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<1>
Accession Number
615956392
Title
Evolocumab and clinical outcomes in patients with cardiovascular disease.
Source
New England Journal of Medicine. 376 (18) (pp 1713-1722), 2017. Date of
Publication: 04 May 2017.
Author
Sabatine M.S.; Giugliano R.P.; Keech A.C.; Honarpour N.; Wiviott S.D.;
Murphy S.A.; Kuder J.F.; Wang H.; Liu T.; Wasserman S.M.; Sever P.S.;
Pedersen T.R.; Fish M.P.; Abrahamsen T.E.; Im K.; Kanevsky E.; Bonaca
M.P.; Lira Pineda A.; Hanlon K.; Knusel B.; Somaratne R.; Kurtz C.; Scott
R.; Accini Mendoza J.L.; Amerena J.; Badariene J.; Burgess L.; Ceska R.;
Charng M.J.; Choi D.; Cobos J.L.; Dan G.A.; De Ferrari G.M.; Deedwania
P.C.; Chopra V.K.; Erglis A.; Ezhov M.V.; Ferreira J.; Filipova S.;
Gaciong Z.A.; Pasierski T.; Georgiev B.G.; Gonzalez-Galvez G.;
Gouni-Berthold I.; Schaufele T.; Hirayama A.; Huber K.; Rammer M.;
Kjaerulf Jensen H.; Wermuth S.; Jiang L.; Jukema J.W.; Kraydashenko O.;
Leiter L.A.; Lewis B.S.; Lopez-Miranda J.; Lorenzatti A.J.; Mach F.;
McAdam B.; Nilsson L.; Olsson A.; Rallidis L.; Rogelio G.G.; Kerr Saraiva
J.F.; Scheen A.; Schiele F.; Connolly D.; Siu C.W.; Tay L.; Thorgeirsson
G.; Tikkanen M.J.; Tokgozoglu S.L.; Toth K.; Viigimaa M.; Wan Ahmad W.A.;
Hennekens C.H.; Andreotti F.; Baigent C.; Brown W.V.; Davis B.R.; Newcomer
J.W.; Wood S.K.; LaRosa J.; Ansell B.; Lowe C.; Zahn L.; Awtry E.; Berger
C.; Croce K.; Desai A.; Gelfand E.; Ho C.; Leeman D.; Link M.; Norden A.;
Pande A.; Rost N.; Ruberg F.; Silverman S.; Singhal A.; Vita J.; Mackinnon
I.; Vogel D.R.; Leon de la Fuente R.; Perna E.; Amuchastegui M.; Pacora
F.; Hershson A.; Blumberg E.; Glenny J.A.; Colombo H.; Cuadrado J.A.;
Nicolosi L.; Rojas C.G.; Ulla M.R.; Hasbani E.G.; Cuneo C.; Lopez Santi
R.G.; Sanabria H.D.; Hrabar A.; Lozada A.; Begg A.; Lehman S.; Wittert G.;
Juergens C.; Kostner K.; Beltrame J.; Simpson R.; Sinhal A.; Adams M.;
Kritharides L.; Roberts Thomson P.; Cross D.; Thompson P.; Van Gaal W.;
Cox N.; Farshid A.; Hammett C.; Garrahy P.; Prasan A.; Horrigan M.;
Ebenbichler C.; Hanusch U.; Prager R.; Schernthaner G.; Luger A.;
Siostrzonek P.; Toplak H.; Bergler-Klein J.; Paulweber B.; Sinzinger H.;
Buysschaert I.; Thoeng J.; Vandekerckhove H.; Catez E.; Verheye S.;
Descamps O.; Hoffer E.; Wollaert B.; Chenu P.; van de Borne P.; De
Meulemeester M.; Friart A.; Charlier F.; De Raedt H.; Rietzschel E.;
Roelandt R.; Lalmand J.; Tavares Russo L.A.; Reis G.; Duarte Barbosa E.C.;
Vidotti M.H.; Fernandes Manenti E.R.; Dutra O.; Leaes P.E.; Rech R.L.;
Bertolim Precoma D.; Nicolau J.C.; Amoedo R.; Eliaschewitz F.G.; Pereira
A.; Kurtz Lisboa H.R.; Soares Piegas L.; Cunha Borges J.L.; Ferreira Rossi
P.R.; Pimentel Filho P.; Bodanese L.C.; de Sa Cunha R.; Moura Jorge J.C.;
Ardito W.R.; Barroso de Souza W.K.; Hissa M.; Izar M.C.; Manolova A.;
Kitova L.; Kinova E.; Tzekova M.; Velchev V.; Tarnovska-Kadreva R.;
Gotchev D.; Petrov I.; Raev D.; Trendafilova-Lazarova D.; Yotov Y.; Lazov
P.; Rahimi S.; St Amour E.; Constance C.; Pesant Y.; Hess A.; Anderson T.;
Sussex B.; Henein S.; Tsoukas G.; Pandey A.S.; Bergeron J.; Hart R.;
Gosselin G.; Chehayeb R.; Hamet P.; Hartleib M.; Mukherjee A.; Halperin
F.; Petrella R.; Bhargava R.; Lonn E.; Sabbah E.; Bata I.; Cha J.; Gaudet
D.; Chapman K.; Murthy D.; Nigro F.; Rupka D.; Gossard D.; Gupta M.;
Dowell A.; Mansour S.; Baass A.; Geadah C.; Huynh T.; Peterson S.; Poirier
P.; Sabe-Affaki G.; Vertes G.; Crowley D.; Duchesne L.; Pincetti Jofre
C.P.; Potthoff Cardenas S.; Conejeros Kindel C.; Saavedra Gajardo V.A.;
Lanas Zanetti F.; Sepulveda Varela P.A.; Stockins Fernandez B.A.; Li W.;
Li D.; Zhao S.; Li Z.; Wang J.; Yang Y.; Zhang L.; Yang P.; Zhang X.;
Huang H.; Xue L.; Zheng Z.; Huang W.; Dai H.; Su H.; Zeng X.; Zheng Y.;
Tang Y.; Yao Z.; Sun Y.; Du Y.; Ge Z.; Yan J.; Chen X.; Liu F.; Pei H.;
Yang X.; Cui H.; Gu Y.; Yang Z.; Li J.; Lian Y.; Cui Y.; Wang D.; Jiang
J.; Li X.; Chen J.; Mo Z.; Xu P.; He Y.; Zhou C.; Qu P.; Zhu Y.; Liu Y.;
Shen X.; Gao X.; Terront Lozano M.A.; Moncada Corredor M.A.; Hernandez
Triana E.; Botero Lopez R.; Coronel Arroyo J.A.; Quintero Baiz A.E.;
Sanchez Vallejo G.; Arana Londono C.; Molina de Salazar D.I.; Castellanos
Bueno R.; Manzur Jattin F.; Cure Cure C.A.; Sotomayor Herazo A.; Spinar
J.; Hala T.; Machkova M.; Klimsa Z.; Polasek R.; Jerabek O.; Kazdera P.;
Pozdisek Z.; Vaclavik J.; Frana P.; Elbl L.; Kucera D.; Kryza R.; Malecha
J.; Reichert P.; Sochor K.; Ludka O.; Kellnerova I.; Peterka K.; Zidkova
E.; Cech V.; Brabec T.; Fiserova N.; Kvasnicka J.; Rosolova H.; Nemecek
E.; Adamkova V.; Dunaj M.; Pojsl S.; Cepelak M.; Podpera I.; Kuchar L.;
Rysava D.; Burianova H.; Spinarova L.; Skrobakova J.; Charvat J.; Homza
M.; Zemanek J.; Koleckar P.; Karen I.; Krupicka J.; Blaha V.; Matuska J.;
Brotanek J.; Cifkova R.; Kuchar R.; Vomacka Z.; Kosek Z.; Hulinsky V.;
Krejcova H.; Kuchar J.; Jelinek Z.; Jelinek P.; Markdanner Lindgren L.;
Saetre Lihn A.; Korsgaard Thomsen K.; Bronnum-Schou J.; Nielsen H.;
Nielsen T.; Egstrup K.; Klausen I.C.; Mickley H.; Hove J.; Jeppesen J.;
Melchior T.; Schmidt E.B.; Valter I.; Rosenthal A.; Kaik J.; Kork A.; Alt
I.; Strand J.; Nieminen S.; Kahri J.; Suomi J.; Nyman K.; Strandberg T.E.;
Piippo T.; Savolainen M.; Vikman S.; Pucheu Y.; Cariou B.; Henry P.;
Ferrari E.; Montalescot G.; Ferrieres J.; Roubille F.; Bonnet B.;
Angoulvant D.; Range G.; Bammert A.; Delarche N.; Mariat C.; Cayla G.;
Durlach V.; Coisne D.; Paillard F.; Rouzier R.; Goralski M.; Khanoyan P.;
Cottin Y.; Ziegler O.; Khalife K.; Le Corvoisier P.; Motreff P.; Spaulding
C.; VanBelle E.; Bourhaial H.; Opitz C.; Kahrmann G.; Contzen C.; Appel
K.; Schenkenberger I.; Rinke A.; Trenk D.; Maus O.; Karakas M.; Hanefeld
M.; Darius H.; Hetzel G.; Munzel T.; Wohrle J.; Stawowy P.; Marten I.;
Isermann B.; Kast P.; Vorpahl M.; Bosiljanoff P.; Hengstenberg C.; Kassner
U.; Salbach P.; Fischer M.; Steiner S.; Wagner S.; Kraatz U.; von
Hodenberg E.; Weyland K.; Mantas I.; Tziakas D.; Bousboulas S.;
Patsilinakos S.; Mertzanos G.; Panagoulis C.; Bilianou H.; Skoumas I.;
Elisaf M.; Manolis A.; Moschos N.; Kochiadakis G.; Ntaios G.; Richter D.;
Athyros V.; Kolovou G.; Danias P.; Melidonis A.; Fan K.Y.Y.; Siu S.C.;
Hornyik A.; Lakatos F.; Zilahi Z.; Nagy K.; Laszlo Z.; Peterfai E.;
Lupkovics G.; Andreka P.; Merkely B.; Herczeg B.; Piros G.A.; Salamon C.;
Mark L.; Papp A.; Szakal I.; Edes I.; Mohacsi A.; Tomcsanyi J.; Hajko E.;
Nagy A.; Papp E.; Kiss R.; Karadi I.; Sigurdsson A.; Jain A.; Pai R.;
Kothiwale V.; Kulkarni G.; Mahajan A.; Aggarwal S.; Mehta V.; Rajadhyaksha
G.; Joshi A.; Khandait V.; Parmar M.; Tyagi S.; Airody Govinda R.; Dwivedi
S.K.; Parikh K.; Pothineni R.B.; Solanki B.; O'Donnell M.; Crean P.;
Barton J.; Shechter M.; Shotan A.; Klutstein M.; Chorin E.; Gavish D.;
Kracoff O.; Atar S.; Rigler S.; Hasin Y.; Schiff E.; Merlini P.; Rapezzi
C.; Pirro M.; Gonnelli S.; Floresta A.M.; Mennuni M.; Ardissino D.; Senni
M.; Marenzi G.; Marcucci R.; Sampietro T.; Cosmi F.; Perrone Filardi P.;
De Caterina R.; Fedele F.; Moretti L.; Biasucci L.M.; Ferri C.; Go Y.;
Kiyosue A.; Higashi Y.; Tokunaga T.; Kawasaki T.; Sakagami S.; Namba S.;
Saku K.; Oku K.; Arakawa T.; Iida H.; Nakamura Y.; Yamamoto K.; Hata Y.;
Katsuda Y.; Koga Y.; Shimizu M.; Uehara H.; Kajiyama S.; Okamoto H.;
Shinozaki T.; Fujino Y.; Funazaki T.; Higa N.; Kaigawa K.; Koike A.;
Nakane H.; Sato K.; Satoh Y.; Shirasawa K.; Sugino H.; Tanabe J.; Uemura
O.; Yoshimichi G.; Akai A.; Himeno H.; Inage T.; Inoko M.; Kadokami T.;
Noguchi Y.; Yamashita K.; Yasumura Y.; Yuge M.; Hosokawa S.; Kawamitsu K.;
Kozuma K.; Matsuo H.; Nakashima E.; Okada M.; Wada A.; Yokoya K.; Iwade
K.; Kawabata K.; Tanno H.; Ako J.; Fujita H.; Izumiya Y.; Kanno M.;
Nunohiro T.; Ohmura H.; Ueno T.; Kakurina N.; Jasinkevica I.; Stukena I.;
Veze I.; Eglite R.; Teterovska D.; Sime I.; Strazdiene V.; Venceviciene
L.; Gustiene O.; Radzeviciene-Jurgute R.; Kucinskiene A.; Maskon O.; Lee
C.Y.; Erng T.; Gan H.W.; Mohamed Yusof A.K.; Ramanathan G.L.; Liew H.;
Lopez Alvarado A.; Nevarez Ruiz L.A.; De los Rios Ibarra M.O.; Bazzoni
Ruiz A.E.; Ramos Lopez G.A.; Llamas Esperon G.A.; De la Pena Topete
G.D.J.; Violante Ortiz R.M.; Illescas Diaz J.J.; Leon Gonzalez S.; Sanchez
Diaz C.J.; Mendez Machado G.F.; Venegas Carrillo L.A.; Aldrete Velasco
J.A.; Cardona Munoz E.G.; Leiva Pons J.L.; Perez Alva J.C.; van der Zwaan
C.; Oomen A.; van de Wal R.; Magro M.; Boswijk D.; Janus C.; Groutars R.;
Tonino W.; Cornel J.H.; Oude Ophuis A.; Troquay R.; Liem A.; Westendorp
I.; Van Hessen M.; Lok D.; De Nooijer C.; Den Hartog F.; Van Beek E.;
Bendermacher P.; Jansen R.; Romer T.; Rensing B.; Hersbach F.; Herrman J.;
Ladyjanskaia G.; Karalis I.; Linssen G.; Bokern M.; Visman A.; Kooij A.;
Monajemi H.; Lieverse A.; Baker J.; Tie S.; Risberg K.; Hysing J.; Hoivik
H.O.; Norheim P.; Solnor L.; Hovland A.; Kjaernli T.; Jocson G.; Coching
R.M.; Batalla E.; Go A.; Habaluyas R.; Barcinas R.; Sy R.A.; Estepar R.A.;
Germar A.; Trebacz J.; Szymkowiak K.; Wnetrzak-Michalska R.; Kopaczewski
J.; Przekwas-Jaruchowska M.; Kania G.; Zabowka M.; Mirek-Bryniarska E.;
Dabrowska M.; Napora P.; Konieczny M.; Spyra J.; Lysek R.; Pijanowski Z.;
Grzegorzewski B.; Bednarkiewicz Z.; Kinasz L.; Antkowiak-Piatyszek K.;
Stania K.; Szpajer M.; Staneta P.; Skonieczny G.; Ksiezycka-Majczynska E.;
Blicharski T.; Piepiorka M.; Wozakowska-Kaplon B.; Zechowicz T.; Ilkowski
J.; Lubiszewska B.; Hiczkiewicz J.; Wierzbicka K.; Kosior D.; Garbocz P.;
Kubica J.; Raczak G.; Wozniak I.; Cygler J.; Kramarczuk E.; Bystryk L.;
Pentela-Nowicka J.; Dabrowski M.; Podolec P.; Zieba B.; Mosiewicz J.;
Dubaniewicz W.; Banach M.; Tyszecka G.; Lepich T.; Rychlewska-Hanczewska
A.; Guzik T.; Monteiro P.; Pereira H.; Oliveira L.; Matos P.; Soares
Goncalves S.; Leitao A.; Vasco Salgado A.; Timoteo A.T.; Pintilei E.;
Badila E.; Militaru C.; Tudoran M.; Arsenescu-Georgescu C.; Mitu F.;
Zdrenghea D.; Lighezan D.; Teodorescu I.; Popescu M.I.; Coman I.; Vintila
M.M.; Vishnevsky A.; Lukyanov Y.; Blokhin A.; Kostenko V.; Shvarts Y.;
Markov V.; Motylev I.; Dronov D.; Sherenkov A.; Barbarash O.; Shutemova
E.; Bolshakova O.; Kobalava Z.; Voevoda M.; Treshkur T.; Zrazhevskiy K.;
Pimenov L.; Solovev O.; Tarasov N.; Arkhipov M.; Freidlin M.; Shalaev S.;
Yakhontova P.; Shustov S.; Goloshchekin B.; Panov A.; Bart B.; Bubnova M.;
Gordeev I.; Osipova I.; Tereshenko S.; Solovieva E.; Meshkov A.;
Zateyshchikov D.; Tan J.L.; Subramaniam T.; Pella D.; Fulop P.; Antalik
L.; Dzupina A.; Banikova A.; Sosovec D.; Urgeova L.; Mazur J.; Hranai M.;
Banik M.; Vinanska D.; Lennerova J.; Kovar F.; Pastrnakova E.; Uhliar R.;
Blasko P.; Gonsorcik J.; Lukacova J.; Oriesek R.; Hatalova K.; du Toit M.;
Ebrahim I.; Vawda G.; Lipschitz S.; Blignaut S.; Engelbrecht J.; Coetzer
T.F.; Pretorius M.; Urbach D.; Badat A.; Pillay S.; Van Zyl L.; Abelson
M.; van der Walt E.; Moodley R.; Jacovides A.; Oosthuysen W.M.; Klug E.;
Lottering H.; Kok J.; Saaiman J.; Dawood S.; De Jong D.M.; Kapp C.;
Makotoko E.; Bayat J.; Sarvan M.; Vally T.; Stapelberg A.; Kim M.; Bae J.;
Cho Y.; Kim S.; Han K.H.; Her S.; Kim B.; Lee S.; Hong B.; Kim W.; Rha S.;
Jeong M.; Shin G.J.; Vida Gutierrez M.; Valdes Chavarri M.; Pinto Sala X.;
Gonzalez Juanatey J.R.; Civeira Murillo F.; Zamorano Gomez J.L.; Lekuona
Goya I.; Iniguez Romo A.; Cordero Fort A.; Ascaso Gimilio J.F.; Millan
Nunez-Cortes J.; Lindholm C.; Soderberg S.; Suutari A.; Berglund S.; Mooe
T.; Kusiak D.; Bandh S.; Dahlen G.; Olsson S.; Witt N.; Tyden P.;
Johansson P.; Cizinsky S.; Falck G.; Pettersson S.I.; Rasmanis G.;
Ostergren J.; Moccetti T.; Beer H.J.; Eberli F.; Krahenbuhl S.; Linka A.;
Ackermann D.; Michel P.; Yeh H.; Tsai C.F.; Wu C.; Hsia C.; Juang J.;
Hsieh I.; Lai W.; Huang C.; Hsieh Y.; Sahin T.; Duzenli M.; Yigit Z.;
Demir M.; Yilmaz M.B.; Muderrisoglu I.H.; Kirma C.; Ercan E.; Kayikcioglu
L.; Balbay Y.; Lymar I.; Kulynych O.; Prokhorov O.; Karpenko O.; Kraiz I.;
Vakaliuk I.; Stanislavchuk M.; Korzh O.; Rudyk I.; Zhurba S.; Svishchenko
Y.; Tseluyko V.; Gyrina O.; Reshotko D.; Kopytsya M.; Volkov V.; Myshanych
G.; Rebrov B.; Rishko M.; Rudenko L.; Shatylo V.; Parkhomenko O.; Yena L.;
Golovchenko O.; Sorokina I.; Malynovsky Y.; Ivan P.; Blagden M.; Dear H.;
Mathew A.; Lagocki S.; Kondagunta V.; Ahsan A.; McKinnon C.; Douglas F.;
Thom S.; Fiore G.; Caulfield M.; Lynch M.; Thomas H.; Bain S.; Hall A.;
McNally D.; Fisher M.; Keeling P.; Al-Bahrani A.; Lip G.; Ellery A.;
Purohit J.; Travill C.; Cappuccio F.; Davis G.; Gaunt R.; Adlam D.;
Asamoah N.; Jaafar F.; McCormack T.; Jupp B.; Pye M.; Ainsworth P.;
Chauhan A.; Paul N.; Fairlie H.; Fox C.; Muzulu S.; Trevelyan J.; Aggarwal
R.; Issa B.; Saravanan P.; Cruickshank K.; Gorog D.; Heller S.; Newby D.;
Nicolson A.; Hare P.O.; Donnelly P.; Rutherfurd S.; de Belder M.;
Finlayson J.; Harvey J.; Hoye A.; Kingston D.; Sarkar D.; Negahban A.;
Webster J.; Wyatt N.; Muir S.; Cummings M.; Mackenzie I.; Senior R.; Capps
N.; Fotherby K.; McIntyre H.; Aldegather J.; Dixon L.; Saksena R.; Butler
R.; Ramstad D.; Pierpont B.; Levinson D.; Mohammed A.; Haddad T.; Goel A.;
Dave K.; Haught W.H.; Desire A.; Hershon K.; Napoli M.; Tami L.;
Rothschild R.; Khurana S.; Gupta D.; Cheung D.; Hearne S.; Grubb S.;
Miller A.; Baird I.; Marcus A.; Srivastava S.; Forgosh L.; Fritz R.; Mays
M.; Bertolet B.; Reddy J.; Khan M.; Nakhle S.; Dill S.; Fishbein G.; Khan
B.; Marais H.; Reschak M.; Malone M.; Nadar V.; Whitney R.; Reichman A.;
Reyes H.; El Shahawy M.; Rabinowitz A.; Weinstein D.; Farhat N.; Onyema
D.; Potu R.; Runquist L.; Barnum O.; Crater T.; Fialkow J.; Shah A.;
Thompson C.; Wiseman A.; Doyle T.; Henderson D.; Herzog W.; Schnitzler R.;
Carr K.; Davis M.; Nagajothi N.; Olsen S.; Rogers W.; Rubino J.; Singh I.;
Tarleton G.; Bhagwat R.; Clardy D.; Jardula M.; Robinson J.; Torres M.;
Vijay N.; Farris N.; Lillo J.; Moriarty P.; Recknor C.; Berlacher P.;
Christensen T.; Gabra N.; Issa M.; Janik M.; Lawless A.; Molter D.; Stout
E.; Brezina B.; Claxton E.; Linsky R.; Poock J.; Remler R.; Roseman H.;
Schramm E.; Al-Joundi T.; Amin J.; Hitchcock J.; Isserman S.; Kirstein J.;
Rider J.; Shalek M.; Sherman H.; Bernstein M.; Chandra L.; Hatharasinghe
R.; Ibrahim H.; Iteld B.; Linzmeyer K.; Seaton B.; Zeig S.; Christofides
E.; Dunbar R.; Griffin S.; Kohli N.; Koren M.; Pharr W.; Purdy D.; Spencer
R.; Yeoman G.; Banerjee S.; Cheek H.B.; Engel E.; Hamroff G.; Huling R.;
Kozlowski L.; Levin P.; Makam S.; Meengs M.; Bhushan R.; Erickson B.;
Herman L.; Lo E.; McDowell E.; McGrew F.; Miller M.; Ord J.; Webel R.;
Wilhoit G.; Wise J.; Yang E.; Budoff M.; Collins J.; Dauber I.; Dobkin L.;
Focil A.; Gandy W.; Pasquini J.; Ramos M.; Rodriguez D.; Rosenson R.;
Sanford K.; Schlau A.; Snyder B.; Stonesifer L.; Tang A.; De Souza J.;
Elam M.; French J.; Guyton J.; Hage Korban E.; Kereiakes D.; King M.; Loh
I.; Navarro J.; Simons R.; Tobin T.; Younis L.; Aboufakher R.; Baldari D.;
Ballantyne C.; Broughton R.; Eaton C.; Johnston J.; Simon W.; Thomson S.;
Vora K.; Youngman D.; Alzohaili O.; Auerbach E.; Brown C.; Burrough B.;
Chen Y.; Gilpatrick M.; Landzberg J.; Mitchell C.; Rice L.; Rubenfire M.;
Sofley C.W.; Strobl D.; Atassi K.; Davila W.; Diogo J.; Fagan T.; Joffe
I.; Krishna J.; Osea E.; Penny W.; Rowe W.; Shapiro M.; Welker J.; Benton
R.; Dobratz D.; Fortuin F.; Graham J.; Henry B.; Kusnick B.; Lutskiy M.;
McRae A.; Saway W.; Scott J.; Shah M.; Weinberg B.; Zarich S.; Acheatel
R.; Case C.; Earl J.; Fernandez S.; Giugliano G.; Handelsman Y.; Hermany
P.; Holder S.; Kashyap M.; Khan A.; Lader E.; Peniston J.; Raoof T.; Sacco
J.; Shore K.; Spriggs D.; Stringam S.; Tahirkheli N.; Delgado E.; Derian
W.; Greenwald J.; Harris M.; Jackson R.; Marhefka G.; McElveen W.; Mooss
A.; Morris P.; Murray J.; Pearlstein P.; Raisinghani A.; Rezkalla S.;
Sakhrani L.; Schreibman D.; Shaoulian E.; Steinsapir J.; Yataco A.; De La
Cruz A.; Fredrick M.; Goldenberg E.; Lee D.; McCullum K.; McLellan B.;
Stephens L.; Wilson S.; Alfieri A.; Mandviwala M.; ORourke D.; Samal A.;
Schmedtje J.; Waxman F.; Carhart R.; Clements B.; Dyke C.; Ghali J.;
Gruberg L.; Hack T.; Jehle A.; Pogue B.; Schooley C.; Shifrin G.
Institution
(Sabatine, Giugliano, Wiviott, Murphy, Kuder) Division of Cardiovascular
Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115,
United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Honarpour, Wang, Liu, Wasserman) Amgen, Thousand OaksCAUnited States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Evolocumab is a monoclonal antibody that inhibits proprotein
convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density
lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it
prevents cardiovascular events is uncertain. METHODS We conducted a
randomized, double-blind, placebo-controlled trial involving 27,564
patients with atherosclerotic cardiovascular disease and LDL cholesterol
levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were
receiving statin therapy. Patients were randomly assigned to receive
evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching
placebo as subcutaneous injections. The primary efficacy end point was the
composite of cardiovascular death, myocardial infarction, stroke,
hospitalization for unstable angina, or coronary revascularization. The
key secondary efficacy end point was the composite of cardiovascular
death, myocardial infarction, or stroke. The median duration of follow-up
was 2.2 years. RESULTS At 48 weeks, the least-squares mean percentage
reduction in LDL cholesterol levels with evolocumab, as compared with
placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4
mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P<0.001).
Relative to placebo, evolocumab treatment significantly reduced the risk
of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%];
hazard ratio, 0.85; 95% confidence interval [CI], 0.79 to 0.92; P<0.001)
and the key secondary end point (816 [5.9%] vs. 1013 [7.4%]; hazard ratio,
0.80; 95% CI, 0.73 to 0.88; P<0.001). The results were consistent across
key subgroups, including the subgroup of patients in the lowest quartile
for baseline LDL cholesterol levels (median, 74 mg per deciliter [1.9 mmol
per liter]). There was no significant difference between the study groups
with regard to adverse events (including new-onset diabetes and
neurocognitive events), with the exception of injection-site reactions,
which were more common with evolocumab (2.1% vs. 1.6%). CONCLUSIONS In our
trial, inhibition of PCSK9 with evolocumab on a background of statin
therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter
(0.78 mmol per liter) and reduced the risk of cardiovascular events. These
findings show that patients with atherosclerotic cardiovascular disease
benefit from lowering of LDL cholesterol levels below current
targets.<br/>Copyright &#xa9; 2017 Massachusetts Medical Society.

