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<1>
Accession Number
2013460634
Authors
Turner A. Hambridge J. Baker A. Bowman J. McElduff P.
Institution
(Turner, Hambridge) Liaison Psychiatry Department, John Hunter Hospital,
Newcastle, Australia
(Turner, Baker, McElduff) School of Medicine and Public Health, University
of Newcastle, University of Newcastle, Newcastle, NSW 2308, Australia
(Bowman) Health Psychology, School of Behavioural Sciences, University of
Newcastle, Newcastle, Australia
Title
Randomised controlled trial of group cognitive behaviour therapy versus
brief intervention for depression in cardiac patients.
Source
Australian and New Zealand Journal of Psychiatry. 47 (3) (pp 235-243),
2013. Date of Publication: March 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: To determine whether a six-session group cognitive behaviour
therapy (CBT) programme results in a greater reduction in depression
symptoms than a brief intervention alone in cardiac patients with
clinically significant symptoms of depression. Method: Fifty-seven
community dwelling cardiac patients scoring >13 on the Beck Depression
Inventory-II (BDI-II) received a single-session brief intervention. They
were then block randomised to either six sessions of group CBT (n = 25) or
no further intervention (BI; n = 32). All were re-assessed at 2, 6 and 12
months. Differences between treatment groups in the primary (BDI-II) and
secondary [rates of depression; anxiety symptoms, as measured by the
Hospital Anxiety and Depression Scale-Anxiety (HADS-A)] outcomes were
examined using generalised linear mixed models with a random intercept
term for the individual. Results: Significant improvements were seen for
the total group from baseline to 12 months on BDI-II and HADS-A scores.
However, no differences were found between the CBT and BI conditions on
change in BDI-II score, rates of major depressive episode or HADS-A score.
Post hoc analysis on the total group found 12-month symptom non-remission
was associated with higher baseline BDI-II score (p = 0.03), more visits
to health professionals 12 months prior to baseline (p = 0.05) and a
greater likelihood of either drinking alcohol over recommended levels or
smoking at baseline (p = 0.01). Conclusions: Group CBT of up to six
sessions did not result in greater reductions in depression or anxiety
symptoms compared with a single-session brief intervention. Further work
should focus on the efficacy and role of brief interventions, and
addressing smoking and alcohol misuse in cardiac patients with depression.
2012 The Royal Australian and New Zealand College of Psychiatrists.

<2>
Accession Number
2013436938
Authors
Natsuaki M. Kozuma K. Morimoto T. Kadota K. Muramatsu T. Nakagawa Y.
Akasaka T. Igarashi K. Tanabe K. Morino Y. Ishikawa T. Nishikawa H. Awata
M. Abe M. Okada H. Takatsu Y. Ogata N. Kimura K. Urasawa K. Tarutani Y.
Shiode N. Kimura T.
Institution
(Natsuaki, Kimura) Department of Cardiovascular Medicine, Kyoto
University, Graduate School of Medicine, 54 Shogoin Kawahara-cho,
Sakyo-ku, Kyoto 606-8507, Japan
(Kozuma) Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
(Morimoto) Center for General Internal Medicine and Emergency Care, Kinki
University School of Medicine, Osaka-Sayama, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Muramatsu) Division of Cardiology, Saiseikai Yokohama-City Eastern
Hospital, Yokohama, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University Hospital, Wakayama, Japan
(Igarashi) Division of Cardiology, Hokkaido Social Insurance Hospital,
Sapporo, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Iwate Medical University Hospital,
Morioka, Japan
(Ishikawa) Division of Cardiology, Saitama Cardiovascular and Respiratory
Center, Kumagaya, Japan
(Nishikawa) Division of Cardiology, Mie Heart Center, Mie, Japan
(Awata) Division of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
(Abe) Division of Cardiology, National Hospital Organization Kyoto Medical
Center, Kyoto, Japan
(Okada) Division of Cardiology, Seirei Hamamatsu General Hospital,
Hamamatsu, Japan
(Takatsu) Division of Cardiology, Hyogo Prefectural Amagasaki Hospital,
Amagasaki, Japan
(Ogata) Division of Cardiology, Tokai University Hospital, Isehara, Japan
(Kimura) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Urasawa) Division of Cardiology, Caress Sapporo Tokeidai Memorial
Hospital, Sapporo, Japan
(Tarutani) Division of Cardiology, Okamura Memorial Hospital, Shizuoka,
Japan
(Shiode) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
Title
Biodegradable polymer biolimus-eluting stent versus durable polymer
everolimus-eluting stent: A randomized, controlled, noninferiority trial.
Source
Journal of the American College of Cardiology. 62 (3) (pp 181-190), 2013.
Date of Publication: 16 Jul 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives NEXT (NOBORI Biolimus-Eluting Versus XIENCE/PROMUS
Everolimus-Eluting Stent Trial) was designed for evaluating the
noninferiority of a biolimus-eluting stent (BES) relative to an
everolimus-eluting stent (EES) in terms of target lesion revascularization
(TLR) at 1 year. Background Efficacy and safety data comparing
biodegradable polymer BES with durable polymer cobalt-chromium EES are
currently limited. Methods The NEXT trial is a prospective, multicenter,
randomized, open-label, noninferiority trial comparing BES with EES.
Between May and October 2011, 3,235 patients were randomly assigned to
receive either BES (n = 1,617) or EES (n = 1,618). Results At 1 year, the
primary efficacy endpoint of TLR occurred in 67 patients (4.2%) in the BES
group, and in 66 patients (4.2%) in the EES group, demonstrating
noninferiority of BES relative to EES (p for noninferiority <0.0001, and p
for superiority = 0.93). Cumulative incidence of definite stent thrombosis
was low and similar between the 2 groups (0.25% vs. 0.06%, p = 0.18). An
angiographic substudy enrolling 528 patients (BES: n = 263, and EES: n =
265) demonstrated noninferiority of BES relative to EES regarding the
primary angiographic endpoint of in-segment late loss (0.03 +/- 0.39 mm
vs. 0.06 +/- 0.45 mm, p for noninferiority <0.0001, and p for superiority
= 0.52) at 266 +/- 43 days after stent implantation. Conclusions One-year
clinical and angiographic outcome after BES implantation was noninferior
to and not different from that after EES implantation in a mostly stable
coronary artery disease population. One-year clinical outcome after both
BES and EES use was excellent, with a low rate of TLR and extremely low
rate of stent thrombosis. (NOBORI Biolimus-Eluting Versus XIENCE/PROMUS
Everolimus-Eluting Stent Trial [NEXT]; NCT01303640). 2013 by the American
College of Cardiology Foundation.

