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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.; Daniels C.J.; Aboulhosn
J.A.; Bozkurt B.; Broberg C.S.; Colman J.M.; Crumb S.R.; Dearani J.A.;
Fuller S.; Gurvitz M.; Khairy P.; Landzberg M.J.; Saidi A.; Valente A.M.;
Van Hare G.F.; Asirvatham S.J.; Book W.M.; Gidding S.S.; Kim Y.Y.;
Raghuveer G.; Warnes C.A.; Bartz P.J.; Cohen M.I.; Jacobs M.L.; Latson
L.A.; Mavroudis C.; McElhinney D.B.; Oechslin E.N.; Triedman J.K.;
Al-Khatib S.M.; Ammash N.; Baumgartner H.; Blankenship J.C.; Brindis R.G.;
Campbell R.M.; Curtis L.H.; Fitzgerald K.K.; Fleisher L.A.; Gentile F.;
Hlatky M.A.; January C.T.; Joglar J.A.; Jones T.K.; Kogon B.E.; Kumar G.;
Krieger E.V.; Levine G.N.; Lin C.H.; Mancone M.; Marelli A.; Niwa K.;
Oster M.; Otto C.M.; Page R.L.; Perry J.; Pressler S.J.; Silversides C.K.;
Wijeysundera D.N.; Zaidi A.N.; Zaragoza-Macias E.
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. METHOD(S): 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. RESULT(S): 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.
 CONCLUSION(S): 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. Copyright © 2015
Massachusetts Medical Society.

<2>
Accession Number
604760831
Title
Effects of on-pump and off-pump surgery in the arterial revascularization
trial.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 1059-1065), 2015.
Date of Publication: 01 Sep 2014.
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Nugara F.; Yu L.-M.;
Flather M.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Altman, Yu) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Altman, Yu) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Botnar Research Centre, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Headington, Oxford, United Kingdom
(Lees, Nugara, Flather) Clinical Trials and Evaluation Unit, Royal
Brompton and Harefield NHS Trust, London, United Kingdom
(Lees, Flather) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The Arterial Revascularization Trial (ART) is a randomized
comparison of bilateral internal mammary artery (BIMA) versus single
internal mammary artery (SIMA) grafting in coronary artery bypass graft
(CABG) surgery and is one of the largest randomized trials of surgery ever
conducted. ART is also one of the largest studies of contemporary CABG
with a high proportion of off-pump surgeries (41%). The objective of this
post hoc analysis was to evaluate the surgical process and 1-year outcomes
for surgery performed on-pump compared with off-pump. METHOD(S): ART
randomized 3102 patients with multivessel coronary artery disease (CAD) to
SIMA or BIMA grafts to determine if BIMA grafts have an additional
survival advantage at 10 years. The 1-year interim analysis showed an
overall very low mortality and major morbidity rate irrespective of
whether the procedure was with an SIMA or BIMA. The surgical process and
1-year outcomes were analysed according to whether surgery was performed
on-pump or off-pump. RESULT(S): Baseline variables were not
statistically significantly different between on- and off-pump surgery
within each treatment group after taking account of the effects of
clustering by individual surgeons. At both 30 days and 1 year, there was a
low incidence of death (1.2%, 2.3%), stroke (1.1%, 1.7%), myocardial
infarction (MI) (1.4%, 1.9%), repeat revascularization (0.5%, 1.5%) and
wound reconstruction (1.2%). A similar average number of grafts were
performed with on- and off-pump surgery (median = 3), but the duration of
surgery was 20-30 min and ventilation time ~2 h shorter with off-pump
surgery. Blood loss and platelet transfusions were lower in the off-pump
group, with no difference in the need for balloon pump or renal support.
Sternal wound reconstruction was similar with off-pump surgery in the SIMA
group (0.5 vs 0.6%) and lower with off-pump surgery in the BIMA group (1.4
vs 2.2%). Repeat revascularization was marginally higher in off-pump
patients at 30 days (0.8 vs 0.3%) and at 1 year (1.7 vs 1.3%).
 CONCLUSION(S): The outcomes of contemporary CABG are excellent with
low mortality, stroke, myocardial infarction and need for wound
reconstruction and repeat revascularization whether performed on-pump or
off-pump. CLINICAL TRIAL REGISTRATION: Controlled-trials.com
(ISRCTN46552265). Copyright © The Author 2014. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
602270078
Title
Miniaturized extracorporeal circulation versus off-pump coronary artery
bypass grafting: A meta-analysis of randomized controlled trials.
Source
International Journal of Surgery. 14 (pp 96-104), 2015. Date of
Publication: 01 Feb 2015.
Author
Benedetto U.; Ng C.; Frati G.; Biondi-Zoccai G.; Vitulli P.; Zeinah M.;
Raja S.G.
Institution
(Benedetto, Ng, Raja) Department of Cardiac Surgery, Harefield Hospital,
London, United Kingdom
(Frati, Biondi-Zoccai, Vitulli) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati) Department of AngioCardio Neurology, IRCCS NeuroMed, Pozzilli,
Italy
(Zeinah) Ain Shams University, Cairo, Egypt
Publisher
Elsevier Ltd
Abstract
Background: Controversies exist whether off-pump coronary artery bypass
(OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in
reducing deleterious effects of cardiopulmonary bypass as only a number of
smaller randomized controlled trials (RCT) currently provide a limited
evidence base. The main purpose of conducting the present meta-analysis
was to overcome the expected low power in RCTs in an attempt to establish
whether MECC is comparable to OPCAB. Method(s): A MEDLINE/PubMed
search was conducted to identify eligible RCTs. A pooled summary effect
estimate was calculated by means of Mantel-Haenszel method.
 Result(s): The search yielded 7 RCTs included in this meta-analysis
enrolling 271 patients in the OPCAB group and 279 in the MECC group. The
OPCAB and MECC groups were comparable in terms of incidence of in-hospital
mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P=0.55;
I2=0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P=0.69;
I2=0%), need for renal replacement therapy (RD 0.00; -0.06,
0.06; P=1; I2=0%), postoperative atrial fibrillation (RD -0.03;
-0.17, 0.10; P=0.64; I2=0%), re-exploration for bleeding (RD
-0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%), transfusion rate (RD
-0.01; 95%CI -0.03, 0.02; P=0.65; I2=0%) and the amount of
blood loss (weighted mean difference -25mL; 95%CI -71, 21; P=0.28;
I2=0%). Conclusion(s): Using a meta-analytic approach,
MECC achieves clinical results comparable to OPCAB including postoperative
blood loss and blood transfusion requirement. On the basis of our
findings, MECC should be considered as a valid alternative to OPCAB in
order to reduce surgical morbidity of conventional cardiopulmonary
bypass. Copyright © 2015 Surgical Associates Ltd.

<4>
Accession Number
602248146
Title
Infective endocarditis in patients with an implanted transcatheter aortic
valve: Clinical characteristics and outcome of a new entity.
Source
Journal of Infection. 70 (6) (pp 565-576), 2015. Date of Publication: 01
Jun 2015.
Author
Pericas J.M.; Llopis J.; Cervera C.; Sacanella E.; Falces C.; Andrea R.;
Garcia de la Maria C.; Ninot S.; Almela M.; Pare J.C.; Sabate M.; Moreno
A.; Marco F.; Mestres C.A.; Miro J.M.; Miro J.M; Pericas J.M; Tellez A.;
Castaneda X.; Gatell J.M.; de la Maria C.G.; Armero Y.; Vila J.; Carlos
Pare J.; Azqueta M.; Sitges M.; Vidal B.; Quintana E.; Cartana R.; Pereda
D.; Pomar; Castella M.; Ramirez J.; Ribalta T.; Brunet M.; Soy D.; Fuster
D.; Granados U.
Institution
(Pericas, Cervera, Garcia de la Maria, Moreno, Miro) Infectious Diseases
Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi
i Sunyer, University of Barcelona, Barcelona, Spain
(Llopis) Department of Statistics, Faculty of Biology, University of
Barcelona, Spain
(Sacanella) Internal Medicine Service, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona,
Barcelona, Spain
(Falces, Andrea, Vidal, Pare, Sabate) Cardiology Service, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Ninot, Mestres) Department of Cardiovascular Surgery, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Almela) Microbiology Service, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
(Marco) ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology
Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
(Miro, Pericas, Tellez, Castaneda, Gatell, de la Maria, Armero, Vila,
Carlos Pare, Azqueta, Sitges, Vidal, Quintana, Cartana, Pereda, Pomar,
Castella, Ramirez, Ribalta, Brunet, Soy, Fuster, Granados) Hospital
Clinic-IDIBAPS, University of Barcelona School of Medicine, Barcelona,
Spain
Publisher
W.B. Saunders Ltd
Abstract
Aims: This study reports one case and review the literature on
TAVI-associated endocarditis (TAVIE), to describe its clinical picture and
to perform an analysis on prognostic factors. Methods and Results: A
MEDLINE search from January 2002 to October 2014 revealed 31 cases of
TAVIE, including 1 from our hospital. Median age was 81 years (IQR,
78-85), 53% of patients were males and the median age-adjusted Charlson
score was 7 (IQR, 5-8). Heart failure was recorded in 42%, embolic events
in 19%, and periannular complications in 45%. The most common causative
agent was Enterococcus spp (36%). Ten patients (32%) underwent surgery and
nine patients died (29%). The prognostic factors for 6-month mortality
were heart failure (HR, 9.97 [3.7-24.5]; p=0.001), periannular
complications (HR, 11.82 [3.3-41.3]; p=0.004), and
nonenterococcal/streptococcal etiology (HR, 4.76 [2.1-11.1]; p=0.03). In
patients with heart failure who did not undergo surgery, mortality was 89%
(8 out of 9); in those who did undergo surgery, mortality was 0%
(p<0.001). Conclusion(s): TAVIE is an emerging entity with high
mortality. Patients with heart failure who did not undergo surgery had a
higher probability of dying. Surgical treatment provided better outcomes
even in patients in whom surgery had previously been ruled
out. Copyright © 2015 The British Infection Association.

<5>
Accession Number
601699409
Title
Circulating cardiac biomarkers and postoperative atrial fibrillation in
the OPERA trial.
Source
European Journal of Clinical Investigation. 45 (2) (pp 170-178), 2015.
Date of Publication: 01 Feb 2015.
Author
Masson S.; Wu J.H.Y.; Simon C.; Barlera S.; Marchioli R.; Mariani J.;
Macchia A.; Lombardi F.; Vago T.; Aleksova A.; Dreas L.; Favaloro R.R.;
Hershson A.R.; Puskas J.D.; Dozza L.; Silletta M.G.; Tognoni G.;
Mozaffarian D.; Latini R.
Institution
(Masson, Barlera, Latini) Department of Cardiovascular Research,
IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
(Wu) The George Institute for Global Health, Sydney Medical School, The
University of Sydney, Sydney, NSW, Australia
(Simon) Cardiovascular Department, Cardiac Surgery, Ospedali Riuniti di
Bergamo, Bergamo, Italy
(Marchioli) Hematology-Oncology Therapeutic Delivery Unit, Quintiles,
Milan, Italy
(Mariani, Macchia) GESICA Foundation, Buenos Aires, Argentina
(Lombardi) U.O.C. Malattie Cardiovascolari, Fondazione IRCCS Ospedale
Maggiore Policlinico, Department of Clinical and Community Sciences,
University of Milan, Milan, Italy
(Vago) Laboratory of Endocrinology, Ospedale Luigi Sacco, Milan, Italy
(Aleksova, Dreas) Cardiovascular Department, 'Ospedali Riuniti' and
University of Trieste, Trieste, Italy
(Favaloro, Hershson) AR Fundacion Favaloro, Buenos Aires, Argentina
(Puskas) Emory Health Care, Atlanta, GA, United States
(Dozza) E.S. Research Foundation, GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Italy
(Silletta, Tognoni) Laboratory of Clinical Epidemiology of Cardiovascular
Disease, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
(Mozaffarian) Departments of Epidemiology and Nutrition, Harvard School of
Public Health, Boston, MA, United States
(Mozaffarian) Division of Cardiovascular Medicine and Channing Division of
Network Medicine, Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, MA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery and predicts increased morbidity and
mortality. Identification of patients at high risk of POAF with the help
of circulating biomarkers may enable early preventive treatment but data
are limited, especially in contemporary surgical patients. Method(s):
Plasma concentrations of N-terminal pro-B-type natriuretic peptide
(NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were
measured at enrolment, on the morning of cardiac surgery, at end surgery,
and 2 days postsurgery in 562 patients undergoing cardiac surgery,
randomized to perioperative supplementation with oral fish oil or placebo
in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial
Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting
>= 30 s, centrally adjudicated and confirmed electrocardiographically.
 Result(s): Higher levels of NT-proBNP and hs-cTnT before surgery were
associated with older age, renal or cardiac dysfunction and EuroSCORE.
NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median
[Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L).
Fish oil supplementation did not alter the time course of the cardiac
biomarkers (P > 0.05). Concentrations of NT-proBNP or hs-cTnT, on the
morning of surgery, or changes in their level between morning of surgery
and postsurgery, were not significantly associated with POAF after
adjustment for clinical and surgical characteristics. Conclusion(s):
Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are
related to clinical and surgical characteristics, have different
perioperative time courses but are not independently associated with risk
of POAF. Copyright © 2014 Stichting European Society for Clinical
Investigation Journal Foundation.

<6>
Accession Number
605930417
Title
Prevention of vitamin D deficiency in children following cardiac surgery:
study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 402. Date of
Publication: 09 Sep 2015.
Author
McNally J.D.; O'Hearn K.; Lawson M.L.; Maharajh G.; Geier P.; Weiler H.;
Redpath S.; McIntyre L.; Fergusson D.; Menon K.
Institution
(McNally, Lawson, Geier, Redpath, Menon) Faculty of Medicine, University
of Ottawa, Children's Hospital of Eastern Ontario, Department of
Pediatrics, Ottawa, Canada
(McNally, O'Hearn, Lawson, Geier, Menon) Children's Hospital of Eastern
Ontario, Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
(Maharajh) Division of Cardiovascular Surgery, University of Ottawa,
Ottawa, Canada
(Weiler) School of Dietetics and Human Nutrition, McGill University,
Montreal, QC, Canada
(McIntyre) University of Ottawa, Department of Medicine (Division of
Critical Care), Ottawa Hospital Research Institute (OHRI), Ottawa, ON,
Canada
(Fergusson) Ottawa Hospital Research Institute (OHRI), University of
Ottawa, Department of Epidemiology and Community Medicine, Ottawa, ON,
Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Vitamin D is a pleiotropic hormone important for the recovery
of organ systems after critical illness. Recent observational studies have
suggested that three out of every four children are vitamin D deficient
following cardiac surgery, with inadequate preoperative intake and
surgical losses playing important contributory roles. Observed
associations between postoperative levels, cardiovascular dysfunction and
clinical course suggest that perioperative optimization of vitamin D
status could improve outcome. With this two-arm, parallel, double blind,
randomized controlled trial (RCT), we aim to compare immediate
postoperative vitamin D status in children requiring cardiopulmonary
bypass for congenital heart disease who receive preoperative daily high
dose vitamin D supplementation (high-dose arm) with those who receive
usual intake (low-dose arm). Methods/Design: Eligibility requirements
include age (>36 weeks, <18 years) and a congenital heart defect requiring
cardiopulmonary bypass surgical correction. Enrollment of 62 participants
will take place at a single Canadian tertiary care center over a period of
2 years. Children randomized to the high-dose group will receive age-based
dosing that was informed by the Institute of Medicine (IOM) daily
tolerable upper intake level (<1 year old = 1,600 IU/day, >1 year old =
2,400 IU/day). Children in the low-dose arm will receive usual care based
on IOM recommendations (<1 year old = 400 IU, >1 year old = 600 IU). The
primary outcome measure is immediate postoperative vitamin D status, using
blood 25(OH)D. Discussion(s): Maintaining adequate postoperative
vitamin D levels following surgery could represent an effective therapy to
speed recovery following CHD surgery. The proposed research project will
determine whether preoperative supplementation with a dosing regimen based
on the IOM recommended daily upper tolerable intake will prevent
postoperative vitamin-D deficiency in the majority of children. The
results will then be used to inform the design of a large international
RCT exploring whether preoperative optimization of vitamin D status might
improve short and long-term outcomes in this vulnerable population. Trial
Registration: Clinicaltrials.gov Identifier - NCT01838447Date of
registration: 11 April 2013 Copyright © 2015 McNally et al.

<7>
Accession Number
605795873
Title
Influenza vaccination during the first 6 months after solid organ
transplantation is efficacious and safe.
Source
Clinical Microbiology and Infection. 21 (11) (pp 1040.e11-1040.e18), 2015.
Date of Publication: November 2015.
Author
Perez-Romero P.; Bulnes-Ramos A.; Torre-Cisneros J.; Gavalda J.; Aydillo
T.A.; Moreno A.; Montejo M.; Farinas M.C.; Carratala J.; Munoz P.; Blanes
M.; Fortun J.; Suarez-Benjumea A.; Lopez-Medrano F.; Barranco J.L.; Peghin
M.; Roca C.; Lara R.; Cordero E.; Alamo J.M.; Gasch A.; Gentil-Govantes
M.A.; Molina-Ortega F.J.; Lage E.; Martinez-Atienza J.; Sanchez M.; Rosso
C.; Arizon J.M.; Aguera M.; Cantisan S.; Montero J.L.; Paez A.; Rodriguez
A.; Santos S.; Vidal E.; Berasategui C.; Campins M.; Lopez-Meseguer M.;
Saez B.; Marcos M.A.; Sanclemente G.; Diez N.; Goikoetxea J.; Casafont F.;
Cobo-Belaustegy M.; Duran R.; Fabrega-Garcia E.; Fernandez-Rozas S.;
Gonzalez-Rico C.; Zurbano-Goni F.; Bodro M.; Niubo J.; Oriol S.; Sabe N.;
Anaya F.; Bouza E.; Catalan P.; Diez P.; Eworo A.; Kestler M.; Lopez-Roa
P.; Rincon D.; Rodriguez M.; Salcedo M.; Sousa Y.; Valerio M.;
Morales-Barroso I.; Aguado J.M.; Origuen J.
Institution
(Perez-Romero, Bulnes-Ramos, Aydillo, Roca, Cordero) Instituto de
Biomedicina de Sevilla (IBIS), University Hospital Virgen del
Rocio/CSIC/University of Sevilla, Seville, Spain
(Torre-Cisneros, Barranco, Lara) Reina Sofia University
Hospital-Maimonides Institute for Biomedical Research (IMIBIC), University
of Cordoba (UCO), Cordoba, Spain
(Gavalda, Peghin) Vall d'Hebron University Hospital-VHIR, Barcelona, Spain
(Moreno) University Clinic Hospital, Barcelona, Spain
(Montejo) University Hospital Cruces, Bilbao, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Carratala) University Hospital Belltvitge-IDIBELL, University of
Barcelona, Barcelona, Spain
(Munoz) General University Hospital Gregorio Maranon, Madrid, Spain
(Blanes) University Hospital La Fe, Valencia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Sevilla, Spain
(Lopez-Medrano) University Hospital 12 de Octubre, Madrid, Spain
(Alamo, Gasch, Gentil-Govantes, Molina-Ortega, Lage, Martinez-Atienza,
Sanchez, Rosso) University Hospital Virgen del Rocio-IBIS, Spain
(Arizon, Aguera, Cantisan, Montero, Paez, Rodriguez, Santos, Vidal)
University Hospital Reina Sofia-IMIBIC-UCO, Cordoba, Spain
(Berasategui, Campins, Lopez-Meseguer, Saez) Val d'Hebron Hospital,
Barcelona, Spain
(Marcos, Sanclemente) Clinic Hospital, Barcelona, Spain
(Diez, Goikoetxea) University Hospital Cruces, Bilbao, Spain
(Casafont, Cobo-Belaustegy, Duran, Fabrega-Garcia, Fernandez-Rozas,
Gonzalez-Rico, Zurbano-Goni) University Hospital Marques de Valdecilla,
Santander, Spain
(Bodro, Niubo, Oriol, Sabe) University Hospital Belltvitge-IDIBELL,
University of Barcelona, Barcelona, Spain
(Anaya, Bouza, Catalan, Diez, Eworo, Kestler, Lopez-Roa, Rincon,
Rodriguez, Salcedo, Sousa, Valerio) General University Hospital Gregorio
Maranon, Madrid, Spain
(Morales-Barroso) University Hospital Virgen Macarena, Seville, Spain
(Aguado, Origuen) Universty Hospital 12 de Octubre, Madrid, Spain
Publisher
Elsevier B.V.
Abstract
Preventing influenza infection early after transplantation is essential,
given the disease's high mortality. A multicentre prospective cohort study
in adult solid organ transplant recipients (SOTR) receiving the influenza
vaccine during four consecutive influenza seasons (2009-2013) was
performed to assess the immunogenicity and safety of influenza vaccination
in SOTR before and 6 months after transplantation. A total of 798 SOTR,
130 of them vaccinated within 6 months of transplantation and 668 of them
vaccinated more than 6 months since transplantation. Seroprotection was
similar in both groups: 73.1% vs. 76.5% for A/(H1N1)pdm (p 0.49), 67.5%
vs. 74.1% for A/H3N2 (p 0.17) and 84.2% vs. 85.2% for influenza B (p
0.80), respectively. Geometric mean titres after vaccination did not
differ among groups: 117.32 (95% confidence interval (CI) 81.52, 168.83)
vs. 87.43 (95% CI 72.87, 104.91) for A/(H1N1)pdm, 120.45 (95% CI 82.17,
176.57) vs. 97.86 (95% CI 81.34, 117.44) for A/H3N2 and 143.32 (95% CI
103.46, 198.53) vs. 145.54 (95% CI 122.35, 174.24) for influenza B,
respectively. After adjusting for confounding factors, time since
transplantation was not associated with response to vaccination. No cases
of rejection or severe adverse events were detected in patients vaccinated
within the first 6 months after transplantation. In conclusion, influenza
vaccination within the first 6 months after transplantation is as safe and
immunogenic as vaccination thereafter. Thus, administration of the
influenza vaccine can be recommended as soon as 1 month after
transplantation. Copyright © 2015 European Society of Clinical
Microbiology and Infectious Diseases.

<8>
Accession Number
600454715
Title
Surgical Versus Percutaneous Revascularization in Patients with
Multivessel Coronary Artery Disease.
Source
Current Atherosclerosis Reports. 16 (12) (pp 1-13), 2014. Article Number:
461. Date of Publication: 2014.
Author
Davierwala P.M.; Mohr F.W.
Institution
(Davierwala, Mohr) Department of Cardiac Surgery, Heart Center, University
of Leipzig, Struempellstrase 39, Leipzig 04289, Germany
Publisher
Current Medicine Group LLC 1
Abstract
New-generation stents have been continually developed in order to improve
the safety and efficacy of percutaneous coronary intervention (PCI).
Several randomized clinical trials have been conducted over the last two
decades to compare the outcomes of PCI with coronary artery bypass
grafting (CABG), which has been the time-tested treatment of multivessel
coronary artery disease. The Synergy between PCI with Taxus and Cardiac
Surgery (SYNTAX) trial is one of the most recent and largest randomized
controlled trials comparing PCI using the paclitaxel-eluting
first-generation stent with CABG and was uniquely formulated to represent
"real world" daily practice. The final 5-year main results of this trial
and its various prespecified subgroups have been published in the past
year. These results will form the basis of the new guidelines that will be
published in the near future. This review is a compilation of the results
of the SYNTAX trial and comparisons with other contemporary trials,
meta-analyses, and retrospective studies of large registries and how these
results help cardiac surgeons and cardiologists in judicious
decision-making for their patients with multivessel coronary artery
disease requiring revascularization. Copyright © 2014, Springer
Science+Business Media New York.

<9>
Accession Number
2003781942
Title
Aortic valve myxoma. Systematic review and a new case report.
Source
Cirugia Cardiovascular. 26 (6) (pp 283-288), 2019. Date of Publication:
November - December 2019.
Author
Espinosa-Queb N.N.; Luna-Sanchez J.A.; Revilla-Casaos H.;
Dominguez-Rodriguez J.A.; Lara-Valdes A.J.; Tarelo-Saucedo J.M.
Institution
(Espinosa-Queb, Luna-Sanchez, Revilla-Casaos, Dominguez-Rodriguez,
Lara-Valdes, Tarelo-Saucedo) Servicio de Cirugia Cardio-Toracica, Hospital
regional General Ignacio Zaragoza, ISSSTE, Ciudad de Mexico, Mexico
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: Primary cardiac tumors are very rare
(0.0017-0.23%); myxomas being the most frequent (80%). Its location is
mainly the left atrium and very rarely on the valves (<1%). There are few
cases reported on its aortic valve location, therefore we report a new
case to which a primary resection of aortic valve myxoma, but which
subsequently required valve replacement. The objective of this article is
to perform a systematic review of aortic valve myxoma reported.
 Method(s): The information found in the search engines PubMed and
Google Scholar was collected, using the words: myxoma valve, cardiac
myxoma, heart myxoma, and aortic valve myxoma. Result(s): We found 14
reports of aortic valve myxoma published until August 2019. Therefore, by
adding ours, we analyzed the information of 15 cases in total.
 Conclusion(s): The aortic valve myxoma is very rare, it occurs most
frequently in children under 20 years and over 50 years, the male sex is
the most affected. It is a solitary tumor with a diameter less than 1.5 cm
and early and total resection with preservation of the native valve should
be of choice, however, valvular replacement should be
assessed. Copyright © 2019 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<10>
Accession Number
630017151
Title
High versus low blood pressure targets for cardiac surgery with
cardiopulmonary bypass.
Source
Cochrane Database of Systematic Reviews. 2019 (11) (no pagination), 2019.
Article Number: CD013494. Date of Publication: 29 Nov 2019.
Author
Kotani Y.; Kataoka Y.; Izawa J.; Fujioka S.; Yoshida T.; Kumasawa J.;
Kwong J.S.W.
Institution
(Kotani) Kameda Medical Center, Department of Intensive Care Medicine,
Kamogawa, Japan
(Kataoka) Hyogo Prefectural Amagasaki General Medical Center, Department
of Respiratory Medicine, 2-17-77, Higashi-Naniwa-Cho, Amagasaki, Hyogo
660-8550, Japan
(Izawa, Fujioka, Yoshida) Jikei University School of Medicine, Department
of Anesthesiology, Tokyo, Japan
(Kumasawa) Sakai City Medical Center, Department of Critical Care
Medicine, Department of Clinical Research and Epidemiology, Sakai City,
Japan
(Kwong) National Center for Child Health and Development, Department of
Health Policy, 10-1 Okura 2-chome, Setagaya-ku, Tokyo 157-8535, Japan
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows:. To assess the benefits and harms of a higher versus lower
blood pressure target during cardiac surgery with cardiopulmonary bypass
(CPB). Copyright © 2019 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<11>
Accession Number
2004265284
Title
CV3 MECHANICALLY EXPANDED VERSUS SELF-EXPANDING TRANSCATHETER AORTIC VALVE
REPLACEMENT IN HIGH-RISK PATIENTS WITH AORTIC STENOSIS: A BUDGET IMPACT
ANALYSIS.
Source
Value in Health. Conference: ISPOR Europe 2019. Denmark. 22 (Supplement 3)
(pp S409), 2019. Date of Publication: November 2019.
Author
Neeser K.; Rizik D.G.; Amorosi S.L.; Dlotko E.; Agrawal M.; Rojanasarot
S.; Feng C.; Ihlberg L.; Reardon M.J.
Institution
(Neeser, Dlotko, Agrawal) Certara, Loerrach, BW, Germany
(Rizik) HonorHealth Heart Group, Scottsdale, AZ, United States
(Amorosi, Rojanasarot, Ihlberg) Boston Scientific, Marlborough, MA, United
States
(Feng) Boston Scientific, Maple Grove, MN, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
Publisher
Elsevier Ltd
Abstract
Objectives: Each transcatheter aortic valve replacement (TAVR) technology
is associated with device-specific benefits and risks. This study
evaluated Medicare costs of TAVR with a mechanically expanded valve (MEV)
versus a self-expanding valve (SEV) in high-risk patients with severe
aortic stenosis. Method(s): A 1-year budget impact model was
developed from a Medicare perspective. MEV and SEV clinical event rates
were obtained from the REPRISE III randomized controlled trial at 12
months of follow-up. The model included all relevant procedural
complications, including non-disabling and disabling stroke, repeat TAVR
procedure, pacemaker implant, surgical aortic valve replacement,
hospitalizations for worsening heart failure (HF), major vascular
complications, life-threatening bleeds and acute kidney injury.
Patient-level costs were assessed for the index TAVR admission (days 0-7)
and post-TAVR short- (days 8-30) and long-term (days 31-365)
complications. Acute care costs were obtained from 2019 Medicare MS-DRG
rates. Long-term care costs for disabling stroke and worsening HF were
derived from REPRISE III and published Medicare analyses. One-way
sensitivity analysis (OWSA) was performed. Result(s): At 1 year,
disabling stroke, repeat procedure and HF hospitalization rates were lower
for MEV compared to SEV; pacemaker rates were higher for MEV. Other
complication rates in the model were similar. Total Medicare costs for MEV
were lower than SEV ($45,030 versus $47,006). This difference was
attributable to the lower costs of disabling stroke (-$1,370), repeat
procedure (-$574) and worsening HF (-$314). Pacemaker costs were higher
for MEV ($774) than SEV ($477). OWSA showed TAVR procedure costs and the
occurrence rates of disabling stroke, repeat procedures and
hospitalizations for worsening HF had the greatest influence on model
results. Conclusion(s): MEV is a less costly alternative to SEV at 1
year from a Medicare perspective. Continued technological innovation in
TAVR aimed at reducing complications may result in greater savings for
payers. Copyright © 2019

<12>
Accession Number
630202407
Title
Budesonide for Protein Losing Enteropathy in Patients with Fontan
Circulation: A Systematic Review and Meta-Analysis.
Source
World journal for pediatric & congenital heart surgery. 11 (1) (pp 85-91),
2020. Date of Publication: 01 Jan 2020.
Author
Kewcharoen J.; Mekraksakit P.; Limpruttidham N.; Kanitsoraphan C.;
Charoenpoonsiri N.; Poonsombudlert K.; Pattison R.J.; Rattanawong P.
Institution
(Kewcharoen, Limpruttidham, Kanitsoraphan, Poonsombudlert, Pattison,
Rattanawong) University of Hawaii Internal Medicine Residency Program, HI,
Honolulu, United States
(Mekraksakit) Department of Medicine, Phramongkutklao College of Medicine,
Bangkok, Thailand
(Charoenpoonsiri) Faculty of Medicine, Chulalongkorn University Hospital,
Bangkok, Thailand
(Rattanawong) Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recent studies have shown that oral budesonide can be used to
improve albumin level in patients with protein-losing enteropathy (PLE)
following Fontan procedure. However, there has never been a systematic
review and meta-analysis to confirm this finding. We performed a
systematic review and meta-analysis to explore the therapeutic effect of
budesonide in patients with PLE post-Fontan procedure. METHOD(S): We
searched the databases of MEDLINE and EMBASE from inception to January
2019. Included studies were published studies that evaluate albumin level
before and after budesonide therapy in patients with PLE following Fontan
procedure. Data from each study were combined using the random-effects
model. RESULT(S): Five studies with 36 post-Fontan operation patients
with PLE were included. In random-effects model, there was a statistically
significant difference in albumin level between before and after
budesonide treatment (weighted mean difference = 1.28, 95% confidence
interval: 0.76-1.79). No publication bias was observed on a funnel plot
and Egger test with a P value of .676. CONCLUSION(S): The results of
this systematic review and meta-analysis show that budesonide can be used
to increase albumin level in patients with PLE following Fontan operation.
Further studies may focus on the impact of outcome of budesonide in this
population.

<13>
Accession Number
630188548
Title
Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO
Guideline.
Source
Journal of clinical oncology : official journal of the American Society of
Clinical Oncology. (pp JCO1902748), 2019. Date of Publication: 12 Dec
2019.
Author
Schneider B.J.; Ismaila N.; Aerts J.; Chiles C.; Daly M.E.; Detterbeck
F.C.; Hearn J.W.D.; Katz S.I.; Leighl N.B.; Levy B.; Meyers B.; Murgu S.;
Nekhlyudov L.; Santos E.S.; Singh N.; Tashbar J.; Yankelevitz D.; Altorki
N.
Institution
(Schneider, Hearn) University of Michigan Health System, MI, Ann Arbor,
United States
(Ismaila) American Society of Clinical Oncology, VA, Alexandria, Egypt
(Aerts) Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
(Chiles) Wake Forest Health Science Center, Winston-Salem
(Daly) University of California Davis Comprehensive Cancer Center,
Sacramento, CA
(Detterbeck) Yale University, CT, New Haven, United States
(Katz) University of Pennsylvania Perelman School of Medicine,
Philadelphia, United States
(Leighl) Princess Margaret Cancer Centre, University Health Network,
Toronto, ON, Canada
(Levy) Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial
Hospital, DC, WA
(Meyers) Washington University, St Louis, MO
(Murgu) University of Chicago, Chicago, Mexico
(Nekhlyudov) Brigham and Women's Hospital, MA, Boston
(Santos) Florida Precision Oncology/21st Century Oncology, FL, Aventura,
United States
(Singh) Postgraduate Institute of Medical Education and Research,
Chandigarh, India
(Tashbar) FL, Circle of Hope for Cancer Research, Orlando, United States
(Yankelevitz) Mount Sinai Hospital, NY, NY
(Altorki) Weill Cornell Medicine/Cornell University, NY, NY
Publisher
NLM (Medline)
Abstract
PURPOSE: To provide evidence-based recommendations to practicing
clinicians on radiographic imaging and biomarker surveillance strategies
after definitive curative-intent therapy in patients with stage I-III
non-small-cell lung cancer (NSCLC) and SCLC. METHOD(S): ASCO convened
an Expert Panel of medical oncology, thoracic surgery, radiation oncology,
pulmonary, radiology, primary care, and advocacy experts to conduct a
literature search, which included systematic reviews, meta-analyses,
randomized controlled trials, and prospective and retrospective
comparative observational studies published from 2000 through 2019.
Outcomes of interest included survival, disease-free or recurrence-free
survival, and quality of life. Expert Panel members used available
evidence and informal consensus to develop evidence-based guideline
recommendations. RESULT(S): The literature search identified 14
relevant studies to inform the evidence base for this guideline.
RECOMMENDATIONS: Patients should undergo surveillance imaging for
recurrence every 6 months for 2 years and then annually for detection of
new primary lung cancers. Chest computed tomography imaging is the optimal
imaging modality for surveillance. Fluorodeoxyglucose positron emission
tomography/computed tomography imaging should not be used as a
surveillance tool. Surveillance imaging may not be offered to patients who
are clinically unsuitable for or unwilling to accept further treatment.
Age should not preclude surveillance imaging. Circulating biomarkers
should not be used as a surveillance strategy for detection of recurrence.
Brain magnetic resonance imaging should not be used for routine
surveillance in stage I-III NSCLC but may be used every 3 months for the
first year and every 6 months for the second year in patients with stage
I-III small-cell lung cancer who have undergone curative-intent treatment.

<14>
Accession Number
2004284068
Title
Intensive LDL cholesterol-lowering treatment beyond current
recommendations for the prevention of major vascular events: a systematic
review and meta-analysis of randomised trials including 327 037
participants.
Source
The Lancet Diabetes and Endocrinology. 8 (1) (pp 36-49), 2020. Date of
Publication: January 2020.
Author
Wang N.; Fulcher J.; Abeysuriya N.; Park L.; Kumar S.; Di Tanna G.L.;
Wilcox I.; Keech A.; Rodgers A.; Lal S.
Institution
(Fulcher, Keech) NHMRC Clinical Trials Centre, University of Sydney,
Sydney, NSW, Australia
(Wang, Park, Wilcox, Keech, Lal) University of Sydney, Sydney, NSW,
Australia
(Wang, Fulcher, Wilcox, Keech, Lal) Department of Cardiology, Royal Prince
Alfred Hospital, Sydney, NSW, Australia
(Abeysuriya) Princess Alexandra Hospital, Brisbane, QLD, Australia
(Wang, Di Tanna, Rodgers) The George Institute, Sydney, NSW, Australia
(Kumar) Royal North Shore Hospital, Sydney, NSW, Australia
(Fulcher, Wilcox, Lal) Central Sydney Cardiology, Sydney, NSW, Australia
(Wang, Rodgers) University of New South Wales, Sydney, NSW, Australia
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The benefits of LDL cholesterol-lowering treatment for the
prevention of atherosclerotic cardiovascular disease are well established.
However, the extent to which these effects differ by baseline LDL
cholesterol, atherosclerotic cardiovascular disease risk, and the presence
of comorbidities remains uncertain. Method(s): We did a systematic
literature search (MEDLINE, Embase, and the Cochrane Central Register of
Controlled Trials, from inception up to June 15, 2019) for randomised
controlled trials of statins, ezetimibe, and proprotein convertase
subtilisin/kexin type 9 inhibitors with at least 1000 patient-years of
follow-up. Random-effects meta-analysis and meta-regressions were done to
assess for risk of major vascular events (a composite of cardiovascular
mortality, non-fatal myocardial infarction, non-fatal ischaemic stroke, or
coronary revascularisation) per 1 mmol/L (38.7 mg/dL) reduction in LDL
cholesterol concentrations. Finding(s): 327 037 patients from 52
studies were included in the meta-analysis. Each 1 mmol/L reduction in LDL
cholesterol was associated with a 19% relative risk (RR) reduction for
major vascular events (RR 0.81 [95% CI 0.78-0.84]; p<0.0001). Similar
reductions (per 1 mmol/L reduction in LDL cholesterol) were found in
trials with participants with LDL cholesterol 2.60 mmol/L or lower,
2.61-3.40 mmol/L, 3.41-4.10 mmol/L, and more than 4.1 mmol/L (p=0.232 for
interaction); and in a subgroup of patients who all had a baseline LDL
cholesterol less than 2.07 mmol/L (80 mg/dL; RR 0.83 [95% CI 0.75-0.92];
p=0.001). We found greater RR reductions in patients at lower 10-year
atherosclerotic cardiovascular disease risk (change in RR per 10% lower
10-year atherosclerotic cardiovascular disease 0.97 [95% CI 0.95-0.98];
p<0.0001) and in patients at younger age across a mean age of 50-75 years
(change in RR per 10 years younger age 0.92 [0.83-0.97]; p=0.015). We
found no difference in RR reduction for participants with or without
diabetes (p=0.878 for interaction) and chronic kidney disease (p=0.934 for
interaction). Interpretation(s): For each 1 mmol/L LDL cholesterol
lowering, the risk reduction of major vascular events is independent of
the starting LDL cholesterol or the presence of diabetes or chronic kidney
disease. Patients at lower cardiovascular risk and younger age might have
a similar relative reduction in risk with LDL-cholesterol lowering
therapies and future studies should investigate the potential benefits of
earlier intervention. Funding(s): None. Copyright © 2020
Elsevier Ltd

<15>
Accession Number
2004229078
Title
Comparing the efficacy of nidepine and cardepine in lowering blood
pressure after cardio-aortic surgery: A randomized, double-blinded
controlled trial.
Source
Journal of the Medical Association of Thailand. 102 (12) (pp 1289-1295),
2019. Date of Publication: 2019.
Author
Ekkarat P.; Sangkhathat S.; Namchaisiri J.
Institution
(Ekkarat) Department of Surgery, Nakhon Pathom Hospital, Nakhon Pathom,
Thailand
(Sangkhathat) Department of Surgery, Faculty of Medicine, Prince of
Songkla University, Hat Yai, Songkhla, Thailand
(Namchaisiri) Department of Surgery, Faculty of Medicine, Chulalongkorn
University, Bangkok 10330, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Parenteral nicardipine is an effective calcium channel blocker
for blood pressure control during the post-cardioaortic surgical period.
 Objective(s): To compare two preparations of nicardipine
hydrochloride, Nidepine, and Cardepine, as a single treatment for acute
hypertension after cardioaortic surgery in adult patients.
 Material(s) and Method(s): The study was a prospective randomized
double-blinded controlled trial of 50 post-cardioaortic surgery patients
with a systolic pressure greater than 140 mmHg that were divided into two
groups. The first group received Nidepine at the initial dose of 1 mg per
hour and titrated every 15 minutes until reaching the target blood
pressure, while the other group received Cardepine at the same dose. The
primary outcome was blood pressure reduction at 15 and 30 minutes of
treatment. Result(s): The blood pressures in both groups were
significantly reduced within 15 minutes with 40% of the cases reaching the
target of systolic pressure lower than 140 mmHg at 30 minutes. Systolic
pressure reduction at 15 minutes in the Nidepine group (7.45% of baseline)
was not significantly different from that of the Cardepine (5.04% of
baseline) group. The mean arterial pressure reductions in both groups
(6.42% and 6.99% of baseline in the Nidepine group and Cardepine groups,
respectively) were comparable. There were no significant differences in
total drug use in 24 hours (16.3 and 23.8 mg, respectively). The average
duration of therapy was 22.8 hours in the Nidepine group, and 25.3 hours
in the Cardepine group. Resumption of medication after cessation of
treatment was required in two cases (8%) in the Nidepine group and three
cases (12%) in the Cardepine group. There were no statistically
significant differences between the groups in overall complication rates.
 Conclusion(s): Nidepine is therapeutically equivalent to Cardepine in
lowering blood pressure in acute hypertension following cardioaortic
surgery. Copyright © JOURNAL OF THE MEDICAL ASSOCIATION OF
THAILAND 2019.

<16>
Accession Number
630200329
Title
Evaluating the quality of evidence for diagnosing ischemic heart disease
from verbal autopsy in Indonesia.
Source
World Journal of Cardiology. 11 (10) (pp 244-255), 2019. Date of
Publication: 2019.
Author
Zhang W.; Usman Y.; Iriawan R.W.; Lusiana M.; Sha S.; Kelly M.; Rao C.
Institution
(Zhang, Sha, Kelly, Rao) Department of Global Heath, Research School of
Population Health, Australian National University, 62 Mills Road,
Canberra, ACT 2602, Australia
(Usman, Iriawan, Lusiana) National Agency for Health Research and
Development, Ministry of Health, Jakarta 10110, Indonesia
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
BACKGROUND Mortality and cause of death data are fundamental to health
policy development. Civil Registration and Vital Statistics systems are
the ideal data source, but the system is still under development in
Indonesia. A national Sample Registration System (SRS) has provided
nationally representative mortality data from 128 subdistricts since 2014.
Verbal autopsy (VA) is used in the SRS to obtain causes of death. The
quality of VA data must be evaluated as part of the SRS data quality
assessment. AIM To assess the strength of evidence used in the assignment
of Ischaemic Heart Disease (IHD) as causes of death from VA. METHODS The
sample frame for this study is the 4,070 deaths that had IHD assigned as
the underlying cause in the SRS 2016 database. From these, 400 cases were
randomly selected. A data extraction form and data entry template were
designed to collect relevant data about IHD from VA questionnaires. A
standardised categorisation was designed to assess the strength of
evidence used to infer IHD as a cause of death. A pilot test of 50 cases
was carried out. IBM SPSS software was used in this study. RESULTS Strong
evidence of IHD as a cause of death was assigned based on surgery for
coronary heart disease, chest pain and two out of: sudden death, history
of heart disease, medical diagnosis of heart disease, or terminal
shortness of breath. More than half (53%) of the questionnaires contained
strong evidence. For deaths outside health facilities, VA questionnaires
for male deaths contained acceptable evidence in significantly higher
proportions as compared to those for female deaths. (P < 0.001). Nearly
half of all IHD deaths were concentrated in the 50-69 year age group
(48.40%), and a further 36.10% were aged 70 years or more. Nearly
two-thirds of the deceased were male (58.40%). Smoking behaviour was found
in 44.11% of IHD deaths, but this figure was 73.82% among males.
CONCLUSION More than half of the VA questionnaires from the study sample
were found to contain strong evidence to infer IHD as the cause of death.
Results from medical records such as electrocardiograms, coronary
angiographies, and load tests could have improved the strength of evidence
and contributed to IHD cause of death diagnosis. Copyright © The
Author(s) 2019

<17>
Accession Number
2004207266
Title
Honorary authorship in cardiothoracic surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Noruzi A.; Takkenberg J.J.M.; Kayapa B.; Verhemel A.; Gadjradj P.S.
Institution
(Noruzi, Takkenberg) Department of Cardiothoracic Surgery, Erasmus Medical
Centre, Rotterdam, Netherlands
(Kayapa, Verhemel, Gadjradj) Department of Neurosurgery, Leiden University
Medical Centre, Leiden, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Honorary authorship (HA) refers to enlisted authors who did
not make sufficient contributions to a paper according to the guidelines,
as defined by the International Committee of Medical Journal Editors
(ICMJE). This study assessed the proportion of, and factors associated
with, HA in cardiothoracic surgical literature in 2017. Method(s):
Five cardiothoracic surgery journals were selected based on their impact
factors in 2017 for evaluation of HA. Articles were included in the
analysis if there was more than 1 listed author and if there was an
available E-mail address of the corresponding author. All corresponding
authors received an invitation to fill out our survey regarding their
paper in 2017. Result(s): In total, 1511 authors opened the
invitation, resulting in a total of 590 respondents (28.9%); 77.1% of all
authors were aware of the ICMJE guidelines and 47.0% were aware of the
general issue of HA. A total of 367 (62.7%) authors stated that at least
one of the coauthors had performed solely nonauthorship tasks, whereas 148
(25.3%) authors stated that they believed that their article contained at
least one honorary author. Having a senior member who was automatically
included on all submitted manuscripts and not being aware of the general
issue of HA were associated with significantly greater odds of having HA.
 Conclusion(s): Our results show that, despite the high awareness of
the ICMJE guidelines, there is a large discrepancy in perceived HA and
guideline-based HA. The authors plead for a better understanding and
implementation of the guidelines in a more transparent authorship
system. Copyright © 2019 The American Association for Thoracic
Surgery

<18>
Accession Number
2004192412
Title
Effect of atrial pacing on post-operative atrial fibrillation following
coronary artery bypass grafting: Pairwise and network meta-analyses.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ruan Y.; Robinson N.B.; Naik A.; Silva M.; Hameed I.; Rahouma M.; Oakley
C.; Di Franco A.; Zamvar V.; Girardi L.N.; Gaudino M.
Institution
(Ruan, Robinson, Naik, Silva, Hameed, Rahouma, Oakley, Di Franco, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
(Zamvar) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Ruan) Department of Cardiovascular Surgery, Renmin Hospital of Wuhan
University, Wuhan, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: To determine the effect of atrial pacing on the rate of
post-operative atrial fibrillation (POAF) following coronary artery bypass
grafting. Method(s): After a systematic literature search, randomized
clinical trials (RCTs) comparing any combination of no pacing (NP),
bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA)
pacing were included. Pairwise and network meta-analyses were performed
using the generic inverse variance method. The primary outcome was POAF
incidence. Secondary outcomes were postoperative bleeding, infection, and
operative mortality. Leave-one-out and meta-regression were done.
 Result(s): Fourteen RCTs were included with a total of 1727 patients.
Compared with NP, any form of atrial pacing was significantly associated
with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence
interval [CI]: 0.35-0.69). BiA pacing was associated with the larger risk
reduction (OR: 0.36; 95% CI: 0.20-0.64 vs. 0.59; 95% CI: 0.34-1.02 for LA
and 0.64; 95% CI: 0.38-1.07 for RA). Secondary outcomes were similar
between the no pacing and pacing groups. On meta-regression, age and the
use of continuous monitoring were associated with lower reduction of the
incidence of POAF. In the network meta-analysis, BiA pacing ranked the
best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21-0.55).
 Conclusion(s): Compared to other pacing modalities, BiA pacing is
associated with lower rates of POAF following CABG. Copyright ©
2019 Elsevier B.V.

<19>
Accession Number
600319977
Title
Comparison of sirolimus- and paclitaxel-eluting stents in patients with
moderate renal insufficiency: Results from the J-DESsERT trial.
Source
Cardiovascular Revascularization Medicine. 15 (6-7) (pp 323-328), 2014.
Date of Publication: 01 Sep 2014.
Author
Otsuka M.; Yokoi H.; Matsuyama Y.; Hayashi Y.; Shiode N.; Masaoka Y.;
Okimoto T.; Tamekiyo H.; Kawase T.; Yamane K.; Kagawa Y.; Nakamura M.;
Muramatsu T.; Nanto S.
Institution
(Otsuka, Hayashi, Shiode, Masaoka, Okimoto, Tamekiyo, Kawase, Yamane,
Kagawa) Division of Cardiology, Cardiovascular Center, Akane Foundation
Tsuchiya General Hospital, Hiroshima, Japan
(Yokoi) Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka,
Japan
(Matsuyama) Department of Biostatistics, School of Public Health, The
University of Tokyo, Tokyo, Japan
(Nakamura) Department of Cardiovascular Medicine, Toho University School
of Medicine, Ohashi Medical Center, Tokyo, Japan
(Muramatsu) Division of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Nanto) Nishinomiya Hospital Affairs, Nishinomiya Municipal Central
Hospital, Nishinomiya, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: It is unclear whether there are differences in clinical
outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting
stents (PES) in patients with moderate renal insufficiency (RI).
 Method(s): The Japan-Drug Eluting Stents Evaluation; a Randomized
Trial (J-DESsERT) was a prospective, randomized multicenter trial which
compared 1:1 coronary stenting between SES and PES patients. Patient with
serious RI (serum creatinine value 2mg/dL or higher) were excluded.
Patients were classified into 2 arms according to renal function: a non-RI
arm of 2220 patients (SES 1094 and PES 1126 patients with estimated
glomerular filtration rate (eGFR) >=60mLmin-1
1.73m-2) and an RI arm of 1206 patients (SES 613, PES 593 with
30<=eGFR <60mLmin-1 1.73m-2). Result(s): At 12.
months, the primary endpoint of target vessel failure in the non-RI arm
occurred in 6.0% in the SES group and 8.7% in the PES group (p. =. 0.02).
In the RI arm, this occurred in 5.7% and 8.1% (p. =. 0.10). Mortality
rates were 0.8% vs 0.7% (p. =. 0.78) in the non-RI arm, and 2.2% vs 2.1%
(p. =. 0.90) in the RI arm. Cardiac death was 0.4% vs 0.1% (p. =. 0.17) in
the non-RI arm, and 1.0% vs 1.0% (p. =. 0.96) in the RI arm. Mortality was
higher in patients with RI than those without RI (2.1% vs 0.8%; p. <.
0.01). Cardiac death rates increased in the RI arm compared with those in
the non-RI arm (1.0% vs 0.2%; p. <. 0.01). Conclusion(s): Regardless
of the presence or absence of moderate RI, differences in outcomes between
SES and PES change little except mortality and cardiac
death. Copyright © 2014 Elsevier Inc.