<2>
Accession Number
604918312
Title
Ezetimibe added to statin therapy after acute coronary syndromes.
Source
New England Journal of Medicine. 372 (25) (pp 2387-2397), 2015. Date of
Publication: 18 Jun 2015.
Author
Cannon C.P.; Blazing M.A.; Giugliano R.P.; McCagg A.; White J.A.; Theroux
P.; Darius H.; Lewis B.S.; Ophuis T.O.; Jukema J.W.; De Ferrari G.M.;
Ruzyllo W.; De Lucca P.; Im K.; Bohula E.A.; Reist C.; Wiviott S.D.;
Tershakovec A.M.; Musliner T.A.; Braunwald E.; Califf R.M.; Musliner T.;
Tershakovec A.; Gurfinkel E.; Aylward P.; Tonkin A.; Maurer G.; Van de
Werf F.; Nicolau JC.; Genest J.; Armstrong P.; Corbalan R.; Isaza D.;
Spinar J.; Grande P.; Voitk J.; Bassand JP.; Farnier M.; Keltai M.; Mathur
A.; Mittal S.; Reddy K.; White H.; Pedersen T.; Britto F.; Carrageta M.;
Duris T.; Dalby A.; Seung KB.; Lopez-Sendon J.; Dellborg M.; Mach F.;
Guneri S.; Parkhomenko A.; Brady A.; Ballantyne C.; de Lemos J.; Kleiman
N.; McGuire DK.; Centeno E.; Casalins M.; Cartasegna L.; Beltrano MC.;
Guerrero R.; Fanuele M.; Berra F.; Egido J.; Colombo H.; Dellatorre M.;
Terns P.; Blumberg E.; Reges P.; Azize G.; Ramos H.; Fernandez R.;
Carlessi C.; Milesi R.; Schmuck R.; Duronto E.; Procopio G.; Carlevaro O.;
Maffeo H.; Beloscar J.; Viso M.; Hominal M.; Castoldi M.; Bluguermann J.;
Mauro D.; Macin S.; Cocco N.; Ruiz N.; Ricart J.; Lozada A.; Nani S.;
Turri D.; Fernandez H.; Caruso O.; Zarandon R.; Bono J.; Arias V.; Allall
O.; Marino J.; Cusimano S.; Schygiel P.; Buzetti C.; Penaloza N.; Berli
M.; Worthley S.; Roach A.; Chew D.; Wright T.; Leitch J.; Hicks E.; Rankin
J.; Venn-Edmonds C.; Lehman R.; Morrison H.; Shaw J.; Mak V.; Hii C.;
Smith K.; Cross D.; Lilwall L.; Nelson G.; Loxton A.; Horowitz J.; Rose
J.; Steinwender C.; Leisch F.; Kammler J.; Brussee H.; Zweiker R.; Niederl
E.; Weihs W.; Giorgio G.; Lang I.; Drexel H.; Zanolin D.; Hoppe U.;
Atzenhofer-Baumgartner K.; Pichler M.; Hainzer D.; Eber B.; Pichler F.;
Foeger B.; Wechselberger T.; Mayr H.; Hofer J.; Stockenhuber F.; Warlits
B.; Huber K.; Egger F.; Weidinger F.; Ziegler B.; Jirak P.; Metzler B.;
Pachinger O.; Wanitschek M.; Auer J.; Grabscheit G.; Podczeck-Schweighofer
A.; Priesnitz T.; Frank H.; El Allaf D.; Marechal P.; Roosen J.; Joly E.;
Lefebvre P.; Arend C.; Sinnaeve P.; De Velder L.; Hellemans S.;
Vanhauwaert B.; Van Dorpe A.; Heyse A.; Vantomme C.; Striekwold H.; Van
Den Broeck D.; Lancellotti P.; Schoors D.; Lemoine I.; Taeymans Y.; De
Wolf L.; Brike C.; Vercauteren S.; Tahon S.; Vervoort G.; Mestdagh I.;
Pirenne B.; Cardinal F.; Lips S.; Dujardin K.; Debrouwer K.; Dhooghe G.;
Holvoet G.; van de Borne P.; Renard M.; De Clippel M.; Lesseliers H.; Van
Miert N.; Saraiva J.; Vicente C.; Rossi P.; Dos Santos LB.; Duda N.;
Tognon AP.; Serrano C.; Gomes FL.; Manenti ER.; Silveira DS.; Maia L.;
Mouco OM.; Paiva M.; Antonangelo A.; de Souza J.; Lino EA.; Leaes P.;
Blacher MG.; Kormann A.; Ultramari FT.; Dutra O.; Mendelski AM.; Morgado
S.; Ardito W.; Greque G.; Ardito RV.; Pimentel Filho P.; Zucchetti C.;
Alves A.; Seabra AM.; Mattos M.; Miranda LF.; Silva D.; Uehara RM.; Marin
Neto J.; Schmidt A.; Braga J.; Rodrigues A.; Abrantes J.; Pinheiro L.;
Bodanese L.; Magedanz E.H.; Piegas L.; Dos Santos ES.; Wainstein M.;
Ribeiro J.; Stein R.; Marino R.; Machado VM.; Moraes Junior J.; Guimaraes
S.; da Costa FA.; Ferraz RF.; Albuquerque D.; Rocha RM.; de Carvalho
Moreira R.; Dohmann H.; Costantini C.; Tarastchuk JC.; Coelho O.; Cirillo
W.; Sousa A.; Almeira AS.; Stefanini E.; Silva F.; Teixeira M.; da Cunha
C.; Precoma D.; Facchi TL.; Rupka D.; Thiessen S.; Warnica J.; Smith B.;
Della Siega A.; Klinke P.; Nelson S.; Dion D.; Gilbert N.; Hui W.; Kvill
L.; Sussex B.; Luther A.; Dupuis R.; Ouimet F.; Pandey A.; Clarus S.;
Senaratne M.; Ferdinandis H.; Mukherjee A.; Bozek B.; Vizel S.; Markov G.;
Zimmermann R.; Stephens W.; Tremblay B.; Wong G.; Uchida N.; Brossoit R.;
Peck C.; Van Kieu C.; Forgione M.; Bata I.; Cossett J.; Kostuk W.; Arnold
M.; Bone C.; Grondin F.; Bilodeau N.; Gosselin G.; David M.; Giannoccaro
J.; Beresford P.; Polasek P.; Roberts P.; Doucet M.; Beaudry M.; Cheung
S.; Cleveland T.; Bhargava R.; McCallum A.; Ma P.; Morrissette J.;
Cleveland D.; Chadwyn D.; Nigro F.; Weeks A.; Cryderman C.; Leader R.;
Houde G.; Rousseau S.; Pearce M.; Radyk M.; Lonn E.; Magi A.; Lefkowitz
C.; Sandrin F.; Coffin N.; Lubelsky B.; Coldwell J.; Habot J.; McPherson
C.; De Larochelliere R.; Roy M.; Haichin R.; Barber C.; Bhesania T.;
Kitagawa H.; To T.; Donnelly B.; Tymchak W.; Harris L.; Kouz S.; Huynh T.;
St Jacques B.; Lamy A.; Rizzo A.; Stein J.; Childs C.; Wong B.; Poirier
R.; Gupta M.; Dela Cruz C.; Constance C.; Gauthier M.; Ervin F.; Ouellette
M.; Kokis A.; Lemay C.; Kwok K.; Leung C.; Lee D.; Nesmith J.; Renton J.;
Syan G.; Turek M.; Hogan D.; Griffin P.; Lipson A.; Winestock J.; Abramson
B.; Fogel A.; Gagne C.; Bergeron J.; Clarke A.; Slipp S.; Darcel I.;
Carling-Chambers L.; Kannampuzha P.; Pallie S.; Krekorian S.; Vertes G.;
Roth S.; Lai K.; Heath J.; Arriagada G.; Castro P.; Villa F.; Ramos G.;
Baraona F.; Nunez A.; Garcia M.; Jofre C.; Silva P.; Lamich R.; Yovaniniz
P.; Escobar E.; Dussaubat A.; Segura E.; Ramirez M.; Lapostol C.; Palma
A.; Encina L.; Zapata M.; Baeza N.; Varela P.; Perez L.; Jaramillo C.;
Ruiz S.; Sanchez G.; Perdomo I.; Manzur F.; Cohen LE.; Velasquez J.; Arana
C.; Alvarez Y.; Triana M.; Balaguera J.; de Salazar D.; Rendon N.; Botero
R.; Ruiz A.; Saaibi J.; Medina J.; Jaramillo M.; Calderon M.J.; Delgado
J.; Bohorquez R.; Medina MF.; Herrera M.; Rosales D.; Mendoza F.; Martinez
S.; Ternera A.; Castro R.; Baiz A.; Martinez M.; Orozco A.; Suarez M.;
Fonseca Y.; Beltran R.; Cepeda M.; Jaramillo N.; Valenzuela C.; Gutierrez
M.; Sanchez A.; Vitovec J.; Hlinomaz O.; Poloczek M.; Mayer O.; Veselka
J.; Vejvoda J.; Soucek M.; Spac J.; Novobilsky K.; Srp V.; Francek L.;
Branny M.; Sknouril L.; Motovska Z.; Rohac F.; Stankova A.; Fiala T.;
Holub M.; Zeman K.; Pohludkova L.; Pospisilova E.; Tuma P.; Cihalik C.;
Oral I.; Podpera I.; Stepanovova R.; Uricar M.; Solar M.; Pelouch R.;
Porzer M.; Grussmannova K.; Stipal R.; Reichert P.; Hradec J.; Kral J.;
Sejkova B.; Janek B.; Pitha J.; Linhart A.; Polacek P.; Koeber L.;
Clemmensen P.; Hebin CH.; Schmidt E.; Pedersen MS.; Roseva-Nielsen N.;
Kristensen K.; Bang-Hansen T.; Jensen J.; Laage-Petersen J.; Nielsen H.;
Stokholm E.; Thayssen P.; Cappelen H.; Jensen T.; Winther-Friis B.;
Klausen I.; Hedegaard B.; May O.; Andersen M.; Bottzauw J.; Lush A.;
Markenvard J.; Vestager KM.; Bronnum-Schou J.; Hempel H.; Petersen J.;
Nielsen AJ.; Thomsen K.; Nielsen T.; Nygaard A.; Sykulski R.; Jensen BS.;
Ralfkiaer N.; Gottschalck H.; Rasmussen S.; Pedersen LR.; Dodt K.;
Skovsbol M.; Andersen O.; Tuxen C.; Meier AW.; Kristensen T.; Rasmussen
O.; Lopez J.; Salazar D.; Sanchez L.; Rosero F.; Penaherrera E.; Duarte
YC.; Marmol R.; Andrade G.; Guzman E.; Morillo A.; Aug L.; Loogna I.;
Laanmets P.; Mustonen J.; Mantyla P.; Kesaniemi A.; Ukkola O.; Kervinen
H.; Juhela S.; Juvonen J.; Toppinen A.; Jarvenpaa J.; Syvanne M.; Svahn
T.; Voutilainen S.; Huotari A.; Nikkila M.; Raiskinmaki S.; Kotila M.;
Rajala A.; Laukkanen J.; Hiltunen P.; Melin J.; Nyman K.; Luukkonen J.;
Kosonen P.; Huttunen M.; Seppanen V.; Airaksinen J.; Juonala M.; Lehto S.;
Savolainen K.; Halkosaari M.; Sia J.; Palomaki A.; Luoma J.; Utriainen S.;
Valpas S.; Tiensuu T.; Lilleberg J.; Kainulainen R.; Schiele F.; Bassand
J.; Meneveau N.; Galinier M.; Jean M.; Martelet M.; Mouallem J.; Elbaz M.;
Puel J.; Carrie D.; Coisne D.; Varroud-Vial N.; Jaboureck O.; Dujardin J.;
Leroy F.; Mansourati J.; Funck F.; Jourdain P.; Guillard N.; Coviaux F.;
Gay A.; Dourmap-Collas C.; Froger-Bompas C.; Paillard F.; Tricot O.;
Maquin-Mavier I.; Dubois-Rande J.L.; Pongas D.; Paris AP.; Delahaye F.;
Ovize M.; Benyahya L.; Bonnet J.; Belle L.; Mangin L.; Lafitte B.; Zemour
G.; Doux N.; Agraou B.; El Mansour N.; Traisnel G.; El Jarroudi M.;
Ohlmann P.; Diadema B.; Escande M.; Legros G.; Demarcq JM.; Haftel Y.;
Alsagheer S.; Dambrine P.; Cottin Y.; Ghostine S.; Caussin C.; Gacem A.;
Bouvier JM.; Poulard J.; Davy J.; Furber A.; Prunier F.; Muenzel T.;
Genth-Zotz S.; Appel K.; Kretzschmar D.; Ferrari M.; Terres W.; Uher T.;
Schulze H.; Ochs H.; Morbach S.; Duengen H.; Gross M.; Oezcelik C.;
Tahirovic E.; Heuer H.; Laschewski B.; Kadel C.; Rahn G.; Steiner S.;
Kreuzer J.; Tsoy I.; Zeiher A.; Muegge A.; Hanefeld C.; Boehm S.; Boudriot
E.; Hodenberg E.; Lippe B.; Hausdorf C.; Sydow K.; Baldus S.; Schlesner
C.; Tiroch K.; Haltern G.; Guelker H.; Wilhelm J.; Dietz S.; Ebelt H.;
Buerke M.; Rupprecht H.; Rittgen J.; Schaeufele T.; Meinhardt G.; Schieber
M.; Honold M.; Sieprath S.; Nienaber C.; Hacker J.; Butter C.; Lapp H.;
Hirn S.; Pauschinger M.; Zahn R.; Scheffler U.; Schaefer A.; Schieffer B.;
Tebbe U.; Kriete M.; Mudra H.; Raeder T.; Braun P.; Zeymer U.; Kouraki K.;
Reppel M.; Schunkert H.; Weil J.; Olbrich H.; Schwaiger P.; Mueller O.;
Blessing E.; Buss I.; Bohlscheid V.; Kaddatz J.; Skowasch D.; Nickenig G.;
Twelker K.; Osterhues H.; Varghese T.; Burghard S.; Kaeaeb S.; Klauss V.;
Sohn HY.; Hauptmann K.; Schulze M.; Gall K.; Felix S.; Doerr M.; Mante J.;
Gulba D.; Freick M.; Werner G.; Kleinertz K.; Hobbach HP.; Halbach M.;
Mueller-Ehmsen J.; Mueller ME.; Mitrovic V.; Peil A.; Laufs U.; vom Dahl
J.; Baumanns S.; Scholtz W.; Wiemer M.; Haude M.; Van de Loo A.; Pistorius
K.; Schaefer J.; Schwinger R.; Goeing O.; Jung W.; Birkemeyer R.; Lee W.;
Kong S.; Yu C.; Chui K.; Merkely B.; Szelenyi Z.; Polgar P.; Svab S.;
Herczeg B.; Bajcsi E.; Vertes A.; Davidovits S.; Nagy A.; Kiraly C.;
Lupkovics G.; Kenez A.; Poor F.; Takacs J.; Kirschner R.; Simonyi G.;
Koncz J.; Edes I.; Gergely S.; Katona A.; Nagy E.; Kovacs Z.; Gyetvai I.;
Salamon C.; Kolman E.; Sitkei E.; Csapo K.; Molnar K.; Mezo I.; Sereg M.;
Reddy P.; Manjunath C.; Narayanappa S.; Kumar S.; Sinha N.; Kapoor A.;
Christopher J.; Reddy G.; Rani M.; Oomman A.; Ramamurthee K.; Kumar N.;
Pasha SS.; Rao C.; Murty GS.; Chopra A.; Kapila D.; Bali H.; Chattree K.;
Hasan O.; Suryaprakash G.; Rao D.; Babu R.; Bhargavi M.; Naik S.; Khan S.;
Chopra V.; Sapra R.; Kaul U.; Ghose T.; Menon R.; Battikadi S.; Mullasari
A.; Subban VK.; Dani S.; Iby M.; Chandra P.; Sethi S.; Bhargava M.; Arora
P.; Tyagi G.; Padmanabhan T.; Malhotra S.; Talwar K.; Shafiq N.; Kasliwal
R.; Bansal M.; Eldar M.; Berger M.; Shechter M.; Atar S.; Roguin N.;
Kilimnik M.; Hayek T.; Hamoud S.; Katz A.; Plaev T.; Shotan A.; Vazan A.;
Weiss A.; Leibowitz D.; Zimlichman R.; Ben-Aharon J.; Hammerman H.; Dragu
R.; Rozenman Y.; Witzling V.; Tzivoni D.; Moriel M.; Halkin A.; Sheps D.;
Bogomolny N.; Mosseri M.; Khudyak Y.; Halabi S.; Uziel-Iunger K.; Yuval
R.; Shimoni S.; Caspi A.; Botwin S.; Gavish D.; Sandler A.; Pollak A.;
Kreisberg B.; Hussein O.; Jabal K.; Henkin Y.; Grosbard A.; Rosenschein
U.; Rivlin E.; Zeltser D.; Platner N.; Porter A.; Harel N.; Lishner M.;
Elis A.; Karny M.; Fuchs S.; Stein G.; Grossman E.; Gealel Z.; Schlaeffer
F.; Liberty I.; Golik A.; Tzuman O.; Pavesi C.; Poggio L.; Damiano S.;
Pazzano AS.; Mennuni M.; Paloscia L.; Mascellanti M.; Piovaccari G.;
Grosseto D.; Mascia F.; Vetrano A.; Zingarelli A.; Mazzantini S.; Visconti
L.; Terzi G.; Senni M.; Gavazzi A.; Scuri P.; Carmelo M.; De Caterina R.;
Conti M.; Novo S.; Graceffa A.; Arvigo L.; Lunetta M.; Filardi P.;
Chiariello M.; Scala O.; Pirozzi E.; Musella F.; Moretti L.; Testa M.;
Vicentini A.; De Feo S.; Biasucci L.; Cardillo MT.; Puccioni E.; Galli M.;
Menegato A.; Margheri M.; Maresta A.; Gatti C.; Guarini P.; Damiano M.;
Golino P.; Porcu M.; Fele N.; Gensini G.; Lombardi A.; Ciuti G.; Bernardi
D.; Mariani P.; Paolini E.; Marenzi G.; Moltrasio M.; Terrosu P.; Chessa
P.; Guglielmino G.; Miccoli F.; Oldoino E.; Ragni M.; Poli M.; Basso V.;
Rapezzi C.; Branzi A.; Gallelli I.; Perna G.; Guazzarotti F.; Marra S.;
Usmiani T.; Olivari Z.; Calzolari D.; Santoro G.; Minneci C.; Achilli A.;
Nassiacos D.; Sommariva L.; Romeo F.; Fedele F.; Foschi ML.; Bruno N.;
Centurion C.; Patrizi G.; De Maria E.; Gonnelli S.; Vichi V.; Cassadonte
F.; Rotella G.; Capucci A.; Villani G.; Gaspardone A.; Ferrante R.; Scollo
V.; Pancaldi L.; Sacca S.; Gabrielli D.; Ciliberti D.; Savini E.; Binaghi
G.; Di Biase M.; Ieva R.; Fattore L.; Cicia G.; Cavallini C.; Tamburino
C.; Sacco A.; Mafrici A.; Di Pasquale G.; Pavesi PC.; Scioli R.; Lioy E.;
Occhiuzzi E.; Matino MG.; Russo V.; Moscogiuri MG.; Cuccia C.; Forgione
C.; Volpe M.; Palano F.; Branca G.; Rossi R.; Modena M.; Olaru IA.; Zanini
R.; Cianflone D.; Cristell N.; Pantaleoni M.; Guiducci U.; Menozzi C.;
Gaddi O.; Fasulo A.; Indolfi C.; Emanuele V.; Guerra F.; Iliceto S.;
Marotta C.; Morocutti G.; Presbitero P.; Rossi M.; Bonatti S.; Grieco A.;
Chiodi L.; Betti I.; Zuppiroli A.; Fanelli R.; Stanco G.; Azzolini P.;
Ruggieri C.; Bocconcelli P.; Airoldi F.; Tavano D.; Brunelli C.; Caso P.;
Scalzone A.; Ghigliotti G.; Facciorusso A.; Sim K.; Kiam O.; Chee K.; Bin
Ismail O.; Zambahari R.; Ophuis T.; van Nes E.; Werter CJ.; Ophuis AJ.;
Troquay RP.; Hamer BJ.; Lenderink T.; Feld RJ.; van Hessen MW.; Viergever
EP.; van der Sluis A.; Lok DJ.; Badings EA.; Nierop PR.; Danse IY.;
Hermans WR.; Holwerda NJ.; Thijssen HJ.; Theunissen LJ.; van der Zwaan C.;
Van Den Berg BJ.; Hendriks IH.; Ronner E.; Withagen AJ.; Dijkshoorn-Giesen
AH.; Ezechiels JP.; Kuijper AF.; Den Hartog FR.; Van Kalmthout P.M.; Buijs
EM.; van der Zeijst M.; Zwart PA.; Zuidgeest JA.; van Eck M.; Daniels MC.;
van der Ven-Elzebroek N.; Van't Hof A.; van Boven AJ.; van der Weerdt A.;
Dunselman PH.; Alings MA.; van Es RF.; The SH.; Gurlek C.; Liem AH.; van
Lennep HW.; Van Vlies B.; Kalkman C.; Swart HP.; van der Bij P.; Taverne
R.; Ciampricotti R.; van Dam C.; Spierenburg H.; van Ruijven I.; van
Kempen L.H.; Willems FF.; Dirkali A.; Stoel I.; Plomp J.; Veldmeijer S.;
Tjeerdsma G.; Nijmeijer R.; Van Hal JM.; Bartels GL.; Posma JL.; Linssen
GC.; Fauser CG.; Waalewijn RA.; Groenemeijer BE.; Pos L.; Fast JH.; Droste
HT.; Westenburg J.; Veenstra W.; Koolen J.; van Loo LW.; Smits W.; Milhous
JG.; van Rossum P.; Stuij S.; Scott R.; Richards AM.; Morrison Z.; Devlin
G.; Fisher R.; Stewart R.; Benetar J.; Voss J.; Wong S.; Scott D.; Luke
R.; Tang E.; Davidson L.; Hamer A.; Wilson S.; Price R.; Hart H.; Turner
A.; Jortveit J.; Calic S.; Gundersen T.; Brunvand H.; Fosse L.; Nygaard
O.; Gjellefall B.; Gravdal SA.; Ringstad R.; Atar D.; Clausen H.; Hysing
J.; Arvesen K.; Topper M.; Flagstad E.; Graven T.; Haug HH.; Dalin L.;
Al-Ani R.; Otterstad J.; Ausen K.; Aaser E.; Olufsen M.; Halvorsen S.;
Gullestad L.; Stueflotten W.; Waage K.; Stodle R.M.; Hall C.; Aase O.;
Nordeng J.; Soyland E.; Fageraas ER.; Lied A.; Aske R.; Raouf N.;
Johansson J.; Herrscher T.; Skogrand E.; Bjornstad H.; Aagnes I.; Arntsen
BI.; Vegsundvaag J.; Skjold ME.; Velle H.; Aambakk MB.; Skjetne O.;
Byfuglien A.; Rodriguez J.; Galvez D.; Medina F.; Hernandez HA.; Chavez
V.; Morales R.; Huapalla E.; Velasquez D.; Torres F.; Aguirre O.; Yanez
L.; Andrade M.; Campos C.; Arce R.; Mogrovejo W.; Osores F.; Bustamante
G.; Rodriguez M.; Berrospi P.; Talledo M.; Navarro P.; Horna M.; Herrera
V.; Kadziela J.; Rybicka-Musialik A.; Trusz-Gluza M.; Berger-Kucza A.;
Musial W.; Tycinska A.; Gil R.; Gziut A.; Gorny J.; Tyllo M.; Reszka Z.;
Mickiewicz-Pawlowska M.; Wrzosek B.; Kosior J.; Staneta P.; Korzeniak R.;
Kalarus Z.; Markowicz E.; Miekus P.; Konarzewski M.; Kleinrok A.; Puzniak
M.; Grajek S.; Janus M.; Krzyzanowski M.; Hoffmann A.; Muzalewski P.;
Polonski L.; Kazik A.; Nowalany-Kozielska E.; Wojciechowska C.; Ponikowski
P.; Nawrocka S.; Filipiak K.; Serafin A.; Dubiel J.; Mielecki W.; Ogorek
M.; Kopcik D.; Jaworska K.; Skonieczny G.; Kawecka-Jaszcz K.; Bryniarski
L.; Tracz W.; Lesniak-Sobelga A.; Jankielewicz J.; Zaluska R.; Trojnar R.;
Kawalek P.; Gaciong Z.; Pulkowski G.; Anaszewicz M.; Samul W.; Adamus J.;
Cholewa M.; Kubik L.; Szczechowicz R.; Rekosz J.; Kwiatkowska D.; Gajek
J.; Mazurek W.; Kominek M.; Siminiak T.; Guzniczak E.; Monteiro P.;
Providencia L.; Monteiro S.; Pinho T.; Gavina C.; Sousa C.; Loureiro J.;
Ferreira AR.; Cardoso A.; Araujo J.; Rebolo I.; Catarino C.; Santos J.;
Nunes LP.; Mimoso J.; Marques N.; Leitao M.; Pais J.; Fernandes A.; Diogo
A.; Nobrega J.; Moreira JI.; Mateus P.; Oliveira J.; Selas M.; Ribeiro V.;
Albuquerque A.; Reis R.; Ramos A.; Salazar F.; Nair D.; Ng CK.; Yeo D.;
Wong A.; Funiak S.; Belicova M.; Striezova I.; Krajci P.; Sojka G.; Herman
O.; Zemberova A.; Pella D.; Fedacko J.; Banikova A.; Micko K.; Macek V.;
Moscovic M.; Vahala P.; Vykoukalova T.; Dzupina A.; Marusakova M.; Stevlik
J.; Akubzanova E.; Hatalova K.; Burgess L.; Coetzee C.; Mabin T.; Roos J.;
Mohamed Z.; Pillay T.; Corbett C.; Bodenstein W.; Tayob F.; Ebrahim I.;
Bolsman C.; Horak A.; Lloyd E.; Pretorius M.; Commerford P.; De Andrade
M.; Roux J.; Murray A.; Soma P.; Delport E.; Cassel G.; Van Zyl L.; Cronje
T.; Sarvan M.; Moodley R.; Guerra M.; Swanepoel N.; Bayat J.; Klug E.;
Hellig S.; Yoon J.; Kim J.; Chung W.; Choi Y.; Cho M.; Lee S.; Kwon H.;
Hong B.; Seung K.; Chang K.; Rha S.; Jeong MH.; Hong Y.; Lee C.; Seong I.;
Jeong J.; Tahk S.; Yoon M.; Chae SC.; Kim H.; Lopez V.; Roldan JM.;
Mancisidor P.; Froufe J.; Lopez A.; Franco S.; Molina A.; Soriano F.;
Cobos M.; Mejia H.D.; Sanz R.; Vazquez A.; Garri F.; Esteban I.; Marco P.;
Artaecheverria J.; Cequier A.; Esplugas E.; Gonzalez J.; de Sa E.; Armada
E.; Worner F.; Hernandez I.; Roncales F.; Gomollon J.; del Rio A.; Alameda
J.; Basilio E.; Rafols M.; Ferres R.; Molla C.; Pascual J.; Cortada J.;
Garcia C.; Iglesias G.; Villa E.; Aros F.; Goya I.; Bueno M.; Pereira RV.;
Clavero X.; Pasaron CD.; Jorda R.; Pereira R.; Perez O.; de Teresa E.;
Navarro M.; de la Guia F.; Lozano T.; Antorrena I.; Aranda M.; Alonso L.;
Mirelis J.; Alcasena S.; Paniagua VA.; Juanatey J.; Gregorian L.; Munoz
J.; Escorihuela A.; Sanz A.; Flores A.; Garcia PA.; Alfonso F.; Marin E.;
Lozano A.; Bethencourt A.; Grau A.; Rubio A.; Sala J.; Royuela N.; San
Jose J.; Bugos V.; de Valdecilla H.; Martin J.; Jimenez R.; Felgueres M.;
Escalera P.; Ruiz R.; Bescos L.; Sanchez I.; Chavarri M.; Casares G.;
Johanson P.; Hultsberg-Olsson G.; Witt N.; Samad B.; Damm T.; Risenfors
M.; Ortgren L.; Henareh L.; Jernberg T.; Berglund M.; Karlsson J.; Koch
A.; Lycksell M.; Lundgren C.; Herlitz J.; Sjolin M.; Erlinge D.; Matson
E.; Cizinsky S.; Carlsson F.; Ryttberg B.; Johansson K.; Tygesen H.;
Bergsten J.; Naslund U.; Sundholm C.; Timberg I.; Wikstrom P.; Hardhammar
P.; Lisbeth A.; Lund L.; Hage C.; Rosenqvist U.; Grandas M.; Larsson L.;
Hammerman A.; Andersson G.; Johansson S.; Bennermo M.; Tjerneld H.;
Forsgren M.; Eriksson K.; Eriksson M.; Bengtsson PO.; Yu W.; Ceder-Brolin
K.; Stafberg C.; Andersson E.; Roussine V.; Angman K.; Melin B.; Thorsen
S.; Lundell L.; Buijs F.; Ostberg S.; Sigaud P.; Moccetti T.; Bondio M.;
Kuehlkamp V.; Pieper M.; Gallino A.; Zender H.; Genne D.; Gauthey J.;
Wilhelm M.; Saner H.; Trachsel L.; Roethlisberger C.; Schlaepfer H.;
Kujawski T.; Pagnamenta A.; Meyer-Monard S.; Krapf R.; Biedermann B.;
Schneider H.; Rickli H.; Ramsay D.; Linka A.; Ballmer P.; Oswald M.; Girod
G.; Charng M.; Shu-Ling H.; Ping-Han L.; Wu C.; Liu S.; Lin M.; Chian-Yi
W.; Yeh H.; Mei-Juan C.; Hsieh I.; Wang Y.; Ural E.; Sahin T.; Yildiz Z.;
Kayikcioglu M.; Kultursay H.; Yigit Z.; Calpar I.; Ata N.; Goktekin O.;
Senol U.; Yalcin R.; Timurkaynak T.; Kaya U.; Yildirir A.; Karacaglar E.;
Faynyk A.; Sorokivskyy M.; Koval O.; Kaplan P.; Kraiz I.; Popova K.; Kyyak
Y.; Barnett O.; Karpenko O.; Todoriuk L.; Tseluyko V.; Kopytsya M.;
Petyunina O.; Kovalskyy I.; Zhukova Y.; Katerenchuk I.; M'yakinkova L.;
Lutay Y.; Syvolap V.; Kyselov S.; Vakaliuk I.; Nesterak R.; Nikonov V.;
Feskov O.; Goloborodko B.; Golovtsev Y.; Berezniakov I.; Lebedynska M.;
Rudenko L.; Tutov I.; Ahsan A.; Burton J.; Levy T.; Lakeman N.; Spratt J.;
Langford E.; Sutcliffe S.; Khwanda A.; Davis G.; Rodrigues E.; Dickinson
D.; Been M.; Trouton T.; Riddell J.; Moriarty A.; McEneaney D.; Squire I.;
Narayan H.; Goode G.; Helliwell L.; Boos C.; Greaves K.; Knops K.; Pegge
N.; Signy M.; Wong Y.; Moore S.; Fluck D.; Atkinson C.; Adgey A.; McKeag
N.; Bishop A.; Glover J.; Barbir M.; Breen J.; Robson H.; Townend J.;
Dwenger E.; Ekpo E.; Shakespeare C.; Barr C.; McClements B.; McAllister
A.; De Belder M.; Cooke J.; Williams S.; Daniel D.; Pye M.; Griffith K.;
Wright L.; Trevelyan J.; Doughty A.; Hughes E.; Phillips C.; Penny W.;
Groves P.; Kardos A.; Purvis J.; McNeill A.; Jones A.; Brown J.; Saeed B.;
Sprigings D.; Herity N.; Brown C.; Unks M.; Cauthren T.; Bertolet B.;
Jones M.; Decker S.; Chambers J.; Stahlberg J.; Varma S.; Gencheff N.;
Price A.; McElroy D.; Chu A.; Crutchfield B.; Eaton G.; Looney A.; Qureshi
M.; Wilks J.; Drenning D.; Overman A.; Andreou C.; Russo P.; Stuckey T.;
Pruitt H.; D'Urso M.; DeRaad R.; Rogers W.; Thorington S.; Pasquini J.;
Iwaoka R.; Tannenbaum M.; Prouty D.; Wiseman A.; Sharow A.; Graham B.; Ali
MI.; Dale H.; Tarsi D.; Picone M.; Juarez S.; Hamroff G.; Hollenweger L.;
Scirica B.; Sabatine M.; Marti J.; Perlman R.; Pavlides A.; Joffe I.;
Albirini A.; Campbell T.; Puri S.; Lopez C.; Pearce D.; Shah D.; McPherson
J.; Donegan R.; Murdock D.; Block D.; Malik A.; Musina R.; Dauber I.;
Varner C.; Bach R.; Palazzolo M.; Bhalla H.; Thompson M.; Pollock S.;
Johnson S.; Lipson L.; Brunk S.; Karas S.; Vicari R.; Kuvin J.; Mooney P.;
Aycock G.; Lane B.; Sharma M.; Gibson T.; Chang G.; DiVito P.; Mehta R.;
Watkins K.; Chiu A.; Gunderson J.; Tedder B.; Williams P.; Hage-Korban E.;
Childs A.; Banerjee S.; Kazi F.; Bennett J.; Barnes D.; Wohns D.; Noorman
C.; Aggarwal K.; Lau-Sickman A.; Paulowski J.; Amos M.; Rider J.; Fenton
S.; Schantz M.; Hakas J.; Mcsorley J.; Felten W.; Bitzer V.; Russell J.;
Loyo J.; Adjei A.; Mehta K.; Uretsky B.; Hale M.; Shaikh S.; Miller M.;
Hollenbaugh D.; Crawford K.; Fortuin D.; Galindo A.; Del Core M.; Butkus
E.; Collins J.; Prior J.; Hahn R.; Greene-Nashold J.; Alexander J.; Genova
E.; MacDonell A.; Broadwater S.; Kereiakes D.; White D.; Lopez M.; Schenks
R.; Lui H.; Gibbons P.; Davis B.; Thornton K.; Daley P.; Budzon S.;
McCullum K.; Delio-Cox B.; Nadar V.; Keim S.; McLaurin B.; Davis C.; Betzu
R.; Al-Jumaily J.; Bolli R.; Alshaher M.; Leesar M.; Collins T.; Akkad H.;
Bilazarian S.; Marsters M.; Kennett J.; Melegrito K.; Mostel E.; Harris
R.; Chang M.; Hatfield G.; Makam S.; Garvey M.; Levite H.; Abdel-Latief
A.; Pelletier L.; Carr K.; Mckenna K.; Soto G.; Kozina J.; Harris D.;
Vlastaris A.; Bittel B.; Riba A.; Gugudis J.; Singh N.; Qureshi I.; Doty
W.; Lehmann J.; Lieber I.; Martin S.; Nicu M.; Bhalodkar N.; Ravi P.;
Canto J.; Bass M.; Campbell C.; Steinhubl S.; Moles K.; Harjai K.;
Stapleton DD.; Hoey K.; Erwin J.; Fikes W.; Stein B.; Sabatino K.;
Teklinski A.; Colfer H.; Ward P.; Langevin E.; Faucett S.; Mamdani S.;
DeSimone L.; Tuohy E.; Cullen T.; Eisenberg S.; Chronos N.; Allen RP.;
Erickson B.; Mahon K.; Kirby A.; Siegel C.; Stroud L.; Johnson J.; Panchal
V.; Pearson A.; Abell T.; De Gregorio M.; Boomer L.; Vahdat O.; VanNatta
B.; Long P.; Chalavarya G.; Skatrud L.; Carey C.; Wright W.; Mechem C.;
Matthews B.; Adams A.; Vora K.; Wead J.; Koren M.; Gregory D.; El Khadra
M.; Peacock G.; Kieval J.; Barron M.; Lewis D.; Grice R.; Bobek M.; Moore
C.; Nygaard T.; Fischell T.; Salman W.; Schneider C.; Muhlestein B.;
Peeler D.; Chang D.; Todd A.; Chilakamarri V.; Hanley P.; Gelormini J.;
Iacona MA.; Effron B.; Mazzurco S.; Mazzella M.; Wyman P.; Orchard R.;
Battin D.; Rezkalla S.; Bishop C.; Sharp S.; Gredler F.; Knap P.; Fadel
M.; Saucedo J.; Keng A.; Imburgia M.; Blank E.; Effat M.; Khoury S.;
Mardis R.; Baldari D.; Tafuri L.; Mascolo R.; Taylor D.; Mandviwala M.;
Khan W.; Mumford T.; Mayer N.; Mitchell B.; Oliver T.; Lombardi W.;
Zimmerman T.; Rohrbeck S.; Cooke L.; Craig M.; Mego D.; Griffin B.; Perez
J.; LeClerc K.; Addington J.; Aboufakher R.; Ahmed A.; Westecott B.; Steel
K.; Hawkins K.; Shah A.; Ward U.; McGreevy M.; Goldberg R.; Prashad R.;
McDonough C.; Silver K.; Josephson R.; Witsaman S.; Labib S.; Woodhead G.;
Schrank J.; Bell K.; Chandna H.; Bethea C.; Fife B.; Gruberg L.; Singer
A.; Ramgadoo M.; Lalonde T.; Morin R.; French W.; Barillas O.; Gradner G.;
Kahn Z.; Gress J.; Rocco D.; Thew S.; Stifter W.; Fisher M.; McNamara J.;
Kupfer J.; Agocha A.; Cush S.; Jones S.; Whitaker T.; Stover T.; Kumkumian
G.; Kent K.; Greenberg A.; Pandey P.; Pytlewski G.; Matsumura M.; Kai W.;
Sameshima S.; Thomas J.; MacNicholas D.; Pillai K.; Jones D.; Navas JP.;
Laskoe B.; Patel P.; Fini G.; Minor S.; Shipwash T.; Cabrera-Santamaria
A.; Rivera E.; Mincher L.; Jafar M.; Yen M.; Finkle C.; Rahimtoola A.;
Severson L.; Labroo A.; Jinich D.; Tam K.; Vogel C.; Aggarwal R.; Zakhary
B.; Curtis S.; Lyster M.; Humphrey K.; Lavine P.; Fujise K.; Birnbaum Y.;
Allen J.; Kesselbrenner M.; Michel K.; Staniloae C.; Liu M.; Sonel A.;
Macioce-Caffas A.; Amidon T.; Leggett J.; Yedinak S.; Gudmundsson G.;
Sabharwal J.; Dagefoerde N.; Wu W.; Meyerrose G.; Roongsritong C.; Jenkins
L.; Lieberman S.; Sokol S.; Gutierrez C.; Nelson C.; Barrett J.; Hotchkiss
D.; Farley A.; Atassi K.; Christy L.; Baig M.; Di Fazio J.; Meengs M.;
Thomas K.; Surmitis J.; DeVault S.; Farhat N.; Hulyalkar A.; Riddell L.;
Rivera W.; Sheynberg B.; Kobayashi J.; Katsaropoulos J.; Jan M.; Krucoff
M.; Paterno C.; Chandrasekaran S.; Curry R.; Cassavar D.; Wheeler M.;
McGarvey J.; Schwarz L.; Miller E.; Andrea B.; Carswell BS.; Lurie M.;
Patti J.; Bowden W.; Vasiliauskas T.; Latham R.; Schwartz B.; Bradford L.;
Mattleman S.; Wertheimer J.; Goulden D.; Khan M.; Hawkins B.; Ostfeld R.;
Mueller H.; Ash Y.; Wilson V.; Bayer M.; Marshall J.; Dobies D.; Dawson
G.; Osman A.; Saba F.; Costello T.; Fuentes F.; Underwood C.; Vijay N.;
Washam M.; Dietz W.; Glasgow B.; Mukherjee S.; Hinchion N.; Speirs S.;
Thornley A.; Lee K.; Movahed M.; Strootman D.; Chernick R.; Parrott C.;
Flock C.; Marques V.; Syzmanski E.; Rama P.; Domingo D.; Holly D.; Wu L.;
Bauer B.; Dionisopoulos P.; Aggarwal A.; Holcomb R.; Foster R.; Hancock
T.; Hargrove J.; Fletcher A.; Stine R.; Bullivant M.; Adams K.; Lohman J.;
Klepper V.; Kabour A.; Neidhardt J.; Phillips W.; Tardiff S.; Aji J.;
Corut S.; Foster G.; Firek C.; St Goar F.; Sumner R.; Davis T.; Schneider
R.; Schneider W.; Villa A.; Desai V.; Chhabra A.; Banks K.; Herzog W.;
Burley T.; Quyyumi A.; Smiley W.; Manocha P.; Fishbein G.; Weller C.;
Coffman A.; Kim C.; Kedia A.; Firth B.; Rizvi M.; Dahiya R.; Foster B.;
Balcells E.; Metzger DC.; Lester J.; Bissett J.; Fahdi I.; Sides EA.;
Azrin M.; Martin C.; Quick A.; Conaway D.; Garg M.; Schallert G.;
Lancaster L.; Mckissick S.; Atieh M.; Garbarino J.; Eisenberg D.;
Uusinarkaus K.; Wirtemburg P.; Ellis J.; Cristaldi J.; Berglund R.; Negus
B.; Pappas J.; Rocha R.; Nguyen T.; Stone J.; Janosik D.; Labovitz A.;
Elmore N.; Dave R.; Loffredo K.; Gabriel G.; Snyder C.; Ahmed O.; Stone
H.; Kelley M.; Diffenback M.; Friedman B.; Zirkle J.; Severa L.; Sample
S.; Dignen K.; Raisinghani A.; Ben-Yehuda O.; Ghannadian B.; Moscoso R.;
Mankowski J.; Boliek W.; Rukavina M.; Davis W.; Ledbetter S.; Handel F.;
Mastouri R.; Mahenthiran J.; Foltz J.; Malhotra V.; Jonas J.; Berk M.;
Singh V.; Nelson M.; Elsner G.; Gall J.; Kondo N.; Frank S.; Chandraratna
P.; Ranasinghe S.; Ebrahimi R.; Treadwell M.; Walters B.; Hughes L.;
Kramer J.; Kumar K.; Mente T.; Lachterman B.; Schifferdecker B.; Munshi
K.; Sease D.; Waldo D.; Chandler G.; Manns D.; Nahhas A.; Kamalesh M.;
Williams V.; Reich D.; Desalca M.; Sharma S.; Liston M.; Gupta K.; Costa
M.; Altschuller A.; Lemmertz K.; Shanes J.; Hansen C.; Therrien M.;
Mendelson R.; Ramnarine R.; Myers G.; Donovan C.; Klein M.; Fine D.; Owens
S.; Murray C.; Ketroser R.; Heifetz S.; Darnell Z.; Touchon R.; Taghizadeh
B.; Bohle D.; Norwood D.; Forrest T.; Jackson S.; Shumate K.; Bayles A.;
Masroor M.; North WK.; Fishberg R.; Merveil-Ceneus B.; Butcher R.;
Menapace F.; Kilbride S.; Ramabadran RS.; Loukinen K.; Khalil J.;
Ramabadran R.; Walsh S.; Gill S.; Cyncar R.; McLachlan J.; Surakanti V.;
Rusterholtz L.; Shoukfeh F.; Stephenson L.; Tsang M.; Nolan V.; Gilchrist
I.; Jefferson D.; Feldman T.; Reyes L.; Santos R.; Little W.; Wesley D.;
Gharib W.; Mendell A.; Esham G.; Kakavas P.; Whitcomb C.; Book K.; Bazzi
A.; Alvarez J.; Cohen Y.; Ayres T.; Rhule V.; Labib A.; Schuler P.;
Zughaib M.; Telck K.; Bikkina M.; Turnbull K.; Sharma T.; Orosz S.; Shah
R.; Petrino M.; Hughes M.; Hershey J.; Hudock D.; Hui P.; Von Bakonyi A.;
Arnold A.; Kappel D.; Pennock G.; Cloud B.; Tucker K.; Harp L.; Hoover C.;
Eisenhauer M.; Roth J.; Young C.; Thai H.; Escalante A.; Bautista J.;
Gazmuri R.; Nyland J.; Cubeddu L.; DeFranco A.; Dias D.; Fielding M.;
Reeves R.; Hermany P.; Meissner-Dengler S.; Evans M.; Flores E.;
Tannenbaum A.; McGarr K.; Moran J.; Stout E.; Allred S.; Henderson D.;
Crandall L.; Strote J.; Voyles W.; Robeson D.; Bedoya R.; Omar B.;
Pettyjohn F.; Revere C.; Coy K.; Margolis J.; Sotolongo C.; Scheffel M.;
Munir A.; Shirwany A.; Douglas L.; Girala R.; Humphreys R.; Agarwal J.;
Bankowski D.; Watson R.; Bishop B.; Klementowicz P.; Blais D.; Cohen B.;
Lobur E.; Dimenna J.; Dempsey K.; Izzo M.; Bondi L.; Carell E.; Eaton C.;
Saltiel F.; Grewal G.; Connolly T.; Little T.; Wiegman P.; Gips S.; Held
J.; Paraschos A.; Quesada R.; Goudreau E.; Sears M.; Istfan P.; Holt S.;
McClung J.; Nguyen N.; Quintana O.; Gottlieb D.; Knutson T.; Barringhaus
K.; Lester F.; Sullivan P.; Rodriguez-Ospina L.
Institution
(Cannon, Giugliano, McCagg, Im, Bohula, Wiviott, Braunwald) Thrombolysis
in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital,
Harvard Medical School, Boston, United States
(Blazing, White, Reist, Califf) Duke Clinical Research Institute (DCRI),
Durham, NC, United States
(Theroux) Montreal Heart Institute, Montreal, Canada
(Darius) Vivantes Neukolln Medical Center, Berlin, Germany
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ophuis) Canisius-Wilhelmina Ziekenhuis, Nijmegen, Netherlands
(Jukema) Netherlands Leiden University Medical Center, Leiden, Netherlands
(De Ferrari) Fondazione IRCCS Policlinico San Matteo, University of Pavia,
Pavia, Italy
(Ruzyllo) National Institute of Cardiology, Warsaw, Poland
(De Lucca, Tershakovec, Musliner) Merck, Kenilworth, NJ, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL)
cholesterol levels and the risk of cardiovascular events, but whether the
addition of ezetimibe, a nonstatin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further is not known. METHODS: We conducted a double-blind, randomized
trial involving 18,144 patients who had been hospitalized for an acute
coronary syndrome within the preceding 10 days and had LDL cholesterol
levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they
were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3
to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy.
The combination of simvastatin (40 mg) and ezetimibe (10 mg)
(simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo
(simvastatin monotherapy). The primary end point was a composite of
cardiovascular death, nonfatal myocardial infarction, unstable angina
requiring rehospitalization, coronary revascularization (>=30 days after
randomization), or nonfatal stroke. The median follow-up was 6 years.
RESULTS: The median time-weighted average LDL cholesterol level during the
study was 53.7 mg per deciliter (1.4 mmol per liter) in the
simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8
mmol per liter) in the simvastatin-monotherapy group (P<0.001). The
Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in
the simvastatin-ezetimibe group, as compared with 34.7% in the
simvastatin-monotherapy group (absolute risk difference, 2.0 percentage
points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P =
0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse
effects and cancer were similar in the two groups. CONCLUSIONS: When added
to statin therapy, ezetimibe resulted in incremental lowering of LDL
cholesterol levels and improved cardiovascular outcomes. Moreover,
lowering LDL cholesterol to levels below previous targets provided
additional benefit.<br/>Copyright &#xa9; 2015 Massachusetts Medical
Society.

