Results Generated From:
Embase <1980 to 2013 Week 15>
Embase (updates since 2013-04-05)
Embase <1980 to 2013 Week 15>
Embase (updates since 2013-04-05)
Embase <1980 to 2013 Week 15>
Embase (updates since 2013-04-05)
<1>
Accession Number
2013200948
Authors
Manolis A.J. Poulimenos L.E.
Institution
(Manolis) Department of Cardiology, Asklepeion, Voula General Hospital,
Emory University, 1 Vas Pavlou Ave., 16673 Voula, Atlanta GA, United
States
(Manolis) Department of Hypertension, Boston University, Boston MA, United
States
(Poulimenos) Attending Cardiologist, Department of Cardiology, Voula
Hospital, 1 Vas Pavlou Ave, 16673 Voula, Greece
Title
Prevention of stroke by antithrombotic therapy in patients with atrial
fibrillation.
Source
Journal of Atrial Fibrillation. 5 (5) (pp 84-92), 2013. Date of
Publication: February-March 2013.
Publisher
CardioFront LLC (135th St, Ste 264, Overland Park KS 66223, United States)
Abstract
Atrial Fibrillation (AF) is the most common clinically significant
sustained cardiac arrhythmia, a major risk factor for strokes whether it
is symptomatic or silent. The older CHADS2 score and the newer
CHA2DS2-VASc are well validated to determine stroke risk and guide
initiation of antithrombotic therapy, but haemorrhagic risk has to be
respected as well, and scores such as HAS-BLED should be widely used. Old
fashioned warfarin became standard of care outperforming antiplatelets in
every trial but novel classes of anticoagulants that overcome many of
warfarin drawbacks have been introduced and are already guideline
recommended regiments. Nevertheless their use poses new questions that
have to been answered in the near future.
<2>
Accession Number
71029126
Authors
Anwar S. Rahman J. Sharma C. Hemming A. Langford R.
Institution
(Anwar, Rahman, Sharma, Hemming, Langford) Pain and Anaesthesia Research
Centre, Barts Health NHS Trust, London, United Kingdom
Title
Randomised controlled trial data of preemptive analgesia to prevent the
development of neuropathic pain after cardiac surgery.
Source
Journal of Pain. Conference: 32nd Annual Scientific Meeting of the
American Pain Society New Orleans, LA United States. Conference Start:
20130509 Conference End: 20130511. Conference Publication: (var.pagings).
14 (4 SUPPL. 1) (pp S46), 2013. Date of Publication: April 2013.
Publisher
Churchill Livingstone Inc.
Abstract
Persistent postoperative pain (PPP) following sternotomy, either
neuropathic or non-neuropathic in nature, is common (30-55%) and difficult
to treat once established. Known risk factors such as young age and
increased duration of surgery are not modifiable. Evidence is gathering
for the role of NMDA receptor antagonists and gabapentinoids in the
prevention of chronic pain after various forms of surgery. We conducted a
randomised, triple-blind, controlled trial of 150 elective cardiac
surgical patients, assigned to one of three arms: A: 14 days of placebo
capsule and 48-hour placebo infusion B: 14 days of perioperative
pregabalin and 48-hour placebo infusion C: 14 days of pregabalin with a
48-hour infusion of low dose ketamine Responses to experimental pain
modalities, before and after surgery, were recorded as potential
predictors of chronic pain. Pain outcomes were measured in the acute
postoperative period and at three and six months following surgery.
Results are presented here of a planned interim analysis, following
completion of data collection for the first 50 patients. There were
significant differences between groups A, B and C respectively, in terms
of chronic pain at three months after surgery (50% vs. 24% vs.6% p=0.0015)
and at six months (31% vs. 17% vs. 6% p=0.02) Poor responses to
Conditioned Pain Modulation (CPM) testing before surgery, as defined by
less than 100kPa increase in algometry-derived pain threshold, predicted
the development of chronic pain in 75% and 78% of PPP patients, at three
and six months respectively. This is the first study to demonstrate the
preventive effect of perioperative pregabalin, alone or in combination
with ketamine, on chronic pain following sternotomy. In addition, there is
potential to predict the development of PPP by assessing CPM efficiency
before surgery. Analysis of the full trial data set is required in order
to draw further conclusions.
<3>
Accession Number
71023987
Authors
Kulkarni S. Molony D.
Institution
(Kulkarni, Molony) University of Texas Houston Medical School, Houston,
TX, United States
Title
Sevelamer (SV) is more cost-effective than calcium-based phosphate binders
in ESRD patients: A cost-effectiveness (CE) and sensitivty analysis.
Source
American Journal of Kidney Diseases. Conference: National Kidney
Foundation 2013 Spring Clinical Meetings Orlando, FL United States.
Conference Start: 20130402 Conference End: 20130406. Conference
Publication: (var.pagings). 61 (4) (pp A56), 2013. Date of Publication:
April 2013.
Publisher
W.B. Saunders
Abstract
Background: Efforts to improve the quality of and to reduce the cost of
end stage renal disease (ESRD) care have focused on the comparative
effectiveness of oral ESRD medications. We chose to evaluate the CE of the
most commonly used phosphate binders, SV and the calcium salts - calcium
carbonate (CC)/ acetate (CA) and to perform a sensitivity analysis of the
factors that influence the observed CE. Methods: Wc constructed an
economic model to calculate the incremental cost-effectiveness ratios
(ICER) of SV vs. CC/CA using mortality estimates from a recent
meta-analysis and the hospitalization rate from the literature. Costs
included direct medication cost and savings from reduced hospital days and
CV surgeries. We performed a sensitivity analysis by varying hospital days
and medication dosages. The impact of binder choice on quality of life
(QOL) could not be tested. Results: In incident ESRD patients, the ICERs
are $36,485.53 and $28,428.62/patient year saved for SV vs. CC and SV vs.
CA, respectively. In prevalent ESRD patients, the ICERs are $46,674.79 and
$36,367.84/patient year saved for SV vs. CC and SV vs. CA, respectively.
In a sensitivity analysis we showed that a reduction in hospital days of
greater than 1 for incident patients and of greater than 2 for prevalent
patients will produce ICERs less than the conventional threshold of
$50,000. Conclusions: This CE analysis demonstrates that SV is a
cost-effective phosphate binder compared to CC/CA. SV is cost-effective
because of reductions in mortality, number of hospital days, and
cardiovascular surgeries.
<4>
Accession Number
71021366
Authors
Sardar P. Chatterjee S.
Institution
(Sardar, Chatterjee) New York Medical College Metropolitan Hospital
Center, New York, NY, USA, Brown University and the Providence VAMC,
Providence, RI, USA
Title
Early surgery reduces mortality in patients with infective endocarditis:
Insight from a meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E2003), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: The effect of early surgical intervention on mortality in
patients with infective endocarditis (IE) remains controversial. We
conducted a systematic review and meta-analysis of available studies to
evaluate the clinical outcome of early surgery compared with conventional
medical therapy or conservative management for IE. Methods: The authors
searched the PubMed, CENTRAL, CINAHL, and EMBASE databases for related
studies from 1966 to October, 2012. Studies comparing early surgery with
conventional or conservative medical therapy were included. Early surgery
was defined as surgical intervention with valve repair or replacement
within two weeks of IE diagnosis. The primary outcome assessed was risk of
all-cause mortality. We used a random effects model to evaluate outcomes
between early surgery versus conventional/conservative strategies. The
methodological quality of the studies was assessed. Statistical analysis
was done with Review Manager V5.1. Results: Five studies that satisfied
the inclusion criteria were included in the final analysis. Patient
randomized to early surgery had significantly less all-cause mortality
compared to those receiving conventional medical treatment or conservative
therapy (Risk ratio, 0.51; 95% confidence interval, 0.34 to 0.76,
p=0.001). Conclusions: As compared with conventional medical therapy or
conservative approach, early surgery significantly reduced the mortality
in patients with infective endocarditis. (Table Presented).
<5>
Accession Number
71021326
Authors
Macon C. Ghatak A. Tamariz L. Badheka A. O'Neill B. Martinez-Clark P.
Alfonso C. Cohen M. O'Neill W. De Marchena E.
Institution
(Macon, Ghatak, Tamariz, Badheka, O'Neill, Martinez-Clark, Alfonso, Cohen,
O'Neill, De Marchena) University of Miami Miller, School of Medicine,
Miami, FL, United States
Title
Incidence of stroke in patients undergoing transcatheter aortic valve
replacement using edwards SAPIEN valve for critical aortic stenosis.
Meta-analysis comparing transfemoral versus transapical approach.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1963), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Trancatheter aortic valve replacement (TAVR) is associated
with a higher risk of stroke as compared to surgical aortic valve
replacement. The data on the difference in the incidence of stroke between
the transfemoral (TF) vs transapical (TA) approaches is limited to
individual studies. Methods: We performed a comprehensive electronic
database search for patients undergoing TAVR from Jan 2009 to July 2012.
