Results Generated From:
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<1>
Accession Number
2012736191
Authors
Howell N. Senanayake E. Freemantle N. Pagano D.
Institution
(Howell, Senanayake, Pagano) Department of Cardiac Surgery, University
Hospital Birmingham, Birmingham, United Kingdom
(Howell, Senanayake, Pagano) School of Clinical and Experimental Medicine,
University Hospital Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
Title
Putting the record straight on aprotinin as safe and effective: Results
from a mixed treatment meta-analysis of trials of aprotinin.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (1) (pp 234-240),
2013. Date of Publication: January 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Meta-analysis of small, randomized, placebo-controlled trials
demonstrated efficacy and safety of aprotinin. After highly publicized
retrospective studies and the early stopping of the Blood Conservation
Using Antifibrinolytics in a Randomized Trial (BART), aprotinin was
withdrawn. We conducted a new meta-analysis (including BART) on safety and
efficacy of aprotinin in cardiac surgery. Methods: We conducted a mixed
treatment comparisons network meta-analysis estimating the effects of
aprotinin and alternative agents in reducing blood loss during surgery. We
implemented a combination of direct and indirect evidence in mixed
treatment comparisons and estimated relative effects for different agents
on all-cause mortality and return to the operating room for bleeding and
conducted a supportive analysis of the effects of different agents with
only directly randomized trials. Results: Mixed treatment analysis of 88
trials randomizing 15,528 patients to 1 of 3 antifibrinolytic agents
demonstrated no difference in mortality between placebo and
antifibrinolytic agents. Analysis of aprotinin versus tranexamic acid and
-aminocaproic acid in 17 and 6 trials, respectively and tranexamic acid
versus -aminocaproic acid in 5 trials demonstrated no difference in
mortality between treatment allocations. All agents were superior to
placebo in reducing reexploration for bleeding, with aprotinin numerically
superior: aprotinin odds ratio, 2.6 (95% confidence interval, 1.9-3.7);
tranexamic acid odds ratio, 1.79 (1.2-2.9), and -aminocaproic acid odds
ratio, 2.4 (1.3-6.6). Conclusions: This mixed treatment comparisons
meta-analysis demonstrates no increased mortality risk with aprotinin
versus other antifibrinolytic agents. All agents were superior to placebo
in reducing reexploration for bleeding after adult cardiac surgery.
Copyright 2013 by The American Association for Thoracic Surgery.
<2>
Accession Number
2012745188
Authors
Rortgen D. Bergrath S. Rossaint R. Beckers S.K. Fischermann H. Na I.-S.
Peters D. Fitzner C. Skorning M.
Institution
(Rortgen, Bergrath, Rossaint, Beckers, Fischermann, Na, Peters, Skorning)
Section Emergency Medical Care, Department of Anaesthesiology, University
Hospital Aachen, RWTH Aachen University, Germany
(Beckers) Department of Intensive Care Medicine and Intermediate Care,
University Hospital Aachen, RWTH Aachen University, Germany
(Fitzner) Department of Medical Statistics, RWTH Aachen University,
Germany
Title
Comparison of physician staffed emergency teams with paramedic teams
assisted by telemedicine - a randomized, controlled simulation study.
Source
Resuscitation. 84 (1) (pp 85-92), 2013. Date of Publication: January 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Purpose and background: Emergency medical services (EMSs) vary
considerably. While some are physician staffed, most systems are run by
paramedics. The objective of this randomized, controlled simulation study
was to compare the emergency care between physician staffed EMS teams
(control group) and paramedic teams that were supported telemedically by
an EMS physician (telemedicine group). Methods: Overall 16 teams (1 EMS
physician, 2 paramedics) were randomized to the control group or the
telemedicine group. Telemedical functionalities included two-way audio
communication, transmission of vital data (numerical values and curves)
and video streaming from the scenario room to the remotely located EMS
physician. After a run-in scenario all teams completed four standardized
scenarios, in which no highly invasive procedures (e.g. thoracic drain)
were required, two using high-fidelity simulation (burn trauma,
intoxication) and two using standardized patients (renal colic,
barotrauma). All scenarios were videotaped and analyzed by two
investigators using predefined scoring items. Results: Non case-specific
items (31 vs. 31 scenarios): obtaining of 'symptoms', 'past medical
history' and 'events' were carried out comparably, but in the telemedicine
group 'allergies' (17 vs. 28, OR 7.69, CI 2.1-27.9, p=0.002) and
'medications' (17 vs. 27, OR 5.55, CI 1.7-18.0, p=0.004) were inquired
more frequently. No significant differences were found regarding the
case-specific items and in both groups no potentially dangerous
mistreatments were observed. Conclusion: Telemedically assisted paramedic
care was feasible and at least not inferior compared to standard EMS teams
with a physician on-scene in these scenarios. 2012 Elsevier Ireland Ltd.
<3>
Accession Number
2012742468
Authors
Cardillo G. Carleo F. Carbone L. De Massimi A.R. Lococo A. Santini P.F.
Janni A. Gonfiotti A.
Institution
(Cardillo, Carleo, Carbone, De Massimi) Unit of Thoracic Surgery, Carlo
Forlanini Hospital, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
(Lococo) Unit of Thoracic Surgery, Pescara General Hospital, Pescara,
Italy
(Santini, Janni, Gonfiotti) Unit of Thoracic Surgery, Careggi Hospital,
Florence, Italy
Title
Adverse effects of fibrin sealants in thoracic surgery: The safety of a
new fibrin sealant: Multicentre, randomized, controlled, clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 657-662), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: The safety of fibrin sealants (FS) has been questioned in the
light of recent reports of adverse effects. We evaluated the safety of a
new FS in a randomized controlled trial (RCT). Methods: Multicentre,
open-label Phase II/III RCT to evaluate the safety of the new FS. The
trial was approved by the Ethic Committee of each three
participatingCentre. FS includes two components (component 1: fibrinogen;
component 2: thrombin), each of them subjected to two viralinactivation
procedures. Out of 200 screened patients, 185 eligible patients (49
females, 136 males), aged between 18 and 75 years, undergoing major
thoracic surgery were randomized to receive FS (#91 patients) as an
adjuvant for air leak control or no treatment (#94 patients, control
group). Safety variables were: percentage of subjects with adverse
eventsassociated with the therapy; formation of antibodies against bovine
aprotinin; vital signs (blood pressure, body temperature, heart and
respiratory rate); laboratory parameters. Results: Overall operative
mortality was 3.2% (6/185), 1.1% in the FS group and 5.3% in the control
group, respectively. Twenty patients (22%) had adverse events in the FS
group and 22 (23.4%) in the control group. Atrial fibrillation (five
patients in the FS group and four in the control group) and hyperpyrexia
(five and seven patients, respectively, in the two groups) were the most
common adverse events. No patient reported thromboembolic events
(pulmonary embolism or deep vein thrombosis) during the in hospital stay
or within 1 month from discharge. None of the adverse events was
considered as treatment related. The formation of bovine aprotinin
antibodies was reported in a total of 34 patients (37.4%) in the FS group
and was not related to any adverse effect. Conclusions: The present RCT
did not show any increased risk of adverse events, and of surgical
complications, related to the use of the new FS. The Author 2011.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
<4>
Accession Number
2012742452
Authors
Aydemir N. Harmanda B. Karac A.R. Erdem A. Yurtseven N. Sasmaze A. Yekeler
I.