<20>
Accession Number
600192536
Title
Efficacy and safety of a booster dose of influenza vaccination in solid
organ transplant recipients, TRANSGRIPE 1-2: Study protocol for a
multicenter, randomized, controlled clinical trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 338. Date of
Publication: August 28, 2014.
Author
Martinez-Atienza J.; Rosso-Fernandez C.; Roca C.; Aydillo T.A.; Gavalda
J.; Moreno A.; Montejo J.M.; Torre-Cisneros J.; Farinas M.C.; Fortun J.;
Sabe N.; Munoz P.; Blanes-Julia M.; Suarez-Benjumea A.; Lopez-Medrano F.;
Perez-Romero P.; Cordero E.; Pilar P.R.; Cristina R.O.; Teresa A.A.; angel
B.R.; Juliana M.A.; Clara R.F.; Ortega F.J.M.; Miguel A.G.; Jose M.A.;
Jose M.S.; Ernesto L.C.; Antonia G.I.; Magdalena S.A.; Hernandez M.J.R.;
Bravo M.A.G.; Gabriel B.B.; Laureano G.C.; Rosario L.C.; Barranco J.L.;
Vega A.P.; Morales J.M.; Delgado J.F.; Minero M.V.; Martinez I.C.;
Magdalena S.; Casasnovas Y.S.; Rodriguez Ferrero M.L.; Roa P.L.; Catalan
P.; Cruz C.P.; Davila P.M.; Jimenez M.A.; Marugan R.B.; Letosa R.M.; Elena
N.M.; Revilla A.; Abad O.L.; Peguin M.; Berga A.P.; Lidia G.; Broto A.R.;
Nuria S.; Marimont B.; Bosch J.N.; Navarro A.F.; Garriga L.L.; Comellas
C.B.; Costello J.G.; Sorroche B.B.; Ferrer A.; Gonzalez E.; Fornieles
L.M.; Gil R.F.; Elias J.R.; Margalef M.N.; Bayas J.M.; alvarez C.C.; Villa
F.P.; Ulloa I.H.; Arroyo J.C.; Frederic C.; Marcos M.A.; Juarros.G.S.;
Hernandez J.M.; Urcelay Lopez M.I.; Herran N.D.; Rienda M.I.M.; Rodriguez
J.C.; Guerrero R.C.; Busselo M.S.; Txertudi A.B.; Tovar S.C.; Aldeguer
J.L.; Lleti M.S.; Zazo N.B.; Maria.T. Torder; Raquel P; Belen G.; Acebal
J.G.; Ruiz A.L.; Castilla C.G.; Barroso I.M.; Santander M.; Duran Calvo
M.R.; Goni F.Z.; Belaustegui M.C.; Morencos F.C.; Garcia E.F.; Castillo
C.A.; Luis M.; Rico C.G.; Rozas S.F.
Institution
(Martinez-Atienza, Roca, Aydillo, Perez-Romero, Cordero) Hospital
Universitario Virgen del Rocio and Biomedicine Research Institute (IBIS),
Infectious Diseases Research Group, Avda. Manuel Siurot, s/n, Seville
41013, Spain
(Martinez-Atienza, Rosso-Fernandez) Hospital Universitario Virgen del
Rocio, Clinical Trial Unit, Avda. Manuel Siurot s/n, Seville 41013, Spain
(Gavalda) Hospital Vall d'Hebron, Infectious Diseases Research Group,
Passeig de la Vall d'Hebron, 119-129, Barcelona 08035, Spain
(Moreno) Hospital Clinic, Infectious Diseases Research Group, Carrer
Villarroel,170, Barcelona 08036, Spain
(Montejo) Hospital Universitario de Cruces, Infectious Diseases Research
Group, Plaza de Cruces, 12, San Vicente de Barakaldo, Vizcaya 48903, Spain
(Torre-Cisneros) Hospital Universitario Reina Sofia, Infectious Diseases
Research Group, Avda. Menendez Pidal, s/n, Cordoba 14004, Spain
(Farinas) Hospital Universitario Marques de Valdecilla, Infectious
Diseases Research Group, Av Valdecilla, s/n, Santander, Cantabria 39008,
Spain
(Fortun) Hospital Universitario Ramon y Cajal, Ctra. de Colmenar Viejo,
km. 9, 100, Madrid 28034, Spain
(Sabe) Hospital Universitario de Bellvitge, Infectious Diseases Research
Group, Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona,
Spain
(Munoz) Hospital General Universitario Gregorio Maranon, Infectious
Diseases Research Group, Calle Doctor Esquerdo, 46, Madrid 28007, Spain
(Blanes-Julia) Hospital Universitario La Fe, Infectious Diseases Research
Group, Avenida Campanar, 21, Valencia 46026, Spain
(Suarez-Benjumea) Hospital Universitario Virgen Macarena, Infectious
Diseases Research Group, Avd. Dr. Fedriani, Sevilla 341007, Spain
(Lopez-Medrano) Hospital Universitario 12 de Octubre, Infectious Diseases
Research Group, Avda de Cordoba, s/n, Madrid 28041, Spain
(Pilar, Cristina, Teresa, angel, Juliana, Clara, Ortega, Miguel, Jose,
Jose, Ernesto, Antonia, Magdalena, Hernandez, Bravo, Gabriel, Laureano)
Virgen del Rocio University Hospital, Elisa Cordero Matia PI Seville,
Spain
(Rosario, Barranco, Vega) Reina Sofia University Hospital-IMIBIC-UCO
Cordoba, Julian de la Torre Cisneros PI, Spain
(Morales, Delgado) 12 de Octubre University Hospital, Francisco
Lopez-Medrano PI, Madrid, Spain
(Morales, Delgado) Gregorio Maranon General University Hospital, Patricia
Munoz Garcia (PI), Madrid, Spain
(Minero, Martinez, Magdalena, Casasnovas, Rodriguez Ferrero, Roa, Catalan,
Cruz) Ramon y Cajal University Hospital, Jesus Fortun Abete (PI), Madrid,
Spain
(Davila, Jimenez, Marugan, Letosa, Elena, Revilla) Vall d'Hebron Hospital,
Joan Gavalda Sant Pau PI, Barcelona, Spain
(Abad, Peguin, Berga, Lidia, Broto) Bellvitge University Hospital, Jordi
Carratala (PI), Barcelona, Spain
(Nuria, Marimont, Bosch, Navarro, Garriga, Comellas, Costello, Sorroche,
Ferrer, Gonzalez, Fornieles, Gil, Elias, Margalef) Barcelona Clinic
Hospital, Asuncion Moreno Camacho PI, Barcelona, Spain
(Bayas, alvarez, Villa, Ulloa, Arroyo, Frederic, Marcos, Juarros.G.S.)
Cruces University Hospital, San Vicente de Barakaldo, Jose Miguel Montejo
PI, Spain
(Hernandez, Urcelay Lopez, Herran, Rienda, Rodriguez, Guerrero, Busselo,
Txertudi) La Fe University Hospital, Marino Blanes Julia PI, Valencia,
Spain
(Tovar, Aldeguer, Lleti, Zazo, Maria.T., Raquel) Virgen Macarena
University Hospital, Alejandro Suarez Benjumea PI, Seville, Spain
(Belen, Acebal, Ruiz, Castilla, Barroso) Marques de Valdecilla University
Hospital, Carmen Farinas PI, Spain
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite administration of annual influenza vaccination,
influenza-associated complications in transplant recipients continue to be
an important cause of hospitalization and death. Although influenza
vaccination has been proven to be the most effective measure to reduce
influenza infection after transplantation, transplant recipients are still
vulnerable to influenza infections, with lower serological responses to
vaccination compared to the general population. In order to assess the
efficacy and safety of an alternative immunization scheme for solid organ
transplant recipients, the TRANSGRIPE1-2 Study Group aimed to test a
booster dose administration 5 weeks after the standard vaccination. The
primary objective of this trial was to compare short-term and long-term
neutralizing antibody immunogenicity of a booster dose of influenza
vaccination to the standard single-dose immunization scheme. Secondary
objectives included the evaluation of the efficacy and/or safety, cellular
immune response, incidence of influenza infection, graft rejection,
retransplant and mortality rates.Methods/Design: This phase III,
randomized, controlled, open-label clinical trial was conducted between
October 2012 and December 2013 in 12 Spanish public referral hospitals.
Solid organ transplant recipients (liver, kidney, heart or lung), older
than 16 years of age more than 30 days after transplantation were eligible
to participate. Patients (N = 514) were stratified 1:1 by center, type of
organ and time after transplantation and who either received the standard
single dose (n = 257) or were treated according to a novel influenza
vaccination schedule comprising the administration of a booster dose 5
weeks after standard vaccination (n = 254). Seroconversion rates were
measured as a determinant of protection against influenza (main outcome).
Efficacy and safety outcomes were followed until 1 year after influenza
vaccination with assessment of short-term (0, 5, 10 and 15 weeks) and
long-term (12 months) results. Intention-to-treat, per-protocol and safety
analyses will be performed. Discussion(s): This trial will increase
knowledge about the safety and efficacy of a booster dose of influenza
vaccine in solid organ transplant recipients. At the time the manuscript
was submitted for publication, trial recruitment was closed with a total
of 499 participants included during a 2-month period (within the seasonal
influenza vaccination campaign).Trial registration: ClinicalTrials.gov
Identifier: NCT01761435 (registered 13 December 2012).EudraCT Identifier:
2011-003243-21 (registered 4 July 2011). Copyright © 2014
Martinez-Atienza et al.; licensee BioMed Central Ltd.

<21>
Accession Number
601067629
Title
Appropriate Revascularization in Stable Angina: Lessons From the BARI 2D
Trial.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1595-1601), 2014. Date of
Publication: 01 Dec 2014.
Author
Krone R.J.; Althouse A.D.; Tamis-Holland J.; Venkitachalam L.; Campos A.;
Forker A.; Jacobs A.K.; Ocampo S.; Steiner G.; Fuentes F.; Pena Sing I.R.;
Brooks M.M.
Institution
(Krone) Division of Cardiology, Washington University, St. Louis, MO,
United States
(Althouse, Brooks) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Tamis-Holland) Mount Sinai Saint Luke's Hospital, New York, NA, United
States
(Venkitachalam) Department of Biomedical and Health Informatics,
University of Missouri-Kansas City, Kansas City, MO, United States
(Campos, Ocampo) Department of Cardiology, Hospital de Especialidades,
Centro Medico La Raza, IMSS, MEX City, Mexico
(Forker) Mid America Heart Institute, University of Missouri-Kansas City,
Kansas City, MO, United States
(Jacobs) Boston University and Boston Medical Center, Boston, MA, United
States
(Steiner) The University of Toronto, Toronto, ON, Canada
(Fuentes) Division of Cardiology, The University of Texas Health Science
Center at Houston, Houston, TX, United States
(Pena Sing) Heart and Vascular Catheterization Laboratories, Nanticoke
Memorial Hospital, Seaford, DE, United States
(Pena Sing) New York University, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The 2012 Guidelines for Diagnosis and Management of Patients
with Stable Ischemic Heart Disease recommend intensive antianginal and
risk factor treatment (optimal medical management [OMT]) before
considering revascularization to relieve symptoms. The Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized
patients with ischemic heart disease and anatomy suitable to
revascularization to (1) initial OMT with revascularization if needed or
(2) initial revascularization plus OMT and found no difference in major
cardiovascular events. Ultimately, however, 37.9% of the OMT group was
revascularized during the 5-year follow-up period. Method(s): Data
from the 1192 patients randomized to OMT were analyzed to identify
subgroups in which the incidence of revascularization was so high that
direct revascularization without a trial period could be justified.
Multivariate logistic analysis, Cox regression models of baseline data,
and a landmark analysis of participants who did not undergo
revascularization at 6 months were constructed. Result(s): The models
that used only data available at the time of study entry had limited
predictive value for revascularization by 6 months or by 5 years; however,
the model incorporating severity of angina during the first 6 months could
better predict revascularization (C statistic= 0.789). Conclusion(s):
With the possible exception of patients with severe angina and proximal
left anterior descending artery disease, this analysis supports the
recommendation of the 2012 guidelines for a trial of OMT before
revascularization. Patients could not be identified at the time of
catheterization, but a short period of close follow-up during OMT
identified the nearly 40% of patients who underwent
revascularization. Copyright © 2014 Canadian Cardiovascular
Society.

<22>
Accession Number
628718331
Title
Deferral Versus Performance of Revascularization for Coronary Stenosis
With Grey Zone Fractional Flow Reserve Values: A Systematic Review and
Meta-Analysis.
Source
Angiology. 71 (1) (pp 48-55), 2020. Date of Publication: 01 Jan 2020.
Author
Du Y.; Liu Y.; Cai G.; Yang B.; Cheng Y.; Liu J.; Liu W.; Liu X.; Zhou Z.;
Zhao Y.; Zhou Y.
Institution
(Du, Liu, Cai, Cheng, Liu, Liu, Liu, Zhou, Zhao, Zhou) Department of
Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Disease, Beijing, China
(Cai) Department of Cardiology, Wujin Hospital affiliated with Jiangsu
University, Changzhou, Jiangsu, China
(Yang) Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital,
Yunnan, Kunming, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We searched PubMed, EMBASE, Cochrane Library, and Web of Science for
studies using fractional flow reserve (FFR) to determine whether
revascularization should be performed or deferred for patients with
coronary stenosis and grey zone FFR. Meta-analysis was performed using the
generic inverse variance method, and hazard ratios (HR) were synthesized
with a random-effects model. Of 2766 records, 7 nonrandomized studies
including 2683 patients were selected. The pooled results demonstrated,
during a median follow-up of 32 months, that revascularization
significantly reduced the risk of major adverse cardiac events (MACE; 7
studies: HR [95% confidence interval, CI]: 0.65 [0.45-0.93], P =.02) and
target vessel revascularization (TVR; 4 studies: HR [95% CI]: 0.52
[0.36-0.76], P <.01). Whereas revascularization was not significantly
superior in terms of all-cause death (3 studies: HR [95% CI]: 0.56
[0.26-1.22], P =.14), cardiac death (2 studies: HR [95% CI]: 0.57
[0.16-2.01], P =.38), myocardial infarction (MI; 4 studies: HR [95% CI]:
1.03 [0.26-4.03]), and all-cause death or MI (3 studies: HR [95% CI]: 0.66
[0.20-2.19], P =.50). Therefore, revascularization appeared to be superior
to deferral for patients with grey zone FFR in MACE and TVR, while hard
end points did not show such significance. This work was registered in
PROSPERO (CRD42019118432). Copyright © The Author(s) 2019.

<23>
Accession Number
626398779
Title
De-escalation versus standard dual antiplatelet therapy in patients
undergoing percutaneous coronary intervention: a systematic review and
meta-analysis.
Source
Platelets. 31 (1) (pp 15-25), 2020. Date of Publication: 02 Jan 2020.
Author
Guo C.; Li M.; Lv Y.-H.; Zhang M.-B.; Wang Z.-L.
Institution
(Guo, Li, Lv, Zhang) The First Clinical Medical College of Lanzhou
University, Lanzhou, China
(Wang) Department of Cardiology, The First Hospital of Lanzhou University,
Lanzhou, Gansu, China
Publisher
Taylor and Francis Ltd
Abstract
Switching from a potent P2Y<inf>12</inf> blocker to clopidogrel is not
uncommon for antiplatelet therapy in patients undergoing percutaneous
coronary intervention. This meta-analysis aimed to investigate the
efficacy and safety of this de-escalation strategy. Medical literature
databases were searched for analysis comparing continued potent
antiplatelet therapy and switching to clopidogrel with no language
restrictions from inception to 07/May/2018. The primary endpoints of major
adverse cardiovascular events (MACE) and major bleeding together with
additional efficacy outcomes were assessed by random-effects and
fixed-effects meta-analysis. A total of 17 896 patients in 13 studies were
eligible for analysis, while 17 579 (98.2%) patients presented as acute
coronary syndrome and 4105 (23%) patients received the de-escalation
therapy. Incidence of MACE was virtually identical in both de-escalation
and standard potent antiplatelet therapy groups (odds ratio 0.91, 95% CI
0.73-1.14; P = 0.43). Insignificant difference was also observed in major
bleeding (0.99, 0.62-1.60; P = 0.97), all-cause death (0.95, 0.61-1.46; P
= 0.81), cardiovascular death (0.66, 0.31-1.42; P = 0.29), myocardial
infarction (1.12, 0.80-1.58; P = 0.51), stent thrombosis (1.09, 0.50-2.36;
P = 0.83), unplanned revascularization (1.09, 0.83-1.41; P = 0.54), and
stroke (1.16, 0.62-2.19; P = 0.64). In conclusion, de-escalation of
antiplatelet therapy is associated with nonsignificant differences in both
ischemic events and major bleeding compared with standard potent
antiplatelet therapy in patients undergoing percutaneous coronary
intervention. The feasibility and even superiority of this strategy need
to be elucidated by further randomized trials. Copyright © 2019,
© 2019 Taylor & Francis Group, LLC.

<24>
Accession Number
626361140
Title
The effect of smoking on residual platelet reactivity to clopidogrel: a
systematic review and meta-analysis.
Source
Platelets. 31 (1) (pp 3-14), 2020. Date of Publication: 02 Jan 2020.
Author
Liu Z.; Xiang Q.; Mu G.; Xie Q.; Zhou S.; Wang Z.; Chen S.; Hu K.; Gong
Y.; Jiang J.; Cui Y.
Institution
(Liu, Xiang, Mu, Xie, Zhou, Wang, Chen, Hu, Cui) Department of Pharmacy,
Peking University First Hospital, Beijing, China
(Liu, Cui) School of Pharmaceutical Sciences, Peking University Health
Science Center, Beijing, China
(Gong, Jiang) Department of Cardiology, Peking University First Hospital,
Beijing, China
Publisher
Taylor and Francis Ltd
Abstract
Cigarette smoking is an important cardiovascular risk factor, causing
morbidity and mortality. There are many original studies on the impact of
smoking, but its influence on platelet ADP-P2Y12 receptor inhibitors lack
consistency. Thus, we conducted a systematic review and meta-analysis of
already existing data/studies to further explore this issue. PubMed, Web
of science, EMBASE, Clinical Trials, and the Cochrane Library were
searched from inception to March 2018. Studies investigating the residual
platelet reactivity categorized by smoking status and patients treated
with platelet ADP-P2Y12 receptor inhibitors qualified the inclusion
criteria. The primary outcome was P2Y12 reaction unit (PRU) value measured
by VerifyNow P2Y12 assay, compared with different smoking status in
ADP-P2Y12 receptor inhibitors treatment groups. Secondary outcome was
post-treatment with 5 mumol/L ADP-inhibition of platelet aggregation
(ADP-IPA) measured by light transmittance aggregometry (LTA). Of the 4954
citations retrieved, 12 studies involving 16 296 patients with acute
coronary syndrome and/or stent deployment using platelet ADP-P2Y12
receptor inhibitors were included for meta-analysis. Pooled analysis
revealed that PRU values of current smokers were 25.70 lower than
nonsmokers (95% CI -38.81 to -12.60, p = 0.0001), getting better effects
of antiplatelet treatment. In the smoking extent subgroup analysis,
patients smoking >10 cigarettes/day shown about 46.49 lower of PRU values
than patients smoking <10 cigarettes/day (p < 0.00001). Racial subgroup
analyses found that smokers had increased platelet inhibition in the
Caucasian population. Further, pooled analysis of ADP-IPA values for 1658
patients from five studies showed a significantly lower residual platelet
reactivity in current smokers compared to that in nonsmokers (MD = -4.19;
95% CI -6.55 to -1.83; p = 0.0005). This systematic review and
meta-analysis suggested that smokers have increased platelet inhibition
and lower aggregation in response to clopidogrel than nonsmokers. These
residual platelet reactivity observations may help to explain differential
clinical outcomes in smokers vs. nonsmokers in large scale clinical
trials. Copyright © 2019, © 2019 Taylor & Francis Group,
LLC.

<25>
Accession Number
2003621111
Title
Different effects of additional ganglion plexus ablation on catheter and
surgical ablation for atrial fibrillation: a systemic review and
meta-analysis.
Source
Journal of Cardiovascular Electrophysiology. 30 (12) (pp 3039-3049), 2019.
Date of Publication: 01 Dec 2019.
Author
Yan F.; Zhao S.; Wu W.; Xie Z.; Guo Q.
Institution
(Yan, Wu, Guo) Laboratory of Cardiovascular Diseases, Regenerative
Medicine Research Center, West China Hospital, Sichuan University,
Chengdu, China
(Zhao, Xie) Department of Cardiology, Yunnan Fuwai Cardiovascular
Hospital, Kunming Medical University, Kunming, China
(Guo) Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital,
Kunming Medical University, Kunming, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The effect of ganglion plexus (GP) ablation in addition to pulmonary veins
isolation (PVI) for atrial fibrillation (AF) remained controversial
between the catheter and surgical-based studies. Eleven studies (five
randomized controlled trials and six nonrandomized studies) of 1750
patients were included in a meta-analysis to elucidate the incremental
benefit of additional GP ablation in patients undergoing catheter or
surgical ablation. Risk ratios were calculated for freedom from AF or AT
recurrence after a single procedure. Additional GP ablation was associated
with a better rhythm outcome for patients undergone catheter ablation but
did not seem to increase freedom from AF/AT for surgical patients. Both
paroxysmal and non-paroxysmal AF showed a positive outcome comparing
additional GP ablation with PVI alone. Copyright © 2019 Wiley
Periodicals, Inc.

<26>
Accession Number
630017148
Title
Prophylactic plasma transfusion for patients without inherited bleeding
disorders or anticoagulant use undergoing non-cardiac surgery or invasive
procedures.
Source
Cochrane Database of Systematic Reviews. 2019 (11) (no pagination), 2019.
Article Number: CD012745. Date of Publication: 28 Nov 2019.
Author
Huber J.; Stanworth S.J.; Doree C.; Fortin P.M.; Trivella M.; Brunskill
S.J.; Hopewell S.; Wilkinson K.L.; Estcourt L.J.
Institution
(Huber) University Hospital Southampton NHS Foundation Trust, Shackleton
Department of Anaesthesia, Tremona Road, Southampton, Hampshire So16 6YD,
United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
(Doree, Brunskill) NHS Blood and Transplant, Systematic Review Initiative,
John Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Fortin) 5639 Gowland Rd., Sechelt, BC V0N 3A8, Canada
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Hopewell) University of Oxford, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research
Centre, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Wilkinson) Southampton University NHS Hospital, Paediatric and Adult
Cardiothoracic Anaesthesia, Tremona Road, Southampton SO16 6YD, United
Kingdom
(Estcourt) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Level 2, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, United
Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: In the absence of bleeding, plasma is commonly transfused to
people prophylactically to prevent bleeding. In this context, it is
transfused before operative or invasive procedures (such as liver biopsy
or chest drainage tube insertion) in those considered at increased risk of
bleeding, typically defined by abnormalities of laboratory tests of
coagulation. As plasma contains procoagulant factors, plasma transfusion
may reduce perioperative bleeding risk. This outcome has clinical
importance given that perioperative bleeding and blood transfusion have
been associated with increased morbidity and mortality. Plasma is
expensive, and some countries have experienced issues with blood product
shortages, donor pool reliability, and incomplete screening for
transmissible infections. Thus, although the benefit of prophylactic
plasma transfusion has not been well established, plasma transfusion does
carry potentially life-threatening risks. Objective(s): To determine
the clinical effectiveness and safety of prophylactic plasma transfusion
for people with coagulation test abnormalities (in the absence of
inherited bleeding disorders or use of anticoagulant medication) requiring
non-cardiac surgery or invasive procedures. Search Method(s): We
searched for randomised controlled trials (RCTs), without language or
publication status restrictions in: Cochrane Central Register of
Controlled Trials (CENTRAL; 2017 Issue 7); Ovid MEDLINE (from 1946); Ovid
Embase (from 1974); Cumulative Index to Nursing and Allied Health
Literature (CINAHL; EBSCOHost) (from 1937); PubMed (e-publications and
in-process citations ahead of print only); Transfusion Evidence Library
(from 1950); Latin American Caribbean Health Sciences Literature (LILACS)
(from 1982); Web of Science: Conference Proceedings Citation Index-Science
(CPCI-S) (Thomson Reuters, from 1990); ClinicalTrials.gov; and World
Health Organization (WHO) International Clinical Trials Registry Search
Platform (ICTRP) to 28 January 2019. Selection Criteria: We included
RCTs comparing: prophylactic plasma transfusion to placebo, intravenous
fluid, or no intervention; prophylactic plasma transfusion to alternative
pro-haemostatic agents; or different haemostatic thresholds for
prophylactic plasma transfusion. We included participants of any age, and
we excluded trials incorporating individuals with previous active
bleeding, with inherited bleeding disorders, or taking anticoagulant
medication before enrolment. Data Collection and Analysis: We used
standard methodological procedures expected by Cochrane. Main
Result(s): We included five trials in this review, all were conducted in
high-income countries. Three additional trials are ongoing. One trial
compared fresh frozen plasma (FFP) transfusion with no transfusion given.
One trial compared FFP or platelet transfusion or both with neither FFP
nor platelet transfusion given. One trial compared FFP transfusion with
administration of alternative pro-haemostatic agents (factors II, IX, and
X followed by VII). One trial compared the use of different transfusion
triggers using the international normalised ratio measurement. One trial
compared the use of a thromboelastographic-guided transfusion trigger
using standard laboratory measurements of coagulation. Four trials
enrolled only adults, whereas the fifth trial did not specify participant
age. Four trials included only minor procedures that could be performed by
the bedside. Only one trial included some participants undergoing major
surgical operations. Two trials included only participants in intensive
care. Two trials included only participants with liver disease. Three
trials did not recruit sufficient participants to meet their
pre-calculated sample size. Overall, the quality of evidence was low to
very low across different outcomes according to GRADE methodology, due to
risk of bias, indirectness, and imprecision. One trial was stopped after
recruiting two participants, therefore this review's findings are based on
the remaining four trials (234 participants). When plasma transfusion was
compared with no transfusion given, we are very uncertain whether there
was a difference in 30-day mortality (1 trial comparing FFP or platelet
transfusion or both with neither FFP nor platelet transfusion, 72
participants; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.13 to
1.10; very low-quality evidence). We are very uncertain whether there was
a difference in major bleeding within 24 hours (1 trial comparing FFP
transfusion vs no transfusion, 76 participants; RR 0.33, 95% CI 0.01 to
7.93; very low-quality evidence; 1 trial comparing FFP or platelet
transfusion or both with neither FFP nor platelet transfusion, 72
participants; RR 1.59, 95% CI 0.28 to 8.93; very low-quality evidence). We
are very uncertain whether there was a difference in the number of blood
product transfusions per person (1 trial, 76 participants; study authors
reported no difference; very low-quality evidence) or in the number of
people requiring transfusion (1 trial comparing FFP or platelet
transfusion or both with neither FFP nor platelet transfusion, 72
participants; study authors reported no blood transfusion given; very
low-quality evidence) or in the risk of transfusion-related adverse events
(acute lung injury) (1 trial, 76 participants; study authors reported no
difference; very low-quality evidence). When plasma transfusion was
compared with other pro-haemostatic agents, we are very uncertain whether
there was a difference in major bleeding (1 trial; 21 participants; no
events; very low-quality evidence) or in transfusion-related adverse
events (febrile or allergic reactions) (1 trial, 21 participants; RR 9.82,
95% CI 0.59 to 162.24; very low-quality evidence). When different triggers
for FFP transfusion were compared, the number of people requiring
transfusion may have been reduced (for overall blood products) when a
thromboelastographic-guided transfusion trigger was compared with standard
laboratory tests (1 trial, 60 participants; RR 0.18, 95% CI 0.08 to 0.39;
low-quality evidence). We are very uncertain whether there was a
difference in major bleeding (1 trial, 60 participants; RR 0.33, 95% CI
0.01 to 7.87; very low-quality evidence) or in transfusion-related adverse
events (allergic reactions) (1 trial; 60 participants; RR 0.33, 95% CI
0.01 to 7.87; very low-quality evidence). Only one trial reported 30-day
mortality. No trials reported procedure-related harmful events (excluding
bleeding) or quality of life. Authors' conclusions: Review findings show
uncertainty for the utility and safety of prophylactic FFP use. This is
due to predominantly very low-quality evidence that is available for its
use over a range of clinically important outcomes, together with lack of
confidence in the wider applicability of study findings, given the paucity
or absence of study data in settings such as major body cavity surgery,
extensive soft tissue surgery, orthopaedic surgery, or neurosurgery.
Therefore, from the limited RCT evidence, we can neither support nor
oppose the use of prophylactic FFP in clinical practice. Copyright
© 2019 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<27>
Accession Number
629992071
Title
Immunosuppressive Treatment for Myocarditis in the Pediatric Population: A
Meta-Analysis.
Source
Frontiers in Pediatrics. 7 (no pagination), 2019. Article Number: 430.
Date of Publication: 15 Nov 2019.
Author
He B.; Li X.; Li D.
Institution
(He, Li, Li) Department of Pediatrics, Renmin Hospital of Wuhan
University, Wuhan, China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
The use of immunosuppressants in the treatment of myocarditis in children
remains controversial. The aim of this meta-analysis is to summarize the
current empirical evidence for immunosuppressive treatment for myocarditis
in the pediatric population. We searched PubMed, MEDLINE, and Embase for
articles to identify studies analyzing the efficiency of immunosuppressive
treatment in the pediatric population. Pooled estimates were generated
using fixed- or random-effect models. Heterogeneity within studies was
assessed using Cochran's Q and I2 statistics. Funnel plots and
Begg's rank correlation method were constructed to evaluate publication
bias. Sensitivity analyses were also conducted to evaluate the potential
sources of heterogeneity. After a detailed screening of 159 studies, six
separate studies were identified, with 181 patients in the
immunosuppressive treatment group, and 199 in the conventional treatment
group. The immunosuppressive treatment group showed a significant
improvement in left ventricular ejection fraction (LVEF) [mean difference
1.10; 95% CI: 0.41, 1.79] and significantly decreased left ventricular
end-diastolic dimension (LVEDD) [mean difference -0.77 mm, 95% CI: -1.35
to -0.20 mm] when compared to the conventional treatment group.
Furthermore, the risk of death and heart transplant in conventional
treatment was significantly higher than in the immunosuppressive treatment
group [relative risk (RR): 4.74; 95% CI: 2.69, 8.35]. No significant
heterogeneity across the studies was observed. There was no evidence of
publication bias when assessed by Begg's test. Conclusion(s): There
may be a possible benefit, in the short term, to the addition of
immunosuppressive therapy in the management of myocarditis in the
pediatric population. However, further prospective investigation is
warranted to validate this finding. © Copyright © 2019 He,
Li and Li.

<28>
Accession Number
626726676
Title
Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing
Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 19 (5) (pp 465-476), 2019. Date
of Publication: 01 Oct 2019.
Author
Khan M.S.; Memon M.M.; Usman M.S.; Alnaimat S.; Khan S.U.; Khan A.R.;
Yamani N.; Fugar S.; Mookadam F.; Krasuski R.A.; Doukky R.
Institution
(Khan, Yamani, Fugar) Department of Internal Medicine, John H Stroger Jr.
Hospital of Cook County, 1900 W Harrison Street, Chicago, IL, United
States
(Memon, Usman) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Alnaimat) Department of Internal Medicine, University of Iowa Hospitals
and Clinics, Iowa City, IA, United States
(Khan) West Virginia University, Morgantown, WV, United States
(Khan) Division of Cardiology, University of Louisville, Louisville, KY,
United States
(Mookadam) Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale,
AZ, United States
(Krasuski) Department of Cardiovascular Medicine, Duke University Health
System, Durham, NC, United States
(Doukky) Division of Cardiology, Cook County Health and Hospitals System,
Chicago, IL, United States
(Doukky) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
Publisher
Springer International Publishing
Abstract
Background: The newer P2Y<inf>12</inf> inhibitors have better efficacy
than clopidogrel. However, whether ticagrelor or prasugrel have a better
comparative safety and efficacy profile, especially in the long-term,
remains inconclusive. Objective(s): We compared prasugrel and
ticagrelor in patients with acute coronary syndrome (ACS) undergoing
percutaneous coronary intervention (PCI). Method(s): MEDLINE and the
Cochrane library were queried for randomized controlled trials (RCTs) or
observational studies comparing prasugrel with ticagrelor in patients with
ACS undergoing PCI. Random-effects pooling was used to calculate odds
ratios (ORs) with 95% confidence intervals (CI). Analyses were stratified
by duration of follow-up (short term [<= 3 months] and long term [>= 1
year]) and study design. Result(s): In total, 14 studies (six RCTs,
eight observational studies), including 40,188 patients, met eligibility
criteria. Pooled analysis did not indicate that prasugrel significantly
decreased all-cause mortality compared with ticagrelor in the short term
(OR 0.49; 95% CI 0.20-1.20; p = 0.11) or long term (OR 0.74; 95% CI
0.48-1.15; p = 0.38). Pooled observational studies showed significantly
lower long-term all-cause mortality (OR 0.63; 95% CI 0.43-0.92; p = 0.02)
and short-term stent thrombosis (OR 0.46; 95% CI 0.28-0.75; p = 0.002)
with prasugrel. No significant difference was observed in the risk of
nonfatal myocardial infarction, ischemic stroke, bleeding, or repeat
revascularization between the two groups. Results remained similar after
stratification according to follow-up and study design.
 Conclusion(s): The present analysis suggests that prasugrel might
have a better efficacy profile than ticagrelor in patients with ACS
undergoing PCI. However, this advantage was only seen in pooled
observational studies and is likely to be affected by selection
bias. Copyright © 2019, Springer Nature Switzerland AG.

<29>
Accession Number
2004082861
Title
Efficacy of thoracic mobility and breathing exercises on chest expansion
and pulmonary function values in post intra- cardiac repair surgery
patients.
Source
Journal of Pharmaceutical Sciences and Research. 11 (10) (pp 3458-3461),
2019. Date of Publication: 2019.
Author
Nair S.; Kazi A.
Institution
(Nair) Department of Cardiovascular and Respiratory Physiotherapy, Ravi
Nair Physiotherapy College, Datta meghe Institute Of Medical Sciences
(Deemed University), Sawangi (Mehge), Wardha, Maharashtra 442001, India
(Kazi) Guide and Head Of Department of Cardiovascular and Respiratory
Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute Of
Medical Sciences(Deemed University), Sawangi (Meghe), Wardha, Maharashtra
442001, India
Publisher
Pharmainfo Publications (Plot No 5, Dr. Murugapriya Nagar, Lalpuram Post,
Chidambaram, Tamil Nadu 608 602, India. E-mail: jpsronline@gmail.com)
Abstract
Background: Post intra-cardiac repair (ICR) surgery patients are prone to
have incision or suture site pain that will interfere with the thoracic
wall mobility thereby resulting in reduced pulmonary function. Thoracic
mobility and Breathing exercises along with conventional chest
physiotherapy have been widely demonstrated to decrease the post (ICR)
pain, to increase chest expansion and increase the pulmonary functions in
phase I intra cardiac rehabilitation program. Objective(s): To
determine the efficacy of thoracic mobility and breathing exercises in
chest expansion and pulmonary function values in post (ICR) surgery
patients. Material(s) and Method(s): Total 24 participants were
discovered to be eligible as per inclusion criteria that were included in
this study. Participants were randomly selected and assigned in 2 groups,
Group A (n=12) received Thoracic mobility and various Breathing exercises
along with Conventional Chest Physiotherapy& Group B (n=12) received
Conventional Chest Physiotherapy including percussions & vibrations. Pre
and Post pain on NPRS, chest expansion at axillary and xphisternum level
and pulmonary function values for FVC, FEV1 and FEV1/FVC were recorded.
Readings obtained on 5 & 18 postth th operative day was compared.
 Result(s): The results were significant for all outcome measures
except FEV1/FVC, which was not significant, when the two groups were
compared. Conclusion(s): The study concludes that thoracic mobility
and breathing exercises were beneficial in reducing the postoperative pain
and improving the chest expansion and pulmonary function values in post
(ICR) surgery patients and the results were significant in both groups
(group A and B). Copyright © 2019 Pharmainfo Publications. All
rights reserved.

<30>
Accession Number
2003479561
Title
Perioperative care of children with sickle cell disease: A systematic
review and clinical recommendations.
Source
American Journal of Hematology. 95 (1) (pp 78-96), 2020. Date of
Publication: 01 Jan 2020.
Author
Schyrr F.; Dolci M.; Nydegger M.; Canellini G.; Andreu-Ullrich H.; Joseph
J.-M.; Diezi M.; Cachat F.; Rizzi M.; Renella R.
Institution
(Schyrr, Diezi, Rizzi, Renella) Pediatric Hematology-Oncology Unit,
Division of Pediatrics, Department "Woman-Mother-Child", Lausanne
University Hospital and Lausanne University, Lausanne, Switzerland
(Dolci, Nydegger) Division of Anesthesia, Department of Surgery, Lausanne
University Hospital and Lausanne University, Lausanne, Switzerland
(Canellini, Andreu-Ullrich) Transfusion Medicine Unit, Department of
Laboratory Medicine, Lausanne University Hospital and Lausanne University,
Lausanne, Switzerland
(Joseph) Division of Pediatric Surgery, Department "Woman-Mother-Child",
Lausanne University Hospital and Lausanne University, Lausanne,
Switzerland
(Cachat) Pediatric Nephrology Unit, Division of Pediatrics, Department
"Woman-Mother-Child", Lausanne University Hospital and Lausanne
University, Lausanne, Switzerland
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Children with sickle cell disease (SCD) require specific perioperative
care, and clinical practice in this area remains poorly defined. We aimed
to conduct a systematic, PRISMA-based review of the literature, available
clinical guidelines and practice recommendations. We also aimed to extract
any valuable information for the "best of available-evidence"-based
prevention of perioperative adverse events in children with SCD, and
highlight the most urgent priorities in clinical research. As data
sources, US National Library of Medicine, Medline, National Guideline
Clearinghouse, International Guideline Network, TRIP databases were
searched for any content until January 2019. We also included
institutional, consortia and expert group guidelines. Included were
reports/guidelines in English, French, German, and Italian. Excluded were
reports on obstetrical and fetal management. We identified 202
reports/guidelines fulfilling the criteria outlined above. A majority
focused on visceral, cardiovascular and orthopedic surgery procedures, and
only five were multicenter randomized controlled trials and two
prospective randomized studies. After grading of the quality of the
evidence, the extracted data was summarized into clinical recommendations
for daily practice. Additionally, we designed a risk-grading algorithm to
identify contexts likely to be associated with adverse outcomes. In
conclusion, we provide a systematic PRISMA-based review of the existing
literature and ancillary practice and delineate a set of clinical
recommendations and priorities for research. Copyright © 2019
Wiley Periodicals, Inc.

<31>
Accession Number
628428105
Title
Minimally invasive surgical approaches to left main and left anterior
descending coronary artery revascularization are superior compared to
first- and second-generation drug-eluting stents: a network meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (1) (pp 18-27), 2020.
Date of Publication: 01 Jan 2020.
Author
Indja B.; Woldendorp K.; Black D.; Bannon P.G.; Wilson M.K.; Vallely M.P.
Institution
(Indja, Woldendorp, Bannon) Sydney Medical School, University of Sydney,
NSW, Camperdown, Australia
(Woldendorp, Bannon) Baird Institute of Applied Heart & Lung Surgical
Research, Sydney, Australia
(Woldendorp, Bannon) Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, NSW, Camperdown, Sydney, Australia
(Black) Faculty of Health Sciences, University of Sydney, NSW, Camperdown,
Australia
(Wilson, Vallely) Sydney Heart and Lung Surgeons, NSW, Camperdown,
Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: There are a number of minimally invasive approaches to
revascularization of coronary artery disease that involve the left main or
proximal left anterior descending artery; however, studies to date provide
mixed results. METHOD(S): A Bayesian network meta-analysis was
performed to compare early and late postoperative outcomes between
percutaneous coronary intervention with first- and second-generation
drug-eluting stents (DESs), off-pump coronary artery bypass and minimally
invasive direct coronary artery bypass (MIDCAB) in patients with
involvement of left main or left anterior descending disease.
 RESULT(S): A total of 37 studies with 31 728 patients were included
in the analysis. There were no significant differences in early mortality
rates, strokes or myocardial infarctions (MIs). The long-term all-cause
mortality rate was equivalent between the groups. Patients who had
off-pump coronary artery bypass had fewer late MI compared with those who
had first-generation DES (DES1) [odds ratio (OR) 0.38, 95% confidence
interval (CI) 0.20-0.72] and MIDCAB (OR 0.41, 95% CI 0.17-0.97) and
reduced late target vessel revascularization compared with DES1 (OR 0.17,
95% CI 0.09-0.32) and second-generation DES (DES2) (OR 0.32, 95% CI
0.14-0.72). The rate of late major adverse cardiac events was lower with
off-pump coronary artery bypass compared with that with DES1 (OR 0.33, 95%
CI 0.26-0.43) and DES2 (OR 0.62, 95% CI 0.45-0.90). The rate of late major
adverse cardiac events with MIDCAB was lower than that with DES1 (OR 0.43,
95% CI 0.31-0.62) as was that with DES2 compared with DES1 (OR 0.53, 95%
CI 0.39-0.70). CONCLUSION(S): Surgical approaches to left main or
proximal left anterior descending disease remain superior to first- or
second-generation DES in terms of long-term freedom from MI and target
vessel revascularization as well as improved overall long-term survival.
Conflicting rates of late MI and target vessel revascularization in
patients who underwent MIDCAB suggest disease in alternate vessels that
may best be approached via hybrid techniques. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<32>
[Use Link to view the full text]
Accession Number
629726679
Title
A Novel Patient-Specific Model for Predicting Severe Oliguria; Development
and Comparison With Kidney Disease: Improving Global Outcomes Acute Kidney
Injury Classification.
Source
Critical care medicine. 48 (1) (pp e18-e25), 2020. Date of Publication: 01
Jan 2020.
Author
Howitt S.H.; Oakley J.; Caiado C.; Goldstein M.; Malagon I.; McCollum C.;
Grant S.W.
Institution
(Howitt, Oakley, Malagon, McCollum, Grant) Division of Cardiovascular
Sciences, University of Manchester, ERC, Manchester University Hospitals
Foundation Trust, Manchester, United Kingdom
(Howitt, Malagon) Department of Cardiothoracic Anaesthesia and Critical
Care, Wythenshawe Hospital, Manchester University Hospitals Foundation
Trust, Manchester, United Kingdom
(Oakley, Caiado, Goldstein) Department of Mathematical Sciences, Durham
University, Durham, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The Kidney Disease: Improving Global Outcomes urine output
criteria for acute kidney injury lack specificity for identifying patients
at risk of adverse renal outcomes. The objective was to develop a model
that analyses hourly urine output values in real time to identify those at
risk of developing severe oliguria. DESIGN: This was a retrospective
cohort study utilizing prospectively collected data. SETTING: A cardiac
ICU in the United Kingdom. PATIENTS: Patients undergoing cardiac surgery
between January 2013 and November 2017.None. MEASUREMENT AND MAIN RESULTS:
Patients were randomly assigned to development (n = 981) and validation (n
= 2,389) datasets. A patient-specific, dynamic Bayesian model was
developed to predict future urine output on an hourly basis. Model
discrimination and calibration for predicting severe oliguria (<
0.3mL/kg/hr for 6hr) occurring within the next 12 hours were tested in the
validation dataset at multiple time points. Patients with a high risk of
severe oliguria (p > 0.8) were identified and their outcomes were compared
with those for low-risk patients and for patients who met the Kidney
Disease: Improving Global Outcomes urine output criterion for acute kidney
injury. Model discrimination was excellent at all time points (area under
the curve > 0.9 for all). Calibration of the model's predictions was also
excellent. After adjustment using multivariable logistic regression,
patients in the high-risk group were more likely to require renal
replacement therapy (odds ratio, 10.4; 95% CI, 5.9-18.1), suffer prolonged
hospital stay (odds ratio, 4.4; 95% CI, 3.0-6.4), and die in hospital
(odds ratio, 6.4; 95% CI, 2.8-14.0) (p < 0.001 for all). Outcomes for
those identified as high risk by the model were significantly worse than
for patients who met the Kidney Disease: Improving Global Outcomes urine
output criterion. CONCLUSION(S): This novel, patient-specific model
identifies patients at increased risk of severe oliguria. Classification
according to model predictions outperformed the Kidney Disease: Improving
Global Outcomes urine output criterion. As the new model identifies
patients at risk before severe oliguria develops it could potentially
facilitate intervention to improve patient outcomes.

<33>
Accession Number
630092679
Title
Benefits of ultra-fast-track anesthesia for children with congenital heart
disease undergoing cardiac surgery.
Source
BMC Pediatrics. 19 (1) (no pagination), 2019. Article Number: 487. Date of
Publication: 11 Dec 2019.
Author
Xu J.; Zhou G.; Li Y.; Li N.
Institution
(Xu, Zhou, Li, Li) Department of Anesthesiology, China Emergency General
Hospital, 29 Liufangnanli Rd, Beijing 100028, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To compare the outcomes of ultra-fast-track anesthesia (UFTA)
and conventional anesthesia in cardiac surgery for children with
congenital heart disease (CHD) and low birth weight. Method(s): One
hundred and ninety-four CHD children, aged 6 months to 2 years, weighting
5 to 10 kg, were selected for this study. The 94 boys and 100 girls with
the American Society of Anesthesiologists (ASA) physical status III and IV
were randomly divided into two groups each consisting of 97 patients, and
were subjected to ultra-fast-track and conventional anesthesia for cardiac
surgery. For children in UFTA group, sevoflurane was stopped when
cardiopulmonary bypass (CPB) started and cis-atracurium was stopped at the
beginning of rewarming, and remifentanil (0.3 mug/kg/mim) was then
infused. Propofol and remifentanil were discontinued at skin closure. 10
min after surgery, extubation was performed in operating room. For
children in conventional anesthesia group, anesthesia was given routinely
and they were directly sent to ICU with a tracheal tube. Extubation time,
ICU stay and hospital stay after operation were recorded.
Sedation-agitation scores (SAS) were assessed and adverse reactions as
well as other anesthesia -related events were recorded. Result(s):
The extubation time, ICU stay and hospital stay were significantly shorter
in UFTA group (P < 0.05) and SAS at extubation was lower in UFTA group
than in conventional anesthesia group, but similar in other time points.
For both groups, no airway obstruction and other serious complications
occurred, and incidence of other anesthesia -related events were low.
 Conclusion(s): UFTA shortens extubation time, ICU stay and hospital
stay for children with CHD and does not increase SAS and incidence of
adverse reactions. Copyright © 2019 The Author(s).

<34>
Accession Number
2004095171
Title
Improved Analgesic Effect of Paravertebral Blocks before and after
Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized
Controlled Trial.
Source
Pain Research and Management. 2019 (no pagination), 2019. Article Number:
9158653. Date of Publication: 2019.
Author
Chu L.; Zhang X.; Lu Y.; Xie G.; Song S.; Fang X.; Cheng B.
Institution
(Chu, Zhang, Xie, Song, Fang, Cheng) Department of Anesthesiology, First
Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun
Road 79, Hangzhou 31003, China
(Zhang) Department of Anesthesiology, Hangzhou Red Cross Hospital, East
Road 208, Hangzhou 31003, China
(Lu) Department of Anesthesiology, Jiaxing First Hospital, South Zhonghuan
Road 1882, Jiaxing 314000, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Despite being less invasive, patients who underwent video-assisted
thoracic surgery (VATS) suffered considerable postoperative pain.
Paravertebral block (PVB) was proven to provide effective analgesia in
patients with VATS; however, there is no difference in pain relief between
preoperative PVB and postoperative PVB. This study was aimed to
investigate the analgesic efficacy of combination of preoperative and
postoperative PVB on the same patient undergoing VATS. In this
prospective, double-blinded, randomized controlled trial, 44 patients
undergoing VATS were enrolled, and they received patient-controlled
intravenous analgesia (PCIA) with sufentanil plus preoperative PVB (Group
A, n = 15) or postoperative PVB (Group B, n = 15), or combination of
preoperative and postoperative PVB (Group C, n = 14). The primary outcome
was sufentanil consumption and PCIA press times in the first 24 hours
postoperatively. Also, data of postoperative use of PCIA and visual
analogue scale (VAS) were collected. In the first 24 hours
postoperatively, median sufentanil consumption in Group C was 0 (0-34.75)
mug, which was much less than that in Group A (45.00 (33.00-47.00) mug,
p=0.005) and Group B (36 (20.00-50.00) mug, p=0.023). Patients in Group C
pressed less times of PCIA (0 (0-0) times) than patients in Group A (2
(1-6) times, p<0.001) and Group B (2 (1-3) times, p=0.009). Kaplan-Meier
analysis showed patients with combination of preoperative and
postoperative PVB had a higher PCIA-free rate than patients with either
technique alone (p=0.003). The VAS among the three groups was comparable
postoperatively. The combination of both preoperative and postoperative
PVB provides better analgesic efficacy during the early postoperative
period and may be an alternative option for pain control after VATS. This
trial is registered with ChiCTR1800017102. Copyright © 2019 Lihua
Chu et al.

