of 2468 patients will be
enrolled in 34 sites and followed up for up to 48 months. If the BALANCE
Program is found to decrease cardiovascular events and reduce risk
factors, this may represent an advance in the care of patients with
cardiovascular disease.
<8>
Accession Number
2015166171
Authors
Samardzic J. Skoric B. Milicic D.
Institution
(Samardzic, Skoric, Milicic) ZagrebCroatia
Title
Temporal Changes of Platelet Reactivity after Coronary Stenting - A Thing
to Think about.
Source
American Journal of Cardiology. 116 (5) (pp 824), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc.
<9>
Accession Number
20151057844
Authors
Ghatak A. Singh V. Shantha G.P.S. Badheka A. Patel N. Alfonso C.E. Biswas
M. Pancholy S.B. Grines C. O'Neill W.W. De Marchena E. Cohen M.G.
Institution
(Ghatak, Singh, Patel, Alfonso, De Marchena, Cohen) Cardiovascular
Division, University of Miami Miller, School of Medicine, Miami, FL,
United States
(Shantha) Johns Hopkins University Bloomberg, School of Public Health,
Baltimore, MD, United States
(Shantha, Biswas, Pancholy) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Badheka) Yale School of Medicine, New Haven, CT, United States
(Grines) Detroit Medical Center, Detroit, MI, United States
(O'Neill) Henry Ford Health System, Detroit, MI, United States
Title
Aspiration thrombectomy in patients undergoing primary angioplasty for ST
elevation myocardial infarction: An updated meta-analysis.
Source
Journal of Interventional Cardiology. 28 (6) (pp 503-513), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background The Trial of Routine Aspiration Thrombectomy with PCI versus
PCI alone in patients with STEMI (TOTAL trial) refuted the salutary effect
of routine aspiration thrombectomy (AT) in PPCI for patients with
ST-elevation myocardial infarction (STEMI). Objectives We performed an
updated meta-analysis to assess clinical outcomes with AT prior to PPCI
compared with conventional PPCI alone including the additional trial data.
Methods and Results Clinical trials (n = 20) that randomized patients (n =
21,281) with STEMI between Routine AT (n = 10,619) and PPCI (n = 10,662)
were pooled. There was no difference in all-cause mortality between the 2
groups (RR: 0.89, 95%CI: 0.78-1.01, P = 0.08). Stratifying by follow up at
1-month (RR: 0.87, 95%CI: 0.69-1.10, P = 0.25), up to 6 months (RR: 0.91,
95%CI: 0.74-1.13, P = 0.39 and beyond 6 months (RR: 0.88, 95%CI:
0.74-1.05, P = 0.16) yielded similar results. There was a statistically
significant increase risk of stoke rate in the AT arm (RR: 1.51, 95%CI:
1.01-2.25, P = 0.04). The 2 groups were similar with regards to target
vessel revascularization (0.94, 95%CI: 0.83-1.06, P = 0.28) recurrent MI
(RR: 0.96, 95%CI: 0.80-1.16, P = 0.68, MACE events (RR: 0.91 95%CI:
0.81-1.02, P = 0.11), early (0.59, 95%CI: 0.23-1.50, P = 0.27) and late
(RR: 0.91, 95%CI: 0.69-1.18, P = 0.47) stent thrombosis and net clinical
benefit (RR 0.99, 95%CI: 0.91-1.07, P = 0.76). Conclusion Routine AT prior
to PPCI in STEMI is associated with higher risk of stroke. There is no
statistical difference in clinical outcome parameters of mortality, major
adverse cardiac events, target vessel revascularization, stent thrombosis,
and net clinical benefit between AT and PCI alone.
<10>
Accession Number
20151060204
Authors
Jacob K.A. De Heer L.M. De Heer F. Kluin J.
Institution
(Jacob, De Heer, De Heer, Kluin) Department of Cardiothoracic Surgery,
University Medical Centre Utrecht, Utrecht, Netherlands
Title
Chronic alcoholic donors in heart transplantation: A mortality
meta-analysis.