<3>
Accession Number
2013433814
Authors
Gao R.-L. Xu B. Lansky A.J. Yang Y.-J. Ma C.-S. Han Y.-L. Chen S.-L. Li H.
Zhang R.-Y. Fu G.-S. Yuan Z.-Y. Jiang H. Huo Y. Li W. Zhang Y.-J. Leon
M.B.
Institution
(Gao, Xu, Yang, Li) Department of Cardiology, Fu Wai Hospital, National
Center for Cardiovascular Diseases of China, No.167 Beilishi Road, Xicheng
District, 100037 Beijing, China
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Ma) Capital Medical University, Beijing, China
(Han) Shenyang Northern Hospital, Shenyang, China
(Chen, Zhang) Nanjing First Hospital, Nanjing Medical University, Nanjing,
China
(Li) Daqing Oil Field General Hospital, Daqing, China
(Zhang) Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Fu) Zhejiang University School of Medicine, Hangzhou, China
(Yuan) Xi'An Jiaotong University School of Medicine, Xi'an, China
(Jiang) Wuhan University People's Hospital, Wuhan, China
(Huo) Peking University First Hospital, Beijing, China
(Leon) Columbia University Medical Center, New York, NY, United States
Title
A randomised comparison of a novel abluminal groove-filled biodegradable
polymer sirolimus-eluting stent with a durable polymer everolimus-eluting
stent: Clinical and angiographic follow-up of the TARGET I trial.
Source
EuroIntervention. 9 (1) (pp 75-83), 2013. Date of Publication: 2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The study sought to evaluate the safety and efficacy of FIREHAWK, a
novel abluminal groove-filled biodegradable polymer sirolimus-eluting
stent (SES) for treating patients with single de novo coronary lesions
compared with the durable polymer everolimus-eluting stent (EES) XIENCE V.
Methods and results: A total of 458 patients with single de novo native
coronary lesions <=24 mm in length and a coronary artery >=2.25 to <=4.0
mm in diameter were enrolled in the TARGET I study, a prospective,
randomised, non-inferiority trial. The primary endpoint was in-stent late
lumen loss (LLL) at nine-month follow-up. The secondary endpoint, target
lesion failure (TLF), was defined as the composite of cardiac death,
target vessel myocardial infarction (TVMI), or ischaemia-driven target
lesion revascularisation (iTLR). Patients were centrally randomised to
treatment with either biodegradable polymer SES (n=227) or durable polymer
EES (n=231). The nine-month in-stent LLL of the biodegradable polymer SES
was comparable to the EES group (0.13+/-0.24 mm vs. 0.13+/-0.18 mm,
p=0.94; difference and 95% confidence interval 0.00 [-0.04, 0.04] mm; p
for non-inferiority <0.0001). Cardiac death (0.4% vs. 0.0%), TVMI (1.3%
vs. 1.7%), iTLR (0.4% vs. 0.4%) and TLF (2.2% vs. 2.2%) were similar
between the biodegradable polymer SES and durable polymer EES groups at
12-month follow-up (all p>0.05). No definite/probable stent thrombosis was
observed in both of these groups. Conclusions: In the multicentre TARGET I
trial, the novel abluminal groove-filled biodegradable polymer SES
FIREHAWK was non-inferior to the durable polymer EES XIENCE V with respect
to the primary endpoint of in-stent LLL at nine months for treating
patients with single de novo coronary lesions. The incidences of clinical
endpoints were low in both of the stents at 12-month follow-up.
(ClinicalTrials.gov identifier: NCT01196819). Europa Digital & Publishing
2013. All rights reserved.

<4>
Accession Number
2013433811
Authors
Badings E.A. The S.H.K. Dambrink J.-H.E. Van Wijngaarden J. Tjeerdsma G.
Rasoul S. Timmer J.R. Van Der Wielen M.L.J. Lok D.J.A. Van't Hof A.W.J.
Institution
(Badings, Van Wijngaarden, Lok) Deventer Ziekenhuis, Deventer, Netherlands
(Dambrink, Rasoul, Timmer, Van't Hof) Department of Cardiology, Isala
Klinieken, Groot Wezenland 20, 8011 JW Zwolle, Netherlands
(The, Van Der Wielen) Ziekenhuis Bethesda, Hoogeveen, Netherlands
(Tjeerdsma) Ziekenhuis de Tjongerschans, Heerenveen, Netherlands
Title
Early or late intervention in high-risk non-ST-elevation acute coronary
syndromes: Results of the ELISA-3 trial.
Source
EuroIntervention. 9 (1) (pp 54-61), 2013. Date of Publication: 2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To compare an early to a delayed invasive strategy in high-risk
patients with NSTE-ACS. Methods and results: In this prospective
multicentre trial, 542 patients hospitalised with NSTE-ACS were randomised
to either an immediate (angiography and revascularisation if appropriate
<12 hr) or a delayed invasive strategy (>48 hr after randomisation).
Patients were eligible if they had two of the following three high-risk
characteristics: evidence of extensive myocardial ischaemia on ECG,
elevated biomarkers for myocardial necrosis (TropT >0.10 mug/L), and an
age above 65 years. Primary endpoint of the study was the combined
incidence of death, reinfarction and/or recurrent ischaemia at 30-day
follow-up. Secondary endpoints were enzymatic infarct size as assessed by
a single cardiac troponin T, at 72-96 hours after admission or at
discharge, and the percentage of patients without a rise in CKMB during
admission. Median age was 71.9 (interquartile range [IQR] 64.5-78.4)
years. Median time between randomisation and start of angiography was 2.6
(IQR 1.2-6.2) hours in the immediate and 54.9 (44.2-74.5) hours in the
delayed intervention group. The composite of death, reinfarction and/or
recurrent ischaemia at 30 days occurred in 12% of patients and was not
significantly different between the two groups (9.9% and 14.2%,
respectively, p=0.135). All secondary endpoints and bleeding complications
were comparable. Hospital duration was two days shorter in the immediate
intervention group (4 days [IQR 2-10] vs. 6 days [IQR 4-12]). Conclusions:
Although no definitive conclusion can be drawn due to a lower than
expected prevalence of the primary endpoint, an immediate invasive
strategy was safe and feasible but not superior to a delayed invasive
strategy in terms of the combined primary endpoint of death, reinfarction
and/or recurrent ischaemia at 30 days. These results are consistent with
previous randomised trials which studied the effect of timing of
angiography in patients with NSTE-ACS. Trial Registration: ISRCTN Register
9230163. Europa Digital & Publishing 2013. All rights reserved.