<3>
Accession Number
372153520
Title
Varespladib and cardiovascular events in patients with an acute coronary
syndrome: The VISTA-16 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (3) (pp 252-262),
2014. Date of Publication: 2014.
Author
Nicholls S.J.; Kastelein J.J.P.; Schwartz G.G.; Bash D.; Rosenson R.S.;
Cavender M.A.; Brennan D.M.; Koenig W.; Jukema J.W.; Nambi V.; Wright
R.S.; Menon V.; Lincoff A.M.; Nissen S.E.; Hennekens C.; Brown W.V.;
DeMets D.; Pfeffer M.; Roleau J.; Abraham J.; Gebel J.; Huff C.; Katzan
I.; Shishehbor M.; Rassi A.; Uchino K.; Vest A.; Zishiri E.; Heckman M.J.;
Balog C.; Dart A.; Amerena J.; Prasad C.; Farshid A.; Gunalingam B.;
Thompson P.; Collins N.; Arstall M.; van Gaal W.; Aroney C.; Mahar L.;
Youssef G.; Horowitz J.; Anand D.; Rodes-Cabau J.; Polasek P.; Lai C.;
Huynh T.; Hubacek J.; Kokis A.; Paradis J.M.; Mukherjee A.; Senaratne M.;
Constance C.; Gosselin G.; Lavi S.; Parker J.; Zadra R.; Abramson B.;
Della-Siega A.; Spinar J.; Pudil R.; Motovska Z.; Maly M.; Hutyra M.;
Pleva L.; Mayer O.; Semenka J.; Klimovic T.; Horak D.; Cervinka P.; Klimsa
Z.; Hulinsky V.; Reichert P.; Monhart Z.; Rotterova H.; Kobulia B.;
Shaburishvili T.; Mamatsashvili M.; Chapidze G.; Chumburidze V.;
Megreladze I.; Khintibidze I.; Leithauser B.; Voehringer H.F.; Wachter R.;
Nogai K.; Lapp H.; Haltern G.; Gielen S.; Dorsel T.; Mollmann H.;
Stellbrink C.; Hengstenberg C.; Dengler T.; Heuer H.; Kreuzer J.; Leschke
M.; Mudra H.; Werner N.; Braun-Dullaeus R.; Rosenberg M.; Frey N.;
Strasser R.; Genth-Zotz S.; Kiss R.; Nagy A.; Kovacs Z.; Csapo K.; Edes
I.; Sereg M.; Vertes A.; Ronaszeki A.; Kancz S.; Benczur B.; Polgar P.;
Muller G.; Simonyi G.; Dezsi C.; Merkely B.; Dinnyes J.; Lupkovics G.;
Kahali D.; Banker D.; Trivedi S.; Rajput R.; Premchand R.; Dani S.;
Vadaganelli P.; Gupta S.; Chandra S.; Fulwani M.; Chawla K.; Parikh K.;
Prati F.; Speciale G.; Valgimigli M.; Suriano P.; Berni A.; Sangiorgi G.;
Fineschi M.; Merenda R.; Marenzi G.; Berti S.; Corrada E.; Cuccia C.;
Testa R.; Moretti L.; Mennuni M.; Biasucci L.M.; Lioy E.; Auguadro C.;
Magagnini E.; Fedele F.; Piscione F.; Azar R.; Trip M.D.; Liem A.; den
Hartoog M.; Lenderink T.; van de Wetering M.L.; Lok D.; Oei F.; Tans J.G.;
Ilmer B.; Keijzers M.; Monraats P.; Kedhi E.; Breedveld R.W.; Herrman J.;
van Wijk L.; Ronner E.; Nierop P.; Bosschaert M.; Hermans W.; Doevendans
P.; Troquay R.; van der Heijden R.; Veen G.; Bokern M.J.; Bronzwaer P.N.;
Kie S.H.; Den Hartog F.; Elliott J.; Wilkins G.; Hart H.; Devlin G.;
Harding S.; Ponikowski P.; Madej A.; Kochmanski M.; Witkowski A.; Pluta
W.; Bronisz M.; Kornacewicz-Jach Z.; Wysokinski A.; Ujda M.; Drozdz J.;
Derlaga B.; Gessek J.; Dabrowski M.; Miekus P.; Kozlowski A.; Gniot J.;
Musial W.; Dobrzycki S.; Rynkiewicz A.; Psuja P.; Rekosz J.; Drzewiecki
A.; Kuznetsov V.; Gordeev I.; Goloshchekin B.; Markov V.; Barbarich V.;
Belenky D.; Mikhin V.; Volkova E.; Timofeev A.; Ermoshkina L.; Barbarash
O.; Klein G.; Libis R.; Vishnevsky A.; Linev K.; Khaisheva L.; Ruda M.;
Dovgalevskiy Y.; Shvarts Y.; Zateyshchikov D.; Kostenko V.; Shalnev V.;
Simanenkov V.; Arkhipov M.; Ovcharenko E.; Guseva G.; Akhunova S.; Ortiz
A.I.; Navarro M.J.; Romero A.J.; Goya I.L.; Penaranda A.S.; Cendon A.A.;
Rubio A.M.; Zubiri J.J.; Soriano F.R.; Sanz R.R.; Genis A.B.; Lago V.N.;
Fernandez J.D.; Romo A.I.; Franco S.N.; Martin I.H.; Montero J.S.; Martin
Mde M.; Gonzalez M.J.; Antolin J.M.; Areses E.L.; Miranda J.M.;
Alonso-Pulpon L.; Esquivias G.B.; Jarne E.F.; Cortes J.M.; Perez M.B.;
Gormaz C.L.; Alegret J.M.; Nava J.S.; Ingelmo J.M.; Urbano R.H.; Sanmartin
M.; Katerenchuk O.; Vakaliuk I.; Karpenko O.; Prokhorov O.; Koval O.;
Faynyk A.; Kopytsya M.; Karpenko Y.; Kraiz I.; Feskov O.; Rudenko L.;
Kozhukhov S.; Goloborodko B.; Rivera E.; Broadwater S.; Crowley S.; Vijay
N.; Goswami R.; Ferrier L.; Blanchard A.; McCullum K.; Chernick R.;
Bertolet B.; Battaglia J.; Richardson J.; Lochridge S.; Lieberman S.;
Amkieh A.; Cavender J.B.; Denning S.; Treasure C.; Kmetzo J.; Stillabower
M.; Brilakis E.; Acheatel R.; Kukuy E.; Ashchi M.; Skelding K.; Martin L.;
Gillespie E.; French W.; Pollock S.; Polk D.; Black R.; Drenning D.;
Anderson J.; Sanz M.; Korban E.; Wiley M.; Rezkalla S.; Minisi A.; Shah
A.; Silverman P.; Amlani M.; Eaton G.; Brown A.; Jay D.; Loussararian A.;
Lamas G.; Lauer M.; Williams J.; Asfour A.; Runquist L.; Robertson R.;
Blonder R.; Davies C.; Downes T.; Chronos N.; Marso S.; Haldis T.; Eich
D.; Ahmed M.; East C.; MacDonald L.; Seigel P.; White M.; Camp A.; Kleiman
N.; Burtt D.; Strain J.; Go B.; Henry P.; Sultan P.; Delafontaine P.;
Kashou H.; Lambert C.; Movahed M.; Saucedo J.; Thadani U.; Chandrashekhar
Y.; Lu D.; Chandna H.; Mann J.; Ramaswamy G.; Browne K.; Janik M.; Cannon
K.; Tolerico P.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Schwartz) Veterans Affairs Medical Center, University of Colorado,
Denver, CO, United States
(Bash, Brennan, Menon, Lincoff, Nissen) Cleveland Clinic Coordinating
Center for Clinical Research, Cleveland, OH, United States
(Rosenson) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Cavender) Brigham and Women's Hospital, Boston, MA, United States
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Jukema) Interuniversity Cardiology Institute of the Netherlands, Utrecht,
Netherlands
(Nambi) Michael E. DeBakey Veterans Affairs Hospital, Baylor College of
Medicine, Houston, TX, United States
(Wright) Mayo Clinic, Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Secretory phospholipase A<inf>2</inf> (sPLA<inf>2</inf>)
generates bioactive phospholipid products implicated in atherosclerosis.
The sPLA<inf>2</inf> inhibitor varespladib has favorable effects on lipid
and inflammatory markers; however, its effect on cardiovascular outcomes
is unknown. OBJECTIVE: To determine the effects of sPLA<inf>2</inf>
inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING,
AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362
academic and community hospitals in Europe, Australia, New Zealand, India,
and North America of 5145 patients randomized within 96 hours of
presentation of an acute coronary syndrome (ACS) to either varespladib (n
= 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and
March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS:
Participants were randomized to receive varespladib (500 mg) or placebo
daily for 16 weeks, in addition to atorvastatin and other established
therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a
composite of cardiovascular mortality, nonfatal myocardial infarction
(MI), nonfatal stroke, or unstable angina with evidence of ischemia
requiring hospitalization at 16 weeks. Six-month survival status was also
evaluated. RESULTS: At a prespecified interim analysis, including 212
primary end point events, the independent data and safety monitoring board
recommended termination of the trial for futility and possible harm. The
primary end point occurred in 136 patients (6.1%) treated with varespladib
compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR],
1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with
a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39;
log-rank P = .005). The composite secondary end point of cardiovascular
mortality, MI, and stroke was observed in 107 patients (4.6%) in the
varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36;
95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with
recent ACS, varespladib did not reduce the risk of recurrent
cardiovascular events and significantly increased the risk of MI. The
sPLA<inf>2</inf> inhibition with varespladib may be harmful and is not a
useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014
American Medical Association. All rights reserved.

<4>
Accession Number
365787657
Title
Prasugrel versus clopidogrel for acute coronary syndromes without
revascularization.
Source
New England Journal of Medicine. 367 (14) (pp 1297-1309), 2012. Date of
Publication: 04 Oct 2012.
Author
Roe M.T.; Armstrong P.W.; Fox K.A.A.; White H.D.; Prabhakaran D.; Goodman
S.G.; Cornel J.H.; Bhatt D.L.; Clemmensen P.; Martinez F.; Ardissino D.;
Nicolau J.C.; Boden W.E.; Gurbel P.A.; Ruzyllo W.; Dalby A.J.; McGuire
D.K.; Leiva-Pons J.L.; Parkhomenko A.; Gottlieb S.; Topacio G.O.; Hamm C.;
Pavlides G.; Goudev A.R.; Oto A.; Tseng C.D.; Merkely B.; Gasparovic V.;
Corbalan R.; McLendon R.C.; Winters K.J.; Brown E.B.; Lokhnygina Y.;
Aylward P.E.; Huber K.; Hochman J.S.; Ohman E.M.; Ohman E.; Bassand J.P.;
Castillo V.R.; Chua T.; Cinteza M.; Erlinge D.; Foley D.P.; Fridrich V.;
Ge J.; Goodman S.; Goudev A.; Gratsiansky N.; Hamm C.W.; Jeong M.H.;
Jun-Ren Z.; Lopez-Sendon J.; Luscher T.; Mogrovejo W.E.; Nicolau J.;
Petrauskiene B.; Roe M.; Sritara P.; Syvanne M.; Topacio G.; Verheugt F.;
Widimsky P.; Wiviott S.D.; Zambahari R.; Van de Werf F.; Budaj A.; Gersh
B.J.; Montalescot G.; Pocock S.J.; Wilcox R.G.; Williams D.O.; Wilson M.;
Mehta R.H.; Alexander J.H.; Kong D.F.; Lopes R.; Mahaffey K.W.; Melloni
C.; Newby L.; Shah B.R.; Tricoci P.; George D.J.; Beaven A.W.; Blackwell
K.L.; Morse M.A.; Onken J.E.; Ready N.E.; Strickler J.H.; Zafar S.; Hafley
G.; Pieper K.; Stevens S.; Schibler T.; Chan M.; Chin C.T.; Gharacholou
S.; Subherwal S.; McLendon R.; Marshall D.; Macias W.; Lenarz L.; Petijean
H.; Plat F.; van Kranen R.; Zamoryakhin D.; Albisu J.; Alvarez C.;
Amuchastegui M.; Astesiano A.L.; Beloscar J.; Bergallo J.; Bono J.;
Bordonava A.; Botta C.E.; Budassi N.; Caccavo A.; Cartasegna L.; Colombo
H.; Costello R.; Covelli G.; De Valais F.; Dran R.; Duronto E.; Forte
E.H.; Garcia D.F.; Garcia Escudero A.; Hominal M.; Hrabar A.D.; Ibanez
J.O.; Jure H.; Leon de la Fuente R.; Lobo Marquez L.; Luciardi H.; Luquez
H.; Marino J.; Martingano R.; Moises Azize G.; Nul D.; Patocchi C.; Piombo
A.; Prado A.; Rodriguez M.; Romero Acuna A.; Scaro G.B.; Sosa Liprandi A.;
Varini S.D.; Vigo S.J.; Aroney G.; Arstall M.; Blenkhorn A.; Carroll P.;
Chew D.; Collins N.; Hammett C.; Lee A.; Marrinan M.; Roberts-Thomson P.;
Waites J.; Benzer W.; Lang I.; Podczeck-Schweighofer A.; Baetsle P.;
Beauloye C.; De Tollenaere M.; Lancellotti P.; Marechal P.; Van Dorpe A.;
Albuquerque D.; Andrade Lotufo P.; Ardnt M.; Arminio G.; Alves da Cost
F.A.; Baracioli L.M.; Bertolim Precoma D.; Carvalho Neuenschwander F.;
Damiao Gomes Seabra M.; De Souza J.; Duda N.T.; Dutra O.P.; Feitosa A.;
Filho H.; Finimundi H.C.; Gomes M.; Gubolino L.; Guimaraes A.E.; Hernandes
M.; Jardim C.A.; Kunz Sebba Barroso de Souza W.; Leaes P.E.; Maia L.N.;
Manenti E.; Marin Neto J.A.; Marino R.; Michalaros Y.; Mora Junior R.;
Moraes Junior J.B.; Nogueira Liberato de Sousa L.; Pimentel Filho P.;
Polanczyk C.; Rabelo Alves A.; Ramos R.; Reis G.; Rocha Faria Neto J.;
Rossi Dos Santos F.; Saporito W.; Saraiva J.F.; Sartori P.C.; Scholz Issa
J.; Silva Junior D.; Sousa A.; Teixeira M.; Zimmermann S.L.; Lazov P.;
Tokmakova M.; Penchev K.; Petrov I.; Baldjiev E.; Georgiev P.;
Hergeldjieva V.; Manolova A.; Dimov B.; Mihov A.; Pencheva G.; Raev D.;
Ramshev K.; Tumbev H.; Tzekova M.; Boichev B.; Kadiiski A.; Devedzhiev T.;
Bakbak A.; Berlingieri J.; Burstein J.; Dery J.P.; Heath J.; Huynh T.;
Kassam S.; Kostuk W.; Labonte R.; Maccallum C.; Nawaz S.; Quraishi A.U.;
Senaratne M.; Syan G.; Syan R.; Vizel S.; Castro P.; Florenzano F.; Lamich
R.; Manriquez L.; Potthoff S.; Stockins B.; Bugueno C.; Cobos J.;
Sepulveda P.; Opazo M.; Montecinos H.; Ke Y.; Chen Y.D.; Chen J.; Wang J.;
Li W.; Xu B.; Ma G.; Li Z.; Sun Y.; Tang J.; Yuan Z.; Tang L.; Zhou Y.; He
Q.; Xu J.; Zhang H.; Yang K.; Zhou S.; Zhao S.; Zheng Z.; Li X.; Wang D.;
Hong X.; Guan R.; Wang L.; Huang H.; Xia Y.; Hao Y.; Zhang S.; Zhao X.;
Liu X.; Yan J.; Huang Y.; Wang B.; Vallejo G.S.; Bohorquez R.; Gomez N.I.;
Fernandez R.; Mayorga L.E.; Gomez J.; Quintero A.; Figueredo A.; Senior
J.; Accini J.L.; Roncallo E.; Frischwasser S.; Sanchez M.S.; Bouzid Y.;
Ciglenecki N.; Certic J.F.; Grman J.; Sutalo K.; Bergovec M.; Knezevic A.;
Mirat J.; Padovan M.; Car S.; Samardzic P.; Bagatin J.; Kraus L.; Coufal
Z.; Janota T.; Kettner J.; Linhart A.; Hondl M.; Osmancik P.; Padour M.;
Telekes P.; Vojacek J.; Vojtisek P.; Francek L.; Sedlon P.; Bronnum-Schou
J.; Hansen P.; Nielsen H.; El-Etreby A.; El Hawary A.; El Rakshy Y.;
Mowafy A.; Ragy H.; Reda A.; Sabri S.; Nyman K.; Laine M.; Bressollette
E.; Rifai A.; Danchin N.; Ovize M.; Cottin Y.; Farah B.; Furber A.; Coste
P.; Elbaz M.; Morel O.; Schiele F.; Elhadad S.; Belhassane A.; El Mansour
N.; Leroy F.; Coisne D.; Ferrari E.; Nguyen-Khac O.; Range G.; Moulin F.;
Poulard J.E.; Sechtem U.; Kaelsch T.; Ebelt H.; Gawaz M.; Genth-Zotz S.;
Moellmann H.; Heuer H.; Kadel C.; Klein H.; Werner G.; Boudriot E.;
Kruells-Muench J.; Baer F.; Alexopoulos D.; Manolis A.; Platogiannis D.;
Anastasiou-Nana M.; Nanas I.; Cokkinos D.; Fotiadis I.; Koliopoulos N.;
Moschos N.; Olympios C.; Ples Z.; Illyes L.; Csikasz J.; Zolyomi S.; Kis
E.; Kovacs Z.; Lupkovics G.; Nagy A.; Regos L.; Tomcsanyi J.; Janosi A.;
Medvegy M.; Szakal I.; Vertes A.; Szalai G.; Banker D.; Dani S.; Kumar S.;
Sarna M.K.; Seerangachar R.K.; Deshpande A.; Khan I.A.; Gupta S.K.;
Dharmadhikari A.; Babu P.; Fulwani M.; Kerkar P.G.; Varma S.; Singh P.;
Babu R.; Menon J.; Sengupta S.; Sathe S.; Premchand R.K.; Kalra R.;
Kalashetti S.; Pai V.; Bose V.; Jain V.; Kale V.; Benjarge P.; Ghaisas N.;
Thanvi S.; Durgaprasad R.; Kulkarni R.L.; Joshi H.; Abyankar A.; Bisne V.;
Chopra V.; Reddy P.; Sarma R.; Garg N.; Agarwal D.K.; Arneja J.;
Bandyopadhyay S.; Bharani A.; Yadav R.; Dutta S.; Chidambaram N.; Dande
A.; Gadkari M.; Grant P.; Khan A.; Gupta R.; Gupta J.B.; Shetty G.; Lavhe
P.V.; Jain R.; Joseph J.; Calambur N.; Joseph S.; Mardikar H.; Mathur A.;
Mohanan P.; Kumbla M.; Nair T.; Nambiar A.; Jathappa N.; Parale G.; Patel
T.; Puri A.; Rao B.; Saligrama R.; Sawhney J.; Sethi S.; Singh B.;
Srinivas A.; Jagadesa B.S.; Foley D.; Mahon N.; Mulvihill N.; Nash P.;
Arad T.; Balkin J.; Francis A.; Hammerman H.; Hasin Y.; Katz A.; Kracoff
O.; Marmor A.; Mosseri M.; Atar S.; Roth A.; Zahger D.; Turgeman Y.; Weiss
A.; De Luca M.; Antonelli G.; Piovaccari G.; Barbiero M.; Cuccia C.; De
Servi S.; Fedele F.; Golino P.; Manari A.; Menozzi A.; Berti S.; Moretti
L.; Musumeci G.; Pajes G.; Paloscia L.; Mos L.; Salvioni A.; Volpe M.; De
Luca G.; Astarita C.; Merlini P.; Di Lorenzo L.; Fattore L.; Ambrosio G.;
Mircoli L.; Galvani M.; Cavallini C.; Nassiacos D.; Scioli R.; Yoon J.;
Kim D.K.; Hur S.H.; Bae J.H.; Rha S.W.; Lee S.R.; Kim K.S.; Ko Y.G.; Jeong
J.O.; Lee S.K.; Hong T.J.; Kim M.; Hwang J.Y.; Shin E.K.; Kim S.W.;
Anusauskiene J.; Dambrauskaite A.; Jarasuniene D.; Raugaliene R.;
Babarskiene M.R.; Ahmad W.A.; Yusof Z.; Maskon O.; Ong T.K.; Abdullah
H.N.; Chandran A.; Chong Y.S.; Lee C.Y.; Ramanathan L.; Sciberras R.;
Xuereb R.G.; Fajardo P.; Ramos-Lopez G.; Alcocer M.A.; Ramirez M.C.;
Ibarra M.O.; Esperon G.L.; Diaz C.S.; Hamer A.; Elliott J.; Harding S.;
Hart H.; Castillo B.G.; Ortega R.N.; Frago G.; Henriquez F.; Acosta D.C.;
Zambrano E.C.; Mogrovejo W.; Chois A.; Gamio C.F.; Barrera M.A.; Cabrera
J.; Dextre L.Z.; Reyes M.; Tellez D.; Castillo R.; Chavez C.; Godoy A.;
Llerena N.; Morales C.A.; Habaluyas R.; Rogelio G.; Ramos E.J.; Chua P.;
Mendoza V.; Tirador L.; Abanilla J.; Edmilao M.I.; Coching R.M.; Morales
D.; Dalkowski M.; Sciborski R.; Lewczuk J.; Hoffmann A.; Lesnik J.;
Andruszkiewicz B.; Wojciechowski D.; Kus W.; Jozwa R.; Kasprzak J.;
Lubinski A.; Karczmarczyk A.; Wojcik J.; Gruchala M.; Bartus S.; Bronisz
M.; Mirek-Bryniarska E.; Dudek D.; Gorny J.; Grzywna R.; Kawka-Urbanek T.;
Niezgoda K.; Olszewski R.; Ogorek M.; Gniot J.; Nessler J.; Ponikowski P.;
Wita K.; Zinka E.; Zmudka K.; Szelemej R.; Moreira J.; Bastos J.M.;
Ferreira J.; Martins D.; Providencia L.; Ribeiro V.G.; Silva G.; Seixo F.;
Morais J.; Rinaldi R.; Rodriguez-Ospina L.; Colon-Hernandez P.; Matei C.;
Tatu-Chitoiu G.P.; Iordachescu-Petica D.; Teodorescu I.; Ochean V.;
Constantinescu M.C.; Stanciulescu G.E.; Bobescu E.; Bolohan F.R.; Coman
I.M.; Creteanu M.; Dan G.A.; Dobre I.; Ionescu P.; Minescu B.; Olinic
D.M.; Pop C.; Stamate S.C.; Gurevich V.; Bichan N.; Baranov E.;
Zateyshchikov D.; Barbarich V.; Gordeev I.; Tereshchenko S.; Dovgalevskiy
Y.; Boyarkin M.; Shogenov Z.; Suprun E.; Shalaev S.; Arutyunov G.;
Supryadkina T.; Perepech N.; Nikolskaya I.; Rossovskaya M.; Khaisheva L.;
Simanenkov V.; Boldueva S.; Zrazhevskiy K.; Barbarash O.; Egorova L.;
Markov V.; Novikova N.; Alexeeva N.; Ermoshkina L.; Ishmurzin G.;
Miloradovic V.; Pavlovic M.; Ilic S.; Krotin M.; Neskovic A.; Otasevic P.;
Vasiljevic-Pokrajcic Z.; Ostojic M.; Chan M.Y.; Goh P.P.; Kokles M.; Bugan
V.; Urban M.; Sirotiakova J.; Belicova M.; Duris T.; Poliacik P.; Slanina
M.; Letcher G.; Abelson M.; Dalby A.; Gould T.; Manga P.; Pillay T.;
Theron H.; Venter T.; van Zyl L.; Essop M.; van der Merwe N.; Alegret
J.M.; Gomez D.L.; Vera T.R.; Bruguera I Cortada J.; Garcia J.H.; Dalli E.;
Paz M.A.; Ridocci F.; Coronado J.L.; Romero C.; Urbano R.H.; Carlsson R.;
Falck G.; Gallino A.; Linka A.; Lai W.T.; Shyu K.G.; Li A.H.; Chiang C.E.;
Hou J.Y.; Kuanprasert S.; Srimahachota S.; Wongvipaporn C.; Laothavorn P.;
Krittayaphong R.; Tangsuntornwiwat S.; Moleerergpoom W.; Kaewsuwanna P.;
Sakulsaengprapha T.; Viboolkitvarakul N.; Buakhamsri A.; Braam R.; Basart
D.C.; Troquay R.P.; Herrman J.P.; van der Heijden D.J.; Broeders M.; Romer
T.; Post J.C.; Viergever E.; Zwart P.; Groutars R.; Breedveld R.; Ronner
E.; Hoedemaker G.; van Kalmthout P.; Kuijper A.; Geertman J.H.; Hamer B.;
Werter C.; Westendorp I.; Kruik H.J.; Zouari S.B.; Boughzala E.; Boujnah
R.; Gamra H.; Haouala H.; Kammoun S.; Ben Khalfallah A.; Maatouk F.; Ural
D.; Kutlu M.; Sahin M.; Ebinc H.; Kucukoglu S.; Demirtas M.; Kirma C.;
Altun A.; Aydinlar A.; Aydogdu S.; Cayli M.; Bozkurt E.; Buyukoner E.E.;
Erdogan D.; Acikel M.; Ozdemir M.; Ozdemir K.; Yazici M.; Goloborodko B.;
Nykonov V.; Vakaliuk I.; Yagensky A.; Vatutin M.; Shcherbak V.; Kovalskyy
I.; Bagriy A.; Ushakov O.; Zhurba S.; Sierkova V.; Bashkirtsev O.;
Vasylenko A.; Karpenko Y.; Kaydashev I.; Amosova K.; Batushkin V.; Faynyk
A.; Horbach L.; Karpenko O.; Koval' O.; Kraiz I.; Potapenko P.; Rudenko
L.; Malynovsky Y.; Tseluyko V.; Volkov V.; Prokhorov O.; Sarkar D.;
Moriarty A.; El-Harari M.; Brigden G.; Qureshi N.; Alamgir F.; de Belder
A.; Keeling P.; Cooke J.; Brown N.; Junejo S.; Vuyyuru R.; Connolly D.;
Kadr H.; Griffiths H.; Tang K.; Cotton J.; Barr C.; Lindsay S.;
Venkataraman A.; Rittoo D.; Jacob A.; Watkin R.; Lang C.; Pye M.; Chambers
J.; Mavromatis K.; Rossi P.; Ahmad A.; Anderson H.; Roberts J.; Klugherz
B.; Haidar A.; Downes T.; Russo D.; Wallace W.; Bhagwat R.; Mathew T.;
Jetty P.; Henderson D.; Dy J.; Isserman S.; Kondle V.; Quintana O.; Brener
S.; Masud Z.; Vijay N.; Jain M.; Longo J.; Safley D.; Pancholy S.;
Shaoulian E.; Allan J.; Bazzi A.; Chahin J.; Shurmur S.; Santos R.;
Goldberg J.; Gigliotti O.; Irimpen A.; Khan M.; Kusnick B.; Treasure C.;
Rogers J.; Zebrack J.; Turner M.; Adjei N.; Ingram C.; Mathis C.; Buchanan
W.; Heins G.; Ahsan C.; Anderson J.; Atassi K.; Bachinsky W.; Baig M.;
Rodriguez A.; Tang A.; Foreman R.; Berlin H.; Bouchard A.; Thew S.;
Borromeo S.; Bowden W.; Boyek T.; Arter J.; Blair J.; Chandna H.; Katz J.;
Conn E.; Connelly T.; Del Core M.; Shanes J.; Dotani I.; Drenning D.;
Bustros N.; Fastabend C.; Flores E.; Goudreau E.; Gredler F.; Greenfield
R.; Guidera S.; Gogia H.; Hearne S.; Hermany P.; Taheri H.; Izzo M.;
Jaffrani N.; Johnson G.; Keedy D.; Waxman F.; Kesselbrenner M.; Floro J.;
Korban E.; Labroo A.; Lui H.; Georgeson S.; Breall J.; Baman R.; Mandak
J.; Marais H.; Lee D.; Meisner J.; Micale P.; Meymandi S.; Vicari R.;
Mouhaffel A.; Moscoso R.; Papademetriou V.; Piegari G.; Promisloff S.;
Rivera E.; Rogers W.; Roth D.; Sadler D.; Canto J.; Schmedtje J.; Shaikh
S.; Shalev Y.; Sharma M.; Rahman A.; Schwartz S.; Sporn D.; Staniloae C.;
Tami L.; Barnum O.; Tu T.; Tuma J.; Wali A.; Welka S.; Wilson V.; Younis
L.; Zakhary B.; Ziperman D.; Singh N.; Kukuy E.; Leimbach W.; Chang M.;
Carter M.; Simpson P.; Miklin J.; Niess G.; Schaefer S.; Lambert C.; Soh
E.; Heintz K.; Miller J.; Chandrashekhar Y.; Pappas J.; Rashid H.U.;
Wright W.; Rees A.; Bach R.; Wu W.; Singhi S.; Quyyumi A.; Lau T.; Nobel
J.; Kamdar A.; Kabour A.; Stys T.; Keller N.; Kumar A.; Danisa K.; Smith
S.; Espinoza A.; Deac D.; Roberts D.; Gumm D.; Saucedo J.; Gimple L.;
Weinstein D.; Blonder R.; Moran M.; Iwaoka R.; Bayron C.; Tejada L.; White
L.; Ingersoll H.; Casterella P.; Chiaramida S.; Harris J.; Rodriguez R.;
Vo A.; Dave K.; Giacomini J.; Kotha P.; Park C.; Arif I.; McGrew F.; Atieh
M.; Huang X.; Zarrella G.; McGarvey J.; Koganti D.; Albirini A.; Kozman
H.; Slepian M.; Quion J.A.; Ramanathan K.; Bessen M.; Rafael A.; Aycock G.
Institution
(Roe, McLendon, Lokhnygina, Ohman) Duke Clinical Research Institute, Duke
University Medical Center, 2400 Pratt St, Durham, NC 27705, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Goodman) Division of Cardiology, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(White) Auckland City Hospital, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Prabhakaran) Center for Chronic Disease Control, New Delhi, India
(Cornel) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Bhatt) VA Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Clemmensen) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Parma, Italy
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Boden) Department of Medicine, Stratton VA Medical Center, Albany Medical
College, Albany, NY, United States
(Hochman) Leon H. Charney Division of Cardiology, New York University
School of Medicine, NYU Langone Medical Center, NY, United States
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Dalby) Milpark Hospital, Johannesburg, South Africa
(McGuire) University of Texas-Southwestern Medical Center, Dallas, TX,
United States
(Leiva-Pons) Cardiology Department, Hospital Central Dr. Morones Prieto,
San Luis Potosi, Mexico
(Parkhomenko) Emergency Cardiology, Institute of Cardiology, Kiev, Ukraine
(Gottlieb) Department of Cardiology, Bikur Cholim Hospital, Jerusalem,
Israel
(Topacio) Department of Medicine, Medical Center Manila, Manila,
Philippines
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Pavlides) Cardiology Division, Onassis Cardiac Surgery Center, Kallithea,
Greece
(Goudev) Cardiology Department, Queen Giovanna University Hospital, Sofia,
Bulgaria
(Oto) Department of Cardiology, Hacettepe University Faculty of Medicine,
Ankara, Turkey
(Tseng) Division of Cardiology, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Merkely) Heart Center, Semmelweis University, Budapest, Hungary
(Gasparovic) Department of Intensive Care Medicine, Clinical Hospital
Center Zagreb, Zagreb, Croatia
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Cinteza) Division of Cardiology, Emergency University Hospital of
Bucharest, Bucharest, Romania
(Winters, Brown) Eli Lilly, Indianapolis, IN, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: The effect of intensified platelet inhibition for patients
with unstable angina or myocardial infarction without ST-segment elevation
who do not undergo revascularization has not been delineated. METHODS: In
this double-blind, randomized trial, in a primary analysis involving 7243
patients under the age of 75 years receiving aspirin, we evaluated up to
30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75
mg daily). In a secondary analysis involving 2083 patients 75 years of age
or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel.
RESULTS: At a median follow-up of 17 months, the primary end point of
death from cardiovascular causes, myocardial infarction, or stroke among
patients under the age of 75 years occurred in 13.9% of the prasugrel
group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel
group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21).
Similar results were observed in the overall population. The prespecified
analysis of multiple recurrent ischemic events (all components of the
primary end point) suggested a lower risk for prasugrel among patients
under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P =
0.04). Rates of severe and intracranial bleeding were similar in the two
groups in all age groups. There was no significant between-group
difference in the frequency of nonhemorrhagic serious adverse events,
except for a higher frequency of heart failure in the clopidogrel group.
CONCLUSIONS: Among patients with unstable angina or myocardial infarction
without ST-segment elevation, prasugrel did not significantly reduce the
frequency of the primary end point, as compared with clopidogrel, and
similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi
Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.) Copyright
&#xa9; 2012 Massachusetts Medical Society.

