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<1>
Accession Number
2012050720
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van De Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H.K. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W.
Institution
(Tricoci, Huang, Lokhnygina, Leonardi, Rorick, Harrington, Mahaffey) Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Held, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Moliterno) University of Kentucky, Lexington, United States
(Armstrong) Canadian Virtual Coordinating Center for Global Collaborative
Cardiovascular Research, University of Alberta, Edmonton, Canada
(Van De Werf, Sinnaeve) University Hospital Gasthuisberg, Leuven
Coordinating Center, Leuven, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Aylward) Flinders Medical Centre, Bedford Park, SA, Australia
(Chen, Pei, Kilian, Strony) Merck, Whitehouse Station, NJ, United States
(Jennings) CirQuest Labs., Department of Medicine, University of
Tennessee, Memphis, TN, United States
(Ambrosio) University of Perugia School of Medicine, Perugia, Italy
(Bode) Department of Internal Medicine III-Cardiology and Angiology,
University Hospital, Freiburg, Germany
(Cequier) Hospital Universitari de Bellvitge, Universitat de Barcelona,
Barcelona, Spain
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Erkan) Department of Cardiology, Ufuk University, Ankara, Turkey
(Huber) Department of Medicine, Cardiology, and Emergency Medicine,
Wilhelminen Hospital, Vienna, Greece
(Hudson) Henry Ford Hospital, Detroit, United States
(Jiang) Cardiovascular Institute and Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lincoff) Cleveland Clinic Coordinating Center for Clinical Research,
Cleveland, United States
(Montalescot) Institut de Cardiologie, Hopital Pitie-Salpetriere, Paris,
France
(Nicolau) Unidade de Coronariopatia Aguda, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Ogawa) Department of Cardiovascular Medicine, Kumamoto University
Graduate School of Medical Sciences, Kumamoto City, Japan
(Pfisterer) Division of Cardiology, University Hospital Basel, Basel,
Switzerland
(Prieto) Cardiovascular Department, Clinical Hospital, University of
Chile, Santiago, Chile
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Valgimigli) Universitaria di Ferrara, Unita Operativa di Cardiologia,
Ferrara, Italy
(Whellan) Division of Cardiology, Thomas Jefferson University,
Philadelphia, United States
(Widimsky) University Hospital Kralovske Vinohrady, Charles University,
Prague, Czech Republic
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
New England Journal of Medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1)
antagonist that inhibits thrombin-induced platelet activation. METHODS: In
this multinational, double-blind, randomized trial, we compared vorapaxar
with placebo in 12,944 patients who had acute coronary syndromes without
ST-segment elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. RESULTS:
Follow-up in the trial was terminated early after a safety review. After a
median follow-up of 502 days (interquartile range, 349 to 667), the
primary end point occurred in 1031 of 6473 patients receiving vorapaxar
versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate,
18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to
1.01; P = 0.07). A composite of death from cardiovascular causes,
myocardial infarction, or stroke occurred in 822 patients in the vorapaxar
group versus 910 in the placebo group (14.7% and 16.4%, respectively;
hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and
severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo
group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. CONCLUSIONS: In patients with acute coronary
syndromes, the addition of vorapaxar to standard therapy did not
significantly reduce the primary composite end point but significantly
increased the risk of major bleeding, including intracranial hemorrhage.
(Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)
Copyright 2011 Massachusetts Medical Society.

<2>
Accession Number
2012050719
Authors
Mega J.L. Braunwald E. Wiviott S.D. Bassand J.-P. Bhatt D.L. Bode C.
Burton P. Cohen M. Cook-Bruns N. Fox K.A.A. Goto S. Murphy S.A. Plotnikov
A.N. Schneider D. Sun X. Verheugt F.W.A. Gibson C.M.
Institution
(Mega, Braunwald, Wiviott, Bhatt, Murphy, Gibson) Brigham and Women's
Hospital, Harvard Medical School, Boston, United States
(Bhatt) Veterans Affairs Boston Healthcare System, Boston, United States
(Bassand) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Bode) University Hospital Freiburg, Freiburg, Germany
(Cook-Bruns) Bayer Healthcare, Wuppertal, Germany
(Burton, Plotnikov, Sun) Johnson and Johnson Pharmaceutical Research and
Development, Raritan, NJ, United States
(Cohen) Newark Beth Israel Medical Center, Newark, NJ, United States
(Fox) Centre for Cardiovascular Science, Edinburgh University and Royal
Infirmary, Edinburgh, United Kingdom
(Goto) Tokai University School of Medicine, Tokyo, Japan
(Schneider) University of Vermont/Fletcher Allen Health Care, Burlington,
United States
(Verheugt) Radboud University Nijmegen Medical Center, Nijmegen,
Netherlands
Title
Rivaroxaban in patients with a recent acute coronary syndrome.
Source
New England Journal of Medicine. 366 (1) (pp 9-19), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Acute coronary syndromes arise from coronary atherosclerosis
with superimposed thrombosis. Since factor Xa plays a central role in
thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might
improve cardiovascular outcomes in patients with a recent acute coronary
syndrome. METHODS: In this double-blind, placebo-controlled trial, we
randomly assigned 15,526 patients with a recent acute coronary syndrome to
receive twice-daily doses of either 2.5 mg or 5 mg of rivaroxaban or
placebo for a mean of 13 months and up to 31 months. The primary efficacy
end point was a composite of death from cardiovascular causes, myocardial
infarction, or stroke. RESULTS: Rivaroxaban significantly reduced the
primary efficacy end point, as compared with placebo, with respective
rates of 8.9% and 10.7% (hazard ratio in the rivaroxaban group, 0.84; 95%
confidence interval [CI], 0.74 to 0.96; P = 0.008), with significant
improvement for both the twice-daily 2.5-mg dose (9.1% vs. 10.7%, P =
0.02) and the twice-daily 5-mg dose (8.8% vs. 10.7%, P = 0.03). The
twice-daily 2.5-mg dose of rivaroxaban reduced the rates of death from
cardiovascular causes (2.7% vs. 4.1%, P = 0.002) and from any cause (2.9%
vs. 4.5%, P = 0.002), a survival benefit that was not seen with the
twice-daily 5-mg dose. As compared with placebo, rivaroxaban increased the
rates of major bleeding not related to coronary-artery bypass grafting
(2.1% vs. 0.6%, P<0.001) and intracranial hemorrhage (0.6% vs. 0.2%, P =
0.009), without a significant increase in fatal bleeding (0.3% vs. 0.2%, P
= 0.66) or other adverse events. The twice-daily 2.5-mg dose resulted in
fewer fatal bleeding events than the twice-daily 5-mg dose (0.1% vs. 0.4%,
P = 0.04). CONCLUSIONS: In patients with a recent acute coronary syndrome,
rivaroxaban reduced the risk of the composite end point of death from
cardiovascular causes, myocardial infarction, or stroke. Rivaroxaban
increased the risk of major bleeding and intracranial hemorrhage but not
the risk of fatal bleeding. (Funded by Johnson & Johnson and Bayer
Healthcare; ATLAS ACS 2-TIMI 51 ClinicalTrials.gov number, NCT00809965.)
Copyright 2011 Massachusetts Medical Society.

<3>
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Accession Number
2012067247
Authors
Lucchinetti E. Bestmann L. Feng J. Freidank H. Clanachan A.S. Finegan B.A.
Zaugg M.
Institution
(Lucchinetti, Zaugg) Department of Anesthesiology and Pain Medicine,
University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB T6G
2G3, Canada
(Bestmann, Feng) Department of Anesthesiology and Pain Medicine,
University of Alberta, Edmonton, AB T6G 2G3, Canada
(Freidank) Department of Pharmacology, University of Alberta, Canada
(Clanachan) Chief Operating Officer, UNILABS, St. Gallen, Switzerland
(Finegan) Department of Radiation Oncology, University of Zurich, Zurich,
Switzerland
Title
Remote ischemic preconditioning applied during isoflurane inhalation
provides no benefit to the myocardium of patients undergoing on-pump
coronary artery bypass graft surgery: Lack of synergy or evidence of
antagonism in cardioprotection?.
Source
Anesthesiology. 116 (2) (pp 296-310), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Two preconditioning stimuli should induce a more consistent
overall cell protection. We hypothesized that remote ischemic
preconditioning (RIPC, second preconditioning stimulus) applied during
isoflurane inhalation (first preconditioning stimulus) would provide more
protection to the myocardium of patients undergoing on-pump coronary
artery bypass grafting. METHODS:: In this placebo-controlled randomized
controlled study, patients in the RIPC group received four 5-min cycles of
300 mmHg cuff inflation/deflation of the leg before aortic cross-clamping.
Anesthesia consisted of opioids and propofol for induction and isoflurane
for maintenance. The primary outcome was high-sensitivity cardiac troponin
T release. Secondary endpoints were plasma levels of N-terminal pro-brain
natriuretic peptide, high-sensitivity C-reactive protein, S100 protein,
and short- and long-term clinical outcomE.S. Gene expression profiles were
obtained from atrial tissue using microarrays. RESULTS:: RIPC (n = 27) did
not reduce high-sensitivity cardiac troponin T release when compared with
placebo (n = 28). Likewise, N-terminal pro-brain natriuretic peptide, a
marker of myocardial dysfunction; high-sensitivity C-reactive protein, a
marker of perioperative inflammatory response; and S100, a marker of
cerebral injury, were not different between the groups. The incidence for
the perioperative composite endpoint combining new arrhythmias and
myocardial infarctions was higher in the RIPC group than the placebo group
(14/27 vs. 6/28, P = 0.036). However, there was no difference in the
6-month cardiovascular outcome. N-terminal pro-brain natriuretic peptide
release correlated with isoflurane-induced transcriptional changes in
fatty-acid metabolism (P = 0.001) and DNA-damage signaling (P < 0.001),
but not with RIPC-induced changes in gene expression. CONCLUSIONS:: RIPC
applied during isoflurane inhalation provides no benefit to the myocardium
of patients undergoing on-pump coronary artery bypass grafting. Copyright
2012, the American Society of Anesthesiologists, Inc. Lippincott.