Only studies comparing TF vs TA approaches using the Edwards SAPIEN aortic
valves were included. The primary endpoint was occurrence of any stroke
(major or minor) within 30 days of the procedure. Results: A total of 9
studies including 3,007 patients (TF= 1,639; TA= 1368) met our inclusion
criteria. The cumulative incidence of 30-day stroke post TAVR was
non-significantly different between the two approaches (TF=3.15% vs
TA=3.17%, p=NS). The pooled relative risk of stroke for these two
approaches was 0.893 (95% CI 0.501 to 1.589). Conclusions: The transapical
and transfemoral approaches are associated with similar risk of 30 day
peri-procedural stroke. Our meta-analysis suggests that manipulation of
aorta may not be the prime cause of peri-procedural stroke. (Table
Presented).
<6>
Accession Number
71021325
Authors
Panchal H.B. Desai S. Ramu V.
Institution
(Panchal, Desai, Ramu) East Tennessee State University, Johnson City, TN,
United States
Title
A meta-analysis of mortality and major adverse cardiovascular and
cerebrovascular events following transcatheter aortic valve implantation
versus surgical aortic valve replacement for severe aortic stenosis.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1962), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: The purpose of this meta-analysis is to compare the
post-procedural outcomes of transcatheter aortic valve implantation (TAVI)
and surgical aortic valve replacement (SAVR) for severe aortic stenosis.
Methods: Seventeen studies (n=4710) comparing TAVI (n=2288) and SAVR
(n=2422) were included. End points were baseline logistic EuroScore,
all-cause mortality, cardiovascular mortality, myocardial infarction,
stroke, transient ischemic attack, major bleeding and major vascular
events. The odds ratio (OR) with 95% confidence interval (CI) was computed
and p<0.05 was considered as a level of significance. Results: No
significant difference was found between SAVR and TAVI for baseline
logistic EuroScore (p=0.07), all-cause mortality at 30 days (p=0.92) and
average 69 weeks (p=0.11) (figure 1), cardiovascular mortality (p=0.54),
myocardial infarction (p=0.59), stroke (p=0.4) and transient ischemic
attacks (p=0.85). Compared to SAVR, TAVI had significantly lower major
bleeding (OR:1.78, CI:1.35-2.33, p<0.00001) and higher major vascular
complications (OR:0.42, CI:0.17-1, p=0.05). Conclusion: Our meta-analysis
of 17 studies with 4710 matched-risk propensity population showed that
TAVI has similar cardiovascular and allcause mortality to SAVR at average
69 weeks follow-up. TAVI is superior to SAVR for major bleeding
complications and non-inferior to SAVR for postprocedural cerebrovascular
events, myocardial infarctions and major vascular events. (Table
Presented).
<7>
Accession Number
71021267
Authors
Ribeiro H.B. Nombela-Franco L. Urena M. Mok M. Pasian S. Doyle D. De
Larochelliere R. Cote M. Laflamme L. De Larochelliere H. Dumont E.
Rodes-Cabau J.
Institution
(Ribeiro, Nombela-Franco, Urena, Mok, Pasian, Doyle, De Larochelliere,
Cote, Laflamme, De Larochelliere, Dumont, Rodes-Cabau) Quebec Heart and
Lung Institute, Quebec, Canada
Title
Coronary obstruction following transcatheter aortic valve implantation:
Insights on baseline patients' characterisctics, management and clinical
outcomes.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1904), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Very few data exist on coronary obstruction following
transcatheter aortic valve implantation (TAVI). The objective of this
study was to evaluate, through a systematic review of the literature, the
main baseline characteristics, management and clinical outcomes of
patients suffering coronary obstruction following TAVI. Methods: Studies
published between 2002 and 2012, with regards to coronary obstruction as a
complication of TAVI, were identified using a systematic electronic
search. Only the studies reporting data on the main baseline and
procedural characteristics, management of the complication, and clinical
outcomes were analyzed. Results: A total of 16 publications describing 24
patients who had experienced coronary obstruction related to a TAVI were
identified. Most (83%) patients were women, with a mean age of 83+/-7
years, and a mean logistic EuroSCORE of 25.1 +/- 12.0%. Most patients
(88%) had received a balloon-expandable valve, and coronary obstruction
occurred more frequently at the level of the left coronary artery ostium
(LCA; 88%), that presented a mean height of 10.3+/-1.6 mm. Most (88%)
patients presented with persistent severe hypotension and 54.2% exhibited
ST-segment changes, usually occurring immediately after valve
implantation. Percutaneous coronary intervention (PCI) was attempted in 23
cases (95.8%) and was successful in all but 2 patients (91.3%). Stent
recoil requiring a second stent, mechanical hemodynamic support and
conversion to open-heart surgery were required in 3, 6, and 2 patients,
respectively. At 30-day follow-up, there were no cases of stent thrombosis
or repeat revascularization, and the mortality rate was of 8.3% (0% among
those patients who had had successful PCI). Conclusions: Coronary
obstruction following TAVI occurred more frequently in women, and in
patients receiving a balloon-expandable valve, and the LCA was the most
commonly involve artery. PCI was a feasible and successful treatment in
most cases, but complication rates remained important. Continuous efforts
should be made to identify the factors associated with this life
threatening complication in order to implement the appropriate measures
for its prevention.
<8>
Accession Number
71021229
Authors
Meduri C. Reynolds M. Rassi A. Burke D. Popma J.
Institution
(Meduri, Reynolds, Rassi, Burke, Popma) Beth Israel Deaconess Medical
Center, Boston, MA, USA, Harvard School of Public Health, Boston, MA, USA
Title
Cost-effectiveness of surgical aortic valve replacement versus
transcatheter aortic valve replacement in high-risk patients using
real-world registry data.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1866), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Cost-Effective Analysis (CEA) from recent RCTs comparing TAVR
and SAVR are useful but may not represent outcomes expected in a broad
clinical practice. Markov decision analytic modeling may provide useful
insights in this setting Methods: We developed a Markov decision analytic
lifetime model with Monte Carlo simulations in cohorts at "high risk"for
SAVR. We informed the TAVR arm of our model using data from a recent
meta-analysis of 16 registries using VARC outcomes (Genereux JACC 2012),
and 4 contemporary surgical registries. Utilities for TAVR and SAVR were
used from the Partner A data. Results: Probabilistic sensitivity analysis
using Monte Carlo simulation of 10,000 samples estimated that TAVR was
associated with a lifetime cost of $81,548 +/- $1,240 and an effectiveness
of 3.54 +/- 0.07 QALYS. Patients undergoing SAVR accumulated $99,641+/-
$3,126 and 3.45 +/- 0.08 QALYS. TAVR was found to be a dominant strategy.
The model was sensitive to variations in the probability of new dialysis
in SAVR patients. If this rate fell below 3.3% in the SAVR arm, SAVR
provided a greater net monetary benefit. Our estimated value with perfect
information (EVPI) would save $2,919 and gain 0.2 QALYS per patient by
using TAVR over SAVR. Discussion: In our decision model, TAVR was the
dominant strategy over SAVR, though with a significant reduction in cost
and small gain in QALYs. Prospective cost-analysis of these patients
outside the setting of clinical trials will be beneficial for further
evaluation of these therapies. (Table Presented).
<9>
Accession Number
71021226
Authors
Kodali S.K. . Murat Tuzcu E. Rihal C. Fearon W. Babaliaros V. Zajarias A.
Herrmann H. Williams M. Brown D.L. Mack M. Teirstein P. Whisenant B.
Makkar R. Kapadia S. Leon M.
Institution
(Kodali, . Murat Tuzcu, Rihal, Fearon, Babaliaros, Zajarias, Herrmann,
Williams, Brown, Mack, Teirstein, Whisenant, Makkar, Kapadia, Leon)
Columbia University Medical Center, New York, NY, United States
Title
Outcomes after transfemoral tavr from the non-randomized continued access
registry of the par TNER trial.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1863), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: The randomized phase of the PARTNER trial was an early
transcatheter aortic valve replacement (TAVR) experience for US sites and
operators using the Edwards Sapien valve. Subsequently, 1080 patients were
treated via transfemoral (TF) approach as part of a non-randomized
continued access (NRCA) registry. Methods: Inclusion/exclusion criteria,
data collection and monitoring were the same in NRCA as in the randomized
controlled trial (RCT); core labs for data analysis remained unchanged.