Institution
(Aydemir, Harmanda, Karac, Sasmaze, Yekeler) Department of Pediatric
Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Training and
Research Hospital, Istanbul, Turkey
(Erdem) Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and
Cardiovascular Training and Research Hospital, Istanbul, Turkey
(Yurtseven) Department of Anesthesiology and Reanimation, Dr. Siyami Ersek
Thoracic and Cardiovascular Training and Research Hospital, Istanbul,
Turkey
Title
Randomized comparison between mild and moderate hypothermic
cardiopulmonary bypass for neonatal arterial switch operation.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 581-586), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: To compare neonates receiving arterial switch operation (ASO)
either with mild or moderate hypothermic cardiopulmonary bypass. Methods:
Forty neonates undergoing ASO were randomized to receive either mild
(Mi>32degreeC, n=20) or moderate (Mo>26degreeC, n=20) hypothermic
cardiopulmonary bypass (CPB) between April 2007 and June 2010. All
patients were diagnosed with simple transposition of the great arteries.
Mean age (Mi: 8.32 +/-4.5 days, Mo: 7.54 +/-5.0 days, P=0.21) and body
weight were similar in both groups (Mi: 3.64 +/- 0.91 kg, Mo: 3.73 +/-
0.84 kg, P=0.14). Follow-up was 3.1 +/- 2.5 years for all patients.
Results: Lowest perioperative rectal temperature was 33.5+/- 1.4degreeC
(Mi) versus 28.2+/-2.1degreeC (Mo) (P<0.001). All patients safely weaned
from CPB required lower doses of dopamine (Mi: 5.1 +/-2.4 mug/kg min, Mo:
6.5 +/-2.1 mu/kg min, P=0.04), dobutamine (Mi: 7.2 +/- 2.5 mug/kg min, Mo:
8.6+/-2.4mu/kg min, P=0.04) and adrenalin (Mi: 0.02 +/- 0.02 mug/kg min,
Mo: 0.05 +/-0.03 mu/kg min, P=0.03) in mild hypothermia group.
Intraoperative blood transfusion (Mi: 190 +/-58 ml, Mo: 230 +/-24 ml,
P=0.03) and postoperative lactate levels (Mi: 2.7 +/-0.9 mmol/l, Mo: 3.1
+/-2.2 mmol/l, P=0.02) were lower under mild hypothermia. Secondary chest
closure was performed in 30% (Mi) versus 35% (Mo) (P=0.65). Duration of
inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15) days, P=0.03), time to
extubation (Mi: 108 (88-128) h, Mo: 128 (102-210) h, P=0.04), lengths of
intensive care unit (ICU) stay (Mi: 9 (5-14) days, Mo: 12 (10-18) days,
P=0.04) and hospital stay (Mi: 19 (10-29) days, Mo: 23 (15-37) days,
P=0.04) were significantly shorter under mild hypothermia. Two-year
freedom from reoperation was 100% for both the groups. Conclusions: The
ASO under mild hypothermia seemed to be beneficial for pulmonary recovery,
need for inotropic support and length of ICU and hospital stay. No worse
early-or intermediate-term effects of mild hypothermia were found. The
Author 2011. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<5>
Accession Number
2012742387
Authors
Aarsaether E. Straumbotn E. Rosner A. Busund R.
Institution
(Aarsaether, Rosner, Busund) Department of Cardiothoracic and Vascular
Surgery, University Hospital of North Norway, Tromso, Norway
(Straumbotn, Rosner, Busund) Department of Clinical Medicine, Faculty of
Health Sciences, University of Tromso, Tromso, Norway
Title
Oral beta-glucan reduces infarction size and improves regional contractile
function in a porcine ischaemia/reperfusion model.
Source
European Journal of Cardio-thoracic Surgery. 41 (4) (pp 919-925), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: We previously reported a cardioprotective effect of oral
beta-glucan in patients who underwent coronary artery bypass grafting. The
present study was conducted to determine whether oral beta-glucan could
reduce myocardial infarction size and whether these changes would be
reflected by better preservation of contractile indices measured by
speckle tracking echocardiography (STE). Methods: Fourteen pigs were
randomized to receive oral beta-glucan 50 mg/kg (n = 7) or placebo
(control, n = 7) 10 days before they were anaesthetized and subjected to 1
h clamping of the left anterior descending coronary artery followed by
reperfusion for 3 h. Longitudinal strain, circumferential strain and
radial strain were assessed by STE after 3 h of reperfusion. Infarction
size and area at risk were determined by Evans blue and
2,3,5-triphenyltetrazolium chloride staining. Results: Pretreatment with
beta-glucan reduced the infarct area/area at risk ratio by 36% (P < 0.05)
and the total necrotic area of the left ventricle by 37% (P < 0.05)
compared with controls. Viable myocardium at risk was 30% higher in the
beta-glucan vs. control group (P < 0.05). Anterior apical strain values
for beta-glucan vs. control were -4.7 +/- 9.4 vs. 5.9 +/- 6.1% (P < 0.05)
for longitudinal strain, -14.7 +/- 6.6 vs. -7.7 +/- 4.3 (P < 0.05) for
circumferential strain, 15.1 +/- 7.7 vs. 7.1 +/- 11.8 (ns) for radial
strain. Conclusions: Oral beta-glucan pretreatment reduces infarction size
and improves regional contractile function in a porcine
ischaemia/reperfusion model. The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<6>
Accession Number
2012742354
Authors
Siregar S. Groenwold R.H.H. de Heer F. Bots M.L. van der Graaf Y. van
Herwerden L.A.
Institution
(Siregar, de Heer, van Herwerden) Department of Cardio-Thoracic Surgery,
Heart and Lungs Division, University Medical Center Utrecht, Utrecht,
Netherlands
(Siregar, Groenwold, Bots, van der Graaf) Julius Center for Health
Sciences and Primary Care, University Medical Center Utrecht, Utrecht,
Netherlands
Title
Performance of the original EuroSCORE.
Source
European Journal of Cardio-thoracic Surgery. 41 (4) (pp 746-754), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
The European system for cardiac operative risk evaluation (EuroSCORE) is a
commonly used risk score for operative mortality following cardiac
surgery. We aimed to conduct a systematic review of the performance of the
additive and logistic EuroSCORE. A literature search resulted in 67
articles. Studies applying the EuroSCORE on patients undergoing cardiac
surgery and which reported early mortality were included. Weighted
meta-regression showed that the EuroSCORE overestimated mortality.
However, this performance depended on the risk profile of patients: in
high-risk patients, the additive model actually underestimated mortality.