<35>
Accession Number
2004163815
Title
The no-touch saphenous vein is an excellent alternative conduit to the
radial artery 8 years after coronary artery bypass grafting: A randomized
trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Dreifaldt M.; Mannion J.D.; Geijer H.; Liden M.; Bodin L.; Souza D.
Institution
(Dreifaldt, Souza) Faculty of Medicine and Health, Department of
Cardiothoracic and Vascular Surgery and University Health Care Research
Center, Orebro University, Orebro, Sweden
(Mannion) Department of Surgery, Bayhealth Medical Center, Dover, Del,
United States
(Geijer, Liden) Faculty of Medicine and Health, Department of Radiology,
Orebro University, Orebro, Sweden
(Bodin) Unit of Intervention and Implementation Research, Institute of
Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: In 2004, a prospective randomized trial demonstrated that
after 3 years, saphenous veins (SVs) harvested with a no touch (NT)
technique had a greater patency than radial grafts for coronary bypass
surgery. Here we report the 8-year follow-up data of this trial.
 Method(s): The trial included 108 patients undergoing coronary artery
bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1
radial artery (RA) graft to either the left or right coronary territory to
complement the left internal thoracic artery (LITA). Sequential grafting
was common, so overall graft patency as well as the patency of each
anastomosis were assessed. Result(s): Angiography was performed in 84
patients (78%) at mean of 97 months postoperatively. Graft patency were
high and similar for both NT and RA: 86% for NT versus 79% for RA (P =
.22). The patency of coronary anastomoses was significantly higher with
the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent
patency in coronary arteries with <90% stenosis (93% patency) and in
coronary arteries of small diameter (87% patency) or with mild
calcification (88% patency). Patency for the LITA was 92%.
 Conclusion(s): NT SV grafts have excellent patency similar to that of
RA grafts after 8 years. In addition, NT SV grafts can be used in
situations that are not ideal for RA grafts. Copyright © 2019 The
American Association for Thoracic Surgery

<36>
Accession Number
630183745
Title
Safety and efficacy of perioperative benzodiazepine administration: study
protocol for a systematic review and meta-analysis.
Source
BMJ open. 9 (12) (pp e031895), 2019. Date of Publication: 11 Dec 2019.
Author
Spence J.; Young J.; Alhazzani W.; Whitlock R.; D'Aragon F.; Um K.; Mazer
D.; Beaver C.; Jacobsohn E.; Belley-Cote E.
Institution
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods, Evaluation, and Impact (HEI); Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, Ontario,
Canada
(Alhazzani) Departments of Critical Care, Medicine (Gastroenterology), and
Health Research Methods, Evaluation, and Impact (HEI), McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation and Impact (HEI); Population Health Research Institute
(PHRI), McMaster University, Hamilton, Ontario, Canada
(D'Aragon) Faculte de medecine et des sciences de la sante, Universite de
Sherbrooke, Sherbrooke, QC, Canada
(Um) Population Health Research Institute, McMaster University, Hamilton,
Ontario, Canada
(Mazer) Department of Anesthesia and Li Ka Shing Knowledge Institute, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Beaver) Sheridan College, Oakville, ON, Canada
(Jacobsohn) Rady Faculty of Health Sciences and Max Rady College of
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Belley-Cote) Departments of Critical Care and Medicine (Cardiology);
Population Health Research Institute (PHRI), McMaster University,
Hamilton, Ontario, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Perioperative benzodiazepines are used because of their
anxiolytic, sedative and amnestic effects. Evidence has demonstrated an
association of benzodiazepines with adverse neuropsychiatric effects.
Nonetheless, because of their potential benefits, perioperative
benzodiazepines continue to be used routinely. We seek to evaluate the
body of evidence of the risks and benefits of benzodiazepine use during
the perioperative period. METHODS AND ANALYSIS: We will search Cochrane
CENTRAL, MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science from
inception to March 2019 for randomised controlled trials (RCTs) and
observational studies evaluating the administration of benzodiazepine
medications as compared with all other medications (or nothing) in
patients undergoing cardiac and non-cardiac surgery. We will exclude
studies assessing the use of benzodiazepines for procedural sedation or
day surgery. We will examine the impact of giving these medications
before, during and after surgery. Outcomes of interest include the
incidence of delirium, duration of delirium, postprocedure cognitive
change, the incidence of intraoperative awareness, patient
satisfaction/quality of life/quality of recovery, length-of-stay (LOS) in
the intensive care unit (ICU), hospital LOS and in-hospital
mortality.Reviewers will screen references and assess eligibility using
predefined criteria independently and in duplicate. Two reviewers will
independently collect data using prepiloted forms. We will present results
separately for RCTs and observational studies. We will pool data using a
random effect model and present results as relative risk with 95% CIs for
dichotomous outcomes and mean difference with 95%CI for continuous
outcomes. We will pool adjusted ORs for observational studies. We will
assess risk of bias for individual studies using the Cochrane
Collaboration tool for RCTs. For observational studies, we will use tools
designed by the Clinical Advances through Research and Information
Translation group. Quality of evidence for each outcome will be assessed
using the Grading of Recommendations Assessment, Development and
Evaluation approach. ETHICS AND DISSEMINATION: This systematic review
involves no patient contact and no interaction with healthcare providers
or systems. As such, we did not seek ethics board approval. We will
disseminate the findings of our systematic review through the presentation
at peer-reviewed conferences and by seeking publication in a peer-reviewed
journal. PROSPERO REGISTRATION NUMBER: CRD42019128144. Copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC
BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

<37>
Accession Number
630181582
Title
Perioperative restrictive versus goal-directed fluid therapy for adults
undergoing major non-cardiac surgery.
Source
The Cochrane database of systematic reviews. 12 (pp CD012767), 2019. Date
of Publication: 12 Dec 2019.
Author
Wrzosek A.; Jakowicka-Wordliczek J.; Zajaczkowska R.; Serednicki W.T.;
Jankowski M.; Bala M.M.; Swierz M.J.; Polak M.; Wordliczek J.
Institution
(Wrzosek, Zajaczkowska, Serednicki, Wordliczek) Jagiellonian University
Medical College, Department of Interdisciplinary Intensive Care, Krakow,
Poland
(Wrzosek) University Hospital, Department of Anaethesiology and Intensive
Care, Krakow, Poland
(Jakowicka-Wordliczek, Jankowski) University Hospital, Department of
Anaesthesiology and Intensive Care, Krakow, Poland
(Jankowski) Jagiellonian University Medical College, Department of
Internal Medicine; Systematic Reviews Unit, Krakow, Poland
(Bala) Jagiellonian University Medical College, Chair of Epidemiology and
Preventive Medicine, Department of Hygiene and Dietetics; Systematic
Reviews Unit, Kopernika 7, Krakow, Poland, 31-034
(Swierz) Jagiellonian University Medical College, Department of Hygiene
and Dietetics; Systematic Reviews Unit, Krakow, Poland
(Polak) Jagiellonian University Medical College, Department of
Epidemiology and Population Studies in the Institute of Public Health,
Krakow, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative fluid management is a crucial element of
perioperative care and has been studied extensively recently; however,
'the right amount' remains uncertain. One concept in perioperative fluid
handling is goal-directed fluid therapy (GDFT), wherein fluid
administration targets various continuously measured haemodynamic
variables with the aim of optimizing oxygen delivery. Another recently
raised concept is that perioperative restrictive fluid therapy (RFT) may
be beneficial and at least as effective as GDFT, with lower cost and less
resource utilization. OBJECTIVE(S): To investigate whether RFT may be
more beneficial than GDFT for adults undergoing major non-cardiac surgery.
 SEARCH METHOD(S): We searched the following electronic databases on
11 October 2019: Cochrane Central Register of Controlled Trials, in the
Cochrane Libary; MEDLINE; and Embase. Additionally, we performed a
targeted search in Google Scholar and searched trial registries (World
Health Organization (WHO) International Clinical Trials Registry Platform
(ICTRP) and ClinicalTrials.gov) for ongoing and unpublished trials. We
scanned the reference lists and citations of included trials and any
relevant systematic reviews identified. SELECTION CRITERIA: We included
randomized controlled trials (RCTs) comparing perioperative RFT versus
GDFT for adults (aged >= 18 years) undergoing major non-cardiac surgery.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened
references for eligibility, extracted data, and assessed risk of bias. We
resolved discrepancies by discussion and consulted a third review author
if necessary. When necessary, we contacted trial authors to request
additional information. We presented pooled estimates for dichotomous
outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), and for
continuous outcomes as mean differences (MDs) with standard deviations
(SDs). We used Review Manager 5 software to perform the meta-analyses. We
used a fixed-effect model if we considered heterogeneity as not important;
otherwise, we used a random-effects model. We used Poisson regression
models to compare the average number of complications per person. MAIN
RESULTS: From 6396 citations, we included six studies with a total of 562
participants. Five studies were performed in participants undergoing
abdominal surgery (including one study in participants undergoing
cytoreductive abdominal surgery with hyperthermic intraperitoneal
chemotherapy (HIPEC)), and one study was performed in participants
undergoing orthopaedic surgery. In all studies, surgeries were elective.
In five studies, crystalloids were used for basal infusion and colloids
for boluses, and in one study, colloid was used for both basal infusion
and boluses. Five studies reported the ASA (American Society of
Anesthesiologists) status of participants. Most participants were ASA II
(60.4%), 22.7% were ASA I, and only 16.9% were ASA III. No study
participants were ASA IV. For the GDFT group, oesophageal doppler
monitoring was used in three studies, uncalibrated invasive arterial
pressure analysis systems in two studies, and a non-invasive arterial
pressure monitoring system in one study. In all studies, GDFT optimization
was conducted only intraoperatively. Only one study was at low risk of
bias in all domains. The other five studies were at unclear or high risk
of bias in one to three domains. RFT may have no effect on the rate of
major complications compared to GDFT, but the evidence is very uncertain
(RR 1.61, 95% CI 0.78 to 3.34; 484 participants; 5 studies; very
low-certainty evidence). RFT may increase the risk of all-cause mortality
compared to GDFT, but the evidence on this is also very uncertain (RD
0.03, 95% CI 0.00 to 0.06; 544 participants; 6 studies; very low-certainty
evidence). In a post-hoc analysis using a Peto odds ratio (OR) or a
Poisson regression model, the odds of all-cause mortality were 4.81 times
greater with the use of RFT compared to GDFT, but the evidence again is
very uncertain (Peto OR 4.81, 95% CI 1.38 to 16.84; 544 participants; 6
studies; very low-certainty evidence). Nevertheless, sensitivity analysis
shows that exclusion of a study in which the final volume of fluid
received intraoperatively was higher in the RFT group than in the GDFT
group revealed no differences in mortality. Based on analysis of secondary
outcomes, such as length of hospital stay (464 participants; 5 studies;
very low-certainty evidence), surgery-related complications (364
participants; 4 studies; very low-certainty evidence), non-surgery-related
complications (74 participants; 1 study; very low-certainty evidence),
renal failure (410 participants; 4 studies; very low-certainty evidence),
and quality of surgical recovery (74 participants; 1 study; very
low-certainty evidence), GDFT may have no effect on the risk of these
outcomes compared to RFT, but the evidence is very uncertain. Included
studies provided no data on administration of vasopressors or inotropes to
correct haemodynamic instability nor on cost of treatment. AUTHORS'
 CONCLUSION(S): Based on very low-certainty evidence, we are uncertain
whether RFT is inferior to GDFT in selected populations of adults
undergoing major non-cardiac surgery. The evidence is based mainly on data
from studies on abdominal surgery in a low-risk population. The evidence
does not address higher-risk populations or other surgery types. Larger,
higher-quality RCTs including a wider spectrum of surgery types and a
wider spectrum of patient groups, including high-risk populations, are
needed to determine effects of the intervention. Copyright © 2019
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<38>
Accession Number
630174814
Title
A systematic review of the cost-effectiveness of heart valve replacement
with a mechanical versus biological prosthesis in patients with heart
valvular disease.
Source
Heart failure reviews. (no pagination), 2019. Date of Publication: 10 Dec
2019.
Author
Azari S.; Rezapour A.; Omidi N.; Alipour V.; Tajdini M.; Sadeghian S.;
Bragazzi N.L.
Institution
(Azari, Rezapour, Alipour) Department of Health Economics, School of
Health Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Omidi, Tajdini, Sadeghian) Department of Cardiology, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bragazzi) Laboratory for industrial and applied mathematics (LIAM),
Department of mathematics and statistics, York university, Toronto, Canada
Publisher
NLM (Medline)
Abstract
Heart valve disease (HVD) affects 2.5% of the US population and one
million individuals aged 65 years and older in the UK. Given its burden,
the aim of the present review was to assess the cost-effectiveness of
heart valve replacement with mechanical versus biological prosthesis in
HVD patients. We performed a systematic search in various electronic
databases from January 1990 to June 2019. Five out of 542 articles were
entered into the study, from which 2 papers were subsequently excluded not
meeting the minimum number of items of the CHEERS checklist.
Quality-Adjusted Life Year, Life Years Gained, and the Incremental
Cost-Effectiveness Ratio (ICER) regarding the type of replaced heart valve
were extracted and reported. Studies were conducted in three different
countries (Iran, France, and USA). ICER ranged from $1253 in Iran to
54,634 in France. Survival rate of mitral mechanical versus biological
valves at 10 and 20 years was 72.9% versus 76.0% and 51% versus 30%,
respectively. Survival rate at 20 years in patients undergoing atrial
valve replacement was 20%. Ten- and 20-year death rates for biological
valves were higher with respect to mechanical prosthesis (15.5% versus
8.4% at 10 years), with this difference becoming more relevant at 20 years
(36.9% versus 13.9%). Due to higher ICER, mortality rate, and lower
success rates in the long term for biological prostheses compared to
mechanical ones, these appear to be more suitable for older patients (aged
>=70 years).

<39>
Accession Number
2004268545
Title
Rationale and design of the STeroids to REduce Systemic inflammation after
infant heart Surgery (STRESS) trial.
Source
American Heart Journal. 220 (pp 192-202), 2020. Date of Publication:
February 2020.
Author
Hill K.D.; Baldwin H.S.; Bichel D.P.; Butts R.J.; Chamberlain R.C.; Ellis
A.M.; Graham E.M.; Hickerson J.; Hornik C.P.; Jacobs J.P.; Jacobs M.L.;
Jaquiss R.D.; Kannankeril P.J.; O'Brien S.M.; Torok R.; Turek J.W.; Li
J.S.
Institution
(Hill, Chamberlain, Hornik, Torok, Turek, Li) Duke University Pediatric
and Congenital Heart Center, Durham, NC, United States
(Hill, Ellis, Hickerson, Hornik, O'Brien, Li) Duke Clinical Research
Institute, Durham, NC, United States
(Baldwin, Bichel, Kannankeril) Vanderbilt University Medical Center,
Nashville, TN, United States
(Butts, Jaquiss) University of Texas Southwestern, Dallas, TX, United
States
(Graham) Medical University of South Carolina, Charleston, SC, United
States
(Jacobs, Jacobs) Johns Hopkins University School of Medicine, Baltimore,
MD, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For decades, physicians have administered corticosteroids in the
perioperative period to infants undergoing heart surgery with
cardiopulmonary bypass (CPB) to reduce the postoperative systemic
inflammatory response to CPB. Some question this practice because steroid
efficacy has not been conclusively demonstrated and because some studies
indicate that steroids could have harmful effects. STRESS is a randomized,
placebo-controlled, double-blind, multicenter trial designed to evaluate
safety and efficacy of perioperative steroids in infants (age < 1 year)
undergoing heart surgery with CPB. Participants (planned enrollment =
1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered
into the CPB pump prime versus placebo. The trial is nested within the
existing infrastructure of the Society of Thoracic Surgeons Congenital
Heart Surgery Database. The primary outcome is a global rank score of
mortality, major morbidities, and hospital length of stay with components
ranked commensurate with their clinical severity. Secondary outcomes
include several measures of major postoperative morbidity, postoperative
hospital length of stay, and steroid-related safety outcomes including
prevalence of hyperglycemia and postoperative infectious complications.
STRESS will be one of the largest trials ever conducted in children with
heart disease and will answer a decades-old question related to safety and
efficacy of perioperative steroids in infants undergoing heart surgery
with CPB. The pragmatic "trial within a registry" design may provide a
mechanism for conducting low-cost, high-efficiency trials in a
heretofore-understudied patient population. Copyright © 2019
Elsevier Inc.

<40>
Accession Number
2003829240
Title
Preemptive Anti-Stress Response Effects of Oxycodone Versus Sufentanil for
Patients Undergoing Cardiac Valve Replacement-A Randomized Controlled
Trial.
Source
Clinical Pharmacology in Drug Development. (no pagination), 2019. Date of
Publication: 2019.
Author
Zhang J.; Tu Q.; Gan J.; Miao S.; Zhou Y.; Li Q.; Zheng C.
Institution
(Zhang) Department of Anesthesiology, Sichuan Provincial Hospital for
Women and Children/Affiliated Women and Children's Hospital of Chengdu
Medical College, Chengdu, China
(Tu) Department of Anesthesiology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
(Gan) Department of Anesthesiology, Tangshan People's Hospital, Tangshan,
China
(Miao) Department of Anesthesiology, Wuxi People's Hospital, Nanjing
Medical University, Wuxi, China
(Zhou, Li, Zheng) Department of Anesthesiology, the Third People's
Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
Publisher
Blackwell Publishing Ltd
Abstract
Patients undergoing cardiac valve replacement may experience
cardiovascular adverse events during the preoperative period before
anesthesia. The study was to compare the preemptive anti-stress response
effects of oxycodone versus sufentanil for patients undergoing cardiac
valve replacement. Ninety-four patients were enrolled and assigned to
group Oxy, group Suf and group NS. Patients in group Oxy were
administrated with oxycodone 0.1 mg/kg, group Suf received sufentanil 0.1
mug/kg and group NS were given equivalent volume of normal saline. The
primary outcomes included serum levels of cortisol, norepinephrine, and
adrenaline. The secondary outcomes involved bispectral index value and the
observer's assessment of awareness/sedation grade, levels of mean arterial
pressure, heart rate, and the adverse reactions. Compared to group NS, the
serum levels of cortisol at T<inf>1</inf> to T<inf>5</inf> (P <.05), and
levels of norepinephrine and adrenaline at T<inf>3</inf> to T<inf>5</inf>
(P <.05) in group Oxy and Suf were lower. The bispectral index value and
observer's assessment of awareness/sedation grade T<inf>1</inf> to
T<inf>2</inf> (P <.05) in group Suf were lower than those in group Oxy and
NS. Compared with group NS, the levels of mean arterial pressure and heart
rate in group Oxy and Suf at T<inf>3</inf> to T<inf>5</inf> (P <.05) were
lower. The incidence of coughing was significantly higher in group Suf
(23.3%), but not in group NS (6.7%), than that in group Oxy (3.3%). The
preemptive analgesia of oxycodone may be used to inhibit the stress
response, without leading to excessive sedation and respiratory
depression, which may also help to stabilize hemodynamics during
preoperative period. Copyright © 2019, The American College of
Clinical Pharmacology

<41>
Accession Number
2003783139
Title
Outcomes with retrograde versus antegrade chronic total occlusion
revascularization.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Megaly M.; Ali A.; Saad M.; Omer M.; Xenogiannis I.; Werner G.S.;
Karmpaliotis D.; Russo J.J.; Yamane M.; Garbo R.; Gagnor A.; Ungi I.;
Rinfret S.; Pershad A.; Wojcik J.; Garcia S.; Mashayekhi K.; Sianos G.;
Galassi A.R.; Burke M.N.; Brilakis E.S.
Institution
(Megaly, Omer, Xenogiannis, Garcia, Burke, Brilakis) Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Omer) Department of Cardiovascular Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Ali) Department of Medicine, Mercy Hospital and Medical Center, Chicago,
IL, United States
(Saad) Division of Cardiovascular Medicine, The Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Department of Cardiovascular Medicine, Ain Shams University
Hospitals, Cairo, Egypt
(Werner) Medizinische Klinik I (Cardiology and Intensive Care), Klinikum
Darmstadt GmbH, Darmstadt, Germany
(Karmpaliotis, Russo) Department of Cardiology, Columbia University, New
York, NY, United States
(Yamane) Department of Cardiology, Sayama Hospital, Saitama, Japan
(Garbo) Department of Invasive Cardiology, San Giovanni Bosco Hospital,
Turin, Italy
(Gagnor) Department of Invasive Cardiology, Maria Vittoria Hospital,
Turin, Italy
(Ungi) Division of Invasive Cardiology, University of Szeged, Second
Department of Internal Medicine and Cardiology Center, Szeged, Hungary
(Rinfret) Division of Interventional Cardiology, McGill University Health
Centre, Montreal, Canada
(Pershad) Division of Cardiology, Banner-University Medical Center,
Phoenix, AZ, United States
(Wojcik) Department of Cardiology, Hospital of Invasive Cardiology
IKARDIA, Naleczow, Poland
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Sianos) First Department of Cardiology, AHEPA University Hospital,
Thessaloniki, Greece
(Galassi) Department of Clinical and Experimental Medicine,
Catheterization Laboratory and Cardiovascular Interventional Unit,
Cannizzaro Hospital, University of Catania, Catania, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of the study was to evaluate the outcomes of
retrograde versus antegrade approach in chronic total occlusion (CTO)
percutaneous coronary intervention (PCI). Background(s): The
retrograde approach has increased the success rate of CTO PCI but has been
associated with a higher risk for complications. Method(s): We
conducted a meta-analysis of studies published between 2000 and August
2019 comparing the in-hospital and long-term outcomes with retrograde
versus antegrade CTO PCI. Result(s): Twelve observational studies
(10,240 patients) met our inclusion criteria (retrograde approach 2,789
patients, antegrade approach 7,451 patients). Lesions treated with the
retrograde approach had higher J-CTO score (2.8 vs. 1.9, p <.001).
Retrograde CTO PCI was associated with a lower success rate (80.9% vs.
87.4%, p <.001). Both approaches had similar in-hospital mortality, urgent
revascularization, and cerebrovascular events. Retrograde CTO PCI was
associated with higher risk of in-hospital myocardial infarction (MI; odds
ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p <.001), urgent
pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p =.002), and
contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p <.001). During
a mean follow-up of 48 +/- 31 months retrograde crossing had similar
mortality (OR 1.79, 95% CI 0.84-3.81, p =.13), but a higher incidence of
MI (OR 2.07, 95% CI 1.1-3.88, p =.02), target vessel revascularization (OR
1.92, 95% CI 1.49-2.46, p <.001), and target lesion revascularization (OR
2.08, 95% CI 1.33-3.28, p =.001). Conclusion(s): Compared with
antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions
and is associated with a higher risk for acute and long-term adverse
events. Copyright © 2019 Wiley Periodicals, Inc.

<42>
Accession Number
601554983
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385 (9976) (pp 1397-1405), 2015. Date of Publication: 01 Jan
2015.
Author
Fulcher J.; O'Connell R.; Voysey M.; Emberson J.; Blackwell L.; Mihaylova
B.; Simes J.; Collins R.; Kirby A.; Colhoun H.; Braunwald E.; La Rosa J.;
Pedersen T.R.; Tonkin A.; Davis B.; Sleight P.; Franzosi M.G.; Baigent C.;
Keech A.; De Lemos J.; Blazing M.; Murphy S.; Downs J.R.; Gotto A.;
Clearfield M.; Holdaas H.; Gordon D.; Koren M.; Dahlof B.; Poulter N.;
Sever P.; Knopp R.H.; Fellstrom B.; Jardine A.; Schmieder R.; Zannad F.;
Goldbourt U.; Kaplinsky E.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Kjekshus J.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.;
Maggioni A.; Marchioli R.; Tognoni G.; Bloomfield H.; Robins S.; Armitage
J.; Parish S.; Peto R.; Ridker P.M.; Holman R.; Meade T.; MacMahon S.;
Marschner I.; Shaw J.; Serruys P.W.; Nakamura H.; Knatterud G.; Furberg
C.; Byington R.; Macfarlane P.; Ford I.; Murphy M.; Marschner I.C.; Blauw
G.J.; Packard C.; Shepherd J.; Wilhelmsen L.; Cannon C.; Bowman L.;
Landray M.; Rossouw J.; Probstfield J.; Cobbe S.; Flather M.; Kastelein
J.; Newman C.; Shear C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Barnes
E.H.; Herrington W.G.; Holland L.E.; Reith C.
Institution
(Simes, Kirby, Keech, Marschner, Barnes) CTC, University of Sydney,
Australia
(Emberson, Blackwell, Mihaylova, Collins, Baigent, Herrington, Holland,
Reith) CTSU, University of Oxford, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. Method(s): We performed meta-analyses on data from 22
trials of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 1.0 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin
vs control trials and roughly 0.5 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 1.0 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99%
CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for
those women and men at less than 10% predicted 5 year absolute
cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the
proportional reductions in major coronary events, coronary
revascularisation, and stroke did not differ significantly by sex. No
adverse effect on rates of cancer incidence or non-cardiovascular
mortality was noted for either sex. These net benefits translated into
all-cause mortality reductions with statin therapy for both women (RR
0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted
heterogeneity p=0.43). Interpretation In men and women at an equivalent
risk of cardiovascular disease, statin therapy is of similar effectiveness
for the prevention of major vascular events.

<43>
Accession Number
52015679
Title
The effects of lowering LDL cholesterol with statin therapy in people at
low risk of vascular disease: Meta-analysis of individual data from 27
randomised trials.
Source
The Lancet. 380 (9841) (pp 581-590), 2012. Date of Publication: 01 Aug
2012.
Author
Mihaylova B.; Emberson J.; Blackwell L.; Keech A.; Simes J.; Barnes E.H.;
Voysey M.; Gray A.; Collins R.; Baigent C.; De Lemos J.; Braunwald E.;
Blazing M.; Murphy S.; Downs J.R.; Gotto A.; Clearfield M.; Holdaas H.;
Gordon D.; Davis B.; Koren M.; Dahlof B.; Poulter N.; Sever P.; Knopp
R.H.; Fellstrom B.; Jardine A.; Schmieder R.; Zannad F.; Goldbourt U.;
Kaplinsky E.; Colhoun H.M.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Kjekshus J.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.;
Maggioni A.; Marchioli R.; Tognoni G.; Franzosi M.G.; Bloomfield H.;
Robins S.; Armitage J.; Parish S.; Sleight P.; Pedersen T.R.; Ridker P.M.;
Holman R.; Meade T.; MacMahon S.; Marschner I.; Tonkin A.; Shaw J.;
Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.; Byington R.;
MacFarlane P.; Cobbe S.; Ford I.; Murphy M.; Blauw G.J.; Packard C.;
Shepherd J.; Wilhelmsen L.; Cannon C.; Bowman L.; Peto R.; Landray M.; La
Rosa J.; Rossouw J.; Probstfi Eld J.; Flather M.; Kastelein J.; Newman C.;
Shear C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies M.; McGovern
M.; Barclay J.; Belder R.; Mitchel M.Y.; Musliner T.; Ansquer J.-C.;
Llewellyn B.M.; Pharma N.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski
B.; Olsson G.; Pears J.; DeMicco D.; Baxter A.; Bhala N.; Buck G.;
Herrington W.G.; Holland L.E.; Kearney P.M.; Kirby A.; Lewis D.A.;
Pollicino C.; Reith C.; Sourjina T.
Institution
(Baigent, Marschner, Baxter, Bhala, Buck, Herrington, Holland, Kearney,
Kirby, Lewis, Pollicino, Reith, Sourjina) National Health and Medical
Research Council (NHMRC), Clinical Trial Centre, University of Sydney,
Mallett Street Campus M02, NSW 2006, Australia
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statins reduce LDL cholesterol and prevent vascular events, but
their net effects in people at low risk of vascular events remain
uncertain. Methods This meta-analysis included individual participant data
from 22 trials of statin versus control (n=134 537; mean LDL cholesterol
difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of
more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years).
Major vascular events were major coronary events (ie, non-fatal myocardial
infarction or coronary death), strokes, or coronary revascularisations.
Participants were separated into five categories of baseline 5-year major
vascular event risk on control therapy (no statin or low-intensity statin)
(<5%, >=5% to <10%, >=10% to <20%, >=20% to <30%, >=30%); in each, the
rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.
Findings Reduction of LDL cholesterol with a statin reduced the risk of
major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L
reduction), largely irrespective of age, sex, baseline LDL cholesterol or
previous vascular disease, and of vascular and all-cause mortality. The
proportional reduction in major vascular events was at least as big in the
two lowest risk categories as in the higher risk categories (RR per 1.0
mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81],
0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86],
and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant
reductions in these two lowest risk categories in major coronary events
(RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74,
p<0.0001) and in coronary revascularisations (RR 0.52, 99% CI 0.35-0.75,
and 0.63, 99% CI 0.51-0.79; both p<0.0001). For stroke, the reduction in
risk in participants with 5-year risk of major vascular events lower than
10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% CI 0.61-0.95,
p=0.0012) was also similar to that seen in higher risk categories (trend
p=0.3). In participants without a history of vascular disease, statins
reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction
0.85, 95% CI 0.77-0.95) and all-cause mortality (RR 0.91, 95% CI
0.85-0.97), and the proportional reductions were similar by baseline risk.
There was no evidence that reduction of LDL cholesterol with a statin
increased cancer incidence (RR per 1.0 mmol/L LDL cholesterol reduction
1.00, 95% CI 0.96-1.04), cancer mortality (RR 0.99, 95% CI 0.93-1.06), or
other non-vascular mortality. Interpretation In individuals with 5-year
risk of major vascular events lower than 10%, each 1 mmol/L reduction in
LDL cholesterol produced an absolute reduction in major vascular events of
about 11 per 1000 over 5 years. This benefi t greatly exceeds any known
hazards of statin therapy. Under present guidelines, such individuals
would not typically be regarded as suitable for LDL-lowering statin
therapy. The present report suggests, therefore, that these guidelines
might need to be reconsidered.

<44>
Accession Number
51141585
Title
Efficacy and safety of more intensive lowering of LDL cholesterol: A
meta-analysis of data from 170 000 participants in 26 randomised trials.
Source
The Lancet. 376 (9753) (pp 1670-1681), 2010. Date of Publication: 13 Nov
2010.
Author
Baigent C.; Blackwell L.; Emberson J.; Holland L.E.; Reith C.; Bhala N.;
Peto R.; Barnes E.H.; Keech A.; Simes J.; Collins R.; De Lemos J.;
Braunwald E.; Blazing M.; Murphy S.; Downs J.R.; Gotto A.; Clearfield M.;
Holdaas H.; Gordon D.; Davis B.; Koren M.; Dahlof B.; Poulter N.; Sever
P.; Knopp R.H.; Fellstrom B.; Jardine A.; Schmieder R.; Zannad F.;
Goldbourt U.; Kaplinsky E.; Colhoun H.M.; Betteridge D.J.; Durrington
P.N.; Hitman G.A.; Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye
L.; Pfeffer M.; Hawkins C.M.; Barter P.; Tavazzi L.; Maggioni A.;
Marchioli R.; Tognoni G.; Franzosi M.G.; Bloomfield H.; Robins S.;
Armitage J.; Parish S.; Sleight P.; Pedersen T.R.; Ridker P.M.; Holman R.;
Meade T.; MacMahon S.; Marschner I.; Tonkin A.; Shaw J.; Serruys P.W.;
Nakamura H.; Knatterud G.; Furberg C.; Byington R.; Macfarlane P.; Cobbe
S.; Ford I.; Murphy M.; Blauw G.J.; Packard C.; Shepherd J.; Kjekshus J.;
Wilhelmsen L.; Cannon C.; Bowman L.; Baxter A.; Landray M.; La Rosa J.;
Rossouw J.; Probstfield J.; Flather M.; Kastelein J.; Newman C.; Shear C.;
Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies M.; McGovern M.;
Barclay J.; Belder R.; Mitchel Y.; Musliner T.; Ansquer J.-C.; Llewellyn
M.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski B.; Olsson G.; Pears J.;
De Micco D.; Buck G.; Herrington W.G.; Kearney P.M.; Kirby A.; Lewis D.A.;
Pollicino C.; Sourjina T.
Institution
(De Lemos, Braunwald, Blazing, Murphy) Phase Z, United States
(Downs, Gotto, Clearfield) AFCAPS/TEXCAPS (AirForce/Texas Coronary
Atherosclerosis Prevention Study), United States
(Holdaas) ALERT (Assessment of Lescol in Transplantation), United States
(Gordon, Davis) ALLHAT (Antihypertensive Lipid Lowering Heart Attack
Trial), United States
(Koren) ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac
Events), United States
(Dahlof, Poulter, Sever) ASCOT (Anglo-Scandinavian Cardiac Outcomes
Trial), United States
(Knopp) ASPEN, United States
(Holdaas, Fellstrom, Jardine, Schmieder, Zannad) AURORA, United States
(Goldbourt, Kaplinsky) BIP (Bezafibrate Infarction Prevention Study),
United States
(Colhoun, Betteridge, Durrington, Hitman, Fuller, Neil) CARDS
(Collaborative Atorvastatin Diabetes Study), United States
(Wanner, Krane) 4D (Die Deutsche Diabetes Dialyse Study), United States
(Sacks, Moye, Pfeffer) CARE (Cholesterol and Recurrent Events Study),
United States
(Keech, Barter) FIELD (Fenofibrate Intervention and Event Lowering in
Diabetes), United States
(Tavazzi, Maggioni) GISSI (Gruppo Italiano per Lo Studio della
Sopravvivenza nell'Infarto Miocardico)-Heart Failure, Italy
(Maggioni, Marchioli, Tognoni, Franzosi) GISSI-Prevention, Italy
(Bloomfield, Robins) HIT (Veteran Administration Low HDL Intervention
Trial), United States
(Peto, Keech, Collins, Armitage, Parish, Sleight) HPS (Heart Protection
Study), United States
(Pedersen) IDEAL (Incremental Decrease in Endpoints Through Aggressive
Lipid-lowering), United States
(Ridker) JUPITER, United States
(Holman) LDS (Lipids in Diabetes Study), United States
(Meade) LEADER (Lower Extremity Arterial Disease Event Reduction Trial),
United States
(Keech, Simes, MacMahon, Marschner, Tonkin, Shaw) LIPID (Long-term
Intervention with Pravastatin in Ischaemic Disease), United States
(Serruys) LIPS (Lescol Intervention Prevention Study), United States
(Nakamura) MEGA (Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese), United States
(Knatterud) Post-CABG (Post- Coronary Artery Bypass Graft Study), United
States
(Furberg, Byington) PPP (Pravastatin Pooling Project), United States
(Macfarlane, Cobbe, Ford, Murphy, Blauw, Packard, Shepherd) PROSPER
(Prospective Study of Pravastatin in the Elderly at Risk), United States
(Pedersen, Kjekshus, Wilhelmsen) 4S (Scandinavian Simvastatin Survival
Study), United States
(Braunwald, Murphy, Cannon) PROVE-IT (Pravastatin or Atorvastatin
Evaluation and Infection Therapy), United States
(Peto, Collins, Armitage, Parish, Sleight, Bowman) SEARCH (Study of
Effectiveness of Additional Reductions in Cholesterol and Homocysteine),
United States
(Baigent, Collins, Baxter, Landray) SHARP (Study of Heart and Renal
Protection), United States
(La Rosa) TNT (Testing New Targets), United States
(Rossouw, Probstfield) WHI (Women's Health Initiative), United States
(Macfarlane, Cobbe, Ford, Shepherd) WOSCOPS (West of Scotland Coronary
Prevention Study), United Kingdom
(Mellies, McGovern, Barclay, Belder) Bristol-Myers Squibb, United States
(Mitchel, Musliner) Merck, United States
(Ansquer) Laboratoires Fournier, United States
(Llewellyn) Bayer, United States
(Bortolini) Novartis Pharma, United States
(Brandrup-Wognsen, Bryzinski, Olsson, Pears) AstraZeneca, United States
(De Micco) Pfizer, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Lowering of LDL cholesterol with standard statin regimens reduces the risk
of occlusive vascular events in a wide range of individuals. We aimed to
assess the safety and efficacy of more intensive lowering of LDL
cholesterol with statin therapy. We undertook meta-analyses of individual
participant data from randomised trials involving at least 1000
participants and at least 2 years' treatment duration of more versus less
intensive statin regimens (five trials; 39 612 individuals; median
follow-up 5.1 years) and of statin versus control (21 trials; 129 526
individuals; median follow-up 4.8 years). For each type of trial, we
calculated not only the average risk reduction, but also the average risk
reduction per 1.0 mmol/L LDL cholesterol reduction at 1 year after
randomisation. In the trials of more versus less intensive statin therapy,
the weighted mean further reduction in LDL cholesterol at 1 year was 0.51
mmol/L. Compared with less intensive regimens, more intensive regimens
produced a highly significant 15 (95 CI 11-18; p<0.0001) further reduction
in major vascular events, consisting of separately significant reductions
in coronary death or non-fatal myocardial infarction of 13 (95 CI 7-19;
p<0.0001), in coronary revascularisation of 19 (95 CI 15-24; p<0.0001),
and in ischaemic stroke of 16 (95 CI 5-26; p=0.005). Per 1.0 mmol/L
reduction in LDL cholesterol, these further reductions in risk were
similar to the proportional reductions in the trials of statin versus
control. When both types of trial were combined, similar proportional
reductions in major vascular events per 1.0 mmol/L LDL cholesterol
reduction were found in all types of patient studied (rate ratio [RR]
0.78, 95 CI 0.76-0.80; p<0.0001), including those with LDL cholesterol
lower than 2 mmol/L on the less intensive or control regimen. Across all
26 trials, all-cause mortality was reduced by 10 per 1.0 mmol/L LDL
reduction (RR 0.90, 95 CI 0.87-0.93; p<0.0001), largely reflecting
significant reductions in deaths due to coronary heart disease (RR 0.80,
99 CI 0.74-0.87; p<0.0001) and other cardiac causes (RR 0.89, 99 CI
0.81-0.98; p=0.002), with no significant effect on deaths due to stroke
(RR 0.96, 95 CI 0.84-1.09; p=0.5) or other vascular causes (RR 0.98, 99 CI
0.81-1.18; p=0.8). No significant effects were observed on deaths due to
cancer or other non-vascular causes (RR 0.97, 95 CI 0.92-1.03; p=0.3) or
on cancer incidence (RR 1.00, 95 CI 0.96- 1.04; p=0.9), even at low LDL
cholesterol concentrations. Further reductions in LDL cholesterol safely
produce definite further reductions in the incidence of heart attack, of
revascularisation, and of ischaemic stroke, with each 1.0 mmol/L reduction
reducing the annual rate of these major vascular events by just over a
fifth. There was no evidence of any threshold within the cholesterol range
studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would
reduce risk by about 40-50. UK Medical Research Council, British Heart
Foundation, European Community Biomed Programme, Australian National
Health and Medical Research Council, and National Heart
Foundation. Copyright © 2010 Elsevier Ltd.

<45>
Accession Number
2003880319
Title
Combined Coronary Artery Bypass Surgery With Bone Marrow Stem Cell
Transplantation: Are We There Yet?.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1913-1921), 2019. Date of
Publication: December 2019.
Author
Ayyat K.S.; Argawi A.; Mende M.; Steinhoff G.; Borger M.A.; Deebis A.M.;
McCurry K.R.; Garbade J.
Institution
(Ayyat, McCurry) Department of Thoracic and Cardiovascular Surgery, Heart
and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United
States
(Ayyat, McCurry) Department of Inflammation and Immunity, Lerner Research
Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
(Ayyat, Deebis) Department of Cardiothoracic Surgery, Zagazig University,
Zagazig, Egypt
(Argawi, Borger, Garbade) Department of Cardiac Surgery, Heart Center
University, Medicine Leipzig, Leipzig, Germany
(Mende) Coordination Centre for Clinical Trials, University of Leipzig,
Leipzig, Germany
(Steinhoff) Department of Cardiac Surgery, Reference and Translation
Center for Cardiac Stem Cell Therapy, University Medicine Rostock,
Rostock, Germany
Publisher
Elsevier USA
Abstract
Background: Although the safety and feasibility of combined coronary
artery bypass grafting (CABG) and bone marrow stem cell (BMSC)
transplantation have been proven, the efficacy of this approach remains
controversial. Therefore, we conducted an updated meta-analysis of
randomized controlled trials to evaluate the efficacy of this procedure.
 Method(s): Electronic databases were systematically searched for
randomized trials comparing 4-month to 6-month follow-up outcomes in
patients who underwent isolated CABG (CABG group) and patients who
received BMSC transplantation with CABG (BMSC group). A random-effects
meta-analysis was conducted across eligible studies. Meta-regression and
subgroup analyses were utilized to identify sources of data heterogeneity.
 Result(s): Thirteen trials were eligible, with a total number of 292
patients in the BMSC group and 247 patients in the CABG group. Compared
with the CABG group, the BMSC group showed significant improvement of
follow-up left ventricular ejection fraction (n = 539, 4.8%; 95%
confidence interval [CI], 2.3%-7.3%; P = .001). The analyzed data showed
significant heterogeneity (I2 = 74.2%, P < .001). The reduction
in scar size (n = 120; -2.2 mL; 95% CI, -18.2 mL to 13.7 mL; P = .44) and
the improvement in the 6-minute walk test (n = 212; 41 m; 95% CI, -13 m to
95 m; P = .10) did not reach statistical significance. No significant
correlation was found between the number of the injected BMSCs or the
method of injection and the change in ejection fraction.
 Conclusion(s): The present evidence suggests that combined CABG and
BMSC transplantation is associated with improvement of left ventricular
ejection fraction. However, the heterogeneity in the data suggests
variations in patient response to this therapy. Further studies are
required to understand these variations. Copyright © 2019 The
Society of Thoracic Surgeons

<46>
Accession Number
2003880288
Title
The Choice of Treatment in Ischemic Mitral Regurgitation With Reduced Left
Ventricular Function.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1901-1912), 2019. Date of
Publication: December 2019.
Author
Nappi F.; Avtaar Singh S.S.; Padala M.; Attias D.; Nejjari M.; Mihos C.G.;
Benedetto U.; Michler R.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Padala) Structural Heart Research & Innovation, Laboratory, Carlyle
Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University,
Atlanta, Georgia
(Attias) Department of Cardiology, Centre Cardiologique du Nord,
Saint-Denis, France
(Nejjari) Department of Cardiology, Interventional Cardiology Centre
Cardiologique du Nord, Saint-Denis, France
(Mihos) Echocardiography Laboratory, Division of Cardiology, Columbia
University, Mount Sinai Heart Institute, Miami Beach, FL, United States
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Michler) Department of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
NY, United States
Publisher
Elsevier USA
Abstract
Background: Ischemic mitral regurgitation is a condition characterized by
mitral insufficiency secondary to an ischemic left ventricle. Primarily,
the pathology is the result of perturbation of normal regional left
ventricular geometry combined with adverse remodeling. We present a
comprehensive review of contemporary surgical, medical, and percutaneous
treatment options for ischemic mitral regurgitation, rigorously examined
by current guidelines and literature. Method(s): We conducted a
literature search of the PubMed database, Embase, and the Cochrane Library
(through November 2018) for studies reporting perioperative or late
mortality and echocardiographic outcomes after surgical and nonsurgical
intervention for ischemic mitral regurgitation. Result(s): Treatment
of this condition is challenging and often requires a multimodality
approach. These patients usually have multiple comorbidities that may
preclude surgery as a viable option. A multidisciplinary team discussion
is crucial in optimizing outcomes. There are several options for treatment
and management of ischemic mitral regurgitation with differing benefits
and risks. Guideline-directed medical therapy for heart failure is the
treatment choice for moderate and severe ischemic mitral regurgitation,
with consideration of coronary revascularization, mitral valve surgery,
cardiac resynchronization therapy, or a combination of these, in
appropriate candidates. The use of transcatheter mitral valve therapy is
considered appropriate in high-risk patients with severe ischemic mitral
regurgitation, heart failure, and reduced left ventricular ejection
fraction, especially in those with hemodynamic instability.
 Conclusion(s): The role of mitral valve surgery and transcatheter
mitral valve therapy continues to evolve. Copyright © 2019 The
Society of Thoracic Surgeons

<47>
Accession Number
2003793143
Title
Aortic valve replacement with pulmonary hypertension: Meta-analysis of 70
676 patients.
Source
Journal of Cardiac Surgery. 34 (12) (pp 1617-1625), 2019. Date of
Publication: 01 Dec 2019.
Author
Rocha R.V.; Friedrich J.O.; Hong K.; Lee J.; Cheema A.; Bagai A.; Verma
S.; Yanagawa B.
Institution
(Rocha, Hong, Lee, Verma, Yanagawa) Divisions of Cardiac Surgery,
University of Toronto, Toronto, ON, Canada
(Friedrich) Critical Care and Medicine, University of Toronto, Toronto,
ON, Canada
(Cheema, Bagai) Cardiology St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: We compared early and late outcomes of
surgical aortic valve replacement (SAVR) in patients with aortic stenosis
(AS) and pulmonary hypertension (PHT). Method(s): We searched MEDLINE
and EMBASE databases until July 2018 for studies comparing patients with
AS and none, mild-moderate, or severe PHT undergoing SAVR. Random-effects
meta-analysis was performed. Result(s): There were 12 observational
studies with 70 676 patients with median follow-up 4.0 years
(interquartile range, 2.6-4 years). Compared to patients with no PHT,
patients with any PHT undergoing SAVR were older (mean difference [MD],
2.31 years; 95% confidence interval [CI], 1.38-3.23 years; P <.01), with
greater comorbidities and reduced ejection fraction (MD, -4.36; 95%CI,
-5.94 to -2.78; P <.01). Patients with any PHT had higher unadjusted (5.2%
vs 2.4%; risk ratio [RR], 2.27; 95%CI, 2.04-2.53; P <.01) and adjusted
(RR, 1.65; 95%CI, 1.28-2.14; P <.01) in-hospital mortality compared with
no PHT. Severe (RR, 3.53; 95%CI, 1.46-8.54; P <.01) and mild-moderate PHT
(RR, 2.13; 95%CI, 1.28-3.55; P <.01) were associated with higher
unadjusted in-hospital mortality compared with no PHT. Any PHT was
associated with a higher unadjusted risk of stroke (RR, 1.64; 95%CI,
1.42-1.90; P <.01), acute kidney injury (RR, 2.02; 95%CI, 1.50-2.72; P
<.01), prolonged ventilation (RR, 1.62; 95%CI, 1.04-2.52; P =.03), and
longer hospital stay (MD, 1.76 days; 95%CI, 0.57-2.95; P <.01). Severe
(HR, 2.44; 95%CI, 1.60-3.72; P <.01) but not mild-moderate PHT (HR, 2.25;
95%CI, 0.91-5.59; P =.08) was associated with higher adjusted long-term
mortality compared with no PHT. Conclusion(s): Patients with severe
AS and severe PHT had a significant increase in operative mortality and
more than double the risk of long-term mortality following SAVR compared
with patients with no PHT. Such patients may benefit from a less invasive
transcatheter aortic valve intervention. Copyright © 2019 Wiley
Periodicals, Inc.

<48>
Accession Number
2003538705
Title
Remote ischemic preconditioning and its role in the prevention of new
onset atrial fibrillation post-cardiac surgery. A meta-analysis of
randomized control trials.
Source
Journal of Arrhythmia. 35 (6) (pp 789-794), 2019. Date of Publication: 01
Dec 2019.
Author
Kumar A.; Singh H.; Shariff M.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Singh) Internist, Michigan Primary Care Partners, Rapids, MI, United
States
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Background: The denouement of remote ischemic preconditioning on new onset
atrial fibrillation (NOAF) post-cardiac surgery is not well-established.
An updated meta-analysis of randomized control trials was performed by
comparing remote ischemic preconditioning with controls and the outcome of
interest was NOAF. Method(s): The systemic review was performed in
accordance with the PRISMA (Preferred reporting items for systemic review)
and AHA (American Heart Association) guidelines. PubMed database was
searched to include relevant randomized control trials from inception to
July 2019. We used Mantel-Haenzsel method with random error model to
calculate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity
was assessed using the I2 test> 50% or chi2 P <.05.
Publication bias was visually assessed using a funnel plot.
 Result(s): Twelve randomized control trials were included in the
final analysis. Remote ischemic preconditioning did not alter the risk of
NOAF post-cardiac surgery [RR: 0.95, CI: 0.83-1.09, P =.48, I2
= 37%, chi2 P =.09]. Conclusion(s): In conclusion, the
present meta-analysis failed to provide any evidence for the beneficial
effect of remote ischemic preconditioning in the prevention of
NOAF. Copyright © 2019 The Authors. Journal of Arrhythmia
published by John Wiley & Sons Australia, Ltd on behalf of the Japanese
Heart Rhythm Society.