Baseline characteristics and outcomes of the 423 patients who underwent
TF-TAVR in the RCT were compared to the 1080 patients who underwent TF
TAVR in the NRCA phase. Event rates are presented as Kaplan-Meier
estimates. Results: NRCA patients were older (mean age 84.8 +/- 7.8 vs
83.6 +/- 7.6, p< 0.001), but had fewer comorbidities as evidenced by a
lower mean STS score (10.9 +/- 3.8 vs 11.5 +/- 4.5, p<0.001) and lower
frequency of cerebrovascular disease (21.4 vs 26.1, p=0.06), peripheral
vascular disease (27.4 vs 33.3, p=0.02) and renal disease (15.0 vs 20.4,
p=0.01). In hospital mortality was similar (4.9% vs 5.7%, p=0.54);
however, strokes were less frequent in NRCA than RCT (3.3% vs 5.4%,
p=0.06). Other complications including vascular and bleeding events in the
NRCA population are still undergoing adjudication, and will be available
for presentation. Procedure times were shorter and rates of
post-dilatation were lower (p<0.0001 for both measures), suggesting a
learning curve. One-year mortality (18.0% vs 25.8%, p=0.001) and strokes
(4.8% vs 7.3%, p=0.05) were lower in NRCA. The frequency of mod-severe
paravalvular regurgitation (PAR) was not different between RCT and NRCA
(15.3% vs 14.9%) and mod- severe PAR was associated with higher late
mortality compared to mild or none-trace PAR (37.8% vs 21.7% vs 20.2%,
p<0.001). Conclusions: The favorable results after TF-TAVR achieved in the
PARTNER RCT were reproduced in the subsequent NRCA. Procedural outcomes
have improved with device iteration and procedural learning. The
improvement in long term results suggests better patient selection with
greater experience. PAR remains a concern with current generation devices.
<10>
Accession Number
71021080
Authors
Bandeali S.J. Choudhary M.M. Virani S. Jneid H. Sewani S.A. Waqas A. Basra
S. Tsai P. Kleiman N. Coselli J. Lakkis N. Alam M.
Institution
(Bandeali, Choudhary, Virani, Jneid, Sewani, Waqas, Basra, Tsai, Kleiman,
Coselli, Lakkis, Alam) Baylor College of Medicine, Houston, TX, United
States
Title
PCI or coronary artery bypass graft: Implications in end-stage renal
disease patients.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1717), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Mode of coronary revascularization in end stage renal disease
(ESRD) patients remains a controversy due to lack of randomized clinical
trials. Improvements in PCI technology including use of drug eluting
stents has resulted in wide spread use of PCI in general population. We
therefore conducted a meta-analysis comparing the mortality outcomes in
ESRD patients undergoing PCI or CABG. Methods: A comprehensive time
unlimited PubMed search revealed 19 studies comparing PCI and CABG in ESRD
patients. Primary clinical endpoint was all-cause mortality at 30 days and
12 months follow-up. Long term mortality (24 and 36 months) was also
calculated. Subgroup analyses were performed on patients undergoing PTCA
vs. CABG and PCI vs. CABG. Odds ratio (OR) and confidence interval (CI)
were estimated using random effects model. Results: Of the 32696 patients
analyzed 17385 underwent PCI and 15311 underwent CABG. Revascularization
with PCI was associated with decreased mortality at 30 days in both PTCA
and PCI groups compared to CABG. However, this mortality benefit was not
maintained at subsequent follow-up (24, 36 months) with CABG being
superior among all groups. In a sensitivity analysis excluding the 2
largest studies (n=30090), CABG remained associated with lower mortality
at long term follow-up (Table). Conclusion: In ESRD patients undergoing
coronary revascularization with PCI, short-term mortality was low however,
at longer-term follow-up; CABG was associated with a lower risk of
all-cause death. (Table Presented).
<11>
Accession Number
71021012
Authors
Alomar M.E. Michael T.T. Rangan B.V. Banerjee S. Brilakis E.S.
Institution
(Alomar, Michael, Rangan, Banerjee, Brilakis) Dallas Veterans Affairs
Medical Center, Dallas, TX, USA, University of Texas Southwestern Medical
Center, Dallas, TX, USA
Title
Stent loss and retrieval during coronary intervention: A systematic review
and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1649), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Stent loss is an infrequent but potentially grave complication
of percutaneous coronary intervention (PCI). We performed a systematic
review to determine the frequency, treatment and consequences of stent
loss during PCI. Methods: We identified and reviewed all published
literature in English on stent loss between 1991 and 2012. We used
articles that contained data on number of patients/PCIs, number of lost
stents, clinical presentations, mechanisms of stent loss, management
strategies and clinical outcomes. Results: Between 1991 and 2012, 18 case
series and 45 case reports were published on stent loss. Overall, a total
of 1048 stents were lost in 968 PCIs. In the 18 case series, stent loss
occurred in 919 of 71,655 PCIs (2.4%, 95% confidence interval 1.1% to
3.7%). The incidence of stent loss was 5% in studies published before
2000, 1% between 2000 and 2005, and 0.3% after 2005 (p< 0.0001). The most
common mechanism of loss was target vessel calcification and/or tortuosity
in 347 cases (36%). Of the 1048 lost stents, 698 (66.4%) were successfully
retrieved from the coronary circulation: 381 (55%) were removed from the
body and 317(45%) were lost in the peripheral circulation. A total of 130
(12%) stents were deployed, 27 (3%) were crushed and 28 (2.6%) stents were
left undeployed/uncrushed. The treatment of 165 (16%) stents was not
reported. A complication occurred in 189 of 968 patients (20%): coronary
artery bypass graft surgery 107(51%), myocardial infarction 43(20%), death
33 (16%), bleeding requiring transfusion 11(5%), dissection 9(4%),
vascular surgery 2 (1%) and other complications 6 (3%) (some patients had
more than one event). Conclusions: The incidence of stent loss during PCI
is low and has been steadily decreasing. Although the lost stents were
successfully retrieved in the majority of cases, stent loss was associated
with high rates of complications, such as coronary artery bypass graft
surgery, myocardial infarction and death.
<12>
Accession Number
71020965
Authors
Alam M. Bandeali S. Kayani W. Shahzad S.A. Jneid H. Birnbaum Y. Kleiman N.
Coselli J. Ballantyne C. Lakkis N. Virani S.
Institution
(Alam, Bandeali, Kayani, Shahzad, Jneid, Birnbaum, Kleiman, Coselli,
Ballantyne, Lakkis, Virani) Baylor College of Medicine, Houston, TX,
United States
Title
Impact of female gender on mortality after isolated coronary artery bypass
grafting.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1602), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Introduction: Short & long term mortality in women undergoing CABG has
been evaluated in multiple studies with conflicting results. We conducted
meta-analysis of existing literature to evaluate the impact of female sex
on mortality in patients undergoing isolated CABG. Methods: A
comprehensive literature search (PubMed, Scopus, Ovid till 05/31/2012)
identified 20 studies comparing men & women undergoing isolated CABG.
All-cause mortality was evaluated at short (post-op and/or 30-days),
intermediate (1 yr) & long term (5 yr) follow-up. Review Manager 5.1 was
used to conduct meta-analysis using Odds ratio (OR) with random effects
model. Results: A total of 966492 patients [688709 men (71%); 277783 women
(29%)] were analyzed. Women were more likely to be older and had
significantly greater HTN, DM, HLD, unstable angina, CHF and PAD. Both
post-op (OR 1.85, 95% CI 1.66 - 2.05) & 30-day (OR 1.66, 95% CI 1.59 -
1.74) mortality were higher in women. At intermediate and long term
follow-up, mortality remained high in women. Women suffered from higher
short term mortality in two subgroup analyses including prospective
[41,500 patients, OR 1.83, 95% CI 1.59 - 2.12] and propensity score
matched studies [11,522 patients, OR 1.36; 95% CI 1.04-1.78] (Table).
Conclusion: Women undergoing isolated CABG experience higher mortality at
short, intermediate and long term follow-up compared to men. Mortality
remains independently associated with female sex even after propensity
score matched analysis of outcomes. (Table Presented).
<13>
Accession Number
71020818
Authors
Singh M. Kommu S. Sethi A. Arora R.
Institution
(Singh, Kommu, Sethi, Arora) Chicago Medical School, North Chicago, IL,
United States
Title
Omega-3 fatty acids in prevention of post-cardiac surgery at rial
fibrillation: A meta-analysis of randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1455), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Previous randomized studies have reported conflicting results
on the efficacy of omega-3 fatty acids (PUFA) in preventing atrial
fibrillation (AF) post cardiac surgery. Therefore, a meta-analysis of the
role of PUFA in the prevention of atrial fibrillation in post-cardiac
surgery patients was conducted. Methods: A systematic search was conducted
to identify all of the studies in human subjects published until end of
October 2012, that reported the effects PUFA on the prevention of atrial
fibrillation in post-cardiac surgery patients. Comprehensive meta-analysis
software version 2.0 was used for statistical analysis. Combined odds
ratios (OR) across all the studies and 95% confidence intervals (CI) were
computed. A two-sided alpha error <0.05 was considered statistically
significant. Results: A total of 2687 patients (1337 PUFA therapy group,
1387 placebo group) from 8 prospective randomized controlled studies were
included. Both groups had similar baseline characteristics. The use of
PUFA significantly reduced the incidence of postoperative AF (odds ratio
[OR] 0.75; 95% confidence interval [CI], 0.57 to 0.99; P: 0.04) [Figure
1]. On sensitivity analysis, no statistically significant difference was
noted when stratified by study design or quality of the studies.