Discriminative performance was good. Given the poor predictive
performance, the EuroSCORE may not be suitable as a tool for patient
selection nor for benchmarking. The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<7>
Accession Number
2012740074
Authors
Yu J. Mehran R. Dangas G.D. Claessen B.E. Baber U. Xu K. Parise H. Fahy M.
Lansky A.J. Witzenbichler B. Grines C.L. Guagliumi G. Kornowski R. Wohrle
J. Dudek D. Weisz G. Stone G.W.
Institution
(Yu, Mehran, Dangas, Baber, Weisz, Stone) Zena and Michael A. Weiner
Cardiovascular Institute, Mount Sinai Medical Center, Mount Sinai School
of Medicine, One Gustave L. Levy Place, New York, NY 10029, United States
(Yu) Prince of Wales Clinical School, Randwick, NSW, Australia
(Mehran, Dangas, Claessen, Xu, Parise, Fahy) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Lansky) Yale Cardiovascular Research Group, Yale University School of
Medicine, New Haven, CT, United States
(Witzenbichler) Detroit Medical Center Heart and Vascular Institute,
Detroit, MI, United States
(Grines) Charite Campus Benjamin Franklin, Berlin, Germany
(Guagliumi) Clinic of Internal Medicine II, University of Ulm, Ulm,
Germany
(Kornowski) Cardiovascular Department, Ospedali Riuniti di Bergamo,
Bergamo, Italy
(Wohrle) Interventional Cardiology, Rabin Medical Center, Petah Tikva,
Israel
(Dudek) Jagiellonian University, Krakow, Poland
(Weisz, Stone) Division of Cardiology, Columbia University Medical Center,
New York, NY, United States
Title
Safety and efficacy of high- versus low-dose aspirin after primary
percutaneous coronary intervention in ST-segment elevation myocardial
infarction: The HORIZONS-AMI (Harmonizing Outcomes with Revascularization
and Stents in Acute Myocardial Infarction) trial.
Source
JACC: Cardiovascular Interventions. 5 (12) (pp 1231-1238), 2012. Date of
Publication: December 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to examine the relationship between the
aspirin dose prescribed at hospital discharge and long-term outcomes after
ST-segment elevation myocardial infarction in patients treated with
primary percutaneous coronary intervention (PCI). Background: Patients
with ST-segment elevation myocardial infarction who undergo primary PCI
are prescribed maintenance aspirin doses that vary between 75 and 325 mg
daily. Whether the dose of aspirin affects long-term patient outcomes is
unknown. Methods: We compared 3-year outcomes in patients who were
prescribed high-dose (>200 mg daily) versus low-dose (<=200 mg daily)
aspirin from the large-scale HORIZONS-AMI (Harmonizing Outcomes With
Revascularization and Stents in Acute Myocardial Infarction) trial.
Results: Among 2,851 patients, 2,289 patients (80.3%) were discharged on
low-dose aspirin and 562 patients (19.7%) were discharged on high-dose
aspirin. Patients discharged on high-dose rather than low-dose aspirin
were more likely to have a history of hypertension, hyperlipidemia, family
history of premature coronary disease, prior treatment with PCI or
coronary artery bypass surgery, and to be enrolled in the United States.
Patients discharged on high-dose aspirin had higher 3-year rates of major
adverse cardiovascular events, reinfarction, ischemic target vessel
revascularization, major bleeding, and stent thrombosis. After
multivariable analysis, discharge on high-dose aspirin was an independent
predictor of major bleeding (hazard ratio: 2.80; 95% confidence interval:
1.31 to 5.99; p = 0.008), but not of adverse ischemic events. Conclusions:
In patients with ST-segment elevation myocardial infarction undergoing
primary PCI, discharge on high-dose rather than low-dose aspirin may
increase the rate of major bleeding without providing additional ischemic
benefit. 2012 American College of Cardiology Foundation.
<8>
Accession Number
2012740073
Authors
Van Geuns R.-J. Tamburino C. Fajadet J. Vrolix M. Witzenbichler B.
Eeckhout E. Spaulding C. Reczuch K. La Manna A. Spaargaren R.
Garcia-Garcia H.M. Regar E. Capodanno D. Van Langenhove G. Verheye S.
Institution
(Van Geuns, Regar) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Tamburino, La Manna, Capodanno) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Fajadet) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Vrolix) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
(Witzenbichler) Department of Cardiology, Charite Campus Benjamin
Franklin, Berlin, Germany
(Eeckhout) Cardiology Service, Centre Hospitalier Universitaire Vaudois,
Lausanne, Switzerland
(Spaulding) Hopital Europeen Georges Pompidou, Assistance Publique
Hopitaux de Paris, Paris Descartes University, Paris, France
(Spaulding) Institut National de la Sante et de la Recherche Medicale
Unite 970, Paris, France
(Reczuch) Military Hospital, Wroclaw, Poland
(Reczuch) Medical University, Wroclaw, Poland
(Spaargaren) STENTYS SA, Paris, France
(Garcia-Garcia) Cardialysis, Rotterdam, Netherlands
(Van Langenhove, Verheye) Department of Cardiology, Antwerp Cardiovascular
Center, ZNA Middelheim, Antwerp, Belgium
Title
Self-expanding versus balloon-expandable stents in acute myocardial
infarction: Results from the APPOSITION II Study: Self-expanding stents in
ST-segment elevation myocardial infarction.
Source
JACC: Cardiovascular Interventions. 5 (12) (pp 1209-1219), 2012. Date of
Publication: December 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to investigate whether self-expanding stents
are more effective than balloon-expandable stents for reducing stent
malapposition at 3 days after implantation in patients with ST-segment
elevation myocardial infarction undergoing primary percutaneous coronary
intervention. Background: Acute myocardial infarction is associated with
vasoconstriction and large thrombus burden. Resolution of vasoconstriction
and thrombus load during the first hours to days after primary
percutaneous coronary intervention may lead to stent undersizing and
malapposition, which may subsequently lead to stent thrombosis or
restenosis. In addition, aggressive stent deployment may cause distal
embolization. Methods: Eighty patients with ST-segment elevation
myocardial infarction undergoing primary percutaneous coronary
intervention were randomized to receive a self-expanding stent (STENTYS,
STENTYS SA, Paris, France) (n = 43) or a balloon-expandable stent (VISION,
Abbott Vascular, Santa Clara, California; or Driver, Medtronic,
Minneapolis, Minnesota) (n = 37) at 9 European centers. The primary
endpoint was the proportion of stent strut malapposition at 3 days after
implantation measured by optical coherence tomography. Secondary endpoints
included major adverse cardiac events (cardiac death, recurrent myocardial
infarction, emergent bypass surgery, or clinically driven target lesion
revascularization). Results: At 3 days after implantation, on a per-strut
basis, a lower rate of malapposed stent struts was observed by optical
coherence tomography in the self-expanding stent group than in the
balloon-expandable group (0.58% vs. 5.46%, p < 0.001). On a per-patient
basis, none of the patients in the self-expanding stent group versus 28%
in the balloon-expandable group presented >=5% malapposed struts (p <
0.001). At 6 months, major adverse cardiac events were 2.3% versus 0% in
the self-expanding and balloon-expandable groups, respectively (p = NS).
