EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015717478
Author
Gupta A.; Smith D.A.
Institution
(Gupta) Division of Endocrinology, Diabetes, and Bone Diseases, Icahn
School of Medicine at Mount Sinai, Box 1055, New York, NY 10029, United
States
(Smith) Mount Sinai Heart, Icahn School of Medicine, Box 1014, 1 Gustave
Levy Place, New York, NY 10029-6574, United States
Title
The 2013 American college of cardiology/American heart association
guidelines on treating blood cholesterol and assessing cardiovascular
risk: A busy practitioner's guide.
Source
Endocrinology and Metabolism Clinics of North America. 43 (4) (pp
869-892), 2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
The 2013 ACC/AHA risk assessment and cholesterol treatment guidelines
emphasize important core concepts and introduce new concepts for risk
assessment. They differ substantially from the previous ATP-III
guidelines, particularly with respect to primary prevention of CVD. The
ATP-III guidelines place more emphasis on levels of LDL-C to select
patients for statin therapy, whereas the new guidelines base the
recommendation solely on the 10-year ASCVD predicted risk, as long as the
LDL-C level is 70 to 189 mg/dL or higher. High-intensity statin treatment
is recommended in all people with known ASCVD irrespective of their LDL-C
levels and in those without such disease but at high LDL-C levels greater
than or equal to 190 mg/dL or with diabetes with increased ASCVD risk. The
guidelines have identified patient groups in which a more intensive
treatment is superior to a moderate treatment, and focus on statins as the
mainstay of therapy rather than clinically unproven lipid-lowering drug
combinations. These steps are important to simplify and improve care for
high-risk individuals. It is recommended that clinicians determine an
individual's absolute 10-year risk score by standard clinical testing in
order to engage in a meaningful clinician-patient discussion regarding the
potential for ASCVD risk reduction, treatment adverse effects, drug-drug
interactions, and patient preferences. The recommendation to treat
individuals with 10-year risks of 7.5% or greater has been boosted by the
newest validation study of REGARDS18; the validity of lifetime risk
prediction algorithms remain controversial but may help in stimulating
more serious conversations between doctors and patients at younger ages
when 10-year risk is low. According to these new guidelines, more than 30
million people without existing CVD might be candidates for statin
therapy. These large numbers should mobilize the medical community to
ientify potentially modifiable risk factors affected by lifestyle and
institute behavioral changes before starting statins in order to further
contain the epidemic of CVD. They are intended to guide decision making
but not replace clinical judgment

<2>
Accession Number
25596472
Author
van Osch D.; Dieleman J.M.; van Dijk D.; Jacob K.A.; Kluin J.; Doevendans
P.A.; Nathoe H.M.
Institution
(van Osch) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Dieleman) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(van Dijk) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(Jacob) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Kluin) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Doevendans) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Nathoe) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address:
h.m.nathoe@umcutrecht.nl
Title
Dexamethasone for the prevention of postoperative atrial fibrillation.
Source
International journal of cardiology. 182 (pp 431-437), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Postoperative atrial fibrillation (AF) is a common
complication after cardiac surgery. Inflammation is believed to play a
pivotal role in the etiology of postoperative AF. There is a suggestion
from small studies that perioperative treatment with corticosteroids may
reduce postoperative AF. The DExamethasone for Cardiac Surgery (DECS)
study was a large randomized trial showing no protective effect of
dexamethasone on major adverse events. The aim of this study was to
investigate the effect of dexamethasone treatment on the occurrence of AF
after cardiac surgery.
METHODS: The DECS study compared intra-operative dexamethasone (1mg/kg) or
placebo treatment in 4494 adult patients undergoing cardiac surgery. AF
was defined by the occurrence of any reported AF within 30days after
surgery. We also performed an in-depth analysis of a subset of 1565
patients on new-onset AF. Relative risks (RRs) with 95% confidence
intervals (CIs) were calculated.
RESULTS: The incidence of any AF in the main study of 4494 patients was
33.1% in the dexamethasone and 35.2% in the placebo group (RR 0.94, 95%
CI: 0.87-1.02, p=0.14). In the substudy of 1565 patients, the incidence of
new-onset AF was 33.0% vs. 35.5% (RR 0.93, 95% CI: 0.81-1.07, p=0.31),
respectively. There was no protective effect of dexamethasone across
clinically important patient subgroups.
CONCLUSION: Intraoperative administration of dexamethasone had no
protective effect on the occurrence of any or new-onset atrial
fibrillation after cardiac surgery. Therefore, the use of dexamethasone
for the reduction of postoperative AF should not be recommended.

<3>
Accession Number
25596468
Author
Reuter P.-G.; Rouchy C.; Cattan S.; Benamer H.; Jullien T.; Beruben A.;
Montely J.-M.; Assez N.; Raphael V.; Hennequin B.; Boccara A.; Javaud N.;
Soulat L.; Adnet F.; Lapostolle F.
Institution
(Reuter) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France. Electronic address:
(Rouchy) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Cattan) Departement de Cardiologie, Groupe Hospitalier Intercommunal Le
Raincy-Montfermeil, 10 Rue du General Leclerc, 93370 Montfermeil, France
(Benamer) Departement de Cardiologie, Clinique la Roseraie, 120 Avenue de
la Republique, 93300 Aubervilliers, France
(Jullien) Departement de Cardiologie, Centre Cardiologique du Nord, 36 Rue
des Moulins Gemeaux, 93200 Saint-Denis, France
(Beruben) Service Mobile d'Urgence et de Reanimation, Groupe Hospitalier
Intercommunal Le Raincy-Montfermeil, 10 Rue du General Leclerc, 93370
Montfermeil, France
(Montely) Departement de Cardiologie, Centre Hospitalier Intercommunal
Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois,
France
(Assez) Service d'Aide Medicale Urgente du Nord Pole de l'Urgence, Centre
Hospitalier Regional Universitaire de Lille, 5 avenue Oscar-Lambret, 59037
Lille Cedex, France
(Raphael) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
Intercommunal Robert Ballanger, Boulevard Robert Ballanger, 93600
Aulnay-sous-Bois, France
(Hennequin) Service Mobile d'Urgence et de Reanimation, Centre hospitalier
de Saint-Denis, 2 Rue du Docteur Delafontaine, 93200 Saint-Denis, France
(Boccara) Departement de Cardiologie, Centre Hospitalier Intercommunal
Andre Gregoire, 56 Boulevard de la Boissiere, 93100 Montreuil, France
(Javaud) Service des Urgences, Centre Hospitalier Universitaire Jean
Verdier, Assistance Publique-Hopitaux de Paris, Avenue du 14 Juillet,
93140 Bondy, France
(Soulat) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Adnet) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France
(Lapostolle) Service des Urgences et Service d'Aide Medicale Urgente,
Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de
Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite
Paris 13, Sorbonne Paris Cite, EA 3509 Bobigny, France
Title
Early invasive strategy in high-risk acute coronary syndrome without
ST-segment elevation. The Sisca randomized trial.
Source
International journal of cardiology. 182 (pp 414-418), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: The optimal therapeutic strategy for patients with high-risk
acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains
unclear.
OBJECTIVE: Our aim was to compare the effectiveness of an early invasive
strategy and a delayed invasive strategy in the management of high-risk
NSTE-ACS patients.
METHODS: This randomized clinical trial in a primarily pre-hospital
setting enrolled patients with chest pain, electrocardiographic criteria
for an NSTE-ACS, and at least one criterion of severity (ESC criterion or
TIMI score >5). Patients were randomized to either an early invasive
strategy (tirofiban infusion and coronary angiography within 6h) or
delayed invasive strategy (as per guidelines and physician discretion;
coronary angiography within 6h was not advised). The primary endpoint was
the cumulative incidence of deaths, myocardial infarctions, or urgent
revascularizations at 30days of follow-up. Secondary endpoints were
failure of delayed management, length of hospital stay and long-term
mortality.
RESULTS: Between January 2007 and February 2010, 170 patients were
enrolled. The cumulative incidence of adverse outcomes was significantly
lower for early invasive than delayed management (2% [95% CI 0-9] vs. 24%
[95% CI 16-35], p<10(-4)). Delayed management failed in 24% of cases. The
length of hospital stay was significantly shorter in patients undergoing
angioplasty or treated with tirofiban within 6h (p=0.0003). Long-term
mortality was 16% in both arms after a median follow-up of 4.1years.
CONCLUSION: An early invasive strategy reduced major adverse cardiac
events in patients with high-risk NSTE-ACS. Early angiography or tirofiban
(GP IIb/IIIa inhibitor) infusion proved necessary in a quarter of patients
assigned to delayed management.