Conclusions: In post-cardiac surgery patients, PUFA therapy significantly
reduces the risk of developing AF. (Table Presented).
<14>
Accession Number
71020640
Authors
Pradhan R. Okabe T. Yoshida K. Angouras D. Decaro M. Marhefka G.
Institution
(Pradhan, Okabe, Yoshida, Angouras, Decaro, Marhefka) Thomas Jefferson
University Hospital, Philadelphia, PA, USA, Attikon University Hospital,
Athens, Greece
Title
Patient characteristics and predictors of mortality associated with
pericardial decompression syndrome.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1277), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Pericardial decompression syndrome (PDS) is a rare and
potentially fatal complication of apparently successful
pericardiocentesis, characterized by paradoxical hemodynamic
deterioration, ventricular dysfunction and pulmonary edema. We sought to
elucidate epidemiology and clinical factors associated with mortality in
PDS. Methods: A systematic review of PDS reported in PubMed was performed.
We collected baseline clinical variables, echocardiographic and
hemodynamic variables, methods of drainage (needle versus surgical
drainage), amount of fluid, and clinical outcomes. A case of PDS from our
institution was added. T-test and Fisher's exact test were used for
analysis of continuous and categorical variables, respectively. Results:
Total 34 cases (male 12: female 22) were identified. Needle
pericardiocentesis, surgical drainage, or both were performed in 18, 15
and 1 patients, respectively. The procedure was done for cardiac tamponade
in 32 cases. The mean age was 48 +/- 17. Large effusion was seen in 29
(85%) cases. Twenty patients (59%) had an underlying malignancy.
Etiologies of effusion were malignant, infectious, traumatic,
post-radiation, postcardiotomy and unknown in 12 (35%), 3 (9%), 1 (4%),
1(4%), 1(4%) and 15 (44%) cases, respectively. Thirty cases reported the
amount of effusion drained, and the mean amount was 902 +/- 404 mL. The
minimum drained effusion was 450 mL. The onset of PDS after the procedure
varied widely, ranging from "immediate"to 48 hours. Cardiogenic pulmonary
edema without shock, left ventricular (LV) failure only, right ventricular
failure only, biventricular failure, and non cardiogenic pulmonary edema
were seen in 9 (26%), 14 (41%), 3 (9%), 7 (20%) and 1 (4%) cases,
respectively. Ten patients (33%) died of PDS. Mortality was seen only
after surgical drainage and the association was statistically significant
(p < 0.001). Severe LV dysfunction normalized in all PDS survivors.
Conclusion: PDS is a rare complication of pericardiocentesis with a high
mortality rate. The minimum amount of drained effusion in our series was
450 mL. Surgical drainage was a predictor of mortality in PDS.
<15>
Accession Number
71020567
Authors
Sun J.C. Don C. Kulik A. Verrier E. Aldea G.
Institution
(Sun, Don, Kulik, Verrier, Aldea) University of Washington, Seattle, WA,
United States
Title
Clopidogrel combined with aspirin improves graft patency after coronary
bypass surgery: Results of a systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E1204), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: The use of aspirin in the immediate postoperative period after
coronary artery bypass grafting (CABG) has been shown to improve survival,
graft patency and reduces ischemic events. Results of studies comparing
the combination of clopidogrel and aspirin versus aspirin alone after CABG
have been conflicting. Methods: A search strategy for MEDLINE and PubMed
for all English and non-English articles including coronary bypass surgery
and clopidogrel was created. Two reviewers independently performed the
search and applied predetermined inclusion and exclusion criteria for
randomized controlled trials (RCTs) comparing combination clopidogrel and
aspirin therapy to aspirin alone after CABG. The primary outcome was graft
patency and safety was measured using bleeding events. Outcomes were
pooled using a fixed effects model and Mantel-Hansel odds ratios were
used. Results: Four RCTs were included involving 761 patients (380
clopidogrel and aspirin, 381 aspirin alone) of whom 683 (89.8%) underwent
followup imaging of 2,252 bypass grafts to check for patency. Follow-up
imaging took place at 50-365 days after surgery. Meta-analysis showed
improved overall graft patency for patients receiving combined clopidogrel
and aspirin versus aspirin alone (OR 1.58 [1.13,2.21]). Subgroup analysis
by graft type showed a significant reduction in saphenous vein graft
failure (OR 1.68 [1.16,2.43]) with clopidogrel use but not for internal
mammary arteries or radial artery grafts. There was no difference detected
in total bleeding events between the two groups (0.92 [0.44,1.92]).
Conclusion: The addition of clopidogrel to aspirin in the immediate
postoperative period after CABG is safe and improved overall graft patency
driven mainly by a reduction in saphenous vein graft failure.
<16>
Accession Number
71019784
Authors
Smith-Parrish M. Yu S. Donohue J. Ohye R. Bove E. Best M.
Institution
(Smith-Parrish, Yu, Donohue, Ohye, Bove, Best) Caren Goldberg, University
of Michigan Health System, Ann Arbor, MI, United States
Title
A randomized clinical trial of regional cerebral perfusion versus deep
hypothermic circulatory arrest: Five-year follow-up for neurodevelopmental
outcomes in children with functional single ventricle.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E421), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Regional cerebral perfusion (RCP) has been endorsed as a
method to improve cerebral protection during neonatal aortic arch
reconstruction. However, no human study has demonstrated improvement in
developmental outcomes with RCP. We aimed to: 1. Compare early school-age
(ESA) neurodevelopmental outcomes among children with single ventricle who
underwent the Norwood operation with RCP rather than deep hypothermic
circulatory arrest (DHCA), 2. Determine the predictive value of early
developmental testing, and 3. Identify additional contributors to ESA
development. Methods: Children enrolled in the RCP randomized controlled
trial of infants with single ventricle undergoing the Norwood operation
with randomization to aortic arch reconstruction with either RCP or DHCA
were included. A comprehensive neuropsychological evaluation was performed
at ages 5-8 years with this analysis focusing on the Wechsler Intelligence
Scales. Additional candidate predictors were investigated as associated
with impaired neurodevelopment with chi square and t tests for categorical
and continuous variables respectively. Results: Forty-one patients
returned for ESA follow-up. The overall mean full scale IQ was 93.4 +/-
18.8 with a mean verbal IQ of 95.9 +/- 17.6, a mean performance IQ of 94.5
+/- 19.2, and a mean processing speed IQ of 92.5 +/- 15.2. There were no
statistical differences between the RCP and DHCA groups. The one year
Bayley Scale of Infant Development Psychomotor Development Index (r= 0.68,
p<0.0001) and Mental Development Index (r= 0.64, p<0.0001) correlated with
the full scale IQ at ESA. Participants with lower socioeconomic status
(SES) and those without fetal diagnosis had lower IQ scores. However, SES
was higher for those with a fetal diagnosis. Conclusion: Neurodevelopment
is delayed after the Norwood operation without an associated improvement
with RCP. Bayley Scale of Infant Development scores at 1 year predict ESA
measures, though additional unmeasured factors likely explain a
significant portion of ESA developmental outcomes. Fetal diagnosis and
higher SES are associated with higher IQ scores, but the mechanism remains
unclear as SES is higher among those with fetal diagnosis.
<17>
Accession Number
71019641
Authors
Adrian V.H. Kaw R. Pasupuleti V. Bina P. John P.A.I. Bueno H. Boersma E.
Institution
(Adrian, Kaw, Pasupuleti, Bina, John, Bueno, Boersma) Cleveland Clinic,
Cleveland, OH, USA, Universidad Peruana de Ciencias Aplicadas (UPC), Lima,
Peru
Title
Association between obesity and postoperative at rial fibrillation in
patients undergoing cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E278), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: The strongest evidence linking obesity and atrial fibrillation
(AF) in adults comes from the Framingham study. Up to 40% of patients
undergoing cardiac surgery are obese (BMI> 30). We systematically
evaluated whether obesity is associated with postoperative atrial
fibrillation (POAF) in patients undergoing cardiac surgery. Methods: A
literature search was conducted by three authors in Pubmed-MEDLINE, the
Web of Science and Scopus until December 2011. Our search was restricted
to observational studies in adult (>18 years-old) patients, with
information available on POAF in patients with and without obesity (subset
with categorical BMI) or on BMI distribution in patients with or without
POAF (subset with continuous BMI), published in any language. Only studies
that excluded the presence of preoperative AF were included in the
analysis. Secondary analyses evaluated whether POAF was associated with
postoperative complications (stroke, respiratory failure and operative
mortality). Meta-analysis used random effects models, and associations are
shown as Odds Ratios (OR) and 95% Confidence Intervals (CI). Subgroup
analyses by type of cardiac surgery (CABG vs. CABG + valve surgery), by
study design, and by year of publication were performed. Results: Eighteen
studies were included in the analysis (n=36,147). Obese patients had a
modest higher risk of POAF in comparison to non-obese (OR 1.12, 95%CI
1.04-1.21, p=0.002). POAF was associated with higher risk of stroke (OR
1.77, 95%CI 1.36-2.31, p<0.0001), respiratory failure (OR 2.11, 95%CI
1.29-3.45, p=0.003), and operative mortality (OR 2.76, CI 1.77- 4.32,
p<0.0001). The association between obesity and POAF did not vary
substantially by type of cardiac surgery, study design or year of
publication. Conclusions: In patients without known history of atrial
fibrillation undergoing cardiac surgery, presence of obesity is associated
with a modest increase in POAF risk. POAF is strongly associated with
other postoperative complications like stroke, respiratory failure and
postoperative mortality.