Conclusions: Strut malapposition at 3 days is significantly lower in
ST-segment elevation myocardial infarction patients allocated to
self-expanding stents when than in those allocated to balloon-expandable
stents. The impact of this difference on clinical outcome and the risk of
late stent thrombosis need to be evaluated further. (Randomized Comparison
Between the STENTYS Self-expanding Coronary Stent and a Balloon-expandable
Stent in Acute Myocardial Infarction [APPOSITION II]; NCT01008085) 2012
American College of Cardiology Foundation.
<9>
Accession Number
2012742546
Authors
Khan R. Jang I.-K.
Institution
(Khan) Department of Medicine, Division of Cardiology, University of
Western Ontario, London, ON, Canada
(Jang) Department of Medicine, Division of Cardiology, Massachusetts
General Hospital and Harvard Medical School, Boston, MA, United States
Title
Evaluation of coronary allograft vasculopathy using multi-detector row
computed tomography: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 41 (2) (pp 415-422), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Coronary allograft vasculopathy (CAV) is a significant cause of morbidity
and mortality aftercardiac transplantation and requires frequent
surveillance with catheter-based coronary angiography (CCA).
Multi-detector row computed tomography (MDCT) has been shown to be
effective in assessingatherosclerosis in native coronary arteries. This
article systematically reviews the literature todetermine the accuracy of
MDCT in CAV assessment. An English-language literature search was
performed using EMBASE, OVID, PubMed, and Cochrane Library databases.
Studies that directly compared MDCT with CCA and/or IVUS for the detection
of coronary artery stenosis or significant intimal thickening in cardiac
transplant patients were analyzed. Data were pooled to obtain weighted
sensitivities, specificities, and diagnostic accuracies. Negative and
positive predictive values (NPV/PPV)were calculated. A total of seven
studies with a sum of 272 patients were included in this review. There
were three studies examining 16-slice MDCTand four studies looking at
64-slice MDCT in CAV.Using per-segment analysis, MDCTassessed between 91%
and 96% of all coronary segments when evaluatingfor stenosis. Pooled
estimates for sensitivity and specificity for MDCT ranged from 82% to 89%
an 89% to 99%, respectively, while NPV was 99%. Per-patient analysis
revealed a sensitivity of 87-100% and NPV of 96-100%. PPV was less than
50% for 64-slice MDCT in both per-segment and per-patient analysis. When
compared with IVUS, MDCT had a sensitivity of 74-96% and specificity of
88-92%in assessment of intimal thickening. NPV and PPV were 80-81% and
84-98%, respectively. The high sensitivity and NPV of MDCTsuggest that it
may be a useful, noninvasive screening tool to rule out CAV. The Author
2011. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.
<10>
Accession Number
2012742591
Authors
Biancari F. Mikkola R. Heikkinen J. Lahtinen J. Airaksinen K.E.J. Juvonen
T.
Institution
(Biancari, Mikkola, Heikkinen, Lahtinen, Juvonen) Department of Surgery,
Oulu University Hospital, Oulu, Finland
(Airaksinen) Division of Cardiology, Department of Internal Medicine,
Turku University Hospital, Turku, Finland
Title
Estimating the risk of complications related to re- exploration for
bleeding after adult cardiac surgery: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 41 (1) (pp 50-55), 2012. Date
of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objective: The aim of this study was to evaluate the impact of
re-exploration for bleeding after cardiac surgery on the immediate
postoperative outcome. Methods: Systematic review of the literature and
meta-analysis of data on re-exploration for bleeding after adult cardiac
surgery were performed. Results: The literature search yielded eight
observational studies reporting on 557 923 patients and were included in
the present analysis. Patients requiring re-exploration were significantly
older, more frequently males, had a higher prevalence of peripheral
vascular disease and preoperative exposure to aspirin, and more frequently
underwent urgent/emergency surgery. Re-exploration was associated with
significantly increased risk ratio (RR) of immediate postoperative
mortality (RR 3.27, 95% confidence interval (CI) 2.44-4.37), stroke, need
of intra-aortic balloon pump, acute renal failure, sternal wound
infection, and prolonged mechanical ventilation. The pooled analysis of
four studies (two being propensity score-matched pairs analysis) reporting
adjusted risk for mortality led to an RR of 2.56 (95%CI 1.46-4.50).
Studies published during the last decade tended to report a higher risk of
re-exploration-related mortality (RR 4.30, 95%CI 3.09-5.97) than those
published in the 1990s (RR 2.75, 95%CI 2.06-3.66). Conclusions: This study
suggests that re-exploration for bleeding after cardiac surgery carries a
significantly increased risk of postoperative mortality and morbidity.
The Author 2011. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<11>
Accession Number
2012742582
Authors
Esmea H. Apiliogullari B. Duran F.M. Yoldas B. Bekci T.T
Institution
(Esmea, Apiliogullari, Duran, Yoldas) Departments of Thoracic Surgery,
Konya Education and Research Hospital, Konya, Turkey
(Bekci) Departments of Pulmonary Diseases, Konya Education and Research
Hospital, Konya, Turkey
Title
Comparison between intermittent intravenous analgesia and intermittent
paravertebral subpleural analgesia for pain relief after thoracotomy.
Source
European Journal of Cardio-thoracic Surgery. 41 (1) (pp 10-13), 2012. Date
of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objective: In the present prospective double-blind randomized trial, the
effects of intermittent paravertebral subpleural bupivacaine and morphine
on pain management in patients undergoing thoracotomy were evaluated and
compared with intermittent systemic analgesia. Methods: Forty-five
patients undergoing elective lobectomy were included in the present study.
Three randomized groups consisting of 15 patients each were compared.
Those in the control group were administered intravenously with tramadol
100 mg plus metamizol 1000 mg every 4 h for 3 days. We placed the catheter
just below the parietal pleura along the paravertebral sulcus at the level
of T5-T7. At the end of the operation and every 4 h thereafter, the
patients received either 1.5 mg kg<sup>-1</sup> bupivacaine (bupivacaine
group) or 0.2 mg kg<sup>-1</sup> morphine sulfate (morphine group) with
paravertebral subpleural catheter for 3 days. Data regarding demographics,
visual analog pain scores, need for supplementary intravenous analgesia,
pulmonary function tests, and postoperative pulmonary complications were
recorded for each patient. Results: Visual analog pain scores (visual
analog scale (VAS)) were lower in the morphine and bupivacaine groups
compared with control group at all postoperative time points. The mean
postoperative VAS was significantly different between the control and
bupivacaine groups at postoperative hour 12, the control and morphine
groups at postoperative hours 6, 12, 48, and 72, and the bupivacaine and
morphine groups at postoperative hours 6 and 24 (p < 0.05). In the control
group, additional analgesic requirement was significantly higher than in
the bupivacaine and morphine groups (p < 0.05). Postoperative pulmonary
complications occurred in three patients (20%) in the control group, in
two patients (13%) in the bupivacaine group, and in one (6%) in the
morphine group. Conclusions: The patients undergoing lung resection
through a thoracotomy were observed with reduced postoperative pain and
better surgical outcomes with respect to the length of hospital stay,
postoperative forced expiratory volume in the first second, pulmonary
complications, and need for bronchoscopic management, when paravertebral
subpleural analgesia was induced by morphine. The Author 2011. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<12>
Accession Number
2012731384
Authors
Al-Lawati J.A. Al-Zakwani I. Sulaiman K. Al-Habib K. Al Suwaidi J.