<5>
Accession Number
623954503
Title
Safety and Efficacy of Percutaneous Mitral Valve-in-Valve and Mitral
Valve-in-Ring Procedures: Systematic Review and Pooled Analysis of 30 Day
and One Year Outcomes.
Source
Structural Heart. 2 (5) (pp 421-430), 2018. Date of Publication: 03 Sep
2018.
Author
Sengodan P.; Sankaramangalam K.; Jobanputra Y.; Athappan G.; Jaber W.;
White J.; Mick S.; Navia J.; Krishnaswamy A.; Tuzcu E.M.; Kapadia S.
Institution
(Sengodan) Department of Medicine, Cleveland Clinic, Cleveland, OH, United
States
(Sankaramangalam, Jobanputra, Jaber, White, Krishnaswamy, Kapadia)
Department of Cardiovascular Medicine, Heart & Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
(Athappan) Minneapolis Heart Institute, Minneapolis, MN, United States
(Mick, Navia) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The purpose of this study was to perform a systematic review
and pooled analysis to evaluate 30-day and 1-year outcomes of
transcatheter mitral valve-in-valve (VIV) and valve-in-ring (VIR)
procedures. Data from the Valve-in-Valve Data Registry revealed that there
were several safety and efficacy concerns, although procedural success was
achieved in most cases. Methods: Studies reporting data on either mitral
VIV and/or VIR with at least five patients were pooled using weighted
proportional analysis. Results: The 30-day pooled estimate of all-cause
mortality in the mitral VIV group was 7%, valve embolization, 5%, stroke,
3%, and major bleeding, 9%. At 1 year the all-cause mortality was 11%,
valve thrombosis, 10%, stroke, 6%, and major bleeding, 16%. In the mitral
VIR group, the 30-day pooled estimate for all-cause mortality was 8%,
renal failure, 11%, valve embolization, 3%, and left ventricular outflow
tract obstruction, 10% and at 1 year the all-cause mortality was about
22%. Conclusions: Mitral VIV and VIR procedures are safe and feasible in
high risk surgical candidates. The long-term safety and efficacy data
beyond 1 year for both mitral VIV and VIR need to be
established.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Cardiovascular
Research Foundation.

<6>
Accession Number
623954493
Title
Mono versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
Structural Heart. 2 (5) (pp 448-462), 2018. Date of Publication: 03 Sep
2018.
Author
Khalil C.; Mosleh W.; Megaly M.; Gandhi S.; Iskander F.H.; Iskander M.H.;
Ibrahim A.; Shah T.; Ekladios C.; Corbelli J.
Institution
(Khalil, Mosleh, Ibrahim, Shah, Ekladios, Corbelli) Division of
Cardiology, University at Buffalo, The State University of New York,
Buffalo, NY, United States
(Megaly) Division of Cardiology, Hennepin County Medical
Center-Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Gandhi) Division of Cardiology, University of Toronto, Toronto, ON,
Canada
(Iskander, Iskander) Division of Cardiology, Cook County Health and
Hospitals System, Chicago, IL, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Dual antiplatelet therapy (DAPT) is routinely prescribed after
transcatheter aortic valve replacement (TAVR) despite the lack of
definitive data demonstrating its superiority over mono-antiplatelet
therapy (MAPT). We aim to investigate the benefits of DAPT versus MAPT and
at different follow-up time points post TAVR. Methods: A systematic search
was conducted for studies investigating DAPT versus MAPT in patients who
underwent TAVR. The primary outcome was net adverse clinical events (NACE)
at longest reported follow-up, defined as a composite end-point of
all-cause mortality, major stroke, myocardial infarction (MI), and
combined life threatening and major bleeding. Secondary endpoints included
each outcome individually. We performed subgroup analysis according to
study type (randomized control trials vs. observational studies) and
follow-up duration post-TAVR (<= 30 days, between 3 and 6 months, and >= 1
year). Results: Twelve studies with 9,650 patients were included.
Post-TAVR MAPT was associated with significantly reduced NACE (0.60 [0.45,
0.81], p < 0.001), all-cause mortality (OR 0.54 [0.33, 0.88], p = 0.01),
and combined life threatening and major bleeding (0.57 [0.39, 0.84], p =
0.005) in the first 30 days after the procedure when compared to DAPT. The
difference in outcomes diminishes with longer-term follow up durations
(3-6 month or >= 6-month). No differences were seen with other secondary
endpoints. Conclusion: MAPT is associated with improved outcomes compared
to DAPT in the first 30 days post-TAVR with no difference in outcomes on
longer-term follow up. Future prospective, adequately powered,
multicenter, placebo-controlled, randomized double-blinded cohort studies
are warranted to confirm our findings.<br/>Copyright &#xa9; 2018, &#xa9;
2018 Cardiovascular Research Foundation.

<7>
Accession Number
623954484
Title
Single Anti-Platelet Therapy versus Dual Anti-Platelet Therapy after
Transcatheter Aortic Valve Replacement: A Meta-Analysis.
Source
Structural Heart. 2 (5) (pp 408-418), 2018. Date of Publication: 03 Sep
2018.
Author
Abuzaid A.; Ranjan P.; Fabrizio C.; Felpel K.; Chawla R.; Topic A.;
Elgendy I.Y.
Institution
(Abuzaid, Ranjan, Fabrizio, Felpel, Chawla, Topic) Department of
Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson
University/Christiana Care Health System, Newark, DE, United States
(Elgendy) Department of Medicine, Division of Cardiovascular Medicine,
University of Florida, Gainesville, FL, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The optimal anti-platelet regimen after transcatheter aortic
valve replacement (TAVR) remains uncertain. The objective of this study
was to compare the efficacy and safety of single anti-platelet therapy
(SAPT) vs. dual anti-platelet therapy (DAPT) after transcatheter aortic
valve replacement (TAVR). Methods: Electronic databases were searched for
randomized and observational studies, which compared SAPT versus DAPT
after TAVR. The primary outcomes were all-cause mortality, and major
bleeding. Summary adjusted risk ratios (RR) were calculated using a
Der-Simonian and Liard model. The risk of bias of the included studies was
assessed by the Cochrane scale and New-castle Ottawa assessment tool.
Results: A total of 10 studies with 2,412 patients were included. There
was no difference in 30-days all-cause mortality (RR 1.19, 95% CI
0.79-1.81, p = 0.41, I² = 0.0%) and at the longest available
follow up (i.e. mean 6.4 months) (RR 1.03, 95% CI 0.69-1.57, p = 0.86,
I² = 0.0%). The risk of major bleeding was higher in the DAPT
group (RR 2.14, 95% CI 1.37-3.31, p = 0.001). These findings were
consistent on analyzing randomized versus observational studies
(P<inf>interaction</inf> = 0.97, and 0.76 for all-cause mortality and
major bleeding, respectively). There was no difference in the risk of
life-threatening bleeding, major vascular complications, myocardial
infarction, and stroke between both groups (all p-values > 0.05).
Conclusion: DAPT post TAVR is associated with an increased risk of major
bleeding with no benefit on mortality, stroke, or myocardial infarction.
The evidence is driven mainly from observational studies, and therefore
future high quality randomized trials are needed.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Cardiovascular Research Foundation.

<8>
Accession Number
623954886
Title
Transcatheter versus Surgical Aortic Valve Replacement in Patients with
Moderate to Severe Chronic Kidney Disease: A Systematic Review and
Analysis.
Source
Structural Heart. 2 (2) (pp 129-136), 2018. Date of Publication: 04 Mar
2018.
Author
Panchal H.B.; Leon M.B.; Kirtane A.J.; Kodali S.K.; McCarthy P.; Davidson
C.J.; Thourani V.; Beohar N.
Institution
(Panchal) Division of Cardiology, East Tennessee State University, Johnson
City, TN, United States
(Leon, Kirtane, Kodali) Division of Cardiology, Columbia University
Medical Center, New York Presbyterian Hospital, Columbia University, New
York, NY, United States
(McCarthy, Davidson) Division of Cardiothoracic Surgery, Northwestern
University, Chicago, IL, United States
(Thourani) Department of Cardiac Surgery, Medstar Washington Hospital
Center, Washington, DC, United States
(Beohar) Columbia University Division of Cardiology at Mount Sinai Medical
Center, Miami Beach, FL, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Patients with chronic kidney disease (CKD) and aortic stenosis
(AS) have poor prognosis after both transcatheter aortic valve replacement
(TAVR) and surgical aortic valve replacement (SAVR). The objective of our
study was to assess the outcomes of TAVR versus SAVR for severe AS among
patients with moderate to severe CKD (stage >=3). Methods: PubMed,
Cochrane Center Register of Controlled Trials and clinical trial registry
were searched through April 2017. Seven studies comparing TAVR (n = 878)
and SAVR (n = 2531) in patients with CKD stage >=3 were included. End
points were clinical and qualitative outcomes. Odds ratio (OR) or mean
difference (MD) with 95% confidence interval (CI) was computed and p <
0.05 was considered significant. Results: There was no difference in
all-cause mortality (p = 0.7), cerebrovascular accidents (p = 0.28),
myocardial infarction (p = 0.55) or new permanent pacemaker placement (p =
0.06) with TAVR compared with SAVR. Post-procedural worsening renal
failure or acute kidney injury (AKI), new dialysis and length of intensive
care unit stay were lower with TAVR compared with SAVR (OR:0.47,
CI:0.33-0.68, p < 0.0001; OR:0.44, CI:0.25-0.74, p = 0.002 and MD: -68.32
hours, CI: -86.35 to -50.28 hours, p < 0.00001 respectively). Major
vascular complications were higher and red blood cell transfusion was
lower with TAVR compared with SAVR (OR:8.84, CI:1.6-49, p = 0.01 and
OR:0.39, CI:0.18-0.82, p = 0.01 respectively). Conclusion: The results of
our meta-analysis comparing TAVR with SAVR in patients with severe AS and
moderate to severe CKD suggest that TAVR is comparable to SAVR with the
advantage of a decreased incidence of worsening of renal failure or AKI,
new dialysis, and intensive care unit stay.<br/>Copyright &#xa9; 2017,
&#xa9; 2017 Cardiovascular Research Foundation.

<9>
Accession Number
623954776
Title
Outcomes for Percutaneous Mitral Valve-in-Valves and Mitral Valve-in-Rings
in the Transapical and Transseptal Access Routes: A Systematic Review and
Pooled Analysis.
Source
Structural Heart. 2 (3) (pp 214-220), 2018. Date of Publication: 04 May
2018.
Author
Sengodan P.; Sankaramangalam K.; Banerjee K.; Athappan G.; Jobanputra Y.;
Krishnaswamy A.; Tuzcu M.E.; Kapadia S.
Institution
(Sengodan) Department of Medicine, Cleveland Clinic at Fairview Hospital,
Cleveland, OH, United States
(Sankaramangalam, Banerjee, Jobanputra, Krishnaswamy, Kapadia) Department
of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
(Athappan) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi,
Al Maryah Island, United Arab Emirates
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: The transapical (TA) route for mitral valve-in-valve (MVIV)
and mitral valve-in-ring (MVIR) techniques has been predominantly used.
Currently, there is an increasing trend towards the transseptal (TS)
route. The purpose of the study was to assess the outcomes of TA and TS
access for percutaneous MVIV and MVIR techniques in terms of procedural
success, 30-day mortality, major bleeding events and valve embolization.
Methods: A comprehensive literature search of EMBASE, PubMed, and the
Cochrane CENTRAL was completed. We identified and pooled all studies
reporting either the TS or TA approach for MVIV or MVIR with at least five
patients using weighted proportional analysis. For analysis we used
studies reporting the outcomes of percutaneous MVIV or MVIR based on the
TS/TA approach. Results: From the initial 1,993 abstracts, 15 studies
reporting on 236 patients were analyzed to find the pooled estimate of the
endpoints. In the TA arm, 11 studies were included, and in the TS arm, 8
studies were included. Of these, 5 studies reported data for both the TA
and TS arms. There was no difference between the groups in terms of
technical success, 30-day all-cause mortality, major bleeding events, and
valve embolization. Conclusion: Although the TA approach has been used in
most of the published studies, the TS approach appears to be equally
effective at 30 days. Long-term studies are needed to establish the
relative efficacy of one approach over the other.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Cardiovascular Research Foundation.

<10>
Accession Number
623954762
Title
Subclinical Leaflet Thrombosis and Clinical Outcomes after TAVR: A
Systematic Review and Meta-Analysis.
Source
Structural Heart. 2 (3) (pp 223-228), 2018. Date of Publication: 04 May
2018.
Author
Kalra A.; Raza S.; Puri R.; Deo S.V.; Auffret V.; Khera S.; Attizzani
G.F.; Zia A.; Khan M.S.; Reardon M.J.; Kleiman N.S.; Latib A.; Rodes-Cabau
J.; Sabik J.F.; Bhatt D.L.
Institution
(Kalra, Attizzani) Harrington Heart & Vascular Institute, University
Hospitals Cleveland Medical Center, Division of Cardiovascular Medicine,
Department of Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH, United States
(Raza, Deo, Sabik) Department of Surgery, University Hospitals Cleveland
Medical Center, Cleveland, OH, United States
(Puri) Quebec Heart & Lung Institute, Laval University, Cleveland Clinic
Coordinating Center for Clinical Research (C5R), Cleveland, OH, United
States
(Puri) Department of Medicine, University of Adelaide, North Terrace
Campus, Adelaide, Australia
(Auffret) Department of Cardiology and Vascular Disease, CIC-IT 804,
Rennes 1 University, Pontchaillou University Hospital, Signal and Image
Processing Laboratory (LTSI), INSERM U1099, Rennes, France
(Khera) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Zia) Dow University of Health Sciences, Karachi, Pakistan
(Khan) Department of Internal Medicine, John H. Stroger, Jr. Hospital of
Cook County, Chicago, IL, United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston Methodist Hospital, Houston, TX, United States
(Latib) Interventional Cardiology Unit, Cardiology and Cardiothoracic
Surgery Department, San Raffaele University Hospital, Milan, Italy
(Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, QC, Canada
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Little is known about the influence of subclinical leaflet
thrombosis (SCLT) on clinical outcomes after transcatheter aortic valve
replacement (TAVR). Therefore, we sought to perform a systematic review
and meta-analysis of studies that reported clinical outcomes in patients
with or without SCLT after TAVR. Methods: We searched Medline, PubMed, and
Embase in September 2017 for studies reporting the clinical outcomes in
patients with or without SCLT after TAVR. SCLT was defined as the presence
of hypo-attenuated leaflet thickening (HALT) and/or hypo-attenuation
affecting leaflet motion (HAM) shown on computed tomography. End-points
studied included (1) mortality; (2) stroke; and (3) stroke and/or TIA.
Odds ratio (OR) meta-analysis was conducted by the Peto method using a
random effects model; results are presented at the 95% confidence level.
Results: A total of five studies (91 patients with SCLT; 672 patients
without SCLT) met the inclusion criteria. Pooled incidence of SCLT was
15.2% (7.8-27.7%) in patients undergoing TAVR. There was no significant
difference in mortality (OR: 0.86 [0.29-2.51]), stroke (OR: 1.3
[0.26-6.67]), or stroke and/or TIA (OR: 4.56 [0.35-58.8]) in patients with
or without SCLT. Conclusions: This study-level meta-analysis suggests a
15% incidence of SCLT post-TAVR, with no statistically significant
associations with mortality and stroke/TIA, though with broad confidence
intervals and limited statistical power. Given the lack of availability of
patient-level data, as well as the relatively limited numbers of patients
included across a handful of registries, ongoing surveillance as well as
systematic attempts to understand better the clinical significance of SCLT
will be required.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Cardiovascular
Research Foundation.

<11>
Accession Number
623906721
Title
Evaluation of pain and patient satisfaction by music therapy in patients
with endoscopy/colonoscopy.
Source
Turkish Journal of Gastroenterology. 29 (5) (pp 574-579), 2018. Date of
Publication: September 2018.
Author
Bashiri M.; Akcali D.; Coskun D.; Cindoruk M.; Dikmen A.; Cifdaloz B.U.
Institution
(Bashiri, Akcali, Coskun) Department of Anesthesiology and Reanimation,
Gazi University School of Medicine, Ankara, Turkey
(Cindoruk) Department of Gastroenterology, Gazi University School of
Medicine, Ankara, Turkey
(Dikmen) Department of Public Health, Gazi University School of Medicine,
Ankara, Turkey
(Cifdaloz) Department of Musicology, Gazi University Turkish Music
National Conservatory, Ankara, Turkey
Publisher
AVES Ibrahim KARA (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background/Aims: Endoscopy and colonoscopy are frequently performed
procedures to evaluate the gastrointestinal system. These procedures are
sometimes disturbing and painful for the patient. In gastrointestinal
suits, endoscopy and colonoscopy may be performed on awake or sedated
patients. Music therapy is a common and non-pharmacological treatment for
various medical conditions, pain, and anxiety. The aim of the present
study was to add music therapy to sedation administered during endoscopy
and colonoscopy. The effect of music treatment on drug consumption,
anxiety, and pain was investigated. Materials and Methods: American
Anesthesiologist Association I-III adult patients scheduled for
endo/colonoscopy were randomized to music treatment and no music treatment
groups. Patients with endoscopic ultrasound and endoscopic retrograde
colangiopancreaticography were excluded from the study. Anxiety score and
pain severity were evaluated before and after the procedure. Heart rate,
mean arterial pressure, and oxygen saturation were recorded before,
during, and after the procedure. Total drug consumption was recorded.
Patient satisfaction and desire for the same protocol for recurrent
procedures were investigated. Results: Music therapy added to deep
sedation administered by anesthesiologists provided decreased anxiety
score and propofol consumption. Patient satisfaction was increased, and
patients reported a desire for the same protocol for recurrent procedures.
Conclusion: The present study may serve as the beginning of using music
therapy for pain treatment in gastroenterology procedures in our hospital
with/without sedation. Music and other non-pharmacological treatment
methods must be remembered to increase patient comfort during
enco/colonoscopies and other painful procedures.<br/>&#xa9; Copyright 2018
by The Turkish Society of Gastroenterology * Available online at
www.turkjgastroenterol.org

<12>
[Use Link to view the full text]
Accession Number
623945707
Title
Impact of coronary artery revascularization completeness on outcomes of
patients with coronary artery disease undergoing transcatheter aortic
valve replacement a meta-analysis of studies using the residual syntax
score (synergy between PCI with taxus and cardiac surgery).
Source
Circulation: Cardiovascular Interventions. 11 (3) (no pagination), 2018.
Article Number: e006000. Date of Publication: 01 Mar 2018.
Author
Witberg G.; Zusman O.; Codner P.; Assali A.; Kornowski R.
Institution
(Witberg, Zusman, Codner, Assali, Kornowski) Sackler Faculty of Medicine,
Tel-Aviv University, Israel
(Witberg, Zusman, Codner, Assali, Kornowski) Department of Cardiology,
Rabin Medical Center, 100 Jabutinski St, Petah Tikva 98100, Israel
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Coronary artery disease (CAD) is highly prevalent in patients
undergoing transcatheter aortic valve replacement. In the overall CAD
population, complete revascularization or reasonable incomplete
revascularization (ICR) is associated with improved outcomes; whether the
same applies for the transcatheter aortic valve replacement population is
still a matter of debate. Methods and Results-We conducted a systematic
review and meta-analysis of studies that examined the prognostic effect of
revascularization completeness in patients undergoing transcatheter aortic
valve replacement using the residual SYNTAX score (Synergy Between PCI
With Taxus and Cardiac Surgery) to separate between reasonable ICR and ICR
(using the individual threshold used by each study). Six studies with a
total of 3107 patients were included. The duration of follow-up ranged
from 0.7 to 3 years. Overall, ICR was associated with an increased risk
for mortality. This was true when comparing ICR patients to those with no
CAD (odds ratio, 1.85; 95% confidence interval, 1.42-2.40; P<0.01), to
those with reasonable ICR (odds ratio, 1.69; 95% confidence interval,
1.26-2.28; P<0.001), or to both groups combined (odds ratio, 1.71; 95%
confidence interval, 1.36-2.16; P<0.001). On the contrary, patients in the
reasonable ICR category did not show an increased risk for mortality when
compared with those with no CAD (odds ratio, 1.11; 95% confidence
interval, 0.89-1.39; P=0.33). Conclusions-Our results suggest that for
patients with CAD undergoing transcatheter aortic valve replacement, a
residual SYNTAX score-guided revascularization strategy may carry
significant benefits in terms of mortality. Adequate revascularization may
offer a unique and valuable opportunity to improve the prognosis of these
patients.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<13>
Accession Number
623937971
Title
Use of low-dose dexmedetomidine in combination with opioids and midazolam
in pediatric cardiac surgical patients: Randomized controlled trial.
Source
Minerva Anestesiologica. 84 (9) (pp 1053-1062), 2018. Date of Publication:
September 2018.
Author
Garisto C.; Ricci Z.; Tofani L.; Benegni S.; Pezzella C.; Cogo P.
Institution
(Garisto, Ricci, Benegni) Pediatric Cardiac Intensive Care Unit,
Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, IRCCS, Rome, Italy
(Tofani) Department of Neurosciences, Psychology, Drug Research and Child
Health, University of Florence, Florence, Italy
(Pezzella) ASLTO3, Susa-Rivoli Hospital, Rivoli, Italy
(Cogo) Department of Medicine, University of Udine, Udine, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Dexmedetomidine is a selective agonist of alpha2 receptors
that induces hypnotic, sedative and mild analgesic effect. The aim of our
study was to test the effects of dexmedetomidine in combination with
opioids and benzodiazepines compared to benzodiazepine-opioids alone.
METHODS: Arandomized controlled trial was conducted. Patients (children
>30 days and <24 months undergoing correction of complex congenital heart
diseases [CHD]) were randomized to receive 0.5 mcg/kg/h dexmedetomidine in
addition to half dose of opioids and benzodiazepines (D-CASES) or standard
dose opioids and benzodiazepines (CONTROLs). Primary outcome: to compare
the duration of mechanical ventilation (MV) in D-CASEs and CONTROLs.
Secondary outcomes: 1) the degree of sedation; 2) the onset of withdrawal
symptoms; 3) the occurrence bradycardia and hypotension. RESULTS: Overall,
48 patients, 26 in CONTROLs group and 22 in D-CASEs group were ultimately
included in the analysis after enrollment. The median duration of MV was
33.5 (16.7-75) hours in CONTROLs and 41.5 (23.7-71.2) hours in D-CASEs
(P=0.51). Dexmedetomidine did not affect COMFORTand FLACCscales but it
reduced the SOSscale in 15 D-CASEs vs. 11 CONTROLs (P=0.001). The
incidence of bradycardia and hypotension and vasoactive support did not
show significant differences in the two groups. CONCLUSIONS: Low dose of
dexmedetomidine in combination with morphine and midazolam was safe in a
high-risk cohort of CHD children after cardiac surgery and reduced the
onset of withdrawal symptoms. However, it did not decrease MV time and the
total amount of other sedative and analgesic drugs required in the
post-operative period.<br/>Copyright &#xa9; 2018 Edizioni Minerva Medica.

<14>
Accession Number
623935711
Title
Outcomes after Transcatheter and Surgical Aortic Valve Replacement in
Intermediate Risk Patients with Preoperative Mitral Regurgitation:
Analysis of PARTNER II Randomized Cohort.
Source
Structural Heart. 2 (4) (pp 336-343), 2018. Date of Publication: 04 Jul
2018.
Author
Malaisrie S.C.; Hodson R.W.; McAndrew T.C.; Davidson C.; Swanson J.; Hahn
R.T.; Pibarot P.; Jaber W.A.; Quader N.; Zajarias A.; Svensson L.; George
I.; Trento A.; Thourani V.H.; Szeto W.Y.; Dewey T.; Smith C.R.; Leon M.B.;
Webb J.G.
Institution
(Malaisrie, Davidson) Division of Cardiac Surgery, Northwestern
University, Bluhm Cardiovascular Institute, Chicago, IL, United States
(Hodson, Swanson) Providence Valve Center, Providence St. Vincent Medical
Center, Portland, OR, United States
(McAndrew, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Hahn, George, Smith, Leon) Columbia University Medical Center, New York,
NY, United States
(Pibarot) Department of Medicine, Laval University, Quebec, QC, Canada
(Jaber, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Quader, Zajarias) Washington University School of Medicine, St. Louis,
MI, United States
(Trento) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Medstar Washington Hospital Center, Washington, DC, United
States
(Szeto) University of Pennsylvania, Philadelphia, PA, United States
(Dewey) Medical City Dallas Hospital, Dallas, TX, United States
(Webb) Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver,
BC, Canada
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Preoperative mitral regurgitation (MR) in patients undergoing
transcatheter (TAVR) and surgical aortic valve replacement (SAVR) has been
studied in high-risk cohorts. This study examines the outcomes of
preoperative MR (>= moderate) in a larger, intermediate-risk cohort.
Methods: The Placement of Aortic Transcatheter Valves (PARTNER) 2A Trial
randomized 2032 intermediate-risk patients with severe, symptomatic aortic
stenosis to TAVR or SAVR. An ad-hoc analysis was performed on 1738
patients with baseline MR echocardiographic data. Patients were analyzed
according to the degree of preoperative MR (>= moderate versus <= mild).
Results: At baseline, >= moderate MR was reported in 300 patients (17%).
At 30 days, >= moderate MR had improved in 47% to <= mild. Thirty-day
mortality was higher in SAVR patients with >= moderate MR (8.0 versus
3.5%; p = 0.01), but this difference was not seen in TAVR (2.7 vs. 3.1%; p
= 0.78). At 2-years, the combined outcome of death (20.5 vs. 16.3%; p =
0.07), stroke (12.9 vs. 9.0%; p = 0.06), and rehospitalization (22.0
versus 17.4%; p = 0.06) was higher in the >= moderate MR (40.4 vs. 32.6%;
p = 0.009), and similar between SAVR and TAVR (39.8 vs. 41.0%; p = 0.89).
Conclusions: Significant MR is prevalent in patients with severe AS and
affects clinical outcomes after both TAVR and SAVR. SAVR patients with MR
have high early risk, but the increased risk of
death/stroke/rehospitalization becomes similar in both groups over time.
Improvement in MR is common, especially in patients with lower ejection
fraction and larger left-ventricular dimensions.<br/>Copyright &#xa9;
2018, &#xa9; 2018 Cardiovascular Research Foundation.

<15>
Accession Number
623954593
Title
Radiologist initiated specialty referral for patients suspected of having
a thoracic malignancy.
Source
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 1 (4)
(pp 180-185), 2017. Date of Publication: 02 Oct 2017.
Author
Tremblay A.; Strilchuk N.; Taghizadeh N.; Fortin M.; Burrowes P.; Hampton
L.; Chee A.; MacEachern P.; Koetzler R.; McFadden S.
Institution
(Tremblay, Strilchuk, Taghizadeh, Fortin, Hampton, Chee, MacEachern,
Koetzler) Division of Respiratory Medicine, University of Calgary and
Alberta Thoracic Oncology Program, Calgary, AB, Canada
(Burrowes) Department of Diagnostic Imaging, Alberta Health Services,
Calgary, AB, Canada
(McFadden) Division of Thoracic Surgery, University of Calgary and Alberta
Thoracic Oncology Program, Calgary, AB, Canada
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
RATIONALE: The time interval between detection of a lesion suspicious for
thoracic malignancy on imaging and referral to specialty care can be too
long. OBJECTIVES: We aimed to evaluate an expedited referral process in
which a radiologist could trigger a referral to specialty care at the time
of CT interpretation. METHODS: Prospective observational non-randomized
study of two groups of patients referred to the Alberta Thoracic Oncology
Program-South (ATOP-S). Group 1: Subjects referred through a radiologist
referral at the time of interpretation. Group 2: Subjects referred through
another health care provider. The time interval between dates of first
suspicious CT scan to acceptance of referral (CT-R), first specialty
appointment date (CT-A), and treatment decision (CT-D) were compared
between both groups. MEASUREMENTS AND MAIN RESULTS: Seventy-five cases met
study criteria for group 1 and 836 for group 2. The median
(75^th, 90^th percentile) CT-R was 4 (8, 13) days in
group 1 and 8 (19, 37) days in group 2. For CT-A, the time intervals were
14 (19, 26) days in group 1 and 20 (32, 52) days in group 2 and for CT-D
26 (40, 63) days in group 1 and 32 (49, 71) days in group 2. Subjects in
group 1 had a significantly shorter CT-R, CT-A, and CT-D intervals
compared to subjects in group 2 (P-values < 0.001, < 0.001 and 0.004,
respectively). CONCLUSION: A radiologist initiated referral program
significantly reduced the interval between first CT scan suggestive of a
lung malignancy to receipt of referral to a specialist, first specialty
appointment date and treatment decision. RESUME JUSTIFICATION:
L'intervalle de temps entre la detection d'une lesion suspecte de
malignite thoracique par imagerie et la reference en soins specialises
peut etre trop long. OBJECTIFS: Nous voulions evaluer un processus de
reference accelere dans le cadre duquel un radiologue pouvait declencher
une reference en soins specialises au moment de l'interpretation de la
tomodensitometrie. METHODES: Etude observationnelle prospective non
randomisee de deux groupes de patients referes au Programme d'oncologie
thoracique de l'Alberta-Sud (ATOP-S). Groupe 1: Sujets referes par le
biais d'une reference du radiologue au moment de l'interpretation. Groupe
2: Sujets referes par le biais d'un autre prestataire de soins.
L'intervalle de temps entre la date de la premiere tomographie suspecte et
la date de l'acception de la reference (CT-R), la date du premier
rendez-vous en soins specialises (CT-A) et la date decision de traitement
(CT-D) a ete compare entre les deux groupes. MESURES ET PRINCIPAUX
RESULTATS: Soixante-quinze cas repondaient aux criteres de l'etude pour le
groupe 1 et 836 pour le groupe 2. Le CT-R median (75^e,
90^e percentile) etait de 4 (8, 13) jours pour le groupe 1 et de
8 (19, 37) jours pour le groupe 2. Pour le CT-A, les intervalles de temps
ont ete de 14 (19, 26) jours pour le groupe 1 et de 20 (32, 52) jours pour
le groupe 2, tandis que pour le CT-D, ils ont ete de 26 (40, 63) jours
pour le groupe 1 et de 32 (49, 71) jours pour le groupe 2. Les sujets du
groupe 1 avaient des intervalles de CT-R, de CT-A et de CT-D
significativement plus courts comparativement aux sujets du groupe 2
(valeurs p < 0,001, < 0,001 et 0,004, respectivement). CONCLUSION: Un
programme de reference initiee par le radiologue reduit de maniere
significative l'intervalle entre la premiere tomodensitometrie evocatrice
d'une malignite pulmonaire et la reception de la reference par un
specialiste, le premier rendez-vous en soins specialises et la decision de
traitement.<br/>Copyright &#xa9; 2017, &#xa9; 2017 Canadian Thoracic
Society.