Source
International Journal of Cardiology. 191 (pp 7-10), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd
<11>
Accession Number
20151060177
Authors
Sterling L.H. Windle S.B. Filion K.B. Eisenberg M.J.
Institution
(Sterling, Windle, Filion, Eisenberg) Division of Clinical Epidemiology,
Lady Davis Institute for Medical Research, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Sterling, Filion, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Suite H-421.1, Montreal, QC H3T
1E2, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
Title
Pharmacological management strategies for stroke prevention following
transcatheter aortic valve replacement: A systematic review.
Source
International Journal of Cardiology. 191 (pp 303-311), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The most appropriate pharmacological treatment for stroke
prevention after transcatheter aortic valve replacement (TAVR) is unclear.
We performed a systematic review of randomized controlled trials (RCTs)
and observational studies examining the effect of various pharmacological
treatment regimens on rates of stroke, bleeding, and death after TAVR.
Methods We searched Cochrane Library, Embase, and Medline for RCTs and
observational studies comparing > 2 antithrombotic regimens in TAVR
patients. Included antithrombotic regimens were defined as one or more
antiplatelet agents (aspirin, clopidogrel, prasugrel, or ticagrelor)
and/or anticoagulants (vitamin K antagonists or novel oral
anticoagulants). Results Eight studies (2 RCTs and 6 observational
studies) met our inclusion criteria (n = 1598). Rates of major stroke
ranged from 0% to 5.6% with no detected differences between treatment
arms. All-cause mortality ranged from 5% to 15%, and no differences in
mortality were detected between therapies. A consistent pattern of
reduction in major or life-threatening bleeding was found with a single
antiplatelet therapy (SAPT) compared to dual antiplatelet therapy (DAPT).
However, this difference only reached statistical significance in a single
cohort study (risk ratio 0.24; 95% confidence interval 0.12, 0.46). No
differences between anticoagulant therapies were detected for any
endpoint. Overall, studies were underpowered to detect differences between
treatment groups. Conclusion Similar rates of stroke, bleeding, and
mortality were found among most studies. A trend towards reduced rates of
major or life-threatening bleeding when comparing SAPT to DAPT was found.
Numbers of events were small, highlighting the need for larger studies on
which to base pharmacological recommendations post-TAVR.
<12>
Accession Number
2015232137
Authors
Takesue T. Takeuchi H. Ogura M. Fukuda K. Nakamura R. Takahashi T. Wada N.
Kawakubo H. Kitagawa Y.
Institution
(Takesue, Takeuchi, Ogura, Fukuda, Nakamura, Takahashi, Wada, Kawakubo,
Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Title
A Prospective Randomized Trial of Enteral Nutrition After Thoracoscopic
Esophagectomy for Esophageal Cancer.
Source
Annals of Surgical Oncology. 22 (pp 802-809), 2015. Date of Publication:
01 Dec 2015.
Publisher
Springer New York LLC
Abstract
Background: Several studies have reported that postoperative enteral
nutrition (EN) reduced complications and decreased weight loss and
hospital stay periods; however, the majority of patients analyzed in these
studies underwent open thoracic surgery. No studies have been conducted
regarding EN in patients after thoracoscopic esophagectomy as a less
invasive surgery. The aim of this study was to investigate the efficacy of
EN after thoracoscopic esophagectomy. Methods: Fifty patients who
underwent thoracoscopic esophagectomy for esophageal cancer were divided
into two groups: parenteral nutrition (PN; n = 25) and EN (n = 25). The
rate of weight loss at postoperative day (POD) 14, levels of prealbumin at
POD 10, postoperative complications until POD 14, and other perioperative
data were collected for each group. Results: This study analyzed data for
47 patients. The rate of weight loss at POD 14 was significantly lower in
the EN group (3.0 +/- 3.2 %) than in the PN group (4.0 +/- 3.6 %; p =
0.020). Prealbumin levels were 21.0 +/- 7.5 mg/dL in the PN group and 18.4
+/- 5.8 mg/dL in the EN group at POD 10, with no significant differences
between the groups. However, the incidence of postoperative pneumonia was
higher in the PN group (30.4 %) than in the EN group (12.5 %).