Panduranga P. Alsheikh-Ali A.A. Almahmeed W. Al Faleh H. Al Saif S. Hersi
A. Asaad N. Al-Motarreb A. Mikhailidis D.P. Amin H.
Institution
(Al-Lawati) Department of Non-Communicable Diseases Surveillance and
Control, Ministry of Health, Muscat, Oman
(Al-Zakwani) Department of Pharmacology and Clinical Pharmacy, College of
Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35,
Al-Khodh, PC-123, Muscat, Oman
(Al-Zakwani) Gulf Health Research, Muscat, Oman
(Sulaiman, Panduranga) Department of Cardiology, Royal Hospital, Muscat,
Oman
(Al-Habib, Al Faleh, Hersi) King Fahad Cardiac Centre, King Khalid
University Hospital, College of Medicine, Riyadh, Saudi Arabia
(Al Suwaidi, Asaad) Department of Cardiology, Hamad Medical Corporation
(HMC), Doha, Qatar
(Alsheikh-Ali, Almahmeed) Department of Cardiology, Sheikh Khalifa Medical
City, Abu Dhabi, United Arab Emirates
(Alsheikh-Ali) Tufts Clinical and Translational Science Institute, Tufts
University School of Medicine, Boston, MA, United States
(Al Saif) Saud Al Babtain Cardiac Center, Dammam, Saudi Arabia
(Asaad) Weill Cornell Medical School, Doha, Qatar
(Al-Motarreb) Faculty of Medicine, Sana'a University, Sana'a, Yemen
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Hospital,
University College London Medical School, University College London,
London, United Kingdom
(Amin) Mohammed Bin Khalifa Cardiac Centre, Bahrain
Title
Weekend versus weekday, morning versus evening admission in relationship
to mortality in acute coronary syndrome patients in 6 middle Eastern
Countries: Results from Gulf Race 2 registry.
Source
Open Cardiovascular Medicine Journal. 6 (1) (pp 106-112), 2012. Date of
Publication: 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
We used prospective cohort data of patients with acute coronary syndrome
(ACS) to compare their manage-ment on weekdays/mornings with
weekends/nights, and the possible impact of this on 1-month and 1-year
mortality. Analyses were evaluated using univariate and multivariate
statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were
on weekdays. There were no significant differences in 1-month (odds ratio
(OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI:
0.70-1.10), respectively, between weekday and weekend admissions.
Similarly, there were no significant differences in 1-month (OR, 0.92; 95%
CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20),
respectively, between nights and day admissions. In conclusion, apart from
lower utilization of angiography (P <.001) at weekends, there were largely
no significant discrepancies in the management and care of patients
admitted with ACS on weekdays and during morning hours compared with
patients admitted on weekends and night hours, and the overall 30-day and
1-year mortality was similar between both the cohorts. Al-Lawati et al.
<13>
Accession Number
2012738396
Authors
Chevalier B. Moulichon R. Teiger E. Brunel P. Metzger J.-P. Pansieri M.
Carrie D. Stoll H.-P. Wittebols K. Spaulding C. Fajadet J.
Institution
(Chevalier) Institut Cardiovasculaire Paris-Sud, 6 Avenue Noyer Lambert,
91300 Massy, France
(Moulichon) Clinique Saint Pierre, Perpignan, France
(Teiger) Centre Hospitalier Henri Mondor, Assistance Publique Hopitaux de
Paris, Creteil, France
(Brunel) Nouvelles Cliniques Nantaises-Site Saint-Henri, Nantes, France
(Metzger) Centre Hospitalier Universitaire Pitie-Salpetriere, Assistance
Publique Hopitaux de Paris, Paris, France
(Pansieri) Centre Hospitalier Henri Duffaut, Avignon, France
(Carrie) Centre Hospitalier Universitaire Rangeuil, Toulouse, France
(Stoll, Wittebols) Cordis Corporation (Johnson and Johnson), Waterloo,
Belgium
(Spaulding) Hopital Europeen Georges Pompidou, Assistance Publique
Hopitaux de Paris, Paris Descartes University, Paris, France
(Fajadet) Unite de Cardiologie Interventionnelle, Clinique Pasteur,
Toulouse, France
Title
One-year results of the CRISTAL trial, a randomized comparison of cypher
sirolimus-eluting coronary stents versus balloon angioplasty for
restenosis of drug-eluting stents.
Source
Journal of Interventional Cardiology. 25 (6) (pp 586-595), 2012. Date of
Publication: December 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives: We compared the efficacy of the Cypher Select (Cordis
Corporation, Bridgewater, NJ, USA) sirolimus-eluting stent (SES) versus
balloon angioplasty (BA) in in-stent restenosis (ISR) of Taxus or Taxus
Liberte paclitaxel-eluting stents (PES; Boston Scientific, Natick, MA,
USA) or Cypher/Cypher Select SES. Background: Optimal treatment strategies
have not been identified for drug-eluting stent (DES) ISR. Methods:
Patients with a native coronary artery SES or PES ISR were randomized to
SES or BA. In addition, a control group included BMS ISR treated with SES.
Angiographic control was performed at 12 months. Results: 281 patients
were enrolled. Significant differences favoring SES over BA were noted in
immediate and net gain (1.39 +/- 0.51 vs. 0.97 +/- 0.54 mm, P < 0.0001 and
1.07 +/- 0.69 vs. 0.49 +/- 0.67 mm, P < 0.0001), 12-month mean luminal
diameter (MLD; 2.14 +/- 0.62 vs. 1.71 +/- 0.55 mm, P < 0.0001) and percent
diameter stenosis (%DS; 21 +/- 19.24 vs. 29.82 +/- 18.47, P = 0.001).
There was no significant difference at 12 months between SES and BA in the
primary end-point late lumen loss (LLL; 0.37 +/- 0.57 vs.0.41 +/- 0.63, P
= 0.73) and in in-stent binary restenosis (11.1% vs. 14%, P = 0.59).
Target-lesion revascularization (TLR) was numerically lower in patients
treated with SES (5.9% vs. 13.1%, P = 0.097). There was no difference
according to the initial DES. In contrast, significantly higher immediate
and net gains and MLD were noted in the BMS control group treated by SES.