<5>
Accession Number
21819581
Authors
Paulus F. Veelo D.P. de Nijs S.B. Beenen L.F. Bresser P. de Mol B.A.
Binnekade J.M. Schultz M.J.
Institution
(Paulus) Department of Intensive Care Medicine, Academic Medical Center,
Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Title
Manual hyperinflation partly prevents reductions of functional residual
capacity in cardiac surgical patients--a randomized controlled trial.
Source
Critical care (London, England). 15 (4) (pp R187), 2011. Date of
Publication: 2011.
Abstract
Cardiac surgery is associated with post-operative reductions of functional
residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway
plugging, and as such could prevent the reduction of FRC after surgery.
The main purpose of this study was to determine the effect of MH on
post-operative FRC of cardiac surgical patients. This was a randomized
controlled trial of patients after elective coronary artery bypass graft
and/or valve surgery admitted to the intensive care unit (ICU) of a
university hospital. Patients were randomly assigned to a "routine MH
group" (MH was performed within 30 minutes after admission to the ICU and
every 6 hours thereafter, and before tracheal extubation), or a "control
group" (MH was performed only if perceptible (audible) sputum was present
in the larger airways causing problems with mechanical ventilation, or if
oxygen saturation (SpO2) dropped below 92%). The primary endpoint was the
reduction of FRC from the day before cardiac surgery to one, three, and
five days after tracheal extubation. Secondary endpoints were SpO2 (at
similar time points) and chest radiograph abnormalities, including
atelectasis (at three days after tracheal extubation). A total of 100
patients were enrolled. Patients in the routine MH group showed a decrease
of FRC on the first post-operative day to 71% of the pre-operative value,
versus 57% in the control group (P = 0.002). Differences in FRC became
less prominent over time; differences between the two study groups were no
longer statistically significant at Day 5. There were no differences in
SpO2 between the study groups. Chest radiographs showed more abnormalities
(merely atelectasis) in the control group compared to patients in the
routine MH group (P = 0.002). MH partly prevents the reduction of FRC in
the first post-operative days after cardiac surgery. Netherlands Trial
Register (NTR): NTR1384. http://www.trialregister.nl.

<6>
Accession Number
21816077
Authors
Haase-Fielitz A. Mertens P.R. Plass M. Kuppe H. Hetzer R. Westerman M.
Ostland V. Prowle J.R. Bellomo R. Haase M.
Institution
(Haase-Fielitz) Department of Nephrology and Hypertension & Endocrinology
and Metabolic Diseases, Otto-von-Guericke-University, Leipziger Strasse
44, D-39120 Magdeburg, Germany.
Title
Urine hepcidin has additive value in ruling out cardiopulmonary
bypass-associated acute kidney injury: an observational cohort study.
Source
Critical care (London, England). 15 (4) (pp R186), 2011. Date of
Publication: 2011.
Abstract
Conventional markers of acute kidney injury (AKI) lack diagnostic accuracy
and are expressed only late after cardiac surgery with cardiopulmonary
bypass (CPB). Recently, interest has focused on hepcidin, a regulator of
iron homeostasis, as a unique renal biomarker. We studied 100 adult
patients in the control arm of a randomized, controlled trial
http://www.clinicaltrials.gov/NCT00672334 who were identified as being at
increased risk of AKI after cardiac surgery with CPB. AKI was defined
according to the Risk, Injury, Failure, Loss, End-stage renal disease
classification of AKI classification stage. Samples of plasma and urine
were obtained simultaneously (1) before CPB (2) six hours after the start
of CPB and (3) twenty-four hours after CPB. Plasma and urine hepcidin
25-isoforms were quantified by competitive enzyme-linked immunoassay. In
AKI-free patients (N = 91), urine hepcidin concentrations had largely
increased at six and twenty-four hours after CPB, and they were three to
seven times higher compared to patients with subsequent AKI (N = 9) in
whom postoperative urine hepcidin remained at preoperative levels (P =
0.004, P = 0.002). Furthermore, higher urine hepcidin and, even more so,
urine hepcidin adjusted to urine creatinine at six hours after CPB
discriminated patients who did not develop AKI (area under the curve (AUC)
receiver operating characteristic curve 0.80 [95% confidence interval (95%
CI) 0.71 to 0.87] and 0.88 [95% CI 0.78 to 0.97]) or did not need renal
replacement therapy initiation (AUC 0.81 [95% CI 0.72 to 0.88] 0.88 [95%
CI 0.70 to 0.99]) from those who did. At six hours, urine hepcidin
adjusted to urine creatinine was an independent predictor of ruling out
AKI (P = 0.011). Plasma hepcidin did not predict no development of AKI.
The study findings remained essentially unchanged after excluding patients
with preoperative chronic kidney disease. Our findings suggest that urine
hepcidin is an early predictive biomarker of ruling out AKI after CPB,
thereby contributing to early patient risk stratification.