Conclusions: EN could suppress weight loss and reduce the incidence of
pneumonia after thoracoscopic esophagectomy.
<13>
[Use Link to view the full text]
Accession Number
20151053992
Authors
Bittl J.A. He Y. Lang C.D. Dangas G.D.
Institution
(Bittl) Cardiac Catherization Laboratory, Munroe Regional Medical Center,
1221 SE 5th St, Ocala, FL, United States
(He) Office of Research and Methodology, National Center for Health
Statistics, Hyattsville, MD, United States
(Lang) Division of Cardiology, Eastern Maine Medical Center, Bangor, ME,
United States
(Dangas) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Title
Factors Affecting Bleeding and Stent Thrombosis in Clinical Trials
Comparing Bivalirudin with Heparin during Percutaneous Coronary
Intervention.
Source
Circulation: Cardiovascular Interventions. 8 (12) (no pagination), 2015.
Article Number: e002789. Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Patients treated with bivalirudin in randomized clinical trials
of percutaneous coronary intervention generally have less bleeding but
more acute stent thrombosis (ST) than do patients treated with heparin,
but differences have varied among trials. Methods and Results-We modeled
the risk of major hemorrhage and ischemic outcomes 30 days after
percutaneous coronary intervention by treatment assignment and the use of
adjunctive therapies in 18 randomized clinical trials enrolling 41 871
patients. Overall bivalirudin caused less major bleeding (odds ratio [OR],
0.64; 95% confidence interval [CI], 0.53-0.76), more ST (OR, 1.58; 95% CI,
1.19-2.09), and no difference in mortality (OR, 0.93; 95% CI, 0.77-1.14)
than heparin. A risk-benefit analysis identified 19 fewer bleeds and 5
more STs for every 1000 patients treated with bivalirudin in place of
heparin. No significant bleeding advantage of bivalirudin over heparin
could be identified in randomized clinical trials when transradial access
(OR, 0.89; 95% CI, 0.57-1.41) and planned glycoprotein IIb/IIIa inhibitors
were used with bivalirudin in the majority of patients (OR, 1.07; 95% CI,
0.87-1.31). The use of prasugrel or ticagrelor eliminated bleeding
differences (OR, 0.80; 95% CI, 0.63-1.03) but did not reduce the risk of
ST after bivalirudin (OR, 2.20; 95% CI, 1.48-3.27).
Conclusions-Substituting bivalirudin for heparin conferred a tradeoff
between bleeding and ST. Transradial access, adjunctive glycoprotein
IIb/IIIa inhibitors, and potent P2Y12 inhibitors attenuated the bleeding
advantage of bivalirudin over heparin but had no apparent effect on early
ST. New approaches to reduce bleeding and ischemic complications during
percutaneous coronary intervention warrant further investigation.
<14>
Accession Number
20151058422
Authors
Marashi S.M. Saeedinia S.M. Sadeghi M. Movafegh A. Marashi S.
Institution
(Marashi, Saeedinia, Sadeghi, Movafegh, Marashi) Department of
Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Attenuation of hemodynamic responses to intubation by Gabapentin in
coronary artery bypass surgery: A randomized clinical trial.
Source
Acta Medica Iranica. 53 (12) (pp 733-737), 2015. Date of Publication:
2015.
Publisher
Medical Sciences University of Teheran
Abstract
A varieties of medications have been suggested to prevent hemodynamic
instabilities following laryngoscopy and endotracheal intubation. This
study was conducted to determine the beneficial effects of gabapentin on
preventing hemodynamic instabilities associated with intubation in
patients who were a candidate for coronary artery bypass surgery (CABG).