<4>
Accession Number
25617608
Author
Orlandini A.; Castellana N.; Pascual A.; Botto F.; Cecilia Bahit M.;
Chacon C.; Luz Diaz M.; Diaz R.
Institution
(Orlandini) ECLA (Estudios Clinicos Latino America), Argentina. Electronic
address: aorlandinimd@eclainternational.org
(Castellana) ECLA (Estudios Clinicos Latino America), Argentina
(Pascual) ECLA (Estudios Clinicos Latino America), Argentina
(Botto) ECLA (Estudios Clinicos Latino America), Argentina
(Cecilia Bahit) ECLA (Estudios Clinicos Latino America), Argentina
(Chacon) ECLA (Estudios Clinicos Latino America), Argentina
(Luz Diaz) ECLA (Estudios Clinicos Latino America), Argentina
(Diaz) ECLA (Estudios Clinicos Latino America), Argentina
Title
Myocardial viability for decision-making concerning revascularization in
patients with left ventricular dysfunction and coronary artery disease: a
meta-analysis of non-randomized and randomized studies.
Source
International journal of cardiology. 182 (pp 494-499), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Myocardial viability tests have been proposed as a key factor
in the decision-making process concerning coronary revascularization
procedures in patients with left ventricular dysfunction and coronary
artery disease (LVD-CAD).
METHODS: We performed a systematic review and meta-analysis of studies
that compared medical treatment with revascularization in patients with
viable and non-viable myocardium and recorded mortality as outcome.
RESULTS: Thirty-two non-randomized (4328 patients) and 4 randomized (1079
patients) studies were analyzed. In non-randomized studies,
revascularization provided a significant mortality benefit compared with
medical treatment (p<0.05). Since the heterogeneity was significant
(p<0.05) a viability subgroup analysis was performed, showing that
revascularization provided a significant mortality benefit compared with
medical treatment in patients with viable myocardium (p<0.05) but not in
patients without (p=0.34). There was a significant subgroup effect
(p<0.05) related to the intensity of the effect, but not to the direction.
In randomized studies, revascularization did not provide a significant
mortality benefit compared with medical treatment in either patients with
viable myocardium or those without (p=0.21). There was no significant
subgroup effect (p=0.72). Neither non-randomized nor randomized studies
demonstrated any significant difference in outcomes between patients with
and without viable myocardium.
CONCLUSIONS: The available data are inconclusive regarding the usefulness
of myocardial viability tests for the decision-making process concerning
revascularization in LVD-CAD patients. Patients with viable myocardium
appear to benefit from revascularization, but similar benefits were
observed in patients without viable myocardium. Moreover, a neutral or
adverse effect of revascularization cannot be excluded in either group of
patients.

<5>
Accession Number
20160310678
Author
Zhang L.; Diao Y.; Chen G.; Tanaka A.; Eastwood G.M.; Bellomo R.
Institution
(Zhang, Diao) Department of Nephrology, West China Hospital of Sichuan
University, Sichuan, Chengdu, China
(Chen) Department of Anesthesiology, Austin Hospital, 145 Studley Road,
Heidelberg, VIC 3084, Australia
(Zhang, Tanaka, Eastwood, Bellomo) Department of Intensive Care Unit,
Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
(Eastwood, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Melbourne, VIC, Australia
Title
Remote ischemic conditioning for kidney protection: A meta-analysis.
Source
Journal of Critical Care. 33 (pp 224-232), 2016. Date of Publication: 01
Jun 2016.
Publisher
W.B. Saunders
Abstract
Background: Results from randomized controlled trials (RCTs) concerning
kidney effect of remote ischemic conditioning (RIC) are inconsistent.
Methods: We searched for relevant studies in Medline, Embase, the Cochrane
Library, Google Scholar and Chinese database (SinoMed), as well as
relevant references from their inception to November 2015. We performed a
systematic review and meta-analysis of all eligible RCTs of RIC with
kidney events. Results: We included 37 RCTs from 2007 to 2015 involving
8168 patients. Pooled analyses of all RCTs showed RIC significantly
reduced the incidence of investigator-defined acute kidney injury (AKI)
compared with control groups (RR 0.84, 95% CI 0.73-0.96, P =.009)
(I² = 25%). However, the difference was not significant when
only RIFLE (Risk, Injury, Failure, Loss, End Stage), AKIN (Acute Kidney
Injury Network), or KDIGO (Kidney Disease Improving Global Outcomes)
criteria were applied to the definition of AKI (RR 0.87, 95% CI 0.74-1.02,
P =.08) (I² = 22%). In subgroup analysis, RIC showed a
significant benefit on reducing investigator-defined AKI in patients
following percutaneous coronary intervention (RR 0.64, 95% CI 0.46-0.87),
but not after cardiac surgery (RR 0.93, 95% CI 0.82-1.06). There was no
difference for changes in the incidence of renal replacement therapy,
estimated glomerular filtration rate or serum creatinine. Conclusions: RIC
might be beneficial for the prevention of investigator-defined AKI;
however, the effect is likely small. Moreover, due to lack of an effect on
use of renal replacement therapy, estimated glomerular filtration rate,
RIFLE, AKIN, or KDIGO-defined AKI, and serum creatinine, the evidence for
RIC is not robust. Finally, recent large-scale RCTs of RIC focusing on
patient-centered outcomes do not support the wider application of RIC.

<6>
Accession Number
20160303586
Author
Poyrazoglu H.H.; Duman Z.; Demir S.; Avsar M.K.; Atalay A.; Ciftci B.;
Bayraktar I.; Tor F.
Institution
(Poyrazoglu, Duman, Atalay, Ciftci, Bayraktar, Tor) Department of
Cardiovascular Surgery, Cukurova University School of Medicine, Adana,
Turkey
(Demir) Department of Cardiology, Adana State Hospital, Adana, Turkey
(Avsar) Department of Cardiovascular Surgery, Medicana International
Hospital, Istanbul, Turkey
Title
Investigating the impacts of preoperative steroid treatment on tumor
necrosis factor-alpha and duration of extubation time underwent
ventricular septal defect surgery.
Source
Balkan Medical Journal. 33 (2) (pp 158-163), 2016. Date of Publication:
March 2016.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background: Cardiopulmonary bypass is known to cause inflammatory events.
Inflammation occurs due to many known important biological processes.
Numerous mechanisms are known to be responsible for the development of
inflammatory processes. Currently, there are many defined mediators as a
tumor necrosis factor-alpha (TNF-alpha) playing an active role in this
process. Aims: This research was to investigate the effects of
preoperative steroid use on inflammatory mediator TNF-alpha and on time to
extubation postoperatively in ventricular septal defect patients
undergoing cardiopulmonary bypass surgery. Study Design: Controlled
clinical study. Methods: This study included 30 patients. These patients
were assigned into two groups, each containing 15 patients. 5
micrograms/kg methylprednisolone was injected intravenously 2 hours before
the surgery to Group I, whereas there was no application to the patients
in Group II. TNF-alpha (pg/mL) level was measured in arterial blood
samples obtained at four periods including: the preoperative period (Pre
TNF); at the 5^th minute of cross-clamping (Per TNF); 2 hours
after termination of cardiopulmonary bypass (Post TNF); and at the
postoperative 24th hours in cardiovascular surgery intensive care unit
(Post 24 h TNF). Results: The mean cross-clamp time was 66+/-40 and
55+/-27 minutes in Group I and Group II respectively. No significant
difference was found between the groups in terms of cross-clamp time
(p>0.05). The mean time to extubation was 6.1+/-2.3 hours in Group I and
10.6+/-3.4 hours in Group II. Group I extubation time was significantly
shorter than Group II. Group I TNF-alpha levels at Post TNF and Post24h
TNF was lower than Group II. These differences are also statistically
significant (p<0.05). Conclusion: There is a strong indication that
preoperative steroid treatment reduced the TNF-alpha level together with
shortens duration of postoperative intubation and positively contributes
to extubation in ventricular septal defect patients operated in cardiac
surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier:
TCTR20150930001).

<7>
Accession Number
20160292575
Author
Bernardi M.H.; Rinoesl H.; Dragosits K.; Ristl R.; Hoffelner F.; Opfermann
P.; Lamm C.; Preissing F.; Wiedemann D.; Hiesmayr M.J.; Spittler A.
Institution
(Bernardi, Rinoesl, Opfermann, Hiesmayr) Medical University of Vienna,
Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care
Medicine, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Dragosits, Lamm, Preising, Spittler) Medical University of Vienna,
Department of Surgery, Research Laboratories, Lazarettgasse 14, Vienna
A-1090, Austria
(Ristl) Medical University of Vienna, Centre for Medical Statistics,
Informatics and Intelligent Systems, Spitalgasse 23, Vienna A-1090,
Austria
(Hoffelner, Wiedemann) Medical University of Vienna, Department of Cardiac
Surgery, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Spittler) Medical University of Vienna, Core Facilities, Core Facility
Flow Cytometry, Lazarettgasse 14, Vienna 1090, Austria
Title
Effect of hemoadsorption during cardiopulmonary bypass surgery - a
blinded, randomized, controlled pilot study using a novel adsorbent.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 96. Date of
Publication: April 09, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Cardiopulmonary bypass (CPB) surgery initiates a systemic
inflammatory response, which is associated with postoperative morbidity
and mortality. Hemoadsorption (HA) of cytokines may suppress inflammatory
responses and improve outcomes. We tested a new sorbent used for HA
(CytoSorbTM; CytoSorbents Europe GmbH, Berlin, Germany) installed in the
CPB circuit on changes of pro- and anti-inflammatory cytokines levels,
inflammation markers, and differences in patients' perioperative course.
Methods: In this first pilot trial, 37 blinded patients were undergoing
elective CPB surgery at the Medical University of Vienna and were randomly
assigned to HA (n = 19) or control group (n = 18). The primary outcome was
differences of cytokine levels (IL-1beta, IL-6, IL-18, TNF-alpha, and
IL-10) within the first five postoperative days. We also analyzed whether
we can observe any differences in ex vivo lipopolysaccharide (LPS)-induced
TNF-alpha production, a reduction of high-mobility box group 1 (HMGB1), or
other inflammatory markers. Additionally, measurements for fluid
components, blood products, catecholamine treatment, bioelectrical
impedance analysis (BIA), and 30-day mortality were analyzed. Results: We
did not find differences in our primary outcome immediately following the
HA treatment, although we observed differences for IL-10 24 hours after
CPB (HA: median 0.3, interquartile range (IQR) 0-4.5; control: not
traceable, P = 0.0347) and 48 hours after CPB (median 0, IQR 0-1.2 versus
not traceable, P = 0.0185). We did not find any differences for IL-6
between both groups, and other cytokines were rarely expressed. We found
differences in pretreatment levels of HMGB1 (HA: median 0, IQR 0-28.1;
control: median 48.6, IQR 12.7-597.3, P = 0.02083) but no significant
changes to post-treatment levels. No differences in inflammatory markers,
fluid administration, blood substitution, catecholamines, BIA, or 30-day
mortality were found. Conclusions: We did not find any reduction of the
pro-inflammatory response in our patients and therefore no changes in
their perioperative course. However, IL-10 showed a longer-lasting
anti-inflammatory effect. The clinical impact of prolonged IL-10 needs
further evaluation. We also observed strong inter-individual differences
in cytokine levels; therefore, patients with an exaggerated inflammatory
response to CPB need to be identified. The implementation of HA during CPB
was feasible. Trial registration: ClinicalTrials.gov: NCT01879176,
registration date: June 7, 2013.