<16>
Accession Number
621755580
Title
Percutaneous Versus Surgical Revascularization for Left Main or
Multivessel Coronary Artery Disease: Results From a Large-Scale
Meta-Analysis in the Era of Drug-Eluting Stents.
Source
Angiology. 69 (9) (pp 812-824), 2018. Date of Publication: 01 Oct 2018.
Author
Verdoia M.; Barbieri L.; Kedhi E.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita," Eastern Piedmont
University, Novara, Italy
(Barbieri) Presidio Ospedaliero S. Andrea, Vercelli, Italy
(Kedhi) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Kedhi, Suryapranata) UMC St Radboud, Nijmegen, Netherlands
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The best treatment options for left main (LM) or multivessel coronary
disease (MVD) are still debated. We performed a meta-analysis of
randomized trials comparing percutaneous versus surgical revascularization
for LM or MVD. Primary end point was overall mortality. Secondary end
points were major adverse cardiovascular events, recurrent myocardial
infarction, repeated revascularization, or stroke. A total of 8 randomized
trials were included, involving 8694 patients, 50% undergoing percutaneous
coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality
was 8.2% with no difference for PCI versus coronary artery bypass grafting
(CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P
=.24, P for heterogeneity [P<inf>het</inf>] =.01). However, CABG was
slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P =.008,
P<inf>het</inf> =.14 for PCI) whereas noninferior for LM disease (OR [95%
CI] = 0.88 [0.60-1.29]; P =.50, P<inf>het</inf> =.10, P interaction =.03).
A similar benefit with CABG was also observed in terms of repeated
coronary revascularization, whereas PCI significantly reduced stroke. This
meta-analysis shows that surgical coronary revascularization still offers
advantages in survival and recurrent ischemic events compared to PCI using
drug-eluting stents (DES) in MVD although burdened by an increased risk of
stroke. In LM disease, CABG did not provide outcome benefits but was
associated with a higher risk of stroke compared to PCI. Additional
randomized trials are certainly needed with new-generation
DES.<br/>Copyright &#xa9; The Author(s) 2018.

<17>
Accession Number
620676738
Title
Retrospective Review of a Prothrombin Complex Concentrate (Beriplex P/N)
for the Management of Perioperative Bleeding Unrelated to Oral
Anticoagulation.
Source
Clinical and Applied Thrombosis/Hemostasis. 24 (7) (pp 1159-1169), 2018.
Date of Publication: 01 Oct 2018.
Author
Chowdary P.; Tang A.; Watson D.; Besser M.; Collins P.; Creagh M.D.;
Qureshi H.; Rokicka M.; Nokes T.; Diprose P.; Gill R.
Institution
(Chowdary) Katharine Dormandy Haemophilia Centre and Thrombosis Unit,
Royal Free Hospital, London, United Kingdom
(Tang, Watson) Lancashire Cardiac Centre, Blackpool Teaching Hospital FT,
Blackpool, United Kingdom
(Tang) Faculty of Health and Medicine, Lancaster University, Lancaster,
United Kingdom
(Besser) Addenbrooke's Hospital, University of Cambridge, Cambridge,
United Kingdom
(Collins) Arthur Bloom Haemophilia Centre, University Hospital of Wales,
Cardiff, United Kingdom
(Creagh) Department of Haematology, Royal Cornwall Hospital, Truro, United
Kingdom
(Qureshi) Department of Transfusion Medicine, Glenfield Hospital,
Leicester, United Kingdom
(Rokicka) Royal Blackburn Hospital, Blackburn, United Kingdom
(Nokes) Derriford Hospital, Plymouth, United Kingdom
(Diprose, Gill) Department of Anaesthesia, University Hospital
Southampton, Southampton, United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
A multicenter, retrospective, observational study of 4-factor prothrombin
complex concentrate (PCC) and/or fresh frozen plasma (FFP) use within
routine clinical care unrelated to vitamin K antagonists was conducted.
The PCC was administered preprocedure for correction of coagulopathy
(prophylactic cohort) and treatment of bleeding postsurgery (treatment
cohort). Of the 445 patients included, 40 were in the prophylactic cohort
(PCC alone [n = 16], PCC and FFP [n = 5], FFP alone [n = 19]) and 405 were
in the treatment cohort (PCC alone [n = 228], PCC and FFP [n = 123], FFP
alone [n = 54]). Cardiovascular surgery was the most common setting. PCC
doses ranged between 500 and 5000 IU. Effectiveness (assessed
retrospectively) was reported as effective in 93.0% in the PCC-only group
(95% confidence interval, 89.1% to 95.9%), 78.9% (70.8% to 85.6%) with PCC
and FFP, and 86.3% (76.2% to 93.2%) with FFP alone. In the treatment
cohort, international normalized ratio was significantly reduced in all 3
groups. In patients who received PCC, the rate of thromboembolic events
(1.9%) was below rates in the literature for similar procedures. PCCs
offer a potential alternative to FFP in the management of perioperative
bleeding unrelated to oral anticoagulant therapy.<br/>Copyright &#xa9; The
Author(s) 2018.

<18>
Accession Number
2001111846
Title
Fungal endocarditis after transcatheter aortic valve replacement (TAVR):
Case report and review of literature.
Source
Journal of Infection and Chemotherapy. (no pagination), 2018. Date of
Publication: 2018.
Author
Morioka H.; Tokuda Y.; Oshima H.; Iguchi M.; Tomita Y.; Usui A.; Yagi T.
Institution
(Morioka, Iguchi, Tomita, Yagi) Department of Infectious Diseases, Nagoya
University Hospital, Japan
(Tokuda, Oshima, Usui) Department of Cardiac Surgery, Nagoya University
Hospital, Japan
Publisher
Elsevier B.V.
Abstract
The reported number of transcatheter aortic valve replacement-associated
infective endocarditis (TAVR-IE) cases has been increasing worldwide, but
information about the incidence and clinical features of fungal TAVR-IE is
quite limited. We present a patient who acquired TAVR-IE caused by Candida
parapsilosis four month after TAVR, who was successfully treated
redo-aortic valve replacement and prolonged antifungal
therapy.<br/>Copyright &#xa9; 2018 Japanese Society of Chemotherapy and
The Japanese Association for Infectious Diseases

<19>
Accession Number
2001111602
Title
Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac
Surgery and Their Parents: Effect of Brief Intervention-A Randomized
Control Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Kumar A.; Das S.; Chauhan S.; Kiran U.; Satapathy S.
Institution
(Kumar, Das, Chauhan, Kiran) Department of Cardiac Anaesthesia, All India
Institute of Medical Sciences, New Delhi, India
(Satapathy) Department of Clinical Psychology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To know the effects of psychological preparation on
perioperative stress, anxiety, and mood in children undergoing cardiac
surgery and their parents. Design: Prospective randomized control
nonblinded trial. Setting: Single-center tertiary teaching hospital.
Participants: A total of 60 children aged 5 to 15 years undergoing cardiac
surgery were included in the study. One of the parents, preferably the
father, was selected from the respective children. Interventions: Subjects
were randomized into 2 groups: noninterventional (group 1) and
interventional (group 2). Intervention was in the form of toys and video
games in children, and counseling and information in parents. Preoperative
and postoperative anxiety in parents was measured using the State-Trait
Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS)
scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child
version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker
faces pain scale were applied and serum cortisol was measured.
Measurements and Main Results: Group 2 children had significantly less (p
< 0.001) stress, anxiety, and pain and improved mood. Group 2 parents had
a significant reduction in state anxiety (42 +/- 4.4 v 54.5 +/- 7.8; p <
0.001) and ICS score (68.1+/-9.6 v 84.2 +/- 9.2; p < 0.001) and an
improvement in mood (7.5 +/- 0.7 v 5.9 +/- 1; p < 0.001) compared with
group 1. Postoperatively, cortisol levels in group 2 were lower than group
1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]). Conclusion:
Providing video games and toys preoperatively reduced postoperative stress
and anxiety and improved mood in children undergoing congenital cardiac
surgery. Parents were relieved of anxiety and stress with proper
counseling and information.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<20>
Accession Number
2001108334
Title
Remote ischaemic conditioning for prevention of acute kidney injury after
valvular heart surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2018. Date of
Publication: 2018.
Author
Song J.W.; Lee W.K.; Lee S.; Shim J.K.; Kim H.J.; Kwak Y.L.
Institution
(Song, Lee, Shim, Kim, Kwak) Department of Anaesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Lee) Department of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Elsevier Ltd
Abstract
Background: Repeated remote ischaemic conditioning (RIC) during weaning
from cardiopulmonary bypass and in the early postoperative period may
confer protection against acute kidney injury (AKI). We evaluated the
effect of repeated RIC on the incidence of AKI in patients undergoing
valvular heart surgery. Methods: Patients were randomised into either the
RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on
each patient's thigh. Upon removal of the aortic cross-clamp, three cycles
of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in
the RIC group. Additionally, three cycles of RIC were repeated at
postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease:
Improving Global Outcomes guideline. The incidences of renal replacement
therapy, permanent stroke, sternal wound infection, newly developed atrial
fibrillation, mechanical ventilation >24 h, and reoperation for bleeding
during hospitalisation were recorded. Results: The incidences of AKI were
not significantly different between the control (19.4%) and RIC (15.8%)
groups (a difference of 3.5 percentage points; 95% confidence interval:
-6.8%-13.9%; P=0.470). Perioperative serum creatinine concentrations were
similar in the control and RIC groups (P=0.494). Fluid balance, urine
output, blood loss, transfusion, and vasopressor/inotropic requirements
were not significantly different between the groups (all P>0.05). The
occurrences of a composite of morbidity and mortality endpoints were not
significantly different between the control (46.0%) and RIC (39.2%) groups
(a difference of 6.8 percentage points; 95% confidence interval:
-6.4%-20.0%; P=0.283). Conclusions: The results of our study do not
support repeated RIC to decrease the incidence of AKI after valvular heart
surgery. Clinical trial registration: NCT02720549.<br/>Copyright &#xa9;
2018 British Journal of Anaesthesia

<21>
Accession Number
624005634
Title
A radiological and anatomic examination of intralaminar screws in the
thoracic spine-a theoretical feasibility study.
Source
Acta Neurochirurgica. (no pagination), 2018. Date of Publication: 2018.
Author
Muller J.; Muller J.-U.; Koppe T.; Nowak S.; Schroeder H.W.S.; Baldauf J.
Institution
(Muller, Muller, Nowak, Schroeder, Baldauf) Department of Neurosurgery,
E.-M.-Arndt University, Greifswald, Germany
(Koppe) Institute of Anatomy and Cell Biology, E.-M.-Arndt University,
Greifswald, Germany
Publisher
Springer-Verlag Wien (E-mail: michaela.bolli@springer.at)
Abstract
Background: Failure of pedicle screws and anatomical variations which
prevent pedicle screw implantation make the search for an alternative to
pedicle screws in thoracic spine surgery necessary. To date, published
data have shown that intralaminar screws could be a possible way of
fixation. Object of this study is a systematic examination of the
feasibility of lamina screws in the whole thoracic spine. Methods: Fifty
females and 50 males (age 20 to 60 years) who underwent a polytrauma CT
from 2010 to 2012 were randomly selected. Patients with injury of the
thoracic spine, trauma-independent deformity, or dysplasia of the thoracic
spine were excluded. A three-dimensional reconstruction of the thoracic
spine was performed from the data set. The anatomical data of the lamina
were measured under consideration of the potential trajectory of a laminar
screw. The caliber of the corresponding pedicle was measured as well.
Results: The diameters of the lamina show a decline in superior-inferior
direction (0.66 cm in T1 to 0.60 cm in T12 in males, 0.62 to 0.56 cm in
females). Diameters of pedicle and lamina show no correlation. Twenty
percent of the pedicles have a hypoplasia with a diameter of less than 0.5
cm. However, in these vertebrae, 62.3% of the laminae would be suitable
for 0.4-cm lamina screws. Only in 2.75% of the vertebral bodies, there was
no possibility for intralaminar or pedicle screws. Conclusions: This study
shows that it is possible to use intralaminar screws in the thoracic spine
in most of patients.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH
Austria, part of Springer Nature.

<22>
[Use Link to view the full text]
Accession Number
623933316
Title
Effect of remote ischemic preconditioning on outcomes in adult cardiac
surgery: A systematic review and meta-analysis of randomized controlled
studies.
Source
Anesthesia and Analgesia. 127 (1) (pp 30-38), 2018. Date of Publication:
01 Jul 2018.
Author
Xie J.; Zhang X.; Xu J.; Zhang Z.; Klingensmith N.J.; Liu S.; Pan C.; Yang
Y.; Qiu H.
Institution
(Xie, Zhang, Xu, Liu, Pan, Yang) Department of Critical Care Medicine,
Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
(Zhang) Department of Critical Care Medicine, Jinhua Municipal Central
Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, China
(Klingensmith) Department of Surgery, Emory Critical Care Center, Emory
University School of Medicine, Atlanta, GA, United States
(Qiu) Department of Critical Care Medicine, Zhongda Hospital, School of
Medicine, Southeast University, Nanjing 210009, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Remote ischemic preconditioning (RIPC) has been demonstrated
to prevent organ dysfunction in cardiac surgery patients. However, recent
large, prospective, multicenter, randomized controlled trials (RCTs) had
controversial results. Thus, a meta-analysis of RCTs was performed to
investigate whether RIPC can reduce the incidence of acute myocardial
infarction (AMI), acute kidney injury (AKI), and mortality in adult
cardiac surgery patients. METHODS: Study data were collected from Medline,
Elsevier, Cochrane Central Register of Controlled Trials and Web of
Science databases. RCTs involving the effect of RIPC on organ protection
in cardiac surgery patients, which reported the concentration or total
release of creatine kinase-myocardial band, troponin I/troponin T
(TNI/TNT) after operation, or the incidence of AMI, AKI, or mortality,
were selected. Two reviewers independently extracted data using a
standardized data extraction protocol where TNI or TNT concentrations;
total TNI released after cardiac surgery; and the incidence of AKI, AMI,
and mortality were recorded. Review Manager 5.3 software was used to
analyze the data. RESULTS: Thirty trials, including 7036 patients were
included in the analyses. RIPC significantly decreased the concentration
of TNI/TNT (standard mean difference [SMD], -0.25 ng/mL; 95% confidence
interval [CI], -0.41 to -0.048 ng/mL; P = .004), creatine
kinase-myocardial band (SMD, -0.22; 95% CI, -0.07-0.35 ng/mL; P = .46),
and the total TNI/TNT release (SMD, -0.49 ng/mL; 95% CI, -0.93 to -0.55
ng/mL; P = .03) in cardiac surgery patients after a procedure. However,
RIPC could not reduce the incidence of AMI (relative risk, 0.89; 95% CI,
0.70-1.13; P = .34) and AKI (relative risk, 0.88; 95% CI, 0.72-1.06; P =
.18), and there was also no effect of RIPC on mortality in adult cardiac
surgery patients. Interestingly, subgroup analysis showed that RIPC
reduced incidence of AKI and mortality of cardiac surgery patients who
received volatile agent anesthesia. CONCLUSIONS: Our meta-analysis
demonstrated that RIPC reduced TNI/TNT release after cardiac surgery. RIPC
did not significantly reduce the incidence of AKI, AMI, and mortality.
However, RIPC could reduce mortality in patients receiving volatile
inhalational agent anesthesia.<br/>Copyright &#xa9; 2018 International
Anesthesia Research Society.

<23>
Accession Number
2000701390
Title
Safety of intermediate left main stenosis revascularization deferral based
on fractional flow reserve and intravascular ultrasound: A systematic
review and meta-regression including 908 deferred left main stenosis from
12 studies.
Source
International Journal of Cardiology. 271 (pp 42-48), 2018. Date of
Publication: 15 November 2018.
Author
Cerrato E.; Echavarria-Pinto M.; D'Ascenzo F.; Gonzalo N.; Quadri G.;
Quiros A.; de la Torre Hernandez J.M.; Tomassini F.; Barbero U.;
Nombela-Franco L.; Nunez-Gil I.; Biondi-Zoccai G.; Macaya C.; Varbella F.;
Escaned J.
Institution
(Cerrato, Quadri, Tomassini, Varbella) Interventional Cardiology, San
Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital,
Rivoli, Turin, Italy
(Echavarria-Pinto) Department of Cardiology, Hospital General ISSSTE,
Queretaro, Mexico
(D'Ascenzo) Division of Cardiology, Citta della Salute e della Scienza,
University of Turin, Turin, Italy
(Gonzalo, Nombela-Franco, Nunez-Gil, Macaya, Escaned) Interventional
Cardiology, Hospital Clinico San Carlos, Madrid, Spain
(Quiros) Statistical Department, Univeristy of Leon, Leon, Spain
(de la Torre Hernandez) Interventional Cardiology, Hospital Universitario
Marques de Valdecilla, Valdecilla, Santander, Spain
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Barbero) Division of Cardiology, Santissima Annunziata Hospital,
Savigliano, Italy
(Barbero) Cardiovascular Research Unit, Royal Brompton Hospital, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Current guidelines recommend intravascular ultrasound (IVUS)
or fractional flow reserve (FFR) to decide upon ambiguous left main (LM)
disease. However, no study has compared the safety of LM revascularization
deferral based on FFR or IVUS. Methods: MEDLINE/PubMed was systematically
screened for studies reporting on deferred treatment of angiographically
ambiguous LM based upon FFR or IVUS evaluation. Baseline, angiographic and
outcome data were appraised and pooled separately for each strategy
according to random-effect models with inverse-variance weighting.
Results: A total of 908 LM stenoses from 7 FFR and 5 IVUS studies were
included with median follow-up of 29.0 and 31.5 months respectively. Per
year of follow-up occurrence of overall MACE were 5.1% in FFR group and
6.4% in IVUS group while death, myocardial infarction, LM
revascularization were respectively 2.6%, 1.5% and 1.8% vs. 3.0%, 0.5% and
2.2%. Meta-regression analysis suggested the influence of a distal LM
stenosis on MACE in FFR group (beta = 0.06, p = 0.01) and age in IVUS
group (beta = 0.4, p = 0.001). In individual studies several independent
predictors of MACE were identified including use of lower doses of
intracoronary adenosine (OR 1.39, p = 0.04) in FFR group and plaque burden
(OR 1.34, p = 0.025), number of other diseased vessels (OR 1.39, p = 0.04)
and any untreated stenosis (OR 3.80; p = 0.037) in IVUS- studies.
Conclusions: Deferring LM intermediate stenosis on the basis of FFR or
IVUS showed an acceptable and similar risk of events in a mid-term
follow-up. Conversely, several different variables related to each
technique showed an interaction on outcome.<br/>Copyright &#xa9; 2018
Elsevier B.V.

<24>
[Use Link to view the full text]
Accession Number
623904071
Title
Meta-analysis of death and myocardial infarction in the DEFINE-FLAIR and
iFR-SWEDEHEART trials.
Source
Circulation. 136 (24) (pp 2389-2391), 2017. Date of Publication: December
2017.
Author
Berry C.; McClure J.D.; Oldroyd K.G.
Institution
(Berry, McClure) British Heart Foundation Glasgow Cardiovascular Research
Centre, Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Scotland, United Kingdom
(Berry, Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Clydebank, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<25>
Accession Number
623993873
Title
Febuxostat versus allopurinol streamlined trial (FAST): Baseline
characteristics of the randomised patient population.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2018. Netherlands. 77 (Supplement 2) (pp 1631), 2018.
Date of Publication: June 2018.
Author
Mackenzie I.; MacDonald T.; Ford I.; Nuki G.
Institution
(Mackenzie, MacDonald) MEMO Research, University of Dundee, Dundee, United
Kingdom
(Ford) Robertson Centre for Biostatistics, University of Glasgow, Glasgow,
United Kingdom
(Nuki) Centre for Genomic and Experimental Medicine, University of
Edinburgh, Edinburgh, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background: The Febuxostat versus Allopurinol Streamlined Trial (FAST) is
a prospective, randomised, open-label, blinded endpoint trial comparing
the cardiovascular safety of allopurinol and febuxostat in patients with
symptomatic hyperuricaemia. 1 The trial includes patients aged over 60
years who are taking chronic allopurinol therapy at baseline and have at
least one additional cardiovascular risk factor. After uptitration on
allopurinol to reach EULAR urate targets, patients are randomised to
febuxostat or allopurinol then followed up for events. Patient recruitment
to the trial completed in late 2017 and follow-up is ongoing. Objectives:
To describe the baseline characteristics of the patients randomised into
the FAST study. Methods: The primary endpoint of the FAST study is the
composite of non-fatal myocardial infarction, non-fatal stroke or
cardiovascular death. The primary analysis is a non-inferiority analysis
with a non-inferiority upper limit for the hazard ratio for the primary
outcome of 1.3. Results: 6142 patients from UK, Denmark and Sweden have
been randomised into the FAST study. The mean age at randomisation was
71.0+/-6.4 (SD) years. 85.3% of participants are male. 57.3% are former
smokers and 7.9% current smokers. Mean systolic blood pressure was
138+/-18 mmHg and mean diastolic blood pressure 75+/-12 mmHg. Mean body
mass index was 31.1+/-5.2 kg/m². 10.7% of participants had a
history of previous myocardial infarction, 5.0% a history of previous
cerebrovascular accident and 4.8% a history of peripheral arterial
disease. 22.5% had a history of diabetes mellitus and 4.6% a history of
heart failure. 78.0% had a history of high blood pressure. 33.3% had a
history of any cardiovascular disease (defined as history of myocardial
infarction, cerebrovascular accident, transient ischaemic attack, acute
coronary syndrome, coronary revascularisation, angina pectoris or heart
failure). The mean baseline urate at study entry (screening) was 297+/-47
umol/L. The mean allopurinol dose being taken at study entry (screening)
was 225+/-106 mg daily. 2206 patients (35.9%) had at least one uptitration
of allopurinol dose prior to randomisation. Conclusions: This ongoing
European trial will report on the cardiovascular safety of febuxostat
versus allopurinol in patients with symptomatic hyperuricaemia.

<26>
Accession Number
623993832
Title
Allopurinol and cardiovascular outcomes in patients with ischaemic heart
disease (allheart) study: Baseline characteristics of the randomised
patient population.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2018. Netherlands. 77 (Supplement 2) (pp 1631), 2018.
Date of Publication: June 2018.
Author
Mackenzie I.; Ford I.; Hawkey C.; Begg A.; Taggar J.; Struthers A.; Wei
L.; Avery A.; Walker A.; Duce S.; Barr R.; Dumbleton J.; MacDonald T.
Institution
(Mackenzie, Duce, Barr, MacDonald) MEMO Research, University of Dundee,
Dundee, United Kingdom
(Ford) Robertson Centre for Biostatistics, University of Glasgow, Glasgow,
United Kingdom
(Hawkey, Taggar, Avery, Dumbleton) University of Nottingham, Nottingham,
United Kingdom
(Begg) Townhead Medical Practice, Montrose, United Kingdom
(Struthers) University of Dundee, Dundee, United Kingdom
(Wei) University College London, London, United Kingdom
(Walker) University of Glasgow, Glasgow, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background: Allopurinol is licensed for the prevention of gout. In recent
years, several studies have suggested that allopurinol may have beneficial
effects on cardiovascular parameters. The ALL-HEART study is a large
outcome trial designed to investigate whether allopurinol improves
cardiovascular outcomes in patients with ischaemic heart disease[.1 It is
a multicentre, controlled, prospective, randomised, open-label, blinded
endpoint trial of allopurinol (up to 600 mg daily) versus no treatment
added to usual care in patients aged 60 and over with ischaemic heart
disease. Patients are followed up by electronic record-linkage and annual
questionnaires. Patient recruitment to the trial started in 2014 and
completed in 2017 and follow-up is ongoing. Objectives: To describe the
baseline characteristics of the patients randomised into the ALL-HEART
study. Methods: The primary endpoint of the ALL-HEART study is the
composite of non-fatal myocardial infarction, non-fatal stroke or
cardiovascular death. Secondary outcomes include all-cause mortality,
quality of life and cost-effectiveness of allopurinol. The study will end
when 631 adjudicated primary outcomes have occurred. Results: 5938
patients from the UK have been randomised into the ALL-HEART study. The
mean age at randomisation was 72.1+/-6.8 (SD) years. 75.2% of participants
are male. 56.5% are former smokers and 9.4% current smokers. Mean systolic
blood pressure was 133+/-18 mmHg and mean diastolic blood pressure 72
+/-11 mmHg. Mean body mass index was 28.9+/-5.3 kg/m². The
average duration of ischaemic heart disease was 11.5+/-7.9 years. 47.4% of
participants had a history of previous myocardial infarction, 64.2% a
history of angina, 56.4% a history of coronary revascularisation and 69.3%
had other evidence of ischaemic heart disease. 57.6% had a history of
hypertension. 3.9% had a history of previous cerebrovascular accident,
7.6% of peripheral arterial disease, 21.8% of diabetes mellitus, 8.9% of
chronic obstructive pulmonary disease and 5.2% of heart failure.
Conclusions: This large ongoing trial will determine whether allopurinol
improves major cardiovascular outcomes in patients with ischaemic heart
disease.

<27>
Accession Number
623993302
Title
Aortic involvement in relapsing polychondritis: A systematic review.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2018. Netherlands. 77 (Supplement 2) (pp 1124), 2018.
Date of Publication: June 2018.
Author
Erdogan M.; Esatoglu S.N.; Hatemi G.; Hamuryudan V.
Institution
(Erdogan, Esatoglu, Hatemi, Hamuryudan) Internal Medicine division of
Rheumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey
Publisher
BMJ Publishing Group
Abstract
Background: Aortic involvement (AI) is an important complication of
relapsing polychondritis (RP). Current literature is based on case reports
and small case series. Objectives: To delineate the clinical
characteristics and outcome of AI in RP through a systematic literature
review (SLR). Methods: The SLR covered all English articles retrieved with
relevant keyword combinations listed in PubMed until October 2017.
Initially the titles and abstracts were screened by two investigators and
articles considered to be relevant (involvement of the aorta and the
aortic valve) were identified. Data extraction was done by the same
investigators. Results: The SLR revealed 352 papers of which162 were
discarded at the first step and a further 114 after full reading. After
excluding 5 articles reporting on the same patient, we finally had 71
papers reporting 97 patients. The sex distribution was identifiable in 79
patients of whom 39 were men and 40 were women. The median age at the
first symptom of RP was 31.5 years [IQR:24-43 years], the median age at RP
diagnosis was 36 years [IQR: 28-43 years]; median age at the diagnosis of
AI was 37 years [IQR:29-49 years]. Median duration from first RP diagnosis
to AI diagnosis was less than 1 year [Range:0-21]. AI was the presenting
symptom in 3 patients. Seventy patients (73%) had involvement of thoracic
aorta and 16 (23%) had involvement of the abdominal aorta. Other involved
arteries were: coronary (8 patients), subclavian (5 patients), renal (3
patients), iliac (3 patients) and others (8 patients). Two patients had
neurologic and renal involvement, respectively. The most common symptoms
were dyspnea (40%), followed by chest pain (13%), abdominal pain (13%) and
fever (9%). The diagnosis of AI was made during surgery in 6 patients and
with different radiologic methods ranging from chest x-ray to PET-CT. All
patients excluding 1 received corticosteroids either alone or in
combination with classical immunosuppressives (cyclophosphamide,
azathioprine, methotrexate, mycophenolate-mofetil) or biologics
(infliximab, tocilizumab, adalimumab). The majority of the patients (53/87
patients (61%) underwent surgery including aortic graft replacement,
coronary by-pass, aortic valve or mitral valve replacement operations. 16
patients died after a median follow up of 24 [IQR:11-43] months. The
reasons for deaths were mainly vascular (acute myocardial infarction,
heart failure, cardiovascular operation, abdominal aorta dissection,
aortic rupture and acute aortic valvular dysfunction). Information on
follow-up was known in 30 patients for a median of 18.5 months [IQR 10-48
months]. Conclusions: AI is less frequently recognised but prognostically
important complication of RP. Thoracic aorta is the most frequently
involved site. Surgery is needed in the majority of patients. Medical
treatment is empirical and is based on glucocorticoids and
immunosuppressives including biologic agents. Despite treatment, mortality
is high (18% during a median of 24 months).

<28>
Accession Number
623992595
Title
Change in frequency of arthroplasty surgery in rheumatoid arthritis: A 13
year population health study.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2018. Netherlands. 77 (Supplement 2) (pp 901), 2018.
Date of Publication: June 2018.
Author
Hanly J.G.; Lethbridge L.; Skedgel C.
Institution
(Hanly) Rheumatology And Medicine, Halifax, Canada
(Lethbridge) Dalhousie University, Queen Elizabeth II Health Sciences
Center, Halifax, Canada
(Skedgel) Dalhousie University, Halifax, Canada
Publisher
BMJ Publishing Group
Abstract
Background: Improvement in the medical management of rheumatoid arthritis
(RA) over the past two decades may have reduced the need for arthroplasty
surgery but the literature to date has reported inconsistent findings.
Objectives: To compare the annual frequency of hip, knee and other
arthroplasty surgery in a prevalent cohort of RA cases and matched
controls over 13 years. Methods: A retrospective cohort study was
performed utilising administrative healthcare data from approximately 1
million people with access to universal healthcare between 1997 and 2010.
RA cases were identified using a previously validated RA case definition
in the same dataset.1 Each case was matched by age and sex to 4 randomly
selected controls. The annual frequency of arthroplasties in cases and
controls was compared. In addition the frequency of coronary artery
interventions (bypass grafting, angioplasty and stenting) was compared.
Data included physician billings, hospital discharges and patient registry
information using ICD-9 and ICD-10. Statistical analysis used least
squares regression ttests and 2-proportion z-tests. Results: The number
(prevalence) of RA cases increased from 3913 (0.42%) to 4911 (0.52%) over
the study. The mean (SD) age changed from 56.7 (15.9) to 60.1 (14.9) years
and the proportion of females from 70.8% to 73.9%. In both the first and
last years of the study the frequency of all arthroplasty procedures was
higher in cases than controls (p<0.001) (Table). Over time there was a
gradual and significant reduction in arthroplasty surgery in RA cases by
51.9% (p<0.001). This was in contrast to controls in whom the frequency of
procedures increased by 31.9% (p=0.002) with the exception of hip
arthroplasty. For the latter procedure, the frequency decreased by 63% in
RA cases (p<0.001) and 35% in controls (p=0.617). In contrast to
arthroplasty procedures the frequency of cardiac procedures, which were
higher in RA cases in both the first (p=0.013) and final (p=0.003) years
of observation, increased in both cases and controls over time although
did not reach statistical significance in either. (Table Presented)
Conclusions: There was a striking reduction in arthroplasty surgery in RA
cases over 13 years of observation. Lack of similar changes in controls
and sustained rates of cardiac procedures over the same time suggests that
this was not due to limited surgical access for RA patients. Improvement
in medical treatment of RA is likely responsible.

<29>
Accession Number
623986336
Title
Focus on trimetazidine in acute coronary syndrome.
Source
Heart and Metabolism. (75) (pp 22-27), 2018. Date of Publication: 2018.
Author
Gowdak L.H.W.
Institution
(Gowdak) Heart Institute (InCor), School of Medicine, University of Sao
Paulo, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, SP 05403-000,
Brazil
Publisher
Les Laboratoires Seriver (50 Rue Carnot, F-92284, Suresnes Cedex, France)
Abstract
>Trimetazidine is an anti-ischemic agent that acts at the cellular level
by shifting the cardiac energy metabolism from s-oxidation of free fatty
acids to the more efficient glucose oxidation. In patients with an acute
myocardial infarction (AMI) who are treated with thrombolysis and/or a
percutaneous coronary intervention (PCI), ischemia-reperfusion injury may
occur after reestablishing myocardial blood supply to an ischemic region.
In animal models of ischemia-reperfusion injury, trimetazidine markedly
reduced casein kinase and lactate dehydrogenase activities and decreased
the infarct size. In patients with an AMI, trimetazidine reduced the rate
of any form of reperfusion arrhythmias, more so with potentially
life-threatening arrhythmias. In the EMPI-FR study (European Myocardial
Infarction Project-Free Radicals), in the subset of patients not receiving
thrombolysis assessed as per-protocol analysis, there was an 11.9% and
13.8% risk reduction in 35-day mortality and in-hospital mortality,
respectively, in patients receiving trimetazidine. More recently, it was
shown that trimetazidine, as an adjunctive therapy to PCI, reduced
myocardial damage and preserved left ventricular function more than PCI
alone. In a large registry of patients with AMI, the use of trimetazidine
was associated with significant reductions in all-cause mortality and
combined major adverse cardiac events (MACE), a finding that was confirmed
in the first meta-analysis to report these benefits in patients with AMI
treated with trimetazidine, showing a 67% risk reduction for MACE, which
was defined as the composite of death, recurrent nonfatal MI, target
vessel revascularization, coronary artery bypass graft, recurrence of
angina, and/or hospitalization for heart failure.<br/>Copyright &#xa9;
2018 Les Laboratoires Seriver. All rights reserved.