<7>
Accession Number
21714857
Authors
Ricci Z. Luciano R. Favia I. Garisto C. Muraca M. Morelli S. Di Chiara L.
Cogo P. Picardo S.
Institution
(Ricci) Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of
Pediatric Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, Piazza S, Onofrio 4, 00165, Rome, Italy.
Title
High-dose fenoldopam reduces postoperative neutrophil
gelatinase-associated lipocaline and cystatin C levels in pediatric
cardiac surgery.
Source
Critical care (London, England). 15 (3) (pp R160), 2011. Date of
Publication: 2011.
Abstract
The aim of the study was to evaluate the effects of high-dose fenoldopam,
a selective dopamine-1 receptor, on renal function and organ perfusion
during cardiopulmonary bypass (CPB) in infants with congenital heart
disease (CHD). A prospective single-center randomized double-blind
controlled trial was conducted in a pediatric cardiac surgery department.
We randomized infants younger than 1 year with CHD and biventricular
anatomy (with exclusion of isolated ventricular and atrial septal defect)
to receive blindly a continuous infusion of fenoldopam at 1 mug/kg/min or
placebo during CPB. Perioperative urinary and plasma levels of neutrophil
gelatinase-associated lipocaline (NGAL), cystatin C (CysC), and creatinine
were measured to assess renal injury after CPB. We enrolled 80 patients:
40 received fenoldopam (group F) during CPB, and 40 received placebo
(group P). A significant increase of urinary NGAL and CysC levels from
baseline to intensive care unit (ICU) admission followed by restoration of
normal values after 12 hours was observed in both groups. However, urinary
NGAL and CysC values were significantly reduced at the end of surgery and
12 hours after ICU admission (uNGAL only) in group F compared with group P
(P = 0.025 and 0.039, respectively). Plasma NGAL and CysC tended to
increase from baseline to ICU admission in both groups, but they were not
significantly different between the two groups. No differences were
observed on urinary and plasma creatinine levels and on urine output
between the two groups. Acute kidney injury (AKI) incidence in the
postoperative period, as indicated by pRIFLE classification (pediatric
score indicating Risk, Injury, Failure, Loss of function, and End-stage
kidney disease level of renal damage) was 50% in group F and 72% in group
P (P = 0.08; odds ratio (OR), 0.38; 95% confidence interval (CI), 0.14 to
1.02). A significant reduction in diuretics (furosemide) and vasodilators
(phentolamine) administration was observed in group F (P = 0.0085; OR,
0.22; 95% CI, 0.07 to 0.7). The treatment with high-dose fenoldopam during
CPB in pediatric patients undergoing cardiac surgery for CHD with
biventricular anatomy significantly decreased urinary levels of NGAL and
CysC and reduced the use of diuretics and vasodilators during CPB.
Clinical Trial.Gov NCT00982527.

<8>
Accession Number
21651806
Authors
Maharaj R. Metaxa V.
Institution
(Maharaj) Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
Title
Levosimendan and mortality after coronary revascularisation: a
meta-analysis of randomised controlled trials.
Source
Critical care (London, England). 15 (3) (pp R140), 2011. Date of
Publication: 2011.
Abstract
Patients undergoing coronary revascularization often require inotropic
support that has been associated with an increased risk for death and
morbidity. The purpose of this study was to evaluate the effect of
levosimendan versus control on survival after coronary revascularization.
A systemic review and meta-analysis of the literature was carried out on
published randomized controlled clinical trials that investigated the
efficacy of levosimendan compared to other therapy in patients having
coronary revascularisaion. The databases searched were Pubmed, EMBASE, the
Cochrane Registry of Clinical Trials and the metaRegister of Controlled
Trials. Studies that compared levosimendan to any other therapy for
coronary revascularisation in adult humans and reported at least one
outcome of interest were considered for inclusion. Both percutaneous
coronary intervention and cardiac surgery were included. Data extraction
was performed independently by two reviewers using predefined criteria.
Relevant outcomes included mortality, cardiac index, cardiac enzymes,
length of stay and post-procedural atrial fibrillation. The meta-analysis
included 729 patients from 17 studies. Levosimendan was associated with a
mortality reduction after coronary revascularization, (19/386 in the
levosimendan group vs 39/343 in the control arm) odds ratio (OR) 0.40 (95%
confidence interval (CI) 0.21 to 0.76, P for overall effect 0.005, P for
heterogeneity = 0.33, I2 = 12% with a total of 729 patients. Levosimendan
also had a favourable effect on cardiac index (standardised mean
difference 1.63, 95% CI 1.43 to 1.83, P for overall effect < 0.00001),
length of intensive care stay (random effects model, mean difference -
26.18 hours 95% CI 46.20 to 6.16, P for heterogeneity < 0.00001, I2 = 95%,
P for overall effect P = 0.01), reductions in the rate of atrial
fibrillation (OR 0.54, 95% CI 0.36 to 0.82, P for effect = 0.004, P for
heterogeneity 0.84, I2 = 0% for 465 patients) and troponin I levels group
(mean difference -1.59, 95% CI 1.78 to 1.40, P for overall effect <
0.00001, P for heterogeneity < 0.00001, I2 = 95%). Limitations of this
analysis are discussed. Levosimendan is associated with a significant
improvement in mortality after coronary revascularization. There are also
improvements in several secondary endpoints. A suitably powered randomised
controlled trial is required to confirm these findings and to address the
unresolved questions about the timing and dosing of levosimendan.

<9>
Accession Number
21569437
Authors
Pinheiro A.C. Novais M.C. Neto M.G. Rodrigues M.V. de Souza Rodrigues Jr.
E. Aras Jr. R. Carvalho V.O.
Institution
(Pinheiro) Faculdade Social, Salvador, Bahia, Brazil.
Title
Estimation of lung vital capacity before and after coronary artery bypass
grafting surgery: a comparison of incentive spirometer and ventilometry.
Source
Journal of cardiothoracic surgery. 6 (pp 70), 2011. Date of Publication:
2011.
Abstract
Measurement of vital capacity (VC) by spirometry is the most widely used
technique for lung function evaluation, however, this form of assessment
is costly and further investigation of other reliable methods at lower
cost is necessary. Objective: To analyze the correlation between direct
vital capacity measured with ventilometer and with incentive inspirometer
in patients in pre and post cardiac surgery. Cross-sectional comparative
study with patients undergoing cardiac surgery. Respiratory parameters
were evaluated through the measurement of VC performed by ventilometer and
inspirometer. To analyze data normality the Kolmogorov-Smirnov test was
applied, for correlation the Pearson correlation coefficient was used and
for comparison of variables in pre and post operative period Student's t
test was adopted. We established a level of ignificance of 5%. Data was
presented as an average, standard deviation and relative frequency when
needed. The significance level was set at 5%. We studied 52 patients
undergoing cardiac surgery, 20 patients in preoperative with
VC-ventilometer: 32.95 +/- 11.4 ml/kg and VC-inspirometer: 28.9 +/- 11
ml/Kg, r = 0.7 p < 0.001. In the post operatory, 32 patients were
evaluated with VC-ventilometer: 28.27 +/- 12.48 ml/kg and VC-inspirometer:
26.98 +/- 11 ml/Kg, r = 0.95 p < 0.001. Presenting a very high correlation
between the evaluation forms studied. There was a high correlation between
DVC measures with ventilometer and incentive spirometer in pre and post
CABG surgery. Despite this, arises the necessity of further studies to
evaluate the repercussion of this method in lowering costs at hospitals.