<4>
Accession Number
2012080659
Authors
Mihalcz A. Kassai I. Kardos A. Foldesi C. Theuns D. Szili-Torok T.
Institution
(Mihalcz, Kassai, Kardos, Foldesi) Department of Electrophysiology,
Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
(Theuns, Szili-Torok) Department of Clinical Cardiac Electrophysiology,
Thoraxcentre, Erasmus MC, Dr Molewaterplein 40, kamer Ba 577, Postbus
2040, 3000 CA Rotterdam, Netherlands
Title
Comparison of the efficacy of two surgical alternatives for cardiac
resynchronization therapy: Trans-apical versus epicardial left ventricular
pacing.
Source
PACE - Pacing and Clinical Electrophysiology. 35 (2) (pp 124-130), 2012.
Date of Publication: February 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Epicardial pacing lead implantation is the currently preferred
surgical alternative for left ventricular (LV) lead placement. For
endocardial LV pacing, we developed a fundamentally new surgical method.
The trans-apical lead implantation is a minimally invasive technique that
provides access to any LV segments. The aim of this prospective randomized
study was to compare the outcome of patients undergoing either
trans-apical endocardial or epicardial LV pacing. Methods: In group I, 11
end-stage heart failure (HF) patients (mean age 59.7 +/- 7.9 years)
underwent trans-apical LV lead implantation. Epicardial LV leads were
implanted in 12 end-stage HF patients (group II; mean age 62.8 +/- 7.3
years). Medical therapy was optimized in all patients. The following
parameters were compared during an 18-month follow-up period: LV ejection
fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic
diameter, and New York Heart Association (NYHA) functional class. Results:
Nine out of 11 patients responded favorably to the treatment in group I
(LVEF 39.7 +/- 12.5 vs 26.0 +/- 7.8%, P < 0.01; LVEDD 70.4 +/- 13.6 mm vs
73.7 +/- 10.5 mm, P = 0.002; NYHA class 2.2 +/- 0.4 vs 3.5 +/- 0.4, P <
0.01) and eight out of 12 in group II (LVEF 31.5 +/- 11.5 vs 26.4 +/-
8.9%, P = < 0.001; NYHA class 2.7 +/- 0.4 vs 3.6 +/- 0.4, P < 0.05).
During the follow-up period, one patient died in group I and three in
group II. There was one intraoperative LV lead dislocation in group I and
one early postoperative dislocation in each group. None of the patients
developed thromboembolic complications. Conclusions: Our data suggest that
trans-apical endocardial LV lead implantation is an alternative to
epicardial LV pacing. 2012 Wiley Periodicals, Inc.

<5>
Accession Number
2012074986
Authors
El Deen H.M.S. Deeb A.E.
Institution
(El Deen, Deeb) Department of Anesthesiology, Faculty of Medicine,
Mansoura University, Egypt
Title
Ketamine-propofol versus ketamine fentanyl for anesthesia in pediatric
patients undergoing cardiac catheterization: A prospective randomized
study.
Source
Egyptian Journal of Anaesthesia. 28 (1) (pp 49-53), 2012. Date of
Publication: January 2012.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Objective: The aim of the study was to assess, compare the safety and
efficacy of continuous IV administration of a combination of
ketamine-propofol versus ketamine fentanyl for anesthesia in children
undergoing cardiac catheterization procedures with RT to Lt Shunt.
Methods: Thirty-six children aged from 1 to 8 years, with RT to Lt Shunt
scheduled for Cardiac catheterization in Mansoura Children Hospital were
included in this study. Patients in group KP (n = 18) received ketamine (1
mg/kg) and propofol (2 mg/kg) as induction agents followed by combination
of ketamine (25 mug/kg/min) and propofol (25 mug/kg/min) for maintenance
of anesthesia. On other hand, patients in group KF (n = 18) received
ketamine (1 mg/kg) and fentanyl (1 mug/kg) as induction agents followed by
combination of ketamine (25 mug/kg/min) and fentanyl (0.75 mug/kg/min) for
maintenance of anesthesia. Hemodynamic, oxygenation, recovery variables
and side effects were recorded. Results: There were no statistical
significant differences with age, sex, duration of anesthesia. There were
statistical significant decreases in mean arterial blood pressure (MAP),
systemic vascular resistance (SVR), pulmonary to systemic vascular
resistance ratio in KP group. Additionally, Sao₂ and
Pao₂ after anesthesia in KF group were statistically
significant higher than the other group. Also there was significant
prolongation of time to full recovery in KF group compared with KP group.
Conclusion: We concluded that a combination of ketamine-fentanyl is safer
and more efficacious than ketamine-propofol for pediatric cardiac
catheterization although it was associated with prolonged recovery time.
2011 Egyptian Society of Anesthesiologists. Production and hosting by
Elsevier B.V. All rights reserved.

<6>
Accession Number
2012063351
Authors
Heneghan C. Ward A. Perera R.
Institution
(Heneghan, Ward, Perera) Oxford University, Department of Primary Care
Health Sciences, 23-38 Hythe Bridge St, Oxford, OX1 2ET, United Kingdom
Title
Self-monitoring of oral anticoagulation: Systematic review and
meta-analysis of individual patient data.
Source
The Lancet. 379 (9813) (pp 322-334), 2012. Date of Publication: January
28-February 3, 2012.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background: Uptake of self-testing and self-management of oral coagulation
has remained inconsistent, despite good evidence of their effectiveness.
To clarify the value of self-monitoring of oral anticoagulation, we did a
meta-analysis of individual patient data addressing several important gaps
in the evidence, including an estimate of the effect on time to death,
first major haemorrhage, and thromboembolism. Methods: We searched Ovid
versions of Embase (1980-2009) and Medline (1966-2009), limiting searches
to randomised trials with a maximally sensitive strategy. We approached
all authors of included trials and requested individual patient data:
primary outcomes were time to death, first major haemorrhage, and first
thromboembolic event. We did prespecified subgroup analyses according to
age, type of control-group care (anticoagulation-clinic care vs primary
care), self-testing alone versus self-management, and sex. We analysed
patients with mechanical heart valves or atrial fibrillation separately.
We used a random-effect model method to calculate pooled hazard ratios and
did tests for interaction and heterogeneity, and calculated a
time-specific number needed to treat. Findings: Of 1357 abstracts, we
included 11 trials with data for 6417 participants and 12 800 person-years
of follow-up. We reported a significant reduction in thromboembolic events
in the self-monitoring group (hazard ratio 051; 95 CI 031-085) but not for
major haemorrhagic events (088, 074-106) or death (082, 062-109).
Participants younger than 55 years showed a striking reduction in
thrombotic events (hazard ratio 033, 95 CI 017-066), as did participants
with mechanical heart valve (052, 035-077). Analysis of major outcomes in
the very elderly (age >=85 years, n=99) showed no significant adverse
effects of the intervention for all outcomes. Interpretation: Our analysis
showed that self-monitoring and self-management of oral coagulation is a
safe option for suitable patients of all ages. Patients should also be
offered the option to self-manage their disease with suitable health-care
support as back-up. Funding: UK National Institute for Health Research
(NIHR) Technology Assessment Programme, UK NIHR National School for
Primary Care Research. 2012 Elsevier Ltd.

<7>
Accession Number
2012059181
Authors
Aggarwal V. Rajpathak S. Singh M. Romick B. Srinivas V.S.
Institution
(Aggarwal) Department of Medicine, Jacobi Medical Center, Bronx, NY,
United States
(Rajpathak) Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States
(Singh) Department of Medicine, Bronx-Lebanon Hospital, Bronx, NY, United
States
(Romick, Srinivas) Division of Cardiology, Department of Medicine,
Montefiore Medical Center, 1825, Eastchester Road, Bronx, NY 10461, United
States
Title
Clinical outcomes based on completeness of revascularisation in patients
undergoing percutaneous coronary intervention: A meta-analysis of
multivessel coronary artery disease studies.
Source
EuroIntervention. 7 (9) (pp 1095-1102), 2012. Date of Publication:
January 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Most studies investigating completeness of revascularisation and
outcomes for multivessel disease (MVD) patients are limited by small
sample size. Methods and results: We searched PUBMED, Cochrane and EMBASE
for studies comparing outcomes of MVD patients with complete
revascularisation (CR) vs. incomplete revascularisation (IR) in the stent
era. We identified nine studies that met our selection criteria. Compared
to IR, patients undergoing CR had significantly lower risk of mortality
(relative risk (RR): 0.82; 95% confidence interval (CI): 0.68-0.99;
p=0.05), non-fatal myocardial infarction (MI) (RR: 0.67; 95% CI:
0.53-0.84; p <0.01) and subsequent coronary artery bypass graft surgery
(CABG) (RR: 0.70; 95% CI: 0.52-0.95; p=0.02) whereas no difference was
noted in the incidence of repeat percutaneous coronary intervention (PCI)
(RR: 0.87; 95% CI: 0.69-1.11; p=0.28). Average weighted follow up was
approximately 29 months for mortality, subsequent CABG and Repeat PCI
whereas it was 19 months for non-fatal MI. The results were similar after
excluding the only RCT or the one study restricted to diabetics or the
study restricted to drug-eluting stent use. Conclusions: In patients with
multivessel coronary disease, complete revascularisation with PCI may be
associated with better outcomes than incomplete revascularisation. Europa
Edition 2012. All rights reserved.

<8>
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Accession Number
2012065461
Authors
Ballester M. Llorens J. Garcia-De-La-Asuncion J. Perez-Griera J. Tebar E.
Martinez-Leon J. Belda J. Juez M.
Institution
(Ballester, Llorens, Garcia-De-La-Asuncion, Belda) Department of
Anaesthesiology and Critical Care, Hospital Clinico Universitario, Av de
Vicente Blasco Ibanez 17, 46010 Valencia, Spain
(Perez-Griera) Biochemical Laboratory, Alicante, Spain
(Tebar, Martinez-Leon, Juez) Department of Cardiovascular Surgery,
Alicante, Spain
(Martinez-Leon) Hospital Clinico Universitario, Consorcio Hospital General
Universitario, Alicante, Spain
(Tebar) Valencia and Hospital de Vinalopo, Alicante, Spain
Title
Myocardial oxidative stress protection by sevoflurane vs. propofol: A
Randomised controlled study in patients undergoing off-pump coronary
artery bypass graft surgery.
Source
European Journal of Anaesthesiology. 28 (12) (pp 874-881), 2011. Date of
Publication: December 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Context Myocardial oxidative stress plays an essential role in the
pathogenesis of ischaemia-reperfusion injury associated with coronary
artery bypass grafting (CABG). Both propofol and volatile anaesthetics
have been shown to reduce reactive oxygen species in experimental and
clinical studies. Main objective To compare the influence of sevoflurane
and propofol on myocardial oxidative stress markers (F2-isoprostanes and
nitrates/nitrites) in coronary sinus blood samples from patients
undergoing off-pump CABG. Design and setting Randomised controlled
clinical study of patients scheduled for off-pump CABG in a tertiary
academic university hospital from June 2007 to August 2009. Forty patients
consented to enrolment and were assigned to receive either propofol or
sevoflurane. Interventions Upon completion of the proximal anastomosis, a
retroplegia cannula was inserted in the coronary sinus to obtain blood
samples, according to the study protocol. Main outcome measures Markers of
lipoperoxidation (F2-isoprostanes) and nitrosative stress
(nitrates/nitrites) were measured in coronary sinus blood samples at three
time points: after the end of the proximal anastomosis (T1), after
completion of all grafts (T2) and 15min after revascularisation (T3).
Results Of the 40 recruited patients, 38 fully completed the study. In the
sevoflurane group (n - 20), concentrations of oxidative stress markers in
the coronary sinus remained almost constant and were significantly lower
than those in the propofol group (n=18) at all time points.
F2-isoprostanes concentrations were as follows at T1:sevoflurane group
37.2 +/-27.5 pgml¹ vs. propofol group 170.7+/-30.9pgml
^-1 [95% confidence interval (CI) 112.16-155.08, P<0.0001); at
T2:sevoflurane group 31.94+/-24.6pgml^-1 vs. propofol group
171.6+/-29.7 pgm^-1 (95% CI 119.78-159.63, P< 0.0001); and at
T3:sevoflurane group 23.8 +/-13.0pgml^-1 vs. propofol group
43.6+/-31 pgml^-1 (95% CI 2.87-36.63, P = 0.023). Conclusion In
patients undergoing off-pump CABG, sevoflurane showed better antioxidative
properties than propofol. 2011 Copyright European Society of
Anaesthesiology.