<49>
Accession Number
627090924
Title
Comparing everolimus-based immunosuppression with reduction or withdrawal
of calcineurin inhibitor reduction from 6 months after heart
transplantation: The randomized MANDELA study.
Source
American Journal of Transplantation. 19 (11) (pp 3006-3017), 2019. Date of
Publication: 01 Nov 2019.
Author
Barten M.J.; Hirt S.W.; Garbade J.; Bara C.; Doesch A.O.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Lehmkuhl H.B.; Porstner M.; Schulz
U.
Institution
(Barten) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Hirt) Department of Cardiothoracic Surgery, University Hospital
Regensburg, Regensburg, Germany
(Garbade) University Department of Cardiac Surgery, Leipzig Heart Center,
Leipzig, Germany
(Bara) Division of Cardiovascular, Thoracic and Transplantation Surgery,
Hannover Medical School, Hannover, Germany
(Doesch) Department of Cardiology, University Hospital Heidelberg,
Heidelberg, Germany
(Knosalla, Lehmkuhl) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute Berlin, DZHK (German Centre for Cardiovascular
Research), partner site Berlin, Berlin, Germany
(Grinninger) Department of Cardiac Surgery, Munich Transplantation Center,
Klinikum Groshadern LMU, Munich, Germany
(Stypmann) Department of Cardiovascular Medicine, Division of Cardiology,
University Hospital Munster, Munster, Germany
(Sieder, Porstner) Novartis Pharma GmbH, Nuremberg, Germany
(Schulz) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
Publisher
Blackwell Publishing Ltd
Abstract
In the 12-month, open-label MANDELA study, patients were randomized at
month 6 after heart transplantation to (1) convert to calcineurin
inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic
acid and steroids (CNI-free, n = 71), or to (2) continue reduced-exposure
CNI, with EVR and steroids (EVR/redCNI, n = 74). Tacrolimus was
administered in 48.8% of EVR/redCNI patients and 52.6% of CNI-free
patients at randomization. Both strategies improved and stabilized renal
function based on the primary endpoint (estimated GFR at month 18
posttransplant postrandomization) with superiority of the CNI-free group
vs EVR/redCNI: mean 64.1 mL/min/1.73 m2 vs 52.9 mL/min/1.73
m2; difference + 11.3 mL/min/1.73 m2 (P <.001). By
month 18, estimated GFR had increased by >= 10 mL/min/1.73 m2
in 31.8% and 55.2% of EVR/redCNI and CNI-free patients, respectively, and
by >= 25 mL/min/1.73 m2 in 4.5% and 20.9%. Rates of
biopsy-proven acute rejection (BPAR) were 6.8% and 21.1%; all cases were
without hemodynamic compromise. BPAR was less frequent with EVR/redCNI vs
the CNI-free regimen (P =.015); 6 of 15 episodes in CNI-free patients
occurred with EVR concentration < 5 ng/mL. Rates of adverse events and
associated discontinuations were comparable. EVR/redCNI from month 6
achieved stable renal function with infrequent BPAR. One-year renal
function can be improved by early conversion to EVR-based CNI-free therapy
but requires close EVR monitoring. Clinical trials registry:
ClinicalTrials.gov NCT00862979. Copyright © 2019 The American
Society of Transplantation and the American Society of Transplant Surgeons

<50>
Accession Number
2001492497
Title
Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is
Driven by Incompleteness of Revascularisation.
Source
Heart Lung and Circulation. 29 (1) (pp 149-155), 2020. Date of
Publication: January 2020.
Author
Thakur U.; Nerlekar N.; Muthalaly R.G.; Comella A.; Wong N.C.; Cameron
J.D.; Harper R.W.; Smith J.A.; Brown A.J.
Institution
(Thakur, Nerlekar, Muthalaly, Comella, Wong, Cameron, Harper, Smith,
Brown) Monash Cardiovascular Research Centre, Monash University and
MonashHeart, Monash Health, Melbourne, Vic, Australia
(Thakur, Muthalaly, Comella, Wong, Harper, Smith) Department of Surgery
(School of Clinical Sciences at Monash Health], Monash University,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Off-pump coronary artery bypass grafting (CABG) negates the
requirement for extracorporeal circulation used with the traditional
on-pump approach. However, off-pump CABG is technically more challenging
and may theoretically lead to less complete revascularisation. Recent data
suggests a prognostic benefit for traditional on-pump CABG, but the
mechanism for this remains unclear. We hypothesised that the inferior
outcomes with off-pump CABG could be driven by the need for repeat
revascularisation, with this benefit only becoming clear at long-term
follow-up. We therefore evaluated short, medium and long-term outcomes of
patients undergoing revascularisation with on vs. off-pump CABG.
 Method(s): Electronic databases were searched to identify suitable
randomised controlled trials enrolling >=100 patients in each arm.
Clinical outcomes were extracted at 30-days, 12-months or >4 years. The
primary outcome was long-term all-cause death, while secondary outcomes
included 30-day, 12-month and >4-year cardiac death, stroke, myocardial
infarction or revascularisation. Result(s): Thirteen (13) studies
comprising 13,234 patients were included. Off-pump CABG was associated
with an increased risk of all-cause death (Odds Ratio [OR] 1.18, 95%
confidence interval [CI] 1.02-1.32, p = 0.01) and repeat bypass surgery
(OR 2.57, 95%CI 1.23-5.39, p = 0.01) at long-term follow-up. A
significant, increased requirement for revascularisation in off-pump was
seen at 12-month follow-up (OR 1.59, 95%CI 1.09-2.33, p = 0.02). No
differences were noted between groups at 30-days, 12-months and >4 years
for myocardial infarction or stroke. Conclusion(s): Off-pump CABG is
associated with significantly higher rates of all-cause mortality rate at
long-term follow-up. These outcomes demonstrate a temporal relationship
that may be driven by a greater requirement for repeat revascularisation
at 1- and 5-year follow-up. Study registration: CRD42018102019
(PROSPERO). Copyright © 2018 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<51>
[Use Link to view the full text]
Accession Number
629716439
Title
Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass
Circuit in Pediatric Surgery: A Randomized Clinical Trial.
Source
Anesthesiology. 132 (1) (pp 95-106), 2020. Date of Publication: 01 Jan
2020.
Author
Dieu A.; Rosal Martins M.; Eeckhoudt S.; Matta A.; Kahn D.; Khalifa C.;
Rubay J.; Poncelet A.; Haenecour A.; Derycke E.; Thiry D.; Gregoire A.;
Momeni M.
Institution
(Dieu) From the Departments of Anesthesiology (A.D., M.R.M., C.K., M.M.)
Hematology (S.E.) Cardiac Surgery (J.R., A.P.) Perfusion Services (D.T.,
A.G.) the Pediatric Intensive Care Unit (A.H., University Hospital Saint
Luc, Catholic University of Louvain (Cliniques Universitaires Saint Luc,
Universite Catholique de Louvain), A.M., Brussels, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: In congenital cardiac surgery, priming cardiopulmonary bypass
(CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation
abnormalities. The hypothesis was that CPB priming with crystalloids would
be different compared with FFP in terms of bleeding and/or need for blood
product transfusion. METHOD(S): In this parallel-arm double-blinded
study, patients weighing between 7 and 15 kg were randomly assigned to a
CPB priming with 15 ml . kg PlasmaLyte or 15 ml . kg FFP in addition to a
predefined amount of packed red blood cells used in all patients. The
decision to transfuse was clinical and guided by point-of-care tests. The
primary endpoints included postoperative bleeding tracked by chest tubes,
number of patients transfused with any additional blood products, and the
total number of additional blood products administered intra- and
postoperatively. The postoperative period included the first 6 h after
intensive care unit arrival. RESULT(S): Respectively, 30 and 29
patients in the FFP and in the crystalloid group were analyzed in an
intention-to-treat basis. Median postoperative blood loss was 7.1 ml . kg
(5.1, 9.4) in the FFP group and 5.7 ml . kg (3.8, 8.5) in the crystalloid
group (P = 0.219); difference (95% CI): 1.2 (-0.7 to 3.2). The proportion
of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of
29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds
ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products
transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and
crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to
0]). There were no study-related adverse events. CONCLUSION(S): The
results demonstrate that in infants and children, priming CPB with
crystalloids does not result in a different risk of postoperative bleeding
and need for transfusion of allogeneic blood products.

<52>
[Use Link to view the full text]
Accession Number
629465258
Title
Effects of Different Rehabilitation Protocols in Inpatient Cardiac
Rehabilitation after Coronary Artery Bypass Graft Surgery: A RANDOMIZED
CLINICAL TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (6) (pp
E19-E25), 2019. Date of Publication: 01 Nov 2019.
Author
Zanini M.; Nery R.M.; De Lima J.B.; Buhler R.P.; Da Silveira A.D.; Stein
R.
Institution
(Zanini, De Lima, Buhler, Da Silveira, Stein) Federal University of Rio
Grande Do sul, Porto Alegre, Rio Grande do Sul, Brazil
(Zanini, Nery, De Lima, Buhler, Da Silveira, Stein) Exercise Cardiology
Research Group, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos,
2350, Terreo (Servico de Fisiatria e Reabilitacao), Porto Alegre, Rio
Grande do Sul 90035-007, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Patients undergoing coronary artery bypass graft (CABG) surgery
typically experience loss of cardiopulmonary capacity in the
post-operative period. The purpose of this study was to evaluate the
effects of different rehabilitation protocols used in inpatient cardiac
rehabilitation on functional capacity and pulmonary function in patient
status post-CABG surgery. Method(s): This was a single-blind
randomized controlled trial. The primary endpoint of functional capacity
and secondary endpoints of lung capacity and respiratory muscle function
were assessed in patients scheduled to undergo CABG. After surgery, 40
patients were randomly assigned across 1 of 4 inpatient cardiac
rehabilitation groups: G1, inspiratory muscle training, active upper limb
and lower limb exercise training, and early ambulation; G2, same protocol
as G1 without inspiratory muscle training; G3, inspiratory muscle training
alone; and G4, control. All groups received chest physical therapy and
expiratory positive airway pressure. Patients were reassessed on
post-operative day 6 and post-discharge day 30 (including cardiopulmonary
exercise testing). Result(s): The 6-min walk distance on
post-operative day 6 was significantly higher in groups that included
exercise training (G1 and G2), remaining higher at 30 d post-discharge (P
<.001 between groups). Peak oxygen uptake on day 30 was also higher in G1
and G2 (P =.005). All groups achieved similar recovery of lung function.
 Conclusion(s): Protocols G1 and G2, which included a systematic plan
for early ambulation and upper and lower limb exercise, attenuated fitness
losses while in the hospital and significantly enhanced recovery 1 mo
after CABG. Copyright © 2019 Wolters Kluwer Health, Inc. All
rights reserved.

<53>
[Use Link to view the full text]
Accession Number
629465135
Title
Effect of Cardiac Rehabilitation on Sexual Satisfaction among Patients
after Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (6) (pp
E26-E30), 2019. Date of Publication: 01 Nov 2019.
Author
Rakhshan M.; Toufigh A.; Dehghani A.; Yaktatalab S.
Institution
(Rakhshan, Toufigh, Dehghani, Yaktatalab) Shiraz University of Medical
Sciences, Community Based Psychiatric Care Research Center, Shiraz
71936-13119, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: After coronary artery bypass graft (CABG) surgery, many patients
experience diminished sexual function and satisfaction. The present study
aimed to investigate the effect of outpatient cardiac rehabilitation (OCR)
on the level of sexual satisfaction among post-CABG patients.
 Method(s): A clinical trial was performed at the Al-Zahra Hospital,
Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion
criteria, 104 post-CABG patients were recruited into the study. The
participants were randomly assigned to the intervention (OCR) group (n =
52) or the usual care group (n = 52). The intervention group received 20
sessions of OCR, whereas the usual care group received the routine
hospital care and education. Data were collected using the Index of Sexual
Satisfaction and a demographic data sheet. The data were analyzed using
the SPSS software, v23.0 (IBM) and the independent sample t test,
paired-samples t test, and chi2 test. Result(s): There was
no statistically significant difference in the mean pre-intervention score
for sexual satisfaction between the groups. However, a statistically
significant difference in the mean post-intervention score for sexual
satisfaction was observed between the groups (P <.001). The difference in
the mean pre-and post-intervention scores for sexual satisfaction in the
intervention group was statistically significant (P <.001), whereas there
was no significant difference in the usual care group. Conclusion(s):
Post-CABG patients who completed the OCR program experienced an increased
level of sexual satisfaction. It is, therefore, recommended to include an
OCR program as part of the patient treatment and aftercare following CABG
surgery. Copyright © 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<54>
Accession Number
2004258207
Title
Pharmacological interventions to reduce edema following cardiopulmonary
bypass: A systematic review and meta-analysis.
Source
Journal of Critical Care. 56 (pp 63-72), 2020. Date of Publication: April
2020.
Author
Dekker N.A.M.; van Leeuwen A.L.I.; van de Ven P.M.; de Vries R.; Hordijk
P.L.; Boer C.; van den Brom C.E.
Institution
(Dekker, van Leeuwen, Boer, van den Brom) Department of Anesthesiology,
Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije
Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(Dekker, van Leeuwen, Hordijk, van den Brom) Department of Physiology,
Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(van de Ven) Department of Epidemiology and Biostatistics, Amsterdam UMC,
Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
(de Vries) Medical Library, Vrije Universiteit, Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Purpose: To compare the effectiveness of different types of
pharmacological agents to reduce organ specific edema following
cardiopulmonary bypass (CPB). Method(s): Pubmed, Embase.com and
Cochrane were searched for studies administrating a pharmacological agent
before CPB. Primary outcome was postoperative edema. Result(s):
Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled
eligibility criteria. Steroids were used in most clinical studies (n = 5,
83%) and reduced postoperative edema in 4 studies, however heterogeneity
precluded meta-analysis. In preclinical studies, a total of 31 different
drugs were tested of which 20 (65%) reduced edema in at least one organ.
Particularly neutrophil inhibitors, and modulators of coagulation or
endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61];
-1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no
treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD
-1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01])
edema following CPB required specific modulators of endothelial barrier.
 Conclusion(s): Overall, neutrophil inhibitors and direct modulators
of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced
edema following CPB, in particular pulmonary edema. Future research should
focus on a combination of these strategies to reduce edema and assess the
effect on organ function and outcome following CPB. Copyright ©
2019 The Authors

<55>
Accession Number
2004072638
Title
Topical vancomycin for neurosurgery wound prophylaxis: An interim report
of a randomized clinical trial on drug safety in a diverse neurosurgical
population.
Source
Journal of Neurosurgery. 131 (6) (pp 1966-1973), 2019. Date of
Publication: 2019.
Author
Radwanski R.E.; Christophe B.R.; Pucci J.U.; Martinez M.A.; Rothbaum M.;
Bagiella E.; Lowy F.D.; Knopman J.; Connolly E.S.
Institution
(Radwanski, Christophe, Pucci, Martinez, Lowy, Connolly) Department of
Neurological Surgery, Columbia University Medical Center, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Radwanski, Rothbaum, Knopman) Department of Neurological Surgery, Weill
Cornell Medical Center, Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Bagiella) Center of Biostatistics, Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Postoperative surgical site infections (SSIs) in neurosurgical
patients carry a significant risk of increased morbidity and mortality.
With SSIs accounting for approximately 20% of nosocomial infections and
costing approximately $1.6 billion USD annually, there is a need for
additional prophylaxis to improve current standards of care. Topical
vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. A randomized controlled trial assessing its efficacy in the general
neurosurgical population is currently underway. Here, the authors report
their initial impressions of topical vancomycin safety among patients
enrolled during the 1st year of the trial. METHODS This prospective,
multicenter, patient-blinded, randomized controlled trial will enroll 2632
patients over 5 years. Here, the authors report the incidence of adverse
events, the degree of systemic vancomycin absorption in treated patients,
and pattern changes of antibiotic-resistant profiles of Staphylococcus
aureus flora among patients enrolled during the 1st year. RESULTS The
topical vancomycin treatment group comprised 257 patients (514 total
enrolled patients), of whom 2 exhibited weakly positive serum levels of
vancomycin (> 3.0 mg/dl). S. aureus was detected preoperatively in the
anterior nares of 35 (18.1%) patients and the skin near the surgical site
of 9 (4.7%). Colonization in the nares remained for many patients (71.4%)
through postoperative day 30. The authors found a significant association
between preoperative S. aureus colonization and postoperative
colonization. Seven methicillin-resistant isolates were detected among 6
different patients. Two isolates were detected preoperatively, and 5 were
de novo postoperative colonization. No adverse responses to treatment have
been reported to date. CONCLUSIONS The authors' data indicate that the use
of topical vancomycin is safe with no significant adverse effects and
minimal systemic absorption, and no development of vancomycin-resistant
microorganisms. Copyright © AANS 2019

<56>
Accession Number
2004269729
Title
American Society of Hematology 2019 guidelines for management of venous
thromboembolism: Prevention of venous thromboembolism in surgical
hospitalized patients.
Source
Blood Advances. 3 (23) (pp 3898-3944), 2019. Date of Publication: 2019.
Author
Anderson D.R.; Morgano G.P.; Bennett C.; Dentali F.; Francis C.W.; Garcia
D.A.; Kahn S.R.; Rahman M.; Rajasekhar A.; Rogers F.B.; Smythe M.A.;
Tikkinen K.A.O.; Yates A.J.; Baldeh T.; Balduzzi S.; Brozek J.L.;
Etxeandia-Ikobaltzeta I.; Johal H.; Neumann I.; Wiercioch W.; Yepes-Nunez
J.J.; Schunemann H.J.; Dahm P.
Institution
(Anderson) Department of Medicine, Dalhousie University, Halifax, NS,
Canada
(Morgano, Baldeh, Brozek, Etxeandia-Ikobaltzeta, Wiercioch, Schunemann)
Department of Health Research Methods, Evidence and Impact, McMaster
University, Hamilton, ON, Canada
(Bennett) Shreveport, LA, United States
(Dentali) Department of Medicine and Surgery, Insubria University, Varese,
Italy
(Francis) Wilmot Cancer Center, University of Rochester Medical Center,
Rochester, NY, United States
(Garcia) Division of Hematology, Department of Medicine, University of
Washington Medical Center, University of Washington School of Medicine,
Seattle, WA, United States
(Kahn) Department of Medicine, McGill University, Lady Davis Institute,
Montreal, QC, Canada
(Rahman) Lillian S. Wells Department of Neurosurgery, University of
Florida, Gainesville, FL, United States
(Rajasekhar) Division of Hematology and Oncology, Department of Medicine,
University of Florida, Gainesville, FL, United States
(Rogers) Trauma and Acute Care Surgery, Penn Medicine Lancaster General
Health, Lancaster, PA, United States
(Smythe) Department of Pharmaceutical Services, Beaumont Hospital, Royal
Oak, MI, United States
(Smythe) Department of Pharmacy Practice, Wayne State University, Detroit,
MI, United States
(Tikkinen) Department of Urology, University of Helsinki, Helsinki
University Hospital, Helsinki, Finland
(Tikkinen) Department of Public Health, University of Helsinki, Helsinki
University Hospital, Helsinki, Finland
(Yates) Department of Orthopedic Surgery, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Balduzzi) Department of Diagnostic, Clinical, and Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
(Brozek, Schunemann) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Johal) Center for Evidence-Based Orthopaedics, Division of Orthopaedic
Surgery, McMaster University, Hamilton, ON, Canada
(Neumann) Department of Internal Medicine, School of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Yepes-Nunez) School of Medicine, Universidad de los Andes, Bogota,
Colombia
(Dahm) Urology Section, Minneapolis VA Health Care System, Minneapolis,
MN, United States
(Dahm) Department of Urology, University of Minnesota, Minneapolis, MN,
United States
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)
Abstract
Background: Venous thromboembolism (VTE) is a common source of
perioperative morbidity and mortality. Objective(s): These
evidence-based guidelines from the American Society of Hematology (ASH)
intend to support decision making about preventing VTE in patients
undergoing surgery. Method(s): ASH formed a multidisciplinary
guideline panel balanced to minimize bias from conflicts of interest. The
McMaster University GRADE Centre supported the guideline-development
process, including performing systematic reviews. The Grading of
Recommendations Assessment, Development and Evaluation (GRADE) approach
was used to assess evidence and make recommendations, which were subject
to public comment. Result(s): The panel agreed on 30 recommendations,
including for major surgery in general (n 5 8), orthopedic surgery (n 5
7), major general surgery (n 5 3), major neurosurgical procedures (n 5 2),
urological surgery (n 5 4), cardiac surgery and major vascular surgery (n
5 2), major trauma (n 5 2), and major gynecological surgery (n 5 2).
 Conclusion(s): For patients undergoing major surgery in general, the
panel made conditional recommendations for mechanical prophylaxis over no
prophylaxis, for pneumatic compression prophylaxis over graduated
compression stockings, and against inferior vena cava filters. In patients
undergoing total hip or total knee arthroplasty, conditional
recommendations included using either aspirin or anticoagulants, as well
as for a direct oral anticoagulant over low-molecular-weight heparin
(LMWH). For major general surgery, the panel suggested pharmacological
prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For
major neurosurgery, transurethral resection of the prostate, or radical
prostatectomy, the panel suggested against pharmacological prophylaxis.
For major trauma surgery or major gynecological surgery, the panel
suggested pharmacological prophylaxis over no prophylaxis. Copyright
© 2019 American Society of Hematology. All rights reserved.

<57>
Accession Number
2003850589
Title
Treatment strategies for mixed aortic valve disease in nonelderly
patients.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2019. Date of
Publication: 2019.
Author
Von Stumm M.; Petersen J.; Westermann D.; Reichenspurner H.; Girdauskas E.
Institution
(Von Stumm, Petersen, Reichenspurner, Girdauskas) Department of
Cardiovascular Surgery, University Heart Center, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Westermann) Department of Cardiology, University Heart Center, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Mixed aortic valve disease (MAVD) is defined by simultaneous
occurrence of aortic stenosis (AS) and aortic regurgitation (AR). In our
review, we focus on treatment options for nonelderly MAVD patients (age<55
years), who suffer from congenital aortic valve disease
(unicuspid/bicuspid aortic valves). Areas covered: A systematic literature
search was performed on PubMed and Embase databases using the following
terms: mixed aortic valve disease, aortic stenosis/regurgitation,
bicuspid/unicuspid aortic valve, mechanical/bioprosthetic aortic valve
replacement, TAVR, Ross procedure. After preselection of title and
abstracts, two authors (M.S. and E.G.) assessed the methodological quality
of the full-text articles prior to final inclusion in the manuscript.
Expert opinion: Currently, no ideal valvular substitutes are available in
the treatment of nonelderly MAVD patients. Mechanical valves are
associated with a reduced life expectancy due to a combination of
prothesis-associated factors, mainly thrombotic and bleeding
complications. Bioprostheses degenerate in the second decade and
re-operations are inevitable, which also limit life expectancy. Long-term
outcomes and durability of transcatheter aortic valve replacement are
currently unknown. Finally, only Ross procedure is a therapeutic option
with excellent long-term outcomes comparable to the healthy population.
However, the Ross procedure has some important drawbacks and should
therefore be only performed in expert centers and in well-selected
patients. Copyright © 2019, © 2019 Informa UK Limited,
trading as Taylor & Francis Group.

<58>
Accession Number
630165000
Title
Albumin Usage in Iran.
Source
Archives of Iranian medicine. 22 (12) (pp 722-727), 2019. Date of
Publication: 01 Dec 2019.
Author
Rezapour A.; Javan-Noughabi J.; Salehiniya H.; Kassani A.; Sadeghi A.
Institution
(Rezapour, Javan-Noughabi) Health Management and Economics Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Javan-Noughabi) Department of Health Economics, School of Health
Management and Information Sciences, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Salehiniya) Zabol University of Medical Sciences, Zabol, Iran, Islamic
Republic of
(Salehiniya) Department of Epidemiology and Biostatistics, School of
Public Health, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Kassani) Department of Community Medicine, Dezful University of Medical
Sciences, Iran, Islamic Republic of
(Sadeghi) Department of Public Health, Esfarayen Faculty of Medical
Sciences, Esfarayen, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Human albumin is an expensive therapy with inappropriate use
in many clinical conditions. Inappropriate use of albumin imposes a
substantial economic burden on the healthcare system and society. Drug use
evaluation (DUE) is one method of assessing the appropriateness of drug
use which has been powered by increasing concern about the
cost-effectiveness of drugs. The objective of this study is to
systematically review the appropriateness of albumin utilization in
Iranian hospitals. METHOD(S): We searched the PubMed, MEDLINE,
EMBASE, SCOPUS, and Google Scholar for articles in English and SID,
Magiran, Medlib, and Irandoc for articles in Persian from 1997 to 2018.
Studies on the DUE of albumin in Iranian hospitals were included in this
study. Articles conducted outside Iran, editorials, letters and review
articles were excluded. RESULT(S): In total, eight studies were
selected for the final review. The majority of the papers were conducted
in Tehran. In most studies, the highest albumin consumption was related to
the intensive care unit. The most frequent reasons for prescribing albumin
were edema, hypoalbuminemia, volume expansion after heart surgery,
ascites, cardiac surgery and cirrhosis. Of the studies included, five
studies evaluated the costs of drug use. CONCLUSION(S): Our findings
show that inappropriate use of albumin imposes a relatively high
additional cost on the society. The included studies show that the
percentage of inappropriate use of albumin is relatively high in Iran and
this abuse is an essential problem in Iranian hospitals. Prescription
based on standard guidelines could improve rational use of albumin and
lead to savings in treatment costs. Copyright © 2019 The
Author(s). This is an open-access article distributed under the terms of
the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
work is properly cited.

<59>
Accession Number
628481200
Title
A comparison of four risk models for the prediction of cardiovascular
complications in patients with a history of atrial fibrillation undergoing
non-cardiac surgery.
Source
Anaesthesia. 75 (1) (pp 27-36), 2020. Date of Publication: 01 Jan 2020.
Author
McAlister F.A.; Youngson E.; Jacka M.; Graham M.; Conen D.; Chan M.;
Szczeklik W.; Alonso-Coello P.; Devereaux P.J.
Institution
(McAlister, Youngson) Alberta SPOR Support Unit, University of Alberta,
Edmonton, AB, Canada
(McAlister) General Internal Medicine, University of Alberta, Edmonton,
AB, Canada
(Jacka) Critical Care Medicine, University of Alberta, Edmonton, AB,
Canada
(Graham) Cardiology, Department of Medicine, University of Alberta,
Edmonton, AB, Canada
(Conen, Devereaux) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong
(Szczeklik) Jagiellonian University Medical College, Department of
Intensive Care and Peri-operative Medicine, Krakow, Poland
(Alonso-Coello) Iberoamerican Cochrane Center, Biomedical Research
Institute Sant Pau (IIB-Sant Pau), CIBER de Epidemiologia y Salud Publica
(CIBERESP), Barcelona, Spain
Publisher
Blackwell Publishing Ltd
Abstract
It is unclear how best to predict peri-operative cardiovascular risk in
patients with atrial fibrillation undergoing non-cardiac surgery. This
study examined the accuracy of the revised cardiac risk index and three
atrial fibrillation thrombo-embolic risk models for predicting 30-day
cardiovascular events after non-cardiac surgery in patients with a
pre-operative history of atrial fibrillation. We conducted a prospective
cohort study in 28 centres from 2007 to 2013 of 40,004 patients >= 45
years of age undergoing inpatient non-cardiac surgery who were followed
until 30 days after surgery for cardiovascular events (defined as
myocardial injury, heart failure, stroke, resuscitated cardiac arrest or
cardiovascular death). The 2088 patients with a pre-operative history of
atrial fibrillation were at higher risk of peri-operative cardiovascular
events compared with the 34,830 patients without a history of atrial
fibrillation (29% vs. 13%, respectively, adjusted odds ratio 1.30 (95%CI
1.17-1.45). Compared with the revised cardiac risk index (c-index 0.60),
all atrial fibrillation thrombo-embolic risk scores were significantly
better at predicting peri-operative cardiovascular events:
CHADS<inf>2</inf> (c-index 0.62); CHA<inf>2</inf>DS<inf>2</inf>-VASc
(c-index 0.63); and R<inf>2</inf>CHADS<inf>2</inf> (c-index 0.65),
respectively. Although the three thrombo-embolic risk prediction models
were significantly better than the revised cardiac risk index for
prediction of peri-operative cardiovascular events, none of the four
models exhibited strong discrimination metrics. There remains a need to
develop a better peri-operative risk prediction model. Copyright
© 2019 Association of Anaesthetists

<60>
Accession Number
626962415
Title
Baseline findings of the population-based, randomized, multifaceted Danish
cardiovascular screening trial (DANCAVAS) of men aged 65-74 years.
Source
British Journal of Surgery. 106 (7) (pp 862-871), 2019. Date of
Publication: June 2019.
Author
Lindholt J.S.; Rasmussen L.M.; Sogaard R.; Lambrechtsen J.; Steffensen
F.H.; Frost L.; Egstrup K.; Urbonaviciene G.; Busk M.; Olsen M.H.; Hallas
J.; Diederichsen A.C.
Institution
(Lindholt) Elitary Research Centre of Individualized Medicine in Arterial
Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Rasmussen) Elitary Research Centre of Individualized Medicine in Arterial
Disease (CIMA), Department of Clinical Biochemistry and Pharmacology,
Odense University Hospital, Odense, Denmark
(Diederichsen) Elitary Research Centre of Individualized Medicine in
Arterial Disease (CIMA), Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Hallas) Institute of Pharmacology, University of Southern Denmark,
Odense, Denmark
(Olsen) CIMA, University of Southern Denmark, Odense, Denmark
(Sogaard) Department of Public Health and Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
(Lambrechtsen, Egstrup) Department of Cardiology, Odense University
Hospital, Svendborg, Denmark
(Steffensen, Busk) Department of Cardiology, Lillebaelt Hospital, Vejle,
Denmark
(Frost, Urbonaviciene) Department of Cardiology, Diagnostic Centre,
Regional Hospital Silkeborg, Silkeborg, Denmark
(Olsen) Department of Internal Medicine, Holbaek Hospital, Holbaek,
Denmark
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The challenge of managing age-related diseases is increasing;
routine checks by the general practitioner do not reduce cardiovascular
mortality. The aim here was to reduce cardiovascular mortality by advanced
population-based cardiovascular screening. The present article reports the
organization of the study, the acceptability of the screening offer, and
the relevance of multifaceted screening for prevention and management of
cardiovascular disease. Method(s): Danish men aged 65-74 years were
invited randomly (1 : 2) to a cardiovascular screening examination using
low-dose non-contrast CT, ankle and brachial BP measurements, and blood
tests. Result(s): In all, 16 768 of 47 322 men aged 65-74 years were
invited and 10 471 attended (uptake 62.4 per cent). Of these, 3481 (33.2
per cent) had a coronary artery calcium score above 400 units. Thoracic
aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or
greater) in 468 men (4.5 per cent), in the arch (at least 40 mm) in 48
(0.5 per cent) and in the descending aorta (35 mm or more) in 233 (2.2 per
cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20
mm or greater) were diagnosed in 533 (5.1 per cent) and 239 (2.3 per cent)
men respectively. Peripheral artery disease was diagnosed in 1147 men
(11.0 per cent), potentially uncontrolled hypertension (at least 160/100
mmHg) in 835 (8.0 per cent), previously unknown atrial fibrillation
confirmed by ECG in 50 (0.5 per cent), previously unknown diabetes
mellitus in 180 (1.7 per cent) and isolated severe hyperlipidaemia in 48
men (0.5 per cent). In all, 4387 men (41.9 per cent), excluding those with
potentially uncontrolled hypertension, were referred for additional
cardiovascular prevention. Of these, 3712 (35.5 per cent of all screened
men, but 84.6 per cent of those referred) consented and were started on
medication. Conclusion(s): Multifaceted cardiovascular screening is
feasible and may optimize cardiovascular disease prevention in men aged
65-74 years. Uptake is lower than in aortic aneurysm
screening. Copyright © 2019 BJS Society Ltd Published by John
Wiley & Sons Ltd

<61>
Accession Number
2003355967
Title
Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1840-1848), 2019. Date of
Publication: December 2019.
Author
Padmanabhan H.; Siau K.; Curtis J.; Ng A.; Menon S.; Luckraz H.; Brookes
M.J.
Institution
(Padmanabhan, Siau, Menon, Brookes) Department of Gastroenterology, Heart
& Lung Centre, Wolverhampton, United Kingdom
(Curtis) Shrewsbury Health Library, Royal Shrewsbury Hospital, Shrewsbury,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton, United Kingdom
(Luckraz) Cardiothoracic Surgery Department, Heart Centre, American
Hospital Dubai, Oud Metha, Dubai, United Arab Emirates
Publisher
Elsevier USA
Abstract
Background: Preoperative anemia is common in patients scheduled for
cardiac surgery. However, its effect on postoperative outcomes remains
controversial. This meta-analysis aimed to clarify the impact of anemia on
outcomes after cardiac surgery. Method(s): A literature search was
conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The
primary outcome was 30-day postoperative or in-hospital mortality.
Secondary outcomes included acute kidney injury, stroke, blood
transfusion, and infection. A meta-analytic model was used to determine
the differences in the above postoperative outcomes between anemic and
nonanemic patients. Result(s): Of 1103 studies screened, 22 met the
inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic.
Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95%
confidence interval [CI], 2.32-3.24; I2 = 69.6%; P < .001),
acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I2 = 71.1%; P
< .001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I2 = 21.6%; P <
.001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I2 = 46.7%;
P < .001). More anemic patients were transfused than nonanemic patients
(33.3% vs 11.9%, respectively). No statistically significant association
was found between mortality and blood transfusion (OR, 1.35; 95% CI,
0.92-1.98; I2 = 83.7%; P = .12), but we were not able to
compare mortality with or without transfusion in those who were or were
not anemic. Conclusion(s): Preoperative anemia is associated with
adverse outcomes after cardiac surgery. These findings support the
addition of preoperative anemia to future risk prediction models and as a
target for risk modification. Copyright © 2019 The Society of
Thoracic Surgeons

<62>
Accession Number
2003793145
Title
Preventing spasm of the radial artery conduit during coronary artery
bypass grafting: Nicardipine versus verapamil.
Source
Journal of Cardiac Surgery. 34 (12) (pp 1505-1510), 2019. Date of
Publication: 01 Dec 2019.
Author
Ozdemir H.I.; van Dijk C.H.B.; Ozdemir A.B.; van Straten B.H.M.;
Haanschoten M.; Soliman-Hamad M.A.
Institution
(Ozdemir, van Dijk, van Straten, Soliman-Hamad) Department of
Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
(Ozdemir) Department of Engineering Technology, KU Leuven, Belgium
(Haanschoten) Department of Anesthesiology, Catharina Hospital, Eindhoven,
Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and aim of the study: In vitro studies have shown a reduction
in radial artery spasm with the use of calcium antagonists. The purpose of
this study was to evaluate the efficacy of topical treatment of the radial
artery conduit using either verapamil or nicardipine before the
anastomoses. Method(s): This prospective randomized study included
131 patients, who underwent coronary artery bypass grafting surgery with
the use of the radial artery as a conduit. In 65 patients, the harvested
radial artery was topically treated with verapamil and in 66 patients with
nicardipine. After harvesting the radial artery, the direct flow through
the conduit was measured in vitro before 5-minute incubation in
nicardipine or verapamil and measured again after incubation. The flow
before and after incubation was compared. Postincubation flow was also
compared in the two groups. After performing the anastomosis, the flow
through the radial artery was measured in vivo. Result(s): The mean
flow after NaCl incubation was 19.93 +/- 12.66 mL/min and after incubation
in the Ca+ channel blocker 47.16 +/- 14.58 mL/min (P <.001). No
significant difference in postincubation free flow was found between
verapamil (46.29 +/- 15.43 mL/min) and nicardipine (48.01 +/- 13.77
mL/min; P =.503). Conclusion(s): Topical treatment with Ca+ channel
blockers reduces radial artery spasm and significantly increases the free
flow through the radial artery conduit. Nicardipine is a safe and
effective alternative of verapamil in preventing spasm of radial artery
conduit. Copyright © 2019 Wiley Periodicals, Inc.

<63>
Accession Number
630049669
Title
The effect of remote ischaemic preconditioning on myocardial injury in
emergency hip fracture surgery (PIXIE trial): Phase II randomised clinical
trial.
Source
The BMJ. 367 (no pagination), 2019. Article Number: l6395. Date of
Publication: 04 Dec 2019.
Author
Ekeloef S.; Homilius M.; Stilling M.; Ekeloef P.; Koyuncu S.; Munster
A.-M.B.; Meyhoff C.S.; Gundel O.; Holst-Knudsen J.; Mathiesen O.; Gogenur
I.
Institution
(Ekeloef, Gogenur) Center for Surgical Science, Department of Surgery,
Zealand University Hospital, Lykkebaekvej 1, Koege DK-4600, Denmark
(Homilius, Stilling) Department of Orthopaedic Surgery, University Clinic
for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro,
Denmark
(Stilling) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
(Ekeloef) Department of Anaesthesiology, Regional Hospital West Jutland,
Holstebro, Denmark
(Koyuncu, Holst-Knudsen, Mathiesen) Centre for Anaesthesiological
Research, Department of Anaesthesiology, Zealand University Hospital,
Koege, Denmark
(Munster) Department of Clinical Biochemistry, Regional Hospital West
Jutland, Holstebro, Denmark
(Munster) Unit for Thrombosis Research, Department of Clinical
Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
(Meyhoff, Gundel) Department of Anaesthesia and Intensive Care, Bispebjerg
and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Gundel) Department of Anaesthesiology, Herlev and Gentofte Hospital,
University of Copenhagen, Herlev, Denmark
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To investigate whether remote ischaemic preconditioning (RIPC)
prevents myocardial injury in patients undergoing hip fracture surgery.
Design Phase II, multicentre, randomised, observer blinded, clinical
trial. Setting Three Danish university hospitals, 2015-17. Participants
648 patients with cardiovascular risk factors undergoing hip fracture
surgery. 286 patients were assigned to RIPC and 287 were assigned to
standard practice (control group). Intervention The RIPC procedure was
initiated before surgery with a tourniquet applied to the upper arm and
consisted of four cycles of forearm ischaemia for five minutes followed by
reperfusion for five minutes. Main outcome measures The original primary
outcome was myocardial injury within four days of surgery, defined as a
peak plasma cardiac troponin I concentration of 45 ng/L or more caused by
ischaemia. The revised primary outcome was myocardial injury within four
days of surgery, defined as a peak plasma cardiac troponin I concentration
of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the
primary outcome was changed owing to availability of testing). Secondary
outcomes were peak plasma troponin I and total troponin I release during
the first four days after surgery (cardiac and high sensitive troponin I),
perioperative myocardial infarction, major adverse cardiovascular events,
and all cause mortality within 30 days of surgery, length of postoperative
stay, and length of stay in the intensive care unit. Several planned
secondary outcomes will be reported elsewhere. Results 573 of the 648
randomised patients were included in the intention-to-treat analysis (mean
age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25
of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control
group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003).
The revised primary outcome occurred in 57 of 286 patients (20%) in the
RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80;
P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC
group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99;
P=0.04). Statistical power was insufficient to draw firm conclusions on
differences between groups for the other clinical secondary outcomes
(major adverse cardiovascular events, 30 day all cause mortality, length
of postoperative stay, and length of stay in the intensive care unit).
Conclusions RIPC reduced the risk of myocardial injury and infarction
after emergency hip fracture surgery. It cannot be concluded that RIPC
overall prevents major adverse cardiovascular events after surgery. The
findings support larger scale clinical trials to assess longer term
clinical outcomes and mortality. Trial registration ClinicalTrials.gov
NCT02344797. Copyright © Published by the BMJ Publishing Group
Limited. For permission to use (where not already granted under a licence)
please go to.

<64>
Accession Number
2002952567
Title
Predictive Capacity of Oxygen Delivery During Cardiopulmonary Bypass on
Acute Kidney Injury.
Source
Annals of Thoracic Surgery. 108 (6) (pp 1807-1814), 2019. Date of
Publication: December 2019.
Author
Newland R.F.; Baker R.A.; Woodman R.J.; Barnes M.B.; Willcox T.W.
Institution
(Newland, Baker) Quality and Outcomes, Cardiothoracic Surgical Unit,
Flinders Medical Centre, Adelaide, Australia
(Newland, Baker) Perfusion Service, Cardiothoracic Surgical Unit, Flinders
Medical Centre, Adelaide, Australia
(Newland, Baker) Department of Surgery, College of Medicine and Public
Health, Flinders University, Adelaide, Australia
(Woodman, Barnes) Flinders Centre for Epidemiology and Biostatistics,
Flinders University, Adelaide, Australia
(Willcox) Greenlane Perfusion, Auckland City Hospital, Auckland, New
Zealand
(Willcox) Department of Anaesthesia, University of Auckland, Auckland, New
Zealand
Publisher
Elsevier USA
Abstract
Background: The randomized goal-directed perfusion trial confirmed
retrospective findings that a goal-directed perfusion strategy to maintain
oxygen delivery index (DO<inf>2</inf>i) during cardiopulmonary bypass
greater than 280 mL/min/m2 reduces the incidence of acute
kidney injury (AKI). We developed a predictive model for AKI using data
from the Australian and New Zealand Collaborative Perfusion Registry to
determine whether these findings could be validated in a real-world
clinical setting and to identify an optimal DO<inf>2</inf>i threshold for
predictive diagnostic accuracy. Method(s): Data in 19,410
cardiopulmonary bypass procedures were randomly divided into training (n =
9705) and validation (n = 9705) datasets. Multivariate logistic regression
was used to determine the best predictive models for AKI (RIFLE [renal
Risk, Injury, Failure, Loss of renal function and End-stage renal disease]
classification), incremental predictive value of minimum cardiopulmonary
bypass DO<inf>2</inf>i, and optimal threshold. Result(s): Minimum
DO<inf>2</inf>i was significantly associated with any AKI, AKI risk, and
AKI injury or greater class in both datasets (validation dataset; any AKI
odds ratio [OR], 0.993; 95% confidence interval [CI], 0.991-0.995; P <
.001; AKI risk OR, 0.994; 95% CI, 0.992-0.996; P < .001, AKI injury or
greater 0.993; 95% CI, 0.991-0.996; P < .001), representing on average a
7% increase in the likelihood of AKI for every 10-mL/min/m2
decrease in DO<inf>2</inf>i. Diagnostic accuracy was similar for both
datasets, with an optimal DO<inf>2</inf>i threshold of 270
mL/min/m2. The odds of any AKI were increased by 52% in those
below the threshold (OR, 1.52; 95% CI, 1.29-1.77; P < .001).
 Conclusion(s): This study confirms previous findings that minimum
DO<inf>2</inf>i during cardiopulmonary bypass is independently associated
with AKI, supporting previous findings in a broader-risk, multicenter
cohort. Copyright © 2019 The Society of Thoracic Surgeons

<65>
Accession Number
2002142929
Title
High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe
Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled
Study-The HEART FLOW Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 157-165),
2020. Date of Publication: January 2020.
Author
Vourc'h M.; Nicolet J.; Volteau C.; Caubert L.; Chabbert C.; Lepoivre T.;
Senage T.; Roussel J.-C.; Rozec B.
Institution
(Vourc'h, Nicolet, Caubert, Chabbert, Lepoivre, Rozec) Intensive Care Unit
of Cardiothoracic Surgery, Department of Anesthesia and Critical Care,
Hopital Laennec, University Hospital of Nantes, Nantes, France
(Volteau) Department of Methodology and Biostatistics, Department of
Research Promotion, University Hospital of Nantes, Nantes, France
(Senage, Roussel) Cardiovascular and Thoracic Surgery Unit, Hopital
Laennec, University Hospital of Nantes, Nantes, France
Publisher
W.B. Saunders
Abstract
Objective: To determine whether high-flow oxygen therapy by nasal cannulae
(HFNC) is more effective than a high-flow face mask (HFFM) in severe
hypoxemia. Design(s): Randomized, single-center, open-labeled,
controlled trial. Setting(s): University Hospital of Nantes, France.
 Participant(s): Cardiac surgery patients presenting oxygen saturation
<96% with Venturi mask 50%. Intervention(s): Oxygenation by HFNC (45
L/min, F<inf>I</inf>O<inf>2</inf> 100%) or Hudson RCI non-rebreather face
mask with a reservoir bag (15 L/min). Measurements and Main Results:
The co-primary outcomes were the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at 1 and 24 hours. In the
intent-to-treat analysis (90 patients), the mean (standard deviation)
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratios were: after 1 hour,
113.4 (50.2) in HFFM versus 137.8 (57.0) in HFNC (mean difference 24.4, CI
97.5% [2.9-45.9], p = 0.03), and after 24 hours, 106.9 (62.6) in HFFM
versus 129.9 (54.0) in HFNC (mean difference 23.0, CI 97.5% [1.5-44.6], p
= 0.04). After adjustment on baseline
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2,</inf> this difference persisted at
24 hours (p = 0.04). For secondary outcomes, the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio after 6 hours was 108.7
(47.9) in HFFM versus 136.0 (45.2) in HFNC (p = 0.01), without difference
after 48 hours (p = 0.95). Refractory hypoxemia requiring noninvasive
ventilation occurred in 13 (28%) patients in HFNC versus 24 (56%) patients
in HFFM (p = 0.007). The HFNC improved satisfaction (p = 0.0002) and
reduced mucus dryness (p = 0.003) compared with HFFM. Conclusion(s):
In patients with severe hypoxemia after cardiac surgery,
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> at 1 and 24 hours were higher
and the use of noninvasive ventilation was reduced in HFNC compared with
HFFM. Copyright © 2019 Elsevier Inc.

<66>
Accession Number
2004001712
Title
Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A
Population-Based Analysis.
Source
Annals of Thoracic Surgery. 109 (1) (pp 203-210), 2020. Date of
Publication: January 2020.
Author
Rehmani S.S.; Raad W.; Weber J.; Lazarev S.; Ayub A.; Al-Ayoubi A.M.;
Bhora F.Y.
Institution
(Rehmani, Raad, Weber, Ayub, Al-Ayoubi, Bhora) Department of Thoracic
Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health
System, New York, NY, United States
(Weber, Bhora) Department of Thoracic Surgery, Health Quest, Poughkeepsie,
NY, United States
(Lazarev) Department of Radiation Oncology, Icahn School of Medicine at
Mount Sinai, Mount Sinai Health System, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: The role of adjuvant radiation therapy (RT) in the management
of thoracic soft tissue sarcomas (STSs) remains unclear. We aimed to study
the characteristics of patients with thoracic STS who received RT after
surgical resection and investigate the impact of RT on survival outcomes.
 Method(s): We queried National Cancer Database to identify patients
with surgically resected thoracic STS from 2004 to 2012. Factors
associated with receiving adjuvant RT were identified. Analyses were
performed to identify prognostic factors and compare overall survival (OS)
in both unmatched and propensity score-matched cohorts. Result(s):
Overall, 1215 patients were identified, of whom 557 (45.8%) received
adjuvant RT. Tumor grade (odds ratio [OR], 2.87; 95% confidence interval
[CI], 2.18-3.77), tumor size (OR, 1.82; 95% CI, 1.36-2.42), and tumor
margins (OR, 1.97; 95% CI, 1.43-2.72) were found to be significant
predictors of receiving RT. Mean OS of patients receiving RT in the
unmatched cohort was 91 months vs 88 months for patients who did not (P =
.556). When adjusted for all variables, adjuvant RT was found to be
associated with improved survival (hazard ratio, 0.79; 95% CI, 0.61-0.96).
Survival analysis of the matched cohort also demonstrated improved
survival with adjuvant RT (120 months vs 100 months; P = .02). Subgroup
analysis in both the unmatched and matched cohorts showed patients with
high-grade tumors more likely to benefit from adjuvant RT.
 Conclusion(s): This population-based analysis is the largest dataset
of primary thoracic STSs to date and suggests significant survival benefit
associated with adjuvant RT. The improvement in OS was more notable in
patients with high-grade tumors. Randomized prospective studies are
warranted to further understand the benefit of RT in this
group. Copyright © 2020 The Society of Thoracic Surgeons

<67>
Accession Number
2003792554
Title
Usefulness of Discharge Resting Heart Rate to Predict Adverse
Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease
Revascularized With Percutaneous Coronary Intervention vs Coronary Artery
Bypass Grafting (from the EXCEL Trial).
Source
American Journal of Cardiology. 125 (2) (pp 169-175), 2020. Date of
Publication: 15 January 2020.
Author
Kosmidou I.; Crowley A.; Macedo L.; Ben-Yehuda O.; Gersh B.J.; Boonstra
P.W.; Kappetein A.P.; Serruys P.W.; Sabik J.F.; Stone G.W.
Institution
(Kosmidou, Crowley, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Macedo, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The prognostic impact of resting heart rate (RHR) following
revascularization with percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) in patients with left main coronary
artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at
discharge on 3-year cardiovascular outcomes following PCI and CABG for
LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to
PCI with everolimus-eluting stents versus CABG. RHR was measured at
discharge following the index hospitalization. The principal outcome
measure was the composite endpoint of death, myocardial infarction (MI) or
stroke at 3 years. Among 1,303 patients in sinus rhythm with available
ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median
discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus
65 [IQR 59 to 74] bpm, p <0.0001). At 3 years, 107 patients (8.2%) had a
primary composite endpoint event including 61 patients (4.7%) who died. By
multivariable analysis, discharge RHR assessed as a continuous variable
(per 5 bpm) was an independent predictor at 3 years of the primary
composite endpoint of death, MI, or stroke (hazard ratio [HR] 1.15, 95%
confidence interval [CI] 1.06 to 1.25, p = 0.0006); the secondary
composite endpoint of death, MI, stroke, or ischemia-driven
revascularization at 3 years (HR 1.12, 95% CI 1.05 to 1.19, p = 0.0007);
all-cause mortality (HR 1.18, 95% CI 1.07 to 1.31, p = 0.002); and
cardiovascular death (HR 1.16, 95% CI 1.00 to 1.33, p = 0.046). No
significant interactions were present between RHR and treatment with PCI
versus CABG for the primary (p<inf>int</inf> = 0.20) or secondary
(p<inf>int</inf> = 0.47) composite endpoints. In patients with LMCAD
undergoing revascularization, an increased RHR at discharge was associated
with a higher risk for adverse cardiovascular outcomes at 3 years,
irrespective of treatment modality. Copyright © 2019 Elsevier
Inc.

<68>
Accession Number
2003366147
Title
Prophylactic Noninvasive Ventilation Versus Conventional Care in Patients
After Cardiac Surgery.
Source
Journal of Surgical Research. 246 (pp 384-394), 2020. Date of Publication:
February 2020.
Author
Liu Q.; Shan M.; Liu J.; Cui L.; Lan C.
Institution
(Liu, Shan, Lan) Department of Respiratory Mechanics Lab, Emergency
Intensive Care Ward, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, Henan, China
(Liu) Department of Thoracic Surgery, the First Affiliated Hospital of
Zhengzhou University, Zhengzhou, Henan, China
(Cui) Department of Preventive Medicine, Epidemiology and Health
Statistics School of Public Health, Zhengzhou University, Zhengzhou,
Henan, China
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Cardiac surgery can be accompanied by postoperative
complications, which are associated with increased postoperative morbidity
and mortality. Therefore, it is necessary to investigate the effect of
prophylactic noninvasive ventilation (NIV) after extubation versus
conventional pulmonary care on complications after cardiac surgery.
 Material(s) and Method(s): An electronic search of PubMed, Cochrane
Library, Ovid, and EMBASE was conducted to find randomized controlled
trials which compared the effect of prophylactic NIV with controlled
strategies on complications and which were published before April 2018.
 Result(s): Ten studies (1011 patients) were included in the final
analysis. The atelectasis rate was 32.6% in the prophylactic-NIV group,
which was lower than that in the control group (48.71%). Prophylactic NIV
could lower the rate of atelectasis, reintubation, and other respiratory
complications (pleural effusion, pneumonia, and hypoxia) (odds ratio =
0.43, 0.33, and 0.45; 95% confidence interval: 0.21-0.88, 0. 13-0.84,
0.27-0.75; P = 0.02, 0.02, and 0.002, respectively). The effect on cardiac
and distal organ complications (P = 0.07) and hospital mortality (P =
0.62) might be limited. Conclusion(s): Prophylactic NIV is associated
with a lower rate of postoperative pulmonary complications. The effect on
the other complications and hospital mortality might be limited. Further
evidence with randomized controlled trials can discern the
benefits. Copyright © 2019 The Authors

<69>
Accession Number
2003528911
Title
Radiation Exposure During Transcatheter Valve Replacement: What Cardiac
Surgeons Need to Know.
Source
Annals of Thoracic Surgery. 109 (1) (pp 118-122), 2020. Date of
Publication: January 2020.
Author
Aquino A.; Khiabani A.J.; Henn M.C.; Zajarias A.; Melby S.J.; Sintek M.;
Lasala J.; Kachroo P.; Novak E.; Maniar H.S.
Institution
(Aquino, Zajarias, Sintek, Lasala, Novak) Cardiovascular Division,
Department of Medicine, Washington University School of Medicine,
Barnes-Jewish Hospital, St Louis, MO, United States
(Khiabani, Henn, Melby, Kachroo, Maniar) Division of Cardiothoracic
Surgery, Department of Surgery, Washington University School of Medicine,
Barnes-Jewish Hospital, St Louis, MO, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) and
transcatheter mitral valve replacement expose operators to radiation.
These procedures differ primarily in whether they are performed via a
transfemoral (TF) or an alternative access (AA) approach. This study
compared operator radiation exposure during transcatheter valve
implantation when performed via a TF vs an AA approach, when performed in
a catheterization lab vs a hybrid operating room (OR), and investigated
the potential benefit of disposable shielding. Method(s): Dosimeters
were worn during TAVR-TF (n = 50) and TAVR-AA (n = 31) procedures by
operators. All TAVR-AA procedures were performed in a hybrid OR and TF
procedures were performed in either catheterization labs (n = 16) or a
hybrid OR (n = 34). Disposable radiation shielding pads (RADPAD; Worldwide
Innovations and Technologies, Inc, Kansas City) or a placebo were added in
a randomized, blinded fashion. Result(s): Team radiation exposure was
higher after TAVR-AA vs TAVR-TF (median 15.1 mRad [interquartile range:
IQR 8.6, 32.4] vs 5.5 mRad [IQR 2.4, 9.8], P < .001). TAVR-TF procedures
required the same amount of fluoroscopy time regardless of where they were
performed (20.3 +/- 7.4 min in hybrid OR vs 19.0 +/- 6.4 min in
catheterization lab, P = .55). However, radiation exposure for TAVR-TF
remained higher when performed in a hybrid OR (median 9.0 mRad [IQR 4.5,
11.9] vs 2.2 mRad [IQR 1.3, 2.8], P < .001). Radiation exposure was
greatest for TAVR-AA (median 15.1 mRad [IQR 8.6, 32.4]). The use of RADPAD
did not decrease radiation exposure (median 9.0 mRad [IQR 4.5, 14.7] vs
9.4 mRad [IQR 2.8, 19.5], P = .82). Conclusion(s): Procedures
performed in the hybrid OR were associated with higher operator radiation
exposure. In comparison with the TF approach, AA cases had the highest
levels of operator radiation. This is particularly important in cases of
transcatheter mitral valve replacement that can only be done via an AA
approach. The use of disposable radiation shielding in this series did not
attenuate operator radiation exposure. Radiation shielding within hybrid
ORs should be scrutinized in an effort to remain on par with that found
within catheterization labs. Copyright © 2020 The Society of
Thoracic Surgeons

<70>
Accession Number
2004121089
Title
Incidence and Prognostic Impact of Atrial Fibrillation After Discharge
Following Revascularization for Significant Left Main Coronary Artery
Narrowing.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kosmidou I.; Liu Y.; Zhang Z.; Redfors B.; Kappetein A.P.; Serruys P.W.;
Gersh B.J.; Kandzari D.E.; Morice M.-C.; Buszman P.E.; Bochenek A.;
Schampaert E.; Sabik J.F.; Ben-Yehuda O.; Stone G.W.
Institution
(Kosmidou, Liu, Zhang, Redfors, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Redfors, Ben-Yehuda) Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Morice) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Paris, France
(Buszman) Department of Epidemiology and Statistics, Medical University of
Silesia, Katowice, Poland
(Buszman) Department of Cardiovascular Research and Development, American
Heart of Poland, Ustron, Poland
(Bochenek) University of Technology, Medical Faculty, Katowice, Poland
(Schampaert) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The incidence, recurrence rate, and prognostic significance of atrial
fibrillation or flutter (AF) following hospital discharge after
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.
We sought to determine the 3-year incidence and clinical impact of
postdischarge AF in patients with LMCAD treated with PCI or CABG. In the
EXCEL trial, 1,905 patients with LMCAD were randomized to PCI versus CABG.
We analyzed the occurrence of postdischarge AF through 3 years and its
time-adjusted association with adverse outcomes. A total of 1,802 patients
without AF at baseline comprised the study cohort. Within 3 years, 227
episodes of AF occurred (29 [12.8%] in the PCI arm and 198 [87.2%] in the
CABG arm, p <0.0001); of those, 63 (27.7%) occurred following discharge
from the index hospitalization in 57 patients. In-hospital AF predicted
postdischarge AF (hazard ratio [HR] 2.94, 95% confidence interval [CI]
1.42 to 6.10, p = 0.004). By multivariable analysis, time-updated
postdischarge AF was an independent predictor of 3-year cardiovascular
death (HR 4.91, 95% CI 1.92 to 12.60, p = 0.0009), stroke (HR 4.87, 95% CI
1.12 to 21.12, p = 0.035), and the composite outcome of death, stroke or
myocardial infarction (HR 3.09, 95% CI 1.56 to 3.6-6.11, p = 0.001). Among
patients with postdischarge AF, the rate of the primary composite outcome
did not vary according to presence or absence of in-hospital AF (21.0% vs
23.8%, p = 0.78). In conclusion, postdischarge AF following CABG or PCI
for LMCAD is associated with increased mortality and stroke. In-hospital
atrial fibrillation is an independent predictor of AF following
discharge. Copyright © 2019 Elsevier Inc.