<10>
Accession Number
2013450974
Authors
Shahid F. Akhtar M. Khan F. Chahal C.A.A.
Institution
(Shahid, Khan, Chahal) Department of Cardiology, London Chest Hospital NHS
Trust, London E2 9JX, United Kingdom
(Akhtar) Department of Cardiology, St Thomas's Hospital, London SE1 7EH,
United Kingdom
Title
Intra-aortic balloon pump counterpulsation: Are we optimizing the
management of cardiogenic shock?.
Source
Journal of the Royal Society of Medicine. 106 (2) (pp 51-56), 2013. Date
of Publication: February 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Intra-aortic balloon pump counterpulsation (IABPC) has been used in
various forms for decades. The change in physiology brought about by their
use is conceptually appealing in managing cardiogenic shock and mechanical
complications of myocardial infarction. A common myth is that this method
of managing acute cardiological emergencies is to be limited to the realms
of this specialist field. However, as medical physicians an appreciation
and understanding of this novel therapy is essential not onlyas a
lifesaving measure but also as a bridging therapy to more definitive
management in the acute medical setting. IABPC is a safe and
under-utilized technique despite featuring in all major international
guidelines (ESC and ACC) for the management of cardiogenic shock secondary
to acute coronary syndromes. Without awareness of this intervention we may
be suboptimally managing patients in the first instance. To improve
awareness we examine the evidence supporting the use of the IABPC therapy
and the contraindications to their use. Complications and advances in
technology are also addressed.

<11>
Accession Number
2013446824
Authors
Tosun Z. Baktir M. Kahraman H.C. Baskol G. Guler G. Boyaci A.
Institution
(Tosun, Baktir, Guler, Boyaci) Department of Anesthesiology and
Reanimation, University of Erciyes, School of Medicine, 38039, Talas,
Kayseri, Turkey
(Kahraman) Department of Cardiovascular Surgery, University of Erciyes,
School of Medicine, Talas, Kayseri, Turkey
(Baskol) Department of Biochemistry, University of Erciyes, School of
Medicine, Talas, Kayseri, Turkey
Title
Does dexmedetomidine provide cardioprotection in coronary artery bypass
grafting with cardiopulmonary bypass? a pilot study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (4) (pp 710-715),
2013. Date of Publication: August 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The purpose of this pilot study was to evaluate whether
dexmedetomidine has a cardioprotective effect during coronary artery
bypass graft surgery with cardiopulmonary bypass (CPB). Design: A
prospective, double-blind, randomized controlled trial. Setting: A
university hospital. Participants: Thirty-eight patients undergoing
coronary artery bypass graft surgery. Interventions: Patients were
randomized into 2 groups: dexmedetomidine and placebo groups. In the
dexmedetomidine group, dexmedetomidine infusion was started by a loading
dose of 0.5 mug/kg/10 min, followed by a continuous infusion of 0.5
mug/kg/h. The placebo group received the same volume of saline.
Measurements of central venous pressure, mean pulmonary artery pressure
(MPAP) and cardiac index were performed before and after dexmedetomidine
loading dose and 2, 24 and 48 hours after CPB. Simultaneously, arterial
blood was sampled for CK-MB, cardiac troponin T, and N-terminal probrain
natriuretic peptide. Measurements and Main Results: CK-MB, cardiac
troponin T and N-terminal probrain natriuretic peptide values were
elevated in the periods after CPB in both groups (p<0.05) and there were
no statistically significant differences between groups. MPAP was
decreased in the dexmedetomidine group at the 2nd, 24th and 48th hour
after CPB (p<0.001, p<0.001, p = 0.002, respectively). Higher cardiac
index values were seen earlier in the dexmedetomidine group than in the
placebo group (p< 0.05). Conclusions: Myocardial damage was not reduced by
administration of 0.5 mug/kg loading dose and 0.5 mug/kg/h infusion of
dexmedetomidine. However MPAP tended to be lower in the dexmedetomidine
group. Large-scale clinical outcome studies are indicated to confirm the
effect of dexmedetomidine. 2013 Elsevier Inc.

<12>
Accession Number
2013449496
Authors
Matot I. Dery E. Bulgov Y. Cohen B. Paz J. Nesher N.
Institution
(Matot, Dery, Bulgov, Cohen) Department of Anesthesiology, Pain, and
Intensive Care, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman
St, Tel Aviv, Israel
(Paz, Nesher) Department of Cardiothoracic Surgery, Tel Aviv Medical
Center, Tel Aviv University, Tel Aviv, Israel
Title
Fluid management during video-assisted thoracoscopic surgery for lung
resection: A randomized, controlled trial of effects on urinary output and
postoperative renal function.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (2) (pp 461-466),
2013. Date of Publication: August 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Increased perioperative fluid administration is an independent
risk factor for lung injury after pulmonary resection. In clinical
practice, fluid therapy is heavily guided by urinary output; however,
diuretic response to plasma volume expansion has been reported to be
blunted during anesthesia and surgery. We therefore hypothesized that in
patients undergoing video-assisted thoracoscopic surgery, different
regimens of intraoperative fluid management would not affect urinary
output as would be expected in the nonsurgical scenario. Moreover, a
restrictive perioperative fluid approach, as indicated in these
operations, will not harm renal function. Methods: One hundred two
patients undergoing video-assisted thoracoscopic surgery were randomly
allocated to receive intraoperatively either high (8 mL/[kgh]; n = 51) or
low (2 mL/[kgh]; n = 51) amounts of Ringer's lactate solution. The primary
end point was intraoperative urinary output. Secondary end points included
postoperative creatinine serum levels and postoperative complication rate.
Results: Demographic and surgical data were comparable between groups.
Regardless of the intraoperatively fluids administered (mean +/- SD, 2131
+/- 850 vs 1035 +/- 652 mL in high and low groups, respectively; P
<.0001), urinary output was similar (median 300 mL). Perioperative
creatinine serum levels decreased significantly postoperatively and were
not significantly different among the groups. Conclusions: In patients
undergoing video-assisted thoracoscopic surgery, intraoperative urinary
output and postoperative renal function are not affected by administration
of fluids in the range of 2 to 8 mL/(kgh). The clinical practice of
administering fluids to enhance diuresis in the perioperative period
should therefore be abandoned. 2013 by The American Association for
Thoracic Surgery.