<9>
Accession Number
70660946
Authors
Vlasakov V. Thomas-Rueddel D.O. Rueddel H. Hutagalung R. Reinhart K.
Hartog C.S.
Institution
(Vlasakov, Thomas-Rueddel, Rueddel, Hutagalung, Reinhart, Hartog)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Germany
(Thomas-Rueddel, Rueddel, Reinhart) Center for Sepsis Control and Care,
Jena University Hospital, Germany
Title
Efficacy and safety of gelatin for fluid therapy in hypovolemia: A
systematic review and meta-analysis.
Source
Infection. Conference: 5th International Congress "Sepsis and Multiorgan
Dysfunction" Weimar Germany. Conference Start: 20110907 Conference End:
20110910. Conference Publication: (var.pagings). 39 (pp S142-S143),
2011. Date of Publication: September 2011.
Publisher
Urban und Vogel
Abstract
Introduction: Gelatin is frequently used as volume expander. There are
growing concerns about safety. Objectives: To systematically assess
clinical evidence concerning mortality, coagulation and renal function.
Methods: Systematic review of randomised controlled trials (RCT) on
gelatin in hypovolemia in comparison to any other fluid with comprehensive
search strategy [Ovid Medline (1948-May 2011), EMBASE (1947-May 2011),
Cochrane Library]. Data were independently extracted and risk of bias
assessed using the 2010 Cochrane tool. Primary outcome was overall
mortality. Secondary outcomes were number of patients exposed to
allogeneic transfusion, frequency of renal replacement therapy (RRT) or
acute renal failure (ARF). Albumin and crystalloid solutions were defined
as ''suitable'', other synthetic colloids as ''unsuitable'' control fluids
since they carry similar risk of side effects. Relative risks (RR) and
weighted mean differences with 95% confidence intervals (CIs) were
calculated. Data were pooled using a random-effects model (RevMan 5.1,
Cochrane Collaboration). Results: The search yielded 1,288 citations, 210
reports were read in full. The final sample contained 73 RCT in English,
German, French and Italian, published between 1975 and 2010, with 5,915
patients overall, 2,538 of which received gelatin. Median sample size in
the gelatin groups was 20 patients (range 10-249). In 54 RCT (74%), the
study period was <=24.0 h. Total gelatin dose was 20 ml/kg (median, range
6-62). Only 39 RCT (53%) used ''suitable'' control fluids. 49 RCT (67%)
investigated elective surgical patients, mostly from cardiac surgery (33
RCT, 465). 9 RCT (12%) investigated critically ill patients, 7 RCT (10%)
were in emergency patients and 7 RCT (10%) were in children. Risk ratio
(RR) for mortality was 1.02 (CI 0.87-1.19, data from 23 RCT with 2,694
patients which reported mortality). Numbers of patients exposed to
allogeneic transfusions were provided in 12 RCT, n = 1,193 patients and RR
was 1.15 (0.94-1.41). When only studies with ''suitable'' control fluids
were included, RR for mortality was 1.13 [0.88-1.46, 10 RCT, 1,392
patients] and risk for transfusion exposure was 1.24 (0.87-1.79, 8 RCT, n
= 702), tending towards control. Only six RCT (n = 662 patients) reported
the occurrence of RRT or ARF, five of them in comparison to HES solutions.
3 RCT reported anaphylactoid events. Conclusions: Most published studies
on gelatin are small and shorttime, use unsuitable control fluids and
report too few events to reliably assess the safety of gelatin.

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<1>
Accession Number
2012052617
Authors
Suleiman M. Koestler C. Lerman A. Lopez-Jimenez F. Herges R. Hodge D.
Bradley D. Cha Y.-M. Brady P.A. Munger T.M. Asirvatham S.J. Packer D.L.
Friedman P.A.
Institution
(Suleiman) Rambam Medical Center, Haifa, Israel
(Koestler, Lerman, Lopez-Jimenez, Herges, Hodge, Bradley, Cha, Brady,
Munger, Asirvatham, Packer, Friedman) Division of Cardiovascular Medicine,
Mayo Clinic, Rochester, MN 55905, United States
Title
Atorvastatin for prevention of atrial fibrillation recurrence following
pulmonary vein isolation: A double-blind, placebo-controlled, randomized
trial.
Source
Heart Rhythm. 9 (2) (pp 172-178), 2012. Date of Publication: February
2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: It is known that statins are effective in preventing atrial
fibrillation (AF) in patients undergoing cardiac surgery. Objective: The
purpose of this study was to evaluate the efficacy of statins in
preventing AF recurrence following left atrial ablation. Methods: One
hundred twenty-five patients who had no statin indication undergoing
catheter ablation due to drug-refractory paroxysmal (n = 90) or persistent
(n = 35) AF were randomized in a prospective, double-blind,
placebo-controlled trial to receive 80 mg atorvastatin (n = 62) or placebo
(n = 63) for 3 months. The primary endpoint was freedom from symptomatic
AF at 3 months. Secondary endpoints included freedom from any atrial
arrhythmia recurrence irrespective of symptoms, quality of life (QoL), and
reduction in C-reactive protein (CRP). Results: At 3 months, 95% of
patients in the atorvastatin group were free of symptomatic AF compared
with 93.5% in the placebo group (P =.75). Similarly, 85% of patients
treated in the atorvastatin group remained free of any recurrent atrial
arrhythmia vs 88% of patients in the placebo group (P =.37). Mean CRP
levels decreased in the atorvastatin group (mean change -0.75 +/- 3, P
=.02) and increased in the placebo group (mean change 2.1 +/- 19.9, P
=.48). Mean QoL score improved significantly in both groups (mean change
13.14 +/- 18.2 in the atorvastatin group and 11.10 +/- 17.7 in the placebo
group, P =.53). Conclusion: In patients with no standard indication for
statin therapy, treatment with atorvastatin 80 mg/day following AF
ablation does not decrease the risk of AF recurrence in the first 3 months
and should not be routinely administered to prevent periprocedural
arrhythmias. 2012 Heart Rhythm Society.

<2>
Accession Number
2012059171
Authors
Boden H. Van Der Hoeven B.L. Liem S.-S. Atary J.Z. Cannegieter S.C. Atsma
D.E. Bootsma M. Jukema J.W. Zeppenfeld K. Oemrawsingh P.V. Van Der Wall
E.E. Schalij M.J.
Institution
(Boden, Van Der Hoeven, Liem, Atary, Atsma, Bootsma, Jukema, Zeppenfeld,
Van Der Wall, Schalij) Dept. of Cardiology, Leiden University Medical
Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Oemrawsingh) Department of Cardiology, Medical Center Haaglanden, The
Hague, Netherlands
(Schalij) P.O. Box 9600, 2300 RC Leiden, Netherlands
Title
Five-year clinical follow-up from the MISSION! Intervention Study:
Sirolimus-eluting stent versus bare metal stent implantation in patients
with ST-segment elevation myocardial infarction, a randomised controlled
trial.
Source
EuroIntervention. 7 (9) (pp 1021-1029), 2012. Date of Publication:
January 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To evaluate the clinical outcomes of sirolimus-eluting stent (SES)
versus bare metal stent (BMS) implantation in patients with ST-segment
elevation myocardial infarction (STEMI) at long-term follow-up. Methods
and results: After five years, 310 STEMI patients randomly assigned to
implantation of either SES or BMS, were compared. Survival rates were
comparable between groups (SES 94.3% vs. BMS 92.8%, p=0.57), as were the
rates of reinfarction (10.6% vs. 13.7%, p=0.40), freedom of death/re-MI
(84.4% vs. 79.8%, p=0.29) and target vessel failure (14.9% vs. 21.7%,
p=0.11). Likewise, rates of overall stent thrombosis (ST) (5.4% vs. 2.7%,
p=0.28) and very late ST (4.1% vs. 0.7%, p=0.07) did not significantly
differ between the SES- and BMSgroup. In 184 patients with IVUS data,
definite and definite/probable VLST was more common in those with late
stent malapposition versus those without late stent malapposition (4.3%
and 6.6% vs. no events [p=0.018 and p=0.004], respectively). The
cumulative incidences of target vessel and target lesion revascularisation
(TVR and TLR) were not significantly lower in the SES-group (11.2% vs.
17.9%, p=0.09 and 7.2% vs. 12.9%, p=0.08), as was the rate of clinically
driven TLR (6.6% vs. 9.5%, p=0.30). Conclusions: SES implantation was
neither associated with increased rates of major adverse cardiac events,
nor with a reduction in re-intervention, compared to implantation of a BMS
in patients with STEMI after five years. However, a trend of more very
late stent thrombosis was observed after SES implantation
(ISRCTN62825862). Europa Edition 2012. All rights reserved.