<71>
Accession Number
2004107413
Title
Effect of red blood cell storage duration on major postoperative
complications in cardiac surgery: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Koch C.G.; Sessler D.I.; Duncan A.E.; Mascha E.J.; Li L.; Yang D.;
Figueroa P.; Sabik J.F.; Mihaljevic T.; Svensson L.G.; Blackstone E.H.
Institution
(Koch) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins Medicine, Baltimore, Md, United States
(Sessler, Mascha, Yang) Department of Outcomes Researc, Cleveland Clinic,
Cleveland, OH, United States
(Duncan) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Mascha, Yang, Blackstone) Department of Quantitative Health Sciences,
Cleveland Clinic, Cleveland, OH, United States
(Li) Division of Science, Department of Biostatistics, MD Anderson Cancer
Center, Houston, Tex, United States
(Figueroa) Department of Clinical Pathology, Cleveland Clinic, Cleveland,
OH, United States
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Mihaljevic, Svensson, Blackstone) Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Although observational studies suggest an association between
transfusion of older red blood cell (RBC) units and increased
postoperative risk, randomized trials have not supported this. The
objective of this randomized trial was to test the effect of RBC storage
age on outcomes after cardiac surgery. Method(s): From July 2007 to
May 2016, 3835 adults undergoing coronary artery bypass grafting, cardiac
valve procedures, or ascending aorta repair, either alone or in
combination, were randomized to transfusion of RBCs stored for <=14 days
(younger units) or for >=20 days (older units) intraoperatively and
throughout the postoperative hospitalization. According to protocol, 2448
patients were excluded because they did not receive RBC transfusions.
Among the remaining 1387 modified intent-to-treat patients, 701 were
randomized to receive younger RBC units (median age, 11 days) and the
remaining 686 to receive older units (median age, 25 days). The primary
endpoint was composite morbidity and mortality, analyzed using a
generalized estimating equation (GEE) model. The trial was discontinued
midway owing to enrollment constraints. Result(s): A total of 5470
RBC units were transfused, including 2783 in the younger RBC storage group
and 2687 in the older RBC storage group. The GEE average relative-effect
odds ratio was 0.77 (95% confidence interval [CI], 0.50-1.19; P = .083)
for the composite morbidity and mortality endpoint. In-hospital mortality
was lower for the younger RBC storage group (2.1% [n = 15] vs 3.4% [n =
23]), as was occurrence of other adverse events except for atrial
fibrillation, although all CIs crossed 1.0. Conclusion(s): This
clinical trial, which was stopped at its midpoint owing to enrollment
constraints, supports neither the efficacy nor the futility of transfusing
either younger or older RBC units. The effects of transfusing RBCs after
even more prolonged storage (35-42 days) remains untested. Copyright
© 2019 The American Association for Thoracic Surgery

<72>
Accession Number
2003392884
Title
Impact of diabetes mellitus on short term vascular complications after
TAVR: Results from the BRAVO-3 randomized trial.
Source
International Journal of Cardiology. 297 (pp 22-29), 2019. Date of
Publication: 15 December 2019.
Author
Goel R.; Power D.; Tchetche D.; Chandiramani R.; Guedeney P.; Claessen
B.E.; Sartori S.; Cao D.; Meneveau N.; Tron C.; Dumonteil N.; Widder J.D.;
Hengstenberg C.; Ferrari M.; Violini R.; Stella P.R.; Jeger R.;
Anthopoulos P.; Deliargyris E.N.; Mehran R.; Dangas G.D.
Institution
(Goel, Power, Chandiramani, Claessen, Sartori, Cao, Mehran, Dangas) The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York City, NY, United States
(Tchetche, Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique
Pasteur, Toulouse, France
(Guedeney) Sorbonne Universite, ACTION Study Group, Institut de
Cardiologie, Pitie Salpetriere Hospital (AP-HP), UMR_S, Paris 1166, France
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
EA3920, Besancon 25000, France
(Tron) Division of Cardiology, CHU de Rouen, Rouen, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Hengstenberg) Department of Internal Medicine II, Division of Cardiology,
Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090,
Austria
(Ferrari) Helios Dr. Horst Schmidt Kliniken Wiesbaden, Germany
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Via
Circonvallazione Gianicolense, Rome, Italy
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Anthopoulos) Arena Pharmaceuticals Inc., Canton of Zug, Zug, Switzerland
(Deliargyris) PLx Pharma Inc., Sparta, NJ, United States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: The impact of diabetes mellitus (DM) on clinical outcomes after
transcatheter aortic valve replacement (TAVR) remains unclear. The aim of
this study was to investigate the impact of DM on short-term clinical
outcomes after TAVR in a large randomized trial population. Methods
and Results: BRAVO-3 trial randomized 802 patients undergoing
trans-femoral TAVR to procedural anticoagulation with bivalirudin or
unfractionated heparin. The study population was divided according to the
presence of DM, and further stratified according to the use of insulin.
Net adverse cardiovascular outcomes (NACE - death, myocardial infarction
(MI), stroke or major bleeding by Bleeding Academic Research Consortium
(BARC) type 3b or above) was the primary outcome in-hospital and at
30-days. Of the total 802 randomized patients, 239 (30%) had DM at
baseline, with 87 (36%) being treated with insulin. At 30-days, DM
patients experienced numerically higher rates of net adverse
cardiovascular events (16.3% vs. 14.4%, p = 0.48) and acute kidney injury
(19.7% vs. 15.1%, p = 0.11), while non-DM (NDM) patients had numerically
higher rates of cerebrovascular accidents (3.6% vs. 1.7%, p = 0.22). After
multivariable adjustment, DM patients had higher odds of vascular
complications at 30-days (OR 1.57, p = 0.03) and life-threatening bleeding
both in-hospital (OR 1.50, p = 0.046) and at 30-days (OR 1.50, p = 0.03)
with the excess overall risk primarily attributed to the higher rates
observed among non-insulin dependent DM patients. Conclusion(s):
Patients with DM had higher adjusted odds of vascular and bleeding
complications up to 30-days post-TAVR. Overall, there was no significant
association between DM and early mortality following TAVR. Copyright
© 2019 Elsevier B.V.

<73>
Accession Number
628880569
Title
Inflammatory Response and Endothelial Dysfunction Following
Cardiopulmonary Bypass: Pathophysiology and Pharmacological Targets.
Source
Recent patents on inflammation & allergy drug discovery. 13 (2) (pp
158-173), 2019. Date of Publication: 2019.
Author
Giacinto O.; Satriano U.; Nenna A.; Spadaccio C.; Lusini M.; Mastroianni
C.; Nappi F.; Chello M.
Institution
(Giacinto, Satriano, Nenna, Lusini, Mastroianni, Chello) Department of
Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Spadaccio) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Endothelial injury occurring during cardiopulmonary bypass is
a major contributing factor in the development of organ dysfunction, which
leads to many of the postoperative complications occurring during cardiac
surgery. OBJECTIVE(S): This narrative review aims to summarize the
main mechanisms of cardiopulmonary bypass - related disease, evaluating
the unfavorable events leading to tissue injury, with a description of
current pharmacologic and non-pharmacologic mechanisms to reduce
CPB-related injury. METHOD(S): A Medline/Pubmed/Scopus search was
conducted using clinical queries with the key terms "cardiac surgery",
"cardiopulmonary bypass", "inflammation" and "endothelial injury", and
related MeSH terms, until July 2019. The search strategy included
meta-analyses, randomized controlled trials, clinical trials, reviews and
pertinent references. Patents were searched using the same key terms from
https://patents.google.com/, www.uspto.gov, and www.freepatentsonline.com.
 RESULT(S): In this review, we discuss the current knowledge of the
mechanisms of vascular endothelial cell injury, the acute inflammatory
response, and the regulatory factors that control the extent of vascular
injury during extracorporeal circulation, summarizing the main target of
anti-inflammatory pharmacologic and non-pharmacologic strategies.
 CONCLUSION(S): Inflammatory response and endothelial dysfunction
following cardiopulmonary bypass are the prices to pay for the benefits
offered during cardiac surgery procedures. Counteracting the detrimental
effect of extracorporeal circulation appears to be crucial to improve
clinical outcomes in pediatric and adult cardiac surgery. The intrinsic
complexity and the tight interplay of the factors involved might require a
holistic approach against inflammation and endothelial
response. Copyright© Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<74>
Accession Number
2004090837
Title
Natriuretic peptides in acute kidney injury - A sojourn on parallel
tracks?.
Source
European Journal of Internal Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Dass B.; Beaver T.M.; Shimada M.; Alquadan K.F.; Koratala A.; Singhania
G.; Singh A.; Ejaz A.A.
Institution
(Dass, Alquadan, Koratala, Singhania, Singh, Ejaz) Division of Nephrology,
Hypertension and Transplantation, University of Florida, P.O. Box 100224,
Gainesville, FL 32610, United States
(Beaver) Division of Cardiovascular Surgery, University of Florida,
Gainesville, United States
(Shimada) Division of Nephrology, Hirosaki University Graduate School of
Medicine, Hirosaki, Japan
Publisher
Elsevier B.V.
Abstract
Objective: The focus of this review was to elicit the mechanistic logic of
the experimental and clinical study designs of natriuretic peptides (NP)
in acute kidney injury (AKI) and to understand their respective outcomes.
 Method(s): Online search of PubMed and manual review of articles.
Randomized trials, observational and physiologic studies of NPs and AKI
were extracted. Rationale, design and study outcomes were analyzed.
 Result(s): In experimental models of AKI, infusion of NP prevented
post-ischemic fall in renal blood flow (RBF) or improvement in RBF, GFR,
diuresis and natriuresis and demonstrated anti-inflammatory properties.
NPs were most effective in the early stages of AKI, also in established
phase of AKI but their effectiveness were limited to the time of infusion.
Hypotension was a major side-effect. Based on these observations,
preliminary clinical studies were performed which demonstrated improved
urine output, RBF and GFR and reduced need for dialysis. However,
randomized, controlled trials failed to demonstrate improvement in
dialysis-free survival in different cohorts and study designs. Although
NPs reduced the incidence of AKI in the postoperative period in cardiac
surgery, it was not associated with improved long-term survival. In
contrast to randomized trials, meta-analysis reported favorable results.
 Conclusion(s): Reasons for the divergence of experimental and
clinical outcomes of NPs in AKI are discussed in this review
article. Copyright © 2019

<75>
Accession Number
630070931
Title
A pragmatic pilot phase II randomised controlled trial of prothrombin
complex concentrates (PCC) versus fresh frozen plasma (FFP) in adult
patients who are undergoing heart surgery (PROPHESY).
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 684. Date of
Publication: 09 Dec 2019.
Author
Green L.; Roberts N.; Cooper J.; Field J.; Gill R.; Klein A.; Agarwal S.;
Stanworth S.; Johnston A.; Monk V.; O'Brien B.
Institution
(Green) Blizard Institute, Queen Mary University of London, NHS Blood and
Transplant and Barts Health NHS Trust, 4 Newark Street, London E1 2AT,
United Kingdom
(Roberts, O'Brien) St Bartholomew's Hospital, West Smithfield, London EC1A
7BE, United Kingdom
(Cooper, Field, Monk) Barts Cardiovascular Clinical Trials Unit (CVCTU),
William Harvey Research Institute, Heart Centre, Barts and the London
School of Medicine, Queen Mary University of London, Charterhouse Square,
London EC1M 6BQ, United Kingdom
(Gill) Southampton General Hospital, Tremona Road, Southampton SO16 6YD,
United Kingdom
(Klein) Papworth Hospitals NHS Foundation Trust, Papworth Everard,
Cambridge CB23 3RE, United Kingdom
(Agarwal) Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL,
United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust, Headley Way,
Oxford OX3 9BQ, United Kingdom
(Johnston) William Harvey Research Institute, Heart Centre, Barts and the
London School of Medicine, Queen Mary University of London, Charterhouse
Square, London EC1M 6BQ, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Fresh frozen plasma (FFP) is the accepted standard treatment
for clotting factor replacement in bleeding patients during or immediately
after cardiac surgery. In the United Kingdom prothrombin complex
concentrate (PCC) is not licensed in this setting, although it is being
used in Europe because it has a higher concentration of clotting factor
levels, and it can be administered rapidly and in small volume, resulting
in less volume overload during cardiac surgery. Method(s): PROPHESY
is a pragmatic, single-centre, open-label, randomised, controlled pilot
trial that will assess whether it is feasible to perform a large trial in
the future that will compare PCC versus FFP in patients who are bleeding
(not on warfarin) and who require blood transfusion. Over a 15-month
period, 50 patients will be randomised to PCC versus FFP if they develop
active bleeding within 24 h of cardiac surgery and for whom the clinician
has decided to administer FFP for treatment of bleeding. Standard
laboratory and point-of-care assessments will be performed as per routine
practice, and additional research blood samples will be taken at three
time points to assess haemostasis. Subjects will be assessed daily up to
hospital discharge or 30 days or death (whichever occurs first) and will
be seen in follow-up for 90 days after surgery to assess for
thromboembolic complications and hospital re-admission since discharge.
Quality-of-life assessment will be performed pre-surgery and at 90 days
post-surgery. We will also perform qualitative research with clinical
experts and patients to explore the understanding of and experience with
the interventions, as well as adherence to study procedures and protocol.
 Discussion(s): There have been no randomised controlled trials that
have compared the safety and efficacy of FFP versus PCC in cardiac surgery
patients who are bleeding. This pilot study will assess if individual
components of a large trial are deliverable to assess the safety and
efficacy of the two blood products in the future. Copyright ©
2019 The Author(s).

<76>
Accession Number
2001951616
Title
Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and
Systematic Review of Literature.
Source
Cardiovascular Revascularization Medicine. 20 (11 Supplement) (pp 15-20),
2019. Date of Publication: November 2019.
Author
Asad Z.U.A.; Ijaz S.H.; Chaudhary A.M.D.; Khan S.U.; Pakala A.
Institution
(Asad, Ijaz, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, United States
(Chaudhary) Nishtar Medical College, Multan, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Hemorrhagic cardiac tamponade (HCT) is characterized by rapid
accumulation of blood in the pericardium causing hemodynamic collapse. We
report a case of HCT due to Apixaban use in a patient with renal cell
carcinoma, supplemented with a systematic review of pericardial tamponade
associated with the use of direct oral anticoagulants (DOACs). Case
report: A 62-year-old African American male with a history of metastatic
renal cell carcinoma presented with dyspnea while taking Apixaban. He was
diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion
was drained. The pericardial fluid analysis was negative for malignancy
and suggestive of HCT. He had a complicated hospital course and died
several days later. Method(s): We searched MEDLINE, EMBASE and other
sources for published cases of pericardial tamponade associated with
DOACs. Our outcomes of interest included patient characteristics, risk
factors, timing from the start of anticoagulation to tamponade, treatment
and mortality. Simple descriptive statistics using percentages for
categorical variables were used to describe the included cases.
 Result(s): A total of 26 cases were included in the final systematic
review after searching MEDLINE, EMBASE and other sources. The mean age was
70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were
associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with
Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine.
Only 2 patients died but 24 had to undergo pericardiocentesis.
 Conclusion(s): Cardiac tamponade is rarely associated with DOACs and
elderly male patients with renal and coagulation abnormalities appear to
have the highest risk. Copyright © 2019 Elsevier Inc.

<77>
Accession Number
617341487
Title
Optimal use of arterial grafts during current coronary artery bypass
surgery.
Source
Surgery Today. 48 (3) (pp 264-273), 2018. Date of Publication: 01 Mar
2018.
Author
Suzuki T.
Institution
(Suzuki) Department of Cardiovascular Surgery, Shiga University of Medical
Science, Setatsukinowa, Otsu, Shiga 520-2192, Japan
Publisher
Springer ( Singapore)
Abstract
Multiple arterial grafting, including the use of the bilateral internal
thoracic arteries (ITAs), has strong benefits on patient clinical outcomes
after coronary artery bypass grafting (CABG) but is far from commonly
accepted at present. We reviewed the previous randomized and leading
observational studies and assembled an up-to-date profile on multiple
arterial grafting. Many of the previous trials successfully showed the
beneficial effects of arterial grafting after CABG. Although many of these
were retrospective studies, the data presented, mostly from world-famous
surgeons, show that multiple arterial grafting does have advantages with
regard to the long-term patient outcome without increasing rates of early
mortality or morbidity. However, it is true that some surgeons experience
a certain amount of stress when using multiple arterial conduits. Multiple
arterial reconstruction has a strong advantage for patients undergoing
CABG and is now a standard worldwide strategy. Surgeons nowadays need to
make efforts to master arterial conduit techniques properly to provide
state-of-the-art CABG to patients. Copyright © 2017, Springer
Japan KK.

<78>
Accession Number
2004128830
Title
Experimental Model to Assess the Efficacy and Safety of Vessel Sealing
Devices in By-pass Surgery.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e316-e317), 2019. Date of Publication: December 2019.
Author
Hernandez M.M.; Espinola M.F.; Garcia L.R.; Nunez L.G.; Ferrer N.R.;
Bernal L.R.
Institution
(Hernandez, Espinola, Garcia, Nunez, Bernal) Vascular Surgery, Hospital
Universitari i Politecnic La Fe, Valencia, Spain
(Ferrer) Pathology, Hospital Universitari i Politecnic La Fe, Valencia,
Spain
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Energy sealing devices achieve hemostasis of blood vessels
through sequential coagulation and tissue transection. The most frequently
used ones are: Electrothermal Bipolar Tissue Sealing System (EB) and
Harmonic Scalpel (HS). Both methods are based on denaturation and fusion
of proteins of the vessel wall (mainly collagen and elastin) by controlled
delivery of energy: electrothermal by radiofrequency and impedance
feed-back (EB) or high frequency ultrasound vibration (HS). Although its
use has been widely spread in multiple surgical fields, most vascular
surgeons are not confident enough about its safety for sealing collaterals
of autologous grafts during by-pass surgery. The aim of this study was to
compare the efficacy and safety of EB and HS with conventional vessel
ligation of saphenous vein (SV) collaterals in an experimental model.
Methods - Twenty-five fragments of SV were extracted from cadaver donor
(n=6) or from residual fragments during amputation or lower limb
revascularization procedures (n=19). To simulate physiological conditions,
a pulsatile flow circuit was performed with a roller pump, and
intravascular pressure was recorded by a pressure gauge and a pressure
monitor. In each fragment, two venous collateral seals were made, one by
conventional ligation with 3/0 silk (control) and the other one with EB
(N= 13) or HS (N= 12), after sequentially consecutive assignment. Each
venous fragment was then incorporated into the pulsatile flow circuit, and
the pressure was progressively increased until 300 mmHg
(supraphysiological) was reached, or until sealing breakage occurred.
Collateral vein diameter, burst pressures, and leakage points were
recorded. A histological study with hematoxylin-eosin and Masson's
trichrome stain was also performed for each energy-sealing device. A
descriptive analysis and analytical statistical tests (U-Mann Whitney,
Chi-square) were performed. Results - The mean diameter of the venous
collaterals was 2.42+/-0.7mm and 2.38+/-0.6 mm, p = NS, for EB and HS,
respectively. The mean burst pressure was slightly higher for EB than for
HS (788.9+/-455.0 mmHg vs 602.5+/-363.1 mmHg, p = 0.268). In only one case
(HS) the outbreak occurred in the sealing zone at pressures below 300
mmHg. In all cases for EB, the rupture occurred at supraphysiological
pressures.The leakage point for HS occurred in sealed collateral in all
cases (12/12). For EB, the leakage point occurred in its sealing zone in 8
of 13 fragments, and in the conventional ligation (control), in the
remaining 5 fragments (p=0.016). The histological study showed no
differences in the tissues coagulated by both devices. Conclusion - Vessel
sealing devices are as effective and safe for the hemostasis of saphenous
vein collaterals as conventional ligation. These devices may be useful
given their fast sealing time and easy handling during surgical venous
graft preparation for lower limb revascularization. In our study, the EB
showed greater strength in the sealing of saphenous vein collaterals
compared to HS, however the outbreak occurred at supraphysiological
pressures, so this fact may not have clinical relevance. References -
Toishi M, Yoshida K, Agatsuma H et al. Usefulness of vessel-sealing
devices for <7mm diameter vessels: a randomized controlled trial for human
thoracoscopic lobectomy in primary lung cancer. Interactive CardioVascular
and Thoracic Surgery, 2014 (19): 448-55. - Rajbabu K, Baber NJ, Chol W et
al. To knot or not to knot? Sutureless haemostasis compared to the
surgeons's knot. Ann R Coll Surg Engl, 2007; 89: 359-62. - Lamberton GR,
Hsi R, Jin D et al. Prospective comparision of four laparoscopic vessel
ligation devices. Journal of endourology, 2008; 22: 1-6. - Lacin T,
Batirel HF, Ozer K et al. Safety of a thermal vessel sealer on main
pulmonary vessels. European Journal of Cardio-thoracic Surgery, 2007; 31:
482-85. Copyright © 2019

<79>
Accession Number
2004128531
Title
Remote Ischaemic Preconditioning Attenuates Kidney Injury Perioperatively
in Patients Undergoing Surgical Lower Limb Revascularisation.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e391-e392), 2019. Date of Publication: December 2019.
Author
Kepler T.; Kuusik K.; Lepner U.; Starkopf J.; Zilmer M.; Eha J.; Lieberg
J.; Kals J.
Institution
(Kepler, Lepner, Lieberg, Kals) Department of Surgery, Institute of
Clinical Medicine, Tartu, Estonia
(Kuusik, Eha) Department of Cardiology, Institute of Clinical Medicine,
Tartu, Estonia
(Starkopf) Department of Anaesthesiology and Intensive Care, Institute of
Clinical Medicine, Tartu, Estonia
(Zilmer, Kals) Department of Biochemistry, Institute of Biomedicine and
Translational Medicine, Centre of Excellence for Genomics and
Translational Medicine, University of Tartu, Tartu, Estonia
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Perioperative acute kidney injury has been found to occur
in 12% of patients undergoing lower limb revascularisation (Arora et al.,
2013). Remote ischaemic preconditioning (RIPC) of short cycles of distant
tissue ischaemia followed by reperfusion is a promising technique to
reduce tissue damage from ischaemia-reperfusion injury. In a recent
meta-analysis, RIPC was shown to reduce kidney injury in patients
undergoing cardiac surgery (Yi et al., 2017). It has also been found to
reduce serum creatinine postoperatively in patients undergoing abdominal
aortic aneurysm repair (Ali et al., 2007) and endovascular aneurysm repair
(Walsh et al., 2009). However, there are many uncertainties regarding
clinical benefits from RIPC during vascular surgery. The aim of the
current double-blinded, randomised and sham-controlled pilot study was to
determine the effect of RIPC in perioperative renal damage in vascular
surgery. Methods - Patients undergoing elective lower limb
revascularisation surgery between January 2016 and February 2018, who gave
full informed consent, were recruited. Stratified randomisation with a
block design was used. Patient, patient's physician and surgical team were
blinded to study intervention. Four episodes of 5 minutes of upper limb
ischaemia were performed preoperatively. In the sham group, pressure equal
to venous pressure was applied instead of ischaemia. Between all episodes,
there was a 5-minute period of reperfusion. Blood samples were collected
preoperatively and 20-28 hours after surgery for assessement of biomarkers
of acute kidney injury. Data were compared by means of t-tests, Wilcoxon's
tests or Chi-squared test. The study was approved by the Research Ethics
Committee of the University of Tartu and registered in the
ClinicalTrials.gov database (NCT02689414). Results - Twenty-nine patients
were enrolled in the sham and 28 patients were enrolled in the
experimental group. The baseline characteristics did not differ between
the groups except for gender (3 women in the RIPC group, 10 women in the
sham group, p=0.0376). The surgery resulted in significant increase of
creatinine (from the median value of 80 to 88, p= 0.0279) and trends
toward increases in urea, cystatin C and beta-2-microglobulin (B2M)
(p=n.s., data not shown) in the sham group. In the RIPC group, in
contrast, significant decline in creatinine (from the mean value of 79 to
75, p= 0.034) and cystatin C (from the median value of 1.1 to 0.9, p=
0.0007) together with trends towards to reduction in urea and B2M (p=n.s.,
data not shown) was noted. However, changes in creatinine, urea, cystatin
C and B2M between the groups were statistically significant (p-values
0.002, 0.0203, 0.0113, 0.0286 respectively (Figure). [Formula presented]
Conclusion - This pilot study demonstrates that RIPC reduces the levels of
biomarkers of acute kidney injury in patients undergoing surgical lower
limb revascularisation. This phenomenon may offer renoprotection during
vascular surgery. References 1. Ali, Z.A., Callaghan, C.J., Lim, E., Ali,
A.A., Nouraei, S.A.R., Akthar, A.M., Boyle, J.R., Varty, K., Kharbanda,
R.K., Dutka, D.P., Gaunt, M.E., 2007. Remote ischemic preconditioning
reduces myocardial and renal injury after elective abdominal aortic
aneurysm repair: a randomized controlled trial. Circulation 116, I98-105.
https://doi.org/10.1161/circulationaha.106.679167 2. Arora, P.,
Davari-Farid, S., Gannon, M.P., Lohr, J.W., Dosluoglu, H.H., Nader, N.D.,
2013. Low levels of high-density lipoproteins are associated with acute
kidney injury following revascularization for chronic limb ischemia. Ren.
Fail. 35, 838-844. https://doi.org/10.3109/0886022X.2013.801271 3. Walsh,
S.R., Boyle, J.R., Tang, T.Y., Sadat, U., Cooper, D.G., Lapsley, M.,
Norden, A.G., Varty, K., Hayes, P.D., Gaunt, M.E., 2009. Remote ischemic
preconditioning for renal and cardiac protection during endovascular
aneurysm repair: a randomized controlled trial. J. Endovasc. Ther. Off. J.
Int. Soc. Endovasc. Spec. 16, 680-689. https://doi.org/10.1583/09-2817.1
4. Yi, B., Chen, X., Shi, H., Lin, T., Lin, H., Xu, Y., Rong, J., 2017.
Remote ischaemic preconditioning reduces acute kidney injury in adult
patients undergoing cardiac surgery with cardiopulmonary bypass: a
meta-analysis. Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc.
Cardio-Thorac. Surg. 51, 616-623. https://doi.org/10.1093/ejcts/ezw372
 Copyright © 2019

<80>
Accession Number
2004217458
Title
Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.
Source
Annals of Thoracic Surgery. 109 (1) (pp 294-301), 2020. Date of
Publication: January 2020.
Author
Biancari F.; Santini F.; Tauriainen T.; Bancone C.; Ruggieri V.G.;
Perrotti A.; Gherli R.; Demal T.; Dalen M.; Santarpino G.; Rubino A.S.;
Nardella S.; Nicolini F.; Zanobini M.; De Feo M.; Onorati F.; Mariscalco
G.; Gatti G.
Institution
(Biancari) Heart Center, Turku University Hospital and Department of
Surgery, University of Turku, Turku, Finland
(Biancari, Tauriainen) Department of Surgery, University of Oulu, Oulu,
Finland
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Bancone, Rubino) Department of Cardiothoracic Sciences, University of
Campania "Luigi Vanvitelli,", Naples, Italy
(Ruggieri, De Feo) Division of Cardiothoracic and Vascular Surgery, Robert
Debre University Hospital, Reims, France
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Gherli) Cardiac Surgery Unit, Department of Cardiovascular Sciences, S.
Camillo-Forlanini Hospital, Rome, Italy
(Demal) Hamburg University Heart Center, Hamburg, Germany
(Dalen) Department of Molecular Medicine and Surgery and Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm;, Sweden
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy
(Nardella) Department of Cardiac Surgery, St Anna Hospital, Catanzaro,
Italy
(Nicolini) 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, Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, Glenfield Hospital, University of Leicester, Leicester, United
Kingdom
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
Publisher
Elsevier USA
Abstract
Background: Epiaortic ultrasonography (EAU) is a valid imaging method to
detect atherosclerotic changes of the ascending aorta and to guide
surgical strategies for the prevention of cerebral embolism in patients
undergoing isolated coronary artery bypass grafting (CABG). However, its
use is not widespread. Method(s): The impact of EAU on the outcome
after isolated CABG was investigated in patients from the European
Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A
systematic review and meta-analysis of the literature was performed to
substantiate the findings of this observational study. Result(s): EAU
was performed intraoperatively in 673 of 7241 patients (9.3%) from the
E-CABG registry. In the overall series, the rates of stroke without and
with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In
660 propensity score-matched pairs, EAU was associated with significantly
lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded
5 studies fulfilling the inclusion criteria. These studies, along with the
present one, included 11,496 patients, of whom 3026 (25.7%) underwent
intraoperative EAU. Their rate of postoperative stroke was significantly
lower than in patients not investigated with EAU (pooled rate, 0.6% vs
1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I2
= 0%). On the basis of these pooled rates, the number needed to treat to
prevent 1 stroke is 76.9. Conclusion(s): Avoiding aortic manipulation
is associated with the lowest risk of stroke in patients undergoing CABG.
When manipulation of the ascending aorta is planned, EAU is effective in
guiding the surgical strategy to reduce the risk for embolic stroke in
these patients. Copyright © 2020 The Society of Thoracic Surgeons

<81>
Accession Number
2003994776
Title
National Lipid Association Scientific Statement on the use of icosapent
ethyl in statin-treated patients with elevated triglycerides and high or
very-high ASCVD risk.
Source
Journal of Clinical Lipidology. 13 (6) (pp 860-872), 2019. Date of
Publication: November - December 2019.
Author
Orringer C.E.; Jacobson T.A.; Maki K.C.
Institution
(Orringer) Miller School of Medicine, Cardiovascular Division, University
of Miami, Miami, FL, United States
(Jacobson) Department of Medicine, Emory University, Atlanta, GA, United
States
(Maki) School of Public Health, Department of Applied Health Science,
Indiana University, Bloomington, IN, United States
(Maki) Midwest Biomedical Research, Center for Metabolic and
Cardiovascular Health, Addison, IL, United States
Publisher
Elsevier Ltd
Abstract
Representatives from the National Lipid Association (NLA) participated in
the development of the 2018 American Heart Association/American College of
Cardiology/Multisociety Guideline on the Management of Blood Cholesterol,
which reaffirmed that lifestyle changes and statin treatment are
therapeutic cornerstones for atherosclerotic cardiovascular disease
(ASCVD) risk reduction. It also updated prior recommendations to
incorporate newer data demonstrating ASCVD risk reduction with ezetimibe
and proprotein convertase subtilisin kexin type 9 inhibitors as adjuncts
to statin therapy for patients at high and very-high ASCVD risk. The 2018
Guideline was finalized shortly before full results were available from a
randomized, placebo-controlled cardiovascular outcomes trial [Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT)]
that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse
cardiovascular events in selected high- or very high-risk, statin-treated
patients with elevated triglycerides. The primary outcome variable of
first major adverse cardiovascular event (cardiovascular death, myocardial
infarction, stroke, coronary revascularization and hospitalization for
unstable angina) was reduced by 25% (95% confidence interval 17%-32%, P
<.001). REDUCE-IT served as the primary basis for the NLA's review of
evidence for the use of IPE for ASCVD risk reduction. Based on this
review, the NLA position is that for patients aged >=45 years with
clinical ASCVD, or aged >=50 years with diabetes mellitus requiring
medication plus >=1 additional risk factor, with fasting triglycerides 135
to 499 mg/dL on high-intensity or maximally tolerated statin therapy
(+/-ezetimibe), treatment with IPE is recommended for ASCVD risk reduction
(evidence rating: class I; evidence level: B-R). Copyright © 2019
National Lipid Association

<82>
Accession Number
2003824856
Title
Effect of exercise on endothelial function in heart transplant recipients:
systematic review and meta-analysis.
Source
Heart Failure Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
de Souza J.A.F.; Araujo B.T.S.; de Lima G.H.C.; Dornelas de Andrade A.;
Campos S.L.; de Aguiar M.I.R.; Carneiro R.M.D.; Brandao D.C.
Institution
(de Souza, Araujo, de Lima, Dornelas de Andrade, Campos, de Aguiar,
Brandao) Physiotherapy Department, Federal University of Pernambuco
(UFPE), Av. Jornalista Anibal Fernandes, s/n, Cidade Universitaria, Recife
CEP 50740-560, Brazil
(Carneiro) Institute of Integral Medicine Professor Fernando Figueira
(IMIP), Recife, Brazil
Publisher
Springer
Abstract
Endothelial dysfunction is associated with increased cardiovascular risk
and death in heart transplant recipients (HTx). Although the measurement
of peripheral endothelial function is considered a significant predictor
of cardiovascular events in several populations, few studies have
investigated this outcome after therapeutic strategies, including
different exercise types, duration, and intensity. This systematic review
and meta-analysis aimed to investigate the effects of continuous moderate
exercise (CON) or high-intensity interval training (HIIT) to improve
endothelial function (EF) in HTx. The search was conducted in Cochrane
Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web
of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence
Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the
evidence was assessed using the Grading of Recommendations Assessment
Development and Evaluation (GRADE). The search strategy retrieved 5192
titles. A total of four articles met the inclusion criteria and were
included for the qualitative analysis. Meta-analysis showed that exercises
improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007)
when compared with the control. However, there was a poor quality of
evidence to demonstrate that CON or HIIT is better than usual care to
improve EF. Exercise training provides benefits to patients, but the poor
quality of evidence does not allow us to state that exercise is related to
endothelial function improvement in HTx. Copyright © 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<83>
Accession Number
2003824279
Title
When is the optimal time to discontinue clopidogrel before in-hospital
coronary bypass surgery? A closer look at the current literature.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Mokhtar A.T.; Baghaffar A.; Jackson S.D.; Horne D.
Institution
(Mokhtar, Jackson) Division of Cardiology, Department of Medicine,
Dalhousie University, Halifax, NS, Canada
(Mokhtar) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Baghaffar, Horne) Division of Cardiac Surgery, Department of Surgery,
Dalhousie University, Halifax, NS, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Clopidogrel and other P2Y12 inhibitors have become the
standard of care among patients presenting with acute coronary syndromes.
A substantial proportion of these patients require surgical
revascularization during index hospitalization. Hypothesis: Guidelines
recommend a 5-day waiting period off clopidogrel before coronary artery
bypass grafting (CABG) to reduce hemorrhagic complications. These
recommendations are not routinely followed in clinical practice, while
recent studies also propose shorter waiting periods off clopidogrel for
patients awaiting in-hospital CABG. Method(s): A preliminary PubMed
search was conducted using the following MeSH terms under the publication
type "Hemorrhage:" "Clopidogrel," AND "Coronary Artery Bypass." Relevant
studies and guidelines were then reviewed and selected based on a
predetermined criteria. Studies that formulated the current
recommendations for stopping clopidogrel preoperative to CABG are
discussed in detail this review. Result(s): A comprehensive review of
recent evidence illustrates mixed bleeding and transfusion outcomes among
CABG patients with preoperative exposure to clopidogrel in less than 5
days. Conclusion(s): The optimal discontinuation time of clopidogrel
before CABG is still poorly defined. The recommendation of a 5-day washout
period for clopidogrel should be reconsidered to be on par with current
clinical practice. Copyright © 2019 Wiley Periodicals, Inc.

<84>
Accession Number
2003823944
Title
New-onset postoperative atrial fibrillation after heart surgery.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 2019.
Author
Gudbjartsson T.; Helgadottir S.; Sigurdsson M.I.; Taha A.; Jeppsson A.;
Christensen T.D.; Riber L.P.S.
Institution
(Gudbjartsson) Department of Cardiothoracic Surgery, Landspitali
University Hospital, Reykjavik, Iceland
(Gudbjartsson, Sigurdsson) Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
(Helgadottir) Department of Cardiothoracic Surgery and Anaesthesia,
Uppsala University Hospital, Uppsala, Sweden
(Sigurdsson) Department of Anaesthesia and Critical Care, Landspitali
University Hospital, Reykjavik, Iceland
(Taha) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Taha, Jeppsson) Department of Molecular and Clinical Medicine, Institute
of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Christensen) Department of Cardiothoracic and Vascular Surgery,
Department of Clinical Medicine, Aarhus University Hospital, Aarhus,
Denmark
(Riber) Department of Cardiothoracic and Vascular Surgery, Department of
Clinical Medicine, Odense University Hospital, University of Southern
Denmark, Odense, Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: New-onset postoperative atrial fibrillation (poAF) complicates
approximately 20-60% of all cardiac surgical procedures and is associated
with an increased periprocedural mortality and morbitity, prolonged
hospital stay, increased costs, and worse long-term survival.
Unfortunately multiple advances in surgery and perioperative care over the
last two decades have not led to a reduction in the incidence of poAF or
associated complications in the daily clinical practice. Method(s): A
narrative review of the available literature was performed.
 Result(s): An extensive review of the pathophysiology of poAF
following cardiac surgery, clinical, and procedural risk-factors is
provided, as well as prophylactic measures and treatment.
 Conclusion(s): Multiple strategies to prevent and manage poAF
following heart surgery already exist. Our hope is that this review will
facilitate more rigorous testing of prevention strategies, implementation
of prophylaxis regimens as well as optimal treatment of this common and
serious complication. Copyright © 2019 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<85>
Accession Number
630136248
Title
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for
Improvement of Great Saphenous Vein Graft Quality from the Lower Leg.
Source
Journal of visualized experiments : JoVE. (153) (no pagination), 2019.
Date of Publication: 19 Nov 2019.
Author
Klopsch C.; Kaminski A.; Prall F.; Dohmen P.
Institution
(Klopsch) Department of Cardiac Surgery, Heart Center Rostock, Rostock
University Medical Center, University of Rostock;
(Kaminski) Department of Cardiac Surgery, Heart Center Rostock, Rostock
University Medical Center, University of Rostock
(Prall) Institute of Pathology, Rostock University Medical Center,
University of Rostock
(Dohmen) Department of Cardiac Surgery, Heart Center Rostock, Rostock
University Medical Center, University of Rostock; Department of
Cardiothoracic Surgery, Faculty of Health Science, University of the Free
State
Publisher
NLM (Medline)
Abstract
Antegrade endoscopic harvesting of autografts for bypass grafting may be
an optimal strategy addressing excellent graft quality and reduced
post-operative wound complications. This standardized protocol for
antegrade endoscopic vein harvesting (EVH) from the lower leg has the
potential to be introduced to routine coronary artery bypass grafting
(CABG). Patients undergoing CABG surgery are positioned on a surgical
table with two additional foam rollers below the extended legs, enabling
antegrade EVH from the lower leg. Following minimally invasive surgical
access through a bridging vein harvest technique, an endoscopic optical
dissector is inserted antegrade into the wound. The main vessel and side
branches are dissected under continuous optical control of vein quality
status and the working channel. After, an endoscopic optical retractor is
inserted with an internal bipolar electrocoagulation device for precise,
safe, and tissue-protective interruption of side branches. After release
of the vein, the vessel is cut off at the proximal and distal ends under
optical control, retrieved from the wound, then cannulated and flushed
with heparinized saline. Finally, all side branches of the vein graft are
double-clipped. Vascular histology is analyzed in a randomized selection
of vein samples. After applying this standardized EVH protocol, the
learning curve was shown to be steep, and graft quality was sufficient for
coronary artery bypass grafting in every case. There was no conversion to
surgical harvesting and low risks for tissue damage and bleeding. Leg
positioning and synergizing EVH with bridging vein harvesting improved
procedural success and vein graft quality. In our hands, antegrade EVH
from the lower leg was feasible, demonstrating straightforward graft
dissection as well as adequate macroscopic and microscopic graft quality
with preserved endothelial integrity. In conclusion, the introduced
technique is safe, shows excellent vein autograft quality, and illustrates
feasibility for elective and urgent isolated CABG and combined CABG
scenarios.

<86>
Accession Number
630129452
Title
Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults With
Tetralogy of Fallot: A Meta-analysis-A Report for the Writing Committee of
the 2019 Update of the Canadian Cardiovascular Society Guidelines for the
Management of Adults With Congenital Heart Disease.
Source
The Canadian journal of cardiology. 35 (12) (pp 1772-1783), 2019. Date of
Publication: 01 Dec 2019.
Author
Mongeon F.-P.; Ben Ali W.; Khairy P.; Bouhout I.; Therrien J.; Wald R.M.;
Dallaire F.; Bernier P.-L.; Poirier N.; Dore A.; Silversides C.; Marelli
A.
Institution
(Mongeon, Khairy, Dore) Adult Congenital Heart Center, Department of
Specialized Medicine, Montreal Heart Institute, Universite de Montreal,
Montreal, Quebec, Canada
(Ben Ali, Bouhout) Department of surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Therrien) Jewish General Hospital, McGill University, Montreal, Quebec,
Canada
(Wald, Silversides) Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Dallaire) Division of Pediatric and Fetal Cardiology, Centre Hospitalier
Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Quebec,
Canada
(Bernier) Department of surgery, McGill University Health Center, McGill
University, Montreal, Quebec, Canada
(Poirier) Department of surgery, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada; Department of surgery,
CHU-Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
(Marelli) McGill Adult Unit for Congenital Heart Disease (MAUDE Unit),
McGill University, Montreal, Quebec, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is no systematic evidence review of the long-term
results of surgical pulmonary valve replacement (PVR) dedicated to adults
with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation.
 METHOD(S): Our primary objective was to determine whether PVR reduced
long-term mortality in adults with rTOF compared with conservative
therapy. Secondary objectives were to determine the postoperative
incidence rate of death, the changes in functional capacity and in right
ventricular (RV) volumes and ejection fraction after PVR, and the
postoperative incidence rate of sustained ventricular arrhythmias. A
systematic search of multiple databases for studies was conducted without
limits. RESULT(S): No eligible randomized controlled trial or cohort
study compared outcomes of PVR and conservative therapy in adults with
rTOF. We selected 10 cohort studies (total 657 patients) reporting
secondary outcomes. After PVR, the pooled incidence rate of death was 1%
per year (95% confidence interval [CI] 0-1% per year) and the pooled
incidence rate of sustained ventricular arrhythmias was 1% per year (95%
CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative
New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24).
Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and
end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased
after PVR, but RV ejection fraction did not change (0.19%, -2.36% to
2.74%). The effect of PVR on RV volumes remained constant regardless of
functional status. CONCLUSION(S): Studies comparing PVR and
conservative therapy exclusively in adults with rTOF are lacking. After
PVR, the incidence rates of death and ventricular tachycardia are both 1
per 100 patient-years. Pooled analyses demonstrated an improved functional
status and a reduction in RV volumes. Copyright © 2019 Canadian
Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

<87>
Accession Number
630099276
Title
Clinical outcomes after TAVR with heparin or bivalirudin as periprocedural
anticoagulation in patients with and without peripheral arterial disease:
Results from the BRAVO-3 randomized trial.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 05 Dec 2019.
Author
Zilberszac R.; Chandiramani R.; Hengstenberg C.; Sartori S.; Cao D.;
Chandrasekhar J.; Schafer U.; Tchetche D.; Violini R.; Jeger R.; Van Belle
E.; Boekstegers P.; Hambrecht R.; Tron C.; Dumenteil N.; Linke A.; Ten
Berg J.M.; Deliargyris E.N.; Anthopoulos P.; Mehran R.; Dangas G.
Institution
(Zilberszac, Hengstenberg) Department of Cardiology, Medical University of
Vienna, Vienna, Austria
(Chandiramani, Sartori, Cao, Chandrasekhar, Mehran, Dangas) Zena and
Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, NY
(Schafer) Department of Cardiology, University Heart Center, Hamburg,
Germany
(Schafer) Department of Cardiology, Asklepios Clinics St. Georg, Hamburg,
Germany
(Tchetche, Dumenteil) Department of General and Interventional Cardiology,
Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse,
France
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Rome,
Italy
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital and CHRU Lille, Lille, France
(Boekstegers) Department of Cardiology, Helios Heart Center Siegburg,
Siegburg, Germany
(Hambrecht) Department of Cardiology, Klinikum Links der Weser, Bremen,
Germany
(Tron) Department of Cardiology, Rouen University Hospital, Rouen, France
(Linke) Department of Cardiology, Universitat Leipzig, Herzzentrum,
Leipzig, Germany
(Ten Berg) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Deliargyris) SpartaNJUnited States
(Anthopoulos) Division of Cardiology, Medicines Company, Zurich,
Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to investigate the clinical outcomes of
patients with and without peripheral artery disease (PAD) in the BRAVO-3
trial with respect to the effect of bivalirudin versus unfractionated
heparin (UFH). BACKGROUND: PAD is found frequently in patients undergoing
transcatheter aortic valve replacement (TAVR) and is reported to confer an
increased risk of adverse events. It is unknown whether patients with and
without PAD may demonstrate a differential response to bivalirudin versus
UFH. METHOD(S): BRAVO-3 was a randomized multicenter trial comparing
transfemoral TAVR with bivalirudin versus UFH (31 centers, n = 802). Major
adverse cardiovascular events (MACE) were a composite of 30-day death,
myocardial infarction, or cerebrovascular accidents (CVA). Net adverse
cardiovascular events (NACE) were a composite of major bleeding or MACE.
 RESULT(S): The total cohort included 119 patients with PAD. Vascular
complications occurred significantly more frequently in patients with PAD
both in-hospital (25.2 vs. 16.7%; OR 1.68) and at 30days (29.4 vs. 17.3%;
OR 1.99). No significant differences were observed regarding mortality,
NACE, MACE, major bleeding or CVA with bivalirudin versus UFH among
patients with or without PAD. In patients with PAD, bivalirudin was
associated with an increased risk of minor vascular complications at
30days. CONCLUSION(S): Patients with PAD undergoing transfemoral TAVR
did not exhibit an increased risk of any major adverse events, according
to the procedural anticoagulant randomization. However, patients treated
with Bivalirudin had significantly higher rates of minor vascular
complications. Copyright © 2019 The Authors. Catheterization and
Cardiovascular Interventions published by Wiley Periodicals, Inc.