<13>
Accession Number
2013449513
Authors
Rogers C.A. Pike K. Angelini G.D. Reeves B.C. Glauber M. Ferrarini M.
Murphy G.J.
Institution
(Rogers, Pike, Angelini, Reeves, Murphy) Bristol Heart Institute,
University of Bristol, Queen's Building, Bristol BS2 8HW, United Kingdom
(Glauber, Ferrarini) Cardiac Surgery Department, Ospedale Pasquinucci,
Massa Carrara, Italy
Title
An open randomized controlled trial of median sternotomy versus
anterolateral left thoracotomy on morbidity and health care resource use
in patients having off-pump coronary artery bypass surgery: The Sternotomy
Versus Thoracotomy (STET) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (2) (pp 306-316.e9),
2013. Date of Publication: August 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Our objective was to compare off-pump coronary artery bypass
surgery carried out via a left anterolateral thoracotomy (ThoraCAB) or via
a conventional median sternotomy (OPCAB). Background: Recent advances in
minimally invasive cardiac surgery have extended the technique to allow
complete surgical revascularization on the beating heart via thoracotomy.
Methods: Patients undergoing nonemergency primary surgery were enrolled
between February 2007 and September 2009 at 2 centers. The primary outcome
was the time from surgery to fitness for hospital discharge as defined by
objective criteria. Results: A total of 93 patients were randomized to
off-pump coronary artery bypass surgery via a median sternotomy (OPCAB)
and 91 to off-pump coronary artery bypass surgery via a left anterolateral
thoracotomy (ThoraCAB). The surgery was longer for patients in the
ThoraCAB group (median, 4.1 vs 3.3 hours) and there were fewer with more
than 3 grafts (2% vs 17%). The median time from surgery to fitness for
discharge was 6 days (interquartile range, 4-7) in the ThoraCAB group
versus 5 days (interquartile range, 4-7) in the OPCAB group (P =.53). The
intubation time was shorter, by on average 65 minutes, in the ThoraCAB
group (P =.017), although the time in intensive care was similar (P =.91).
Pain scores were similar (P =.97), but more analgesia was required in the
ThoraCAB group (median duration, 38.8 vs 35.5 hours, P <.001; tramadol
use, 66% vs 49%, P =.024). ThoraCAB was associated with significantly
worse lung function at discharge (average difference, -0.25 L, P =.01) but
quality of life scores at 3 and 12 months were similar (P =.52). The
average total cost was 10% higher with ThoraCAB (P =.007). Conclusions:
ThoraCAB resulted in no overall clinical benefit relative to OPCAB. 2013
by The American Association for Thoracic Surgery.

<14>
Accession Number
2013449517
Authors
Cao C. Manganas C. Horton M. Bannon P. Munkholm-Larsen S. Ang S.C. Yan
T.D.
Institution
(Cao, Bannon, Munkholm-Larsen, Yan) Collaborative Research (CORE) Group,
Systematic Review Unit, Sydney, Australia
(Cao, Bannon, Yan) Baird Institute for Applied Heart and Lung Surgical
Research, Sydney, Australia
(Cao, Manganas, Horton, Ang) Department of Cardiothoracic Surgery, St
George Hospital, Sydney, Australia
(Munkholm-Larsen) University of Copenhagen, Copenhagen, Denmark
Title
Angiographic outcomes of radial artery versus saphenous vein in coronary
artery bypass graft surgery: A meta-analysis of randomized controlled
trials.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (2) (pp 255-261),
2013. Date of Publication: August 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Introduction: The efficacy of coronary artery bypass graft (CABG) surgery
for patients with ischemic heart disease is dependent on the patency of
the selected conduit. The left internal thoracic artery is considered to
be the best conduit for CABG. However, the preferred conduit between the
radial artery (RA) and saphenous vein (SV) remains controversial. The
present meta-analysis aims to establish the current level IA evidence on
patency outcomes comparing the RA and SV. Methods: Electronic searches
were performed using 6 databases from their inception to March 2012. Two
reviewers independently identified all relevant randomized controlled
trials (RCTs) comparing patency outcomes of RA and SV grafts after CABG.
Data were extracted and meta-analyzed according to angiographic end points
at specified follow-up intervals. Results: Five relevant RCTs were
identified for inclusion in the present meta-analysis. Angiographic
results indicated that the RA was significantly more likely to be
completely patent and less likely to be associated with graft failure or
complete occlusion at 4 years' follow-up and beyond. However, the RA was
significantly more likely to be associated with string sign at 1 year of
follow-up. Conclusions: While acknowledging the limitations of
heterogeneous surgical techniques, results from the present meta-analysis
suggest potential superiority of the RA compared with the SV at midterm
angiographic follow-up. However, the increased incidence of string sign
associated with the RA is of potential clinical concern. Further research
should be directed at correlating angiographic findings of string sign and
graft failure to clinical symptoms and major adverse cardiac and
cerebrovascular events at long-term follow-up. 2013 by The American
Association for Thoracic Surgery.