<3>
Accession Number
2012057982
Authors
Cohen D.J. Lavelle T.A. Van Hout B. Li H. Lei Y. Robertus K. Pinto D.
Magnuson E.A. McGarry T.F. Lucas S.K. Horwitz P.A. Henry C.A. Serruys P.W.
Mohr F.W. Kappetein A.P.
Institution
(Cohen, Li, Lei, Robertus, Magnuson) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, School of Medicine, 4401
Wornall Road, Kansas City, MO 64111, United States
(Lavelle) Harvard School of Public Health, Boston, MA, United States
(Van Hout) University of Sheffield, Sheffield, United Kingdom
(Pinto) Beth Israel Deaconess Medical Center, Boston, MA, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, Oklahoma City,
OK, United States
(Lucas) St. Anthony Hospital, Oklahoma City, OK, United States
(Horwitz) University of Iowa Hospital and Clinics, Iowa City, IA, United
States
(Henry) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Economic outcomes of percutaneous coronary intervention with drug-eluting
stents versus bypass surgery for patients with left main or three-vessel
coronary artery disease: One-year results from the SYNTAX trial.
Source
Catheterization and Cardiovascular Interventions. 79 (2) (pp 198-209),
2012. Date of Publication: 01 Feb 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: To evaluate the cost-effectiveness of alternative approaches
to revascularization for patients with three-vessel or left main coronary
artery disease (CAD). Background: Previous studies have demonstrated that,
despite higher initial costs, long-term costs with bypass surgery (CABG)
in multivessel CAD are similar to those for percutaneous coronary
intervention (PCI). The impact of drug-eluting stents (DES) on these
results is unknown. Methods: The SYNTAX trial randomized 1,800 patients
with left main or three-vessel CAD to either CABG (n = 897) or PCI using
paclitaxel-eluting stents (n = 903). Resource utilization data were
collected prospectively for all patients, and cumulative 1-year costs were
assessed from the perspective of the U.S. healthcare system. Results:
Total costs for the initial hospitalization were $5,693/patient higher
with CABG, whereas follow-up costs were $2,282/patient higher with PCI due
mainly to more frequent revascularization procedures and higher outpatient
medication costs. Total 1-year costs were thus $3,590/patient higher with
CABG, while quality-adjusted life expectancy was slightly higher with PCI.
Although PCI was an economically dominant strategy for the overall
population, cost-effectiveness varied considerably according to
angiographic complexity. For patients with high angiographic complexity
(SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and
the incremental cost-effectiveness ratio for CABG was $43,486 per
quality-adjusted life-year gained. Conclusions: Among patients with
three-vessel or left main CAD, PCI is an economically attractive strategy
over the first year for patients with low and moderate angiographic
complexity, while CABG is favored among patients with high angiographic
complexity. 2011 Wiley Periodicals, Inc.

<4>
Accession Number
2012067513
Authors
Stevenson W.G. Hernandez A.F. Carson P.E. Fang J.C. Katz S.D. Spertus J.A.
Sweitzer N.K. Tang W.H.W. Albert N.M. Butler J. Westlake Canary C.A.
Collins S.P. Colvin-Adams M. Ezekowitz J.A. Givertz M.M. Hershberger R.E.
Rogers J.G. Teerlink J.R. Walsh M.N. Stough W.G. Starling R.C.
Institution
(Stevenson, Givertz) Department of Medicine, Division of Cardiology
Brigham, Women's Hospital, Boston, MA, United States
(Hernandez, Rogers) Department of Medicine, Division of Cardiology, Duke
University Medical Center, Durham, NC, United States
(Carson) Georgetown University, Washington DC Veterans Affairs Medical
Center, Washington, DC, United States
(Fang) Harrington-McLaughlin Heart and Vascular Institute, School of
Medicine, Case Western Reserve University, Cleveland, OH, United States
(Katz) Leon H. Charney Division of Cardiology, New York University, School
of Medicine, New York, NY, United States
(Spertus) Mid-America Heart Institute, St Luke's Hospital, University of
Missouri-Kansas City, Kansas City, MI, United States
(Sweitzer) Department of Medicine, University of Wisconsin, Madison, WI,
United States
(Tang, Starling) Department of Cardiovascular Medicine, Cleveland Clinic,
9500 Euclid Avenue, Cleveland, OH 44195, United States
(Albert) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Butler) Department of Medicine, Division of Cardiology, Emory University,
Atlanta, GA, United States
(Westlake Canary) School of Nursing, Azusa Pacific University, Azusa, CA,
United States
(Collins) Department of Emergency Medicine, Vanderbilt University,
Nashville, TN, United States
(Colvin-Adams) Cardiovascular Division, University of Minnesota,
Minneapolis, MN, United States
(Ezekowitz) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Hershberger) Department of Medicine, Division of Cardiology, University
of Miami, Miami, FL, United States
(Teerlink) Department of Medicine, University of California, San
Francisco, CA, United States
(Walsh) Care Group, Indianapolis, IN, United States
(Stough) Department of Clinical Research, Campbell University College of
Pharmacy and Health Sciences, Buies Creek, NC, United States
Title
Indications for cardiac resynchronization therapy: 2011 update from the
Heart Failure Society of America guideline committee.
Source
Journal of Cardiac Failure. 18 (2) (pp 94-106), 2012. Date of
Publication: February 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Cardiac resynchronization therapy (CRT) improves survival, symptoms,
quality of life, exercise capacity, and cardiac structure and function in
patients with New York Heart Association (NYHA) functional class II or
ambulatory class IV heart failure (HF) with wide QRS complex. The totality
of evidence supports the use of CRT in patients with less severe HF
symptoms. CRT is recommended for patients in sinus rhythm with a widened
QRS interval (>=150 ms) not due to right bundle branch block (RBBB) who
have severe left ventricular (LV) systolic dysfunction and persistent NYHA
functional class II-III symptoms despite optimal medical therapy (strength
of evidence A). CRT may be considered for several other patient groups for
whom evidence of benefit is clinically significant but less substantial,
including patients with a QRS interval of >=120 to <150 ms and severe LV
systolic dysfunction who have persistent mild to severe HF despite optimal
medical therapy (strength of evidence B), some patients with atrial
fibrillation, and some with ambulatory class IV HF. Several evidence gaps
remain that need to be addressed, including the ideal threshold for QRS
duration, QRS morphology, lead placement, degree of myocardial scarring,
and the modality for evaluating dyssynchrony. Recommendations will evolve
over time as additional data emerge from completed and ongoing clinical
trials. 2012 Elsevier Inc. All rights reserved.

<5>
Accession Number
2012066336
Authors
Jukema J.W. Collet J.-P. De Luca L.
Institution
(Jukema) Department of Cardiology, Leiden University Medical Centre, PO
Box 9600, 2300 RC Leiden, Netherlands
(Collet) Groupe Hospitalier Pitie-Salpetriere, Institut de Cardiologie,
Paris, France
(De Luca) Department of Cardiovascular Sciences, Interventional Cardiology
Unit, European Hospital, Rome, Italy
Title
Antiplatelet therapy in patients with ST-elevation myocardial infarction
undergoing myocardial revascularisation: Beyond clopidogrel.
Source
Current Medical Research and Opinion. 28 (2) (pp 203-211), 2012. Date of
Publication: February 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background: Despite revascularisation, outcomes among patients presenting
with ST-elevation myocardial infarction (STEMI) remain suboptimal. Scope:
This review compares clopidogrel, ticagrelor and prasugrel as antiplatelet
strategies with a particular focus on STEMI. Medline and Google Scholar
were searched for relevant terms and citations from these articles were
also assessed. Findings: While clopidogrel represented an important
therapeutic advance, variations in platelet response and a relatively slow
onset of action compromise outcomes in some patients. Ticagrelor and
prasugrel are more effective than clopidogrel, although essentially only
one large study supports each drug. Nevertheless, a detailed examination
of the evidence reveals several issues that may influence the decision to
prescribe ticagrelor instead of prasugrel and vice versa. Arguably,
prasugrel could be the preferred strategy in STEMI, reflecting the drugs'
efficacy in clopidogrel-nave patients, the most common group in clinical
practice. Conversely, ticagrelor may be a better option than clopidogrel
in clopidogrel-pretreated patients showing a mortality benefit
irrespective of clopidogrel pre-treatment. The clinical benefits offered
by prasugrel and ticagrelor need to be offset against the increased cost
and we suggest an algorithm for using these new compounds in the primary
percutaneous coronary intervention (PCI) setting. The risk of bleeding
associated with prasugrel is similar to that of clopidogrel and ticagrelor
following exclusion of at-risk patients. Nevertheless, prasugrel may be
especially appropriate for STEMI patients undergoing PCI who are
considered to be at high risk of ischaemia. Conversely, ticagrelor's short
half-life, while potentially a limitation during maintenance therapy, may
reduce bleeding risk if the patient undergoes CABG during the same
hospital admission, although confirmatory studies are needed. Conclusion:
Future studies also need to address several other outstanding issues, such
as the subsequent approach if patients do not undergo PCI, and to overcome
limitations in and differences between the primary studies. In particular,
head-to-head comparisons need to compare directly the risks and benefits
of ticagrelor and prasugrel in STEMI patients. These caveats
notwithstanding, ticagrelor and prasugrel markedly improve the prognosis
for patients with STEMI. 2012 Informa UK Ltd.

<6>
[Use Link to view the full text]
Accession Number
2012051045
Authors
Landoni G. Biondi-Zoccai G. Greco M. Greco T. Bignami E. Morelli A.
Guarracino F. Zangrillo A.
Institution
(Landoni, Greco, Greco, Bignami, Zangrillo) Department of Anesthesia and
Intensive Care, Universita Vita-Salute San Raffaele, Milano, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
(Morelli) Department of Anesthesiology and Intensive Care, University of
Rome, La Sapienza, Rome, Italy
(Guarracino) Cardiothoracic Department, Azienda Ospedaliera Universitaria
Pisana, Pisa, Italy
Title
Effects of levosimendan on mortality and hospitalization. A meta-analysis
of randomized controlled studies.
Source
Critical Care Medicine. 40 (2) (pp 634-646), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Catecholaminergic inotropes have a place in the management of
low output syndrome and decompensated heart failure but their effect on
mortality is debated. Levosimendan is a calcium sensitizer that enhances
myocardial contractility without increasing myocardial oxygen use. A
meta-analysis was conducted to determine the impact of levosimendan on
mortality and hospital stay. Data Sources: BioMedCentral, PubMed, Embase,
and the Cochrane Central Register of clinical trials were searched for
pertinent studies. International experts and the manufacturer were
contacted. Study Selection: Articles were assessed by four trained
investigators, with divergences resolved by consensus. Inclusion criteria
were random allocation to treatment and comparison of levosimendan vs.
control. There were no restrictions on dose or time of levosimendan
administration or on language. Exclusion criteria were: duplicate
publications, nonadult studies, oral administration of levosimendan, and
no data on main outcomes. Data Extraction: Study end points, main
outcomes, study design, population, clinical setting, levosimendan dosage,
and treatment duration were extracted. Data Synthesis: Data from 5,480
patients in 45 randomized clinical trials were analyzed. The overall
mortality rate was 17.4% (507 of 2,915) among levosimendan-treated
patients and 23.3% (598 of 2,565) in the control group (risk ratio 0.80
[0.72; 0.89], p for effect <.001, number needed to treat = 17 with 45
studies included). Reduction in mortality was confirmed in studies with
placebo (risk ratio 0.82 [0.69; 0.97], p = .02) or dobutamine (risk ratio
0.68 [0.52-0.88]; p = .003) as comparator and in studies performed in
cardiac surgery (risk ratio 0.52 [0.35; 0.76] p = .001) or cardiology
(risk ratio 0.75 [0.63; 0.91], p = .003) settings. Length of hospital stay
was reduced in the levosimendan group (weighted mean difference = -1.31
[-1.95; -0.31], p for effect = .007, with 17 studies included). A trend
toward a higher percentage of patients experiencing hypotension was noted
in levosimendan vs. control (risk ratio 1.39 [0.97-1.94], p = .053).
Conclusions: Levosimendan might reduce mortality in cardiac surgery and
cardiology settings of adult patients. Copyright 2012 by the Society of
Critical Care Medicine and Lippincott Williams & Wilkins.