<30>
Accession Number
623958496
Title
Access site complications after transfemoral aortic valve implantation - a
comparison of Manta and ProGlide.
Source
CVIR Endovascular. 1 (1) (no pagination), 2018. Article Number: 20. Date
of Publication: 01 Dec 2018.
Author
Hoffmann P.; Al-Ani A.; von Lueder T.; Hoffmann J.; Majak P.; Hagen O.;
Loose H.; Klow N.E.; Opdahl A.
Institution
(Hoffmann, Al-Ani, Opdahl) Department of Cardiology, Section for
Interventional Cardiology, Division of Cardiovascular and Pulmonary
Diseases, Oslo University Hospital, Ulleval, Oslo, Norway
(von Lueder) Department of Cardiology B, Division of Medicine, Oslo
University Hospital, Ulleval, Oslo, Norway
(Hoffmann) The Lundberg Laboratory, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Majak) Department of Cardiothoracic Surgery, Division of Cardiovascular
and Pulmonary Diseases, Oslo University Hospital, Ulleval, Oslo, Norway
(Hagen) Department of Anesthesiology, Division of Emergencies and Critical
care, Oslo University Hospital, Ulleval, Oslo, Norway
(Loose) Department of Vascular Diseases, Section for Vascular Surgery,
Division of Cardiovascular and Pulmonary Diseases, Oslo University
Hospital, Oslo, Norway
(Klow) Department of Radiology, Section for Interventional Radiology,
Division of Radiology and Nuclear Medicine, Oslo University Hospital,
Ulleval, and Institute for Clinical Medicine, University of Oslo, Oslo,
Norway
Publisher
Springer
Abstract
Background: Despite decreasing sheath diameter, access site bleeding and
vascular complications are still a major concern in transfemoral aortic
valve implantation (TAVI), and may increase morbidity and even increase
mortality. The aim was to compare safety of arterial closure in
transfemoral TAVI with two different principles, pre-suture with ProGlide
and collagen plug closure with Manta. Results: Seventy-six patients
treated with ProGlide and 75 with Manta were analysed. The endpoints were
1: access site vascular complications and 2: non-planned vascular or
endovascular surgery at the puncture site. Complications occurred in 2
(2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the
learning phase there were no significant differences. In the established
phase there was one event (2%) in the ProGlide group, compared to 6
endpoints (12.0%), p = 0.047, in the Manta group. Unplanned surgery or
intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta
patients, p = ns. There were no significant differences during the
learning phase. In established use, endpoints occurred more frequently in
patients treated with the Manta device (12%), than in patients treated
with the ProGlide (2%), p = 0.047. Conclusion: The ProGlide presuture
closure device was associated with significantly lower rates of vascular
complications and lower rates of surgery and interventions compared to the
collagen plug Manta system. Trial registration: The data were collected
from Internal quality control registry on treatment of patients with
valvular heart disease with or without coronary artery disease, No
2014/17280, Oslo University Hospital, Ulleval.<br/>Copyright &#xa9; 2018,
The Author(s).

<31>
Accession Number
623937687
Title
The efficacy and safety of dexmedetomidine in cardiac surgery patients: A
systematic review and meta-analysis.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0202620. Date of
Publication: September 2018.
Author
Wang G.; Niu J.; Li Z.; Lv H.; Cai H.
Institution
(Wang, Niu, Li, Lv, Cai) Department of Surgical Intensive Care Unit, First
Affiliated Hospital, Medical College, Zhejiang University, Hangzhou,
Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine
versus any other treatment without dexmedetomidine in patients who have
undergone cardiac surgery. Electronic databases including PubMed, Embase,
and Cochrane Library were systematically searched without limitations of
language and publication time. Randomized controlled trials (RCTs) aiming
to evaluate the efficacy and safety of dexmedetomidine versus any other
treatment without dexmedetomidine in patients that have undergone cardiac
surgery were selected. Endpoints such as hemodynamic indexes and adverse
events in eligible studies were extracted by two researchers,
independently. The data was analyzed using RevMan 5.3 and Stata 11.0
software. A total of 18 RCTs met the inclusion criteria, involving 1730
patients. Compared to control (any treatment without dexmedetomidine),
dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95%
confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial
pressure, a standardized mean difference (SMD) of -1.74 for mean arterial
blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23,
-1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22
(95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96;
p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial
fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In
addition, dexmedetomidine could reduce time of surgery and stay in
intensive care units, improve delirium with good safety. Our study shows
clinical application of dexmedetomidine in cardiac surgery patients can
reduce risks of abnormal hemodynamics with good safety.<br/>Copyright
&#xa9; 2018 Wang et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<32>
Accession Number
620395143
Title
N-3 polyunsaturated fatty acids for prevention of postoperative atrial
fibrillation: updated meta-analysis and systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 51 (2) (pp 105-115),
2018. Date of Publication: 01 Mar 2018.
Author
Wang H.; Chen J.; Zhao L.
Institution
(Wang, Chen, Zhao) Department of Cardiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background or purpose: N-3 polyunsaturated fatty acids (PUFA) have been
postulated to have an anti-arrhythmic effect on postoperative atrial
fibrillation (POAF), with conflicting results among studies. This study on
pooled data evaluated the effect of PUFA on POAF among patients undergoing
cardiac surgery. Methods: The Pubmed, EMBASE, and CENTRAL databases were
searched without restriction on language for randomized controlled trials
on the effect of PUFA on POAF that were published before August 31, 2017.
The incidence of POAF was extracted as primary endpoint. Pooled data were
assessed by using a random-effects model. Results: Out of 269 articles
identified, 14 studies with 3570 patients were eligible and included in
the meta-analysis. PUFA reduced incidence of POAF (RR 0.84 [95% CI
0.73-0.98], P = 0.03). The funnel plot and fail-safe number suggested
insignificant publication bias. In sensitivity and subgroup analyses, (1)
PUFA was effective in preventing POAF for eicosapentaenoic acid (EPA)/DHA
OpenSPiltSPi 1 (0.51 [0.36-0.73], P = 0.0003) but not EPA/DHA
CloseSPigtSPi 1 or unknown; (2) the efficacy in reducing POAF was apparent
when placebo was usual care (0.59 [0.44-0.80], P = 0.0005), but not when
placebo was non-fish oils; and (3) PUFA reduced POAF after CABG (0.68
[0.47-0.97], P = 0.03), but not other cardiac surgery. Conclusions: PUFA
appears to reduce the incidence of POAF. However, the said protective
effect may be influenced by EPA/DHA ratio, with OpenSPiltSPi 1 appearing
preferable. PUFA efficacy on POAF prevention appeared insignificant when
compared with non-fish oils and only apparent in the setting of CABG
alone. Further studies are needed to confirm the effect of PUFA on POAF
and to assess the proper use of PUFA against POAF.<br/>Copyright &#xa9;
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<33>
Accession Number
2001098703
Title
Reduced Stroke After Transcatheter Patent Foramen Ovale Closure: A
Systematic Review and Meta-analysis.
Source
American Journal of the Medical Sciences. 356 (2) (pp 103-113), 2018. Date
of Publication: August 2018.
Author
Alvarez C.; Siddiqui W.J.; Aggarwal S.; Hasni S.F.; Hankins S.; Eisen H.
Institution
(Alvarez) Internal Medical Department, Seton Hall University, St. Francis
Medical Center, Trenton, New Jersey, United States
(Siddiqui, Aggarwal, Hasni, Hankins, Eisen) Department of Cardiology,
Drexel University College of Medicine, Philadelphia, Pennsylvania, United
States
(Siddiqui, Aggarwal, Hasni, Hankins, Eisen) Department of Cardiology,
Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Background: Recent randomized control trials (RCTs) have suggested benefit
with transcatheter patent foramen ovale (PFO) closure plus antiplatelet
therapy over medical treatment alone for secondary stroke prevention.
Material and Methods: Data sources: we searched PubMed and Ovid MEDLINE
from the inception until November 10, 2017 for RCTs comparing TPFO closure
to medical therapy in patients with a PFO and a history of cryptogenic
stroke. Results: Five RCTs with 3,627 patients (TPFO closure = 1,829
versus medical therapy =1,798) were included. There was a decreased number
of post-TPFO closure strokes compared to the medical therapy arm; 53
versus 80 strokes (odds ratio [OR] = 0.61, CI: 0.39-0.94, P = 0.03,
I² = 17%). Transient ischemic attacks occurred in 43 patients
after TPFO closure versus 60 patients in the medical therapy group (OR =
0.80, CI: 0.53-1.19, P = 0.26, I² = 0%). There was a higher
incidence of atrial fibrillation in the TPFO closure group, which occurred
in 75 patients, compared to 12 patients in the medical therapy group (OR =
5.23, CI: 2.17-12.59, P = 0.0002, I² = 43%). There was a trend
toward a decreased number of neuropsychiatric events in the TPFO closure
closure group compared to the medical therapy group; 42 versus 67
neuropsychiatric events (OR = 0.71, CI: 0.48-1.06, P = 0.09, I²
= 0%). Conclusions: TPFO closure plus antiplatelet therapy is superior to
medical therapy in patients with a PFO and cryptogenic stroke. PFO closure
is associated with new-onset atrial fibrillation and a trend toward
reduced neuropsychiatric events.<br/>Copyright &#xa9; 2018 Southern
Society for Clinical Investigation

<34>
Accession Number
623900013
Title
Comparasion of low dose bupivacaine and ropivacaine in low thoracic
combined spinal epidural anaesthesia for laparoscopic cholecystectomy.
Source
JK Science. 19 (4) (pp 210-214), 2017. Date of Publication:
October-December 2017.
Author
Kour L.; Rasool A.
Institution
(Kour) Department of Anesthesiology, Government Medical College, Jammu,
Jammu and Kashmir, India
(Rasool) DHS, Jammu, Jammu and Kashmir, India
Publisher
JK Science
Abstract
Laparoscopic cholecystectomy is one of the most commonly performed day
care surgeries today. Thoracic spinal anaesthesia provides efficient
anaesthesia and early ambulation making it a highly suitable anaesthetic
technique for day care surgeries. In this study we aimed at determining
whether bupivacaine or ropivacaine proves more efficacious as an
anaesthetic agent in thoracic combined spinal epidural anaesthesia.60
patients scheduled for laparoscopic cholecystectomies were divided into
two groups: group B and group R. Both the groups were given thoracic
combined spinal epidural anaesthesia (CSE) at the T9-T10/ T10-T11
interspace using 2 ml of isobaric bupivacaine 0.5% (5 mg/ml) +
25micro&#32;g (0.5 ml) of fentanyl in group B and 2 ml of isobaric
ropivacaine 0.5% (5 mg/ml) + 25micro&#32;g (0.5 ml) of fentanyl in group
R. We evaluated the degree of analgesia and motor block, haemodynamics and
neurological complications.Onset of analgesia was comparable in both the
groups-2min. The duration of sensory block and motor block was less with
isobaric ropivacaine than with isobaric bupivacaine. There were no
significant differences in haemodynamic variables and respiratory
parameters between the two groups and no neurological complication in any
patient. By providing a sensory block of longer duration than the motor
block isobaric ropivacaine is reflected in a better indication than
isobaric bupivacaine for upper abdominal surgeries. Thoracic combined
spinal epidural anaesthesia provides excellent anaesthesia for
laparoscopic cholecystectomies.<br/>Copyright &#xa9; 2017, JK Science. All
rights reserved.

<35>
Accession Number
613807117
Title
The effect of methylprednisolone treatment on fibrinolysis, the
coagulation system, and blood loss in cardiac surgery.
Source
Turkish Journal of Medical Sciences. 46 (6) (pp 1645-1654), 2016. Date of
Publication: 2016.
Author
Ebrahimi L.; Kheirandish M.; Foroughi M.
Institution
(Ebrahimi, Kheirandish) Department of Immunology, Blood Transfusion
Research Center, High Institute for Research and Education in Transfusion
Medicine, Tehran, Iran, Islamic Republic of
(Foroughi) Cardiovascular Research Center, Modarres Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: The purpose of this study was to examine steroid
pretreatment in order to decrease postoperative coagulopathy disorders and
bleeding. Materials and methods: In this randomized double-blinded study,
the efficacy of low versus high doses of methylprednisolone on the
coagulation system and postoperative bleeding was compared in patients who
were undergoing cardiac surgery with cardiopulmonary bypass (CPB). The
platelet response to agonists, D-dimer concentration, tissue plasminogen
activator (tPA), plasminogen activator inhibitor (PAI-1) antigens, and
platelet receptors CD42b, CD62P, and CD41a were evaluated. Results: The
platelet response to agonists was reduced. The mean concentrations of
D-dimer and tPA antigen increased although PAI-1 concentration did not
show any significant changes following heparin neutralization.
Postoperative expression of CD42b showed no changes in comparison with
preoperation values in both groups. There was a significant increase in
the expression of CD62P with a methylprednisolone dose of 15 mg/kg, while
there was just a slight increase with a dose of 5 mg/kg. CD41a, as a
fibrinogen receptor, was increased significantly after CPB in both groups.
Significant data were shown in decreasing blood loss with a high dose of
methylprednisolone. Conclusion: Methylprednisolone at a dose of 15 mg/kg
reduced bleeding, probably by increasing CD62P after heparin
neutralization, which can activate platelet activation in favor of better
hemostasis.<br/>Copyright &#xa9; TUBITAK.

<36>
Accession Number
623740753
Title
Randomized controlled trial of a self-administered five-day antiseptic
bundle versus usual disinfectant soap showers for preoperative eradication
of Staphylococcus aureus colonization.
Source
Infection Control and Hospital Epidemiology. 39 (9) (pp 1049-1057), 2018.
Date of Publication: 01 Sep 2018.
Author
Kline S.E.; Neaton J.D.; Lynfield R.; Ferrieri P.; Kulasingam S.; Dittes
K.; Glennen A.; Jawahir S.; Kaizer A.; Menk J.; Johnson J.R.
Institution
(Kline, Dittes, Johnson) University of Minnesota Medical School,
Department of Medicine, Division of Infectious Diseases, 420 Delaware St
SE, MMC# 250, Minneapolis, MN 55455, United States
(Neaton) Division of Biostatistics, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Lynfield, Glennen, Jawahir) Minnesota Department of Health, St Paul, MN,
United States
(Ferrieri) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, MN, United States
(Kulasingam) Division of Epidemiology, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Kaizer, Menk) Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, MN, United States
(Johnson) Veterans Affairs Medical Center, Minneapolis, MN, United States
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
Objective To determine the efficacy in eradicating Staphylococcus aureus
(SA) carriage of a 5-day preoperative decolonization bundle compared to 2
disinfectant soap showers, with both regimens self-administered at
home.Design Open label, single-center, randomized clinical trial.Setting
Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular,
and general surgery clinics at a tertiary-care referral center in the
United States.Participants Patients at the University of Minnesota Medical
Center planning to have elective surgery and not on antibiotics.Methods
Consenting participants were screened for SA colonization using nasal,
throat, axillary, and perianal swab cultures. Carriers of SA were
randomized, stratified by methicillin resistance status, to a
decolonization bundle group (5 days of nasal mupirocin, chlorhexidine
gluconate [CHG] bathing, and CHG mouthwash) or control group (2
preoperative showers with antiseptic soap). Colonization status was
reassessed preoperatively. The primary endpoint was absence of SA at all 4
screened body sites.Results Of 427 participants screened between August
31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers.
Of these, 121 were randomized and 110 were eligible for efficacy analysis
(57 decolonization bundle group, 53 control group). Overall, 90% of
evaluable participants had methicillin-susceptible SA strains. Eradication
of SA at all body sites was achieved for 41 of 57 participants (71.9%) in
the decolonization bundle group and for 13 of 53 participants (24.5%) in
the control group, a difference of 47.4% (95% confidence interval [CI],
29.1%-65.7%; P<.0001).Conclusion An outpatient preoperative antiseptic
decolonization bundle aimed at 4 body sites was significantly more
effective in eradicating SA than the usual disinfectant showers (ie, the
control).Trial Registration ClinicalTrials.gov identifier:
NCT02182115<br/>Copyright &#xa9; 2018 by The Society for Healthcare
Epidemiology of America. All rights reserved.

<37>
Accession Number
2000669038
Title
Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane
Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (5) (pp 2087-2093),
2018. Date of Publication: October 2018.
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To investigate the clinical outcomes of adult patients
receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy
cardiogenic shock (PCS). Design: Meta-analysis of 20 observational
studies. Setting: Hospitals that perform cardiac surgery. Participants:
The study included 2,877 PCS patients undergoing ECMO from 20
observational studies. Interventions: ECMO use. Measurements and Main
Results: Twenty observational studies were selected for final analysis.
The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in
PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0%
(19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%).
The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate
of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure
was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was
16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%).
Most of the included studies commonly revealed that age >65 years,
pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer
duration of ECMO, and neurologic complications were risk factors of
in-hospital mortality in PCS patients undergoing ECMO. Conclusions: The
short-term and midterm survival rates of PCS patients treated with ECMO
were disappointingly low, and post-ECMO complication rates were relatively
high.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<38>
Accession Number
2000755235
Title
Prospective, randomized, controlled trial of polymer cable ties versus
standard wire closure of midline sternotomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (4) (pp 1589-1595.e1),
2018. Date of Publication: October 2018.
Author
Marasco S.F.; Fuller L.; Zimmet A.; McGiffin D.; Seitz M.; Ch'ng S.;
Gangahanumaiah S.; Bailey M.
Institution
(Marasco, Zimmet, McGiffin, Seitz, Ch'ng, Gangahanumaiah) CJOB
Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Marasco, McGiffin) Department of Surgery, The Alfred Hospital, Monash
University, Melbourne, Victoria, Australia
(Fuller) Physiotherapy Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Bailey) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, Victoria, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Midline sternotomy remains the most common access incision for
cardiac operations. Traditionally, the sternum is closed with stainless
steel wires. Wires are well known to stretch and break, however, leading
to pain, nonunion, and potential deep sternal wound infection. We
hypothesized that biocompatible plastic cable ties would achieve a more
rigid sternal fixation, reducing postoperative pain and analgesia
requirements. Methods: A prospective, randomized study compared the ZIPFIX
(De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with
standard stainless steel wires (n = 60). Primary outcomes were pain and
analgesia requirements in the early postoperative period. Secondary
outcome was sternal movement, as assessed by ultrasound at the
postoperative follow-up visit. Results: Groups were well matched in
demographic and operative variables. There were no significant differences
between groups in postoperative pain, analgesia, or early ventilatory
requirements. Patients in the ZIPFIX group had significantly more movement
in the sternum and manubrium on ultrasound at 4 weeks. Conclusions: ZIPFIX
sternal cable ties provide reliable closure but no demonstrable benefit in
this study in pain or analgesic requirements relative to standard wire
closure after median sternotomy.<br/>Copyright &#xa9; 2018

<39>
Accession Number
2001063536
Title
Automated Titanium Fasteners Versus Hand-Tied Knots: A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 106 (4) (pp 1160-1163), 2018. Date of
Publication: October 2018.
Author
Etiwy M.; Javadikasgari H.; Houghtaling P.; Gillinov M.
Institution
(Etiwy, Javadikasgari, Gillinov) Department of Thoracic and Cardiovascular
Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Houghtaling) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier USA
Abstract
Background: The relative benefits of automated titanium fasteners (LSI
Solutions, Victor, NY) have not been examined in patients undergoing
sternotomy. The aim of this study was to assess the time and cost required
for suture fixation with the automated device versus conventional hand
tying in sternotomy for mitral or tricuspid ring annuloplasty. Methods:
Fifty patients scheduled to undergo primary mitral or tricuspid, or both,
ring annuloplasty-based valve repair operation by a single surgeon were
randomly assigned to receive either conventional hand-tied knots or
automated titanium fasteners, with 25 patients in each group. The primary
outcome variable was the time required to affix the annuloplasty device to
the valve annulus. Results: The times taken to affix a mitral annuloplasty
band or ring were 6.1 +/- 0.9 min for manual tying versus 3.1 +/- 0.4 min
for automated fasteners (p < 0.0001); when calculated per annuloplasty
stitch, the values were 22 +/- 2 s versus 12 +/- 1.1 s, respectively (p <
0.0001). The corresponding values for tricuspid annuloplasty were 4.2 +/-
1.2 min (hand tying) versus 2.2 +/- 0.3 min (automated fasteners) (p =
0.0005), and the times for each suture were 20 +/- 2.1 s versus 13 +/- 2
s, respectively (p = 0.0004). The use of the automated fastener had no
significant impact on aortic cross-clamp time or cardiopulmonary bypass
duration. Total cost associated with annuloplasty fixation with automated
titanium fasteners (device cost in addition to operating room time cost)
was significantly higher than with hand tying ($1,190 +/- 374 vs $164 +/-
60; p < 0.0001). Conclusions: Using the automated fastener to facilitate
annuloplasty fixation through a sternotomy resulted in a small procedural
time savings (average of 10 s/stitch) that had no overall impact on
cardiopulmonary bypass or cross-clamp times but added an average cost of
$1,026 to the operation.<br/>Copyright &#xa9; 2018 The Society of Thoracic
Surgeons

<40>
Accession Number
620454145
Title
Transcatheter versus surgical aortic valve replacement in patients at low
surgical risk: A meta-analysis of randomized trials and propensity score
matched observational studies.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 408-416),
2018. Date of Publication: 01 Aug 2018.
Author
Witberg G.; Lador A.; Yahav D.; Kornowski R.
Institution
(Witberg, Lador, Kornowski) Department of Cardiology, Rabin medical
center, Petach, Tikva, Israel
(Witberg, Lador, Yahav, Kornowski) Sackler Faculty of Medicine, Tel-Aviv
university, Tel, Aviv, Israel
(Yahav) Infectious diseases unit, Rabin medical center, Petach, Tikva,
Israel
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although transcatheter aortic valve replacement (TAVR) is
officially indicated for high risk aortic stenosis (AS) patients, the
procedure is increasingly being performed in patients who are not at high
surgical risk, including a substantial number of low risk patients.
However, data on the benefit of TAVR in this patient population is
limited. Methods: We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) and observational studies with
propensity score matching (PSM) of TAVR versus surgical aortic valve
replacement (SAVR) in patients who are at low surgical risk. The primary
outcome was all-cause mortality. The secondary outcomes included stroke,
myocardial infarction, bleeding, and various procedural complications.
Results: Six studies (2 RCTs and 4 PSM studies) totaling 3,484 patients
were included. Follow-up ranged from 3 months to 3 years (median 2 years).
The short-term mortality was similar with either TAVR or SAVR (2.2% for
TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56-1.41, P = 0.62), however,
TAVR was associated with increased risk for intermediate-term mortality
(17.2% for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11-1.89, P = 0.006).
In terms of periprocedural complications, TAVR was associated with reduced
risk for bleeding and renal failure and an increase in vascular
complications and Pacemaker implantation. Conclusions: In patients who are
at low surgical risk, TAVR seems to be associated with increased mortality
risk. Until more data in this population is available, SAVR should remain
the treatment of choice for these patients.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<41>
Accession Number
620453952
Title
Long-term survival after transcatheter versus surgical aortic valve
replacement for aortic stenosis: A meta-analysis of observational
comparative studies with a propensity-score analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 419-430),
2018. Date of Publication: 01 Aug 2018.
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To synthesize evidence regarding long-term survival after
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR) for severe aortic stenosis (AS) from real-world
clinical practice, we performed a meta-analysis of observational studies
with a propensity-score analysis and >=3-year follow-up. Methods:
Databases including MEDLINE and EMBASE were searched through April 2017
using PubMed and OVID. Eligible studies were observational comparative
studies with a propensity-score analysis of TAVI versus SAVR enrolling
patients with severe AS and reporting >=3-year all-cause mortality as an
outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of
follow-up (including early) mortality for TAVI versus SAVR was extracted
from each individual study. Results: Our search identified 14 eligible
studies enrolling a total of 4,197 patients. A pooled analysis of all the
14 studies demonstrated a statistically significant 54% increase in
mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for
effect < 0.00001; P for heterogeneity = 0.14; I² = 30%).
Several sensitivity analyses did not substantially change the
statistically significant benefit for SAVR. There was no evidence of
significant publication bias. Conclusions: On the basis of a meta-analysis
of 14 observational comparative studies with a propensity-score analysis
including a total of >=4,000 patients, TAVI is associated with worse
>=3-year overall survival than SAVR.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<42>
Accession Number
623960533
Title
Are cardiac anomalies and persistent fetal circulation a risk factor for
cardiovascular events during minimally invasive surgery in neonates?
Personal experience and review of the literature.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. Conference:
27th Annual Congress for Endosurgery in Children, IPEG 2018. United
States. 28 (7) (pp A2-A3), 2018. Date of Publication: 2018.
Author
Burgmeier C.; Schier F.
Institution
(Burgmeier) Department of Surgery, Alb Fils Kliniken, Goppingen, Germany
(Schier) Department of Pediatric Surgery, University Center Mainz, Germany
Publisher
Mary Ann Liebert Inc.
Abstract
Introduction: In the past decades, minimally invasive surgery (MIS) has
been proven to be beneficial for the pediatric population and even
neonates. Nevertheless, neonates are a very special group of patients and
require extraordinary consideration. During the first month of life
persistent fetal circulation and/or cardiac anomalies are very common. The
aim of this study was to evaluate the risk for cardiovascular events
during endoscopic surgery in neonates and to analyze the influence of
persistent fetal circulation and/or cardiac anomalies in this exceptional
period of life. Methods: Retrospective, single institution study including
all term and preterm neonates undergoing minimally invasive surgery. The
charts were reviewed for intraoperative cardiovascular events, performed
operative procedure and conversion rate. Special attention was paid to
cardiac anomalies and persistent fetal circulation. Additionally, a review
of the current literature concerning reported cardiovascular events during
MIS in neonates was performed. Results: Between January 2004 until
December 2012 108 term and preterm neonates (62 male and 46 female)
underwent either laparoscopic or thoracoscopic surgery at our institution.
Altogether, 72 (66.7%) of them were term and 36 (33.3%) were preterm
neonates. On average, the surgical procedure was performed on the 12.
postnatal day and median weight at the time of surgery was 3.0 kg (range
from 1.2 to 4.1 kg). Laparoscopic surgery was performed in 91 (84.3%) and
thoracoscopy in 17 (15.7%) babies. None of these 108 term and preterm
neonates developed a cardiovascular event during endoscopic surgery
(0.0%). Persistent fetal circulation and/or cardiac anomalies were
evaluated in 50 of 108 (46.3%) neonates undergoing endoscopic surgery
within the first month of life. Conversion to open surgery was necessary
in 21 neonates (19.4%). In the additionally performed review of the
literature four single case reports were identified. All four authors
published major cardiovascular events during laparoscopic surgery in
neonates. In all four patients gas embolism through a patent umbilical
vein was assumed to be responsible for the cardiovascular event. One of
these babies was known to have a small PDA and a PFO preoperatively. In
the other three cases preoperative cardiac examination was not reported.
Conclusions: In our personal experience none of 108 term and preterm
neonates undergoing endoscopic surgery within the first month of life
developed a major cardiovascular event (0.0%). Approximately half of the
babies were known to have persistent fetal circulation and/or cardiac
anomalies preoperatively. In the literature four case reports on gas
embolism during laparoscopic surgery were published. In all of these
babies injury of a persistent umbilical vein was assumed to be the
entrainment of gas into the cardiovascular system. In our opinion, the
main risk factor for major cardiovascular events during endoscopic surgery
in neonates is vascular injury of a persistent umbilical vein. Persistent
fetal circulation and/or cardiac anomalies seem to be less important for
the development of major cardiovascular events during endoscopic surgery
in neonates. In regard to safety of MIS in neonates further clinical
studies are necessary in the future.

<43>
Accession Number
623967032
Title
Association of heterozygosity for the sickle cell variant with stroke and
cardiovascular disease in African Americans.
Source
Neurology: Genetics. Conference: 21st Workshop of the International Stroke
Genetics Consortium, ISGC 2017. United States. 4 (2 Supplement 1) (pp
7-8), 2018. Date of Publication: April 2018.
Author
Hyacinth H.I.; Carty C.; Seals S.R.; Irvin M.R.; Naik R.P.; Caughey M.C.;
Zakai N.A.
Institution
(Hyacinth) Emory University and Children's Health Care of Atlanta, GA,
United States
(Carty) University of Washington, Seattle, United States
(Seals) University of West Florida, Pensacola, United States
(Irvin) University of Alabama at Birmingham, United States
(Naik) Johns Hopkins University, Baltimore, MD, United States
(Caughey) University of North Carolina, Chapel Hill, United States
(Zakai) University of Vermont, Burlington, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective The objective of this study was to determine whether individuals
of African Ancestry who were heterozygous for the sickle cell mutation or
carry the sickle cell trait (SCT), were at a significantly higher risk for
incident ischemic stroke (IS), myocardial infarction (MI) or coronary
heart disease (CHD) compared to those without SCT. Background Sickle cell
trait (SCT), is the heterozygous carrier status of sickle cell disease in
which the individual has one normal and one sickle hemoglobin gene. SCT
trait has been associated with a hypercoagulable state, renal papillary
necrosis, renal medullary carcinoma, and more recently kidney disease. The
role of SCTas a risk factor for ischemic stroke and/or cardiovascular
diseases has not been clearly resolved. Design/Methods This is a
meta-analysis of genotype and phenotype data from the Women's Health
Initiative (WHI) REasons for Geographic and Racial Differences in Stroke
(REGARDS), Multi-Ethnic Study of Atherosclerosis (MESA), Jackson Heart
Study (JHS) and Atherosclerosis Risk In Communities (ARIC) cohorts, ARIC.
Due to overlap, ARIC could not contribute data to the meta-analysis for
stroke. The outcomes were IS, MI or CHD. Incident IS was defined based on
expert adjudication, MI was defined as adjudicated non-fatal or fatal MI
and CHD was defined as (1) adjudicated non-fatal MI, (2) fatal MI, (3)
documented coronary revascularization procedures or (4) non-MI CHD death.
SCT status was determined by either direct genotyping or imputation for
rs334 using the 1000 Genome reference panel. Homozygous individuals and
those with a prior history of stroke or other cardiovascular diseases were
excluded. Analysis was performed separately in each cohort using a Cox
proportional hazard models to estimate the hazard ratio (HR) comparing SCT
carriers to non-carriers. Models in each cohort were adjusted for age,
sex, population stratification and other relevant covariates based on the
Framingham stroke and CHD risk scores. Results from each cohort were then
meta-analyzed using a random effectmodel. Results A total of 20,053
African Americanmen and women were included in the combined sample; 1,503
with SCT (7.5% prevalence). The HR for incident ischemic stroke was 0.58
(0.14-2.14) in JHS, 0.65 (0.15-2.73) in MESA, 0.69 (0.28-1.69) in REGARDS
and 1.09 (0.47-2.51) in WHI; for MI was: 0.96 (0.49-1.89) in WHI; 1.27
(0.80-2.00) in REGARDS; 1.84 (0.74-4.60) in MESA; 1.24 (0.28-5.44) in JHS;
and 0.68 (0.42-1.10) in ARIC for CHD it was: 1.05 (0.63-1.74) in WHI; 1.49
(1.01-2.18) in REGARDS; 2.82 (1.48-5.38) in MESA; 1.45 (0.50-4.19) in JHS;
and 1.10 (0.80-1.50) in ARIC. Meta-analysis showed that, while SCT status
was not significantly associated with incident ischemic stroke (0.80
[0.47-1.35]) or MI (1.10 [0.73-1.64]), it was significantly associated
with incident CHD (1.42 [1.02-1.98]). Conclusions Our results from the
largest study of the association of SCT with stroke or cardiovascular
disease in African Americans to date suggest that SCT is an independent
risk factor for incident CHD but IS or MI in African Americans.

<44>
Accession Number
623980828
Title
Comparison of Automated Titanium Fasteners to Hand-Tied Knots in Open
Aortic Valve Replacement.
Source
Innovations (Philadelphia, Pa.). 13 (1) (pp 29-34), 2018. Date of
Publication: 01 Jan 2018.
Author
Lee C.Y.; Johnson C.A.; Siordia J.A.; Lehoux J.M.; Knight P.A.
Institution
(Lee) From the Division of Cardiac Surgery, University of Rochester
Medical Center, Rochester, United Kingdom
Abstract
OBJECTIVE: Aortic cross-clamp and cardiopulmonary bypass times are
independent predictors of postoperative morbidity and mortality. Reducing
ischemic times with automated titanium fasteners may improve surgical
outcomes. This study compared operative times and costs of titanium
fasteners versus hand-tied knots for prosthesis securement in open aortic
valve replacement.
METHODS: A randomized control trial was conducted during a 16-month period
at a single university medical center. Patients undergoing elective aortic
valve replacement were randomized to the titanium fastener (n = 37) or
hand-tied groups (n = 36). Knotting, aortic cross-clamp, cardiopulmonary
bypass, and total operating room times were recorded. Hospital charges
were also calculated for these procedures.
RESULTS: Baseline characteristics, concomitant procedures, prosthetic
valve size, and sutures were similar between groups. The titanium fastener
group had significantly reduced knotting (7.4 vs. 13.0 minutes, P <
0.001), aortic cross-clamp (69 vs. 90 minutes, P < 0.05), cardiopulmonary
bypass (86 vs. 114 minutes, P < 0.05), and total operating room times (234
vs. 266 minutes, P < 0.05). Intraoperative complications occurred more
frequently in the hand-tied group compared with the titanium fastener
group. Postoperative complications were similar between groups. Operating
room costs were significantly higher in the titanium fastener group (US
$10,428 vs. US $9671, P = 0.01). Hospitalization costs did not differ
significantly between the titanium fastener and hand-tied group (US
$23,987 vs. US $21,068, P = 0.12).
CONCLUSIONS: Titanium fastener use was associated with shorter knotting,
aortic cross-clamp, cardiopulmonary bypass, and operating room times and
fewer intraoperative complications in open aortic valve replacement,
without significantly increasing hospitalization cost.