<18>
Accession Number
71019522
Authors
Karina W.D. Bigger J.T. Burg M. Carney R. William F.C. Czajkowski S. Joan
D.-H. Nancy F.-S. Freedland K. Haas D. Jaffe A. Ladapo J. Lesperance F.
Medina V. Newman J. Osorio G. Parsons F. Schwartz J. Shaffer J. Shapiro P.
David S.S. Vaccarino V. Whang W. Ye S.
Institution
(Karina, Bigger, Burg, Carney, William, Czajkowski, Joan, Nancy,
Freedland, Haas, Jaffe, Ladapo, Lesperance, Medina, Newman, Osorio,
Parsons, Schwartz, Shaffer, Shapiro, David, Vaccarino, Whang, Ye) Columbia
University Medical Center, New York, NY, United States
Title
Centralized, stepped, patient preference-based treatment for patients with
post-acute coronary syndrome depression: Codiacs vanguard randomized
control trial.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E158), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: Controversy remains about whether depression can be
successfully managed after acute coronary syndrome (ACS) and the costs and
benefits of doing so. Our objective was to determine the effects of
providing centralized, patient preference-based, stepped depression care
post- ACS on depressive symptoms and health care costs. Methods: We
performed a multicenter randomized controlled trial with 150 patients with
elevated depressive symptoms (Beck Depression Inventory score >10) 2 to 6
months after an ACS who were recruited and randomized from 7 private and
academic ambulatory centers across the United States between March 18,
2010 and January 9, 2012. Masked research staff assessed outcomes. The
intervention was six months of centralized depression care (patient
preference for problem-solving treatment, pharmacotherapy, both, or
neither), stepped every 6 to 8 weeks, given by telephone or the internet
(n=73) (active treatment group) compared with locally administered,
physician-guided depression care (usual care group) (n=77). The main
outcome measures were change in depressive symptoms during 6 months and
total health care costs. Results: Depressive symptoms decreased
significantly more (t = -3.5; P=.01) in the active treatment group
(change, -10.1; 95% confidence interval (CI), -12.0 to -8.1) than in the
usual care group (change, -6.6; 95% CI, -8.5 to -4.8). Although cost was
higher ($1110) for active treatment than usual care ($414; adjusted
difference, +$687; 95% CI, $466 to $909; P<.001), after including all
health care costs (ambulatory care, hospitalizations, and cardiac
procedures), the difference was no longer significant (adjusted
difference, -$325; 95% CI, -$2639 to +$1989; P=.78). Conclusions: For
patients with post-ACS depression, active treatment produced substantial
reduction in depression. The depressive symptom effect size of 0.59 was
approximately double that reported in meta-analyses of other depression
treatment trials. This kind of depression care is feasible, effective, and
cost neutral and should be tested in a large phase 3 pragmatic trial.
<19>
Accession Number
71019494
Authors
Veen G. Van Loon R. Kamp O. Van Rossum Albert C.
Institution
(Veen, Van Loon, Kamp, Van Rossum Albert) VU University Medical Center,
Amsterdam, Netherlands
Title
After thrombolysis for acute myocardial infarction culprit vessel
revascularization in patients with viability in the infarct area leads to
a significant improvement in ejection fraction when compared to a medical,
non-invasive management.
Source
Journal of the American College of Cardiology. Conference: 62nd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.13 San Francisco, CA United States.
Conference Start: 20130309 Conference End: 20130311. Conference
Publication: (var.pagings). 61 (10 SUPPL. 1) (pp E130), 2013. Date of
Publication: 12 Mar 2013.
Publisher
Elsevier USA
Abstract
Background: After thrombolysis for acute myocardial infarction (AMI) it
has been demonstrated that without revascularization viability in the
infarct area can be lost. We sought to determine the effect of
revascularization on the process of left ventricular remodeling in
patients with viability in the infarct-area in the early phase after AMI.
Methods: We prospectively investigated 224 patients who were included in
the VIAMI-trial (multicenter, randomized controlled clinical trial).
(Trials 2012; 13:1). Patients in the VIAMI-study did not undergo a primary
or rescue PCI and were stable in the early in-hospital phase. Patients
underwent a low-dose dobutamine echocardiography for the detection of
viability within 72 hours after AMI. Patients with viability were
randomized to an invasive strategy (culprit vessel stenting) or a
conservative strategy (ischemia guided approach). Patients without
viability were followed as a registry group. Follow up (FU)
echocardiography was performed at a mean of 205 days. For the purpose of
this substudy patients were divided in three groups. Group 1: viable and
revascularized before FU. Group 2: viable but medically treated. Group 3:
non-viable patients. Results: Group 1 showed preservation of left
ventricular (LV) volume indices. The ejection fraction (EF) increased
significantly from 54.0% to 57.5% (p=0.047). Group 2 showed a significant
increase in LV volume indices with no improvement in EF (53.3% vs. 53.0%,
p=0.86). Group 3 showed a significant increase in LV volume indices, with
a decrease in EF from 53.5% to 49.1% (p=0.043). Multivariate logistic
regression analysis indicated the number of viable segments and
revascularization during FU as independent predictors for EF improvement,
especially in patients with lower EF at baseline. Conclusion: Viability
early after acute myocardial infarction is associated with improvement in
LV function after revascularization. When viable myocardium is not
revascularized, the LV tends to remodel with increased LV volumes, without
improvement of EF. Absence of viability results in ventricular dilatation
and deterioration of EF.
<20>
Accession Number
2013205694
Authors
Leonardi S. Armstrong P.W. Schulte P.J. Ohman E.M. Newby L.K.
Institution
(Leonardi, Schulte, Ohman, Newby) Duke University Medical Center, Duke
Clinical Research Institute, PO Box 17969, Durham, NC 27715-7969, United
States
(Leonardi) Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
Title
Implementation of standardized assessment and reporting of myocardial
infarction in contemporary randomized controlled trials: A systematic
review.
Source
European Heart Journal. 34 (12) (pp 894-902), 2013. Date of Publication:
21 Mar 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Myocardial infarction (MI) is a key endpoint in randomized controlled
trials (RCTs), but heterogeneous definitions limit comparisons across RCTs
or meta-analyses. The 2000 European Society of Cardiology/American College
of Cardiology MI redefinition and the 2007 universal MI definition
consensus documents made recommendations to address this issue. In
cardiovascular randomized trials, we evaluated the impact of
implementation of three key recommendations from these reports - troponin
use to define MI; separate reporting of spontaneous and procedure-related
MI; and infarct size reporting. We searched ClinicalTrials.gov and MEDLINE
databases for cardiovascular RCTs with more than 500 patients in which
enrolment began between September 2000 and July 2012 and that listed MI in
the primary endpoint. We searched English-language publications with
primary results or design papers. Of 3222 studies screened, 96 (3.0%) met
our criteria. We extracted enrolment start date, number of patients and MI
events, follow-up duration, and coronary revascularization rate. Data
extraction quality was assessed by duplicated extractions. Of 96 RCTs, 80
had a primary results publication, comprising 608 091 patients and 43 621
endpoint MIs. Myocardial infarction represented 45.3% (95% confidence
interval, 40.2-50.4) of events in the primary composite endpoint. Troponin
defined MI in 57% (53/93) of trials with an MI definition available. Of
these RCTs, three used troponin only if creatine kinase-MB was
unavailable, six used troponin to define peri-procedural MI, seven
specified the 99th percentile as the MI decision limit, and three reported
spontaneous and procedure-related MI separately. None reported
biomarker-based infarct size, but five reported MI as multiples of the
assay upper limit of normal. Although MI is a major component of
cardiovascular RCT primary endpoints, standardized MI reporting and
implementation of consensus document recommendations for MI definition are
limited. Developing appropriate strategies for uniform implementation is
required. All rights reserved. The Author 2013.