<7>
[Use Link to view the full text]
Accession Number
2012051026
Authors
Lim T. Ryu H.-G. Jung C.-W. Jeon Y. Bahk J.-H.
Institution
(Lim, Jung, Jeon, Bahk) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Ryu) Department of Anesthesiology and Pain Medicine, Boramae Medical
Center, Seoul National University, Seoul, South Korea
Title
Effect of the bevel direction of puncture needle on success rate and
complications during internal jugular vein catheterization.
Source
Critical Care Medicine. 40 (2) (pp 491-494), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Artery puncture and hematoma formation are the most common
immediate complications during internal jugular vein catheterization. This
study was performed to assess whether the bevel-down approach of the
puncture needle decreases the incidence of posterior venous wall damage
and hematoma formation during internal jugular vein catheterization.
Design: Prospective, randomized, controlled study. Setting: A
university-affiliated hospital. Patients: Three hundred thirty-eight
patients for scheduled for thoracic surgery requiring central venous
catheterization in the right internal jugular vein. Interventions:
Patients requiring internal jugular vein catheterization were enrolled and
randomized to either the bevel-down group (n = 169) or the bevel-up group
(n = 169). All patients were placed in the Trendelenburg position with the
head turned to the left. After identifying the right internal jugular vein
with ultrasound imaging, a double-lumen central venous catheter was
inserted using the modified Seldinger technique. Venous entry of the
needle was recognized by return of venous blood during needle advance or
withdrawal. The internal jugular vein was assessed cross-sectionally and
longitudinally after catheterization to identify any complications. A p
value of <.05 was considered to be statistically significant. Measurements
and Main Results; There was no difference in the incidence of the
puncture-on-withdrawal between the two groups (37 of 169 in the bevel-down
group and 25 of 169 in the bevel-up group). However, the incidence of
posterior hematoma formation was lower in the bevel-down group (six of 169
vs. 17 of 169, p = .031). Additionally, there was less incidence of the
posterior hematoma formation associated with puncture-on-withdrawal in the
bevel-down group (six of 37 vs. 11 of 25, p = .034). Conclusions: The
bevel-down approach of the right internal jugular vein may decrease the
incidence of posterior venous wall damage and hematoma formation compared
with the bevel-up approach, which implicates a reduced probability of
carotid artery puncture with the bevel-down approach during internal
jugular vein catheterization. Copyright 2012 by the Society of Critical
Care Medicine and Lippincott Williams & Wilkins.

<8>
Accession Number
2012053813
Authors
Chen Y.-B. Shu J. Yang W.-T. Shi L. Guo X.-F. Wang F.-G. Qian Y.-Y.
Institution
(Chen, Shu, Yang, Shi, Guo, Wang, Qian) Department of Cardiothoracic
Surgery, Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu
215004, China
Title
Meta-analysis of randomized trials comparing the effectiveness of on-pump
and off-pump coronary artery bypass.
Source
Chinese Medical Journal. 125 (2) (pp 338-344), 2012. Date of
Publication: January 2012.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background The growing enthusiasm for coronary artery bypass grafting
(CABG) without cardiopulmonary bypass (CPB) is emerging, but the role of
off-pump coronary artery bypass (OPCAB) in clinical practice remains
controversial. The purpose of this study was to assess differences in the
incidences of stroke, atrial fibrillation (AF), and myocardial infarction
(MI) between OPCAB and conventional coronary artery bypass grafting
(CCABG) by meta-analyses of randomized clinical trials. Methods A
literature search for the period before March 2010 supplemented with
manual bibliographic review was performed for all Chinese or English
publications in Medline, the Science Citation Index Expanded, the Cochrane
Central Register of Controlled Trials (CENTRAL) and CBMdisc. A systematic
overview (meta-analyses) of randomized clinical trials was conducted to
evaluate the differences between OPCAB and CCABG in the incidences of
stroke, AF, and MI. The meta-analysis was performed using RevMan 5
software. Results Forty-three randomized clinical trials were selected for
meta-analysis after screening a total of 356 references, with 8104
patients in the OPCAB group and 8724 cases in the CCABG group. The
meta-analyses of these trials showed no significant difference between
OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80, 95%
confidence interval (CI)=0.52-1.22, P=0.30) and MI (OR=0.73,
95%CI=0.52-1.02, P=0.06). However, we found a significantly reduced risk
of AF (OR=0.65, 95%CI = 0.52-0.82, P=0.0002) in off-pump patients.
Conclusions Our meta-analyses suggest that OPCAB reduces the risk of
postoperative AF compared with CCABG, but there is no significant
difference in the incidences of stroke and MI between OPCAB and CCABG.

<9>
Accession Number
2012050053
Authors
Boden W.E. Probstfield J.L. Anderson T. Chaitman B.R. Desvignes-Nickens P.
Koprowicz K. McBride R. Teo K. Weintraub W.
Institution
(Boden) University at Buffalo, Buffalo, NY, United States
(Probstfield) University of Washington, Seattle, WA, United States
(Anderson) University of Calgary, Libin Cardiovascular Institute, Calgary,
AB, Canada
(Chaitman) Saint Louis University, St. Louis, United States
(Desvignes-Nickens) National Institutes of Health, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Koprowicz, McBride) Axio Research, 2601 Fourth Ave., Seattle, WA 98121,
United States
(Teo) McMaster University, Hamilton, ON, Canada
(Weintraub) Christiana Care Health Services, Wilmington, DE, United States
Title
Niacin in patients with low HDL cholesterol levels receiving intensive
statin therapy.
Source
New England Journal of Medicine. 365 (24) (pp 2255-2267), 2011. Date of
Publication: 15 Dec 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In patients with established cardiovascular disease, residual
cardiovascular risk persists despite the achievement of target low-density
lipoprotein (LDL) cholesterol levels with statin therapy. It is unclear
whether extended-release niacin added to simvastatin to raise low levels
of high-density lipoprotein (HDL) cholesterol is superior to simvastatin
alone in reducing such residual risk. METHODS: We randomly assigned
eligible patients to receive extended-release niacin, 1500 to 2000 mg per
day, or matching placebo. All patients received simvastatin, 40 to 80 mg
per day, plus ezetimibe, 10 mg per day, if needed, to maintain an LDL
cholesterol level of 40 to 80 mg per deciliter (1.03 to 2.07 mmol per
liter). The primary end point was the first event of the composite of
death from coronary heart disease, nonfatal myocardial infarction,
ischemic stroke, hospitalization for an acute coronary syndrome, or
symptom-driven coronary or cerebral revascularization. RESULTS: A total of
3414 patients were randomly assigned to receive niacin (1718) or placebo
(1696). The trial was stopped after a mean follow-up period of 3 years
owing to a lack of efficacy. At 2 years, niacin therapy had significantly
increased the median HDL cholesterol level from 35 mg per deciliter (0.91
mmol per liter) to 42 mg per deciliter (1.08 mmol per liter), lowered the
triglyceride level from 164 mg per deciliter (1.85 mmol per liter) to 122
mg per deciliter (1.38 mmol per liter), and lowered the LDL cholesterol
level from 74 mg per deciliter (1.91 mmol per liter) to 62 mg per
deciliter (1.60 mmol per liter). The primary end point occurred in 282
patients in the niacin group (16.4%) and in 274 patients in the placebo
group (16.2%) (hazard ratio, 1.02; 95% confidence interval, 0.87 to 1.21;
P = 0.79 by the log-rank test). CONCLUSIONS: Among patients with
atherosclerotic cardiovascular disease and LDL cholesterol levels of less
than 70 mg per deciliter (1.81 mmol per liter), there was no incremental
clinical benefit from the addition of niacin to statin therapy during a
36-month follow-up period, despite significant improvements in HDL
cholesterol and triglyceride levels. (Funded by the National Heart, Lung,
and Blood Institute and Abbott Laboratories; AIM-HIGH ClinicalTrials.gov
number, NCT00120289.) Copyright 2011 Massachusetts Medical Society. All
rights reserved.

<10>
Accession Number
70655312
Authors
Rodseth R.N. Buse G.A.L. Bolliger D.
Title
The predictive ability of preoperative B-type natriuretic peptide in
vascular patients for major adverse cardiac events: An individual patient
data meta-analysis.
Source
Journal of Vascular Surgery. Conference: 40th Annual Symposium of the
Society for Clinical Vascular Surgery, SCVS 2012 Las Vegas, NV United
States. Conference Start: 20120314 Conference End: 20120317. Conference
Publication: (var.pagings). 55 (2) (pp 616), 2012. Date of Publication:
February 2012.
Publisher
Mosby Inc.
Abstract
Conclusion: Preoperative natriuretic peptide levels are independent
predictors of cardiovascular events in the first 30 days following
vascular surgery and improve predictive performance of the revised cardiac
risk index. Summary: A recent randomized international controlled study of
8351 patients from 23 countries found a 6.9 % incidence of cardiovascular
events in patients >45 years of age undergoing non cardiac surgery.
(Devereaux PG. Lancet 2008;371:1839-47). There have been even higher rates
of preoperative mortality, adverse cardiovascular events, and
rehospitalizations reported in vascular surgery patients. (Noordzij PJ.
Anesthesiology 2010; 112:1105-15, and Jencks SF. N Engl J Med
2009;360:418-28). Current guidelines for stratifying cardiac risk utilize
clinical risk factors, type of surgery and exercise tolerance to direct
preoperative investigation. (Fleisher LA et al. J Am Coll Cardiol
2007;50:1707-32). Clinical factors include a history of compensated or
prior heart failure, a history of ischemic heart disease, cerebral
vascular events, renal insufficiency, and diabetes mellitus. (Lee TH et
al. Circulation 1999;100:1043-9). However, use of the revised cardiac risk
index has not provided good discrimination when applied to patients
undergoing vascular surgery (Kertai MD et al. Heart 2003;89: 1327-34).
Preoperative elevations of B-type natriuretic peptide (BNP) or its
prohormone have consistently been associated with cardiovascular events
following major vascular surgery. (Feringa HH. Heart 2007;93:226-31). The
aim of this study was to determine optimal BNP cutoffs to predict
cardiovascular events after vascular surgery and to determine whether the
use of preoperative levels of BNP, or its prohormone, could improve
current risk stratification prior to vascular surgery. The authors used an
electronic database search to identify studies reporting association of
preoperative natriuretic protein concentrations with post operative major
adverse cardiovascular events (cardiovascular death, nonfatal MI) in
vascular surgery. Secondary endpoints included all cause mortality,
cardiac death and non fatal MI. There were six data sets obtained, five
were for BNP (n = 632) and for 1 N-terminal pro-BNP (n = 218). A BNP level
higher than the optimal cut point independently predicted the primary
composite end point (odds ratio, 7.9; 95% CI, 4.7 to 13.3). BNP cut points
were 30pg/mL for screening (95% sensitivity; 44% specificity), 116 pg/mL
for highest accuracy (66% sensitivity; 82% specificity). Reclassification
of risks following the revised cardiac risk index stratification using NP
levels improved risk prediction. (Net reclassification improvement, 58%; P
< .000001). This was particularly so in the intermediate risk group (net
reclassification improvement, 84%; P < .001). Comment: Cardiac risk
stratification in vascular surgery has only been, at best, modestly
successful in predicting preoperative events in the vascular surgical
patient. The results here, suggest that in patients risk stratified with
the revised cardiac risk index, a BNP cut off point can be used to
reclassify these patients and provide a more accurate risk assessment.
This may help better identify patients who would benefit from further
cardiac evaluation. Importantly, it is also crucial to recognize that this
meta analysis, and other studies in this area (Ford MK et al. Ann Intern
Med 2010;152:26-35), raise serious concerns regarding the use the revised
cardiac risk index as a "stand alone" tool in the preoperative cardiac
evaluation of the vascular surgical patient.