<8>
Accession Number
20160281451
Author
Harvey A.; Modak A.; Dery U.; Roy M.; Rinfret S.; Bertrand O.F.; Larose
E.; Rodes-Cabau J.; Barbeau G.; Gleeton O.; Nguyen C.M.; Proulx G.; Noel
B.; Roy L.; Paradis J.-M.; De Larochelliere R.; Dery J.-P.
Institution
(Harvey, Dery, Roy, Rinfret, Bertrand, Larose, Rodes-Cabau, Barbeau,
Gleeton, Nguyen, Proulx, Noel, Roy, Paradis, De Larochelliere, Dery)
Centre de Recherche de l'Institut Universitaire de Cardiologie et
Pneumologie de Quebec, Quebec, QC, Canada
(Modak) Cambridge Isotope Laboratories Inc., Tewksbury, MA 01830, United
States
Title
Changes in CYP2C19 enzyme activity evaluated by the
[¹³C]-pantoprazole breath test after co-administration of
clopidogrel and proton pump inhibitors following percutaneous coronary
intervention and correlation to platelet reactivity.
Source
Journal of Breath Research. 10 (1) (no pagination), 2016. Article Number:
017104. Date of Publication: 27 Jan 2016.
Publisher
Institute of Physics Publishing
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is used for
the prevention of cardiovascular events following percutaneous coronary
intervention (PCI). These agents increase the risk of gastrointestinal
bleeding. To prevent these events, proton pump inhibitors (PPI) are
routinely prescribed. It has been reported that with the exception of
pantoprazole and dexlanzoprazole, PPIs can impede conversion of
clopidogrel by cytochrome P450 2C19 (CYP2C19) to its active metabolite, a
critical step required for clopidogrel efficacy. Changes in CYP2C19 enzyme
activity (phenotype) and its correlation with platelet reactivity
following PPI therapy has not yet been fully described. In this study we
attempted to determine if the [ ¹³C]-pantoprazole breath test
(Ptz-BT) can evaluate changes in CYP2C19 enzyme activity (phenoconversion)
following the administration of PPI in coronary artery disease (CAD)
patients treated with DAPT after PCI. Thirty (30) days after successful
PCI with stent placement, 59 patients enrolled in the Evaluation of the
Influence of Statins and Proton Pump Inhibitors on Clopidogrel
Antiplatelet Effects (SPICE) trial (ClinicalTrials.gov Identifier:
NCT00930670) were recruited to participate in this sub study. Patients
were randomized to one of 4 antacid therapies (omeprazole, esomeprazole.
pantoprazole or ranitidine). Subjects were administered the Ptz-BT and
platelet function was evaluated by vasodilator-stimulated phosphoprotein
(VASP) phosphorylation and light transmittance aggregometry before and 30
d after treatment with antacid therapy. Patients randomized to
esomeprazole and omeprazole had greater high on-treatment platelet
reactivity and lowering of CYP2C19 enzyme activity at Day 60 after 30 d of
PPI therapy. Patients randomized to ranitidine and pantoprazole did not
show any changes in platelet activity or CYP 2C19 enzyme activity. In
patients treated with esomeprazole and omeprazole, changes in CYP2C19
enzyme activity (phenoconversion) correlated well with changes in platelet
reactivity. Co-administration of omeprazole or esomeprazole in patients
treated with clopidogrel results in lower CYP2C19 enzyme activity and
increased platelet reactivity as measured by VASP phosphorylation test
while patients given pantoprazole or ranitidine did not show any
significant changes in CYP2C19 enzyme activity and platelet reactivity.

<9>
Accession Number
20160134815
Author
Damen T.; Reinsfelt B.; Redfors B.; Nygren A.
Institution
(Damen, Reinsfelt, Redfors, Nygren) Department of Anaesthesiology and
Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska
Academy, University of Gothenburg, Sahlgrenska University Hospital,
Section of Cardiothoracic Anaesthesia and Intensive Care, Gothenburg,
Sweden
(Damen, Reinsfelt, Redfors, Nygren) Section of Cardiothoracic Anaesthesia
and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Title
Pressure-dependent changes in haematocrit and plasma volume during
anaesthesia, a randomised clinical trial.
Source
Acta Anaesthesiologica Scandinavica. 60 (5) (pp 560-568), 2016. Date of
Publication: 01 May 2016.
Publisher
Blackwell Munksgaard
Abstract
Background Induction of general anaesthesia has been shown to cause
haemodilution and an increase in plasma volume. The aim of this study was
to evaluate whether prevention of hypotension during anaesthesia induction
could avoid haemodilution. Methods Twenty-four cardiac surgery patients,
66 +/- 10 years, were randomised to receive either norepinephrine in a
dose needed to maintain mean arterial blood pressure (MAP) at
pre-anaesthesia levels after induction or to a control group that received
vasopressor if MAP decreased below 60 mmHg. No fluids were infused.
Changes in plasma volume were calculated with standard formula: 100 x
(Hct<inf>pre</inf>/Hct<inf>post</inf> - 1)/(1 - Hct<inf>pre</inf>).
Arterial blood gas was analysed every 10 minutes and non-invasive
continuous haemoglobin (SpHb) was continuously measured. Results
Pre-anaesthesia MAP was 98 +/- 7 mmHg. Ten minutes after anaesthesia
induction, the haematocrit decreased by 5.0 +/- 2.5% in the control group
compared with 1.2 +/- 1.4% in the intervention group, which corresponds to
increases in plasma volume by 310 ml and 85 ml respectively. MAP decreased
to 69 +/- 15 mmHg compared to 92 +/- 10 mmHg in the intervention group.
The difference maintained throughout the 70 min intervention period. The
change in haemoglobin level measured by blood gas analysis could not be
detected by SpHb measurement. The mean bias between the SpHb and blood gas
haemoglobin was 15 g/l. Conclusion During anaesthesia induction,
haematocrit decreases and plasma volume increases early and parallel to a
decrease in blood pressure. This autotransfusion is blunted when blood
pressure is maintained at pre-induction levels with norepinephrine.

<10>
Accession Number
20160315856
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, The University of Hong Kong, Hong Kong
(Sihoe) Department of Thoracic Surgery, The University of Hong Kong
Shenzhen Hospital, Shenzhen 518053, China
(Sihoe) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Tongji University, Shanghai 200030, China
Title
Reasons not to perform uniportal VATS lobectomy.
Source
Journal of Thoracic Disease. 8 (pp S333-S343), 2016. Date of Publication:
01 Mar 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
The uniportal video assisted thoracic surgery (VATS) approach to lung
lobectomy has generated phenomenal interest in recent years. It promises
to offer patients less morbidity and faster recovery, even when compared
to conventional multiportal VATS. However, critics of the Uniportal VATS
approach may raise concerns about whether this most minimally invasive
surgical approach for lung surgery may compromise safety and treatment
efficacy. This debate has great potential importance not only in
determining how patients are operated on, but in understanding how
'success' is gauged in major pulmonary surgery. This article explores both
sides of this debate, drawing on the experience of how clinical research
in multiportal VATS evolved over the years. Systematic generation of
clinical evidence with progressively increasing sophistication is required
to fairly evaluate the uniportal VATS approach. A review of the current
literature suggests that there remain many large gaps in the evidence
surrounding uniportal VATS. Hence, at the present time, the reasons voiced
by critics as to why Uniportal VATS should not be performed should not be
lightly dismissed. Instead, it behoves surgeons on both sides of the
debate to continue to generate good clinical evidence to resolve it.