<88>
Accession Number
630098216
Title
Consolidated quality improvements following benchmarking with
cardiothoracic surgery registries-a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 06 Dec 2019.
Author
de By T.M.M.H.; Muslem R.; Caliskan K.; Bortolussi G.; Philipsen T.;
Friberg O.; Bogers A.J.J.C.; Pagano D.
Institution
(de By) European Association for Cardio-Thoracic Surgery, Windsor, United
Kingdom
(de By, Muslem, Bogers) Department of Cardiothoracic Surgery, Erasmus
Medical Center, Rotterdam, Netherlands
(Caliskan) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Bortolussi) Department of Cardiac Thoracic Vascular Sciences and Public
Health, Padua University Hospital, Padua, Italy
(Philipsen) Department of Cardiac Surgery, Universitair Ziekenhuis Gent,
Gent, Belgium
(Friberg) Department of Cardiothoracic and Vascular Surgery, Orebro
University Hospital, Sweden
(Pagano) Department of Cardiothoracic Surgery, University of Birmingham,
University Hospital Birmingham, Birmingham, United Kingdom
Publisher
NLM (Medline)
Abstract
The influence of registries in medicine is large. However, there has been
no systematic assessment conducted to quantify the impact of benchmarking
with registries focused on cardiothoracic surgery. Numerous publications
conclude that registry participation leads to improvement of outcomes for
patients. A large number of registries provide evidence sub-structured by
statistics that show decreases in morbidity and mortality in the
participants' clinical units. Many authors praise the benchmarking method
making use of databases of registries as having a positive effect on
outcome of care. However, studies proving the direct causal relation
between the use of cardiothoracic surgery-oriented registries and
improvement of clinical in-hospital outcomes are extremely scarce. We
aimed to analyse the causal relation between the use of cardiothoracic
surgery-oriented registries and improvement of clinical outcomes. In a
systematic literature review, publications demonstrating the use of
registry data to obtain consolidated quality improvements were selected.
After analysis of 2990 scientific publications, 6 studies filled the
inclusion criteria. The selected studies acknowledged that benchmarking of
data against registries was used for a focused and methodologically
organized improvement in cardiothoracic departments. In conjunction with
the impact of the applied methods on healthcare, their results demonstrate
quantifiable enhanced local outcomes over time. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<89>
Accession Number
630101271
Title
New warfarin anticoagulation management model after heart valve surgery:
rationale and design of a prospective, multicentre, randomised trial to
compare an internet-based warfarin anticoagulation management model with
the traditional warfarin management model.
Source
BMJ open. 9 (12) (pp e032949), 2019. Date of Publication: 05 Dec 2019.
Author
Zhu Z.; Meng X.; Han J.; Li Y.; Liu K.; Shen J.; Qin Y.; Zhang H.
Institution
(Zhu, Li, Meng, Han, Li, Liu, Shen, Qin, Zhang) Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Warfarin is an effective anticoagulant and the only oral
anticoagulant available for patients with mechanical heart valves. The
prothrombin time and the associated international normalised ratio (INR)
are routinely tested to monitor the response to anticoagulation therapy in
patients. Patients who undergo mechanical heart valve replacement need
lifelong anticoagulation therapy, and their INR is regularly measured to
adjust the anticoagulation strength and the dose of anticoagulation drugs.
Appropriate warfarin anticoagulation management can reduce patient
complications, such as bleeding and thrombosis, and improve the long-term
survival rate. We propose modern internet technology as a platform to
build a warfarin anticoagulation follow-up system after valve replacement
surgery. This system will provide doctors and patients with more
standardised and safer follow-up methods as well as a method to further
reduce the risk of warfarin anticoagulation-related complications and
improve its therapeutic effects. METHODS AND ANALYSIS: A prospective,
multicentre, randomised, controlled trial will be conducted. A total of
700 patients who require long-term warfarin anticoagulation monitoring
after heart valve replacement will be enrolled and randomly divided at a
1:1 ratio into a traditional outpatient anticoagulation management group
and a group undergoing a new method of management based on the internet
technology with follow-up for 1year. Differences in the percentage of time
in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis
and other related complications will be observed. The primary endpoint is
the difference in the TTR between the two groups. The purpose of this
study is to explore a safer and more effective mode of doctor-patient
interaction and communication in the internet era. As of 13 July 2019, 534
patients had been enrolled. ETHICS AND DISSEMINATION: This study protocol
was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital
Medical University. The results will be published in a peer-reviewed
medical journal. TRIAL REGISTRATION NUMBER:
ChiCTR1800016204. Copyright © Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<90>
Accession Number
630101083
Title
An abluminal biodegradable polymer sirolimus-eluting stent versus a
durable polymer everolimus-eluting stent in patients undergoing coronary
revascularization: 3-year clinical outcomes of a randomized
non-inferiority trial.
Source
Scientific reports. 9 (1) (pp 18549), 2019. Date of Publication: 06 Dec
2019.
Author
Zhang H.; Zhang X.; Yin Y.; Zhou C.; Deng W.; Zhang J.; Hou W.; Lu S.;
Song C.; Cui X.; Wang S.; Yang F.; Liu G.; Duan C.; Ge J.
Institution
(Zhang) Intervention & Vascular Surgery, Medical College of Tongji
University, Shanghai, China
(Zhang) Department of Health Science and Technology, Faculty of Medicine,
Aalborg University, Denmark
(Zhang, Yin, Zhou, Zhang, Hou, Lu, Song, Cui, Liu, Duan) National Joint
Engineering Laboratory for Biomedical Material Modification, Shandong,
China
(Zhang) Intervention & Vascular Surgery, Medical College of Tongji
University, Shanghai, China
(Deng) Key Laboratory of Public Health Safety, Ministry of Education,
School of Public Health, Fudan University, Shanghai, China
(Wang, Yang) Institute of Chemistry, Chinese Academy of Sciences, Beijing,
China
(Ge) Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital,
Fudan University, Shanghai, China
Publisher
NLM (Medline)
Abstract
The Cordimax stent has proved non-inferior to the Cypher Select durable
polymer sirolimus-eluting stent for the primary endpoint of angiographic
in-stent late luminal loss and in-stent mean diameter stenosis at 9
months. The trial was designed to compare the efficacy and safety of the
Cordimax stent with the Xience V stent in patients undergoing coronary
revascularization. This randomized, multicenter trial enrolled 3697
patients treated with Cordimax stent (2460 patients) and Xience V stent
(1237 patients). The primary efficacy endpoint was a target-lesion failure
(TLF) at 1 year and the primary safety endpoint was a composite of death
or myocardial infarction (MI) at 3 years. 3399 patients (91.9%) completed
3-year follow-up. At 1 year, the primary efficacy endpoint occurred in 86
(3.5%) patients in the Cordimax group versus 40 (3.2%) patients in the
Xience V group (0.3% absolute risk difference, 95% CI -1.0-1.5%,
Pnon-inferiority<0.0001). At 3 years, the primary safety endpoint occurred
in 39 (1.6%) patients in the Cordimax group versus 19 (1.5%) patients in
the Xience V group (0.05% absolute risk difference, 95% CI -0.8-0.9%,
Pnon-inferiority<0.0001). The incidence of target lesion revascularization
was low in Cordimax group compared with Xience V group (3.6% versus 5.1%,
P=0.03). There were no differences between Cordimax and Xience V in terms
of Cardiac death (0.3% versus 0.4%, P=0.70), myocardial infarction (1.2%
versus 0.9%, P=0.37), and the stent thrombosis (0.4% versus 0.6%, P=0.61).
In conclusion, safety and efficacy outcomes of Cordimax stent were
non-inferior to the Xience V stent 3 years after stent implantation.

<91>
Accession Number
630100695
Title
Long-term ticagrelor for secondary prevention in patients with prior
myocardial infarction and no history of coronary stenting: insights from
PEGASUS-TIMI 54.
Source
European heart journal. (no pagination), 2019. Date of Publication: 07 Dec
2019.
Author
Furtado R.H.M.; Nicolau J.C.; Magnani G.; Im K.; Bhatt D.L.; Storey R.F.;
Steg P.G.; Spinar J.; Budaj A.; Kontny F.; Corbalan R.; Kiss R.G.; Abola
M.T.; Johanson P.; Jensen E.C.; Braunwald E.; Sabatine M.S.; Bonaca M.P.
Institution
(Furtado, Im, Bhatt, Braunwald, Sabatine, Bonaca) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical
School, Boston, United States
(Furtado, Nicolau) Instituto do Coracao (InCor), Hospital das Clinicas da
Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Eneas de Carvalho
Aguiar 44, Sao Paulo 05403, Brazil
(Magnani) University Hospital of Parma, Via Gramsci ,14, Italy
(Storey) University of Sheffield, Western Bank, Sheffield S10 2TN, United
Kingdom
(Steg) Assistance Publique-Hopitaux de Paris ,3 Avenue Victoria, Paris
75004, France
(Spinar) University Hospital Brno, Brno, Czechia
(Budaj) Centre of Postgraduate Medical Education, Grochowski Hospital,
Grenadierow 51/59, Warsaw 04-073, Poland
(Kontny) Department of Cardiology, Stavanger University Hospital, Gerd
Ragna Bloch Thorsens gate 8, Stavanger, Norway
(Kontny) Drammen Heart Center, Drammen 3004, Norway
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Lira, Santiago 40, Chile
(Kiss) Department of Cardiology, Military Hospital, Budapest 1134, Hungary
(Abola) College of Medicine, University of the Philippines/Philippine
Heart Center, East, Quezon City, Metro Manila, Philippines
(Johanson, Jensen) AstraZeneca, Sweden
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
13199 E Montview Blvd Suite 200, CO, Aurora, United States
Publisher
NLM (Medline)
Abstract
AIMS: PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet
therapy (DAPT) with aspirin and ticagrelor reduced the risk of major
adverse cardiovascular events (MACE), with an acceptable increase in
bleeding, in patients with prior myocardial infarction (MI). While much of
the discussion around prolonged DAPT has been focused on stented patients,
patients with prior MI without prior coronary stenting comprise a
clinically important subgroup. METHODS AND RESULTS: This was a
pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162
patients with prior MI (1-3years) and additional high-risk features to
ticagrelor 60mg, 90mg, or placebo twice daily in addition to aspirin. A
total of 4199 patients had no history of coronary stenting at baseline.
The primary efficacy outcome (MACE) was the composite of cardiovascular
death, MI, or stroke. Patients without history of coronary stenting had
higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR)
1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The
relative risk reduction in MACE with ticagrelor (pooled doses) was similar
in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting
(HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). CONCLUSION(S):
Long-term ticagrelor reduces thrombotic events in patients with prior MI
regardless of whether they had prior coronary stenting. These data
highlight the benefits of DAPT in prevention of spontaneous
atherothrombotic events and indicate that long-term ticagrelor may be
considered in high-risk patients with prior MI even if they have not been
treated with stenting. CLINICALTRIALS.GOV IDENTIFIER:
NCT01225562. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<92>
Accession Number
630105118
Title
Gravity venous drainage and the 3/8-inch venous line: What would
Poiseuille do?.
Source
Journal of Extra-Corporeal Technology. 51 (2) (pp 78-82), 2019. Date of
Publication: 2019.
Author
Datt B.; Pourmoghadam K.K.; Munro H.M.; DeCampli W.M.
Institution
(Datt) Children's Hospital of New Orleans, United States
(Pourmoghadam, Munro, DeCampli) Heart Center, Arnold Palmer Hospital for
Children, 92 W Miller Street, Orlando, FL 32806, United States
(Munro, DeCampli) University of Central Florida College of Medicine,
Orlando, FL, United States
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
The 1/20 venous line has long been the drainage tubing diameter of choice
for adult patients undergoing cardiac surgery. However, several programs
use a smaller diameter venous line when used in conjunction with
kinetic-assisted venous drainage or vacuum-assisted venous drainage. In
2014, our perfusion team made an institution-wide effort to miniaturize
the cardiopulmonary bypass (CPB) circuit for children. One of our changes
was the transition to a 3/80 diameter venous line for drainage, even in
our larger patients (up to 80 kg). We reviewed the current literature on
this topic and delineated the various parameters required to be able to
use the 3/80 venous line with gravity drainage with the aim of using it on
patients up to 115 kg with the appropriate venous reservoir. We have
successfully used the 3/80 venous line in more than 40 of our larger
patients (35-90 kg) without the need for assisted venous drainage. We were
able to reduce CPB prime from 625 6 118 to 425 6 52 mL before retrograde
autologous priming (RAP)/venous autologous priming (VAP). The prime was
further reduced to 325 6 66 mL after RAP/VAP. Homologous blood utilization
was reduced from 217 6 311 mL to 27 6 77 mL. Both results were
statistically significant. We hypothesize that taking into account two of
the parameters of Poiseuille's law, namely length and diameter, it is
possible to safely drain large children and mid-size adults via gravity
venous drainage and the 3/80 venous line. This technique allows reducing
prime volume, simplifies CPB circuits with increased safety and
potentially reduces the need for homologous blood
transfusion. Copyright © 2019 American Society of Extra-Corporeal
Technology. All rights reserved.

<93>
Accession Number
626112800
Title
Systematic review to assess the possibility of return of cerebral and
cardiac activity after normothermic regional perfusion for donors after
circulatory death.
Source
British Journal of Surgery. 106 (3) (pp 174-180), 2019. Date of
Publication: Februaryy 2019.
Author
Shapey I.M.; Summers A.; Augustine T.; van Dellen D.
Institution
(Shapey, Summers, Augustine, van Dellen) Faculty of Biology, Medicine and
Health, University of Manchester, Manchester, United Kingdom
(Shapey, Summers, Augustine, van Dellen) Department of Renal and
Pancreatic Transplantation, Manchester Royal Infirmary, Manchester
University NHS Foundation Trust, Manchester, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Normothermic regional perfusion (NRP) is a novel technique
that aids organ recovery from donors after circulatory death (DCDs).
However, ethical concerns exist regarding the potential return of
spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to
determine the likelihood of ROSCCA in NRP-DCDs of abdominal organs.
 Method(s): Extracorporeal cardiopulmonary resuscitation (ECPR) for
refractory out-of-hospital cardiac arrest (OOHCA) was identified as a
comparator for NRP-DCDs and as a validation cohort. A systematic search
identified all articles relating to NRP-DCDs and ECPR-OOHCA. Rates of
ROSCCA and survival outcomes (ECPR-OOHCA only) were recorded and analysed
according to the duration of no perfusion. Result(s): In NRP-DCDs, 12
of 410 articles identified by database searching were eligible for
inclusion. There were no instances of ROSCCA recorded among 493 donors. In
ECPR-OOHCA, eight of 947 screened articles were eligible for inclusion
(254 patients). Where the absence of perfusion exceeded 5 min in
ECPR-OOHCA, there were no survivors with a favourable neurological
outcome. Conclusion(s): ROSCCA is unlikely following commencement of
NRP and has not occurred to date. Strict observance of the 5-min interval
following asystole provides satisfactory assurance that ROSCCA will not
occur following NRP. Copyright © 2019 The Authors. BJS published
by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

<94>
Accession Number
621664904
Title
Delayed vs. immediate stenting in STEMI with a high thrombus burden: A
systematic review and meta-analysis.
Source
Herz. 44 (8) (pp 726-734), 2019. Date of Publication: 01 Dec 2019.
Author
Sun B.; Liu J.; Yin H.; Yang S.; Liu Z.; Chen T.; Li J.; Guo C.; Jiang Z.
Institution
(Sun, Yin, Liu, Chen, Li, Guo, Jiang) Department of Cardiology, The Third
Hospital of Hebei Medical University, NO.139 Ziqiang Road, Qiaoxi
District, Shijiazhuang 050051, China
(Liu) Department of Occupational and Environmental Health, Xiangya School
of Public Health, Central South University, NO.238 Xiangya Road, Kaifu
District, Changsha 410078, China
(Yang) Center for Disease Control and Prevention of Hebei Province,
Department of Epidemiology and Health Statistics, NO.97 Huaian Road, Yuhua
District, Shijiazhuang 050021, China
Publisher
Springer Medizin (E-mail: kundenservice@springermedizin.de)
Abstract
Background: The results of several large-scale randomized controlled
trials are controversial regarding the advantages of delayed stenting (DS)
compared with immediate stenting (IS). We sought to determine whether DS
has benefits for patients with ST-segment elevation myocardial infarction
(STEMI) with a high thrombus burden compared with IS. Method(s): We
systematically searched four electronic databases. Thrombolysis in
Myocardial Infarction (TIMI) grade 3 flow, TIMI myocardial blush grade
(TMBG), complete ST-segment resolution (>70%), major adverse cardiac
events (MACE), and major bleeding complications were studied as outcomes.
Data analysis was performed using a random-effects model utilizing the
Review Manager 5.3 software. Result(s): Our meta-analysis included
eight studies involving 744 patients. DS showed greater benefits than IS
in terms of TIMI grade 3 flow (odds ratio [OR]: 5.09, 95% confidence
interval [CI]: 1.98-13.02, p< 0.001), TMBG (OR: 4.17, 95% CI: 1.87-9.31,
p< 0.001), complete ST-segment resolution (OR: 2.16, 95% CI: 1.36-3.43, p=
0.001), and MACE (OR: 0.48, 95% CI: 0.25-0.94, p= 0.03). No significant
difference was observed regarding major bleeding events (OR: 1.76, 95% CI:
0.40-7.66, p= 0.45). Conclusion(s): DS yielded satisfactory outcomes
regarding myocardial tissue reperfusion, demonstrated by the improved TIMI
flow grade, TMBG, complete ST-segment resolution, and decreased MACEs
without increasing major bleeding events in patients with STEMI and a high
thrombus burden. DS may be preferred to IS for treating patients with this
characteristic presentation. Copyright © 2018, Springer Medizin
Verlag GmbH, ein Teil von Springer Nature.

<95>
Accession Number
2002659429
Title
Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis,
Meta-Regression, and Trial Sequential Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 119-127),
2020. Date of Publication: January 2020.
Author
Meco M.; Montisci A.; Giustiniano E.; Greco M.; Pappalardo F.; Mammana L.;
Panisi P.; Roscitano C.; Cirri S.; Donatelli F.; Albano G.
Institution
(Meco, Panisi, Roscitano, Albano) Anesthesia and Intensive Care
Department, Humanitas Gavazzeni Clinic, Bergamo, Italy
(Montisci, Cirri) Department of Anesthesia and Intensive Care,
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milano, Italy
(Montisci, Donatelli) Cardiac Surgery, University of Milan, Milano, Italy
(Giustiniano, Greco) Department of Anesthesia and Intensive Care, IRCCS
Humanitas Clinical and Research Center, Rozzano, Italy
(Pappalardo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute and Vita-Salute San Raffaele University,
Milano, Italy
(Mammana, Donatelli) Department of Cardiac Surgery, Cardiothoracic Center,
Istituto Clinico Sant'Ambrogio, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative hemorrhage in cardiac surgery is a significant
cause of morbidity and mortality. Standard laboratory tests fail as
predictors for bleeding in the surgical setting. The use of viscoelastic
(VE) hemostatic assays thromboelastography (TEG) and rotational
thromboelastometry (ROTEM) could be an advantage in patients undergoing
cardiac surgery. The objective of this meta-analysis was to analyze the
effects (benefits and harms) of VE-guided transfusion practice in cardiac
surgery patients. Design(s): A meta-analysis of randomized trials.
 Setting(s): For this study, PubMed, EMBASE, Scopus, and the Cochrane
Collaboration database were searched, and only randomized controlled
trials were included. A systematic review and meta-analysis were performed
in accordance with the standards set forth by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement, using a
random-effects model. Participant(s): The study comprised adult
cardiac surgery patients. Intervention(s): VE-hemostatic assays
transfusion algorithm compared with transfusion algorithms based on
clinicians' discretion. Measurements and Main Results: Seven
comparative randomized controlled trials were considered, including a
total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based
transfusion algorithm was used). In patients treated according to
VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence
interval [CI]: 0.37-0.99; p: 0.04; I2: 66%) and fresh frozen
plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001;
I2: 79%) use was reduced; platelets transfusion was not reduced
(odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I2 74%).
 Conclusion(s): This study demonstrated that the use of VE assays in
cardiac surgical patients is effective in reducing allogenic blood
products exposure, postoperative bleeding at 12 and 24 hours after
surgery, and the need for redo surgery unrelated to surgical
bleeding. Copyright © 2019 Elsevier Inc.

<96>
Accession Number
2002645121
Title
Meta-analysis of propensity matched studies of robotic versus conventional
mitral valve surgery.
Source
Journal of Cardiology. 75 (2) (pp 177-181), 2020. Date of Publication:
February 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: To compare early outcomes after robotic versus conventional
mitral valve surgery (R-MVS versus C-MVS), we performed a meta-analysis of
currently available propensity score matched (PSM) studies.
 Method(s): To identify all PSM studies of R-MVS versus C-MVS, PubMed
and Web of Science were searched thorough November 2018 using the terms of
robotic or robot, mitral, and propensity. Inclusion criteria were PSM
studies of isolated R-MVS versus C-MVS. Odds ratios of dichotomous data
and mean differences for continuous data were generated for each study and
combined in a meta-analysis using the random-effects model.
 Result(s): We identified 7 PSM studies of R-MVS versus C-MVS
enrolling a total of 3764 patients. Pooled analyses demonstrated
significantly longer cardiopulmonary bypass (CPB) (p < 0.00001) and
cross-clamp time (p = 0.004) in R-MVS than C-MVS. However, intensive care
unit (ICU) (p = 0.0005) and hospital stay (p < 0.0001) was significantly
shorter; and incidence of red blood cell (RBC) transfusion (p = 0.03),
prolonged ventilation (p = 0.048), and atrial fibrillation (AF) (p = 0.01)
was significantly less frequent after R-MVS than C-MVS. There was no
significant difference in incidence of reoperation for bleeding and valve
dysfunction, >=moderate mitral regurgitation, renal failure, dialysis,
pneumonia, stroke, cardiac arrest, and all-cause death (p = 0.27) between
R-MVS and C-MVS. Conclusion(s): ICU/hospital stay was shorter and RBC
transfusion/prolonged ventilation/AF was less frequent after R-MVS than
C-MVS despite longer CPB and cross-clamp time in R-MVS than C-MVS. The
other early outcomes including all-cause mortality were similarly frequent
after R-MVS and C-MVS. Copyright © 2019 Japanese College of
Cardiology

<97>
Accession Number
2002503389
Title
The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An
Individual Patient Meta-Analysis of Two Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (1) (pp 99-105),
2020. Date of Publication: January 2020.
Author
Whitlock R.P.; Dieleman J.M.; Belley-Cote E.; Vincent J.; Zhang M.;
Devereaux P.J.; Kalkman C.J.; van Dijk D.; Yusuf S.
Institution
(Whitlock, Belley-Cote, Vincent, Zhang, Devereaux, Yusuf) Population
Health Research Institute, Hamilton Health Sciences and McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Whitlock, Devereaux) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada
(Belley-Cote, Devereaux, Yusuf) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Dieleman, Kalkman, van Dijk) University Medical Center, Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Steroids suppress the inflammatory response to cardiopulmonary
bypass, but the impact on death at 30 days, myocardial infarction or
injury, stroke, renal failure, respiratory failure, new atrial
fibrillation, transfusion requirement, infection, and length of intensive
care unit (ICU) and hospital stays are uncertain. Design(s):
Patient-level data meta-analysis of 2 randomized trials. Setting(s):
Eighty-eight cardiac surgical centers in 19 countries.
 Participant(s): A total of 11,989 participants, from the Steroids in
Cardiac Surgery trial and the Dexamethasone in Cardiac Surgery study,
undergoing cardiac surgery with the use of cardiopulmonary bypass.
 Intervention(s): Participants were randomly assigned to steroid or
placebo. Measures and Main Results: Outcomes assessed were mortality at 30
days, myocardial infarction or injury, stroke, renal failure, respiratory
failure, new atrial fibrillation, transfusion requirement, infection, and
length of ICU and hospital stays. There was no significant difference in
death at 30 days between the steroid and placebo groups (odds ratio [OR],
0.87; 95% confidence interval [CI], 0.72-1.07). Myocardial infarction did
not differ significantly (OR, 1.17; 95% CI, 0.93-1.47); however,
myocardial injury was higher in the steroid group (OR, 1.25; 95% CI,
1.12-1.40). There were no significant differences for the outcomes of
stroke, renal failure, new atrial fibrillation, or transfusion. Steroids
significantly reduced respiratory failure (OR, 0.83; 95% CI, 0.75-0.99),
infection (OR, 0.80; 95% CI, 0.72-0.89), and length of ICU (p < 0.001) and
hospital stays (p = 0.006). Conclusion(s): This patient-level
meta-analysis does not support the routine use of steroids in cardiac
surgery. Steroid administration did not decrease the risk of death,
myocardial infarction, stroke, renal failure, new atrial fibrillation, or
transfusion. Steroids increased the risk of myocardial injury in both the
Steroids in Cardiac Surgery and Dexamethasone in Cardiac Surgery trials.
Finally, steroids lowered the risk of respiratory failure and infection,
and reduced length of ICU and hospital stay. Copyright © 2019

<98>
Accession Number
2002972431
Title
Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus
Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for
Patients with Concomitant Severe Coronary and Carotid Stenosis: A
Systematic Review and Meta-analysis.
Source
Annals of Vascular Surgery. 62 (pp 463-473.e4), 2020. Date of Publication:
January 2020.
Author
Texakalidis P.; Charisis N.; Jonnalagadda A.K.; Chaitidis N.; Giannopoulos
S.; Kaskoutis C.; Machinis T.; Koullias G.J.
Institution
(Giannopoulos) Department of Vascular Surgery, 251 HAF and VA Hospital,
Athens, Greece
(Texakalidis) Department of Neurosurgery, Emory University School of
Medicine, Atlanta, GA, United States
(Charisis) Division of Surgical Oncology, Department of Surgery, Stony
Brook University Hospital, Stony Brook, NY, United States
(Jonnalagadda) Division of Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
(Chaitidis, Kaskoutis) Department of Internal Medicine, 401 General Army
Hospital, Athens, Greece
(Giannopoulos) School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Owing to the systemic nature of atherosclerosis, medium and
large arteries at different sites are commonly simultaneously affected. As
a result, severe coronary artery disease (CAD) requiring coronary artery
bypass graft (CABG) frequently coexists with significant carotid stenosis
that warrants revascularization. The aim of this study was to compare
synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid
artery stenting (CAS) and CABG for patients with concomitant CAD and
carotid artery stenosis in terms of perioperative (30-day) outcomes.
 Method(s): This study was performed according to the Preferred
Reporting Items for Systematic reviews and Meta-Analyses guidelines.
Eligible studies were identified through a search of PubMed, Scopus, and
Cochrane until July 2018. A meta-analysis was conducted with the use of a
random-effects model. The I-square statistic was used to assess
heterogeneity. Result(s): Five studies comprising 16,712 patients
were included in this meta-analysis. Perioperative stroke (odds ratio
[OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I2 =
39.1%), transient ischemic attack (TIA; OR: 0.32; 95% CI: 0.04-2.67;
I2 = 27.6%), and myocardial infarction (MI) rates (OR: 0.56;
95% CI: 0.08-3.85; I2 = 68.9%) were similar between the two
groups. However, patients who underwent simultaneous CEA and CABG were at
a statistically significant higher risk for perioperative mortality (OR:
1.80; 95% CI: 1.05-3.06; I2 = 0.0%). Conclusion(s): The
current meta-analysis did not detect statistically significant differences
in the rates of perioperative stroke, TIA, and MI between the groups.
However, patients in the simultaneous CEA and CABG group had a
significantly higher risk of 30-day mortality. Future randomized trials or
prospective cohorts are needed to validate our results. Copyright
© 2019 Elsevier Inc.

<99>
Accession Number
2003815061
Title
Causes and predictors of readmission after transcatheter aortic valve
implantation: A meta-analysis and systematic review.
Source
Herz. (no pagination), 2019. Date of Publication: 2019.
Author
Li Y.-M.; Mei F.-Y.; Yao Y.-J.; Tsauo J.-Y.; Peng Y.; Chen M.
Institution
(Li, Tsauo, Peng, Chen) Department of Cardiology, West China Hospital,
Sichuan University, 37 Guoxue Street, Chengdu 610041, China
(Mei) Zhejiang Provincial People's Hospital, Hangzhou, China
(Yao) West China School of Medicine, Sichuan University, Chengdu, China
Publisher
Springer Medizin (E-mail: kundenservice@springermedizin.de)
Abstract
Background: Since readmission rate is an important clinical index to
determine the quality of inpatient care and hospital performance, the aim
of this study was to explain the causes and predictors of readmission
following transcatheter aortic valve implantation (TAVI) at short-term and
mid-term follow-up. Methods and Results: A systematic review and
meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and
Ovid was carried out. In all, 10 studies including 52,702 patients were
identified. The pooled estimate for the overall event rate was 0.15, and
cardiovascular causes were the main reason for 30-day readmission (0.42,
95% confidence interval [CI]: 0.39-0.45). In addition, the pooled
incidence of 1-year readmission was 0.31, and cardiovascular events were
still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and
life-threatening bleeding, new permanent pacemaker implantation, and
clinical heart failure were associated with a high risk for early
readmission after TAVI. Moreover, an advanced (>=3) New York Heart
Association classification, acute kidney injury, paravalvular leak, mitral
regurgitation (>= moderate), and major bleeding predicted unfavorable
outcome to 1-year readmission. Female gender and transfemoral TAVI was
associated with a lower risk for unplanned rehospitalization.
 Conclusion(s): This meta-analysis found cardiovascular factors to be
the main causes for both 30-day and 1-year rehospitalization. Heart
failure represented the most common cardiovascular event at both
short-term and mid-term follow-up. Several baseline characteristics and
procedure-related factors were deemed unfavorable predictors of
readmission. Importantly, transfemoral access and female gender were
associated with a lower risk of readmission. Copyright © 2019,
Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<100>
Accession Number
2002091179
Title
Spontaneous Coronary Artery Dissection in a Pregnant Woman Associated with
Fetal Complication: A Case Report and Review of Literature.
Source
Cardiovascular Revascularization Medicine. 20 (11 Supplement) (pp 46-48),
2019. Date of Publication: November 2019.
Author
Ya'qoub L.
Institution
(Ya'qoub) Department of Cardiology, Louisiana State University,
Shreveport, LA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Spontaneous Coronary Artery Dissection (SCAD) is an important cause of
Acute Coronary Syndrome (ACS), especially in pregnant women. SCAD has
angiographic appearance that might mimic atherosclerotic coronary artery
disease (CAD). SCAD in pregnancy can be associated with both maternal and
fetal complications. The best management approach of such cases may be
achieved by a multi-disciplinary team, including an obstetrician, an
interventional cardiologist and a cardiothoracic surgeon. We present a
very interesting case of SCAD involving the left anterior descending (LAD)
artery with two different angiographic appearances in a pregnant woman
which was associated with fetal heart deceleration requiring urgent
cesarean section and later coronary artery bypass graft (CABG)
surgery. Copyright © 2019 Elsevier Inc.

<101>
Accession Number
2004128798
Title
Dual Monitoring During Carotid Endarterectomy Using Near-infrared
Spectroscopy and Stump Pressure.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e430-e432), 2019. Date of Publication: December 2019.
Author
Gimzauskaite A.; Aladaitis A.; Inciura D.; Velicka L.; Antusevas A.
Institution
(Gimzauskaite, Aladaitis, Inciura, Velicka, Antusevas) Vascular Surgery,
Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Surgical treatment of carotid artery stenosis is the main
procedure to reduce the risk of stroke. Insufficient cerebral collateral
flow during cross-clamping of the ICA may result in inadequate perfusion
and intraoperative stroke. To select patients in need of shunting,
neuromonitoring is obligatory. Stump pressure (SP) is widely used, but the
cutoff pressure for when shunting is mandated is discussed[1-2].
Near-infrared spectroscopy (NIRS) is a monitoring system that can be used
throughout theo peration, and reflects the cerebral oxygenation instantly,
but its value is still controversial. Methods - This is a prospective
study. All 86 patients (60% males) who underwent isolated CEA or CEA with
simultaneous coronary artery bypass grafting (CABG) under general or
regional anesthesia were included in this study. There were no
exclusioncriteria. MONITORING All patients were continuously monitored
with NIRS. The sensors were applied on the forehead.During the operation
regional saturation was monitored every 5min. Stump pressure of ICA was
measured before and after ICA clamping. The shunt was used if the stump
pressure was <40mmHg, or there were neurological symptoms during
clamping(forpatients with local anesthesia). NIRS oximeter measurements
were compared with stump pressure. STATISTICAL ANALYSIS T test was used
for continuous normally distributed data. In order to evaluate the ability
topredict cerebral ischaemia, receiver operating characteristic curves
(ROC) were used and theareas under curve for the change in rSO2 using SP
<40mmHg as the cutoff value. For correlation the Spearman Rank Correlation
Coefficient was used. P<0.05 was consideredstatisticaly significant.
Statistical calculation was performed using IBM SPSS 20.0 softwarepackage.
Results - NIRS MEASUREMENT Change of rSO2 after cross-clamping was plotted
against time (Figure 1). This graph showed that rSO2 falls rapidly on
ipsilateral and contralateral sides as soon as the CCA was cross-clamped,
and reached the lowest level after few seconds. The relative change in
rSO2 on the operated side decreased more versus contralateral side after
clamping. A significant decrease of rSO2 was seen soon after clamping on
ipsilateral side. No siginificant changes in rSO2 were observed in the
contralateral side at any moment of procedure. NIRS AND SP CORRELATION We
plotted the change of rSO2 at 5 min after cross-clamping CCA, against
stump pressure measured soon after CCA was cross-clamped. There was no
correlation between NIRS and SP (Pearson R = 0.74). ROC CURVE ANALYSIS ROC
curve showed an area under the curve of 0.54 (95% CI 0.29-0.8) for rSO2 to
indicate shunt requirement using SP <40 mmHg as the cutoff value. At a
cut-off value of 32% decrease or more for the cerebrovascular SO2, a
sensitivity and specificity of 100% was found. Lesser cut-off values
resulted in a gradual decrease of specificity and sensitivity (Table 1).
[Formula presented] Conclusion - Near-infrared spectroscopy (NIRS) allows
easy and continuous monitoring of cerebral ischaemia during carotid
endarterectomy procedure (CEA). Despite all positive features, we showed
that this monitoring method is not so suitable during CEA for selective
shunting. It shows immediate oxygenational change, but it's not
correlating with stump pressure (SP). NIRS shows high sensitivity and
specificity only after cosiderably decrease of frontal lobe regional
saturation (rSO2). References 1. Calligaro K, Dougherty M. Correlation of
carotid artery stump pressure and neurologic changes during 474 carotid
endarterectomies performed in awake patients. Journal of Vascular Surgery.
2005;42(4):684-689.4. Hans S, Jareunpoon O. Prospective evaluation of
electroencephalography, carotid artery stump pressure, and neurologic
changes during 314 consecutive carotid endarterectomies performed in awake
patients. Journal of Vascular Surgery. 2007;45(3):511-515. 2 AbuRahma A,
Stone P, Hass S, Dean L, Habib J, Keiffer T et al. Prospective randomized
trial of routine versus selective shunting in carotid endarterectomy based
on stump pressure. Journal of Vascular Surgery. 2010;51(5):1133-1138.
 Copyright © 2019

<102>
Accession Number
2004128608
Title
Present or Future: Rapid 3d Printing Prototyping Technology for Aortic
Aneurysm Surgery Planning and Its Utility in Open and Endovascular
Treatment.
Source
European Journal of Vascular and Endovascular Surgery. Conference: The
European Society for Vascular Surgery 32nd Annual Meeting 2018. Spain. 58
(6 Supplement 2) (pp e271-e272), 2019. Date of Publication: December 2019.
Author
Bueno G.; Altes P.; Carnovale L.; Hernandez N.; Sancho J.; Zamora G.;
Esteban C.; Llagostera S.
Institution
(Bueno, Altes, Carnovale, Hernandez, Sancho, Zamora, Esteban, Llagostera)
Universitat Autonoma de Barcelona, Barcelona, Spain
(Bueno, Altes, Carnovale, Hernandez, Sancho, Zamora, Esteban, Llagostera)
Angiology and Vascular Surgery, Hospital Universitari Germans Trias i
Pujol, Barcelona, Spain
Publisher
W.B. Saunders Ltd
Abstract
Introduction - Nowadays, the use of 3D printing prototyping technology is
implemented in surgical practice, especially for anatomical modelling and
surgical planning. The aim of this study is to evaluate the utility of 3D
printed model prototypes in the planification of aortic clamping placement
during juxta or pararenal aortic aneurysm open surgery and their impact in
custom made fenestrated endografts for endovascular aortic aneurysm repair
(FEVAR). Methods - A retrospective unicenter study was conducted. We
included patients with juxta and pararenal aortic aneurysm. We analysed
samples using cross sectional DICOM data from each patient computer
tomography. With Horos program we composed a stereolithographic file
through the segmentation process. We obtained the abdominal aortic model
from above celiac trunk to iliac arteries by 3D printing in filaflex
material for open surgery planning and in hard polymer resin for
endovascular planning. In these patients candidates to open repair we used
the model to plan the site of clamping. In candidates to FEVAR, the
puncture approach strategy and the correct alignment of the endograft
fenestrations were analysed. Results - During 2017 we included 7 patients,
3 juxtarenal aortic aneurysm open surgeries and 4 FEVAR. In open surgery,
we performed two infrarenal clamping (66%) and one suprarenal clamping
(33%), all accordance to the previous planned strategy with the 3D printed
model. No complications were observed and anastomosis were in the intended
place. Regarding FEVAR, we designed four 3D models and performed implant
simulations. Among these 4 cases, one endograft had to be redesigned (25%)
due to the incorrect alignments of the fenestration to the ostium of the
model. The other three endografts integrated correctly with the model
(75%). Two FEVAR procedures were performed "in vivo" as planned (50%),
while one of the cases required a different puncture approach due to the
impossibility of cannulating an arterial branch (25%). Conclusion(s):
3D models allowed the correct planification of aortic clamping site in
open surgery. Regarding to FEVAR, the prototypes were useful to stablish
the puncture approach strategy and evaluated the correct fenestrations
alignment. More studies are required to introduce this technology in the
clinical practice. References: 1. Dong M, Chen G, Li J, Qin K, Ding X,
Peng C, et al. Three-dimensional brain arteriovenous malformation models
for clinical use and resident training 2018;3(November 2017). 2. Taher F,
Falkensammer J, McCarte J, Strassegger J, Uhlmann M, Schuch P, et al. The
influence of prototype testing in three-dimensional aortic models on
fenestrated endograft design. J Vasc Surg 2017;65(6):1591-7. 3. Hoang D,
Perrault D, Stevanovic M, Ghiassi A. Surgical applications of
three-dimensional printing: a review of the current literature & how to
get started. Ann Transl Med 2016;4(23):456-456. 4. Burdall OC, Makin E,
Davenport M, Ade-Ajayi N. 3D printing to simulate laparoscopic choledochal
surgery. J Pediatr Surg 2016;51(5):828-31. 5. Treasure T, Takkenberg JJM,
Golesworthy T, Rega F, Petrou M, Rosendahl U, et al. Personalised external
aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year
outcomes by intention-to-treat in a cohort of the first 30 consecutive
patients to receive a novel tissue and valve-conserving procedure,
compared with the publishe. Heart 2014;100(12):969-75. 6. O'Brien CM,
Holmes B, Faucett S, Zhang LG. Three-Dimensional Printing of Nanomaterial
Scaffolds for Complex Tissue Regeneration. Tissue Eng Part B Rev
2015;21(1):103-14. 7. Caudle AS, Yang WT, Mittendorf EA, Kuerer HM. 3D
Printed Biodegradable Polymeric Vascular Grafts 2016;150(2):137-43. 8. Yoo
S-J, Spray T, Austin EH 3rd, Yun T-J, van Arsdell GS. Hands-on surgical
training of congenital heart surgery using 3-dimensional print models. J
Thorac Cardiovasc Surg 2017;153(6):1530-40. 9. Tack P, Victor J, Gemmel P,
Annemans L. 3D-printing techniques in a medical setting: a systematic
literature review. Biomed Eng Online 2016;15(1):115. 10. Powers MK, Lee
BR, Silberstein J. Three-dimensional printing of surgical anatomy. Curr
Opin Urol 2016;26(3). Copyright © 2019

<103>
Accession Number
630054320
Title
High-sensitivity troponin with sex-specific thresholds in suspected acute
coronary syndrome.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1029), 2019. Date of
Publication: October 2019.
Author
Lee K.K.; Ferry A.V.; Anand A.; Strachan F.E.; Chapman A.R.; Newby D.B.;
Tuck C.; Keerie C.; Weir C.J.; Shah A.S.V.; Mills N.L.
Institution
(Lee, Ferry, Anand, Strachan, Chapman, Newby, Tuck, Keerie, Weir, Shah,
Mills) University of Edinburgh, Centre for Cardiovascular Science,
Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Background/Introduction: Major disparities between women and men in the
diagnosis, management and outcome of acute coronary syndrome are well
recognised. Whether sex-specific diagnostic thresholds for myocardial
infarction will address these differences is uncertain. Purpose(s):
To evaluate the impact of implementing a high-sensitivity cardiac troponin
I (hs-cTnI) assay with sex-specific diagnostic thresholds for myocardial
infarction in women and men with suspected acute coronary syndrome.
 Method(s): In a stepped-wedge, cluster-randomized controlled trial
across ten hospitals we evaluated the implementation of a hs-cTnI assay in
48,282 (47% women) consecutive patients with suspected acute coronary
syndrome. During a validation phase the hs-cTnI assay results were
suppressed and a contemporary cTnI assay with a single threshold was used
to guide care. Myocardial injury was defined as any hs-cTnI concentration
>99th centile of 16 ng/L in women and 34 ng/L in men. The primary outcome
was myocardial infarction after the initial presentation or cardiovascular
death at 1 year. In this prespecified analysis, we evaluated outcomes in
men and women before and after implementation of the hs-cTnI assay.
 Result(s): Use of the hs-cTnI assay with sex-specific thresholds
increased myocardial injury in women by 42% (from 3,521 (16%) to 4,991
(22%)) and by 6% in men (from 5,068 (20%) to 5,369 (21%)). Whilst
treatment increased in both sexes, women with myocardial injury remained
less likely than men to undergo coronary revascularisation (15%
versus34%), or to receive dual anti-platelet (26% versus43%), statin (16%
versus26%) or other preventative therapies (P<0.001 for all). The primary
outcome occurred in 18% (369/2,072) and 17% (488/2,919) of women with
myocardial injury during the validation and implementation phase
respectively (adjusted hazard ratio 1.11, 95% confidence interval 0.92 to
1.33), compared to 18% (370/2,044) and 15% (513/3,325) of men (adjusted
hazard ratio 0.85, 95% confidence interval 0.71 to 1.01).
 Conclusion(s): Use of sex-specific thresholds identified five-times
more additional women than men with myocardial injury, such that the
proportion of women and men with myocardial injury is now similar. Despite
this increase, women received approximately half the number of treatments
for coronary artery disease as men and their outcomes were not improved.
(Figure Presented).

<104>
Accession Number
630053897
Title
Antiplatelet effects of intraoperative administration of ticagrelor versus
clopidogrel in patients undergoing one-stop hybrid coronary
revascularization: A single-center randomized controlled trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3417), 2019. Date of
Publication: October 2019.
Author
Zhang Q.; Xu H.Y.; Wu Y.J.
Institution
(Zhang, Xu, Wu) Fu Wai Hospital, Beijing, China
Publisher
Oxford University Press
Abstract
Background: "One-stop" hybrid coronary revascularization (HCR) has emerged
to be a reliable and attractive alternative for selected patients with
multivessel coronary artery disease. However, the optimal antiplatelet
regimen of this procedure still remains controversial. Therefore, we
conducted a randomized controlled trial to compare antiplatelet effect
between ticagrelor and clopidogrel during this hybrid procedure.
 Purpose(s): The study objective was to evaluate the onset of platelet
inhibition between ticagrelor and clopidogrel in patients during
"one-stop" HCR. Method(s): In a single-center, randomized, open-label
study, 60 patients receiving one-stop HCR were randomized equally to
received either clopido-grel (300 mg loading dose, 75 mg once per day), or
ticagrelor (90 mg loading dose, 90 mg twice daily) after confirmation of
LIMA-LAD graft patency. All patients treated with aspirin 100mg once daily
during the treatment period. Platelet reaction units (PRU) was assessed by
Verify NowTM P2Y12 assay before surgery; after confirmation of LIMA-LAD
graft patency before administration study drugs; and at 30 minutes, 1
hour, 2 hours, 6 hours, 12 hours, 24 hours after loading dose. Major
adverse cardiac events and bleeding events within a year follow-up were
recorded. Result(s): Ticagrelor produced further suppression of
platelet aggregation in patients undergoing "one-stop" HCR from 2 hours
after loading dose (PRU 271.0+/-51.6 vs 313.2+/-61.2, P=0.008). The
average PRU value was still better at 24 hours after loading dose in the
ticagrelor group than in the clopidogrel group (121.1+/-75.5 vs
284.3+/-67.0, P<0.001). There were no differences of bleeding or major
adverse cardiac events between two groups. Conclusion(s): In patients
receiving "one-stop" HCR, the onset of action was fater and higher with
ticagrelor than with clopidogrel.

<105>
Accession Number
630053156
Title
Risk of myocardial infarction with coronary artery bypass grafting versus
percutaneous coronary intervention: A systematic review and meta-analysis
of fifteen randomised trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2937), 2019. Date of
Publication: October 2019.
Author
Lee P.H.; Park H.B.; Lee J.S.; Lee S.W.; Lee C.W.
Institution
(Lee, Park, Lee, Lee, Lee) Asan Medical Center, Seoul, South Korea
Publisher
Oxford University Press
Abstract
Background: It remains controversial whether coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI) is more
effective in the prevention of myocardial infarction (MI). MI has been
evaluated only as a secondary endpoint without a focused systematic review
in multiple meta-analyses. Purpose(s): To compare the risk of MI at
the latest follow-up available between CABG versus PCI with stents in
patients with multivessel or left main coronary artery disease in a
pairwise meta-analysis of randomised controlled trials (RCT).
 Method(s): We searched EMBASE, Cochrane, and Pubmed databases for
articles comparing CABG versus PCI for the treatment of multivessel or
left main disease. We utilised random-effects model to calculate pooled
risk ratio (RR) and 95% confidence interval (CI). Fifteen trials with a
total of 13,592 patients treated with either CABG (n=6,596) or PCI
(n=6,996) were eligible and included. A multivariable random-effects
meta-regression model, including variables such as age, sex, diabetes
mellitus, publication year, follow-up duration, type of stent used, and
type of coronary artery disease, was used to explore the source of
potential heterogeneity of the primary result. Result(s): After a
weighted follow-up of 4.3 years, patients treated with CABG had a
significantly lower risk of MI than patients treated with PCI (RR 0.75,
95% CI 0.58-0.96, P=0.024, I2=66%). The lower risk of MI with CABG as
compared to PCI was more evident during a longer duration of follow-up
(>=3 years, RR 0.69, 95% CI 0.52-0.91, P=0.008; >=5 years, RR 0.64, 95% CI
0.48-0.86, P=0.003) and in diabetic population (RR 0.55, 95% CI 0.44-0.70,
P<0.001). There was a statistically meaningful trend toward fewer MIs with
CABG with a similar magnitude of risk reduction across patients with left
main disease (RR 0.74, 95% CI 0.47-1.15) and multivessel disease (RR 0.72,
95% CI 0.53-0.99). Moderate inter-study heterogeneity could not be
explained by the clinical and trial-based variables tested in
meta-regression, and is likely because of differences in definitions of
MI, risk profile of enrolled patients, and procedural specifics.
 Conclusion(s): In patients undergoing revascularization for
multivessel or left main disease, the risk of MI was lower with CABG
compared to PCI. The quality assurance for MI definition and
treatment-specific procedures should be emphasized for future RCTs.

<106>
Accession Number
630052901
Title
Exercise oscillatory ventilation improves the performance of prognosis
scores currently used for heart failure.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3308), 2019. Date of
Publication: October 2019.
Author
Gama F.; Freitas P.; Aguiar C.; Ferreira A.; Strong C.; Ventosa A.;
Ferreira F.; Mendes M.
Institution
(Gama, Freitas, Aguiar, Ferreira, Strong, Ventosa, Ferreira, Mendes)
Hospital de Santa Cruz, Lisbon, Portugal
Publisher
Oxford University Press
Abstract
Background and aim: Several prognostic risk scores are available for heart
failure with reduced ejection fraction (HFrEF), and are used, together
with other criteria, to help decide the ideal timing for listing
candidates for a heart transplant. The detection of an oscillatory
ventilatory pattern (OVP) during cardiopulmonary exercise testing (CPET)
has been associated with more advanced HF and a worse prognosis, but was
not considered in the development of all the current risk scores. We
evaluated whether OVP adds significant prognostic information to four
contemporary HF scores. Method(s): Single-centre retrospective cohort
study of consecutive HFrEF patients undergoing CPET for functional and
prognostic assessment from October 1996 till May 2018. The Heart Failure
Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-analysis
Global Group in Chronic Heart Failure (MAGGIC) and Metabolic Exercise
Cardiac Kidney Index (MECKI) were obtained in each patient. Cox model was
fit with time to death or urgent transplant (whichever came first within 2
years) as the dependent variable and OVP and respective HF score as the
independent variables. We further assessed the added discriminative power
by performing ROC curve comparisons. Result(s): We studied 387
patients, median age 58 (IQR 49; 65) years, and 77% were male. The most
common HFrEF aetiology was ischemic heart disease (54%). Median peak
oxygen consumption was 15,7 mL/kg/min (IQR 12,8; 20,0). OVP was present in
150 (39%) patients. Over the 2-year follow-up period, 48 patients died,
and 52 underwent heart transplantation (of which 25 were urgent). HFSS
showed the weakest (c-statistic 0,625; 95% [CI] 0,54-0,71) and MECKI score
the strongest (c-statistic 0,819; 95% [CI] 0,76-0,88) discriminatory
ability. Contrasting with NTproBNP value, the presence of OVP predicted
the study endpoint independently of the HF prognosis score used (see
table). Adding the occurrence of OVP to the HFSS and the MAGGIC scores
significantly improved their prognostic performance (see Table).
 Conclusion(s): An OVP is a common finding in HFrEF patients
undergoing CPET, and adds prognostic information to contemporary HF
prognosis scores. Systematic evaluation of this easily available criterion
may assist the decision on the appropriate timing for heart
transplantation listing.

<107>
Accession Number
630052824
Title
Sex-specific PCI strategies in patients with AMI and cardiogenic shock: A
substudy of the culprit-shock trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1017), 2019. Date of
Publication: October 2019.
Author
Rubini Gimenez M.; Zeymer U.; Desch S.; De Waha-Thiele S.; Ourrak T.;
Meyer-Saraei R.; Schneider S.; Fuernau G.; Akin I.; Savonitto S.; Jeger
R.; Thiele H.
Institution
(Rubini Gimenez, Jeger) University Hospital Basel, Department of
Cardiology, Basel, Switzerland
(Zeymer) Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
(Desch, Thiele) Heart Center of Leipzig, Leipzig, Germany
(De Waha-Thiele, Meyer-Saraei, Fuernau) Medical University, Luebeck,
Germany
(Ourrak, Schneider) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Akin) University Medical Centre of Mannheim, Mannheim, Germany
(Savonitto) Ospedale Di Bellano Azienda Ospedaliera Provinciale, Lecco,
Italy
Publisher
Oxford University Press
Abstract
Background and purpose: Women are more likely to suffer from a cardiogenic
shock (CS) as the most severe complication of an acute myocardial
infarction (AMI) and tend to have a higher mortality. Data concerning
optimal management among women with CS are lacking. Aim of this study was
therefore to better define characteristics of women suffering a CS and to
investigate the influence of sex on different coronary revascularisation
strategies Methods and Results: In the CULPRIT-SHOCK trial, patients
with CS complicating AMI and multivessel coronary artery disease were
randomly assigned to one of the following coronary revascularisation
strategies: either percutaneous coronary intervention (PCI) of the culprit
lesion only or immediate multivessel PCI. Primary end-point was a
composite of death from any cause or severe renal failure leading to
renal-replacement within 30 days after randomisation. We investigated
sex-specific differences in general and according to the revascularisation
strategies Among all 706 randomised patients 26% were women. After 30
days, the primary end-point occurred in 55% women and 49% men (p=0.20),
showing a relative risk of 1.14; 95% CI 0.94-1.38; p=0.17, women vs. men
Those women were older, more frequent diabetic and had more peripheral
artery disease and less frequent smokers and less often family history of
coronary artery disease Regarding revascularisation strategy the composite
end-point occurred in 55.8% women treated with the culprit-only strategy
(vs. 42.4% men p=0.04) and in 54.7% women in the multivessel group (vs.
55.6% men p=0.99). This resulted in a no-significant difference among both
groups (interaction p-value of 0.11) Conclusion(s): In this large
randomised trial among patients with multivessel coronary disease and CS
complicating AMI, women had similar outcome for mortality and severe renal
failure. Sex did not show to influence mortality and renal failure
according to the different coronary revascularisation strategies. These
data suggest that women and men presenting with CS should be treated
equally.