This double blinded randomized, parallel group clinical trial was carried
out on 58 normotensive patients scheduled for elective CABG under general
anesthesia with endotracheal intubation in Shariati Hospital. Patients
were randomly allocated to two groups of 29 patients that received 1200 mg
of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction
and 600 mg, 2 hours before anesthesia induction) as gabapentin group or
received talc powder as placebo (placebo group). Heart rate, mean arterial
pressure, systolic and diastolic blood pressure were measured immediately
before intubation, during intubation, immediately after intubation, 1 and
2 minutes after tracheal intubation. Inter-group comparisons significantly
showed higher systolic and diastolic blood pressure, mean arterial
pressure and heart rate immediately before intubation, during intubation,
immediately after intubation, 1 and 2 minutes after tracheal intubation in
the placebo group in comparison to gabapentin group. The median of anxiety
verbal analog scale (VAS) at the pre-induction room in gabapentin and
placebo groups were 2 and 4, respectively that was significantly lower in
the former group (P. value =0.04); however, regarding median of pain score
no difference was observed between them (P. value =0.07). Gabapentin
(1200mg) given preoperatively can effectively attenuate the hemodynamic
response to laryngoscopy, intubation and also reduce preoperative related
anxiety in patients who were a candidate for CABG.
<15>
[Use Link to view the full text]
Accession Number
20151054103
Authors
Gunduz S. Ozkan M. Kalcik M. Gursoy O.M. Astarciotlu M.A. Karakoyun S.
Aykan A.C. Biteker M. Gokdeniz T. Kaya H. Yesin M. Duran N.E. Sevinc D.
Guneysu T.
Institution
(Gunduz, Ozkan, Kalcik, Gursoy, Astarciotlu, Karakoyun, Aykan, Biteker,
Gokdeniz, Kaya, Yesin, Duran) Department of Cardiology, Kosuyolu Kartal
Heart Training and Research Hospital, Denizer C. No 2, Kartal, Istanbul
34846, Turkey
(Ozkan) Department of Cardiology, Faculty of Medicine, Kars Kafkas
University, Kars, Turkey
(Sevinc, Guneysu) Department of CT Coronary Angiography, Sonomed Imaging
Center, Istanbul, Turkey
Title
Sixty-Four-Section Cardiac Computed Tomography in Mechanical Prosthetic
Heart Valve Dysfunction: Thrombus or Pannus.
Source
Circulation: Cardiovascular Imaging. 8 (12) (no pagination), 2015. Article
Number: e003246. Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Distinguishing pannus and thrombus in patients with
prosthetic valve dysfunction is essential for the selection of proper
treatment. We have investigated the utility of 64-slice multidetector
computed tomography (MDCT) in distinguishing between pannus and thrombus,
the latter amenable to thrombolysis. Methods and Results - Sixty-two (23
men, mean age 44+/-14 years) patients with suspected mechanical prosthetic
valve dysfunction assessed by transesophageal echocardiography were
included in this prospective observational trial. Subsequently, MDCT was
performed before any treatment was started. Periprosthetic masses were
detected by MDCT in 46 patients, and their attenuation values were
measured as Hounsfield Units (HU). Patients underwent thrombolysis unless
contraindicated, and those with a contraindication or failed thrombolysis
underwent surgery. A mass which was completely lysed or surgically
detected as a clot was classified as thrombus, whereas a mass which was
surgically detected as tissue overgrowth was classified as pannus. A
definitive diagnosis could be achieved in 37 patients with 39 MDCT masses
(22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic
masses was significantly lower than that in 17 pannus (87+/-59 versus
322+/-122; P<0.001). Area under the receiver operating characteristic
curve was 0.96 (95% confidence interval: 0.91-0.99; P<0.001), and a cutoff
point of HU>145 provided high sensitivity (87.5%) and specificity (95.5%)
in discriminating pannus from thrombus. Complete lysis was more common for
masses with HU<90 compared with those with HU 90 to 145 (100% versus
42.1%; P=0.007). Conclusions - Sixty-four slice MDCT is helpful in
identifying masses amenable to thrombolysis in patients with prosthetic
valve dysfunction. A high (HU>145) attenuation suggests pannus overgrowth,
whereas a lower value is associated with thrombus formation. A higher
attenuation (HU>90) is associated with reduced lysis rates.
No comments:
Post a Comment