<11>
Accession Number
20160309803
Author
Hu J.; Liu S.; Jia P.; Xu X.; Song N.; Zhang T.; Chen R.; Ding X.
Institution
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Fudan University, Division of
Nephrology, Zhongshan Hospital, No. 180, Fenglin Road, Xuhui District,
Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Institute of Kidney
and Dialysis, Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Key Laboratory of
Kidney and Blood Purification, Shanghai 200032, China
(Zhang) General Hospital of Ningxia Medical University, Department of
Nephrology, Ningxia 750004, China
Title
Protection of remote ischemic preconditioning against acute kidney injury:
A systematic review and meta-analysis.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 111. Date of
Publication: 20 Apr 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Remote ischemic preconditioning (RIPC) is a promising approach
to preventing acute kidney injury (AKI), but its efficacy is
controversial. Methods: A systematic review of 30 randomized controlled
trials was conducted to investigate the effects of RIPC on the incidence
and outcomes of AKI. Random effects model meta-analyses and
meta-regressions were used to generate summary estimates and explore
sources of heterogeneity. The primary outcome was incidence of AKI and
hospital mortality. Results: The total pooled incidence of AKI in the RIPC
group was 11.5 %, significantly less than the 23.3 % incidence in the
control group (P = 0.009). Subgroup analyses indicated that RIPC
significantly reduced the incidence of AKI in the contrast-induced AKI
(CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the
ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %,
P = 0.173). Random effects meta-regression indicated that RIPC tended to
strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in
these trials with a higher percentage of diabetes mellitus. RIPC had no
significant effect on the incidence of stages 1-3 AKI or renal replacement
therapy, change in serum creatinine and estimated glomerular filtration
rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But
RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P =
0.006) compared with the control group. In addition, the length of ICU
stay in the RIPC group was significantly shorter than in the control group
(2.6 vs 2.0 days, P = 0.003). Conclusions: We found strong evidence to
support the application of RIPC to prevent CI-AKI, but not IR-AKI.

<12>
Accession Number
20160302273
Author
Lurz P.; Luecke C.; Eitel I.; Fohrenbach F.; Frank C.; Grothoff M.; De
Waha S.; Rommel K.-P.; Lurz J.A.; Klingel K.; Kandolf R.; Schuler G.;
Thiele H.; Gutberlet M.
Institution
(Lurz, Fohrenbach, Rommel, Schuler) Department of Internal
Medicine/Cardiology, University of Leipzig, Heart Center,
Struempellstrasse 39, Leipzig 04289, Germany
(Luecke, Frank, Grothoff, Gutberlet) Department of Diagnostic and
Interventional Radiology, University of Leipzig, Heart Center, Leipzig,
Germany
(Eitel, De Waha, Thiele) University Heart Center Luebeck, University of
Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive
Care Medicine), Luebeck, Germany
(Eitel, De Waha, Thiele) German Centre for Cardiovascular Research (DZHK),
Partner Site Hamburg/Kiel/Lubeck, Luebeck, Germany
(Lurz) Department of Electrophysiology, University of Leipzig, Heart
Center, Leipzig, Germany
(Klingel, Kandolf) Department of Molecular Pathology, University Hospital
Tuebingen, Tuebingen, Germany
Title
Comprehensive Cardiac Magnetic Resonance Imaging in Patients with
Suspected Myocarditis the MyoRacer-Trial.
Source
Journal of the American College of Cardiology. 67 (15) (pp 1800-1811),
2016. Date of Publication: 19 Apr 2016.
Publisher
Elsevier USA
Abstract
Background Data suggest that T<inf>1</inf> and T<inf>2</inf> mapping have
excellent diagnostic accuracy in patients with suspected myocarditis.
However, the true diagnostic performance of comprehensive cardiac magnetic
resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been
determined. Objectives This study assessed the performance of CMR imaging,
including T<inf>1</inf> and T<inf>2</inf> mapping, compared with EMB in an
unselected, consecutive patient cohort with suspected myocarditis. It also
examined the potential role of CMR field strength by comparing 1.5-T
versus 3.0-T imaging. Methods Patients underwent biventricular EMB,
cardiac catheterization (for exclusion of coronary artery disease), and
CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current
standard Lake Louise criteria (LLC) for myocarditis as well as native
T<inf>1</inf>, calculation of extracellular volume fraction (ECV), and
T<inf>2</inf> mapping (only on 1.5-T). Patients were divided into 2 groups
according to symptom duration (acute: <14 days vs. chronic: >14 days).
Results A total of 129 patients underwent 1.5-T imaging. In patients with
acute symptoms, native T<inf>1</inf> yielded the best diagnostic
performance as defined by the area under the curve (AUC) of
receiver-operating curves (0.82) followed by T<inf>2</inf> (0.81), ECV
(0.75), and LLC (0.56). In patients with chronic symptoms, only
T<inf>2</inf> mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of
native T<inf>1</inf>, ECV, and LLC were comparable to 1.5-T with no
significant differences. Conclusions In patients with acute symptoms,
mapping techniques provide a useful tool for confirming or rejecting the
diagnosis of myocarditis and are superior to the LLC. However, only
T<inf>2</inf> mapping has acceptable diagnostic performance in patients
with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis
[MyoRacer]; NCT02177630)

<13>
Accession Number
20160302258
Author
Williams M.C.; Hunter A.; Shah A.S.V.; Assi V.; Lewis S.; Smith J.; Berry
C.; Boon N.A.; Clark E.; Flather M.; Forbes J.; McLean S.; Roditi G.; Van
Beek E.J.R.; Timmis A.D.; Newby D.E.
Institution
(Williams, Hunter, Shah, Boon, Clark, Van Beek, Newby) British Heart
Foundation Centre for Cardiovascular Science, University of Edinburgh,
Chancellor's Building, Room SU314, 49 Little France Crescent, Edinburgh
EH16 4SA, United Kingdom
(Assi, Lewis) Centre for Population Health Sciences, University of
Edinburgh, Edinburgh, United Kingdom
(Smith) Health Economics Research Centre, University of Oxford, Oxford,
United Kingdom
(Berry, Roditi) Institute for Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Title
Use of Coronary Computed Tomographic Angiography to Guide Management of
Patients with Coronary Disease.
Source
Journal of the American College of Cardiology. 67 (15) (pp 1759-1768),
2016. Date of Publication: 19 Apr 2016.
Publisher
Elsevier USA
Abstract
Background In a prospective, multicenter, randomized controlled trial,
4,146 patients were randomized to receive standard care or standard care
plus coronary computed tomography angiography (CCTA). Objectives The
purpose of this study was to explore the consequences of CCTA-assisted
diagnosis on invasive coronary angiography, preventive treatments, and
clinical outcomes. Methods In post hoc analyses, we assessed changes in
invasive coronary angiography, preventive treatments, and clinical
outcomes using national electronic health records. Results Despite similar
overall rates (409 vs. 401; p = 0.451), invasive angiography was less
likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios
[HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but
more likely to show obstructive coronary artery disease (283 vs. 230; HR:
1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More
preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <
0.001) were initiated after CCTA, with each drug commencing at a median of
48 to 52 days after clinic attendance. From the median time for preventive
therapy initiation (50 days), fatal and nonfatal myocardial infarction was
halved in patients allocated to CCTA compared with those assigned to
standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020).
Cumulative 6-month costs were slightly higher with CCTA: difference $462
(95% CI: $303 to $621). Conclusions In patients with suspected angina due
to coronary heart disease, CCTA leads to more appropriate use of invasive
angiography and alterations in preventive therapies that were associated
with a halving of fatal and non-fatal myocardial infarction. (Scottish
COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

<14>
Accession Number
20160297594
Author
Geng J.; Qian J.; Cheng H.; Ji F.; Liu H.
Institution
(Geng, Qian, Cheng, Ji) Department of Anesthesiology, First Affiliated
Hospital of Soochow University, Suzhou, Jiangsu, China
(Cheng, Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health System, Sacramento, CA, United States
Title
The influence of perioperative dexmedetomidine on patients undergoing
cardiac surgery: A meta-analysis.
Source
PLoS ONE. 11 (4) (no pagination), 2016. Article Number: e0152829. Date of
Publication: April 2016.
Publisher
Public Library of Science
Abstract
Background: The use of dexmedetomidine may have benefits on the clinical
outcomes of cardiac surgery. We conducted a meta-analysis comparing the
postoperative complications in patients undergoing cardiac surgery with
dexmedetomidine versus other perioperative medications to determine the
influence of perioperative dexmedetomidine on cardiac surgery patients.
Methods: Randomized or quasi-randomized controlled trials comparing
outcomes in patients who underwent cardiac surgery with dexmedetomidine,
another medication, or a placebo were retrieved from EMBASE, PubMed, the
Cochrane Library, and Science Citation Index. Results: A total of 1702
patients in 14 studies met the selection criteria among 1,535 studies that
fit the research strategy. Compared to other medications, dexmedetomidine
has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55,
P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P =
0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for
atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension,
and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition,
dexmedetomidine may reduce the length of intensive care unit (ICU) and
hospital stay. Conclusions: This meta-analysis revealed that the
perioperative use of dexmedetomidine in patients undergoing cardiac
surgery can reduce the risk of postoperative ventricular tachycardia and
delirium, but may increase the risk of bradycardia. The estimates showed a
decreased risk of atrial fibrillation, shorter length of ICU stay and
hospitalization, and increased risk of hypotension with dexmedetomidine.