<45>
Accession Number
2001110854
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of Clinical Anesthesia. 52 (pp 111-118), 2019. Date of
Publication: February 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Zadek, Chiodi, Pugni, Cordolcini, Valenza, Pesenti, Gattinoni)
Department of Pathophysiology and Transplantation, University of Milan,
Milan, Italy
(Langer, Santini, Valenza, Marenghi, Pesenti, Gattinoni) Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Bonanomi, Rosini, Marcucci, Inglese) Geriatric Unit, Department of
Medical Sciences and Community Health, University of Milan, Italy
(Marcucci) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Rosini, Marcucci, Inglese) Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. Design: Randomized controlled pilot trial. Setting:
Perioperative care in a tertiary care teaching hospital with outpatient
follow-up. Patients: One hundred one patients aged >=75 years with ASA
physical status <4, undergoing elective, non-cardiac surgery under general
anesthesia and 33 age-matched healthy controls. Interventions:
Randomization to a personalized intraoperative blood pressure target, mean
arterial pressure (MAP) >= 90% of preoperative values (Target group), or
to a more liberal intraoperative blood pressure management (No-Target
group). Strategies to reach intraoperative blood pressure target were at
discretion of anesthesiologists. Measurements: An experienced
neuropsychologist performed a validated battery of neurocognitive tests
preoperatively and 3 months after surgery. Incidence of POCD at three
months and postoperative delirium were assessed. Intraoperative time spent
with MAP >= 90% of preoperative values, recruitment and drop-out rate at 3
months were feasibility outcomes. Main results: The Target group spent a
higher percentage of intraoperative time with MAP >=90% of preoperative
values (65 +/- 25% vs. 49 +/- 28%, p < 0.01). Incidence of POCD (11% vs.
7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6%
vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not
differ between groups. No correlation was found between intraoperative
hypotension and postoperative cognitive performance (p = 0.75) or delirium
(p = 0.19). Recruitment rate was of 6 patients/month (95% confidential
interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14
to 33%). Conclusions: Intraoperative hypotension did not correlate with
postoperative cognitive dysfunction or delirium occurrence in elderly
patients undergoing general anesthesia for non-cardiac surgery. A
multicenter randomized controlled trial is needed in order to confirm the
effect of intraoperative blood pressure on the development of POCD. Trial
registration number: NCT02428062 www.clinicaltrials.gov.<br/>Copyright
&#xa9; 2018

<46>
Accession Number
623945377
Title
Patent foramen ovale and atrial fibrillation as causes of cryptogenic
stroke: is treatment with surgery superior to device closure and
anticoagulation? A review of the literature.
Source
Acta Radiologica Open. 7 (9) (no pagination), 2018. Date of Publication:
01 Sep 2018.
Author
Kjeld T.; Jorgensen T.S.; Fornitz G.; Roland J.; Arendrup H.C.
Institution
(Kjeld, Arendrup) Department of 53146 Cardiothoracic Surgery, University
of Copenhagen, Rigshospitalet, Copenhagen, Denmark
(Jorgensen) Department of Cardiology, University of Copenhagen, Amager
Hospital, Copenhagen, Denmark
(Fornitz, Roland) Department of Cardiology, University of Zealand,
Slagelse Hospital, Slagelse, Denmark
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Closure of persistent foramen ovale (PFO) to avoid cryptogenic strokes is
performed globally with enthusiasm but lacks prove of efficacy. We present
a 79-year-old man who had had a PFO device introduced nine years
previously because of cryptogenic strokes presenting as syncopes. The
patient was referred from his general practitioner with two new syncopes.
Transthoracic echocardiography revealed no cardiac causes of embolism.
Transesophageal echocardiography (TEE) revealed a misplaced device like an
umbrella in a storm, but no septum defects. Holter revealed seconds-long
episodes of atrial fibrillation (AF). The patient was successfully treated
with anticoagulation. A literature review showed that: (i) the efficacy of
PFO closure devices has not been proven in any trial, but was demonstrated
in a meta-analysis comparing three different devices; (ii) PFO devices are
rarely controlled by TEE during or after insertion; (iii) residual shunts
are detected in up to 45% of cases; (iv) there is an increased rate of
post-arrhythmic complications; (v) the risk of AF in congenital heart
disease increases with increasing age, with a 13% risk of transient
ischemic attacks and stroke; and (vi) surgical treatment of PFO was found
to have a 4.1% risk of complications including stroke. The question to be
asked is whether device closure of PFO should be avoided, considering that
PFO is a congenital heart defect with risks of AF and (cryptogenic)
stroke? Heart surgery should be a treatment option for symptomatic
PFO.<br/>Copyright &#xa9; The Foundation Acta Radiologica 2018.

<47>
Accession Number
623904994
Title
A method for addressing right upper lobe obstruction with right-sided
double-lumen endobronchial tubes during surgery: A randomized controlled
trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 130.
Date of Publication: 18 Sep 2018.
Author
Yu W.; Wang Z.; Gao D.; Zhang W.; Jin W.; Ma X.; Qi S.
Institution
(Yu, Wang, Gao, Zhang, Jin, Ma, Qi) Department of Anaesthesiology, Fourth
Affiliated Hospital, Harbin Medical University, 37 Yiyuan Road, Harbin
Heilongjiang Province 150001, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A right-sided double-lumen tube (R-DLT) tends to obstruct the
right upper lobe intraoperatively due to anatomical distortion during
surgery. If the R-DLT is poorly matched with the patient's airway anatomy,
it will not be possible to correctly replace the tube with a fiberoptic
bronchoscope (FOB). In our study, we aimed to explore an efficient method
for difficult repositioning caused by right upper lobe occlusion during
surgery: repositioning the R-DLT from the right main bronchus into the
left main bronchus. The current study was designed to assess the efficacy
and safety of this method. Methods: Sixty adult patients scheduled to
undergo left-sided thoracic surgery were randomly assigned to two groups.
With the patient in the right lateral position during surgery, the R-DLT
was pulled back to the trachea while being rotated 90degree clockwise; it
was then either rotated 90degree clockwise for placement into the left
main bronchus (Group L) or rotated 90degree anticlockwise and returned to
the right main bronchus (Group R) using FOB guidance. The primary outcomes
included clinical performance, which was measured by intubation time, and
the quality of lung collapse. A secondary outcome was safety, which was
determined according to bronchial injury and vocal cord injury. Results:
The median intubation time (IQR [range]) required for placement of a R-DLT
into the left main bronchus was shorter than the time required for
placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs
23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable
overall results for the quality of lung collapse during the total period
of one-lung ventilation (P = 1.000). The numbers of patients with
bronchial injuries or vocal cord injuries were also comparable between
groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries;
Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries).
Conclusions: Repositioning a R-DLT from the right main bronchus into the
left main bronchus had good clinical performance without causing
additional injury. This may be an efficient method for the difficult
repositioning of a R-DLT due to right upper lobe occlusion during surgery.
Trial registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15006933,
registered on 15 August 2015.<br/>Copyright &#xa9; 2018 The Author(s).

<48>
Accession Number
623812170
Title
Novel oral anticoagulants in the preoperative period: A meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. 45 (3) (pp 386-396), 2018. Date of
Publication: 17 Jan 2018.
Author
He H.; Ke B.; Li Y.; Han F.; Li X.; Zeng Y.
Institution
(He, Ke, Li, Li, Zeng) Department of Emergency Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road Second, Chaoyang
District, Beijing 100029, China
(Han) Department of Epidemiology, Beijing Anzhen Hospital, Beijing
Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical
University, Beijing 100029, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this study is to evaluate the efficacy and safety of novel
oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing
different operations. We performed a systematic review of MEDLINE, EMBASE,
Cochrane Controlled Trials Register, and reports presented at scientific
meetings. The efficacy and safety of NOACs during the perioperative period
was compared to that using warfarin. Of the 2652 studies initially
reviewed, we identified 9 that included 15,880 patients for the
meta-analysis. Compared to warfarin, dabigatran increased the risk of
major bleeding (RR 1.37, 95% CI 1.06-1.78, P = 0.02). Apixaban (RR 0.63,
95% CI 0.40-0.99, P = 0.04) reduced thrombotic events. NOAC therapy
decreased thrombotic events in patients undergoing non-cardiac surgery (RR
0.68, 95% CI 0.50-0.92, P = 0.02). Compared to warfarin, the
administration of NOACs in the perioperative period has the same risk of
thromboembolism and major bleeding. But patients undergoing non-cardiac
surgery may benefit more from perioperative NOAC therapy. Apixaban may
reduce thrombotic events and dabigatran increases the risk of major
bleeding during the perioperative period.<br/>Copyright &#xa9; Springer
Science+Business Media, LLC, part of Springer Nature 2018.

<49>
Accession Number
623952303
Title
Cardiac surgery for Chagas disease.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Author
Magarakis M.; Macias A.E.; Tompkins B.A.; Reis V.; Loebe M.; Batista R.;
Salerno T.A.
Institution
(Magarakis, Reis) Jackson Memorial Hospital-University of Miami Miller
School of Medicine, Department of Surgery, Division of Cardiothoracic
Surgery, Cardiac Surgery section, Miami, FL, United States
(Macias) Department of Surgery, University of Medicine and Health
Sciences, Miami, FL, United States
(Tompkins) Department of Surgery, Jackson Memorial Hospital-University of
Miami Miller School of Medicine, Miami, FL, United States
(Loebe) Jackson Memorial Hospital-University of Miami Miller School of
Medicine, Department of Surgery, Division of Transplant Surgery, Miami,
FL, United States
(Batista) Fundacao Vilela Batista, Curitiba, Brazil
(Salerno) Jackson Memorial Hospital-University of Miami Miller School of
Medicine, Department of Surgery, Division of Cardiothoracic Surgery,
Miami, FL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Although Chagas disease is a rare entity in North America, it is
associated with significant cardiac morbidity. It is estimated that 20-30%
of those who are infected will eventually develop cardiovascular disease
secondary to Chagas disease. We review the literature and share our
experience on the surgical management of this challenging patient
population.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<50>
Accession Number
623952028
Title
The prevalence of computed tomography-defined leaflet thrombosis in intra-
versus supra-annular transcatheter aortic valve prostheses.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Author
Rashid H.N.; Nasis A.; Gooley R.P.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Nasis, Gooley, Cameron, Brown) Monash Cardiovascular Research
Centre, MonashHEART, Monash Health, and Monash University, Clayton, VIC,
Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been shown to
increase cerebrovascular events. The neo-sinus plays an important role in
the development of LT. Intra-annular valves (IAV) have a larger neo-sinus
when compared to supra-annular valves (SAV), and has been associated with
larger thrombus burden. The prevalence of LT with IAV and SAV in a larger,
diverse cohort is unknown. Methods: We performed a systematic review to
assess the prevalence of LT in IAV versus SAV TAVR prostheses. Inclusion
criteria were (1) reported CT-defined LT following TAVR, (2) comparison
between LT and non-LT cohort, (3) separate registry/database, and (4)
fully published status. A total of 2,013 citations were reviewed and 7
studies were included. Results: Overall, 1,644 patients were included from
7 observational studies and the prevalence of LT following TAVR was 12.8%.
The Portico valve system (IAV) had the highest prevalence of LT with
35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the Lotus valve
system (IAV) at 14.5%. LT occurred more frequently in IAV than SAV (13.5%
vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the exclusion of the
Portico valve was performed to ensure results were not influenced by this
valve system and revealed IAV still had higher rates of LT (12.1% vs. 7%,
P = 0.05). Conclusion: In summary, IAV prostheses appear to be associated
with higher rates of LT when compared with SAV.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<51>
Accession Number
623950147
Title
Point-of-care viscoelastic hemostatic testing in cardiac surgery patients:
a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2018. Date of
Publication: 2018.
Author
Lodewyks C.; Heinrichs J.; Grocott H.P.; Karkouti K.; Romund G.; Arora
R.C.; Tangri N.; Rabbani R.; Abou-Setta A.; Zarychanski R.
Institution
(Lodewyks, Arora) Department of Surgery, Section of Cardiac Surgery, Max
Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Tangri, Rabbani, Abou-Setta, Zarychanski) Department of
Community Health Sciences, Max Rady College of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Heinrichs, Grocott) Department of Anesthesia and Perioperative Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Karkouti) Department of Anesthesia, Institute of Health Policy,
Management, and Evaluation, and Peter Munk Cardiac Centre, University of
Toronto, Toronto, ON, Canada
(Romund) Neil John Maclean Library, University of Manitoba, Winnipeg, MB,
Canada
(Rabbani, Abou-Setta, Zarychanski) George & Fay Yee Center for Healthcare
Innovation, University of Manitoba/Winnipeg Regional Health Authority,
Winnipeg, MB, Canada
(Arora, Tangri, Zarychanski) Department of Internal Medicine, Max Rady
College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks) Y3505-409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Thromboelastography and rotational thromboelastometry are
point-of-care (POC) viscoelastic tests used to help guide blood product
administration. It is unclear whether these tests improve clinical or
transfusion-related outcomes. The objective of this study was to appraise
data from randomized trials evaluating the benefit of POC testing in
cardiac surgery patients. Primary outcomes were the proportion of patients
transfused with blood products and all-cause mortality. Source: Medline
(Ovid), EMBASE (Ovid), CENTRAL (the Cochrane Library-Wiley), Web of
Science, Biosis, Scopus, and CINAHL databases, as well as clinical trial
registries and conference proceedings were queried from inception to
February 2018. Principal findings: We identified 1,917 records, 11 of
which were included in our analysis (8,294 patients). Point-of-care
testing was not associated with a difference in the proportion of patients
transfused with any blood product (risk ratio [RR], 0.90; 95% confidence
interval [CI], 0.79 to 1.02; I² = 51%; four trials, 7,623
patients), or all-cause mortality (RR, 0.73; 95% CI, 0.47 to 1.13;
I² = 5%; six trials, 7,931 patients). Nevertheless, POC testing
was weakly associated with a decrease in the proportion of patients
receiving red blood cells (RBC) (RR, 0.91; 95% CI, 0.85 to 0.96;
I² = 0%; seven trials, 8,029 patients), and heterogeneous
reductions in frozen plasma (FP) (RR, 0.58; 95% CI, 0.34 to 0.99;
I² = 87%; six trials, 7,989 patients) and platelets (RR, 0.66;
95% CI, 0.49 to 0.90; I² = 65%; seven trials, 8,029 patients).
Meta-analysis of the number of units of RBCs and FP was not possible due
to heterogeneity in reporting, however POC testing significantly reduced
the units of platelets transfused (standard mean difference, -0.09; 95%
CI, -0.18 to 0.00; four trials, 7,643 patients). Conclusion: Our review
indicates that in cardiac surgery patients, POC viscoelastic hemostatic
testing is not associated with a reduction in the proportion of patients
receiving any blood product or all-cause mortality. However, viscoelastic
testing is weakly associated with a reduction in proportion of patients
transfused with specific blood products. Presently, the benefits
associated with viscoelastic testing in cardiac surgery patients are
insufficiently robust to recommend routine implementation of this
technology. Trial registration: PROSPERO (CRD4201706577). Registered 11
May 2017.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists' Society.

<52>
Accession Number
618803178
Title
Surgical treatment of active native mitral infective endocarditis: A
meta-analysis of current evidence.
Source
Journal of the Chinese Medical Association. 81 (2) (pp 147-154), 2018.
Date of Publication: February 2018.
Author
Liu J.-Z.; Li X.-F.; Miao Q.; Zhang C.-J.
Institution
(Liu, Li, Miao, Zhang) Department of Cardiac Surgery, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing, China
Publisher
Elsevier Ltd
Abstract
Background: The native mitral lesion of active infective endocarditis
implies a poor prognosis and is associated with adverse short- or
long-term results without surgical treatment. Both mitral valvuloplasty
(MVP) and mitral valve replacement (MVR) have been performed in the
treatment of active native mitral infective endocarditis (ANMIE). However,
the outcomes of the two approaches remain unclear. The aim of this study
was to systematically review the two procedures with mortality and
survival as the primary endpoints. Methods: A systematic review of the
literature was conducted to identify all relevant studies with comparative
data on MVP versus MVR for the treatment of ANMIE. Information on baseline
characteristics of patients, operation method, quality of literature,
follow-up, and so forth was abstracted using standardized protocols.
Pooled odds ratio (OR) or hazard ratio (HR) was calculated and possible
publication bias was tested. Results: Nine comparative observational
studies with a total of 633 patients (MVP = 265, MVR = 368) were
identified for qualitative assessment, data extraction, and analysis. The
summary OR for operative mortality, comparing repair with replacement, was
0.37 (95% CI 0.0.18-0.80; p = 0.0005). Summary 1- and 5-year HRs for
event-free survival were 0.43 (95% CI 0.20-0.92; p = 0.03) and 0.44 (95%
CI 0.25-0.77, p = 0.004), respectively (repair vs. replacement). Summary
1- and 5-year survival HRs were 0.51 (95% CI 0.24-1.08; p = 0.08) and 0.55
(95% CI 0.32-0.96; p = 0.004), respectively (repair vs. replacement). No
heterogeneity was revealed between studies, and possible publication bias
was insignificant. Conclusions: This meta-analysis suggests that MVP may
be associated with superior postoperative survival outcomes compared with
MVR. MVP is desirable, if possible, as a durable alternative to
replacement. However, we must consider the influence of different patient
characteristics and surgeons' preferences on the choice of surgical
approach, and additional powered clinical trials will be required to
confirm these findings.<br/>Copyright &#xa9; 2017

<53>
Accession Number
623819120
Title
Coronary CT angiography and 5-year risk of myocardial infarction.
Source
New England Journal of Medicine. 379 (10) (pp 924-933), 2018. Date of
Publication: 06 Sep 2018.
Author
Newby D.E.; Adamson P.D.; Berry C.; Boon N.A.; Dweck M.R.; Flather M.;
Forbes J.; Hunter A.; Lewis S.; MacLean S.; Mills N.L.; Norrie J.; Roditi
G.; Shah A.S.V.; Timmis A.D.; Van Beek E.J.R.; Williams M.C.
Institution
(Newby, Adamson, Boon, Dweck, Hunter, Lewis, Mills, Norrie, Shah, Van
Beek, Williams) University of Edinburgh, Edinburgh, United Kingdom
(Berry, Roditi) University of Glasgow, Glasgow, United Kingdom
(Flather) University of East Anglia, Norwich, United Kingdom
(MacLean) NHS Fife, Kirkcaldy, United Kingdom
(Timmis) Queen Mary University, London, United Kingdom
(Forbes) University of Limerick, Limerick, Ireland
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although coronary computed tomographic angiography (CTA)
improves diagnostic certainty in the assessment of patients with stable
chest pain, its effect on 5-year clinical outcomes is unknown. METHODS In
an open-label, multicenter, parallel-group trial, we randomly assigned
4146 patients with stable chest pain who had been referred to a cardiology
clinic for evaluation to standard care plus CTA (2073 patients) or to
standard care alone (2073 patients). Investigations, treatments, and
clinical outcomes were assessed over 3 to 7 years of follow-up. The
primary end point was death from coronary heart disease or nonfatal
myocardial infarction at 5 years. RESULTS The median duration of follow-up
was 4.8 years, which yielded 20,254 patientyears of follow-up. The 5-year
rate of the primary end point was lower in the CTA group than in the
standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard
ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P = 0.004).
Although the rates of invasive coronary angiography and coronary
revascularization were higher in the CTA group than in the standard-care
group in the first few months of follow-up, overall rates were similar at
5 years: invasive coronary angiography was performed in 491 patients in
the CTA group and in 502 patients in the standard- care group (hazard
ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was
performed in 279 patients in the CTA group and in 267 in the standard-care
group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive
therapies were initiated in patients in the CTA group (odds ratio, 1.40;
95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio,
1.27; 95% CI, 1.05 to 1.54). There were no significant between-group
differences in the rates of cardiovascular or noncardiovascular deaths or
deaths from any cause. CONCLUSIONS In this trial, the use of CTA in
addition to standard care in patients with stable chest pain resulted in a
significantly lower rate of death from coronary heart disease or nonfatal
myocardial infarction at 5 years than standard care alone, without
resulting in a significantly higher rate of coronary angiography or
coronary revascularization. (Funded by the Scottish Government Chief
Scientist Office and others; SCOT-HEART ClinicalTrials.gov number,
NCT01149590.).<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<54>
Accession Number
2000985828
Title
Dual versus single antiplatelet therapy after coronary artery bypass graft
surgery: An updated meta-analysis.
Source
International Journal of Cardiology. 269 (pp 80-88), 2018. Date of
Publication: 15 October 2018.
Author
Cardoso R.; Knijnik L.; Whelton S.P.; Rivera M.; Gluckman T.J.; Metkus
T.S.; Blumenthal R.S.; McEvoy J.W.
Institution
(Cardoso, Whelton, Gluckman, Metkus, Blumenthal, McEvoy) Ciccarone Center
for the Prevention of Cardiovascular Disease, Division of Cardiology,
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD,
United States
(Knijnik, Rivera) Division of Cardiology, Department of Medicine,
University of Miami-Jackson Memorial Hospital, Miami, FL, United States
(Gluckman) Center for Cardiovascular Analytics, Research, and Data Science
(CARDS), Providence Heart Institute, Providence St. Joseph Health,
Portland, OR, United States
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: The potential benefit and risks of dual antiplatelet therapy
(DAPT) over single antiplatelet therapy (SAPT) in patients who undergo
coronary artery bypass graft surgery (CABG) is controversial. Methods: We
performed a systematic review and meta-analysis of observational and
randomized clinical trial (RCT) data comparing DAPT to SAPT following
urgent or elective CABG. Subanalyses were performed restricted to: a)
RCTs; b) stable ischemic heart disease (SIHD); c) extended duration DAPT
(>=6 months); and d) follow-up >=2 years. Results: Twenty-two studies
comprising 20,315 patients undergoing CABG were included. Of the
participants studied, 7481 (37%) received postoperative DAPT and 12,834
(63%) received SAPT. Overall, DAPT was associated with a lower
cardiovascular (CV) mortality (OR 0.67; p = 0.02) and a trend towards
lower all-cause mortality (OR 0.78; p = 0.08). There were no differences
in rates of myocardial infarction or stroke. Subanalyses in RCTs, SIHD,
and prolonged follow-up failed to demonstrate improvement in these
outcomes with DAPT. However, in studies with extended duration DAPT,
stroke was significantly reduced in the DAPT group (OR 0.47; p = 0.04).
Saphenous vein graft (SVG) occlusion up to 1 year after CABG was
significantly lower with DAPT overall (OR 0.64; p < 0.01) and in the RCT
subanalysis (OR 0.58; p < 0.01). Major bleeding was significantly higher
with DAPT (OR 1.31; p = 0.03). Conclusion: While DAPT has been associated
with lower CV mortality in observational samples undergoing CABG, such
findings were not replicated in RCTs. Lower rates of SVG occlusion with
DAPT are offset by a higher rate of major bleeding.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<55>
Accession Number
623819743
Title
Comparative study on estimation of acenocoumarol levels in blood in
patients with extremes and normal INR values after valve replacement
surgery.
Source
Journal of Clinical and Diagnostic Research. 12 (10) (pp FC01-FC04), 2018.
Date of Publication: October 2018.
Author
Jeyalakshmi D.; Bhuvaneshwari S.; Murugesan P.R.; Kumar M.S.S.
Institution
(Jeyalakshmi, Bhuvaneshwari) Department of Pharmacology, PSG Institute of
Medical Science and Research, Coimbatore, Tamil Nadu, India
(Murugesan) Department of Cardiothoracic and Vascular Surgery, PSG
Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India
(Kumar) Department of Molecular Medicine and Therapeutics, PSG Institute
of Medical Science and Research, Coimbatore, Tamil Nadu, India
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar,GT
Karnal Road, Delhi 110007, India)
Abstract
Introduction: Acenocoumarol is an oral-anticoagulant which is commonly
used but with narrow therapeutic index and there is no relation between
dose and adverse effects. The response of acenocoumarol varies according
to individual. Adverse effect like bleeding occurs even when INR is in
normal range. Therapeutic drug monitoring of acenocoumarol is essential to
prevent life threatening complication. Aim: To study the association
between plasma concentration of acenocoumarol at trough and Cmax levels
with their corresponding Internalized Normalised Ratio (INR) values in
patients who have undergone valve replacement. Materials and Methods:
After Human Ethics Committee approval, 56 patients were enrolled for the
study. Participants who were taking acenocoumarol 2 mg with low INR,
normal INR and high INR was included. Blood samples taken for estimation
of trough and Cmax concentrations of acenocoumarol were analysed by High
Performance Liquid Chromatography (HPLC) method. Results: The was no
statistically significant correlation between INR of all the three groups
and respective plasma concentration of acenocoumarol taken at trough and
Cmax by Pearson's correlation (p-value=0.187). The plasma concentration of
acenocoumarol taken at trough and Cmax of all the three groups of
participants was not statistically different by ANOVA (p-value=0.164).
Conclusion: The present study concludes that measuring INR alone will have
limited value for dose adjustment of acenocoumarol as proved by other
studies for warfarin. Hence, estimation of plasma concentration of
acenocoumarol will be ideal and appropriate for the dose adjustment of
acenocoumarol.<br/>Copyright &#xa9; 2018, Journal of Clinical and
Diagnostic Research. All rights reserved.

<56>
Accession Number
623735451
Title
A randomised trial of serratus anterior plane block for analgesia after
thoracoscopic surgery.
Source
Anaesthesia. 73 (10) (pp 1260-1264), 2018. Date of Publication: October
2018.
Author
Park M.H.; Kim J.A.; Ahn H.J.; Yang M.K.; Son H.J.; Seong B.G.
Institution
(Park, Ahn, Yang, Seong) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Kim, Son) Department of Anesthesiology and Pain Medicine, Kangwon
National University School of Graduate Medicine, Chuncheon, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We evaluated the effect of pre-operative serratus anterior plane block on
postoperative pain and opioid consumption after thoracoscopic surgery. We
randomly allocated 89 participants to block with 30 ml ropivacaine 0.375%
(n = 44), or no block without placebo or sham procedure (n = 45). We
analysed results from 42 participants in each group. Serratus anterior
plane block reduced mean (SD) remifentanil dose during surgery, 0.12
(0.06) mg.h^-1 vs. 0.16 (0.06) mg.h^-1, p = 0.016, and
reduced mean (SD) fentanyl consumption in the first 24 postoperative
hours, 3.8 (1.9) mug.kg^-1 vs. 5.7 (1.6) mug.kg^-1, p
= 0.000004. Block also reduced the worst median (IQR [range]) pain scores
reported in the first 24 postoperative hours: 6 (5-7 [3-10]) vs. 7 (6-7
[3-10]), p = 0.027. Block decreased dissatisfaction with pain management,
categorised as 'highly unsatisfactory', 'unsatisfactory', 'neutral',
'satisfactory' or 'highly satisfactory': 1/2/21/18/0 vs. 1/14/15/11/1, p =
0.0038. There were no differences in the rates of nausea, vomiting,
dizziness or length of hospital stay. Serratus anterior plane block may be
used to reduce pain and opioid use after thoracoscopic lung
surgery.<br/>Copyright &#xa9; 2018 Association of Anaesthetists

<57>
Accession Number
2000968654
Title
Comparison of Hospital Outcomes of Transcatheter AorticValve Implantation
With Versus Without Hypothyroidism.
Source
American Journal of Cardiology. 122 (5) (pp 838-843), 2018. Date of
Publication: 1 September 2018.
Author
Subahi A.; Yassin A.S.; Adegbala O.; Akintoye E.; Abubakar H.; Elmoghrabi
A.; Ibrahim W.; Ajam M.; Pahuja M.; Weinberger J.J.; Levine D.; Afonso L.
Institution
(Subahi, Yassin, Akintoye, Abubakar, Elmoghrabi, Ibrahim, Ajam,
Weinberger, Levine) Department of Internal Medicine, Wayne State
University/Detroit Medical Center, Detroit, Michigan, United States
(Adegbala) Department of Internal Medicine, Englewood Hospital and Medical
Center, Seton Hall University-Hackensack Meridian School of Medicine,
Englewood, New Jersey, United States
(Pahuja, Afonso) Division of Cardiology, Department of Internal Medicine,
Wayne State University/Detroit Medical Center, Detroit, Michigan, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Comparative outcomes of transcatheter aortic valve implantation (TAVI) in
patients with and without hypothyroidism were not previously reported.
This study aimed to appraise the clinical outcomes and impact of
hypothyroidism on patients who underwent TAVI. Patients with
hypothyroidism who underwent TAVI from 2011 to 2014 were identified in the
National Inpatient Sample database using the International Classification
of Diseases, ninth Revision, Clinical Modification. The primary outcome
was the effect of hypothyroidism on inpatient mortality. Secondary
outcomes were the impact of hypothyroidism on post-TAVI complications. We
also evaluated the length of hospital stay and the cost of
hospitalization. Propensity score-matched analysis was performed to
address potential confounding. The hypothyroid patients who underwent TAVI
had no significant increase in the risk of in-hospital mortality (odds
ratio 0.78; 95% confidence interval 0.51 to 1.21, p = 0.282), or most
postprocedural complications. However, hypothyroid patients were more
likely to develop hemorrhage requiring transfusion (odds ratio 1.36, 95%
confidence interval 1.05 to 1.76, p = 0.043). In conclusion, TAVI is a
feasible and relatively safe alternative with reasonable in-hospital
outcomes in patients with hypothyroidism and severe symptomatic aortic
stenosis. However, hypothyroid patients are more likely to require a blood
transfusion after TAVI. Additional randomized trials are needed to
evaluate TAVR outcomes in hypothyroid patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<58>
Accession Number
623934461
Title
Accuracy of new-generation handheld ecg devices compared to traditional
3-lead electrocardiogram.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2016. United
States. 27 (1) (pp 28), 2016. Date of Publication: January 2016.
Author
LaPier T.; Horrocks J.
Institution
(LaPier, Horrocks) Physical Therapy, Eastern Washinton University,
Spokane, WA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose/Hypothesis: An electrocardiogram (ECG) has longbeen the standard
for detecting and diagnosing cardiac rhythmdysfunction. Several small,
portable handheld ECG monitors andare now available that will display and
even analyze real-timeECG rhythm strips. There is insufficient scientific
informationregarding the appropriateness of using these devices in
clinicalpractice. The purpose of this study was to evaluate the accuracy
ofheart rate detection and the quality of the ECG tracings obtainedwith 3
new-generation handheld ECG devices. NUMBER OFSUBJECTS: We evaluated 3
different handheld ECG devices 11study participants (6 men, 5 women) 23 to
36 years old. Studyexclusion criteria included: previous diagnosis of
peripheralarterial, peripheral venous disease, ischemic stroke,
coronaryartery disease, acute myocardial infarction, coronary
revascularization, or diabetes, resting HR.120 bpm, presence of an
exercisetesting contraindication (American College of Sports
MedicineGuidelines), or diminished peripheral circulation.
Materials/Methods: The subjects were seated and resting for 10
minutesprior to measurements. A standard 3-lead ECG (Welch-AllynAtlas) was
used to measure HR. Electrode placement areas wereprepared using isopropyl
alcohol soaked gauze and allowed todry. The 3 portable handheld ECG
devices tested included theAliveCor Mobile ECG, Creative Medical Easy ECG
Monitor PC-80B, and Choice Medical MD100E Handheld ECG Monitor. Lead1 ECG
measurement using both hands was recorded using eachdevice in randomized
order. For each device, ECG rhythm wasrecorded for 30 seconds
simultaneously with ECG rhythm fromthe standard 3-lead ECG. Data analysis
included t-tests (P < 0.05)to evaluate differences in HR between a
handheld device andstandard 3-lead ECG as well as a qualitative comparison
of theECG tracings from all 4 ECG monitors using a 5-point Likert
scalewith anchors of 0 5 no artifact and 4 5 severe artifact, unable
torecognize wave components. Results: There was no significantdifference
in accuracy of HR measurement between the 3handheld ECG monitors and the
standard 3-lead ECG. MeanHR difference ranged from 0.4 to 1.1 bpm. Of the
3 handheld ECGmonitors, the MD100E had the poorest quality ECG tracing.
Forthe first 4 to 5 seconds, the AliveCor monitor had a great deal
ofartifact then displayed very clean tracings. Conclusions: All 3handheld
ECG monitors accurately assessed HR at rest. Studyqualitative analysis of
the ECG rhythm tracings suggests that all ofthe devices could be used
clinically to assess ventriculararrhythmias such as preventricular
contractions. The degree ofartifact observed for the MD100E monitor rhythm
tracings wouldmake it difficult to screen for some dysrhythmias like
atrialfibrillation. CLINICAL RELEVANCE: New-generation portablehandheld
ECG monitors can be a useful screening tool forphysical therapists in some
practice settings, for example homehealth. Additionally they could be used
by patients with knowndisease in home self-management and monitoring of
cardiacarrhythmias.

<59>
Accession Number
623934444
Title
The effects of postoperative depression on health-related quality of life
in adults following open heart surgery: A systematic review.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2016. United
States. 27 (1) (pp 26), 2016. Date of Publication: January 2016.
Author
Sanko J.P.; Callahan K.; Moleti C.; Staudenmeier S.; Clyons C.
Institution
(Sanko, Callahan, Moleti, Staudenmeier, Clyons) Physical Therapy,
University of Scranton, Scranton, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE: The purpose of this systematic review was to discussthe effect of
postoperative depression on health-related quality oflife in adult
patients following open heart surgery. DESCRIPTION:Approximately 1 in
every 5 patients experiences a major depressiveepisode during recovery
from open heart surgery (OHS) andapproximately 50% of patients suffer from
depressive symptoms(DS). Previous research has shown that higher levels of
preoperative DS negatively impacts post-surgical health-related qualityof
life (HRQoL). This review examined the independent effect ofpostoperative
depression on HRQoL in adult patients followingOHS. A search of CINAHL,
PubMed, ProQuest Health and MedicalComplete, ProQuest Research Library,
and Psych Info databasesand a hand-search was performed with key words:
(cardiac surgeryOR open heart surgery) AND (depressive disorder OR
depression)AND (quality of life OR QOL). A total of 291 articles were
screenedfor eligibility using selection criteria: peer-reviewed
researchstudies, English, published 2005 to 2015, measured effects
ofpostoperative depression on HRQoL, humans, 18 years and older,history of
OHS, and no prior diagnosis of depression. Five articleswere included and
1 article was added from a hand search bringingthe total to 6. Samples
ranged from 72 to 732 subjects (total 1,486)who were assessed for
depression following OHS. The primaryoutcome measures used to assess
depression were: Beck DepressionInventory, Depression Anxiety Stress
Scales, Multiple AffectAdjective Check List, Center for Epidemiological
StudiesDepression Scale, and Cardiac Attitudes Index. HRQoL wasmeasured
by: 36-item Short Form General Health Survey, MedicalOutcomes Study,
12-item Short Form Health Survey, Duke ActivityStatus Index, and Duke
Older Americans Resources and ServicesProcedures-Instrumental Activities
of Daily Living. All +/- studiesincluded a follow-up assessment, 2 less
than +/- months and 4 greaterthan or equal to +/- months. Two reviewers
methodologically andindependently assessed each article and came to
consensus usingthe MINORS scale. This scale is an objective measure that
is used toevaluate the quality of comparative or non-comparative
researchstudies. MINOR scores ranged from 11 to 14 out of 16 with a
meanscore of 12.2. SUMMARY OF USE: There is moderate to strongevidence
that postoperative depression negatively impacts HRQoLfollowing OHS.
Depression does not need to meet the clinicaldiagnosis criterion in order
to adversely affect HRQoL outcomes.An increase in postoperative depression
negatively impacts HRQoLindependent of preoperative depression. IMPORTANCE
TOMEMBERS: HRQoL is positively associated with self-efficacy forand
compliance with exercise. Clinicians should consider routinescreening of
all patients following OHS to identify DS and makeappropriate referrals to
implement early interventions.