<21>
Accession Number
2013180678
Authors
Carroll J.D. Saver J.L. Thaler D.E. Smalling R.W. Berry S. MacDonald L.A.
Marks D.S. Tirschwell D.L.
Institution
(Carroll) University of Colorado Denver, University of Colorado Hospital,
Aurora, CO, United States
(Saver) University of California Los Angeles, Los Angeles, CA, United
States
(Thaler) Tufts University, Tufts Medical Center, Boston, MA, United States
(Smalling) University of Texas, Memorial Hermann Heart and Vascular
Institute, Houston, TX, United States
(Berry) Berry Consultants, Austin, TX, United States
(MacDonald) South Denver Cardiology, Swedish Medical Center, Littleton,
CO, United States
(Marks) Medical College of Wisconsin Milwaukee, Milwaukee, WI, United
States
(Tirschwell) University of Washington, Seattle, WA, United States
Title
Closure of patent foramen ovale versus medical therapy after cryptogenic
stroke.
Source
New England Journal of Medicine. 368 (12) (pp 1092-1100), 2013. Date of
Publication: 21 Mar 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Whether closure of a patent foramen ovale is effective in the
prevention of recurrent ischemic stroke in patients who have had a
cryptogenic stroke is unknown. We conducted a trial to evaluate whether
closure is superior to medical therapy alone in preventing recurrent
ischemic stroke or early death in patients 18 to 60 years of age. METHODS:
In this prospective, multicenter, randomized, event-driven trial, we
randomly assigned patients, in a 1:1 ratio, to medical therapy alone or
closure of the patent foramen ovale. The primary results of the trial were
analyzed when the target of 25 primary end-point events had been observed
and adjudicated. RESULTS: We enrolled 980 patients (mean age, 45.9 years)
at 69 sites. The medical-therapy group received one or more antiplatelet
medications (74.8%) or warfarin (25.2%). Treatment exposure between the
two groups was unequal (1375 patient-years in the closure group vs. 1184
patient-years in the medical-therapy group, P=0.009) owing to a higher
dropout rate in the medical-therapy group. In the intention-to-treat
cohort, 9 patients in the closure group and 16 in the medical-therapy
group had a recurrence of stroke (hazard ratio with closure, 0.49; 95%
confidence interval [CI], 0.22 to 1.11; P=0.08). The between-group
difference in the rate of recurrent stroke was significant in the
prespecified per-protocol cohort (6 events in the closure group vs. 14
events in the medical-therapy group; hazard ratio, 0.37; 95% CI, 0.14 to
0.96; P=0.03) and in the as-treated cohort (5 events vs. 16 events; hazard
ratio, 0.27; 95% CI, 0.10 to 0.75; P=0.007). Serious adverse events
occurred in 23.0% of the patients in the closure group and in 21.6% in the
medical-therapy group (P=0.65). Procedure-related or device-related
serious adverse events occurred in 21 of 499 patients in the closure group
(4.2%), but the rate of atrial fibrillation or device thrombus was not
increased. CONCLUSIONS: In the primary intention-to-treat analysis, there
was no significant benefit associated with closure of a patent foramen
ovale in adults who had had a cryptogenic ischemic stroke. However,
closure was superior to medical therapy alone in the pre-specified
per-protocol and as-treated analyses, with a low rate of associated risks.
Copyright 2013 Massachusetts Medical Society.
<22>
Accession Number
71025371
Authors
Hardy J.-F.
Institution
(Hardy) University of Montreal, Montreal, QC, Canada
Title
The impact of post-operative anaemia: What is the evidence?.
Source
Transfusion Medicine. Conference: 14th Annual NATA Symposium Vienna
Austria. Conference Start: 20130418 Conference End: 20130419. Conference
Publication: (var.pagings). 23 (pp 13), 2013. Date of Publication: April
2013.
Publisher
Blackwell Publishing Ltd
Abstract
Anaemia is frequent after surgery, particularly after orthopaedic and
cardiac operations. Transfusion of allogeneic red blood cells (RBC) is one
of the many strategies used to treat this condition. An important
randomised controlled trial (RCT) in the critical care setting, the
Transfusion Requirements inCriticalCare (TRICC) trial, recommended the use
of a restrictive transfusion strategy, unless the patient has an active
coronary ischaemic syndrome (Hebert et al., 1999). Since then, some
physicians have adopted a more restrictive approach to transfusion not
only in the critical care setting but also in other settings where
patients may undergo important blood losses, keeping patients anaemic in
the early post-operative period (Vuille-Lessard et al., 2010). While such
a practice is not expected to have any effect on morbidity and mortality,
it remains unclear whether a lowered transfusion threshold allows optimal
functional recovery and quality of life (QoL) following major operations.
Patients undergoing major orthopaedic or cardiac surgeries are often
elderly and have several comorbidities that can lower their tolerance to
anaemia. They are asked to mobilise as soon as possible after surgery and
this increases theirmetabolic demand. Several clinicians believe that
anaemia will incapacitate patients, delay recovery and decrease QoL and
several observational studies may support this view. Notwithstanding the
interest of case reports, case series and registers, the gold standard in
establishing the benefits and the harms of a technology is the RCT
(Browner, 1994). The RCT is a study in which subjects are randomised to an
intervention or control and followed systematically for occurrence of
outcome. Randomisation and blinding of intervention avoid observator bias,
which would, otherwise, be inevitable. Thus, as opposed to observational,
single arm interventional studies or those using historical controls, the
RCT is the only study design where causality, both for benefits and for
harms, can be established. We review the evidence on the impact of
post-operative anaemia on QoL, morbidity and mortality. Fewer than 20 RCTs
have evaluated the impact of a restrictive vs a liberal transfusion
strategy and even fewer have evaluated its impact in surgical patients on
mortality, hospital length of stay, functional recovery, cardiac events,
myocardial infarction, pulmonary oedema, stroke, pneumonia, infections and
a number of other outcomes such as thromboembolism, etc (Carson et al.,
2012). The use of a restrictive transfusion strategy does not appear to
impact overall mortality nor the rate of adverse events. Similarly, a
restrictive transfusion strategy does not affect functional recovery nor
hospital length of stay. In summary, at present, the available evidence
from RCTs supports the use of a restrictive transfusion strategy and the
tolerance of moderate post-operative anaemia (Hb concentrations of 70-80 g
L<sup>-1</sup>). Transfusion of RBC to correct anaemia in an attempt to
improve postoperative recovery is, thus, not only unnecessary but may be
harmful in view of the known risks of RBC transfusions.
<23>
Accession Number
71025369
Authors
Stensballe J.
Institution
(Stensballe) Section for Transfusion Medicine, Capital Region Blood Bank,
Copenhagen, Denmark
(Stensballe) Department of Anesthesiology, Centre of Head and Orthopedics,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Title
Bleeding in cardiac surgery-the blood banker's perspective.
Source
Transfusion Medicine. Conference: 14th Annual NATA Symposium Vienna
Austria. Conference Start: 20130418 Conference End: 20130419. Conference
Publication: (var.pagings). 23 (pp 10-11), 2013. Date of Publication:
April 2013.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiothoracic surgery is associated with severe derangements in the
haemostatic system, coagulopathies, which in turn puts the patient at
risks of microvascular bleeding associated with increased risk of
excessive blood transfusions, surgical re-exploration and mortality.
Microvascular bleeding is associated with cardiopulmonary bypass (CPB),
dilution and fluid therapy, duration of surgery, and antithrombotics, etc.
Coagulopathies occurring in cardiothoracic surgery can be monitored by use
of viscoelastic haemostatic assays (VHA) such as Thrombelastrography TEG
or Thromboelastometry ROTEM. Several studies (involving more than 3000
patients, including three randomised controlled trials), have compared VHA
to routine coagulation tests showing superior ability to predict and
manage bleeding and transfusion requirements. Furthermore, in patients
developing coagulopathies, a close VHA monitoring guideline seems to
improve outcome. Finally, multiple electrode aggregometry (Multiplate)
evaluating measures of aggregation and effects of platelet inhibitors,
seems to be able to complement the VHAs in this respect. Allogeneic
transfusion is often used in cardiothoracic surgery, but its use may even
be harmful or not needed according to current evidence or guidelines.
There is a growing awareness among surgeons, anesthesiologists' and blood
bankers regarding the use of multidisciplinary, multimodal blood
conservation programmes in cardiothoracic surgery in order to reduce
bleeding and transfusion. Pharmacologic, real-time haemostatic monitoring
and cell saving methods should be part of such a blood conservation
programme, where strict adherence to guidelines on perioperative
regulation of antithrombotics is equally important. In conclusion, the
development of the different types of coagulopathies observed in
cardiothoracic surgical patients requires adequate and timely haemostatic
therapy in order to reduce bleeding and transfusion requirements.