<15>
Accession Number
20160033846
Author
Ding S.-A.; Simonson D.C.; Wewalka M.; Halperin F.; Foster K.;
Goebel-Fabbri A.; Hamdy O.; Clancy K.; Lautz D.; Vernon A.; Goldfine A.B.
Institution
(Ding, Simonson, Wewalka, Halperin, Foster, Goebel-Fabbri, Hamdy, Lautz,
Vernon, Goldfine) Harvard Medical School, One Joslin Place, Boston, MA
02215, United States
(Ding, Wewalka, Foster, Goebel-Fabbri, Hamdy, Lautz, Goldfine) Joslin
Diabetes Center, Boston, MA 02215, United States
(Simonson, Halperin, Clancy, Vernon, Goldfine) Brigham and Women's
Hospital, Boston, MA 02115, United States
Title
Management in patients with type 2 diabetes: A randomized clinical trial.
Source
Journal of Clinical Endocrinology and Metabolism. 100 (7) (pp 2546-2556),
2015. Date of Publication: 01 Jul 2015.
Publisher
Endocrine Society
Abstract
Context: Recommendations for surgical, compared with lifestyle and
pharmacologically based, approaches for type 2 diabetes (T2D) management
remain controversial. Objective: The objective was to compare laparoscopic
adjustable gastric band (LAGB) to an intensive medical diabetes and weight
management (IMWM) program for T2D. Design: This was designed as a
prospective, randomized clinical trial. Setting: The setting was two
Harvard Medical School-affiliated academic institutions. Interventions and
Participants: A 12-month randomized trial comparing LAGB (n=23) vs IMWM
(n= 22) in persons aged 21-65 years with body mass index of 30-45 kg/m2,
T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c)
6.5% on antihyperglycemic medication(s). Main Outcome Measure: The
proportion meeting the prespecified primary glycemic endpoint, defined as
HbA1c 6.5% and fasting glucose 7.0 mmol/L at 12 months, on or off
medication. Results: After randomization, five participants did not
undergo the surgical intervention. Of the 40 initiating intervention (22
males/18 females; age,51+/-10y;bodymassindex, 36.5+/-3.7kg/m2; diabetes
duration, 9 +/- 5 y; HbA1c, 8.2+/-1.2%; 40% on insulin), the proportion
meeting the primary glycemic endpoint was achieved in 33% of the LAGB
patients and 23% of theIMWMpatients (P<457). HbA1c reduction was similar
between groups at both 3 and 12 months (-1.2+/-0.3 vs 1.0+/-0.3%; P<496).
Weight loss was similar at 3 months but greater 12 months after LAGB
(-13.5+/-1.7 vs 8.5+/-1.6 kg; P .027). Systolic blood pressure reduction
was greater after IMWM than LAGB, whereas changes in diastolic blood
pressure, lipids, fitness, and cardiovascular risk scores were similar
between groups. Patient-reported health status, assessed using the Short
Form-36, Impact of Weight on Quality of Life, and Problem Areas in
Diabetes, all improved similarly between groups. Conclusions: LAGB and a
multidisciplinary IMWM program have similar 1-year benefits on diabetes
control, cardiometabolic risk, and patient satisfaction, which should be
considered in the context of other factors, such as personal preference,
when selecting treatment options with obese T2D patients. Longer duration
studies are important to understand emergent differences.

<16>
Accession Number
20160289144
Author
Amico F.; Amico A.; Mazzoni J.; Moshiyakhov M.; Tamparo W.
Institution
(Amico, Mazzoni, Moshiyakhov) Department of Cardiology, Deborah Heart Lung
and Center, Browns Mills, NJ, United States
(Amico) Department of Pharmacy, St Johns University, Queens, NY, United
States
(Tamparo) Department of Internal Medicine, New York Hospital Queens,
Flushing Queens, NY, United States
Title
The evolution of dual antiplatelet therapy in the setting of acute
coronary syndrome: Ticagrelor versus clopidogrel.
Source
Postgraduate Medicine. 128 (2) (pp 159-163), 2016. Date of Publication: 01
Jan 2016.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Review of: Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus
clopidogrel in patients with acute coronary syndromes. N Eng J Med 2009;
361(11): 1045-1057. For acute coronary syndrome (ACS), a dual antiplatelet
regimen comprised of treatment with aspirin and either P2Y12 adenosine
diphosphate receptor antagonists, clopidogrel, prasugrel or ticagrelor is
usually employed. This article compares clopidogrel with ticagrelor for
the prevention of vascular events and death in broad population of ACS
patients ranging from UA, NSTEMI to STEMI, utilizing planned strategies of
medical or invasive treatment strategy.

<17>
Accession Number
20160277308
Author
Hussain M.A.; Bin-Ayeed S.A.; Saeed O.Q.; Verma S.; Al-Omran M.
Institution
(Hussain, Al-Omran) Division of Vascular Surgery, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, 30 Bond St, Ste 7-074, Bond Wing,
Toronto, ON M5B 1W8, Canada
(Verma) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Hussain, Verma, Al-Omran) Department of Surgery, University of Toronto,
Toronto, ON, Canada
(Bin-Ayeed) Vascular Surgery Department, King Salman Heart Center, King
Fahad Medical City, Riyadh, Saudi Arabia
(Saeed) Department of Internal Medicine, McMaster University, Hamilton,
ON, Canada
(Verma, Al-Omran) King Saud University, Li Ka Shing Collaborative Research
Program, Department of Surgery, Riyadh, Saudi Arabia
Title
Impact of diabetes on carotid artery revascularization.
Source
Journal of Vascular Surgery. 63 (4) (pp 1099-1107e4), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Mosby Inc.
Abstract
Objective Diabetes has been suggested as a marker of higher operative risk
during carotid artery revascularization. The aim of this study was to
summarize the current evidence comparing the effectiveness of carotid
revascularization in diabetic vs nondiabetic patients. Methods We
conducted a systematic search of MEDLINE, Embase, and the Cochrane Library
databases (1946 to January 2015) for all studies comparing the clinical
outcomes of diabetic vs nondiabetic patients who underwent carotid
endarterectomy (CEA) or carotid artery stenting (CAS) in accordance with
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. Two authors independently reviewed the studies for
inclusion and quality and extracted the data. A third author validated
study selection and data extraction. We calculated treatment effects as
odds ratios (ORs) and 95% confidence intervals (CIs). We quantified
heterogeneity using the I² statistic. All pooled analyses were
based on random-effects models. The predefined review protocol was
registered at the International Prospective Register of Systematic Reviews
(PROSPERO 2015:CRD42015015873). Results Of the 1241 abstracts screened, we
included 14 observational studies involving 16,264 patients. There was
excellent agreement in study selection between the two reviewers (kappa
statistic, 0.83; 95% CI, 0.72-0.94). CEA was used in 10 studies, CAS was
used in 3 studies, and both CEA and CAS were used in 1 study. All included
studies were published after 1984, and 93% were published after 1997.
Carotid revascularization in diabetic patients was associated with a
higher risk of the following outcomes: perioperative stroke (OR, 1.38; 95%
CI, 1.02-1.88; P =.04; I² =13%), death (OR, 1.94; 95% CI,
1.36-2.75; P =.0002; I² = 0%), composite risk of stroke or
death (OR, 1.80; 95% CI, 1.32-2.47; P =.0002; I² = 26%), and
long-term risk of death (OR, 1.57; 95% CI, 1.22-2.03; P =.0005;
I² = 0%). No association was found between diabetes and
perioperative risk of myocardial infarction (MI); composite risk of MI,
stroke, or death; and long-term risk of stroke. Study quality was limited
by selection bias, minimal control for confounders, and single-center
retrospective design. Sensitivity analyses excluding low-quality studies
did not change the effect of diabetes on the risk of stroke, death, or MI.
Conclusions Diabetic patients are at an increased risk of perioperative
stroke, death, and long-term mortality compared with nondiabetic patients
who undergo carotid artery revascularization. This knowledge can help
further risk stratify patients with carotid artery stenosis before
treatment. Future studies should focus on evaluating which mode of
revascularization (CEA or CAS) is more effective in diabetic patients with
carotid artery stenosis.

<18>
Accession Number
2015250863
Author
Gao Y.; Huang R.; Chen R.; Li J.; Luo W.
Institution
(Gao, Huang, Chen, Li, Luo) Department of Cardiothoracic Surgery, Xiangya
Hospital, Central South University, 87 Xiangya Road, Changsha 410008,
China
Title
Ischemic postconditioning altered microRNAs in human valve replacement.
Source
Journal of Surgical Research. 200 (1) (pp 28-35), 2016. Date of
Publication: 25 Feb 2015.
Publisher
Academic Press Inc.
Abstract
Background Although the involvement of microRNAs (miRNAs) has been
intensively studied in myocardial infarction, there is no report on the
regulation of miRNAs by ischemic postconditioning in patients undergoing
cardiac surgery. We aim to explore the regulation of miRNAs by ischemic
postconditioning in double valve replacement. Materials and methods In
this prospective, controlled clinical study, consecutive 30 patients
undergoing double valve replacement were enrolled. The patients were
randomized into two groups, namely an ischemic postconditioning (IPO)
group (n = 15) and a control (CON) group (n = 15). For ethical
considerations, samples of right atrial muscle were harvested,
respectively, 10 min before cardiopulmonary bypass (pre-CPB) and 5 min
after aortic declamping (post-CPB) for analysis of miRNAs, genes and
apoptosis. Results Compared with the CON group, miR-1 was downregulated,
whereas miR-21 was upregulated, and BCL2 messenger RNA (mRNA) was
upregulated, whereas BAX mRNA and programmed cell death 4 mRNA remained
unchanged in the IPO group. Likewise, a significant increase in BCL2
protein and a striking decrease in BAX protein were observed in the IPO
group when compared with those in the CON group. The IPO group showed a
significantly smaller increase of terminal deoxynucleotidyl
transferase-mediated dUTP nick-end labeling-positive myocytes after CPB
than CON group. Conclusions Ischemic postconditioning could regulate
miR-1, miR-21, and downstream effectors and resulted in actual attenuation
of apoptosis in patients undergoing valvular heart surgery.