<11>
Accession Number
70653771
Authors
Singh S. Kong Loke Y. Spangler J. Furberg C.D.
Institution
(Singh) Johns Hopkins University, Baltimore, MD, United States
(Kong Loke) University of East Anglia, Norwich, United Kingdom
(Spangler, Furberg) Wake Forest University, School of Medicine,
Winston-Salem, NC, United States
Title
ODDS of major adverse cardiovascular events associated with varenicline: A
systematic review and metaanalysis of randomized controlled trials.
Source
Journal of General Internal Medicine. Conference: 34th Annual Meeting of
the Society of General Internal Medicine Phoenix, AZ United States.
Conference Start: 20110504 Conference End: 20110507. Conference
Publication: (var.pagings). 26 (pp S290), 2011. Date of Publication:
May 2011.
Publisher
Springer New York
Abstract
BACKGROUND: Varenicline is a partial agonist at the I 4-I² 2
nicotinic acetylcholine receptors and a full agonist at I-7 nicotinic
acetylcholine receptors. Varenicline is associated with myocardial
infarction and cardiac arrest in spontaneous reports. Its effect on
cardiovascular outcomes is unknown. Our objective was to ascertain the
risk of major adverse cardiovascular effects of varenicline compared to
placebo controls among tobacco users. METHODS: Systematic searches were
conducted in August 2010 of relevant articles in MEDLINE, EMBASE,
regulatory authorityWeb-sites in the United States and Europe and
manufacturers' trial registries with no date restrictions. Randomized
controlled trials of varenicline for treatment of nicotine addiction among
smokers or smokeless tobacco users, had at least 7 days of treatment, and
reported on any major adverse cardiovascular event (including zero events)
of myocardial infarction, unstable angina, coronary revascularization,
coronary artery disease, arrythmias, transient ischemic attacks, strokes
and sudden death or cardiovascular death and congestive heart failure were
included. RESULTS: The initial search yielded 347 citations. After a
detailed screening of 45 full text studies for cardiovascular events, 14
double blind placebo controlled randomized controlled trials enrolling
8216 tobacco users were included. Follow-up duration ranged from 7 weeks
to 1 year. Major adverse cardiovascular events occurred among 52 of 4908
participants receiving varenicline and 27 of 3308 patients receiving
placebo therapy (Peto Odds Ratio (OR), 1.72 [95% confidence interval {CI},
1.09-2.71]; P=.02 I2=0%). Sensitivity analysies using treatment arm
continuity correction to account for imbalance in zero events among the
included trials yielded similar results. These estimates were also robust
to the choice of comparators (placebo vs active controls). There was no
evidence of publication bias via funnel plot asymmetry. CONCLUSION: Among
tobacco users varenicline use is associated with significantly increased
odds of major adverse cardiovascular events. (Table presented).

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 11

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<1>
Accession Number
2012042481
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J.
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, FL, United States
(Firstenberg) Division of Cardiothoracic Surgery, Ohio State University
Medical Center, Columbus, OH, United States
(Price, Topol) Division of Cardiovascular Diseases, Scripps Clinic and
Scripps Translational Science Institute, San Diego, CA, United States
(Tummala) Department of Cardiology, Northeast Georgia Heart Center,
Gainesville, GA, United States
(Hutyra) First Internal Clinic, Faculty Hospital Olomouc, Olomouc, Czech
Republic
(Welsby) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Voeltz) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Chandna) Department of Cardiology, Detar Hospital, Victoria, TX, United
States
(Ramaiah) Deptartment of Surgery, University of Kentucky, Lexington, KY,
United States
(Brtko) Deptartment of Cardiac Surgery, University Hospital, Hradec
Kralove, Czech Republic
(Cannon) Cardiac and Vascular Research Center of Northern Michigan,
Northern Michigan Regional Hospital, Petoskey, MI, United States
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, Humble, TX,
United States
(Liu, Prats) Medicines Company, Parsippany, NJ, United States
(Montalescot) Groupe Hospitalier Pitie-Salpetriere, Universite Paris 6,
INSERM CMR 937, Paris, France
(Manoukian) Sarah Cannon Research Institute, Hospital Corporation of
America, Nashville, TN, United States
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 307 (3) (pp 265-274),
2012. Date of Publication: 18 Jan 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Thienopyridines are among the most widely prescribed medications,
but their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding.
Objective: To evaluate the use of cangrelor, an intravenous, reversible
P2Y₁₂ platelet inhibitor for bridging thienopyridine-treated
patients to coronary artery bypass grafting (CABG) surgery. Design,
Setting, and Patients: Prospective, randomized, double-blind,
placebocontrolled, multicenter trial, involving 210 patients with an acute
coronary syndrome (ACS) or treated with a coronary stent and receiving a
thienopyridine awaiting CABG surgery to receive either cangrelor or
placebo after an initial open-label, dose-finding phase (n=11) conducted
between January 2009 and April 2011. Interventions Thienopyridines were
stopped and patients were administered cangrelor or placebo for at least
48 hours, which was discontinued 1 to 6 hours before CABG surgery. Main
Outcome Measures: The primary efficacy end point was platelet reactivity
(measured in P2Y₁₂ reaction units [PRUs]), assessed daily. The
main safety end point was excessive CABG surgery-related bleeding. Results
The dose of cangrelor determined in 10 patients in the open-label stage
was 0.75 mug/kg per minute. In the randomized phase, a greater proportion
of patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P<.001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P=.763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Conclusions: Among patients who discontinue thienopyridine therapy prior
to cardiac surgery, the use of cangrelor compared with placebo resulted in
a higher rate of maintenance of platelet inhibition. Trial Registration:
clinicaltrials.gov Identifier: NCT00767507. 2012 American Medical
Association. All rights reserved.

<2>
Accession Number
2012048144
Authors
Bortolotti U. Milano A.D. Frater R.W.M.
Institution
(Bortolotti) Cardio Thoracic and Vascular Department, University of Pisa
Medical School, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Verona Medical School,
Verona, Italy
(Frater) Department of Cardiothoracic Surgery and Pediatrics, Albert
Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United
States
Title
Mitral valve repair with artificial chordae: A review of its history,
technical details, long-term results, and pathology.
Source
Annals of Thoracic Surgery. 93 (2) (pp 684-691), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Mitral valve repair is considered the procedure of choice for correcting
mitral regurgitation in myxomatous disease, providing long-term results
that are superior to those with valve replacement. The use of artificial
chordae to replace elongated or ruptured chordae responsible for mitral
valve prolapse and severe mitral regurgitation has been the subject of
extensive experimental work to define feasibility, reproducibility, and
effectiveness of this procedure. Artificial chordae made of autologous or
xenograft pericardium have been replaced by chordae made of expanded
polytetrafluoroethylene (PTFE), a material with the unique property of
becoming covered by host fibrosa and endothelium. The use of artificial
chordae made of PTFE has been validated clinically over the past 2 decades
and has been an increasing component of the surgical armamentarium for
mitral valve repair. This article reviews the history, details of the
relevant surgical techniques, long-term results, and fate of artificial
chordae in mitral reconstructive surgery. 2012 The Society of Thoracic
Surgeons.

<3>
Accession Number
2012048143
Authors
Yu L. Gu T. Song L. Shi E. Fang Q. Wang C. Zhao J.
Institution
(Yu, Gu, Shi, Fang, Wang) Department of Cardiac Surgery, First Affiliated
Hospital, China Medical University, Nanjingbei St 155, Shenyang 110001,
China
(Song) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan,
China
(Zhao) Molecular Cardiology Research Institute, Tufts Medical Center,
Boston, MA, United States
Title
Fibrin sealant provides superior hemostasis for sternotomy compared with
bone wax.
Source
Annals of Thoracic Surgery. 93 (2) (pp 641-644), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Purpose: The purpose of this study was to evaluate the hemostatic efficacy
and feasibility of direct injection of fibrin sealant into the sternal
marrow cavity in senior patients undergoing on-pump coronary artery bypass
grafting (CABG). Description: A total of 82 senior patients undergoing
on-pump CABG were randomized to the bone wax group (n = 40) or the fibrin
sealant group (n = 42) for the period July 2010 to January 2011.
Evaluation: The fibrin sealanttreated group had less chest drainage in the
first 24 hours (186.67 +/- 49.53 versus 333.75 +/- 60.49 mL), less total
chest drainage (326.19 +/- 67.24 versus 516 +/- 88.46 mL), less packed red
blood cell (PRBC) administration (3.6 +/- 1.25 versus 7.4 +/- 2.13 U),
less fresh frozen plasma (FFP) administration (5.52 +/- 1.64 versus 8.95
+/- 1.77 U), shorter intubation time (40.36 +/- 8.62 versus 46.25 +/-
10.46 hours), and shorter hospital stay (10.45 +/- 1.17 versus 11.03 +/-
1.37 days) compared with the bone wax group. No significant difference in
the incidence of postoperative complications was found. Conclusions:
Direct injection of fibrin sealant into the sternal marrow cavity
significantly reduces the amount of postoperative blood loss and offers an
attractive new treatment alternative for senior patients undergoing
on-pump CABG. 2012 The Society of Thoracic Surgeons.