Conclusions: In this angiographic randomized trial comparing SES and BA in
SES or PES restenosis, 12 month MLD, immediate and net gain, and %DS
favored SES whereas no difference was noted in LLL. Condensed Abstract
Optimal treatment strategies have not been identified for sirolimus- (SES)
or paclitaxel-eluting stent (PES) in-stent restenosis (ISR). We randomized
patients with a native coronary artery SES or PES ISR to SES or BA. In
addition, a control group included BMS ISR treated with SES. There was no
difference in the primary end-point, late lumen loss (LLL) at 12 months
between the SES and BA groups. However, follow-up MLD and immediate and
net gain favored SES. 2012, Wiley Periodicals, Inc.
<14>
Accession Number
2012735591
Authors
Shim J.-K. Yang S.-Y. Yoo Y.-C. Yoo K.-J. Kwak Y.-L.
Institution
(Shim, Yoo, Kwak) Department of Anaesthesiology and Pain Medicine,
Anaesthesia and Pain Research Institute, Yonsei University Health System,
250 Seongsanno, Seodaemun-Gu, Seoul 120-752, South Korea
(Yoo) Department of Cardiothoracic Surgery, Yonsei University Health
System, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, South Korea
(Yang) Department of Anaesthesiology and Pain Medicine, Chung-Ang
University, College of Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University, College
of Medicine, Seoul, South Korea
Title
Myocardial protection by glucose-insulin-potassium in acute coronary
syndrome patients undergoing urgent multivessel off-pump coronary artery
bypass surgery.
Source
British Journal of Anaesthesia. 110 (1) (pp 47-53), 2013. Date of
Publication: January 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundThe aim of this randomized and controlled trial was to
investigate the effect of a glucose-insulin-potassium (GIK) solution on
myocardial protection in acute coronary syndrome (ACS) patients undergoing
urgent multivessel off-pump coronary artery bypass (OPCAB)
surgery.MethodsSixty- six patients were randomly allocated either to
receive 0.3 ml kg<sup>-1</sup> h<sup>-2</sup> GIK solution (potassium 80
mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent
volume of normal saline (control) upon anaesthetic induction until 6 h
after reperfusion. The primary endpoints were to compare the
concentrations of creatine kinase-MB (CK-MB) and troponin-T between the
groups after reperfusion. The secondary endpoints were to compare the
incidences of postoperative troponin-T >0.8 ng ml<sup>-1</sup> and
myocardial infarction (MI) between the groups.ResultsHighest CK-MB [8.7
(4.4) vs 13.1 (7.9) ng ml<sup>-1</sup>, P=0.006] and troponin-T [0.20
(0.13-0.49) vs 0.48 (0.18-0.91) ng ml<sup>-1</sup>, P<0.0001] values after
reperfusion were significantly lower in the GIK group compared with the
control group. The area under the curve of serially measured troponin-T
was also significantly smaller in the GIK group compared with the control
group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer
patients in the GIK group showed troponin-T >0.8 ng ml<sup>-1</sup> after
reperfusion compared with the control group (3 vs 11, P=0.033). The
incidence of postoperative MI was similar between the
groups.ConclusionsGIK administration in ACS patients undergoing urgent
multivessel OPCAB significantly attenuated the degree of ensuing
myocardial injury without complications related to glycaemic
control.Clinical Trial Registry. URL:
http://clinicaltrials.gov/ct2/show/NCT01384656?term= GIK+AND+OPCAB&rank=1.
Unique identification number NCT01384656. The Author [2012]. Published by
Oxford University Press on behalf of the British Journal of Anaesthesia.
All rights reserved.
<15>
Accession Number
2012723965
Authors
Stoppe C. Spillner J. Rossaint R. Coburn M. Schalte G. Wildenhues A. Marx
G. Rex S.
Institution
(Stoppe, Rossaint, Coburn, Schalte, Wildenhues, Rex) Department of
Anesthesiology, University Hospital, RWTH Aachen, Germany
(Stoppe) Institute of Biochemistry and Molecular Cell Biology, University
Hospital of the RWTH Aachen, Germany
(Spillner) Department of Thoracic, Cardiac and Vascular Surgery,
University Hospital, RWTH Aachen, Germany
(Marx) Department of Intensive Care, University Hospital, RWTH Aachen,
Germany
(Rex) Department of Anesthesiology, University Hospitals Gasthuisberg, KU
Leuven, Belgium
Title
Selenium blood concentrations in patients undergoing elective cardiac
surgery and receiving perioperative sodium selenite.
Source
Nutrition. 29 (1) (pp 158-165), 2013. Date of Publication: January 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: We recently reported that cardiac surgical patients in our
institution exhibited low selenium blood levels preoperatively, which were
further aggravated during surgery and independently associated with the
development of postoperative multiorgan failure. Low circulating selenium
levels result in a decreased antioxidant capacity. Both can be treated
effectively by sodium-selenite administration. Little is known about the
kinetics of exogenously administered sodium-selenite during acute
perioperative oxidative stress. The aim of this study was to assess the
effects of perioperative high-dose sodium-selenite administration on
selenium blood concentrations in cardiac surgical patients. Methods: One
hundred four cardiac surgical patients were enrolled in this prospective
observational trial. Patients received an intravenous bolus of 2000 mug
selenium after an induction of anesthesia and 1000 mug selenium every day
further during their intensive care unit (ICU) stay. Selenium blood levels
were measured at regular intervals. Results: Preoperative sodium-selenite
administration increased selenium blood concentrations to normal values on
ICU admission, but failed to prevent a significant decrease of circulating
selenium on the first postoperative day. During the further ICU stay,
selenium blood levels were normalized by the administration strategy and
did not exceed the German reference range. No acute selenium-specific side
effects occurred. When matching the participating patients to a historical
control group without sodium-selenite administration, the chosen strategy
was associated with a decrease in SAPS II (23 +/- 7 versus 29 +/- 8, P =
0.005) and SOFA scores (4 +/- 3 versus 7 +/- 2, P = 0.007) on the first
postoperative day, but was unable to improve the postoperative outcome in
patients staying >1 d in ICU. Conclusions: Despite preemptive high-dose
sodium-selenite administration, cardiac surgical patients experienced a
significant decrease in circulating selenium levels on the first
postoperative day. 2013 Elsevier Inc.
<16>
Accession Number
2012728040
Authors
Gorantla R. Murthy J.S.N. Muralidharan T.R. Mandava R. Dev B. Chandaga H.
Rajeswaran R. Roy Santosham J.D. Joseph S.
Institution
(Gorantla, Dev, Rajeswaran, Roy Santosham, Joseph) Department of
Radiology, Sri Ramachandra Medical College, Chennai - 600116, India
(Murthy, Mandava) Sri Ramachandra Medical College, Chennai - 600116, India
(Muralidharan) Department of Cardiology, Sri Ramachandra Medical College,
Chennai - 600116, India
(Chandaga) Columbia Asia Hospital, Bengaluru, India
Title
Diagnostic accuracy of 64-slice multidetector computed tomography in
evaluation of post-coronary artery bypass grafts in correlation with
invasive coronary angiography.