<19>
Accession Number
20160273278
Author
Heatley G.; Sood P.; Goldstein D.; Uriel N.; Cleveland J.; Middlebrook D.;
Mehra M.R.
Institution
(Heatley, Sood, Middlebrook) St. Jude Medical, 23 Fourth Avenue,
Burlington, MA 01803, United States
(Goldstein) Department of Cardiothoracic Surgery, Montefiore Medical
Center, New York, NY, United States
(Uriel) Division of Cardiology, University of Chicago, Chicago, IL, United
States
(Cleveland) Department of Surgery, University of Colorado, Anschutz
Medical Center, Denver, CO, United States
(Mehra) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, Ma, United States
Title
Clinical trial design and rationale of the Multicenter Study of MagLev
Technology in Patients Undergoing Mechanical Circulatory Support Therapy
with HeartMate 3 (MOMENTUM 3) investigational device exemption clinical
study protocol.
Source
Journal of Heart and Lung Transplantation. 35 (4) (pp 528-536), 2016. Date
of Publication: 01 Apr 2016.
Publisher
Elsevier USA
Abstract
The HeartMate 3 left ventricular assist system (LVAS; St. Jude Medical,
Inc., formerly Thoratec Corporation, Pleasanton, CA) was recently
introduced into clinical trials for durable circulatory support in
patients with medically refractory advanced-stage heart failure. This
centrifugal, fully magnetically levitated, continuous-flow pump is
engineered with the intent to enhance hemocompatibility and reduce shear
stress on blood elements, while also possessing intrinsic pulsatility.
Although bridge-to-transplant (BTT) and destination therapy (DT) are
established dichotomous indications for durable left ventricular assist
device (LVAD) support, clinical practice has challenged the
appropriateness of these designations. The introduction of novel LVAD
technology allows for the development of clinical trial designs to keep
pace with current practices. The prospective, randomized Multicenter Study
of MagLev Technology in Patients Undergoing Mechanical Circulatory Support
Therapy With HeartMate 3 (MOMENTUM 3) clinical trial aims to evaluate the
safety and effectiveness of the HeartMate 3 LVAS by demonstrating
non-inferiority to the HeartMate II LVAS (also St. Jude Medical, Inc.).
The innovative trial design includes patients enrolled under a single
inclusion and exclusion criteria, regardless of the intended use of the
device, with outcomes ascertained in the short term (ST, at 6 months) and
long term (LT, at 2 years). This adaptive trial design includes a
pre-specified safety phase (n = 30) analysis. The ST cohort includes the
first 294 patients and the LT cohort includes the first 366 patients for
evaluation of the composite primary end-point of survival to transplant,
recovery or LVAD support free of debilitating stroke (modified Rankin
score >3), or re-operation to replace the pump. As part of the adaptive
design, an analysis by an independent statistician will determine whether
sample size adjustment is required at pre-specified times during the
study. A further 662 patients will be enrolled to reach a total of 1,028
patients for evaluation of the secondary end-point of pump replacement at
2 years.

<20>
Accession Number
20160190647
Author
Montalescot G.; Van 'T Hof A.W.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Collet J.-P.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon
M.; Lapostolle F.; Lassen J.F.; Licour M.; Merkely B.; Salhi N.; Silvain
J.; Storey R.F.; Ten Berg J.M.; Tsatsaris A.; Zeymer U.; Vicaut E.; Hamm
C.W.; Bougherbal R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.;
Kaid O.; Krim M.; Hammett C.; Garrahy P.; Jayasinghe R.; Rashford S.;
Neunteufl T.; Brussee H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.;
Prause G.; Baubin M.; Sebald D.; Cantor W.; Vijayaraghavan R.; Bata I.;
Lavoie A.; Ravkilde J.; Jensen L.O.; Christensen A.Mo.; Toftegaard M.;
Kohler D.; Ducrocq G.; Danchin N.; Henry P.; Livarek B.; Berthier R.;
Hovasse T.; Garot P.; Payot L.; Benamer H.; Esteve J.B.; Elhadad S.;
Teiger E.; Bonnet J.L.; Paganelli F.; Cottin Y.; Schiele F.; Thuaire C.;
Cayla G.; Coste P.; Ohlmann P.; Cudraz E.B.; Lantelme P.; Perret T.; Tron
C.; De Labriolle A.; Aptecar E.; Beliard O.; Varenne O.; El Mahmoud R.;
Filippi-Codaccioni E.; Angoulvant D.; Peycher P.; Poitrineau O.; Tabone
X.; Ecollan P.; Broche C.; Lambert Y.; Briole N.; Beruben A.; Porcher N.;
Auffray J.-P.; Freysz M.; Depardieu F.; Poubel D.; De La Cousaye J.-E.;
Bartier J.-C.; Jardel B.; Boulanger B.; Labourel H.; Soulat L.-C.; Julie
V.; Thicoipe M.; Capel O.; Stibbe O.; Carli P.; Tazarourte K.; Alcouffe
F.; Aboucaya D.; Aubert G.; Kierzek G.; Cahun-Giraud S.; Hamm C.; Dengler
T.; Prondzinsky R.; Biever P.M.; Schafer A.; Seyfarth M.; Lemke B.; Werner
G.; Nef H.; Steiger H.; Leschke M.; Munzel T.; Dell Orto M.C.; Loges C.;
Schinke M.; Koberne F.; Reiffen H.P.; Tiroch K.; Wierich D.; Kneussel M.;
Little S.; Sauer H.; Laufenberg-Feldmann R.; Ungi I.; Horvath I.; Edes I.;
Martai I.; Berti S.; Chiarella F.; Calabria P.; Fineschi M.; Galvani M.;
Valgimigli M.; Moretti L.; Tespili M.; Mando M.; Bermano F.; Biagioni R.;
Fabbri A.; Ricciardelli A.; Petroni M.R.; Vatteroni U.R.; Palumbo F.;
Willems F.F.; Al Mafragi A.; Heestermans T.A.A.C.M.; Van Eck M.J.; Heutz
W.M.J.M.; Meppelder H.H.; Jong A.R.-D.; Van De Pas H.; Fillat A.C.; Tenas
M.S.; Ferrer J.M.; Penaranda A.S.; Ferrer J.A.; Del Blanco B.G.; Guardiola
F.M.; Ruiz Nodar J.M.; Romo A.I.; Gonzalez N.V.; Nouche R.T.; De La Llera
L.D.; Hernandez Garcia J.M.; Rivero-Crespo F.; Hernandez F.H.; Zamorano
Gomez J.L.; Farega X.J.; Fernandez G.A.; Toboso J.L.; Carrasco M.;
Barreiro V.; Iglesias Vazquez J.A.; Montero M.D.M.R.; Ortiz F.R.; Escudero
G.G.; Ingelmo V.S.-B.; Garcia A.L.; Oldgren J.; Calais F.; Kastberg R.;
Bergsten P.-A.; Blomberg H.; Thorn K.; Skoog G.; Zaman A.; Gerber R.;
Ryding A.; Spence M.; Swanson N.; Been M.; Grosser K.; Schofield P.;
Mackin D.; Fell P.; Quinn T.; Foster T.; McManus D.; Carson A.
Institution
(Montalescot, Collet, Silvain) Universite Paris 6, ACTION Study Group,
Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire
Pitie-Salpetriere, INSERM UMRS 1166, 47 Boulevard de lHopital, Paris
75013, France
(Van 'T Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-Universitaire Frantz Fanon, Blida, Algeria
(Goodman) Canadian Heart Research Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria
(Janzon) Department of Cardiology, Linkoping University, Linkoping, Sweden
(Lapostolle) SAMU 93 Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Aarhus N,
Denmark
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Salhi) AstraZeneca, Luton, United Kingdom
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Ten Berg) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Vicaut) Unite de Recherche Clinique, Universite Paris 7, Hopital
Lariboisiere, ACTION Study Group, Paris, France
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
Title
Effect of Pre-Hospital Ticagrelor during the First 24 h after Primary
Percutaneous Coronary Intervention in Patients with ST-Segment Elevation
Myocardial Infarction the ATLANTIC-H²⁴ Analysis.
Source
JACC: Cardiovascular Interventions. 9 (7) (pp 646-656), 2016. Date of
Publication: 11 Apr 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this landmark exploratory analysis,
ATLANTIC-H²⁴, was to evaluate the effects of pre-hospital
ticagrelor during the first 24 h after primary percutaneous coronary
intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the
cath Lab or in the Ambulance for New ST elevation myocardial infarction to
open the Coronary artery) study. Background The ATLANTIC trial in patients
with ongoing ST-segment elevation myocardial infarction showed that
pre-hospital ticagrelor was safe but did not improve pre-PCI coronary
reperfusion compared with in-hospital ticagrelor. We hypothesized that the
effect of pre-hospital ticagrelor may not have manifested until after PCI
due to the rapid transfer time (31 min). Methods The
ATLANTIC-H²⁴ analysis included 1,629 patients who underwent
PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction
flow grade 3, >70% ST-segment elevation resolution, and clinical endpoints
over the first 24 h. Results Following PCI, largest between-group
differences in platelet reactivity occurred at 1 to 6 h; coronary
reperfusion rates numerically favored pre-hospital ticagrelor, and the
degree of ST-segment elevation resolution was significantly greater in the
pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the
composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4%
vs. 13.7%; p = 0.039), as were individual endpoints of definite stent
thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All
endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital
ticagrelor, with no differences in bleeding events. Conclusions The
effects of pre-hospital ticagrelor became apparent after PCI, with
numerical differences in platelet reactivity and immediate post-PCI
reperfusion, associated with reductions in ischemic endpoints, over the
first 24 h, whereas there was a small excess of mortality. (Administration
of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation
myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580])