<4>
Accession Number
2011663572
Authors
Chan Y.-K. Stewart S. Calderone A. Scuffham P. Goldstein S. Carrington
M.J.
Institution
(Chan, Stewart, Calderone, Carrington) Preventative Health, Baker IDI
Heart and Diabetes Institute, St Kilda Rd Central, Melbourne, VIC 8008,
Australia
(Scuffham) School of Medicine, Griffith University, Brisbane, Australia
(Goldstein) School of Public Health and Community Medicine, University of
New South Wales, Sydney, Australia
Title
Exploring the potential to remain "young @ Heart": Initial findings of a
multi-centre, randomised study of nurse-led, home-based intervention in a
hybrid health care system.
Source
International Journal of Cardiology. 154 (1) (pp 52-58), 2012. Date of
Publication: 12 Jan 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Disease management programs have been shown to improve health
outcomes in high risk individuals in many but not all health care systems.
Methods: Young @ Heart is a multi-centre, randomised controlled study of a
nurse-led, home-based intervention (HBI) program vs. usual care (UC) in
privately insured patients in Australia aged >= 45 years following an
acute cardiac admission. Intensity of HBI is tailored to an individual's
clinical stability, management and risk profile. The primary endpoint is
the rate of all-cause stay during a mean of 2.5 years follow-up. Results:
A target of 602 adults (72% men) were randomised to HBI (n = 306) or UC (n
= 296); their initial profiles being well matched. At baseline, 71% were
overweight (body mass index 29.7 +/- 3.9 kg/m²) and 66% had an
elevated blood pressure (153 +/- 18/89 +/- 7 mm Hg). Over half had a
history of smoking and 39% had a sub-optimal total cholesterol level > 4
mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease
(27% with multi-vessel disease and 39% underwent cardiac
revascularisation). A further 20% (120 cases) were treated for a cardiac
arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes
mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a
home visit triggering urgent clinical review and/or enhanced clinical
management in many patients. Conclusions: The Young @ Heart intervention
is a well accepted and potentially effective intervention to reduce
recurrent hospital stay in privately insured cardiac patients in
Australia.

<5>
Accession Number
2012011828
Authors
Yusuf A.M. Warkentin T.E. Arsenault K.A. Whitlock R. Eikelboom J.W.
Institution
(Yusuf, Arsenault, Whitlock, Eikelboom) Population Health Research
Institute, Hamilton, ON, Canada
(Warkentin, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
Title
Prognostic importance of preoperative anti-PF4/heparin antibodies in
patients undergoing cardiac surgery: A systematic review.
Source
Thrombosis and Haemostasis. 107 (1) (pp 8-14), 2012. Date of
Publication: January 2012.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
It was the objective of this study to obtain best estimates of the
prevalence of anti-PF4/heparin antibodies in patients not suspected to
have clinical heparin-induced thrombocytopenia (HIT) prior to undergoing
cardiac surgery and to determine whether preoperative antibody status and
antibody class is predictive of postoperative thromboembolic outcomes,
non-thromboembolic outcomes, length of stay, and mortality. PubMed and
EMBASE online databases were searched up to July 2011, and we included
studies involving adults undergoing cardiac surgery examining the
relationship between preoperative anti-PF4/heparin antibodies (ELISA) and
postoperative clinical outcomes. Five studies involving a combined total
of 2,332 patients met our inclusion criteria. Preoperative
anti-PF4/heparin antibodies were detected in 5-22% of patients. No study
demonstrated an association between preoperative anti-PF4/heparin
antibodies and postoperative thromboembolic outcomes or mortality. Three
studies demonstrated a statistically significant association between
preoperative anti-PF4/heparin antibodies and length of stay while two
showed an association with non-thromboembolic complications. In the one
study that examined outcomes by anti-PF4/heparin antibody class, IgM
antibodies predicted non-thromboembolic complications and length-of-stay.
None of the studies reported prior heparin exposure, and most studies did
not examine the relationship of the absolute value of antibody titres
(ELISA OD) and risk, nor the incidence of true/clinical HIT in
preoperative positive or negative patients. In conclusion, pre-formed
anti-PF4/heparin antibodies are common in patients undergoing cardiac
surgery, but the available literature does not support that they predict
postoperative thromboembolic complications or death. There does appear to
be an association between anti-PF4/heparin antibodies and
non-thromboembolic adverse events, but a causal relationship is unlikely.
Schattauer 2012.

<6>
Accession Number
2012052746
Authors
Mazza A. Rigatelli G. Piva M. Rampin L. Cardaioli P. Giordan M. Roncon L.
Zattoni L. Zuin M. Al-Nahhas A. Rubello D. Ramazzina E. Ravenni R.
Casiglia E.
Institution
(Mazza, Zuin, Ramazzina) Department of Internal Medicine, Santa Maria
Della Misericordia Hospital, Rovigo, Italy
(Rigatelli, Cardaioli, Giordan) Interventional Cardiology Unit, Division
of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
(Piva) Unit of Nephrology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Rampin, Rubello) Service of Nuclear Medicine and PET/CT Centre,
Department of Imaging, Santa Maria Della Misericordia Hospital, Rovigo,
Italy
(Roncon) Division of Cardiology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Zattoni) Department of Imaging, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Al-Nahhas) Department of Nuclear Medicine, Hammersmith Hospital, London,
United Kingdom
(Casiglia) Department of Clinical and Experimental Medicine, University of
Padua, Padua, Italy
(Ravenni) Department of Neuroscience, Santa Maria Della Misericordia
Hospital, Rovigo, Italy
Title
In high risk hypertensive subjects with incidental and unilateral renal
artery stenosis percutaneous revascularization with stent improves blood
pressure control but not glomerular filtration rate.
Source
Minerva Cardioangiologica. 59 (6) (pp 533-542), 2011. Date of
Publication: December 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. In high-risk hypertensive subjects (HTs) with incidental unilateral
renal artery stenosis (RAS), the effectiveness of percutaneous
revascularization with stent (PR-STENT) on blood pressure (BP) and
glomerular filtration rate (GFR) is not established. Methods. Eighteen HTs
aged 65.7+/-9.2 years with angiographically diagnosed unilateral RAS
(260%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP
(mercury sphygmomanometer) and GFR (^99mTc-DTPA clearances
during renal scintigraphy) were evaluated yearly for three years.
Echo-Doppler of renal arteries was performed to verify the anatomic
patency and flow velocities of the reperfused artery. Analysis of variance
compared BP and GFR values changes from baseline to the follow-up;
differences for continuous variables were evaluated between groups with
the Tukey's post hoc test after adjustment for age, change of BP between
baseline and at the follow-up, GFR and body mass index (BMI). Results.
Baseline systolic BP and GFR values were not different between groups. The
significantly greater GFR increase observed in PR-STENT than in NO-STENT
at univariate analysis at the end of follow-up (62.5+/-19.2 vs.
42.24+/-17.6, P<0.02) disappeared after adjustment for confounding
factors. However, systolic BP remained significantly lower in PR-STENT
than in NO-STENT (140.1+/-4.6 vs. 170.0+/-8.3, P<0.0001) also after
adjustment for age, GFR and BMI. Conclusion. PR-STENT reduces systolic BP
without improving GFR. Due to the strong association between high BP and
renal dam-age, this study raises the question on whether PR-STENT should
be performed in all HTs with unilateral and incidental RAS.

<7>
[Use Link to view the full text]
Accession Number
2012050182
Authors
Voeks J.H. Howard G. Roubin G.S. Malas M.B. Cohen D.J. Sternbergh III W.C.
Aronow H.D. Eskandari M.K. Sheffet A.J. Lal B.K. Meschia J.F. Brott T.G.
Institution
(Voeks) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Howard) Department of Biostatistics, University of Alabama at Birmingham,
Birmingham, AL, United States
(Roubin) Department of Cardiovascular Medicine, Lenox Hill Hospital, New
York, NY, United States
(Malas) Department of Vascular and Endovascular Surgery, Johns Hopkins
Bayview Medical Center, Johns Hopkins Hospital, Baltimore, MD, United
States
(Cohen) Saint Luke's Mid America Heart and Vascular Institute, Kansas
City, MO, United States
(Sternbergh III) Vascular and Endovascular Surgery, Ochsner Health
Systems, New Orleans, LA, United States
(Aronow) Michigan Heart and Vascular Institute, Ypsilanti, MI, United
States
(Eskandari) Division of Vascular Surgery, Northwestern Memorial Hospital,
Chicago, IL, United States
(Sheffet) Department of Surgery, UMDNJ-New Jersey, Medical School, Newark,
NJ, United States
(Lal) Vascular Surgery, University of Maryland, Medical Center, Baltimore,
MD, United States
(Meschia, Brott) Department of Neurology, Mayo Clinic, 4500 San Pablo Rd.,
Griffin Bldg., Jacksonville, FL 32224, United States
Title
Age and outcomes after carotid stenting and endarterectomy: The Carotid
Revascularization Endarterectomy Versus Stenting Trial.
Source
Stroke. 42 (12) (pp 3484-3490), 2011. Date of Publication: December
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose: High stroke event rates among carotid artery
stenting (CAS)-treated patients in the Carotid Revascularization
Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an
a priori hypothesis that age may modify the relative efficacy of CAS
versus carotid endarterectomy (CEA). In the primary CREST report, we
previously noted significant effect modification by age. Here we extend
this investigation by examining the relative efficacy of the components of
the primary end point, the treatment-specific impact of age, and
contributors to the increasing risk in CAS-treated patients at older ages.
Methods: Among 2502 CREST patients with high-grade carotid stenosis,
proportional hazards models were used to examine the impact of age on the
CAS-to-CEA relative efficacy, and the impact of age on risk within
CAS-treated and CEA-treated patients. Results: Age acted as a treatment
effect modifier for the primary end point (P interaction=0.02), with the
efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk
for the primary end point increased with age (P<0.0001) by 1.77-times (95%
confidence interval, 1.38-2.28) per 10-year increment; however, there was
no evidence of increased risk for CEA-treated patients (P=0.27). Stroke
events were the primary contributor to the overall effect modification (P
interaction=0.033), with equal risk at 64 years. The treatment-by-age
interaction for CAS and CEA was not altered by symptomatic status (P=0.96)
or by sex (P=0.45). Conclusions:Outcomes after CAS versus CEA were related
to patient age, attributable to increasing risk for stroke after CAS at
older ages. Patient age should be an important consideration when choosing
between the 2 procedures for treating carotid stenosis. Clinical Trial
Registration: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00004732. 2011 American Heart Association, Inc.