Source
Indian Heart Journal. 64 (3) (pp 254-260), 2012. Date of Publication: May
2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
64-slice multidetector computed tomography (MDCT) allows more reliable and
non-invasive evaluation of the coronary artery bypass grafts for occlusion
or stenosis both in symptomatic and asymptomatic patients and also
progression of disease in native coronary vessels. 2012, Cardiological
Society of India. All rights reserved.
<17>
Accession Number
2012735648
Authors
Farooq V. Serruys P.W. Bourantas C. Vranckx P. Diletti R. Garcia Garcia
H.M. Holmes D.R. Kappetein A.-P. MacK M. Feldman T. Morice M.C. Colombo A.
Morel M.-A. De Vries T. Van Es G.A. Steyerberg E.W. Dawkins K.D. Mohr F.W.
James S. Stahle E.
Institution
(Farooq, Serruys, Bourantas, Vranckx, Diletti, Garcia Garcia) Department
of Interventional Cardiology, Erasmus University Medical Centre,
Thoraxcenter, s-Gravendijkwal 230, 3015 CE, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(MacK) Medical City Dallas Hospital, Dallas, TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Morice) Institut Jacques Cartier, Massy, France
(Colombo) San Raffaele Scientific Institute, Milano, Italy
(Morel, De Vries, Van Es) Cardialysis BV, Rotterdam, Netherlands
(Steyerberg) Department of Public Health, Erasmus University Medical
Center, Rotterdam, Netherlands
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
(Mohr) Herzzentrum, Leipzig, Germany
(James, Stahle) University Hospital Uppsala, Uppsala, Sweden
Title
Incidence and multivariable correlates of long-term mortality in patients
treated with surgical or percutaneous revascularization in the Synergy
between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery
(SYNTAX) trial.
Source
European Heart Journal. 33 (24) (pp 3105-3113), 2012. Date of Publication:
December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims The aim of this investigation was to determine the incidence and
multivariable correlates of long-term (4-year) mortality in patients
treated with surgical or percutaneous revascularization in the synergy
between percutaneous coronary intervention (PCI) with TAXUS Express and
Cardiac Surgery (SYNTAX) trial.Methods and resultsA total of 1800 patients
were randomized to undergo coronary artery bypass graft (CABG) surgery (n
= 897) or PCI (n = 903). Prospectively collected baseline and peri-and
post-procedural data were used to determine independent correlates of
4-year all-cause death in the CABG and the PCI arms (Cox proportional
hazards model). Four-year mortality rates in the CABG and the PCI arms
were 9.0% [74 deaths (12 in-hospital)] and 11.8% [104 deaths (16
in-hospital)], respectively (log-rank P-value = 0.063). Censored data
comprised 78 patients (8.7%) in the CABG arm, and 24 patients (2.7%) in
the PCI arm (log-rank P-value < 0.001). Within the CABG arm, the strongest
independent correlates of 4-year mortality were lack of discharge aspirin
[hazard ratio (HR) 3.56; 95% CI: 2.04, 6.21; P < 0.001], peripheral
vascular disease (PVD) (HR: 2.65; 95% CI: 1.49, 4.72; P = 0.001), chronic
obstructive pulmonary disease, age, and serum creatinine. Within the PCI
arm, the strongest independent correlate of 4-year mortality was lack of
post-procedural anti-platelet therapy (HR: 152.16; 95% CI: 53.57, 432.22;
P < 0.001), with 10 reported early (within 45 days) in-hospital deaths
secondary to multifactorial causes precluding administration of
anti-platelet therapy. Other independent correlates of mortality in the
PCI arm included amiodarone therapy on discharge, pre-procedural poor left
ventricular ejection fraction, a 'history of gastrointestinal bleeding or
peptic ulcer disease', PVD (HR: 2.13; 95% CI: 1.26, 3.60; P = 0.005), age,
female gender (HR: 1.60; 95% CI: 1.01, 2.56; P = 0.048), and the SYNTAX
score (Per increase in 10 points: HR: 1.25; 95% CI: 1.06, 1.47; P =
0.007).ConclusionIndependent correlates of 4-year mortality in the SYNTAX
trial were multifactorial. Lack of discharge aspirin and lack of
post-procedural anti-platelet therapy were the strongest independent
correlates of mortality in the CABG and the PCI arms, respectively.
Peripheral vascular disease is a common independent correlate of 4-year
mortality and may be a marker of the severity of baseline coronary disease
and risk of future native coronary disease (and extra-cardiac disease)
progression. 2012 The Author.
<18>
Accession Number
2012735644
Authors
Min J.K. Berman D.S. Dunning A. Achenbach S. Al-Mallah M. Budoff M.J.
Cademartiri F. Callister T.Q. Chang H.-J. Cheng V. Chinnaiyan K. Chow
B.J.W. Cury R. Delago A. Feuchtner G. Hadamitzky M. Hausleiter J. Kaufmann
P. Karlsberg R.P. Kim Y.-J. Leipsic J. Lin F.Y. Maffei E. Plank F. Raff G.
Villines T. Labounty T.M. Shaw L.J.
Institution
(Min, Berman, Cheng, Labounty) Department of Medicine Imaging, and
Biomedical Sciences, Cedars-Sinai Heart Institute, Cedars-Sinai Medical
Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
(Min, Berman, Cheng, Labounty) Department of Imaging, Cedars-Sinai Medical
Center, Los Angeles, CA, United States
(Dunning) Department of Public Health, Weill Cornell Medical College, New
York Presbyterian Hospital, New York, NY, United States
(Achenbach) Department of Medicine, University of Erlangen, Erlangen,
Germany
(Al-Mallah) Department of Medicine, Wayne State University, Henry Ford
Hospital, Detroit, MI, United States
(Budoff) Department of Medicine, Harbor UCLA Medical Center, Los Angeles,
CA, United States
(Cademartiri, Maffei) Department of Radiology, Giovanni XXIII Hospital,
Monastier, Treviso, Italy
(Cademartiri, Maffei) Department of Radiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Callister) Tennessee Heart and Vascular Institute, Hendersonville, TN,
United States
(Chang) Division of Cardiology, Severance Cardiovascular Hospital, Seoul,
South Korea
(Chinnaiyan, Raff) William Beaumont Hospital, Royal Oaks, MI, United
States
(Chow) Department of Medicine and Radiology, University of Ottawa, ON,
Canada
(Cury) Baptist Cardiac and Vascular Institute, Miami, FL, United States
(Delago) Capitol Cardiology Associates, Albany, NY, United States
(Feuchtner, Plank) Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria
(Hadamitzky, Hausleiter) Division of Cardiology, Deutsches Herzzentrum
Munchen, Munich, Germany
(Kaufmann) University Hospital, Zurich, Switzerland
(Karlsberg) Cardiovascular Medical Group, Los Angeles, CA, United States
(Kim) Seoul National University Hospital, Seoul, South Korea
(Leipsic) Department of Radiology, University of British Columbia,
Vancouver, BC, Canada
(Lin) Department of Medicine, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, NY, United States
(Villines) Department of Medicine, Walter Reed Medical Center, Washington,
DC, United States
(Shaw) Department of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
Title
All-cause mortality benefit of coronary revascularization vs. medical
therapy in patients without known coronary artery disease undergoing
coronary computed tomographic angiography: Results from CONFIRM (COronary
CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational
Multicenter Registry).