Furthermore, multidisciplinary, multimodal blood conservation programmes
should be implemented in all the perioperative phases.
<24>
Accession Number
71026844
Authors
Tatsumi Y. Watanabe M. Kokubo Y. Nishimura K. Okamura T. Okayama A.
Miyamoto Y.
Institution
(Tatsumi, Watanabe, Kokubo, Nishimura, Miyamoto) National Cerebral and
Cardiovascular Cntr, Suita, Japan
(Okamura) Dept of Preventive Medicine and Public Health, Keio Univ, Suita,
Japan
(Okayama) First Institute of Health Service, Japan Anti-Tuberculosis
Association, Chiyoda-ku, Japan
Title
Age differences in the association between waist-to-height ratio and risk
of cardiovascular disease: The suita study.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Physical Activity, Nutrition and Metabolism 2013 Scientific
Sessions New Orleans, LA United States. Conference Start: 20130319
Conference End: 20130322. Conference Publication: (var.pagings). 127 (12
Meeting Abstracts) , 2013. Date of Publication: 26 Mar 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Waist-to-heightratio (WHtR) has been shown to be useful
global screening tool forcardiovascular disease (CVD) in the recent
meta-analysis. The impact of WHtR on the risks of CVD by age is not well
known. Hypothesis: We assessed whether the association between WHtR and
the risks of CVD was different by age categories. Methods: This study is a
population-based cohort study in an urban area of Japan. Study
participants comprised 5,488 Japanese urban residents (2,600 men and 2,888
women) aged 30-83 years with no history of CVD. At baseline (1989-1994),
waist circumference was measured at the umbilical level and height with
bare feet was measured. WHtR was calculated as waist circumference (cm)
divided by height (cm). The criteria of myocardial infarction were based
on the WHO Monitoring of Trends and Determinants in Cardiovascular Disease
Projects. In addition to myocardial infarction, we also evaluated coronary
angioplasty, coronary artery bypass grafting and sudden cardiac death, all
of which were defined as coronary heart disease (CHD). A stroke was
defined according to criteria from the US National Survey of Stroke and
confirmed by computed tomography. We stratified participants by sex and
age groups (30-49, 50-69 and 70-83 years). The Cox proportional hazard
ratios (HRs) and 95% confidence intervals (95% CIs) for CVD according to
the quartiles of WHtR were calculated after adjustment for age, smoking
and drinking status. Results: During the follow-up period (13.0 years in
average), 428 CVD events (184 CHD and 244 strokes) were observed. Men with
the highest quartile of WHtR aged 50-69 years had significantly increased
the risks of CVD and CHD, compared with the lowest quartile; the HRs (95%
CIs) were 1.81 (1.13-2.90) and 2.47 (1.17-5.20), respectively. There were
statistically significant linear increases in the HRs of CVD (p for trend
=0.01), CHD (p for trend =0.02) and cerebral infarction (p for trend
=0.03) in this group. Women with the highest quartile of WHtR aged 50-69
years had significantly increased the risks of stroke; the HRs (95% CIs)
was 2.43 (1.01-5.84). There were statistically significant linear
increases in the HRs of CVD (p for trend =0.04) and stroke (p for trend
=0.04) in this group. However, the similar results were not observed in
the other age groups in both sexes. We observed a significant interaction
between age groups and WHtR categories for the risks of CVD in men (p for
interaction=0.02). Conclusions: The association between WHtR and CVD was
different among age groups. WHtR could be useful to predict the risks of
CVD in middle aged men and women.
<25>
Accession Number
71026445
Authors
Daher A. Ritz S.B. Graessle W. Asuncion A.M.
Institution
(Daher) Pediatrics, Cooper University Hospital, Collingswood, NJ, United
States
(Ritz) NemoursUnited States
(Graessle, Asuncion) Cooper University Hospital, United States
Title
Can electrocardiogram (ECG) interpretation be taught to pediatric
residents?.
Source
Congenital Heart Disease. Conference: American Academy of Pediatrics
Section on Cardiology and Cardiac Surgery 2012 New Orleans, LA United
States. Conference Start: 20121019 Conference End: 20121021. Conference
Publication: (var.pagings). 7 (5) (pp 511-512), 2012. Date of Publication:
September-October 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose. Accurate electrocardiogram (ECG) interpretation is paramount to
patient care and may prevent unnecessary delay in care delivery and
unwarranted referrals. We established a curriculum to enhance pediatric
residents' ECG interpretation skills. Methods. The curriculum consisted of
a lecture reviewing ECG interpretation methods, common pediatric
arrhythmias and characteristic ECG morphologic findings. A weekly ECG
unknown (n = 17) was distributed to 25 pediatric residents followed later
by an annotated interpretation with a systematic review of pertinent
findings and case review. A test consisting of 15 different ECGs for
interpretation (perfect score = 30) and 5 technical measurements (perfect
score = 5) was administered to residents at baseline and 6 months later.
Residents were surveyed regarding their use of the "ECG of the Week"
educational tool and perceived efficacy. Results. An improvement of at
least 10% in total score was seen in 60% of all residents (PGY1 30.0%;
PGY2 85.7%; PGY3 75.0%, P = .04). The PGY1 class improved in technical
measurements, from mean of 2.0 to 3.4 (P = .02). The PGY2 and PGY3 classes
improved in interpretation skills from mean score of 11.4 to 18.7 (P =
.01), and 14.3 to 19.9 (P = .3), respectively. The pretest diagnoses most
missed were right ventricular hypertrophy, long QTc, and sinus arrhythmia
(84%, 80%, and 76% respectively). The diagnosis most frequently identified
correctly was pericarditis (80% pre, 88% post). Improved correct
recognition was seen in at least 40% of residents for diagnoses of sinus
arrhythmia, right bundle branch block, ventricular tachycardia, and long
QT. 14/15 residents who reported participating consistently in the "ECG of
the Week" showed improvement in total scores (93.3%) in contrast to only
40% of the rest (P < .01). 84.0% of all participants reported the weekly
activity useful and 96.0% felt it should be repeated every year.
Conclusion. This study demonstrates improvement in ECG technical skills in
PGY1 residents and improvement in interpretation skills in PGY2 and PGY3
residents participating in the educational intervention. Acceptance of the
intervention was high among participants. These data suggest areas of
focus for future educational interventions to target identified weaknesses
in ECG interpretation.
<26>
Accession Number
71026329
Authors
Takhar H. Khow K. Dua D. Koczwara B. Karapetis C. Kichenadasse G.
Institution
(Takhar, Khow, Dua, Koczwara, Kichenadasse, Karapetis, Kichenadasse)
Medical Oncology Unit, Flinders Medical Centre, Adelaide, Australia
Title
Intrapericardial chemotherapy for malignant pericardial effusion: Systemic
review.
Source
Asia-Pacific Journal of Clinical Oncology. Conference: Medical Oncology
Group of Australia Incorporated Annual Scientific Meeting: Targeting
Cancer from Diagnosis to Cure and 5th Annual COGNO Annual Scientific
Meeting 2012 Brisbane, QLD Australia. Conference Start: 20120808
Conference End: 20120810. Conference Publication: (var.pagings). 8 (pp
57), 2012. Date of Publication: August 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Malignant pericardial effusion (MPE) resulting in cardiac
tamponade is an uncommon but life threatening complication of cancer. The
most common malignancies associated with MPE are lung, breast, lymphoma
and oesophageal cancer. In addition to pericardiocentesis, the use of
intrapericardial chemotherapy and sclerosing agents may assist in
preventing recurrence and prolong survival by treating the local
neoplastic disease. We have conducted a systematic review of
intrapericardial chemotherapy for MPE in order to provide recommendation
for a standardised approach to therapy and directions for research in this
area. Methods: A search for publications was conducted in PubMed database
using the key terms: malignant, pericardial, effusion, intrapericardial,
chemotherapy. Studies were included if they met the objectives of our
systematic review. Results: 70 publications were identified. 42
publications addressed the use of intrapericardial chemotherapy in MPE of
which, 17 cases studies, 1 retrospective audit, 1 review article and 23
prospective trials. The most common agents investigated included
cisplatin, bleomycin and thiopeta. A number of prospective studies have
shown intrapericardial chemotherapy, in addition to pericardiocentesis,
trending towards improved survival and reduced recurrence. The major
limitation of these studies is the small number of patients included in
individual trials and the variety of agents trialled. Conclusions: Within
the limitations of the available evidence, there appears to be a modest
advantage to intrapericardial chemotherapy post pericardial drainage. A
standardised protocol to ensure consideration of this approach for
appropriate patients should be considered (example protocol will be
presented). A prospective registry of patients with malignant pleural
effusions will assist in more comprehensive evaluation of this approach in
a real life setting.
<27>
Accession Number
2013197133
Authors
Hradec J. Vitouec J. Spinar J.