<8>
Accession Number
2012040438
Authors
Udelsmann A. Maciel F.G. Servian D.C.M. Reis E. de Azevedo T.M. Melo
M.D.S.
Institution
(Udelsmann) Anesthesiology Dept. of the Faculdade de Ciencias Medicas
(FCM) of Univ. de Campinas (Unicamp), Brazil
(Maciel) R3, Unicamp, Brazil
(Servian, Reis, de Azevedo) Anesthesiology Sector of the Hospital das
Clinicas da Unicamp, Brazil
(Melo) Student in Surgical Sciences at FCM/Unicamp, Physician of the
Anesthesiology Sector of Hospital das Clinicas da Unicamp, Brazil
Title
Methadone and Morphine during Anesthesia Induction for Cardiac Surgery.
Repercussion in Postoperative Analgesia and Prevalence of Nausea and
Vomiting.
Source
Revista Brasileira de Anestesiologia. 61 (6) (pp 695-701), 2011. Date of
Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background and objectives: Pain is an aggravating factor in postoperative
morbidity and mortality especially in large size surgeries. Methods to
effectively fend pain collide with elevated costs and for this reason they
are not accessible in every service. The option would be the use of an
opioid with long half-life, such as methadone. The objective of the
present study was to compare the requirements of postoperative analgesia
in patients who received methadone, morphine, or placebo during anesthetic
induction, besides the prevalence of postoperative nausea and vomiting.
Methods: Fifty-five patients scheduled for cardiac surgery were divided
into three groups and they received during anesthetic induction 20. mg of
methadone, 20. mg of morphine, or placebo. At the end of surgery, patients
were transferred to the ICU where the following parameters were evaluated:
duration of anesthesia, time until extubation, time until the need of the
first analgesic, number of doses required in 24 hours, assessment of
analgesia by the patient, and prevalence of nausea/vomiting. Results:
Differences in the duration of anesthesia and time until extubation were
not observed. The first dose of analgesic in patients who received
methadone was administered later than in patients in the other two groups.
The need of analgesics in the methadone group was lower, quality of
analgesia was better, and prevalence of nausea and vomiting was also
lower. Conclusions: Methadone during anesthetic induction was effective
for analgesia in large size surgeries. Lower incidence of nausea and
vomiting was observed in the methadone group and therefore it is a low
cost option available among us that should be stimulated. 2011 Elsevier
Editora Ltda.

<9>
Accession Number
2012044343
Authors
Campanella A. Bergamasco L. Macri L. Asioli S. Devotini R. Scipioni S.
Barbaro S. Rispoli P. Rinaldi M.
Institution
(Campanella, Devotini, Rinaldi) Thoracic and Cardiovascular Department,
Division of Cardiac Surgery, San Giovanni Battista of Turin Hospital,
University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Bergamasco) Physics Department, University of Turin, Corso Bramante 84,
10126 Turin, Italy
(Macri, Asioli) Biomedical Sciences and Human Oncology Department,
Division of Third Pathological Anatomy, San Giovanni Battista of Turin
Hospital, University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Scipioni, Barbaro) Sanitary Direction Department, Division of Hospital
Hygiene and Management of Sanitary Technologies, San Giovanni Battista of
Turin, Corso Bramante 84, 10126 Turin, Italy
(Rispoli) Thoracic and Cardiovascular Department, Division of Vascular
Surgery, San Giovanni Battista of Turin Hospital, University of Turin,
Corso Bramante 84, 10126 Turin, Italy
Title
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for
coronary artery bypass grafting surgery: study protocol for a randomized
controlled trial.
Source
Trials. 12 , 2011. Article Number: 243. Date of Publication: 18 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In coronary artery bypass grafting surgery, arterial conduits
are preferred because of more favourable long-term patency and outcome.
Anyway the greater saphenous vein continues to be the most commonly used
bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is
increasingly being investigated in order to reduce the morbidity
associated with conventional open vein harvesting, includes postoperative
leg wound complications, pain and patient satisfaction. However, to date
the short and the long-term benefits of the endoscopic technique remain
controversial. This study provides an interesting opportunity to address
this gap in the literature.Methods/Design: Endoscopic Saphenous harvesting
with an Open CO₂System trial includes two parallel vein
harvesting arms in coronary artery bypass grafting surgery. It is an
interventional, single centre, prospective, randomized, safety/efficacy,
cost/effectiveness study, in adult patients with elective planned and
first isolated coronary artery disease. A simple size of 100 patients for
each arm will be required to achieve 80% statistical power, with a
significant level of 0.05, for detecting most of the formulated
hypotheses. A six-weeks leg wound complications rate was assumed to be 20%
in the conventional arm and less of 4% in the endoscopic arm. Previously
quoted studies suggest a first-year vein-graft failure rate of about 20%
with an annual occlusion rate of 1% to 2% in the first six years, with
practically no difference between the endoscopic and conventional
approaches. Similarly, the results on event-free survival rates for the
two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5%
cross-over rate, the goal is to enrol 230 patients from a single Italian
cardiac surgery centre.Discussion: The goal of this prospective randomized
trial is to compare and to test improvement in wound healing, quality of
life, safety/efficacy, cost-effectiveness, short and long-term outcomes
and vein-graft patency after endoscopic open CO₂harvesting
system versus conventional vein harvesting.The expected results are of
high clinical relevance and will show the safety/efficacy or
non-inferiority of one treatment approach in terms of vein harvesting for
coronary artery bypass grafting surgery.Trial registration:
www.clinicalTrials.gov NCT01121341. 2011 Campanella et al; licensee
BioMed Central Ltd.

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Accession Number
2012033331
Authors
Wang K.-Y. Wang H.-W. Xin L.-F. Wang Y.-W. Xue Y.-L.
Institution
(Wang, Wang, Xin, Wang, Xue) Department of Anesthesiology, TEDA
International Cardiovascular Hospital, Tianjin 300457, China
Title
Evaluation of high-concentration sevoflurane for induction and
nasotracheal intubation without muscle relaxant for infants with different
pulmonary blood flow undergoing surgery for congenital heart diseases.
Source
Chinese Medical Journal. 124 (24) (pp 4144-4148), 2011. Date of
Publication: 20111220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Inhalational anesthesia with sevoflurane for endotracheal
intubation without muscle relaxant is now used widely for pediatric
patients. This study assessed the efficacy and safety of induction with
high concentration sevoflurane and of nasotracheal intubation without
muscle relaxant in infants with increased or decreased pulmonary blood
flow (PBF) and undergoing surgery for congenital heart diseases. Methods
Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled
for congenital cardiac surgery were enrolled. Subjects were divided into
those with increased (IPBF group, n=29) and decreased (DPBF group, n=26)
pulmonary blood flow. All infants received inhalational induction with 8%
sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal
intubation was performed 4 minutes after induction. Sevoflurane
vaporization was decreased to 4.0% for placement of a peripheral
intravenous line and invasive hemodynamic monitors. Five minutes later,
sedatives and muscle relaxant were administered and the vaporizer was
adjusted to 2% for maintenance of anesthesia. Bispectral index (BIS)
scores, circulatory parameters, satisfactory and successful intubation
ratios, adverse reactions, and complications of intubation were recorded.
Results Times to loss of lash and pain reflexes were longer for the DPBF
group (P <0.01). Satisfactory intubation ratios were 93.1% and 61.5% for
the IPBF and DPBF groups, respectively (P=0.008). Successful intubation
ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively
(P=0.044). Following sevoflurane inhalation, blood pressures decreased
significantly in the IPBF group but remained stable in the DPBF group. BIS
scores declined to similar stable values, and a "nadir BIS" was recorded
for both groups. No obvious adverse reactions or complications of
intubation were noted perioperatively. Conclusions Induction with high
concentration sevoflurane, although faster for infants with IPBF, is safe
for infants with IPBF or DPBF. However, nasotracheal intubation without
muscle relaxant after induction with high concentration sevoflurane is
less successful and less satisfactory for infants with DPBF and should be
used with caution in this patient group.

<11>
Accession Number
70647913
Authors
Berger J.S. Sallum R.H. Katona B.G. Maya J. Ranganathan G. Mwamburi M.
Institution
(Berger) New York University Medical Center, New York, NY, United States
(Sallum, Ranganathan) United BioSource Corporation, Lexington, MA, United
States
(Katona, Maya) Astra Zeneca LP, Wilmington, DE, United States
(Mwamburi) Tufts University, School of Medicine, Boston, MA, United States
Title
Meta-analysis of the relationship between aspirin dosing and efficacy and
bleeding outcomes in medically managed patients with acute coronary
syndromes (ACS).
Source
Pharmacotherapy. Conference: 2011 Annual Meeting of the American College
of Clinical Pharmacy Pittsburgh, PA United States. Conference Start:
20111016 Conference End: 20111019. Conference Publication: (var.pagings).
31 (10) (pp 320e-321e), 2011. Date of Publication: October 2011.
Publisher
Pharmacotherapy Publications Inc.
Abstract
PURPOSE: Acetylsalicylic acid (ASA) dosing guidelines for ACS treatment
are inconsistent and lack supporting data. This analysis evaluated the
relationship between ASA maintenance dosing and clinical outcomes in
patients with ACS who did not undergo revascularization and are managed
medically. METHODS: A meta-analysis was conducted with random-effects
modeling to estimate the frequency of clinical outcomes for low (75-149
mg) and high (150-325 mg) doses of ASA, using data from worldwide clinical
and observational trials published from Jan 1995 to Feb 2010, available
from PubMed, EMBASE and Current Contents. Clinical outcomes measured were:
revascularization rate (overall rate, percutaneous coronary intervention
[PCI] or coronary artery bypass graft [CABG]), cardiovascular (CV) death,
all-cause death, myocardial infarction (MI), stroke, and bleeding at 1, 3,
6 and 12 months. RESULTS: Sixty-eight studies including 207,523 patients
were accepted and appraised for quality using Oxford Centre for Evidence-
Based Medicine scoring. Significant heterogeneity was seen in the results
(quantified using the Cochran's Q statistics and the I²
measures), due to differences in enrolment procedures, medical management
regimens and timing of administration, study designs and some
inconsistencies in the definitions of bleeding and MACE. At one month, the
incidence of clinical outcomes with high- and low-dose ASA groups were
4.9% and 5.0% for MI; 6.3% and 3.7% for revascularization; 1.4% and 1.3%
for stroke; 5.5% and 3.4% for CV death; 5.7% and 4.3% for all cause death;
and 4.0% and 1.7% for major bleeding, respectively. Meta regression
demonstrated a significant association between aspirin dose and major
bleeding (p=0.037). Further data will be presented at the meeting.
CONCLUSIONS: This analysis suggests that in patients receiving medical
management for ACS, major bleeding occurred more frequently in patients
who received higher doses of ASA. ASA dose does not have a statistically
significant impact on the other outcomes analyzed.