<108>
Accession Number
630052348
Title
Individual patient data meta-analysis comparing general anesthesia and
deep sedation on safety and length of intensive care unit stay in patients
undergoing percutaneous mitral valve repair.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2922), 2019. Date of
Publication: October 2019.
Author
Jobs A.; De Waha-Thiele S.; Ledwoch J.; Sievert H.; Rassaf T.; Luedike P.;
Kelm M.; Hellhammer K.; Horn P.; Westenfeld R.; Patzelt J.; Langer H.F.;
Desch S.; Eitel I.; Thiele H.
Institution
(Jobs, Desch, Thiele) Heart Centre Leipzig at University of Leipzig,
Department of Cardiology, Leipzig, Germany
(De Waha-Thiele, Eitel) Medical University, Department of Cardiology,
Angiology and Intensive Care Medicine, Lubeck, Germany
(Ledwoch) Klinikum Rechts der Isar, Technical University of Munich,
Division of Cardiology, Munich, Germany
(Sievert) Sankt Katharinen Hospital, CardioVascular Center Frankfurt,
Frankfurt, Germany
(Rassaf, Luedike) University Hospital of Essen (Ruhr), Department of
Cardiology and Vascular Medicine, Essen, Germany
(Kelm, Hellhammer, Horn, Westenfeld) Medical Faculty of the Heinrich Heine
University Dusseldorf, Department of Cardiology, Pulmonology and Vascular
Medicine, Dusseldorf, Germany
(Patzelt, Langer) University Hospital, Eberhard Karls University,
Department of Cardiology and Cardiovascular Medicine, Tubingen, Germany
Publisher
Oxford University Press
Abstract
Background: Percutaneous edge-to-edge mitral valve repair (PMVR) has
emerged as a treatment option for patients with severe mitral
regurgitation not considered suitable candidates for surgery. The
procedure can be performed in general anesthesia (GA) or deep sedation
(DS) without mechanical ventilation. However, debate remains about the
optimal approach. Purpose(s): To compare the impact of the anesthetic
method on efficacy, safety, and length of intensive care stay.
 Method(s): We identified studies comparing GA versus DS in patients
undergoing PMVR by searching PubMed and CENTRAL. We included studies for
which investigators agreed to provide individual patient data. Analyzed
outcomes were a composite safety endpoint comprising all-cause death,
stroke, pneumonia, and major to life-threating bleeding as well as length
of intensive care unit stay. We performed an one-stage and two-stage
meta-analysis on each outcome after multiple imputation of missing data.
For two-stage meta-analysis, between-study heterogeneity was estimated
according to Paule-Mandel and confidence intervals were derived using the
method proposed by Hartung and Knapp. Result(s): We included five
observational studies (n=647 patients). Procedural success was achieved in
618 of 647 (95.5%) patients. The composite safety endpoint occurred in 92
of 647 (14.2%) patients with no difference between patients treated with
GA or DS. In this regard, risk ratio was 0.78 (95% confidence interval,
0.53 to 1.14; P=0.20) following the one-stage approach and 0.73 (95%
confidence interval, 0.30 to 1.80; P=0.39) following the two-stage
approach. Length of intensive care stay was longer after GA as compared to
DS (adjusted mixed linear regression model, 1.94 days, 95% confidence
interval, 1.29 to 2.59 days, P<0.001; random effects model pooling
study-specific estimates from adjusted linear models 1.40 days, 95%
confidence interval, 0.54 to 2.22 days, P=0.0104). Conclusion(s):
Both, DS and GA offer good procedural success rates and a similar safety
profile. However, length of intensive care stay is shorter after DS.

<109>
Accession Number
630051441
Title
Prognostic impact of SYNTAX Score in patients with myocardial infarction
with multivessel coronary artery disease and cardiogenic shock: Insight
from the CULPRIT-SHOCK trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 642), 2019. Date of
Publication: October 2019.
Author
Guedeney P.; Barthelemy O.; Zeitouni M.; Hauguel-Moreau M.; Hage G.;
Overtchouk P.; Rouanet S.; Vicaut E.; De Waha-Thiele S.; Zeymer U.; Sandri
M.; Akin I.; Desch S.; Thiele H.; Montalescot G.
Institution
(Guedeney, Barthelemy, Zeitouni, Hauguel-Moreau, Hage, Overtchouk,
Montalescot) Hospital Pitie-Salpetriere, Paris, France
(Rouanet) StatEthic, Statistician Unit, Levallois Perret, France
(Vicaut) Action study group, Unite De recherche Clinique, Hopital
Lariboisiere, Paris, France
(De Waha-Thiele, Sandri, Akin, Desch, Thiele) Heart Center of Leipzig,
Cardiology, Leipzig, Germany
(Zeymer) Stiftung Institut fur Herzinfarktforschung, Cardiology,
Ludwigshafen, Germany
Publisher
Oxford University Press
Abstract
Background: The majority of patients presenting with myocardial infarction
(MI) and cardiogenic shock (CS) have multivessel coronary artery disease.
The prognosis impact of the SYNTAX score (SS) in this setting remains
unknown. Purpose(s): To evaluate the prognosis value of the SS in
this high-risk population undergoing percutaneous coronary intervention
(PCI) Methods: The CULPRIT-SHOCK trial was an international, open-label
trial, where patients presenting with MI and multivessel disease
complicated by CS were randomized to a culprit-lesion-only or an immediate
multivessel PCI strategy. Pre-PCI SS was assessed by a central core
laboratory and patients were categorized as low SS (SS <=22), intermediate
SS (22<SS<=32) and high SS (SS>32). Adjudicated endpoints of interest were
the risks of all-cause death or renal replacement therapy at 30 days and
all-cause death at 1 year. Associations between SYNTAX score and outcomes
were assessed using multivariate logistic regression. Result(s): SS
was available in 632 patients, of whom 265 (41.9%), 211 (33.4%) and 156
(24.7%) presented with low, intermediate and high SS, respectively.
Patients with higher SS were older, with more frequent peripheral artery
disease, less current smoking, lower creatinine clearance, and higher use
of catecholamine. A stepwise increase in the incidence of adverse events
transitioning from low to intermediate and high SS was observed with the
30-day risk of death or renal replacement therapy as well as the 1-year
risk of all-cause death (p for trend <0.001, for all). After multiple
adjustment, intermediate and high SS remained strongly associated with
30-day risk of death and renal replacement therapy and 1-year risk of
all-cause death (Figure). There was no significant interaction between
SYNTAX score and the coronary revascularization strategy for all
endpoints. Conclusion(s): In patients presenting with acute MI,
multivessel disease and CS, the SYNTAX score was strongly associated to
30-day and 1-year mortality.(Figure Presented).

<110>
Accession Number
630051390
Title
Left ventricular non-compaction, trait or cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2868), 2019. Date of
Publication: October 2019.
Author
Kayvanpour E.; Sedaghat-Hamedani F.; Gi W.T.; Tugrul O.F.; Amr A.; Haas
J.; Ehlermann P.H.; Uhlmann L.; Katus H.A.; Meder B.
Institution
(Kayvanpour, Sedaghat-Hamedani, Gi, Tugrul, Amr, Haas, Ehlermann, Katus,
Meder) University Hospital of Heidelberg, Department of Medicine III,
Heidelberg, Germany
(Uhlmann) University of Heidelberg, Department of Medical Biometry,
Heidelberg, Germany
Publisher
Oxford University Press
Abstract
Background: The diagnosis of cardiac hypertrabecularization has increased
considerably in recent years. Whether or not the non-compaction is a
pathological condition or a physiological trait is still highly debated.
We performed a meta-analysis and systematic review on more than 7,000
adult individuals with left ventricular non-compaction to provide a
comprehensive overview on its clinical outcome as well as its genetic
background. Method(s): We first retrieved PubMed/Medline literatures
in English language between 2000 to 2018 on clinical outcome and genotype
of patients with non-compaction. Altogether, 35 studies with
non-compaction cardiomyopathy patients passed the selection criteria and
were extensively reviewed and meta-analyzed. Furthermore, we summarized
the results of 8 major studies, which investigated the non-compaction in
athletes, pregnant women, patients with sickle cell disease, or in
individuals from population-based cohorts. Result(s): About 60% of
the patients with left-ventricular non-compaction cardiomyopathy were
male. The diagnosis was mostly made in the mid of patients' 5th decade.
Seven percent of patients had congenital heart diseases (CHD) including
atrial/ventricular septum defect or Ebstein anomaly. Around 25% of the
patients had positive family history for cardiomyopathy. Frequent
phenotypic manifestations were heart rhythm abnormalities including
conduction disease (26%), supraventricular tachycardia (17%), and
sustained or non-sustained ventricular tachycardia (18%). Neuromuscular
disease was a reported comorbidity with a mean frequency of 5%. Three
important outcome measures including systemic thromboembolic events (9%),
heart transplantation (4%), and adequate ICD therapy (15%) were reported.
The genetics of non-compaction cardiomyopathy showed TTN to be the most
frequently mutated gene (11%), followed by MYH7 (9%), MYBPC3 (5%), and
CASQ2, LDB3 (3% each). TPM1, MIB1, ACTC1, and LMNA mutations had an
average frequency of 2% each followed by PLN, HCN4, TAZ, DTNA, TNNT2, and
RBM20 (1% each). Eight studies that investigated the occurrence of
non-compacted myocardial regions in apparently heart healthy individuals
applied different, established imaging-based diagnostic criteria for
non-compaction and could confirm its presence in a wide range of 1.3% to
37%. Conclusion(s): This meta-analysis summarizes the clinical
presentation of left ventricular non-compaction in a large dataset and
indicates that its presence often leads to unfavourable outcome, but can
also be observed in heart healthy individuals. Multimodal diagnostic
workflows are needed for comprehensive understanding of these individuals
and for distinguishing between benign morphological trait and manifest
cardiomyopathy.

<111>
Accession Number
630051262
Title
A novel prediction model for mortality after cardiac surgery using
institutional case volume.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2049), 2019. Date of
Publication: October 2019.
Author
Lee S.; Park J.B.; Cho Y.J.; Ryu H.G.; Jang E.J.
Institution
(Lee, Park, Cho, Ryu) Seoul National University Hospital, Seoul, South
Korea
(Jang) Andong National University, Department of Information Statistics,
Andong, South Korea
Publisher
Oxford University Press
Abstract
Purpose: A number of risk prediction models have been developed to
identify short term mortality after cardiovascular surgery. Most models
include patient characteristics, laboratory data, and type of surgery, but
no consideration for the amount of surgical experience. With numerous
reports on the impact of case volume on patient outcome after high risk
procedures, we attempted to develop a risk prediction models for
in-hospital and 1-year mortality that takes institutional case volume into
account. Method(s):We identified adult patients who underwent cardiac
surgery from January 2008 to December 2017 from the National Health
Insurance Service (NHIS) database by searching for patients with procedure
codes of coronary artery bypass grafting, valve surgery, and surgery on
thoracic aorta during the hospitalization. Study subjects were randomly
assigned to either the derivation cohort or the validation cohort.
In-hospital mortality and 1-year mortality data were collected using the
NHIS database. Risk prediction models were developed from the derivation
cohort using Cox proportional hazards regression. The prediction
performances of models were evaluated in the validation cohort.
 Result(s): The models developed in this study demonstrated fair
discrimination for derivation cohort (N=22,004, c-statistics, 0.75 for
in-hospital mortality; 0.73 for 1-year mortality) and acceptable
calibration in the validation cohort. (N=22,003, Hosmer-Lemeshow
chi2-test, P=0.08 and 0.16, respectively). Case volume was the key factor
of mortality prediction models after cardiac surgery. (50<= x <100 case
per year. 100<= x <200 case per year, >=200 case per year are correlated
with OR 3.29, 2.49, 1.85 in in-hospital mortality, 2.76, 1.99, 1.69 in
1-year mortality respectively, P value <0.001.) Conclusion(s): We
developed and validated new risk prediction models for in-hospital and
1-year mortality after cardiac surgery using the NHIS database. These
models may provide useful guides to predict mortality risks of patients
with basic information and without laboratory findings. (Figure Preseted).

<112>
Accession Number
630051220
Title
Use of renal denervation in the electrical storm management.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3121), 2019. Date of
Publication: October 2019.
Author
Gorev M.; Nardaya S.H.; Petelko S.; Rzaev F.; Vasilieva E.; Shpektor A.
Institution
(Gorev, Vasilieva, Shpektor) Moscow State Medical and Dental University,
Cardiology, Moscow, Russian Federation
(Nardaya, Petelko, Rzaev) Davydovsky Moscow City Clinical Hospital,
Cardiology, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
Background/Introduction: Electrical storm (ES) is a potentially lethal
state developing in 4-28% of ICD patients. Neuroaxial modulation
(betablockers, deep sedation, epidural anesthesia, stellate ganglion
blockade etc) is used to decrease arrhythmogenic predisposition of
ventricular myocardium to trigger and maintain ventricular arrhythmias.
Catheter renal arterial denervation (RDN) is recently described to prevent
atrial fibrillation recurrence after pulmonary vein isolation. We used
this procedure in addition to standard care to improve the results of ES
treatment. Purpose(s): This retrospective single-center case-series
is aimed to analyze ES patient population and to describe the effect of
RDN on the in-hospital number of ventricular tachycardia (VT) episodes and
ICD shocks and on the mid-term survival. Method(s): Pts admitted to
the CCU for more than 3 sustained VT episodes or more than 3 appropriate
ICD shocks during the 24h period in 2017-18 were enrolled into study.
Demographic, echocardiographic, ICD check up, renal arteries anatomy and
mid-term mortality/transplant data were retrospectively analysed.
 Result(s): Eleven pts (all male, age 69+/-9 years) were included.
Seven pts (73%) had CAD, 3 pts (27%) - DCM. Echocardiography revealed LVEF
28+/-8%, and LV EDV - 226+/-91 ml. Time from ICD implantation to ES onset
was from 4 mos to 13 yrs. In 5 pts RDN was performed without VT ablation,
in 3 pts - prior to VT ablation, in 2 - after VT ablation and in 1 pt -
both RDN and VT ablation were performed during the same procedure. Mean
number of renal arteries was 2,5 per pt. Mean number of ablations was 4,8
per artery. The power was 2 to 11 Wt and lesion duration was 90 sec.
Dramatic decrease in the number of VT episodes (49+/-52 vs. 6+/-2) was
found in 6/11 pts directly after RDN procedure. In-hospital rhythm control
was accessed in 10/11 pts, 1 pt with DCM was transferred for heart
transplant due to recurrence of VT after VT ablation and RAD (excluded
from survival analysis). There were no RDN procedure related complications
in this group of pts. In mean 6 mos of follow-up 9/10 pts are free from ES
recurrence, 1/10 was lost for the follow up. Conclusion(s): Catheter renal
artery denervation is effective and safe additional procedure to treat ES
patients. It allows to decrease the number of ICD shocks and stabilize
arrhythmogenicity of ventricular myocardium. Larger multi-center
randomized trials are warranted.

<113>
Accession Number
630051073
Title
Effects of cardiac rehabilitation as independent predictor for favourable
long term postoperative evolution in patients undergoing coronary artery
bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 246), 2019. Date of
Publication: October 2019.
Author
Iliuta L.
Institution
(Iliuta) University of Medicine and Pharmacy Carol Davila, Bucharest,
Romania
Publisher
Oxford University Press
Abstract
Aim: 1. To evaluate whether a supervised cardiac rehabilitation (CR)
program improves physical capacity and quality of life (QoL) of patients
with LV systolic dysfunction undergoing coronary artery bypass grafting
(CABG) compared to patients training by their own. 2. To investigate LV
diastolic function dynamics according to the results of tissue Doppler
imaging (TDI) in these patients. 3. To define the echographic predictors
for long term prognosis in these patients and their adjusted value for
calculation of a preoperative risk score. Material(s) and Method(s):
Prospective randomized study on 665 CABG patients with LV systolic
dysfunction (LVEF<35%), comparing 12 weeks of supervised exercise training
(SET) 3 times per week to home-based training based upon public health
recommendations of minimum level of physical activity. Patients were
evaluated including TDI preoperatively and till 5 years postoperatively.
The primary endpoints were the composites of death from any cause or
hospitalization for cardiac causes and the secondary endpoints were
changes in peak oxygen uptake and in physical capacity (measured with
cardiopulmonary exercise testing), changes in healthrelated QoL and
changes in physical activity level (measured with International Physical
Activity Questionnary). Stastistical analysis used SYSTAT and SPSS
programs. Result(s): 1. SET was more efficient in rehabilitating CABG
patients being an independent predictor for a more favourable
postoperative evolution, mostly in patients with normal LV diastolic
filling pattern (LVDFP) (97,27%) compared with restrictive LV filling
(89.83%). At 5 years postoperatively, cardiovascular event-free survival
was significantly higher in nonrestrictive LVDFP group (74.94%) compared
with restrictive LVDFP (55,75%). 2. Conventional transmitral diastolic
Doppler indices before and after CABG remained unchanged. TDI showed
significant improvement in SET group at 3 and 12 months postoperatively of
both LV systolic (S: 6.1+/-0.9, 7.5+/-1.1 and 7.3+/-1.2cm/s) and diastolic
function (e': 7.2+/-1.8, 8.3+/-1.4 and 8.8+/-1.5cm/s.; E/e' ratio:
17.8+/-2.1, 13.1+/-1.7 and 11.3+/-1.8; Vp 3.2+/-0.55, 2.4+/-0.28 and
1.9+/-0.26) 3. The main predictors for unfavorable evolution at 5 years
postoperatively were: age >75 years (RR=7.3), LV end-systolic volume
(LVESV) >85cm3 (RR=6.4), restrictive LVDFP (RR=8.9) and
pulmonary hypertension (PHT) (RR=5.2). Conclusion(s): 1. SET improves
physical capacity and QoL in CABG patients, mainly in those with normal
LVDFP, the restrictive LVDFP being associated with an early and late
postoperative unfavourable evolution and difficult CR. 2. Exercise
capacity and symptoms are more closely correlated with indices assessed by
TDI which demonstrate significant improvement of LV systolic and diastolic
function in SET patients, regardless of transmitral flow pattern 3. On
long term postoperatively the unfavorable evolution was predicted by:
age>75 years, LVESV>85cm3, restrictive LVDFP and severe PHT.

<114>
Accession Number
630051071
Title
First-line coronary computed tomography predicts long-term clinical
outcome in patients with Non-ST-segment elevation acute coronary
syndrome-The VERDICT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1962), 2019. Date of
Publication: October 2019.
Author
Kofoed K.F.; Engstroem T.; Sigvardsen P.; Torp-Pedersen C.; Linde J.; Riis
Hansen P.; Holmvang L.; Hofsten D.; Elming H.; Gislason G.; Kelbaek H.;
Kober L.
Institution
(Kofoed, Engstroem, Sigvardsen, Linde, Holmvang, Hofsten, Kober)
Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
(Torp-Pedersen) Aalborg University Hospital, Aalborg, Denmark
(Riis Hansen, Gislason) Gentofte University Hospital, Gentofte, Denmark
(Elming, Kelbaek) University Hospital, Roskilde, Denmark
Publisher
Oxford University Press
Abstract
Background: In patients with non-ST segment elevation acute coronary
syndrome (NSTE-ACS) coronary pathology may range from structurally normal
vessels to severe coronary artery disease. Current guidelines recommend
early invasive coronary angiography (ICA) for risk assessment and choice
of treatment strategy. Purpose(s): We tested the hypothesis that 1) a
first-line coronary computed tomography angiography (CCTA) predicts long
term clinical outcome in patients with NSTE-ACS and 2) adding ICA to CCTA
does not improve prediction of cardiovascular events. Method(s): We
included patients with NSTE-ACS confirmed by ischaemic ECG changes and/or
elevated biomarkers of myocardial ischaemia, in whom both CCTA and ICA
were feasible within 12 hours. According to the VERDICT study protocol
(ClinicalTrials.gov number NCT02061891) patients were randomised 1:1 to
evaluation within 12 hours (Very Early) or 48-72 hours (Standard). CCTA
was conducted prior to ICA and patients with an event between tests were
excluded. Based on CCTA and ICA, patients were categorized according to
European Society of Cardiology (ESC) guidelines as having prognostic
indication for coronary revascularization ESCprog (left main stenosis,
proximal left anterior descending artery stenosis or multivessel disease)
or no prognostic indication - ESCnon-prog. The primary endpoint was a
combined endpoint of allcause mortality, non-fatal recurrent myocardial
infarction, hospital admission for refractory myocardial ischemia or
hospital admission for left sided heart failure. Discrimination of
1.5-year outcomes was assessed by timedependent area under the receiver
operating characteristic curve (AUC). Result(s): CCTA and ICA was
conducted in 979 patients. During a median follow-up time of 4.2 (IQR
2.7-5.5) years the primary endpoint occurred in 209 (21.3%) patients.
Patients with ESCprog as defined by CCTA had a hazard ratio of 1.53 (95%
CI 1.16-2.03) for occurrence of the primary endpoint. AUC for the
prediction of the primary endpoint by CCTA was 68.6 (95% CI: 62.7-74.5) as
compared to 68.6 (95% CI: 62.8-74.5), when adding ICA to the model.
Similar findings were noted in patients randomized to either Very Early or
Standard treatment strategy. Conclusion(s): Long-term risk assessment
in patients with NSTE-ACS may be conducted using a first-line CCTA
strategy and may thus potentially guide patient management. Adding
invasive coronary angiography to CCTA does not improve risk assessment.

<115>
Accession Number
630050943
Title
Effect of beta-blocker dose on the prognosis in chronic heart failure
patients depending on the presence of atrial fibrillation. data from FAR
NHL (FARmacology and NeuroHumoraL activation) registry.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 738), 2019. Date of
Publication: October 2019.
Author
Labr K.; Spinar J.; Parenica J.; Spinarova L.; Malek F.; Spinarova M.;
Ludka O.; Jarkovsky J.; Benesova K.; Labrova R.
Institution
(Labr, Spinarova, Spinarova) St. Anne's University Hospital, Masaryk
University, First Department of Internal Medicine, Brno, Czechia
(Spinar, Parenica, Ludka, Labrova) University Hospital Brno, Department of
Internal Cardiology Medicine, Brno, Czechia
(Malek) Na Homolce Hospital, Prague, Czechia
(Jarkovsky, Benesova) Institute of Biostatistics, Analyses of Masaryk
University, Brno, Czechia
Publisher
Oxford University Press
Abstract
Background: Beta-blockers (BB) decrease morbidity and mortality in heart
failure patients and are part of the first line treatment together with
inhibitors of angiotensin converting enzyme. New metaanalysis from year
2014 of main BB studies in chronic heart failure showed no benefit of BB
in patients with atrial fibrillation (AF). Method(s): 1088 at least
one month stable chronic heart failure patients with ejection fraction
<50% were included in FAR NHL (FARmacology and NeuroHumoraL activation)
registry. Three centers with speciality in heart failure in the Czech
Republic were participating from November 2014 to December 2015.
 Result(s): 80% patients were male with median age 66 years. Aetiology
of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated
cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving
beta-blockers 20% received low dose similar to the starting dose, 57%
medium dose and 17% high dose which was set as the target BB dose. Nearly
93.8% of patients received BB. But only 17.0% received the high dose of
BB. 6.2% of patients were not treated by BB at all. One third of patients
(34.5%) had atrial fibrillation in medical history or newly recorded on
electrocardiogram. Patients with AF were much older (median 63 vs. 70
years, respectively; p<0.001), had higher heart rate (72 vs. 74 /min;
p<0.006) and were also in higher class of NYHA (New York Heart
Association; p=0.005). The primary endpoint was set as all cause death,
mechanical circulatory support implantation, orthotopic heart
transplantation or hospitalization for acute heart failure. Patients with
AF survived without primary endpoint in 70.6%, patients without AF in
78.8% (p=0.005) even after age standardization. There was significantly
different survival according to dose of beta-blocker, the higher was dose
of BB, the higher was survival. Patients with no betablocker survived
without primary endpoint in 63.9%, with low dose survived in 72.6%, medium
dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients
into two groups according to atrial fibrillation. Patients without AF had
the better survival without primary endpoint. The higher dose of
beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%,
85.1%; p=0.007). Also patients with AF had better survival without primary
endpoint, the higher dose of beta-blocker they got, the higher was their
survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007).
 Conclusion(s): In FAR NHL registry of stable chronic heart failure
patietnts was one third of patients with atrial fibrillation. Nearly 94%
of patients received beta-blocker. But only 17% received the target dose.
Pacients even with or without atrial fibrillation had the significantly
better survival without primary endpoint the higher was the dose of
beta-blocker.

<116>
Accession Number
630050690
Title
Effects of adjunctive treatment with low-dose alteplase during primary
percutaneous coronary intervention according to ischaemic time.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3702), 2019. Date of
Publication: October 2019.
Author
McCartney P.; Maznyczka A.; Eteiba H.; McEntegart M.; Greenwood J.P.;
Schmitt M.; Maredia N.; McCann G.P.; Fairbairn T.; McAlindon E.; Oldroyd
K.G.; Orchard V.; Radjenovic A.; McConnachie A.; Berry C.
Institution
(McCartney, Maznyczka, Radjenovic, Berry) University of Glasgow, British
Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United
Kingdom
(Eteiba, McEntegart, Oldroyd, Orchard) Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Greenwood) University of Leeds, Leeds, United Kingdom
(Schmitt) University Hospital of South Manchester NHS Foundation Trust,
Manchester, United Kingdom
(Maredia) James Cook University Hospital, Middlesbrough, United Kingdom
(McCann) University Hospital of Leicester, Leicester, United Kingdom
(Fairbairn) Cardiothoracic Centre Trust of Liverpool, Liverpool, United
Kingdom
(McAlindon) New Cross Hospital, Wolverhampton, United Kingdom
(McConnachie) University of Glasgow, Robertson Centre for Biostatistics,
Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Microvascular obstruction affects half of patients with acute
ST-segment elevation myocardial infarction and confers an adverse
prognosis. Purpose(s):We aimed to determine whether the efficacy and
safety of a therapeutic strategy involving low-dose intra-coronary
alteplase infused early after coronary reperfusion associates with
ischaemic time. Method(s): We conducted a prospective, multicentre,
parallel group, 1:1:1 randomised, dose-ranging trial in patients
undergoing primary percutaneous coronary intervention. Ischaemic time,
defined as the time from symptom onset to coronary reperfusion, was a
pre-specified sub-group of interest. Between March 17, 2016, and December
21, 2017, 440 patients presenting at 11 hospitals in the UK were enrolled
with follow up to 3 months. Patients with acute myocardial infarction due
to occlusion of a major coronary artery presenting <=6 hours from symptom
onset were randomly assigned to treatment with placebo, alteplase 10mg or
alteplase 20mg. The primary outcome was the amount of microvascular
obstruction disclosed by cardiac magnetic resonance imaging at 2-7 days.
Secondary outcomes included infarct size, myocardial haemorrhage, left
ventricular ejection fraction, and troponin T area-under-the curve.
 Result(s): 440 patients were randomized (figure), the primary
endpoint was achieved in 396 (90%), seventeen (3.9%) withdrew and all
other patients were followed up to 3 months. In the primary analysis, the
amount of microvascular obstruction did not differ between the groups.
Their ischaemic times were: <=2 hours, n=98; >=2-<4 hours, n=215; and
>=4-6 hours, n=83. In patients with an ischaemic time >=4 hours, treatment
with alteplase (10 mg, n=26; 20 mg, n=30) was associated with a dose
dependent increase in the amount (mean) of microvascular obstruction (%
left ventricular mass) compared to placebo (n=27) 1.14 vs. 3.11 vs. 5.20;
mean difference on square root scale 0.81 (95% CI 0.21, 1.42), p=0.009.
The interaction test between ischaemic time and treatment (active vs.
placebo) was not statistically significant p=0.06, however when the
interaction was assessed for a trend across treatment groups this did
reach statistical significance, p=0.018. Furthermore, a higher proportion
of patients presenting >=4-6 hours treated with 20 mg of alteplase had
myocardial haemorrhage (59.3%) compared to the placebo group (28.0%), odds
ratio 3.81 (95% CI 1.19, 12.25), p=0.025. The amount of haemorrhage was
also greater; estimated mean difference 3.49 (95% CI 1.22, 5.75),
p=0.0026. No between-treatment group differences for myocardial
haemorrhage were observed in patients presenting with shorter ischaemic
times. Conclusion(s): In patients presenting with an ischaemic time
>=4 hours, adjunctive treatment with low-dose intra-coronary alteplase
during primary PCI was associated with increases in microvascular
obstruction and myocardial haemorrhage. The mechanism may involve
haemorrhagic transformation within the infarct core. (Figure Presented).

<117>
Accession Number
630050486
Title
A randomized controlled trial evaluating outcome impact of cilostazol in
patients with coronary artery disease and at a high risk of cardiovascular
disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1219), 2019. Date of
Publication: October 2019.
Author
Chao T.-H.; Tseng S.-Y.; Liu P.-Y.; Li Y.-H.
Institution
(Chao, Tseng, Liu, Li) National Cheng Kung University, College of Medicine
and Hospital, Tainan, Taiwan (Republic of China)
Publisher
Oxford University Press
Abstract
Background: We and others have previously found that cilostazol has a
favorable effect on glucose and lipid homeostasis, endothelial function,
anti-atherosclerosis, and vasculo-angiogenesis. However, it is poorly
understood that if this compound can provide better clinical outcome.
 Purpose(s): This study investigated the outcome effect of cilostazol
in patients with coronary artery disease (CAD) or at a high risk of
cardiovascular (CV) disease. Method(s): We conducted a randomized,
double-blind, placebo controlled trial involving 266 patients to receive
cilostazol 200 mg/day (n=134) or dummy placebo (n=132). The primary
endpoint was a composite of CV death, non-fatal myocardial infarct,
non-fatal stroke, hospitalization for congestive heart failure or
unplanned coronary revascularization. Prespecified secondary endpoints
include the composite major coronary event (MCE) and major adverse CV and
cerebrovascular event (MACCE) on long-term follow-up. The mean duration of
follow-up was 2.9 years. Result(s): Relative to placebo, cilostazol
treatment had a borderline effect on risk reduction in the primary
endpoint (hazard ratio [HR], 0.67; 95% confidence interval (CI),
0.34-1.33), whereas the beneficial effect in favor of cilostazol was
significant in patients with diabetes mellitus or a history of
percutaneous coronary intervention (P for interaction, 0.02 and 0.06,
respectively). Use of cilostazol, but not placebo, significantly reduced
the risk of the MCE (HR, 0.38; 95% CI, 0.17-0.86) and MACCE (HR, 0.47; 95%
CI, 0.23-0.96). A significantly lower risk of angina pectoris (HR, 0.38;
95% CI, 0.17-0.86) and unplanned revascularization (HR, 0.13; 95% CI,
0.02-1.09) was also observed in the cilostazol group. After multi-variable
adjustment, cilostazol treatment independently predicted a lower risk of
the MCE and MACCE. Conclusion(s): Cilostazol treatment significantly
reduced the risk of CV events in patients with CAD or at a high risk of CV
disease.

<118>
Accession Number
630050437
Title
Reduction of mitral regurgitation in patients with heart failure and
secondary mitral regurgitation: Relationship between changes in brain
natriuretic peptide and outcomes from the COAPT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 731), 2019. Date of
Publication: October 2019.
Author
Abraham W.; Lindenfeld J.; Mack M.; Ellis J.; Morishetti D.; Weissman N.;
Stone G.
Institution
(Abraham) Ohio State University, Departments of Medicine, Physiology, and
Cell Biology, Davis Heart and Lung Institute, Columbus, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, United States
(Mack) Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas,
United States
(Ellis, Morishetti) Abbott, Santa Clara, United States
(Weissman) MedStar Health Research Institute, Hyattsville, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, Cardiovascular Research, New York, United States
Publisher
Oxford University Press
Abstract
Background: Brain natriuretic peptide (BNP) is a well-established
predictor of hospitalization and death in patients with heart failure
(HF). In the COAPT trial, treatment of patients with HF and secondary
mitral regurgitation (SMR) with transcatheter mitral valve repair (TMVr)
reduced the 2-year rates of all-cause mortality and HF hospitalization
compared with maximally-tolerated guideline-directed medical therapy
(GDMT) alone. Whether these improvements in outcomes were reflected in
serial changes in BNP levels has not been reported. Purpose(s):
Herein, we report the first results of serial changes in BNP levels by
treatment group in patients from the COAPT trial. Method(s): 614
patients with HF and 3+ or 4+ SMR were randomized 1:1 to TMVr + GDMT or
GDMT alone. Key inclusion criteria included NYHA functional class II-IVa
(ambulatory), ischemic or non-ischemic cardiomyopathy with LVEF 20%-50%
and LVESD <=70 mm. Baseline BNP or NT-proBNP levels were drawn at baseline
and at 6 and 12 months. For the present analysis NT-proBNP (pg/ml) values
were converted to BNP values (pg/ml) using a ratio of 7 to 1.
 Result(s): At baseline, mean values of BNP were not significantly
different between treatment groups (945 pg/ml vs. 964 pg/ml in the TMVr +
GDMT and GDMT groups respectively, p=0.84). At 6 months, mean values of
BNP in the TMVr + GDMT group were significantly lower than in the GDMT
alone group (690 pg/ml vs 893 pg/ml, p=0.02) but not at 12 months (584
pg/ml vs. 728 pg/ml, p=0.22). By analysis of covariance, BNP decreased to
a greater degree after TMVr + GDMT compared with GDMT only at both 6 and
12 months (least squares mean differences of-121 pg/ml and-166 pg/ml
respectively, both p<0.05) (Figure). Conclusion(s): In patients with
HF and 3+ or 4+ SMR enrolled in the COAPT trial, reduction of SMR with
TMVr reduced BNP compared with maximally-tolerated GDMT only, a change
which paralleled the reductions noted in all-cause mortality and HF
hospitalizations with TMVr.(Figure Presented).

<119>
Accession Number
630050121
Title
MitraClip treatment of functional mitral regurgitation-a meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 729), 2019. Date of
Publication: October 2019.
Author
Noutsias M.; Matiakis M.; Ali M.; Abate E.; Ahmadzada B.; Novruzlu R.;
Bigalke B.; Rigopoulos A.
Institution
(Noutsias, Matiakis, Ali, Abate, Ahmadzada, Novruzlu, Rigopoulos)
University Clinic Halle (Saale), Mid-German Heart Center, Department of
Internal Medicine III (KIM-III), Halle, Germany
(Bigalke) Charite-Campus Benjamin Franklin, Berlin, Germany
Publisher
Oxford University Press
Abstract
Moderate-to-severe or severe functional mitral regurgitation (FMR) is
associated with higher rates of hospitalizations and with increased
mortality in heart failure with reduced left ventricular ejection fraction
(HFrEF). Transcatheter mitral valve repair by MitraClipR implantation
(TMVrMC) may effectively reduce severe MR, and is associated with
symptomatic improvement. However, the long-term clinical effects of this
procedure are not well defined. Aim(s): We analyzed outcomes for
rehospitalization and survival in heart failure patients with
moderate-to-severe or severe functional mitral regurgitation (FMR) treated
by either medical treatment (MT) only TMVrMC+MT by meta-analysis.
 Methods and Results: By systematic search of bibliographic databases,
we evaluated publications comparing heart failure patients with FMR
treated by MT only versus treatment by MT combined with TMVrMC. Studies
with a minimum of 25 enrolled patients and a follow/up period of at least
12 months were deemed eligible for this meta-analysis. We identified n=7
studies enrolling 2,884 HFrEF patients, divided into two study arms:
TMVrMC+MT (n=1,618), versus FMR patients receiving MT only (n=1,266). At
12 months, there was a significant reduction in all-cause mortality
favoring TMVR+MT (OR: 0.67; CI 95% 0.55-0.81), as well as a reduction of
unplanned rehospitalizations (OR: 0.69; 95%; CI 0.53-0.89), compared with
the MT only patients. At 24 months, there was a significant reduction of
all-cause mortality in the TMVrMC+MT patient group (OR: 0.50; CI: 95%:
0.38-0.66; p<0.001). TMVrMC+MT was associated with significantly lower
rates of unplanned re-admissions for heart failure compared with MT only
at 12 months (OR: 0.69; 95% CI: 0.53-0.89; p<0.001) and at 24 months (OR:
0.53; 95% CI: 0.39-0.71; p<0.001). In one publication, a survival benefit
of TMVrMC+MT over MT alone was shown at 5 years post intervention (HR:
0.75; 95% CI: 0.69-0.94; p=0.012) after weighting for propensity score and
controlling for age. Conclusion(s): This meta-analysis on n=2,884
patients with moderate-tosevere or severe FMR reveals that TMVrMC+MT, as
compared with MT alone, is associated with a significant reduction of
rehospitalizations and improvement of survival. These data imply
additional evidence for TMVrMC in eligible heart failure patients with
relevant FMR, which might be important for an update of the corresponding
guidelines.

<120>
Accession Number
630049760
Title
Impact of established cardiovascular disease on outcomes in the Global
Leaders trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3108), 2019. Date of
Publication: October 2019.
Author
Garg S.; Chichareon P.; Modolo R.; Tomaniak M.; Serra-Penaranda A.;
Curello S.; Mlodziankowski A.; Hamm C.; Steg G.; Juni P.; Vranckx P.;
Valgimigli M.; Windecker S.; Onuma Y.; Serruys P.W.J.C.
Institution
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Chichareon, Modolo) Academic Medical Center of Amsterdam, Amsterdam,
Netherlands
(Tomaniak, Onuma) Erasmus Medical Center, Thoraxcenter, Rotterdam,
Netherlands
(Serra-Penaranda) Hospital De La Santa Creu i Sant Pau, Barcelona, Spain
(Curello) University of Brescia, Brescia, Italy
(Mlodziankowski) 5Department of Invasive Cardiology and Angiology, Mielec,
Poland
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Steg) University Paris Diderot, Paris, France
(Juni) St. Michael's Hospital, Toronto, Canada
(Vranckx) Virga Jesse Hospital, Hasselt, Belgium
(Valgimigli, Windecker) University of Bern, Bern, Switzerland
(Serruys) Imperial College London, London, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: To investigate the impact of ticagrelor monotherapy following
one-month dual antiplatelet therapy (DAPT) on clinical outcomes after
percutaneous coronary intervention (PCI) in patients with established
cardiovascular disease (CVD) who were enrolled in the Global Leaders
Trial. Background(s): The impact of prolonged monotherapy with P2Y12
inhibitors after PCI in patients with CVD is undetermined. Method(s):
GLOBAL LEADERS was a randomized, superiority, all-comers trial comparing
one-month DAPT with ticagrelor and aspirin followed by 23- month
ticagrelor monotherapy (experimental treatment) with standard 12- month
DAPT followed by 12-month aspirin monotherapy (reference treatment) in
patients treated with a biolimus A9-eluting stent. The cohort was
stratified according to those with- and without established CVD, defined
as a history of >=1 prior myocardial infarction (MI), PCI, coronary artery
bypass operation, stroke or peripheral vascular disease. The degree of CVD
was defined according to the number of vascular territories effected (1,
2, >=3). The primary endpoint was a composite of all-cause death or new
Q-wave MI at 2-years. Secondary endpoints were the patient orientated
composite endpoint (POCE) of death, stroke, MI and any revascularization;
definite stent thrombosis and net adverse cardiovascular events a
composite of POCE and BARC 3 or 5 bleeding. Result(s): Amongst the
15,761 patients included in this cohort were 6693 patients (42.5%) with-
and 9068 patients without established CVD. Patients with CVD were older,
and had significantly higher rates of diabetes, hypertension, and
hypercholesterolaemia (P<0.01). The incidence of the primary endpoint was
significantly higher in patients with established CVD (5.1% vs. 3.3%,
P<0.001) as were all secondary endpoints and their individual components.
There was a trend for a reduction in the primary endpoint in patients with
established CVD receiving the experimental treatment (4.6% vs. 5.6%,
HR0.82 [0.66-1.02], p=0.07), which was not seen in those without prior CVD
(3.2% vs. 3.3%, HR 0.95 [0.76-1.19, p=0.66; p(interaction)=0.37). Compared
with patients without CVD the incidence of the primary and second
endpoints and all their individual components, other than BARC 3/5
bleeding, rose significantly with an increasing degree of CVD. In an
unadjusted model, compared with patients without CVD, the hazard ratio for
the primary endpoint rose from 1.5 (1.21-1.81) to 3.0 (2.32- 4.00) in
patients with one and three territories of CVD, respectively. Similar
rises were seen in models adjusted by age (1.3 [1.01-1.60] to 2.56 [1.94-
3.38]) and age, left ventricular ejection fraction, clinical presentation
and anti-platelet strategy (1.4 [1.10-1.68] to 2.26 [1.69-3.02]).
 Conclusion(s): PCI outcomes are poorer in patients with increasing
degrees of CVD compared to those without. Prolonged monotherapy with
ticagrelor does not mitigate this risk suggesting a greater need to focus
on modifiable risk factors.

<121>
Accession Number
630049700
Title
Effect of high-dose statin pretreatment in patients with ST-segment
elevation myocardial infarction undergoing primary percutaneous coronary
intervention: Meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 432), 2019. Date of
Publication: October 2019.
Author
Burgos L.M.; Battioni L.; Costabel J.P.; Trivi M.
Institution
(Burgos, Battioni, Costabel, Trivi) Cardiovascular Institute of Buenos
Aires (ICBA), Buenos Aires, Argentina
Publisher
Oxford University Press
Abstract
Introduction: Current guidelines recommend the use of high doses of
statins in patients with acute coronary syndrome. However, up to now,
there is not enough evidence about the time of its onset in patients with
acute myocardial infarction with ST elevation (STEMI) undergoing primary
angioplasty. We conducted a systematic review and meta-analysis with the
aim of evaluating the efficacy of pre-treatment with statins in high doses
in the short term in patients with STEMI treated with primary angioplasty.
 Method(s): A systematic search was carried out in Pubmed, EMBASE,
Scopus and Cochrane database, LILACS, and references of relevant articles
were searched manually. We included randomized clinical trials (RCTs)
comparing pretreatment with high doses of statins (rosuvastatin/
atorvastatin) with low doses or without treatment published until April
2018. We evaluated the incidence of MACE (death, spontaneous myocardial
infarction, coronary revascularization and stroke) at 30 days. In addition
the presence of final TIMI III flow, TIMI blush grade, CPK peak, stent
thrombosis and death from any cause during follow-up were evaluated. The
data were combined as relative risk (RR) or difference of means (DM) with
their 95% confidence interval (CI), using RevMan software. The
metaanalysis was performed with the fixed effects model or random effects
according to the heterogeneity. Result(s): Six RCTs met the inclusion
criteria with a total of 1454 patients. The pretreatment with statins in
high doses was associated with a decrease in MACE (RR 0.52 CI 95%
0.37-0.77, I2=0%, P=0.001). The pretreatment was not associated with a
reduction of the final TIMI III flow (RR 1.03 CI 95% 0.98-1.09, I2=0%,
P=0.1), CPK peak (MD 13.99 CI95% -12.68 to 40.6; I2=0%; P=0.3), or stent
thrombosis (RR 0.54 CI95% 0.1- 2.85; I2 = 0%; P=0.46), neither death in
the follow-up (RR 0.52 CI95% 0.16-1.68, I2=0%, P=0.27). In addition, an
improvement in the degree of myocardial blush TIMI was observed (MD 0.36
CI95% 0.20-0.52, I=0%, P<0.0001), Conclusion(s): In this
meta-analysis, treatment with high doses of statins prior to primary
angioplasty in STEMI significantly reduced adverse cardiac events at 30
days. In addition, an improvement in the degree of myocardial blush was
observed in the pretreatment group with high-dose statins. Therefore, the
findings of this meta-analysis can help guide medical decision making
regarding the time of onset of statins in STEMI. (Figure Presented).

<122>
Accession Number
630048785
Title
Five-year outcomes in patients with diabetes mellitus treated with
biodegradable polymer sirolimus-eluting stents versus durable polymer
everolimus-eluting stents.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1257), 2019. Date of
Publication: October 2019.
Author
Iglesias J.F.; Heg D.; Roffi M.; Tueller D.; Lanz J.; Rigamonti F.; Muller
O.; Moarof I.; Cook S.; Weilenmann D.; Kaiser C.; Valgimigli M.; Jueni P.;
Windecker S.; Pilgrim T.
Institution
(Iglesias, Roffi, Rigamonti) Geneva University Hospitals, Cardiology,
Geneva, Switzerland
(Heg) Bern University Hospital, Institute of Social and Preventive
Medicine and Clinical Trials Unit, Bern, Switzerland
(Tueller) Triemli Hospital, Cardiology, Zurich, Switzerland
(Lanz, Valgimigli, Windecker, Pilgrim) Bern University Hospital,
Cardiology, Bern, Switzerland
(Muller) University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne,
Switzerland
(Moarof) Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
(Cook) University of Fribourg, Cardiology, Fribourg, Switzerland
(Weilenmann) Kantonhospital, Cardiology, St Gallen, Switzerland
(Kaiser) University Hospital Basel, Cardiology, Basel, Switzerland
(Jueni) St. Michael's Hospital, Applied Health Research Centre, Department
of Medicine, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: Patients with diabetes mellitus (DM) remain at higher risk for
adverse events after percutaneous coronary intervention (PCI) compared
with non-diabetic individuals. Among available drug-eluting stents (DES),
thin-strut durable polymer everolimus-eluting stents (DP-EES) were shown
to provide the best safety and efficacy profile in diabetics. Whether
biodegradable polymer DES provide additional long-term clinical benefit
compared with DP-EES among diabetic patients remains uncertain.
 Purpose(s): To compare the long-term performance of ultrathin-strut
biodegradable polymer sirolimus-eluting stents (BP-SES) versus DP-EES for
PCI in patients with insulin-requiring and non-insulin-requiring DM.
 Method(s): We performed a prespecified subgroup analysis of the
randomized, multicenter, non-inferiority BIOSCIENCE trial (NCT01443104).
Patients with stable coronary artery disease or acute coronary syndrome
were randomly assigned to treatment with ultrathin-strut BP-SES or
thinstrut DP-EES. Patients were further divided according to diabetic
status. The primary endpoint was target lesion failure (TLF), a composite
of cardiac death, target-vessel myocardial infarction (MI) and
clinically-indicated target lesion revascularization (TLR), within 12
months. Result(s): Among 2'119 patients enrolled between March 2012
and May 2013, 486 (22.9%) presented with DM (insulin-requiring, 33.1%).
Compared with non-diabetics, patients with DM were older and had a greater
baseline cardiac risk profile, including higher prevalence of
hypertension, hypercholesterolaemia, peripheral artery disease, chronic
renal failure and prior PCI, coronary artery bypass graft surgery, or
stroke. At 5 years, TLF occurred similarly in 74 patients (cumulative
incidence, 31.0%) treated with BP-SES and 57 patients (25.8%) treated with
DP-EES (RR 1.23; 95% CI 0.87-1.73; p=0.24) in diabetics, and in 124
patients (16.8%) treated with BP-SES and 132 patients (16.8%) treated with
DP-EES (RR 0.98; 95% CI 0.77-1.26; p=0.90) in non-diabetics (p for
interaction=0.31). Cumulative incidences of cardiac death (14.9% vs. 9.5%;
p=0.10), target-vessel MI (11.4% vs. 11.0%; p=0.81), clinically-indicated
TLR (16.9% vs. 15.8%; p=0.68), and definite thrombosis (3.0% vs. 2.5%;
p=0.63) at 5 years were similar among diabetic patients treated with
ultrathin-strut BP-SES or thinstrut DP-EES. Overall, there was no
interaction between diabetic status and treatment effect of BP-SES versus
DP-EES. Conclusion(s): In a prespecified subgroup analysis of the
BIOSCIENCE trial, we found no difference in clinical outcomes throughout
five years between diabetic patients treated with ultrathin-strut BP-SES
or thin-strut DP-EES.

<123>
Accession Number
630048507
Title
Evaluation of the pharmacodynamics of a ticagrelor reversal agent PB2452.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1356), 2019. Date of
Publication: October 2019.
Author
Jennings L.; Curry B.J.; Bhatt D.L.; Pollack C.V.; Weitz J.I.; Xu S.; Lee
J.S.
Institution
(Jennings, Curry) CirQuest Labs, Memphis, United States
(Bhatt) Harvard Medical School, Boston, United States
(Pollack) Thomas Jefferson University, Philadelphia, United States
(Weitz) McMaster University, Hamilton, Canada
(Xu, Lee) PhaseBio Pharmaceuticals,Inc, Malvern, United States
Publisher
Oxford University Press
Abstract
Background: Ticagrelor is a P2Y12 antagonist used in combination with
aspirin to reduce the risk of recurrent thrombotic cardiovascular events
in patients with acute coronary syndrome. Ticagrelor is associated with a
risk for spontaneous major bleeding or bleeding associated with invasive
procedures, particularly cardiac surgery. A rapid-acting reversal agent
for ticagrelor would be advantageous. The pharmacodynamic effects of
ticagrelor and a ticagrelor reversal agent are best evaluated using a
panel of platelet function tests that have different sensitivities and
methodologies and using a variety of agonists at different concentrations.
 Purpose(s): In a first-in-human randomized, double-blind,
placebocontrolled, healthy volunteer Phase 1 study, intravenous (IV)
PB2452, a monoclonal antibody fragment that binds ticagrelor with high
affinity, was evaluated as a ticagrelor reversal agent. Method(s):
Platelet function was assessed using light transmission aggregometry (LTA)
and 5 and 20 muM adenosine diphosphate (ADP), 1.6 mM arachidonic acid
(AA), and 15 muM thrombin receptor agonist peptide (TRAP-6) as agonists.
The VerifyNow P2Y12 cartridges, which assess whole blood platelet
function, were evaluated as a point-of-care test. A modified
vasodilator-stimulated phosphoprotein (VASP) ELISA was used to assess the
extent of P2Y12 signaling. These assessments were performed 48 h prior to
ticagrelor administration and at multiple time points up to 48 h after
administration of PB2452 or placebo. Result(s): 64 subjects were
randomized; 48 received PB2452 and 16 received placebo. After ticagrelor
administration, LTA response to 20 muM ADP was inhibited by 87% compared
to the pre-ticagrelor values. Platelet function as measured by the
VerifyNow P2Y12 cartridge was completely inhibited (<10 platelet
reactivity units [PRU]). The VASP platelet reactivity index (PRI) was
inhibited by 82%. Ticagrelor reduced TRAP-6 induced LTA by 30% reflecting
the effect of ADP on platelet aggregate stability. PB2452 administered as
a 10 min IV bolus followed by 16 h infusion, significantly restored
platelet function to >80% and >90% of baseline as measured by LTA using
ADP and TRAP-6, respectively, to >180 PRU using VerifyNow, and to >90% PRI
as measured by VASP. The VASP assay enabled batch analyses in a central
laboratory, eliminating the need for special equipment on-site and
reducing operator variability. When platelet function was assessed by
VASP, PB2452 administration produced rapid ticagrelor reversal within 5
min consistent with restoration of P2Y12 signaling. Onset of reversal by
all measurements occurred within 15 min of PB2452 administration and was
sustained for 20-24 h. Conclusion(s): PB2452 is a specific reversal
agent for ticagrelor and produces a rapid and sustained reversal of
ticagrelor inhibition of platelets. Utilizing multiple platelet function
assays provided a broader understanding of the PB2452 pharmacodynamics in
this first-in-human Phase 1 study.