Institution
(Hradec) 3rd Department of Medicine, First Faculty of Medicine and Faculty
General Hospital, Charles University Prague, Czech Republic
(Vitouec) Internal Department of Cardiology and Angiology, Faculty of
Medicine and Faculty St. Ann's Hospital, Masaryk University Brno, Czech
Republic
(Spinar) Internal-Cardiology Department, Faculty of Medicine and Faculty
Hospital Brno, Czech Republic
Title
Summary of the ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure 2012. Prepared by the Czech Society of Cardiology.
Source
Cor et Vasa. 55 (1) (pp E25-E40), 2013. Date of Publication: February
2013.
Publisher
Elsevier Science B.V. (P.O. Box 1527, Amsterdam 1000 BM, Netherlands)
<28>
Accession Number
2013115186
Authors
Haider K. Pinsky M.R.
Institution
(Haider, Pinsky) Department of Critical Care Medicine, University of
Pittsburgh, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261,
United States
(Pinsky) The Clinical Research, Investigation and Systems Modeling of
Acute Illness (CRISMA) Center, University of Pittsburgh, 606 Scaife Hall,
3550 Terrace Street, Pittsburgh, PA 15261, United States
Title
Early surgery for native valve infective endocarditis.
Source
Critical Care. 17 (1) , 2013. Article Number: 304. Date of Publication: 18
Feb 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: The timing and indications for surgical intervention to
prevent systemic embolism in infective endocarditis (IE) remain
controversial. This trial compares clinical outcomes of early surgery and
conventional treatment in patients with IE.Methods: Results: Thirty-seven
patients were assigned to the early-surgery group (<48 hours), whereas 39
were assigned to conventional therapy. Of the 39 randomly assigned to
conventional therapy, 27 patients (77%) underwent surgery during the
initial hospitalization and three during follow-up. One patient (3%) in
the early-surgery group and nine (23%) in the conventional-treatment group
reached the primary endpoint (hazard ratio (HR) 0.10, 95% confidence
interval (CI) 0.01 to 0.82; P = 0.03). There was no significant difference
in all-cause mortality at 6 months in the early-surgery and
conventional-treatment groups (3% and 5%, respectively; HR 0.51, 95% CI
0.05 to 5.66; P = 0.59). The rates of the composite endpoint of death from
any cause, embolic events, or recurrence of IE at 6 months were 3% in the
early-surgery group and 28% in the conventional-treatment group (HR 0.08,
95% CI 0.01 to 0.65; P = 0.02). Conclusions: Early surgery in patients
with IE and large vegetations significantly reduced the composite endpoint
of death from any cause and embolic events by effectively decreasing the
risk of systemic embolism. 2013 BioMed Central Ltd.
<29>
[Use Link to view the full text]
Accession Number
2013192962
Authors
Rady M.Y. Verheijde J.L.
Institution
(Rady) Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo
Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States
(Verheijde) Department of Physical Medicine and Rehabilitation, Mayo
Clinic Hospital, Mayo Clinic, Phoenix, AZ, United States
Title
No-touch time in donors after cardiac death (nonheart-beating organ
donation).
Source
Current Opinion in Organ Transplantation. 18 (2) (pp 140-147), 2013. Date
of Publication: April 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE OF REVIEW: To evaluate arterial pulselessness and the no-touch
time of 5aSmin in defining irreversible cessation of cardiorespiratory
functions in nonheart-beating donation (NHBD). RECENT FINDINGS:
Experimental NHBD studies identified compensatory neurohumoral mechanisms
elicited in controlled terminal shock after withdrawal of life support.
The neurohumoral mechanisms can preserve the viability of the
cardiovascular and central nervous systems by: 1) diverting systemic blood
flow from nonvital to vital organs; and 2) maintaining the perfusion
pressure (arterial to venous pressure gradient minus interstitial tissue
pressure) and microcirculation in vital organs. These compensatory
mechanisms cause an early onset of splanchnic hypoperfusion and antemortem
ischaemia of transplantable organs and preclude irreversible cessation of
cardiorespiratory functions after brief periods of circulatory arrest.
Allograft ischaemia is associated with primary nonfunction or delayed
function in transplant recipients similar in aetiology to organ
dysfunction in the postresuscitation phase of shock. SUMMARY: In-situ
perfusion can reverse ceased cardiac and neurological functions after
arterial pulselessness and a no-touch time of 5aSmin in experimental
models. Perfusion pressures are superior to arterial pulselessness in
determining reversibility of ceased cardiac and neurological functions in
circulatory arrest. Utilizing physiologically relevant circulatory and
neurological parameters in NHBD protocols is essential for ascertaining
irreversible cessation of vital functions in donors. 2013 Wolters Kluwer
Health | Lippincott Williams & Wilkins.
<30>
Accession Number
2013198949
Authors
Lellouche F. Bouchard P.-A. Simard S. L'Her E. Wysocki M.
Institution
(Lellouche, Bouchard, Simard) Centre de Recherch, Institut Universitaire
de Cardiologie et de Pneumologie de Quebec, Universite Laval 2725, Chemin
Sainte-Foy, Quebec City, QC G1V 4G5, Canada
(L'Her) Hotel Dieu de Levis, Quebec City, Canada
(L'Her) Centre Hospitalier Universitaire la Cavale Blanche, Brest, France
(Wysocki) GE Healthcare, Life Care Solution Europe, Buc, France
Title
Evaluation of fully automated ventilation: A randomized controlled study
in post-cardiac surgery patients.
Source
Intensive Care Medicine. 39 (3) (pp 463-471), 2013. Date of Publication:
March 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Discrepancies between the demand and availability of clinicians
to care for mechanically ventilated patients can be anticipated due to an
aging population and to increasing severity of illness. The use of
closed-loop ventilation provides a potential solution. The aim of the
study was to evaluate the safety of a fully automated ventilator. Methods:
We conducted a randomized controlled trial comparing automated ventilation
(AV) and protocolized ventilation (PV) in 60 ICU patients after cardiac
surgery. In the PV group, tidal volume, respiratory rate, FiO<sub>2</sub>
and positive end-expiratory pressure (PEEP) were set according to the
local hospital protocol based on currently available guidelines. In the AV
group, only sex, patient height and a maximum PEEP level of 10
cmH<sub>2</sub>O were set. The primary endpoint was the duration of
ventilation within a "not acceptable" range of tidal volume. Zones of
optimal, acceptable and not acceptable ventilation were based on several
respiratory parameters and defined a priori. Results: The patients were
assigned equally to each group, 30 to PV and 30 to AV. The percentage of
time within the predefined zones of optimal, acceptable and not acceptable
ventilation were 12 %, 81 %, and 7 % respectively with PV, and 89.5 %, 10
% and 0.5 % with AV (P < 0.001). There were 148 interventions required
during PV compared to only 5 interventions with AV (P < 0.001).
Conclusion: Fully AV was safe in hemodynamically stable patients
immediately following cardiac surgery. In addition to a reduction in the
number of interventions, the AV system maintained patients within a
predefined target range of optimal ventilation. 2013 Springer-Verlag
Berlin Heidelberg and ESICM.
<31>
Accession Number
2013198944
Authors
Wolters A.E. Slooter A.J.C. Van Der Kooi A.W. Van Dijk D.
Institution
(Wolters, Slooter, Van Der Kooi, Van Dijk) Department of Intensive Care
Medicine, University Medical Center Utrecht, Mail Stop F.06.149 PO Box
85500, 3508 GA Utrecht, Netherlands
Title
Cognitive impairment after intensive care unit admission: A systematic
review.
Source
Intensive Care Medicine. 39 (3) (pp 376-386), 2013. Date of Publication:
March 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: There is increasing evidence that critical illness and treatment
in an intensive care unit (ICU) may result in significant long-term
morbidity. The purpose of this systematic review was to summarize the
current literature on long-term cognitive impairment in ICU survivors.
Methods: PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO and Embase
were searched from January 1980 until July 2012 for relevant articles
evaluating cognitive functioning after ICU admission. Publications with an
adult population and a follow-up duration of at least 2 months were
eligible for inclusion in the review. Studies in cardiac surgery patients
or subjects with brain injury or cardiac arrest prior to ICU admission
were excluded. The main outcome measure was cognitive functioning.
Results: The search strategy identified 1,128 unique studies, of which 19
met the selection criteria and were included. Only one article compared
neuropsychological test performance before and after ICU admission. The 19
studies that were selected reported a wide range of cognitive impairment
in 4-62 % of the patients after a follow-up of 2-156 months. Conclusion:
The results of most studies of the studies reviewed suggest that critical
illness and ICU treatment are associated with long-term cognitive
impairment. Due to the complexity of defining cognitive impairment, it is
difficult to standardize definitions and to reach consensus on how to
categorize neurocognitive dysfunction. Therefore, the magnitude of the
problem is uncertain. 2013 Springer-Verlag Berlin Heidelberg and ESICM.