Source
European Heart Journal. 33 (24) (pp 3088-3097), 2012. Date of Publication:
December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To date, the therapeutic benefit of revascularization vs. medical
therapy for stable individuals undergoing invasive coronary angiography
(ICA) based upon coronary computed tomographic angiography (CCTA) findings
has not been examined.Methods and resultsWe examined 15 223 patients
without known coronary artery disease (CAD) undergoing CCTA from eight
sites and six countries who were followed for median 2.1 years
(interquartile range 1.4-3.3 years) for an endpoint of all-cause
mortality. Obstructive CAD by CCTA was defined as a >=50% luminal diameter
stenosis in a major coronary artery. Patients were categorized as having
high-risk CAD vs. non-high-risk CAD, with the former including patients
with at least obstructive two-vessel CAD with proximal left anterior
descending artery involvement, three-vessel CAD, and left main CAD. Death
occurred in 185 (1.2%) patients. Patients were categorized into two
treatment groups: revascularization (n = 1103; 2.2% mortality) and medical
therapy (n = 14 120, 1.1% mortality). To account for non-randomized
referral to revascularization, we created a propensity score developed by
logistic regression to identify variables that influenced the decision to
refer to revascularization. Within this model (C index 0.92, chi2 = 1248,
P < 0.0001), obstructive CAD was the most influential factor for referral,
followed by an interaction of obstructive CAD with pre-test likelihood of
CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization
increased from 3.8% for non-high-risk CAD to 51.2% high-risk CAD. In
multivariable models, when compared with medical therapy,
revascularization was associated with a survival advantage for patients
with high-risk CAD [hazards ratio (HR) 0.38, 95% confidence interval
0.18-0.83], with no difference in survival for patients with non-high-risk
CAD (HR 3.24, 95% CI 0.76-13.89) (P-value for interaction =
0.03).ConclusionIn an intermediate-term follow-up, coronary
revascularization is associated with a survival benefit in patients with
high-risk CAD by CCTA, with no apparent benefit of revascularization in
patients with lesser forms of CAD. 2012 The Author.
<19>
Accession Number
2012735636
Authors
Kang H.-J. Kim M.-K. Lee H.-Y. Park K.-W. Lee W. Cho Y.-S. Koo B.-K. Choi
D.-J. Park Y.-B. Kim H.-S.
Institution
(Kang, Lee, Park, Koo, Park, Kim) Division of Cardiology, Department of
Internal Medicine, Seoul National University Hospital, 101 DaeHak-ro,
JongRo-gu, Seoul 110-744, South Korea
(Kim) Healthcare System Gangnam Center, Seoul National University
Hospital, Seoul, South Korea
(Lee) Department of Radiology, Seoul National University, College of
Medicine, Seoul, South Korea
(Cho, Choi) Division of Cardiology, Department of Internal Medicine, Seoul
National University Bundang Hospital, Bundang, South Korea
Title
Five-year results of intracoronary infusion of the mobilized peripheral
blood stem cells by granulocyte colony-stimulating factor in patients with
myocardial infarction.
Source
European Heart Journal. 33 (24) (pp 3062-3069), 2012. Date of Publication:
December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimTo evaluate the long-term effects of peripheral blood stem cell therapy
in myocardial infarction (MI) patients.Methods and resultsA total of 163
patients with MI who were successfully revascularized with drug-eluting
stents were enrolled and randomly assigned to four groups: acute MI (AMI)
cell infusion, AMI control, old MI (OMI) cell infusion, and OMI control.
We compared 5 years' clinical outcomes between the cell infusion group (57
and 22 patients with AMI and OMI, respectively) and the control (60 and 24
patients with AMI and OMI, respectively). In the time-sequence comparison
from baseline to 6 and 24 months follow-up after AMI, left ventricular
ejection fraction (LVEF) by cardiac magnetic resonance imaging was
significantly improved in the cell infusion group (n = 57), but not in the
control group (n = 60). In the between-group comparison, the difference in
improvement of LVEF for 2 years after AMI did not reach statistical
significance between cell infusion and control groups. Intriguingly, the
major adverse cardiac events for 5 years were significantly reduced in the
cell infusion group (n = 79) compared with the control (n = 84; composite
of cardiac death, non-fatal MI, hospitalization for heart failure and
angina, and target vessel revascularization; 22.8 vs. 39.3%, P =
0.015).ConclusionsPeripheral blood stem cell therapy has potential to
improve long-term cardiovascular outcomes in MI patients. 2012 The
Author.
<20>
Accession Number
2012730285
Authors
Bjordahl P.M. Helmer S.D. Gosnell D.J. Wemmer G.E. O'Hara W.W. Milfeld
D.J.
Institution
(Bjordahl, Helmer, Milfeld) Department of Surgery, University of Kansas,
School of Medicine-Wichita, 929 N. Saint Francis St., Wichita, KS 67214,
United States
(Helmer) Department of Medical Education, Via Christi Hospital on Saint
Francis, Wichita, KS, United States
(Gosnell) Department of Nursing, Via Christi Hospital on Saint Francis,
Wichita, KS, United States
(Wemmer) Department of Nursing, Duke University Hospital, Durham, NC,
United States
(O'Hara) Department of Cardiovascular Surgery, Methodist Hospital, Weill
Cornell Medical School, Houston, TX, United States
Title
Perioperative supplementation with ascorbic acid does not prevent atrial
fibrillation in coronary artery bypass graft patients.
Source
American Journal of Surgery. 204 (6) (pp 862-867), 2012. Date of
Publication: December 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Atrial fibrillation occurs after approximately 25% to 45% of
coronary artery bypass graft (CABG) surgeries. Oxidative stress and
related electrophysiological remodeling has been proposed as a potential
cause of this atrial fibrillation. Perioperative supplementation of the
antioxidant ascorbic acid has been evaluated as a preventive agent. The
current investigation was conducted to evaluate the efficacy of ascorbic
acid in reducing atrial fibrillation in CABG patients. Methods: A
prospective, randomized, placebo-controlled, triple-blind,
single-institution study was conducted in nonemergency CABG patients.
Subjects were monitored for episodes of arrhythmia and other
complications. Results: Eighty-nine treatment and 96 control subjects
completed the study protocol. Demographics, comorbidities, and
preoperative drugs were similar between groups. Surgical characteristics
and postoperative medication use also were similar. The incidence of
atrial fibrillation was 30.3% in the treatment group and 30.2% in the
control group (P =.985). No difference was found in postoperative
complications or mortality. Conclusions: Our data indicate that
supplementation of ascorbic acid in addition to routine postoperative care
does not reduce atrial fibrillation after coronary artery bypass grafting.
2012 Elsevier Inc.