<60>
Accession Number
621319794
Title
Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A
systematic review and meta-analysis.
Source
Drug Design, Development and Therapy. 12 (pp 521-531), 2018. Date of
Publication: 12 Mar 2018.
Author
Zhu Z.; Zhou H.; Ni Y.; Wu C.; Zhang C.; Ling X.
Institution
(Zhu, Zhou, Ni, Wu, Zhang) Department of Anesthesiology, the Second
Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
(Ling) Outpatient-Nursing Department, the Second Affiliated Hospital of
Jiaxing University, Jiaxing, Zhejiang, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Cardiac surgery patients always present with atrial fibrillation
(AF) after admission to the intensive care unit, leading to high mortality
and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication
used for sedation in the intensive care unit; however, whether it can
reduce AF needs to be analyzed. Materials and methods: Three primary
databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of
Controlled Trials (CENTRAL), were searched. All English language and
randomized control designed clinical publications comparing DEX to control
medicines for sedation after elective cardiac surgery were included. Two
independent colleagues conducted the data extraction and quality
assessments. The subgroup analysis was performed according to the medicine
used, age, AF history, and whether previous beta-blocker premedication and
cardiopulmonary bypass (CPB) were applied. The overall incidence of AF was
analyzed. Results: A total of 1,295 patients in nine studies met the
selection criteria among 2,587 studies screened from the database. After
quantitative synthesis, our results revealed that the DEX group was not
associated with a decreased incidence of AF compared with the placebo
(risk ratio [RR] 0.76, 95% CI 0.37, 1.55, P=0.44) and morphine groups (RR
0.86, 95% CI 0.56, 1.31, P=0.48). Subgroup analysis also indicated that
the DEX vs propofol comparison exhibited no difference: 1) for patients of
age >60 years (P=0.69) or <=60 years (P=0.69); 2) under CPB surgery
(P=0.45) or without CPB surgery (P=0.88); 3) with beta-blocker
premedication (P=0.32) or without beta-blocker premedication (P=0.90); and
4) with AF history (RR 1.07, 95% CI 0.85, 1.36, P=0.57) or without AF
history (P=0.30). Conclusion: This meta-analysis revealed that DEX could
not reduce the incidence of AF compared to control medicines following
cardiac surgery. DEX may have an increased influence on AF occurrence if
patients had a history of AF. However, cautious interpretation should be
made due to high clinical heterogeneity.<br/>Copyright &#xa9; 2018 Zhu et
al.

<61>
Accession Number
620001638
Title
A systematic review of complications in thoracic spine surgery for
ossification of ligamentum flavum.
Source
Spinal Cord. 56 (4) (pp 301-307), 2018. Date of Publication: 01 Apr 2018.
Author
Hou X.; Chen Z.; Sun C.; Zhang G.; Wu S.; Liu Z.
Institution
(Hou, Zhang, Wu, Liu) Department of Orthopaedics, Peking University
Shougang Hospital China, Beijing, China
(Chen, Sun) Department of Orthopaedics, Peking University Third Hospital,
Beijing, China
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Study design: Systematic review. Objectives: The aim of this systematic
review is to summarize the incidence of complications, to relate
complication incidence to procedures performed, to assess the impact of
the year of study publication and follow-up duration on complication
incidence. Methods: The authors conducted the Cochrane Central Register of
Controlled Trials, PubMed, and EMBASE searches for relevant literatures.
The incidence of complications was summarized. Correlation of the
incidence with year of study publications, follow-up duration, and the
surgical outcome was statistically evaluated. Results: A total of 16
studies met our inclusion criteria, including 475 patients. All of these
studies were retrospective case series. The mean age of patients ranged
from 55 to 64 years. Average follow-up duration ranged from 26 to 65
months. Partial patients in four studies underwent surgeries and reserved
posterior structure of the spinal canal. The others underwent operations
removing posterior structure of spinal canal. The mean recovery rate from
each individual study varied between 31 and 68% and the pooled neurologic
function recovery rate was 53% (95% CI: 43-62%). The mean complication
rate was 24%. Cerebrospinal fluid leakage was the most reported
postoperative complication (19%), then neurologic deterioration (5%).
Other complications included local infections, wound dehiscence, increased
kyphotic deformity, an hematoma. Conclusions: Operations removing
posterior structure of spinal canal are the main technique to decompress
spinal cord. Cerebrospinal fluid leakage and postoperative neurologic
deterioration were the most reported complications.<br/>Copyright &#xa9;
2017 The Author(s) 2017, under exclusive licence to the International
Spinal Cord Society.

<62>
Accession Number
621588365
Title
Continuous renal replacement therapy with a polymethyl methacrylate
membrane hemofilter suppresses inflammation in patients after open-heart
surgery with cardiopulmonary bypass.
Source
Journal of Artificial Organs. 21 (2) (pp 188-195), 2018. Date of
Publication: 01 Jun 2018.
Author
Mukaida H.; Matsushita S.; Inotani T.; Nakamura A.; Amano A.
Institution
(Mukaida, Matsushita, Amano) Department of Cardiovascular Surgery, Faculty
of Medicine, Juntendo University, Tokyo, Japan
(Mukaida, Inotani) Department of Clinical Engineering, Juntendo University
Hospital, Tokyo, Japan
(Nakamura) Department of Clinical Engineering, Faculty of Health Sciences,
Kyorin University, Tokyo, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Cardiopulmonary bypass (CPB) induces a complex inflammatory response
involving an increase in inflammatory cytokines, called postperfusion
syndrome. Previous studies demonstrated that adsorption of the serum
cytokines can reduce acute inflammation and improve clinical outcomes. In
this study, patients were placed on continuous renal replacement therapy
(CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter
immediately after the start of an open-heart surgery with CPB and
throughout the postoperative course to prevent postperfusion syndrome. The
aim of this study was to assess whether continuous CRRT using a PMMA
filter (PMMA-CRRT) could affect cytokine expression and improve
perioperative outcomes. We designed a randomized controlled trial, which
included 19 consecutive adult patients on maintenance dialysis and 7
consecutive adult patients who were not on maintenance dialysis (NHD
group). Patients on maintenance dialysis were randomly divided into two
groups: Ten patients who received CRRT with a polysulfone membrane
hemofilter (PS group) and nine patients who received CRRT with a PMMA
membrane (PMMA group). Blood samples were collected from the radial or
brachial artery at five different time points. Comparisons between the PS,
PMMA, and NHD groups revealed a significant main effect of time on changes
in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p <
0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery
were significantly lower in the PMMA group than in the PS group, while
other cytokines measured in this study were not significantly different.
In addition, clinical outcomes were not significantly different between
the groups. The continuous use of PMMA-CRRT throughout the perioperative
period suppressed serum IL-6 and IL-8 concentrations, although there were
no differences in clinical outcomes.<br/>Copyright &#xa9; 2018, The
Japanese Society for Artificial Organs.

<63>
Accession Number
619391736
Title
Heart failure severity, inappropriate ICD therapy, and novel ICD
programming: a MADIT-RIT substudy.
Source
PACE - Pacing and Clinical Electrophysiology. 40 (12) (pp 1405-1411),
2017. Date of Publication: December 2017.
Author
Daimee U.A.; Vermilye K.; Rosero S.; Schuger C.D.; Daubert J.P.; Zareba
W.; McNitt S.; Polonsky B.; Moss A.J.; Kutyifa V.
Institution
(Daimee, Vermilye, Rosero, Zareba, McNitt, Polonsky, Moss, Kutyifa) Heart
Research Follow-Up Program, University of Rochester Medical Center,
Rochester, NY, United States
(Schuger) Division of Cardiology, Henry Ford Hospital, Detroit, MI, United
States
(Daubert) Cardiology Division, Duke University Medical Center, Durham, NC,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The effects of heart failure (HF) severity on risk of
inappropriate implantable cardioverter-defibrillator (ICD) therapy have
not been thoroughly investigated. We aimed to study the association
between HF severity and inappropriate ICD therapy in MADIT-RIT. Methods:
MADIT-RIT randomized 1,500 patients to three ICD programming arms:
conventional (Arm A), high-rate cut-off (Arm B: >=200 beats/min), and
delayed therapy (Arm C: 60-second delay for >=170 beats/min). We evaluated
the association between New York Heart Association (NYHA) class III (n =
256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A
patients with ICD-only and cardiac resynchronization therapy with
defibrillator (CRT-D). We additionally assessed benefit of novel ICD
programming in Arms B and C versus Arm A by NYHA classification. Results:
In Arm A, the risk of inappropriate therapy was significantly higher in
those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] =
2.55, confidence interval [CI]: 1.51-4.30, P < 0.001) and CRT-D patients
(HR = 3.73, CI: 1.14-12.23, P = 0.030). This was consistent for
inappropriate ATP and inappropriate ICD therapy < 200 beats/min, but not
for inappropriate shocks. Novel ICD programming significantly reduced
inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR =
0.08, P < 0.001; Arm C vs Arm A: HR = 0.17, P < 0.001) and NYHA I-II (Arm
B vs Arm A: HR = 0.25, P < 0.001; Arm C vs Arm A: HR = 0.28, P < 0.001).
Conclusion: Patients with more severe HF are at increased risk for
inappropriate ICD therapy, particularly ATP due to arrhythmias < 200
beats/min. Novel programming with high-rate cut-off or delayed detection
reduces inappropriate ICD therapies in both mild and moderate
HF.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<64>
[Use Link to view the full text]
Accession Number
614578013
Title
Evaluation of ultrasound-assisted thoracic epidural placement in patients
undergoing upper abdominal and thoracic surgery a randomized, double-blind
study.
Source
Regional Anesthesia and Pain Medicine. 42 (2) (pp 204-209), 2017. Date of
Publication: 2017.
Author
Auyong D.B.; Hostetter L.; Yuan S.C.; Slee A.E.; Hanson N.A.
Institution
(Auyong, Hostetter, Yuan, Hanson) Department of Anesthesiology, Virginia
Mason Medical Center, 1100 9th Ave, Seattle, WA 98101, United States
(Slee) Axio Research, Seattle, WA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background andObjectives: The placement of thoracic epidurals can be
technically challenging and requires a thorough understanding of neuraxial
anatomy. Although ultrasound imaging of the thoracic spine has been
described, no outcome studies on the use of this imaging have been
performed. We evaluated whether preprocedural ultrasound of the thoracic
spine would facilitate the process of epidural catheterization. Methods:
Subjects undergoing thoracic or upper abdominal surgery with planned
thoracic epidural placement at T10 or higher were enrolled in this
randomized double-blind study. Subjects were allocated into 1 of 2 groups
for preoperative epidural placement: ultrasound guidance (group US) or
palpation (group Palp). Subjects randomized to group US had a
preprocedural ultrasound examination to identify pertinent spinal anatomy
and make appropriate marks on the skin identifying midline and
interlaminar spaces for targeted Tuohy needle insertion. Subjects in group
Palp had a skin marking performed by palpation alone. Using the skin
markings, all epidurals were performed using a loss of resistance to
saline technique. Block levels were assessed with ice and pain scores
obtained by a blinded nurse in the postanesthesia care unit. The primary
outcome was procedural time from needle insertion to loss of resistance in
the epidural space. Results: Seventy subjects were recruited and completed
the study protocol. Themedian time for epidural needle placement to
achieve loss of resistance in group US and group Palp was 188.5 seconds
(interquartile range [IQR], 79.0-515.0) and 242.0 seconds (IQR,
87.0-627.0), respectively (P = 0.188). Using ultrasound to mark the skin
overlying the targeted epidural space took a median time of 85 seconds
(IQR, 69-113) for group US and 35 seconds (IQR, 27-51) for group Palp (P <
0.001). The number of needle passes was not significantly different
between the 2 groups (P = 0.31). The use of ultrasound assistance resulted
in a decreased number of needle skin punctures to achieve loss of
resistance (P = 0.005).Mean pain scores after surgery were lower in group
US compared to group Palp: 3.0 versus 4.7, respectively (P = 0.015).
Conclusions: This is the first randomized study to evaluate the efficacy
of preprocedural ultrasound marking for placement of thoracic epidural
catheters. We observed that preprocedural ultrasound did not significantly
reduce the time required to identify the thoracic epidural space via loss
of resistance. Clinical Trials Registration: NCT02785055
(https://clinicaltrials.gov/).<br/>Copyright &#xa9; 2017 American Society
of Regional Anesthesia and Pain Medicine.

<65>
Accession Number
617792696
Title
Early versus late initiation of renal replacement therapy impacts
mortality in patients with acute kidney injury post cardiac surgery: A
meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 150. Date of
Publication: 2017.
Author
Zou H.; Hong Q.; Xu G.
Institution
(Zou) Medical Center of the Graduate School, Nanchang University,
Nanchang, China
(Hong) Science and Technology College, Jiangxi University of Traditional
Chinese Medicine, Nanchang, China
(Zou, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006,
China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is a common clinical complication of
cardiac surgery and increases mortality and hospitalization. We aimed to
explore and perform an updated meta-analysis of qualitative and
quantitative evaluations of the relationship between early renal
replacement therapy (RRT) and mortality. Methods: We searched the Chinese
Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE
and PubMed. Results: Fifteen studies (five randomized controlled trials
(RCTs), one prospective cohort and nine retrospective cohorts) including
1479 patients were identified for detailed evaluation. The meta-analysis
suggested that early RRT initiation reduced 28-day mortality (odds ratio
(OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I² 60%),
and shortened intensive care unit (ICU) length of stay (LOS) (mean
difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%) and hospital LOS (MD
-0.69; 95% CI -1.13 to -0.25; I² 88%), and also reduced the
duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I² 69%),
especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI
0.08 to 0.63; I² 73%) and within 24 hours (OR 0.52; 95% CI 0.28
to 0.95; I² 58%) in patients with AKI after cardiac surgery.
Conclusions: Early RRT initiation decreased 28-day mortality, especially
when it was started within 24 hours after cardiac surgery in patients with
AKI.<br/>Copyright &#xa9; The Author(s). 2017.

<66>
Accession Number
613553650
Title
Does Current Evidence Favor Drug-Eluting Stents Over Bare-Metal Stents for
Saphenous Venous Graft Interventions?: Insights From an Updated
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (23) (pp 2456-2458), 2016. Date of
Publication: 12 Dec 2016.
Author
Bavishi C.; Chatterjee S.; Stone G.W.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<67>
Accession Number
2000878518
Title
Safety of FFR-guided revascularisation deferral in Anatomically prognostiC
diseasE (FACE: CARDIOGROUP V STUDY): A prospective multicentre study.
Source
International Journal of Cardiology. 270 (pp 107-112), 2018. Date of
Publication: 1 November 2018.
Author
Barbero U.; D'Ascenzo F.; Campo G.; Kleczynski P.; Dziewierz A.; Menozzi
M.; Jimenez Diaz V.A.; Cerrato E.; Raposeiras-Roubin S.; Ielasi A.;
Rognoni A.; Fineschi M.; Kanji R.; Jaguszewski M.J.; Picchi A.; Ando G.;
Soraci E.; Mancone M.; Sardella G.; Calcagno S.; Gallo F.; Huczek Z.;
Krakowian M.; Verardi R.; Montefusco A.; Omede P.; Lococo M.; Moretti C.;
D'Amico M.; Rigattieri S.; Gaita F.; Rinaldi M.; Escaned J.
Institution
(Barbero, D'Ascenzo, Campo, Kleczynski, Dziewierz, Menozzi, Jimenez Diaz,
Cerrato, Raposeiras-Roubin, Ielasi, Rognoni, Fineschi, Kanji, Jaguszewski,
Picchi, Ando, Soraci, Mancone, Sardella, Calcagno, Gallo, Huczek,
Krakowian, Verardi, Montefusco, Omede, Lococo, Moretti, D'Amico,
Rigattieri, Gaita, Rinaldi, Escaned) Division of Cardiology,
Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Citta della
Salute e della Scienza di Torino, Corso A. M. Dogliotti, 14, Torino 10126,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: FFR-guided coronary intervention is recommended for patients
with intermediate stenoses. However, concerns exist with this approach in
anatomically prognostic disease. Methods: In this prospective, multicentre
study, we consecutively enrolled patients found to have FFR negative
lesions in anatomically significant sites: left main; proximal LAD; last
remaining patent vessel; and multiple vessels with concomitant impaired
left ventricular systolic function (EF < 40%). As per recommendation,
revascularisation was deferred, and patients included into a registry. The
primary endpoint was MACE (death, myocardial infarction and unplanned
target lesion revascularization). Secondary endpoints were the above
individual components. Subgroup analyses were performed for clinical
presentation (stable vs. ACS), localization of lesion (ostial vs. non
ostial) and renal function. Results: The registry included 292 patients
with 297 deferred stenoses. After 1-year, the primary endpoint occurred in
5% of patients, mainly driven by TLR (2.7%). Cardiovascular death occurred
in 0.8% and AMI in 0.8%. During a follow-up of 22.2 +/- 11 months, MACE
occurred in 11.6%. Cardiovascular death occurred in 1.8% and AMI in 2.1%.
After multivariate analysis, impaired renal function (OR 1.99; CI 95%
1.74-5.41; p = 0.046) and ostial disease (OR 2.88; CI 95% 1.04-7.38; p =
0.041) were found to be predictors of MACE. Impaired renal function also
predicted TLR (OR 2.43; CI 95% 1.17-5.02; p = 0.017). Conclusion:
FFR-guided revascularisation deferral is safe in the majority of
anatomically prognostic disease. However, further evaluation is required
in the risk stratification of those patients with ostial disease and renal
disease. Registered on ClinicalTrials, NCT02590926.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<68>
Accession Number
618422321
Title
Safety of preoperative use of ticagrelor with or without aspirin compared
with aspirin alone in patients with acute coronary syndromes undergoing
coronary artery bypass grafting.
Source
JAMA Cardiology. 1 (8) (pp E1-E8), 2016. Date of Publication: November
2016.
Author
Gherli R.; Mariscalco G.; Dalen M.; Onorati F.; Perrotti A.; Chocron S.;
Verhoye J.P.; Gulbins H.; Reichart D.; Svenarud P.; Faggian G.; Santarpino
G.; Fischlein T.; Maselli D.; Dominici C.; Musumeci F.; Rubino A.S.;
Mignosa C.; De Feo M.; Bancone C.; Gatti G.; Maschietto L.; Santini F.;
Nicolini F.; Gherli T.; Zanobini M.; Kinnunen E.-M.; Ruggieri V.G.; Rosato
S.; Biancari F.
Institution
(Gherli, Musumeci) Department of Cardiovascular Sciences, Cardiac Surgery
Unit, San Camillo Forlanini Hospital, Rome, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, University of Leicester, Glenfield Hospital, Groby Rd, Leicester LE3
9QP, United Kingdom
(Dalen, Svenarud, Faggian) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Dalen, Svenarud, Faggian) Department of Cardiothoracic Surgery and
Anesthesiology, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Perrotti, Chocron) Department of Thoracic and Cardiovascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Verhoye, Ruggieri) Division of Cardiothoracic and Vascular Surgery,
Pontchaillou University Hospital, Rennes, France
(Gulbins, Reichart) Hamburg University Heart Center, Hamburg, Germany
(Santarpino, Fischlein) Cardiovascular Center, Paracelsus Medical
University, Nuremberg, Germany
(Maselli, Dominici) Department of Cardiac Surgery, St Anna Hospital,
Catanzaro, Italy
(Rubino, Mignosa) Centro Cuore Morgagni, Pedara, Italy
(De Feo, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti, Maschietto) Division of Cardiac Surgery, Ospedali Riuniti,
Trieste, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Nicolini, Gherli) Division of Cardiac Surgery, University of Parma,
Parma, Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino, Istituto di Ricovero e Cura A Carattere Scientifico, University
of Milan, Milan, Italy
(Kinnunen, Biancari) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Rosato) National Institute of Health, Rome, Italy
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The optimal timing of discontinuation of ticagrelor before
cardiac surgery is controversial. OBJECTIVE To evaluate the safety of
preoperative use of ticagrelor with or without aspirin in patients with
acute coronary syndromes (ACS) undergoing isolated coronary artery bypass
grafting (CABG) compared with aspirin alone. DESIGN, SETTING, AND
PARTICIPANTS This prospective, multicenter clinical trialwas performed at
15 European centers of cardiac surgery. Participants were patients with
ACS undergoing isolated CABG from the European Multicenter Study on
Coronary Artery Bypass Grafting (E-CABG) registry between January and
September 2015. EXPOSURES Before surgery, patients received ticagrelor
with or without aspirin or aspirin alone. MAIN OUTCOMES AND MEASURES
Severe bleeding as defined by the Universal Definition of Perioperative
Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity
score-matched analysis was performed to adjust for differences in baseline
and operative covariates. RESULTS Of 2482 patients from the E-CABG
registry, the study cohort included 786 (31.7%) consecutive patients with
ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%)
were female. One-to-one propensity score matching provided 215 pairs,
whose baseline and operative covariates had a standardized difference of
less than 10%. Preoperative use of ticagrelor was associated with a
similar risk of bleeding according to the UDPB and E-CABG bleeding
classifications, but the incidence of platelet transfusion was higher in
the ticagrelor group (13.5%[29 of 215] vs 6.0% [13 of 215]. Compared with
those receiving aspirin alone, continuing ticagrelor up to the time of
surgery or discontinuing its use less than 2 days before surgery was
associated with a higher risk of platelet transfusion (22.7%[5 of 22] vs
6.4%[12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2%[4 of 22] vs
5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3
and 4 (22.7%[5 of 22] vs 9.6%[18 of 187]). Among patients in whom
antiplatelet drug use was discontinued at least 2 days before surgery, the
incidence of platelet transfusion was 12.4%(24 of 193) in the ticagrelor
group and 3.6%(1 of 28) in the aspirin-alone group. CONCLUSIONS AND
RELEVANCE In propensity score-matched analyses among patients with ACS
undergoing CABG, the use of preoperative ticagrelor with or without
aspirin compared with aspirin alone was associated with more platelet
transfusion but similar degree of bleeding; in patients receiving
ticagrelor 1 day before or up until surgery, there was an increased rate
of severe bleeding.<br/>Copyright 2016 American Medical Association. All
rights reserved.

<69>
[Use Link to view the full text]
Accession Number
623924177
Title
Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and
attenuate myocardial ischemia-reperfusion injury after cardiac surgery
with cardiopulmonary bypass in children: A randomized, double-blind,
placebo-controlled trial.
Source
Medicine. 97 (36) (pp e12100), 2018. Date of Publication: 01 Sep 2018.
Author
Zhang J.-Q.; Yang Q.-Y.; Xue F.-S.; Zhang W.; Yang G.-Z.; Liao X.; Meng
F.-M.
Institution
(Zhang, Zhang, Meng) Department of Anesthesiology, Henan Provincial
People's Hospital of Zhengzhou University, Zhengzhou, China
(Yang, Yang, Liao) Department of Anesthesiology, Plastic Surgery Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
China
(Xue) Department of Anesthesiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
Abstract
BACKGROUND: Both euthyroid sick syndrome and myocardial
ischemia-reperfusion injury are common and have been significantly
associated with morbidity and mortality after pediatric cardiac surgery
with cardiopulmonary bypass. This single-center, prospective,
double-blind, randomized placebo-controlled clinical pilot trial was
designed to assess if preoperative oral thyroid hormone therapy could
prevent the occurrence of euthyroid sick syndrome (ESS) and attenuate
myocardial ischemia-reperfusion injury (IRI) after cardiac surgery with
cardiopulmonary bypass (CPB) in children.
METHODS: Forty children aged 3 to 12 year, scheduled for elective
congenital heart disease repair surgery with CPB, were randomized into 2
groups of equal size to receive the following treatments in a double-blind
manner: placebo (control group) and thyroid tablet 0.4 mg/kg (trial group)
taken orally once a day for 4 days before surgery. The perioperative serum
thyroid hormone levels and hemodynamic variables were determined. The
extubation time, duration of intensive care unit (ICU) stay, and use of
inotropic drugs in the ICU were recorded. The myocardial expressions of
heat shock protein 70 (HSP70), myosin heavy chain (MHC) mRNA, and thyroid
hormone receptor (TR) mRNA were detected. The serum creatine kinase-MB
(CK-MB) activity and troponin I (TnI) positive ratio at 24 hour after
surgery were assessed.
RESULTS: There were no significant differences in hemodynamic variables at
all observed points, extubation time, and duration of ICU stay between
groups. As compared with baselines on administration, serum
triiodothyronine (T3) and free T3 (FT3) levels on the first, second, and
fourth postoperative day, and serum thyrotropic-stimulating hormone (TSH),
tetraiodothyronine (T4), and free T4 (FT4) levels on the first
postoperative day were significantly decreased in the 2 groups. Serum T3,
FT3, and T4 levels on the first and second postoperative day, and serum
FT4 level on the first postoperative day were significantly higher in the
trial group than in control group. As compared with the control group, the
number of patients requiring inotropic drugs in the ICU, serum CK-MB
activity, serum positive TnI ratio, and myocardial expression of MHCbeta
mRNA were significantly decreased, and myocardial expressions of both
HSP70 and MHCalpha mRNA were significantly increased in the trial group.
CONCLUSIONS: In children undergoing cardiac surgery with CPB, preoperative
oral small-dose thyroid hormone therapy reduces severity of postoperative
ESS and provides a protection against myocardial IRI by increasing HSP70
and MHCalpha expression.

<70>
Accession Number
623922607
Title
Adding left atrial appendage closure to open heart surgery provides
protection from ischemic brain injury six years after surgery
independently of atrial fibrillation history: the LAACS randomized study.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 53), 2018. Date of
Publication: 23 May 2018.
Author
Park-Hansen J.; Holme S.J.V.; Irmukhamedov A.; Carranza C.L.; Greve A.M.;
Al-Farra G.; Riis R.G.C.; Nilsson B.; Clausen J.S.R.; Norskov A.S.; Kruuse
C.R.; Rostrup E.; Dominguez H.
Institution
(Park-Hansen, Greve, Clausen, Norskov) Department of Cardiology,
Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57,
Frederiksberg DK-2000, Denmark
(Park-Hansen, Greve, Clausen, Norskov) Department of Biomedicine,
University of Copenhagen, Copenhagen, Denmark
(Holme, Carranza) Department of Thoracic Surgery, Rigshospitalet,
Copenhagen, Denmark
(Irmukhamedov) Department of Thoracic Surgery, Odense University Hospital,
Odense, Denmark
(Al-Farra) Department of Radiology, Herlev Gentofte University Hospital,
Herlev, Denmark
(Riis) Department of Radiology, Bispebjerg and Frederiksberg Hospital,
Frederiksberg, Denmark
(Nilsson) Department of Cardiology, Hvidovre University Hospital,
Copenhagen, Denmark
(Kruuse) Department Neurology, Neurovascular Research Unit, Herlev
Gentofte Hospital, Herlev, Denmark
(Rostrup) Mental Health Center Glostrup, Copenhagen, Denmark
(Dominguez) Department of Cardiology, Bispebjerg and Frederiksberg
University Hospital, Nordre Fasanvej 57, Frederiksberg DK-2000, Denmark
(Dominguez) Department of Biomedicine, University of Copenhagen,
Copenhagen, Denmark
Abstract
BACKGROUND: Open heart surgery is associated with high occurrence of
atrial fibrillation (AF), subsequently increasing the risk of
post-operative ischemic stroke. Concomitant with open heart surgery, a
cardiac ablation procedure is commonly performed in patients with known
AF, often followed by left atrial appendage closure with surgery (LAACS).
However, the protective effect of LAACS on the risk of cerebral ischemia
following cardiac surgery remains controversial. We have studied whether
LAACS in addition to open heart surgery protects against post-operative
ischemic brain injury regardless of a previous AF diagnosis.
METHODS: One hundred eighty-seven patients scheduled for open heart
surgery were enrolled in a prospective, open-label clinical trial and
randomized to concomitant LAACS vs. standard care. Randomization was
stratified by usage of oral anticoagulation (OAC) planned to last at least
3 months after surgery. The primary endpoint was a composite of
post-operative symptomatic ischemic stroke, transient ischemic attack or
imaging findings of silent cerebral ischemic (SCI) lesions.
RESULTS: During a mean follow-up of 3.7 years, 14 (16%) primary events
occurred among patients receiving standard surgery vs. 5 (5%) in the group
randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1-0.8,
p=0.02). In per protocol analysis (n=141), 14 (18%) primary events
occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio
0.3; 95% CI: 0.1-1.0, p=0.05).
CONCLUSIONS: In a real-world setting, LAACS in addition to elective
open-heart surgery was associated with lower risk of post-operative
ischemic brain injury. The protective effect was not conditional on AF/OAC
status at baseline.
TRIAL REGISTRATION: LAACS study, clinicaltrials.gov NCT02378116 , March
4th 2015, retrospectively registered.

<71>
Accession Number
623920637
Title
Outcomes in the Randomized CoreValve US Pivotal High Risk Trial in
Patients With a Society of Thoracic Surgeons Risk Score of 7% or Less.
Source
JAMA cardiology. 1 (8) (pp 945-949), 2016. Date of Publication: 01 Nov
2016.
Author
Reardon M.J.; Kleiman N.S.; Adams D.H.; Yakubov S.J.; Coselli J.S.; Deeb
G.M.; O'Hair D.; Gleason T.G.; Lee J.S.; Hermiller J.B.; Chetcuti S.;
Heiser J.; Merhi W.; Zorn G.L.; Tadros P.; Robinson N.; Petrossian G.;
Hughes G.C.; Harrison J.K.; Maini B.; Mumtaz M.; Conte J.V.; Resar J.R.;
Aharonian V.; Pfeffer T.; Oh J.K.; Huang J.; Popma J.J.
Institution
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Adams) Mount Sinai Health System, NY, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Coselli) Texas Heart Institute, CHI St. Luke's Health, Baylor St. Luke's
Medical Center, Houston, Canada
(Deeb, Chetcuti) University of Michigan Medical Center, Ann Arbor, United
States
(O'Hair) St. Luke's Medical Center/Aurora Health Care, Milwaukee, WI,
United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Hermiller) St. Vincent Medical Center, Indianapolis, IN, United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Zorn, Tadros) University of Kansas Hospital, Kansas City, United States
(Robinson, Petrossian) St. Francis Hospital, Roslyn, NY, United States
(Hughes, Harrison) Duke University Medical Center, Durham, NC, United
States
(Maini, Mumtaz) Pinnacle Health, Coral Springs, FL, United States
(Conte, Resar) Johns Hopkins Hospital, Baltimore, MD, United States
(Aharonian, Pfeffer) Los Angeles Medical Center, Kaiser Permanente, Los
Angeles, CA, United States
(Oh) Mayo Clinic, Rochester, MN, United States
(Huang) Medtronic, Minneapolis, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Abstract
Importance: Transcatheter aortic valve replacement (TAVR) is now a
well-accepted alternative to surgical AVR (SAVR) for patients with
symptomatic aortic stenosis at increased operative risk. There is interest
in whether TAVR would benefit patients at lower risk.
Objective: The Society of Thoracic Surgeons Predicted Risk of Mortality
(STS PROM) has trended downward in US TAVR trials and the STS/American
College of Cardiology Transcatheter Valve Therapy Registry. We
hypothesized that if the Society of Thoracic Surgeons Predicted Risk of
Mortality (STS PROM) alone is sufficient to define decreased risk, the
contribution to survival based on the degree of invasiveness of the TAVR
procedure will decrease, making it more difficult to show improved
survival and benefit over SAVR.
Design, Setting, and Participants: The CoreValve US Pivotal High Risk
Trial was a multicenter, randomized, noninferiority trial. This
retrospective analysis evaluated patients who underwent an attempted
implant and had an STS PROM of 7% or less. The trial was performed at 45
US sites. Patients had severe aortic stenosis and were at increased
surgical risk based on their STS PROM score and other risk factors.
Interventions: Eligible patients were randomly assigned (1:1) to
self-expanding TAVR or to SAVR.
Main Outcomes and Measures: We retrospectively stratified patients by the
overall median STS PROM score (7%) and analyzed clinical outcomes and
quality of life using the Kansas City Cardiomyopathy Questionnaire in
patients with an STS PROM score of 7% or less.
Results: The mean (SD) ages were 81.5 (7.6) years for the TAVR group and
81.2 years (6.6) for the SAVR group. A little more than half were men
(57.9% in the TAVR group and 55.8% in the SAVR group). Of 750 patients who
underwent attempted implantation, 383 (202 TAVR and 181 SAVR) had an STS
PROM of 7% or less (median [interquartile range]: TAVR, 5.3% [4.3%-6.1%];
SAVR, 5.3% [4.1%-5.9%]). Two-year all-cause mortality for TAVR vs SAVR was
15.0% (95% CI, 8.9-10.0) vs 26.3% (95% CI, 19.7-33.0) (log rank P=.01).
The 2-year rate of stroke for TAVR vs SAVR was 11.3% vs 15.1% (log rank
P=.50). Quality of life by the Kansas City Cardiomyopathy Questionnaire
summary score showed significant and equivalent increases in both groups
at 2 years (mean [SD] TAVR, 20.0 [25.0]; SAVR, 18.6 [23.6]; P=.71; both
P<.001 compared with baseline). Medical benefit, defined as alive with a
Kansas City Cardiomyopathy Questionnaire summary score of at least 60 and
a less than 10-point decrease from baseline, was similar between groups at
2 years (TAVR, 51.0%; SAVR, 44.4%; P=.28).
Conclusions and Relevance: Self-expanding TAVR compares favorably with
SAVR in high-risk patients with STS PROM scores traditionally considered
intermediate risk.
Trial Registration: Clinicaltrials.gov Identifier: NCT01240902.