<21>
Accession Number
2015204493
Author
Hu Q.; Luo W.; Huang L.; Huang R.; Chen R.; Gao Y.
Institution
(Hu, Luo, Huang, Huang, Chen, Gao) Department of Cardiothoracic Surgery,
Xiangya Hospital, Central-South University, Changsha, Hunan, China
Title
Multiorgan protection of remote ischemic perconditioning in valve
replacement surgery.
Source
Journal of Surgical Research. 200 (1) (pp 13-20), 2016. Date of
Publication: 10 Mar 2015.
Publisher
Academic Press Inc.
Abstract
Background Remote ischemic perconditioning (RIPerc) is a new alternative
of remote ischemic conditioning and has not been well studied. RIPerc
attenuates myocardial injury when applied during cardiac surgery. However,
its protective effects on other organs remain unknown. Materials and
methods Patients with rheumatic heart disease undergoing valve replacement
surgery were randomized into the RIPerc group (n = 101) or the control
group (n = 100). RIPerc was achieved by three cycles of 5-min
ischemia-5-min reperfusion in the right thigh during surgery. Clinical
data and the levels of injury biomarkers for the heart, lungs, liver, and
kidneys within 48 h after surgery were compared using one-way or repeated
measurement analysis of variance. Results In the RIPerc group, the release
of serum cardiac troponin I (128.68 +/- 102.56 versus 172.33 +/- 184.38, P
= 0.04) and the inotropic score (96.4 +/- 73.8 versus 121.5 +/- 89.6, P =
0.032) decreased compared with that of the control; postoperative drainage
(458.2 +/- 264.2 versus 545.1 +/- 349.0 ml, P = 0.048) and the incidence
of acute lung injury was reduced (36.6% versus 51%, P = 0.04), and the
extent of hyperbilirubinemia was also attenuated. No significant
difference was observed in the levels of biomarkers for renal injury and
systemic inflammation response. Conclusions RIPerc applied during the
valve replacement surgery induced multiple beneficial effects
postoperatively including reduced drainage and myocardial damage, lower
incidence of acute lung injury, and attenuated hyperbilirubinemia.

<22>
[Use Link to view the full text]
Accession Number
20160273266
Author
Bundhun P.K.; Boodhoo K.D.; Long M.-Y.; Chen M.-H.
Institution
(Bundhun, Long, Chen) Institute of Cardiovascular Diseases, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
(Boodhoo) Department of Rheumatology, Xiangya Hospital, Central South
University, Changsha, Hunan, China
Title
Impact of antiphospholipid syndrome and/or systemic lupus erythematosus on
the long-term adverse cardiovascular outcomes in patients after
percutaneous coronary intervention a systematic review and meta-analysis.
Source
Medicine (United States). 95 (12) (no pagination), 2016. Article Number:
e3200. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are
2 rare autoimmune disorders which commonly affect women. Several previous
studies showed APS to have been evolved from SLE. Secondary APS often
coexists with SLE. One common feature relating these 2 diseases are the
antiphospholipid antibodies, which are found in most of the patients with
APS and in approximately 30% to 40% of patients with SLE, among which,
about 10% develop APS. The leading cause of death in these patients is
from cardiovascular disease due to accelerated atherosclerosis, which
often progresses more rapidly, compared with the general population.
However, the impact of APS and/or SLE on the cardiovascular outcomes in
patients undergoing percutaneous coronary intervention (PCI) is
controversial. Therefore, to solve this issue, we aim to compare the
longterm (>1 year) adverse cardiovascular outcomes after PCI, in patients
with APS and/or SLE, and those without these disorders. Medline and EMBASE
databases were searched for studies comparing the long-term adverse
cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE +
APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95%
confidence intervals (CIs) for these categorical variables, and the pooled
analyses were performed with RevMan 5.3. Seven studies consisting of a
total of 253,436 patients (568 patients in the experimental group and
252,868 patients in the control group) were included in this
meta-analysis. During a follow-up period of >1 year, mortality and
myocardial Infarction (MI) were significantly higher in the experimental
group (OR 2.02, 95% CI 1.63-2.49, P<0.00001 and OR 1.59, 95% CI 1.23-2.05,
P=0.0004, respectively). Major adverse cardiac events and repeated
revascularization were also significantly higher in the SLE/APS group (OR
2.40, 95% CI 1.42-4.03, P=0.001 and OR 2.59, 95% CI 1.26-5.31, P=0.01,
respectively). Antiphospholipid syndrome and SLE are associated with
significantly higher long-term (>1 year) adverse cardiovascular outcomes
after PCI. However, because of the limited number of patients and
researches done, and due to a larger percentage of heterogeneity observed
among several subgroups, this analysis may not generate a powerful result.

<23>
Accession Number
20160276498
Author
Uddin J.; Zwisler A.-D.; Lewinter C.; Moniruzzaman M.; Lund K.; Tang L.H.;
Taylor R.S.
Institution
(Uddin) Department of Cardiac Surgery, Ibrahim Cardiac Hospital and
Research Institute, Bangladesh
(Uddin, Zwisler, Taylor) National Institute of Public Health, University
of Southern Denmark, Denmark
(Lewinter) Department of Cardiology, Vejle Hospital, Vejle, Denmark
(Moniruzzaman) Non-communicable Disease Unit, World Health Organization
(WHO), Country Office for Bangladesh, Dhaka, Bangladesh
(Lund) Department of Physiotherapy and Occupational Therapy, Holbaek
Hospital, Denmark
(Tang) Heart Centre, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Tang) CopenRehab, Section of Social Medicine, Department of Public
Health, University of Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Taylor) Department of Health Services Research, Institute of Health
Research, University of Exeter Medical School, South Cloisters, St Lukes
Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
Title
Predictors of exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure: A meta-regression
analysis.
Source
European Journal of Preventive Cardiology. 23 (7) (pp 683-693), 2015. Date
of Publication: 2015.
Publisher
SAGE Publications Inc.
Abstract
Background The aim of this study was to undertake a comprehensive
assessment of the patient, intervention and trial-level factors that may
predict exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure. Design
Meta-analysis and meta-regression analysis. Methods Randomized controlled
trials of exercise-based rehabilitation were identified from three
published systematic reviews. Exercise capacity was pooled across trials
using random effects meta-analysis, and meta-regression used to examine
the association between exercise capacity and a range of patient (e.g.
age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias)
factors. Results 55 trials (61 exercise-control comparisons, 7553
patients) were included. Following exercise-based rehabilitation compared
to control, overall exercise capacity was on average 0.95 (95% CI:
0.76-1.41) standard deviation units higher, and in trials reporting
maximum oxygen uptake (VO<inf>2</inf>max) was 3.3 ml/kg.min^-1
(95% CI: 2.6-4.0) higher. There was evidence of a high level of
statistical heterogeneity across trials (I² statistic > 50%).
In multivariable meta-regression analysis, only exercise intervention
intensity was found to be significantly associated with VO<inf>2</inf>max
(P = 0.04); those trials with the highest average exercise intensity had
the largest mean post-rehabilitation VO<inf>2</inf>max compared to
control. Conclusions We found considerable heterogeneity across randomized
controlled trials in the magnitude of improvement in exercise capacity
following exercise-based rehabilitation compared to control among patients
with coronary heart disease or heart failure. Whilst higher exercise
intensities were associated with a greater level of post-rehabilitation
exercise capacity, there was no strong evidence to support other
intervention, patient or trial factors to be predictive.