<124>
Accession Number
630048446
Title
Mortality advantage of mitraclip in patients with heart failure and mitral
regurgitation: An updated meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3635), 2019. Date of
Publication: October 2019.
Author
Ashukem M.; Bhavi Pandya M.D.; Verma Diva Ratyan M.D.
Institution
(Ashukem, Verma Diva Ratyan) University of Arizona, Phoenix, United States
(Bhavi Pandya) Staten Island University Hospital Northwell Health,
Cardiology, Staten Island, United States
Publisher
Oxford University Press
Abstract
Background: In patients with symptomatic mitral regurgitation who are high
risk for surgery, transcatheter mitral-valve repair has been shown to be
safe and improve clinical outcomes. However, its impact on survival has
shown conflicting results in recent trials. Method(s): PubMed, EMBASE
and Google Scholar databases were queried for all trials about MitraClip
compared with optimal medical therapy Results: This meta-analysis of 9
trials including 3199 patients, found that patients treated with MitraClip
compared to optimal medical therapy had similar 30-day mortality (OR 0.64,
95% CI 0.32- 1.28) while at 12-months MitraClip was associated with
significantly lower all-cause mortality (OR 0.46, 95% CI 0.33- 0.65).
Absolute risk reduction was 13.9% and number needed to treat to save 1
life at 12 months was 7.2. Conclusion(s): In this meta-analysis,
transcatheter mitral valve repair with MitraClip was associated with
significantly lower mortality at 12 months of follow up (Figure
Presented).

<125>
Accession Number
630048268
Title
Upstream therapy using preoperative renin-angiotensin system inhibitors in
prevention of postoperative atrial fibrillation and adverse events: A
collaborative pooled-analysis over 27,000 patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 615), 2019. Date of
Publication: October 2019.
Author
Chen S.; Schmidt B.; Sommer P.; Liu S.; Krucoff M.W.; Kiuchi M.G.; Andrea
B.; Acou W.J.; Schratter A.; Nagase T.; Ling Z.; Yin Y.; Hindricks G.;
Puererfellner H.; Chun K.R.J.
Institution
(Chen, Schmidt, Chun) Cardioangiologisches Centrum Bethanien (CCB) am
Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
(Sommer, Hindricks) Heart Center of Leipzig, Leipzig, Germany
(Liu) Shanghai Jiao Tong University, Affiliated First People's Hospital,
Shanghai, China
(Krucoff) Duke Clinical Research Institute, Durham, United States
(Kiuchi, Andrea) Federal University of Rio De Janeiro, Rio De Janeiro,
Brazil
(Acou) AZ Delta, Roeselare, Belgium
(Schratter) Hietzing Hospital, Vienna, Austria
(Nagase) Saitama Medical University, Saitama, Japan
(Ling, Yin) Second Affiliated Hospital, Chongqing Medical University,
Chongqing, China
(Puererfellner) Elisabethinen University, Teaching Hospital, Linz, Austria
Publisher
Oxford University Press
Abstract
Background: Renin-angiotensin-system inhibitors (RASIs) have been
suggested as an upstream therapy for selected AF patients; however, the
evidence in surgical setting is limited. Objective(s): We aimed to
evaluate the role of preoperative RASIs in prevention of postoperative
atrial fibrillation (POAF) and adverse events for patients undergoing
cardiac surgery. Method(s): In this collaborative pooled-analysis,
both randomized and nonrandomized controlled trials comparing preoperative
RASIs with no preoperative RASIs treatment on the incidence of POAF were
identified. Sensitivity and subgroup analyses of RCTs were performed to
test the stability of the overall-effect, and meta-regression to explore
the potential risk of bias. The primary outcome was POAF, and the
secondary outcomes includes rate of stroke, mortality and duration of
hospitalization. Result(s): Eleven trials involving 27885 patients
(male 74%, median age 65yrs) were included. As compared to the control
group, preoperative RASIs did not significantly reduce the risk of POAF
(OR: 1.04, 95% CI: 0.91-1.19), stroke (OR: 0.86, 95% CI: 0.62-1.19), death
(OR: 1.07, 95% CI: 0.85-1.35), composite adverse cardiac events (OR: 1.04,
95% CI: 0.91-1.18), and hospital stay (WMD: -0.04, 95% CI: -1.05 to 0.98).
Pooled-analysis of randomized trials showed consistent results. The
primary overall-effect was maintained in sensitivity and subgroup
analyses. Meta-regression showed that male-gender was a significant
risk-factor of POAF and use of Beta-blockers was associated with a
significantly reduced risk in developing POAF. Conclusion and relevance:
This study demonstrates that preoperative RASIs do not offer additional
benefit in reducing the risk of postoperative AF, stroke, death and
hospitalization in the setting of cardiac surgery. The results provide no
support for use of RASIs for the prevention of POAF and adverse events in
patients undergoing cardiac surgery.

<126>
Accession Number
630047757
Title
High-sensitivity cardiac troponin and the universal definition of
myocardial infarction: A randomised controlled trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 68), 2019. Date of
Publication: October 2019.
Author
Chapman A.R.; Adamson P.D.; Anand A.; Shah A.S.V.; Lee K.K.; Strachan
F.E.; Ferry A.S.V.; Sandeman D.E.; Berry C.; Gray A.J.; Tuck C.; Fox
K.A.A.; Newby D.E.; Weir C.; Mills N.L.
Institution
(Chapman, Adamson, Anand, Shah, Lee, Strachan, Ferry, Tuck, Fox, Newby,
Weir, Mills) University of Edinburgh, BHF Centre for Cardiovascular
Science, Edinburgh, United Kingdom
(Sandeman) Victoria Hospital, Cardiology, Kirkcaldy, United Kingdom
(Berry) Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
(Gray) Royal Infirmary of Edinburgh, Department of Emergency Medicine,
Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Background: The Universal Definition of Myocardial Infarction recommends
the 99th centile diagnostic threshold using a high-sensitivity cardiac
troponin (hs-cTn) assay and the classification of patients by the etiology
of myocardial injury. Whether implementation of this definition improves
risk stratification, treatment or outcomes is unknown. Method(s): In
a stepped-wedge cluster randomized controlled trial, we implemented a
high-sensitivity troponin assay and the recommendations of the Universal
Definition in 48,282 consecutive patients with suspected acute coronary
syndrome across ten hospitals. In a prespecified secondary analysis, we
compared the primary outcome of myocardial infarction or cardiovascular
death, and secondary outcome of noncardiovascular death at one year across
diagnostic categories as per the Fourth Universal Definition. We applied
competing risks methodology in all analyses, using a cumulative incidence
function and determining the cause-specific hazard ratio (csHR) for
competing outcomes. Result(s): Cardiac troponin concentrations were
elevated in 21.5% (10,360/48,282) of all trial participants.
Implementation increased the diagnosis of type 1 myocardial infarction by
11% (510/4,471), type 2 myocardial infarction by 22% (205/916), acute
myocardial injury by 36% (443/1,233) and chronic myocardial injury by 43%
(389/898). The risk and rate of the primary outcome was highest in those
with type 1 myocardial infarction, whereas the risk and rate of
non-cardiovascular death was highest in those with acute myocardial injury
(Table, Figure). Despite increases in anti-platelet therapy and coronary
revascularization after implementation, the primary outcome was unchanged
in patients with type 1 myocardial infarction (csHR 1.00, 95% CI 0.82 to
1.21), or in any other category. Conclusion(s): Implementation of the
recommendations of the Universal Definition identified patients with
different risks of future cardiovascular and non-cardiovascular events,
but did not improve outcomes. Greater understanding of the underlying
mechanisms and effective strategies for the investigation and treatment of
patients with myocardial injury and infarction are required if we are to
improve outcomes.

<127>
Accession Number
630047741
Title
Is stroke an issue after transcatheter mitral valve repair? A systematic
review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3092), 2019. Date of
Publication: October 2019.
Author
Barros Da Silva P.; Sousa J.P.; Oliveiros B.; Donato H.; Goncalves L.;
Teixeira R.
Institution
(Barros Da Silva, Oliveiros, Goncalves, Teixeira) Faculty of Medicine,
University of Coimbra, Coimbra, Portugal
(Sousa, Donato) University Hospitals of Coimbra, Cardiology, Coimbra,
Portugal
Publisher
Oxford University Press
Abstract
Background: Transcatheter mitral valve repair (TMVR) is a minimally
invasive therapeutic procedure used as an alternative to surgery for
mitral valve regurgitation in high risk patients. This technique creates a
double orifice area, which might be comparable to a mitral prosthesis or
mitral stenosis. So far, no strict antithrombotic therapy has been
recommended and different post-procedure protocols are being currently
applied. Objective(s): To assess stroke rate after TMVR, comparing it
with surgical mitral valve repair (SMVR) and optimal medical treatment
(OMT). Method(s): We systematically searched PubMed, Embase and
Cochrane databases, in December 2018, for both interventional or
observational studies comparing TMVR with SMVR and/or OMT in the treatment
of severe mitral regurgitation. Only studies including data on
post-procedure stroke incidence were selected. Two authors independently
screened articles for inclusion, risk of bias and data extraction.
Random-effects metaanalysis for TMVR, SMVR and OMT were performed. Due to
the low number of pooled events, a cumulative meta-analysis was
subsequently implemented. The meta-analysis was registered on the Prospero
database. Result(s): 15 studies were selected for qualitative
analysis and, among these, 10 were included in the quantitative analyses
(7 of TMVR vs. SMVR and 3 of TMVR vs. OMT), providing a total of 1881
patients. TMVR patients were older and had higher surgical risk scores
than SMVR patients. Groups were homogeneous regarding previous atrial
fibrillation rate (pooled OR 1.45 [0.82-2.55]), whereas post-procedure de
novo atrial fibrillation was more frequent in SMVR when compared with TMVR
(pooled OR 0.20 [0.06-0.7]). Although the pooled stroke rate was
numerically lower in the TMVR group, there was no statistically difference
in the stroke incidence between TMVR and SMVR (pooled OR 0.49 [0.17,
1.42], p=0.19, I2= 0%) - Panel A. On the other hand, cumulative
meta-analysis was able to show a significantly lower stroke rate in TMVR,
when compared to SMVR (OR 0.4 [0.40, 0.67], p<0.05). As for TMVR vs. OMT,
no difference in stroke rate was identified (pooled OR 1.09 [0.60, 1.97],
p=0.79, I2=0%) - Panel B. Conclusion(s): Post-procedure TMVR stroke
rate was similar to that of patients managed with OMT only. For the same
outcome, results favored TMVR when compared with SMVR, which might be
related to its lower incidence of post-procedure de novo atrial
fibrillation. These findings may prove insightful to future
recommendations regarding the conundrum of the best antithrombotic
strategy, particularly for patients with atrial fibrillation. (Figure
Presented).

<128>
Accession Number
630047719
Title
Preoperative levosimendan improves survival in patients with low cardiac
output syndrome undergoing cardiac surgery: A meta-analysis of randomized
controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1741), 2019. Date of
Publication: October 2019.
Author
Brockmeyer M.; Lin Y.; Karathanos A.; Parco C.; Krieger T.; Heinen Y.;
Albert A.; Kelm M.; Schulze V.; Wolff G.
Institution
(Brockmeyer, Lin, Karathanos, Parco, Krieger, Heinen, Kelm, Schulze,
Wolff) Heinrich Heine University, Division of Cardiology, Pulmonology and
Vascular Medicine, Medical Faculty, Dusseldorf, Germany
(Albert) Heinrich Heine University, Division of Cardiovascular Surgery,
Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
Publisher
Oxford University Press
Abstract
Background and purpose: Previous studies and meta-analyses of
perioperative levosimendan to improve the outcomes of patients with low
cardiac output syndrome (LCOS) undergoing cardiac surgery have given
controversial results and the optimal time of infusion of levosimendan
remains uncertain. We thus aimed to elucidate the risk/benefit ratio of
preoperative levosimendan in a meta-analysis of randomized controlled
trials (RCTs). Method(s): Online databases were searched for RCTs
comparing preoperative levosimendan to placebo in patients with LCOS
undergoing cardiac surgery until February 2019. Data from retrieved
studies were abstracted and analyzed in a comprehensive meta-analysis.
Primary outcome was allcause mortality. Secondary outcomes included
myocardial infarction, renal failure/replacement therapy, need for
inotropic therapy, need for left ventricular assist devices, ventricular
arrhythmia and arterial hypotension. Result(s): As a result of the
online database search, six eligible RCTs with 1,326 patients were
included in the meta-analysis. Preoperative levosimendan showed a
significant reduction in all-cause mortality (odds ratio (OR) 0.49, 95%
confidence interval (CI) 0.29-0.83; p<0.01), renal failure/ replacement
therapy (OR 0.48, CI 0.29-0.80; p<0.01) and need for inotropic therapy (OR
0.24, CI 0.06-0.95; p=0.04) compared to placebo. There were no significant
differences in levosimendan vs. placebo concerning the rates of myocardial
infarction (OR 0.61, p=0.38), need for left ventricular assist devices (OR
0.38, p=0.1), ventricular arrhythmia (OR 0.7, p=0.33), and arterial
hypotension (OR 1.28, p=0.07). Conclusion(s): Preoperative
administration of levosimendan may improve survival in patients with low
cardiac output syndrome undergoing cardiac surgery. It reduces need for
inotropic medical support and renal failure/replace-ment therapy compared
to placebo.

<129>
Accession Number
630047673
Title
Is there evidence of a rebound increase in platelet aggregation following
withdrawal of Aspirin or Ticagrelor in patients who have previously
undergone PCI and coronary stenting?.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 126), 2019. Date of
Publication: October 2019.
Author
Hennigan B.W.; Good R.; Adamson C.; Martin L.; Anderson L.; Campbell M.;
Oldroyd K.G.
Institution
(Hennigan, Good, Adamson, Martin, Anderson, Campbell, Oldroyd) Golden
Jubilee National Hospital, Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: In patients treated with coronary stents previous studies
have demonstrated an increased risk of acute coronary syndrome in after
discontinuation of clopidogrel. In this study, we recruited patients
already randomised in the GLOBAL LEADERS study allocated to discontinue
aspirin treatment, while remaining on ticagrelor, 1 month after coronary
stenting (Ticag MonoRx group) and a control group discontinuing ticagrelor
at 6-12 months while remaining on aspirin (ASA MonoRx group). Both groups
underwent platelet studies at day 0, prior to discontinuation of aspirin
or ticagrelor and then on day 2, 7 and 14 day post cessation with multiple
electrode aggregometry. Purpose(s): This study was designed to look
for evidence of a rebound increase in platelet aggregation in response to
collagen after withdrawal of either aspirin or ticagrelor in patients who
have been treated with both drugs after PCI with DES implantation.We
needed a sample size of 26 patients in each group for 90% power to detect
a mean change in platelet aggregation of 100 AU/min with an alpha of 0.05.
The primary outcome measure was change in platelet aggregation in response
to collagen between baseline and day 2, day 7 and day 14 following
cessation of DAPT. A rebound effect was defined as a >10% increase in
collagen induced platelet aggregation on either day 2 or day 7 compared to
day 14 post discontinuation of either aspirin or ticagrelor.
 Method(s): Patients provided written informed consent and underwent
MEA using arachidonic acid (AA), adenosine diphosphate (ADP), thrombin
receptor activator peptide (TRAP) and collagen in prespecified
concentrations timed at 30 mins post phlebotomy. Results were calculated
from the area under the curve and expressed as as whole number aggregation
units (AU). Inbuilt QC analysis was used to determine the need for repeat
assays. Result(s): Collagen induced platelet aggregation was similar
in both groups at day 0 (37 AU vs 34 AU; p=0.687) and at day 2 (55 AU vs
40 AU; p=0.12). By day 7, patients on ticagrelor monotherapy had higher
collagen induced platelet aggregation (78 AU vs 37 AU; p=0.0001) and this
difference was maintained at 14 days (80 AU vs 43 AU; p=0.0001). In
patients, assigned to ticagrelor monotherapy after 1 month of DAPT, AA
induced platelet aggregation progressively increased from day 0 to day 14.
In the patients discontinuing ticagrelor and continuing on aspirin
monotherapy, ADP induced platelet aggregation increased from day 0 to day
14. Rebound was seen in 6/17 (35%) patients in the ticagrelor monotherapy
group versus 8/17 (47%) patients in the aspirin monotherapy group
(p=0.728) with a mean peak of 21 AU (SD 6) and 10 AU (SD 6) respectively
above baseline readings, p=0.003. There was no difference in TRAP induced
aggregation at any time point. Conclusion(s): Ticagrelor monotherapy
was associated with higher collagen induced platelet aggregation than
aspirin monotherapy at both 7 and 14 days post cessation of DAPT.

<130>
Accession Number
630047550
Title
Impact of aortic valve replacement on outcomes of patients with low-flow,
low-gradient moderate aortic stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 3721), 2019. Date of
Publication: October 2019.
Author
Annabi M.S.; Dahou A.; Bergler-Klein J.; Burwash I.G.; Orwat S.;
Baumgartner H.; Bartko P.E.; Mascherbauer J.; Mundigler G.; Cavalcante J.;
Ribeiro H.B.; Rodes-Cabau J.; Clavel M.A.; Pibarot P.
Institution
(Annabi, Dahou, Rodes-Cabau, Clavel, Pibarot) Quebec Heart and Lung
Institute, Quebec, Canada
(Bergler-Klein, Bartko, Mascherbauer, Mundigler) Medical University of
Vienna, Department of Internal Medicine II, Division of Cardiology,
Vienna, Austria
(Burwash) University of Ottawa Heart Institute, Ottawa, Canada
(Orwat, Baumgartner) University Hospital of Munster, Muenster, Germany
(Cavalcante) University of Pittsburgh, Division of Cardiology, Pittsburgh,
United States
(Ribeiro) Heart Institute, University of Sao Paulo (InCor), Sao Paulo,
Brazil
Publisher
Oxford University Press
Abstract
Background: Aortic valve replacement (AVR) is recommended for patients
with low-flow, low-gradient (LFLG) and true-severe aortic stenosis (TSAS).
However, there is very few data on the potential benefit of AVR in
patients with LFLG pseudo-severe (i.e. moderate) AS (PSAS).
 Method(s): Consecutive patients with aortic valve area <=0.6
cm2/m2, mean gradient <40 mmHg were prospectively
recruited in a multicenter observational cohort study. The patients were
categorized in TSAS vs. PSAS using previously reported thresholds of
flow-independent parameters of AS severity (projected valve area at normal
flow rate <=1.0 cm2 and/or aortic valve calcium score by CT
>1200 AU in women and >2000 AU in men). To account for
between-treatment-group differences, inverse probability-oftreatment
weighting was combined to Cox proportional hazards regression.
 Result(s): Among the 430 patients included in this study, 297 (69%)
were classified as TSAS and 274 (57%) underwent AVR. Of note, 21% of the
patients treated by AVR were classified as PSAS. In patients managed
conservatively (ConsRx), 52% had PSAS and 48% TSAS. During a median
follow-up of 28 months [8-60], 198 patients died. The adjusted weighted
hazard ratio (awHR) of death associated with AVR as compared to ConsRx was
0.42 [0.24-0.73] (p<0.0001, Figure1-Panel-A). This survival benefit
associated with AVR was observed not only in patients with TSAS but also
in those with PSAS (awHR: 0.29 [0.12-0.70]; p=0.006, Figure1-Panel-B).
 Conclusion(s): The results of this study suggest that AVR is
associated with a survival benefit not only in LFLG patients with TSAS but
also in those with PSAS. Randomized trials are needed to confirm the
benefit of AVR in patients with moderate AS and depressed LV systolic
function.

<131>
Accession Number
630047169
Title
Design of a multicenter, open-label, randomized controlled trial: Effects
of intensive systolic blood pressure lowering treatment in reducing risk
of vascular events (ESPRIT).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1972), 2019. Date of
Publication: October 2019.
Author
Liu J.; Li J.; Huang X.H.
Institution
(Liu, Li, Huang) Fuwai Hospital, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
Publisher
Oxford University Press
Abstract
Background: Patients with cardiovascular diseases (CVD) are at high risk
for recurrent major cardiovascular events. Effective public health
strategies to lower blood pressure (BP) are necessary to reduce risk of
cardiovascular disease. However, substantial uncertainty remains about the
optimal target level to lower BP in patients with cardiovascular disease.
 Purpose(s): To assess the effects on the incidence of major
cardiovascular events in patients with CVD during the scheduled treatment
period of greater reduction in blood pressure with a systolic BP (SBP)
target <120 mmHg versus <140 mmHg. Method(s): This study is a
multicenter, open-label, randomized controlled trial comparing two
strategies for lowering SBP: lowering SBP to the standard target of <140
mmHg; and lowering BP to a more intensive target of <120 mmHg. This study
will enroll 12,000 Chinese participants from 100-200 hospitals, follow-up
for about 3 years. We will include participants aged >=50 years old with
SBP >=130 mmHg, having a history of vascular disease (including myocardial
infarction, percutaneous coronary intervention, coronary artery bypass
grafting, carotid endarterectomy or carotid stenting, peripheral artery
disease with revascularization, abdominal aortic aneurysm >=5 cm with
repair) or stroke. The primary outcome is the first occurrence of major
cardiovascular events defined as a composite of myocardial infarction,
stroke, coronary or non-coronary revascularization events, and
cardiovascular death. Secondary outcomes include the components of the
primary composite outcome, hospitalized heart failure and all cause of
death and non-cardiovascular outcomes (kidney disease and cognitive
outcomes). Result(s): Regarding the results, we hypothesize that
comparing with SBP target of <140 mmHg, more intensive SBP target of <120
mmHg can further reduce the occurrence of cardiovascular events in CVD
patients with elevated blood pressure. Conclusion(s): This study can
provide reliable evaluation on whether more intensive SBP target of <120
mmHg is more desirable than SBP target of <140 mmHg in CVD patients with
elevated blood pressure.

<132>
Accession Number
630046888
Title
A new scoring system to stratify post-surgical valvular patients during
cardiovascular rehabilitation: Derivation and validation study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1485), 2019. Date of
Publication: October 2019.
Author
Maranta F.; Pistoni A.; Cartella I.; Cianfanelli L.; Cerea P.; De Bonis
M.; Castiglioni A.; Alfieri O.; Cianflone D.
Institution
(Maranta, Alfieri) San Raffaele Scientific Institute, Milan, Italy
(Pistoni, Cartella, Cianfanelli, De Bonis, Castiglioni, Cianflone)
University Vita-Salute San Raffaele, Milan, Italy
(Cerea) University of Milan-Bicocca, Cardiology, Milan, Italy
Publisher
Oxford University Press
Abstract
Background: Guidelines underline the importance of Cardiovascular
Rehabilitation (CR) in post-surgical valvular patients both for the
functional recovery and the monitoring of complications. However, there
are no established indicators to better categorise their risk and to
identify the real probability of recovery. Purpose(s): The aim of
this study is to propose and validate a scoring system to appropriately
stratify post-surgical valvular patients in order to individualise CR
programmes. Method(s): A retrospective study was conducted on 1480
post-surgical valvular patients hospitalized in our CR Unit (902 M - 578
F; median age of 64 years, IQR 53-73). 485 patients underwent single heart
valve repair, 408 single heart valve replacement, 237 single heart valve
surgery and additional interventions, 249 multiple valve interventions and
101 multiple heart valves and additional interventions. Subjects were
randomised in two groups for data analysis: a Derivation (D; n=1000) and a
Validation (V; n=480) group. Initially, in group D we assessed the
predictive value of anamnestic, clinical and laboratory variables for
major complications and functional recovery. We created two scoring
systems for these outcomes and, subsequently, we validated them on group
V. Finally, we interlaced them in an operative algorithm. Result(s):
Chronic kidney disease (OR 2.588; 95% CI 1.232-5.436; p=0.012), sternal
surgical re-synthesis (OR 7.757; 95% CI 2.042-29.471; p=0.003),
post-surgical transfusions (OR 2.419; 95% CI 1.407-4.161; p=0.001) and
Troponin T peak >1400 mug/L (OR 2.441; 95% CI 1.418- 4.200; p=0.001) were
independent predictors for the occurrence of major complications in group
D. Age (OR 0.958; 95% CI 0.9339-0.977; p<0.001), post- surgical
transfusions (OR 1.981; 95% CI 1.160-3.380; p<0.001) and METS at admission
(OR 0.032; 95% CI 0.017-0.061; p<0.001) were independent predictors of a
higher functional recovery in group D. When the two scoring systems were
validated on group V, we obtained a z score of 0.07 (p=0.941) for the
major complications risk score and a z score of 1.23 (p=0.219) for the
functional recovery stratification system, respectively, indicating a very
reliable model. We proceeded to build an operative algorithm to stratify
patients and propose personalised CR strategies. Conclusion(s): We
identified predictors to stratify the risk of complications and to define
the probability of recovery in post-surgical valvular patients undergoing
CR. The proposed final operative algorithm may be a unique tool to support
the cardiologist to tailor rehabilitation programmes. This may lead to
better outcomes and reduction of healthcare expenditure with optimisation
in the use of available resources.

<133>
Accession Number
630046795
Title
The randomised study of epicardial application of hydrogel with amiodarone
for prevention of postoperative atrial fibrillation in patients after
coronary artery bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1297), 2019. Date of
Publication: October 2019.
Author
Bockeria O.; Shvartz V.A.; Kanametov T.
Institution
(Bockeria, Shvartz, Kanametov) A.N. Bakulev National Medical Research
Center for Cardiovascular Surgery, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
The purpose of our study was to evaluate safety and efficacy of local
epicardial application of amiodarone - releasing hydrogel in the
prevention of postoperative atrial fibrillation (AF) in patients
undergoing coronary artery bypass grafting (CABG). Material(s) and
Method(s): We present an open prospective randomised study, in which 60
patients (47 male), mean age of 62+/-8,5 were included. Baseline clinical,
laboratory and instrumental characteristics were similar in all patients.
Patients didn't have any arrhythmic complains or previously registered AF.
All patients underwent elective CABG and were randomised into two groups:
Group #1 (n=30) - had the amiodarone-releasing hydrogel application before
chest closure, and Group #2 (n=30) regular CABG surgery, no local
application. We used 60 mg of amiodarone in hydrogel. This dose was
experimentally determined during previously performed animal study. Heart
rhythm control was monitored continuously during first 5 postoperative
days and occasionally (mornings and evenings) the remaining days before
the discharge. The local ethics committee approved this study design.
 Result(s): The incidence of postoperative AF occurrence was
significantly lower in Group #1: AF was registered in 3.3% cases versus
37% of patients from Group #2 (p<0.001). There was slight increase of PQ
interval duration in Group #1 - 0.14 sec (0.12; 0.16), which however was
significantly higher then in Group #2 - 0.12 (0.12; 0.14), (p<0.01). QRS
and QT intervals were similar in both groups without significant
difference. There were no complications associated with the application
procedure neither during postoperative period, such as AV block, infection
or lifethreatening situations. According to 5 days ECG monitoring, the
average heart rate in the Group #1 was 59 (52; 60) beats per min versus 69
beats per min (65; 75) in Group #2 (p<0.001). Temporary atrial or
atrio-ventricular pacing used for correction of the heart rate if required
in both groups. By the time of discharge none of the patients required
permanent cardiac pacing. The length of stay in Group #1 was significantly
shorter: 6 (6; 7) days versus 8 (8; 9) days (p<0,001). Among all studied
parameters, amiodarone-releasing hydrogel application and older age were
statistically significant in postoperative AF occurrence (p<0.01).
According to the Cox regression model amiodarone-releasing hydrogel
application decreases the incidence of postoperative AF by 18,9 folds. The
older age instead increases the incidence of postoperative AF by 1,2
folds. Conclusion(s): The local epicardial amiodarone (60 mg)
application in hydrogel before chest closure is a safe procedure. This
approach showed it's effectiveness in AF prevention in patient undergoing
elective CABG.

<134>
Accession Number
630046539
Title
Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on
vein-graft patency 1 year after coronary artery bypass grafting with or
without diabetes: A post-hoc analysis of the DACAB tria.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1294), 2019. Date of
Publication: October 2019.
Author
Zhu Y.P.; Liu H.; Zhang M.L.; Mei J.; Zhao Q.
Institution
(Zhu, Zhao) Rui Jin Hospital, Shanghai Jiaotong University, School of
Medicine, Shanghai, China
(Liu, Mei) Xinhua Hospital, Shanghai Jiao Tong University, Cardiovascular
Surgery, Shanghai, China
(Zhang) Shanghai Municipal Center for Disease Control and Prevention,
Shanghai, China
Publisher
Oxford University Press
Abstract
Introduction: The association of diabetes and vein graft patency after
coronary artery bypass grafting (CABG) remains controversial. In patients
with diabetes, impaired endothelial function in vein grafts and high
platelet turnover might result in early vein graft failure. The DACAB
trial showed ticagrelor plus aspirin significantly increased 1-year vein
graft patency vs. aspirin alone, while no significant difference between
ticagrelor alone and aspirin alone. However, whether the results is
different between the patients with or without diabetes is unknown.
 Purpose(s): To assess the effects of ticagrelor with or without
aspirin vs. aspirin alone on 1-year vein grafts patency after CABG in
patients with or without diabetes. Method(s): We examined the
subgroups of patients with and without diabetes from DACAB trial
(NCT02201771), in which 500 patients were randomized to 1 of 3
antiplatelet regimens (ticagrelor 90mg twice daily plus aspirin 100mg once
daily, T+A group; ticagrelor 90mg twice daily, T group; or aspirin 100mg
once daily, A group) within 24 hours post-CABG. The primary outcome was
1-year vein graft patency (FitzGibbon grade A) assessed by multi-slice
computed tomographic angiography or coronary angiography. Result(s):
According to the baseline medical history and/or glycated hemoglobin
(HbA1c) >=6.5%, 283 patients with 818 vein grafts were allocated to the
non-diabetes subgroup, remaining 217 patients with 642 vein grafts to the
diabetes subgroup. By per-graft analysis, no significant difference on
1-year vein graft patency rate was observed between nondiabetes and
diabetes subgroup (84.6% [692/881] for non-diabetes vs. 80.2% [515/642]
for diabetes, adjusted odds ratio (OR) =1.39, 95% CI: 0.92-2.09, P=0.116).
In T+A group, 1-year vein graft patency rates were 91.0% (244/268) for
non-diabetes vs. 85.8% (188/219) for diabetes; In T group, 85.0% (221/260)
for non-diabetes vs. 80.3% (183/228) for diabetes; In A group, 78.3%
(227/290) for non-diabetes vs. 73.9% (144/195) for diabetes. Ticagrelor
plus aspirin showed higher vein graft patency rate than aspirin alone in
both non-diabetes and diabetes subgroup (non-diabetes: adjusted OR = 0.34,
95% CI: 0.17-0.69, and diabetes: adjusted OR = 0.42, 95% CI: 0.19-0.91, P
for interaction = 0.524), whereas ticagrelor alone did not show
improvement on vein graft patency compared with aspirin alone in both
subgroups (non-diabetes: adjusted OR=0.62, 95% CI: 0.32-1.20, and
diabetes: adjusted OR = 0.65, 95% CI: 0.33-1.31, P for interaction =
0.795). Similar results were showed by per-patient analysis. A total 16
major adverse cardiovascular events occurred, 8 (2.8%) for non-diabetes
and 8 (3.7%) for diabetes. Conclusion(s): In the DACAB trial,
diabetes was not found to be associated with decreased vein graft patency
at 1 year after CABG. The effect of ticagrelor plus aspirin on improvement
of 1-year vein graft patency, when compared with aspirin alone, is
consistent in patients with or without diabetes.

<135>
Accession Number
630046481
Title
A novel role of SGLT2 inhibitors to increase circulating proangiogenic
progenitor cells in patients with type 2 diabetes and cardiovascular
disease: A sub-study of the EMPA-HEART CardioLink-6 Trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 115), 2019. Date of
Publication: October 2019.
Author
Terenzi D.C.; Verma S.; Trac J.Z.; Quan A.; Mason T.; Al-Omran M.; Dhingra
N.; Leiter L.A.; Zinman B.; Yan A.T.; Connelly K.A.; Teoh H.; Mazer C.D.;
Hess D.A.
Institution
(Terenzi, Verma, Trac, Quan, Mason, Dhingra, Teoh) St. Michael's Hospital,
Cardiac Surgery, Toronto, Canada
(Al-Omran) St. Michael's Hospital, Vascular Surgery, Toronto, Canada
(Leiter) St. Michael's Hospital, Endocrinology and Metabolism, Toronto,
Canada
(Zinman) Mount Sinai Hospital of the University Health Network,
Endocrinology and Metabolism, Toronto, Canada
(Yan, Connelly) St. Michael's Hospital, Cardiology, Toronto, Canada
(Mazer) St. Michael's Hospital, Anesthesia, Toronto, Canada
(Hess) University of Western Ontario, Physiology and Pharmacology, London,
Canada
Publisher
Oxford University Press
Abstract
Background: SGLT2 inhibitors (SGLT2i) have been demonstrated to reduce
major adverse cardiovascular events and mortality in patients with type 2
diabetes (T2D) who are at high risk for cardiovascular disease (CVD).
However, the mechanism(s) of the underlying benefit remain unclear. Since
regenerative cell exhaustion resulting in impaired vascular homeostasis
has been proposed as a key driver of CV events in T2D, we hypothesised
that modulation of circulating vascular regenerative cell content by
SGLT2i may be a novel basis of cardioprotection. Purpose(s): To
evaluate the effects of the SGLT2i, empagliflozin (EMPA), vs placebo on
circulating vascular regenerative and pro-inflammatory cells in patients
with T2D and CVD. Method(s): This was a biomarker sub-study of the
EMPA-HEART Cardiolink-6 randomised trial of EMPA (10mg QD) vs placebo in
patients with T2D and a history of coronary artery disease (prior
myocardial infarction and/or coronary revascularisation). Blood samples
(baseline N=48; study end N=26) underwent multiparametric progenitor cell
analyses by flow cytometry. Circulating cells were assessed for aldehyde
dehydrogenase (ALDH) activity, a self-protective enzyme highly expressed
in several proangiogenic progenitor cell lineages, as well as cell surface
co-expression of the primitive progenitor (CD34, CD133) or
M1/m2 macrophage (CD80, CD163) markers. Result(s):
Individuals with increased inflammatory burden (ALDHhi granulocytes above
the baseline median) were older (61+/-2 vs 67+/-2 years), more likely to
be current or past smokers (21% vs 42%) and had reduced LV function,
assessed by echocardiography. The placebo- and EMPAassigned groups were
equivalent at baseline with respect to the frequency and distribution of
proangiogenic progenitor cells (ALDHhiSSClo), monocyte/ macrophage
(ALDHhiSSCmid) and inflammatory granulocyte (ALDHhiSSChi) precursors.
Following 6-months of treatment with EMPA, there was a marked increase in
the number of circulating primitive ALDHhiSSClo cells with CD133 (Placebo:
-2.8+/-3.8%, EMPA: +8.6+/-2.5%, P<0.02) or CD133/CD34 (Placebo:
0.4+/-4.5%, EMPA: +13.3+/-3.8%, P<0.05) coexpression. Furthermore, EMPA
treatment was associated with an increase in the frequency of circulating
anti-inflammatory cells with M2 macrophage polarisation marked by CD163
(Placebo: -0.7+/-0.8%, EMPA = +3.9+/-1.3%, P<0.01) expression.
Non-significant increases in circulating proangiogenic monocytes, and
decreases in the frequency of circulating inflammatory granulocytes were
also observed after EMPA treatment (vs placebo). Conclusion(s): We
provide the first evidence showing that SGLT2i treatment with EMPA alters
the balance of key circulating vascular progenitor and inflammatory cells
in patients with T2D and CVD. We suggest that SGLT2i may afford
cardioprotection through a novel and previously unrecognised capacity to
limit regenerative cell exhaustion in T2D.

<136>
Accession Number
630046358
Title
Association of minority status with mortality and hospital readmission in
patients with ischemic cardiomyopathy in the STICH trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1965), 2019. Date of
Publication: October 2019.
Author
Pires J.M.; Brown D.L.
Institution
(Pires, Brown) Washington University, School of Medicine, St. Louis,
United States
Publisher
Oxford University Press
Abstract
Background: Racial and ethnic minorities with coronary artery disease
(CAD) suffer worse outcomes than their non-minority counterparts,
including increased mortality and hospital readmissions. Proposed
explanations include impaired access to care, reduced quality of care,
comorbidity burden and medication access. Study of the outcomes of
minorities in randomized controlled trials (RCT) allows controlling for
some of these factors. Purpose(s): The purpose of the current study
was to evaluate the impact of minority status on mortality and hospital
readmission in patients enrolled in the Surgical Treatment for Ischaemic
Heart Failure (STICH) trial. Method(s): STICH was a multicenter,
international RCT of patients with an ejection fraction (EF) of 35% or
less and CAD amenable to coronary artery bypass graft surgery (CABG) who
were randomized to undergo CABG plus medical therapy or medical therapy
alone. Median follow-up was 9.8 years. Minority status was defined by
self-reported black race or Hispanic ethnicity. Optimal medical therapy
(OMT) was the combination of at least 1 antiplatelet drug, a statin, a
beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin
receptor blocker. The primary outcomes of interest were mortality and
hospital readmission. Separate Cox proportional hazards models were
constructed to examine the independent associations between minority
status and mortality and readmission. Result(s): Of 1212 patients
randomized, 421 (35%) were members of a minority. CABG was the treatment
assignment in 52.5% of minority participants whereas 47.5% were randomized
to medical therapy (P=0.27). Minority patients were significantly younger
than non-minority patients (57.8 vs 61.6 years, P=0.003). Sex, smoking
status, and the prevalence of diabetes, hypertension, stroke and chronic
kidney disease did not differ between minority and non-minority patients.
Fewer minority patients had hyperlipidemia (49% vs. 66%, P<0.001), prior
MI (72% vs 80%, P=0.003), atrial fibrillation (8.1% vs. 15%, P=0.001) or
prior percutaneous coronary intervention (9% vs. 15%, P=0.004). Minority
patients were less often on OMT at 30 days (56% vs. 66%, P=0.001), 1 year
(70% vs. 76%, P=0.048) and 5 years (66% vs. 75%, P=0.002). Crude mortality
rates were lower in minority patients (57% vs. 65%, P=0.004). However,
minority status was independently associated with an increased hazard of
mortality (HR 2.3, 95% CI: 1.5-2.5, P<0.001) but had no effect on
rehospitalization (HR 1.01, 95% CI: 0.78-1.31, P=0.97).
 Conclusion(s): Despite being a low risk population, minority status
in the STICH trial was associated with a 2.3-fold increased hazard of
mortality in patients with ischaemic cardiomyopathy. Additional research
is urgently needed to delineate and address the causes of disparate
outcomes among minority patients.

<137>
Accession Number
630046214
Title
Clinical outcomes of percutaneous mitral valve repair in secondary mitral
regurgitation: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 2544), 2019. Date of
Publication: October 2019.
Author
Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.; Verrengia E.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Zimarino, Ricci, De Innocentiis, Verrengia, Gallina) G. d Annunzio
University, Chieti, Italy
(Capodanno, Grasso, Tamburino) University of Catania, Catania, Italy
(Swaans, Brouwer) St Antonius Hospital, Nieuwegein, Netherlands
(Lombardi) University of Brescia, Brescia, Italy
(De Caterina) University of Pisa, Pisa, Italy
Publisher
Oxford University Press
Abstract
Background: The benefit of percutaneous mitral valve repair with mitraclip
(PMVR) in patients with secondary mitral regurgitation (MR) is still
debated. Method(s): In order to compare the outcome of PMVR with
optimal medical therapy (OMT) versus OMT alone in patients with secondary
MR, we performed a systematic review and meta-analysis of 2 randomized
clinical trials (RCT) and 7 non-randomized observational studies (nROS).
Hazard ratios (HR) and 95% confidence intervals (CI) were pooled through
inverse variance random-effect model to compute the summary effect size
for allcause mortality, cardiovascular death and cardiac-related
hospitalization. Subgroup and meta-regression analysis were also
performed. Result(s): An overall population of 3,118 individuals (67%
men; mean age, 73 years) was included: 1,775 PMVR+OMT and 1,343 OMT
patients, with mean follow-up of 24+/-15 months. PMVR+OMT was associated
with a lower risk of all-cause death (HR: 0.77; 95% CI: 0.68-0.87),
cardiovascular death (HR: 0.55; 95% CI: 0.34-0.89) and cardiac-related
hospitalization (HR: 0.77; 95% CI: 0.64-0.92). Meta-regression analysis
showed that larger left ventricular end-diastolic volume index (LVEDVI)
portends higher mortality after PMVR (p<0.001). Conclusion(s): This
study-level meta-analysis shows that PMVR+OMT is associated with reduced
all-cause death, cardiovascular death and cardiac-related hospitalization
when compared with OMT alone in secondary MR. LVEDVI is a predictive
marker of efficacy, as patients with smaller LVEDVI derive the largest
benefit from PMVR.

<138>
Accession Number
630046141
Title
TAVI is associated with less patient-prosthesis-mismatch than surgical
aortic valve repair of severe aortic stenosis: A systematic review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1085), 2019. Date of
Publication: October 2019.
Author
Abi Khalil C.; Ignatiuk B.; Erdem G.; Chemaitely H.; Barilli F.; Al
Suwaidi J.; Kofler M.; Stastny L.; Jneid H.; Bonaros N.
Institution
(Abi Khalil, Ignatiuk, Erdem, Bonaros) London School of Economics, London,
United Kingdom
(Chemaitely) Weill Cornell Medicine-Qatar, Doha, Qatar
(Barilli) Santa Croce E Carle Hospital, Cuneo, Italy
(Al Suwaidi) Hamad Medical Corporation Heart Hospital, Doha, Qatar
(Kofler, Stastny) Innsbruck Medical University, Innsbruck, Austria
(Jneid) Baylor College of Medicine, Houston, United States
Publisher
Oxford University Press
Abstract
Background: TAVI has shown to be non-inferior to surgical aortic valve
replacement (sAVR) in terms of mortality for the treatment of intermediate
and high-risk patients with severe aortic stenosis (AS). Purpose(s):
We sought to assess whether there is a difference on echocardiographic
parameters up to 2 years after TAVI and sAVR Methods: We conducted a
systematic review and a random-effect model meta-analysis of randomized
controlled trials that compared TAVI and sAVR. The primary outcome was
post-proceduralpatient-prosthesismismatch (PPM). Secondary outcomes were
post-procedural and 2-year effective orifice area (EOA), paravalvular
gradient (PVG) and moderate/ severe paravalvular leak (PVL).
 Result(s): We identified 5 trials with a total of 5552 participants
with AS, including 2777 patients randomized to TAVI and 2775 randomized to
sAVR (Figure 1). TAVI was associated with a significant 35% relative risk
reduction (95% CI [0.50-0.8), p=0.005) in moderate/severe post-procedural
PPM. The effect was more evident in self- than balloon-expandable valves
(p=0.029). Similar results were found in terms of post procedural EOA
(RR=0.53, 95% CI [0.43-0.62]), and residual gradients (RR=0.54, 95% CI
[0.32-0.76]). As expected, TAVI demonstrated higher rates of moderate/
severe PVL (RR=9.41, 95% CI [5.22-16.96]). The results were sustainable at
2 years as seen in pooled increased EOA (pooled mean difference 0.48, 95%
CI [0.24-0.72]), and the pooled decreased residual gradients of 0.58 (95%
CI [0.77-0.25]) in favor of TAVI. The incidence of moderate/ severe PVL
remained also lower in sAVR patients (RR=10.39, 95% CI [4.80-22.46]).
 Conclusion(s): Our meta-analysis suggests that TAVI is associated
with a lower risk of PPM, as well as higher EOA and lower residual
gradients through 2 years of follow-up. This was accompanied by a higher
incidence of moderate/severe PVL compared to sAVR. Future research should
focus on the effect of these echocardiographic differences on clinical
outcomes. (Figure Presented).

<139>
Accession Number
630046056
Title
Platelet aggregability evaluation in patients with acute coronary
syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2019. France. 40 (Supplement 1) (pp 1134), 2019. Date of
Publication: October 2019.
Author
Nakashima C.A.K.; Dallan L.A.O.; Lisboa L.A.F.; Hajjar L.A.; Soeiro A.M.;
Silva B.A.; Costa M.S.S.; Dornas C.J.C.B.; Dalcoquio T.F.; Furtado R.H.M.;
Baracioli L.M.; Fukushima J.T.; Gurbel P.A.; Giugliano R.P.; Nicolau J.C.
Institution
(Nakashima, Dallan, Lisboa, Hajjar, Soeiro, Silva, Costa, Dalcoquio,
Furtado, Baracioli, Fukushima, Nicolau) Heart Institute of the University
of Sao Paulo (InCor), Sao Paulo, Brazil
(Dornas) Hospital do Coracao do Brasil, Brasilia, Brazil
(Gurbel) Duke University Medical Center, Durham, United States
(Giugliano) Brigham and Womens Hospital, Boston, United States
Publisher
Oxford University Press
Abstract
Background: Dual antiplatelet therapy is recommended for patients (pts)
with acute coronary syndromes (ACS). However, 10-15% of pts have
indication of coronary artery bypass graft (CABG) for the index event and
current guidelines recommend stopping clopidogrel at least 5 days prior to
CABG. This waiting time could increase hospital length of stay, thus
having negative impacts on costs and clinical complications.
 Purpose(s): To evaluate if release to CABG based on platelet
aggregability by Multiplate AnalyzerTM would be non-inferior in comparison
with common practice (5 days) in terms of 24-hours post-CABG bleeding.
 Method(s): The PLAT-CABG (NCT 02516267) is a randomized, open label,
non-inferiority trial (boundary 25%) testing a strategy of platelet
aggregability-guided release to CABG versus standard-of-care on the
primary endpoint of chest tube drainage in the first 24 hours post CABG. A
total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and
with indication for CABG, were assigned to clopidogrel discontinued 5 days
prior to CABG (control group) vs. daily measurements of platelet
aggregability to ADP using Multiplate AnalyzerTM (intervention group) with
CABG occurring after recovering from platelet inhibition (pre-defined as a
threshold of 46 AU). Result(s): The main results are depicted in the
table Conclusion(s): Platelet-aggregability guided release to CABG is
non-inferior to standard of care in ACS patients awaiting CABG in terms of
perioperative bleeding and significantly shortens the time to CABG. (Table
Presented).

<140>
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Accession Number
630074580
Title
Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac
Surgery: A Systematic Review.
Source
Critical care nursing quarterly. 43 (1) (pp 28-38), 2020. Date of
Publication: 01 Jan 2020.
Author
Halpin E.; Inch H.; O'Neill M.
Institution
(Halpin) Surgical Critical Care Unit, Hospital of the University of
Pennsylvania, Philadelphia, United States
Publisher
NLM (Medline)
Abstract
This systematic review aims to determine the relationship between
postoperative delirium and the use of dexmedetomidine in comparison with
commonly used sedatives/analgesics in the postoperative cardiac surgery
patient. A systematic literature search of PubMed plus, CINAHL, Scopus,
and Ovid, and limited to the English language in the last 10 years, was
performed. Randomized controlled trials, observational and retrospective
studies, and meta-analyses with at least 1 delirium assessment tool were
included. The search found 196 potential articles; however, only 12 met
the criteria outlined. The systematic review revealed a decrease in
postoperative delirium for patients receiving dexmedetomidine in all
studies. Seven studies demonstrated statistically significant reductions
in postoperative delirium with dexmedetomidine compared with other
sedatives/analgesics. One study also revealed reduction of delirium with
dexmedetomidine as compared with normal saline. Two studies showed a
delayed time to delirium onset in patients receiving dexmedetomidine
versus propofol or morphine. The 2 meta-analyses found that all included
studies had a statistically significant reduction in postoperative
delirium when using dexmedetomidine. Postoperative use of dexmedetomidine
in cardiac surgery patients may reduce the incidence of postoperative
delirium.

<141>
Accession Number
630084623
Title
A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors
With Impaired Cardiac Function.
Source
Progress in transplantation (Aliso Viejo, Calif.). (pp 1526924819893295),
2019. Date of Publication: 05 Dec 2019.
Author
Dhar R.; Stahlschmidt E.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University School of Medicine in St Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St Louis, MO, USA
Publisher
NLM (Medline)
Abstract
RATIONALE: Brain death (BD) precipitates cardiac dysfunction impairing the
ability to transplant hearts from eligible organ donors. Retrospective
studies have suggested that thyroid hormone may enhance myocardial
recovery and increase hearts transplanted. We performed a randomized trial
evaluating whether intravenous thyroxine (T4) improves cardiac function in
BD donors with impaired ejection fraction (EF). METHOD(S): All
heart-eligible donors managed at a single-organ procurement organization
(OPO) underwent protocolized fluid resuscitation. Those weaned off
vasopressors underwent transthoracic echocardiography (TTE) within 12
hours of BD and, if EF was below 60%, were randomized to T4 infusion or no
T4 for 8 hours, after which TTE was repeated. RESULT(S): Of 77
heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction
was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control
(n = 11). Baseline EF was comparable (45%, interquartile range [IQR]
42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more
with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend
to more hearts transplanted (59% vs 27%, P = .14). This difference
appeared to be accounted for by more donors with a history of drug use in
the T4 group, who exhibited greater improvements in EF (15% vs 0% without
drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1
of 9, P = .01). CONCLUSION(S): In this small randomized study of BD
donors with impaired cardiac function, T4 infusion did not result in
greater cardiac recovery. A larger randomized trial comparing T4 to
placebo appears warranted but would require collaboration across multiple
OPOs.

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Saturday, December 21, 2019

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