<15>
Accession Number
2013436940
Authors
Tricoci P. Leonardi S. White J. White H.D. Armstrong P.W. Montalescot G.
Giugliano R.P. Gibson C.M. Van De Werf F. Califf R.M. Harrington R.A.
Braunwald E. Mahaffey K.W. Newby L.K.
Institution
(Tricoci, White, Califf, Mahaffey, Newby) Duke Clinical Research
Institute, 2400 Pratt Street, Terrace Level, Durham, NC 27705, United
States
(Leonardi) Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
(Armstrong) University of Alberta, Edmonton, AB, Canada
(Montalescot) Cardiology Department, La Pitie-Salpetriere Hospital, Paris,
France
(Giugliano, Braunwald) Brigham and Women's Hospital, Boston, MA, United
States
(Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Van De Werf) Division of Cardiology, Catholic University of Leuven,
Leuven, Belgium
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
Title
Cardiac troponin after percutaneous coronary intervention and 1-year
mortality in Non-ST-segment elevation acute coronary syndrome using
systematic evaluation of biomarker trends.
Source
Journal of the American College of Cardiology. 62 (3) (pp 242-251), 2013.
Date of Publication: 16 Jul 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to review cardiac troponin (cTn) trends
during non-ST-segment elevation acute coronary syndrome (NSTE ACS) in
patients undergoing percutaneous coronary intervention (PCI) in the EARLY
ACS (Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation
Acute Coronary Syndromes) and SYNERGY (Superior Yield of the New Strategy
of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors)
studies and to study the relationship between post-PCI cTn and mortality.
Background The prognostic value of cTn post-PCI is controversial. In
patients with NSTE ACS, it is especially difficult to distinguish between
cTn elevations due to PCI or index myocardial infarction (MI). Methods
Time and cTn (indexed by upper limit of normal [ULN]) data pairs were
plotted for 10,199 patients and independently reviewed by 2 physicians to
identify patients in whom post-PCI cTn elevation could be distinguished
from that of index MI. Post-PCI cTn peak was identified for each plot, and
its relationship with 1-year mortality was evaluated using Cox modeling,
correcting for 15 clinical variables from the EARLY ACS 1-year mortality
model (including baseline cTn). We used an identical methodology to assess
the association between creatine kinase-myocardial band and 1-year
mortality. Results Patients with cTn (re-)elevation post-PCI not evaluable
were identified and excluded from further analysis (4,198 [41%] with cTn
rising prior to PCI; 229 [2%] with missing cTn). Among the remainder (n =
5,772 [57%]), in the multivariable model, peak cTn post-PCI was associated
with a 7% increase in mortality (hazard ratio [HR] for 10x ULN increase:
1.07, 95% confidence interval [CI]: 1.02 to 1.11; p = 0.0038). Peak
post-PCI creatine kinase-myocardial band was significantly associated with
1-year mortality (HR for 1x ULN increase: 1.13, 95% CI: 1.05 to 1.21; p =
0.0013). Conclusions We used a methodology that differentiated post-PCI
cTn (re-)elevation from that of presenting MI in more than one-half of
patients with NSTE ACS undergoing PCI. This identified a highly
significant relationship between post-PCI cTn and 1-year mortality, with
implications for both incorporating a cTn post-PCI MI definition and
preventing PCI-related myonecrosis. 2013 by the American College of
Cardiology Foundation.

<16>
Accession Number
2013433841
Authors
Teeuwen K. Van Den Branden B.J.L. Rahel B.M. Laarman G.J. Tijssen J.G.P.
Kelder J.C. Slagboom T. Ten Berg J.M. Suttorp M.J.
Institution
(Teeuwen, Ten Berg, Suttorp) Department of Interventional Cardiology, St.
Antonius Hospital Nieuwegein, Koekoekslaan 1, NL-3435 CM Nieuwegein,
Netherlands
(Van Den Branden) Deparment of Interventional Cardiology, Amphia Hospital,
Breda, Netherlands
(Rahel) Department of Cardiology, Viecuri Hospital, Venlo, Netherlands
(Laarman) Department of Interventional Cardiology, Tweesteden Hospital,
Tilburg, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
(Slagboom) Department of Interventional Cardiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
Title
Late catch-up in lumen diameter at five-year angiography in MACE-free
patients treated with sirolimus-eluting stents in the Primary Stenting of
Totally Occluded Native Coronary Arteries: A randomised comparison of bare
metal stent implantation with sirolimus-eluting stent implantation for the
treatment of total coronary occlusions (PRISON II).
Source
EuroIntervention. 9 (2) (pp 212-219), 2013. Date of Publication: 2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The present study was designed to examine the five-year angiographic
follow-up of MACE-free patients enrolled in the PRISON II study. Methods
and results: In the PRISON II study a total of 200 patients were
randomised to either bare metal stents (BMS) or sirolimus-eluting stents
(SES) after successful recanalisation of total coronary occlusions (TCO).
Patients free of MACE with available angiography at six months were
approached for repeated angiography at five years. The primary endpoint
was in-stent very late luminal loss (VLLL) at five years. The secondary
endpoint was additional late luminal loss (ALLL) between six months and
five years. At five years, repeated angiography was performed in 72
patients, 50/82 (61%) in the SES group and 22/58 (38%) in the BMS group.
In-stent VLLL was lower in the SES group (0.19 mm+/-0.72 vs. 0.51
mm+/-0.71, p=0.09) compared to the BMS group and in-segment VLLL was
comparable in both groups (0.01 mm+/-0.58 vs. 0.03 mm+/-0.73, p=0.89).
Late catch-up in lumen diameter was observed in the SES group with a trend
towards increased ALLL compared to the BMS group (in-stent, 0.35 mm+/-0.88
vs. 0.04 mm+/-0.81, p=0.16; in-segment, 0.20 mm+/-0.74 vs. -0.05
mm+/-0.73, p=0.19). Conclusions: At five-year angiographic follow-up, late
catch-up was observed after successful recanalisation of TCOs treated with
SES. Despite a late catch-up, the angiographic results of SES were
superior in-stent and similar in-segment compared to BMS. Europa Digital
& Publishing 2013. All rights reserved.