<24>
Accession Number
20160286619
Author
Vyas A.; El Accaoui R.; Blevins A.; Karrowni W.
Institution
(Vyas, El Accaoui, Karrowni) Division of Cardiovascular Medicine,
University of Iowa Hospitals and Clinics, Iowa City, IA, United States
(Blevins) Hardin Library of the Health Sciences, University of Iowa Carver
College of Medicine, Iowa City, IA, United States
Title
Outcome comparison of 600 mg versus 300 mg loading dose of clopidogrel for
patients with ST-Elevation myocardial infarction: A meta-analysis.
Source
Postgraduate Medicine. 126 (5) (pp 177-187), 2014. Date of Publication: 01
Jan 2014.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Background: A 600-mg loading dose (LD) of clopidogrel has been shown to be
superior to a 300-mg LD in inhibiting platelet function. However, data for
clinical superiority are limited, and there is a paucity of adequately
powered randomized trials investigating this issue. This meta-analysis was
performed to determine the optimal LD of clopidogrel in ST-elevation
myocardial infarction patients treated with primary percutaneous coronary
intervention. Methods: A meta-analysis of controlled trials and
observational studies was performed comparing 600-mg with 300-mg LDs of
clopidogrel. The primary efficacy end point was a major adverse cardiac
event (MACE), and the primary safety end point was major bleeding. Data
were extracted on an intention to treat basis. The X2 test was used to
evaluate heterogeneity. A random effects model was used, and odds ratios
(OR) were calculated using the Mantel-Haenszel method. Results: Nine
studies involving 18 623 patients were included in the efficacy analysis.
Mean duration of follow-up was 8 months. Four studies were eligible for
the safety analysis. The MACE risk was lower with a 600-mg LD (7.0%
[650/9231]) than with a 300-mg LD (9.2% [867/9392]; OR, 0.75; 95% CI,
0.63-0.91). On the other hand, there was no significant difference in the
major bleeding events between the 2 groups (2.5% [89/3551] with 600 mg vs
2.3% [63/2796] with 300 mg; OR, 0.84; 95% CI, (0.60-1.16). Conclusions: In
ST-elevation myocardial infarction patients treated with primary
percutaneous coronary intervention, administration of a 600-mg LD of
clopidogrel is associated with a lower risk of MACE than is administration
of a 300-mg LD, without increasing the risk of major bleeding.

<25>
Accession Number
72254272
Author
Jennings D.L.; Baker. W.L.
Institution
(Jennings) Department of Pharmacy, New York Presbyterian Columbia
University Medical Center, New York, NY, United States
(Baker.) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Title
Pre-transplant amiodarone exposure increases mortality in cardiac
transplant recipients: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 36th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2016 Washington, DC United States. Conference
Start: 20160427 Conference End: 20160430. Conference Publication:
(var.pagings). 35 (4 SUPPL. 1) (pp S420), 2016. Date of Publication: April
2016.
Publisher
Elsevier USA
Abstract
Purpose: Amiodarone remains a prevalent therapy for treatment of
arrhythmias in patients awaiting cardiac transplant, however the impact of
this medication on post-transplant outcomes is uncertain. We performed a
systematic review and meta-analysis of published studies evaluating the
impact of pre-implant amiodarone use on all-cause mortality rates
following cardiac transplantation. Methods: We searched Medline, SCOPUS
and the Cochrane Central Register of Controlled Trials from inception
through October 2015. Proceedings from related conferences over the prior
2 years were also manually reviewed. Studies, regardless their design,
were included if they were an evaluation of patients undergoing cardiac
transplantation who had received pre-implant amiodarone and reported
postoperative mortality. The earliest reported mortality rates from each
study were included. Outcomes were pooled using a random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluating using the Cochrane Q statistic p-value and I2
value. Publication bias was assessed using Egger's weighted regression
statistic. Results: Six studies, including 869 participants, were
included. Follow-up times varied between the studies. Two reported
in-hospital mortality, three reported 1-month mortality, and the last had
5 years of follow-up. Use of pre-transplant amiodarone was associated with
a 2-fold increase in postoperative mortality versus control (OR 2.26, 95%
1.11 to 4.57;Figure). Neither appreciable statistical heterogeneity (I2 =
23.9%) nor publication bias (Egger's p = 0.66) was observed. Too few
studies reported mean amiodarone dose and/or duration to allow for
meta-regression analyses to be performed. Conclusion: Exposure to
amiodarone prior to cardiac transplantation is associated with a higher
rate of postoperative mortality. (Figure Presented).

<26>
Accession Number
72253642
Author
Foroutan F.; Alba A.; Ng Fat Hing N.; Fan C.; Manlhiot C.; Ross H.J.
Institution
(Foroutan, Alba, Ng Fat Hing, Ross) Cardiology, Toronto General Hospital,
Toronto, ON, Canada
(Fan, Manlhiot) Cardiovascular Data Management Centre, University of
Toronto, Toronto, ON, Canada
Title
Rejection and cardiac allograft vasculopathy are both associated with
increased incidence of sudden cardiac death post-heart transplant: A
meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 36th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2016 Washington, DC United States. Conference
Start: 20160427 Conference End: 20160430. Conference Publication:
(var.pagings). 35 (4 SUPPL. 1) (pp S199), 2016. Date of Publication: April
2016.
Publisher
Elsevier USA
Abstract
Purpose: Sudden cardiac death (SCD) is responsible for approximately 10%
of deaths post-heart transplant (HTx). We conducted a meta-analysis to
evaluate incidence and risk factors associated with increased risk of
post-tx SCD. Methods: We systematically searched electronic databases
including Medline, EMBASE, and CINAHL, and references of included studies.
We selected comparative observational studies on adult HTx recipients
reporting post-transplant SCD. We collected patient population
characteristics about the proportion of patients with CAV, rejection, mean
donor and recipient age, and recipient sex and pre-transplant
cardiomyopathy. We meta-analyzed the incidence of SCD in person-years
using random effect models and performed a meta-regression to evaluate the
association between SCD and population characteristics. Results: We
included 58 studies on 47,533 recipients. Median (25th - 75% percentile)
recipient age was 48 (42 - 52), donor age was 31 (29 - 38), proportion of
female was 22% (14% - 26%), proportion of patients with ischemic
cardiomyopathy was 29% (18% - 50%), patients with CAV was 19% (7% - 48%),
and patients with rejection was 9% (5% - 35%). The pooled incidence rate
of SCD was 2.82 (95% CI: 1.97 - 3.67) per 100 patient-years, with a high
heterogeneity (I2= 99%). An increase in CAV incidence and proportion of
patients with rejection were independently associated with an increase in
SCD incidence (0.21 per 100 person-years, 95% CI: 0.01 - 0.41, p= 0.04 and
10.7 per 1% increase in proportion of rejection, 95% CI: 1.04 - 20.3, p=
0.03). There was no association between SCD incidence rate and recipient
age, sex, and etiology of cardiomyopathy. Conclusion: Our study shows a
2.82 incidence per 100 patient-years of post-transplant SCD with high
heterogeneity across studies. This variation can partially be explained by
higher incidence of CAV, independently of rejection. The risk of SCD
should be separately evaluated in patients with CAV versus rejection.

<27>
Accession Number
72252776
Author
Cho S.; Deshpande A.; Pasupuleti V.; Diaz A.; Uchino K.
Institution
(Cho) Cleveland Clinic, Cleveland, OH, United States
(Deshpande, Pasupuleti, Diaz, Uchino) Cleveland Clinic Foundation,
Cleveland, OH, United States
Title
Radiographic and symptomatic brain embolism in cardiac interventions: A
systematic review and pooled analysis.
Source
Neurology. Conference: 68th American Academy of Neurology Annual Meeting,
AAN 2016 Vancouver, BC Canada. Conference Start: 20160415 Conference End:
20160421. Conference Publication: (var.pagings). 86 (16 SUPPL. 1) (no
pagination), 2016. Date of Publication: 05 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To describe the proportion of radiographic brain infarcts that
are symptomatic in cardiac procedures. Background: Reports vary in
incidence of silent brain infarcts after cardiovascular procedures. In a
systematic review we compared the rates of radiographic brain infarcts
(RBI) to clinical strokes across cardiac interventions: surgical aortic
valve replacement/repair (AVR), transcatheter aortic valve implantation
(TAVI), coronary artery bypass grafting (CABG), and cardiac catherization.
Methods: We searched MEDLINE and 4 other databases for subject headings
and text related to brain infarcts in carotid artery interventions from
inception through February 2015. We included articles with cardiac
interventions if brain MRI was performed systematically, RBI and stroke
incidence were reported. We compared infarct rates between the procedures.
Results: Of 6332 articles retrieved, 24 studies (1770 patients) met the
inclusion criteria. There were 5 cohorts in CABG, 11 cohorts in AVR/TAVI,
and 8 in cardiac catherization. MRI diffusion-weighted imaging scan was
performed pre-procedure in 22 studies and post-procedure in all studies.
Among 320 patients undergoing CABG, the incidence of RBI was 20[percnt]
(range 0-31[ percnt]) with clinical stroke incidence of 2[percnt] (range
0-7.6[ percnt]), indicating 7.9[percnt] of RBI being symptomatic. Among
617 persons undergoing AVR, the incidence of RBI was 68[percnt] (range
7.7-100[ percnt]) with clinical stroke incidence of 9.7[percnt] (range
0-17[ percnt]), indicating that 15[percnt] of RBIs were symptomatic. Among
833 persons undergoing cardiac catheterization, the incidence of RBI was
12[percnt] (range 0-22[ percnt]) with clinical stroke incidence rate of
1.0[percnt] (range 0-2.4[ percnt]) with 7.9[percnt] of RBIs being
symptomatic. Infarct incidence was significantly higher in TAVI (282/357,
79.0[percnt]) compared to AVR (136/260, 52.3[percnt], p < 0.05).
Conclusions: Most radiographic infarcts during CABG, and cardiac
catheterization remained silent. It appears that AVR might have both
higher rate of radiographic infarct but also higher proportions being
symptomatic.