<17>
[Use Link to view the full text]
Accession Number
21743344
Authors
Zhang C.Y. Jiang Y. Yin Q.Y. Chen F.J. Ma L.L. Wang L.X.
Institution
(Zhang) Department of Cardiac Surgery, Liaocheng People's Hospital,
Shandong, People's Republic of China.
Title
Impact of nurse-initiated preoperative education on postoperative anxiety
symptoms and complications after coronary artery bypass grafting.
Source
The Journal of cardiovascular nursing. 27 (1) (pp 84-88), 2012. Date of
Publication: 2012 Jan-Feb.
Abstract
Coronary artery bypass grafting (CABG) in high-risk patients is associated
with significant perioperative complications and anxiety. Prevention of
these postoperative complications and anxiety is important in the
improvement of clinical outcomes following CABG. The objective of the
study was to evaluate the effect of nurse-initiated preoperative education
and counseling on postoperative complications and anxiety symptoms
following CABG. In this prospective and randomized trial, 40 patients were
divided into the study and control groups. All patients received standard
preoperative and postoperative care, but the study group patients also
completed a structured education and counseling course supervised by
designated nurses 3 days before the surgery. Anxiety symptoms were
assessed by Zung's self-rating anxiety scale (SAS) on the day of admission
and at 3 days after the surgery. There was no statistically significant
difference in the baseline characteristics or operational data between the
2 groups (P > .05). Following the surgery, the rate of complications such
as lower extremity edema, urinary retention, constipation, respiratory
infection, and deep venous thrombosis in the study group was lower than in
the control group (P < .05). The mean postoperative SAS scores in the
study group was lower than in the control group (40.1 [SD, 6.5] vs 48.9
[SD, 7.3]; P = .01), and the proportion of patients with a SAS score
greater than 40 in the study group was also lower than in the control
group (15% vs 45%, P = .041). Nurse-initiated preoperational education and
counseling were associated with a reduced rate of perioperative
complications and a reduced level of anxiety following CABG.

<18>
Accession Number
22071819
Authors
Horjus D.L. Oudman I. van Montfrans G.A. Brewster L.M.
Institution
(Horjus) 1Department of Internal Medicine, Division of Vascular Medicine,
Academic Medical Centre, University of Amsterdam, Amsterdam,Netherlands.
Title
Creatine and creatine analogues in hypertension and cardiovascular
disease.
Source
Cochrane database of systematic reviews (Online). (11) (pp CD005184),
2011. Date of Publication: 2011.
Abstract
The creatine kinase system, the central regulatory system of cellular
energy metabolism, provides ATP in situ at ATP-ases involved in ion
transport and muscle contraction. Furthermore, the enzyme system provides
relative protection from tissue ischaemia and acidosis. The system could
therefore be a target for pharmacologic intervention. To systematically
evaluate evidence regarding the effectiveness of interventions directly
targeting the creatine kinase system as compared to placebo control in
adult patients with essential hypertension or cardiovascular disease.
Electronic databases searched: Medline (1950 - Feb 2011), Embase (up to
Feb 2011), the Cochrane Controlled Trials Register (issue 3, Aug 2009),
Latin-American/Caribbean databank Lilacs; references from textbooks and
reviews; contact with experts and pharmaceutical companies; and searching
the Internet. There was no language restriction. Randomized controlled
trials comparing creatine, creatine phosphate, or cyclocreatine (any
route, dose or duration of treatment) with placebo; in adult patients with
essential hypertension, heart failure, or myocardial infarction. We did
not include papers on the short-term use of creatine during cardiac
surgery. The outcomes assessed were death, total myocardial infarction
(fatal or non-fatal), hospitalizations for congestive heart failure,
change in ejection fraction, and changes in diastolic and systolic blood
pressure in mm Hg or as percent change. Full reports or abstracts from
1164 papers were reviewed, yielding 11 trials considering treatment with
creatine or creatine analogues in 1474 patients with heart failure,
ischemic heart disease or myocardial infarction. No trial in patients with
hypertension was identified. Eleven trials (1474 patients, 35 years or
older) comparing add-on therapy of the creatine-based drug on standard
treatment to placebo control in patients with heart failure (6 trials in
1226 / 1474 patients ), or acute myocardial infarction (4 trials in 220 /
1474 patients) or 1 in ischemic heart disease (28 / 1474 patients) were
identified. The drugs used were either creatine, creatine phosphate
(orally, intravenously, or intramuscular) or phosphocreatinine. In the
trials considering heart failure all three different compounds were
studied; creatine orally (Gordon 1995, Kuethe 2006), creatine phosphate
via intravenous infusion (Ferraro 1996, Grazioli 1992), and
phosphocreatinine orally (Carmenini 1994, Maggi 1990). In contrast, the
acute myocardial infarction trials studied intravenous creatine phosphate
only. In the ischemic heart disease trial (Pedone 1984) creatine phosphate
was given twice daily through an intramuscular injection to outpatients
and through an intravenous infusion to inpatients. The duration of the
study intervention was shorter for the acute patients, from a two hour
intravenous infusion of creatine phosphate in acute myocardial infarction
(Ruda 1988, Samarenko 1987), to six months in patients with heart failure
on oral phosphocreatinine therapy (Carmenini 1994). In the acute
myocardial infarction patients the follow-up period varied from the acute
treatment period (Ruda 1988) to 28 days after start of the symptoms
(Samarenko 1987) or end of the hospitalization period (Zochowski 1994). In
the other trials there was no follow-up after discontinuation of
treatment, except for Gordon 1995 which followed the patients until four
days after stopping the intervention.Only two out of four trials in
patients with acute myocardial infarction reported mortality outcomes,
with no significant effect of creatine or creatine analogues (RR 0.73, CI:
0.22 - 2.45). In addition, there was no significance on the progression of
myocardial infarction or improvement on ejection fraction. The main effect
of the interventions seems to be on improvement of dysrhythmia. This
review found inconclusive evidence to decide on the use of creatine
analogues in clinical practice. In particular, it is not clear whether
there is an effect on mortality, progression of myocardial infarction and
ejection fraction, while there is some evidence that dysrhythmia and
dyspnoea might improve. However, it is not clear which analogue, dose,
route of administration, and duration of therapy is most effective.
Moreover, given the small sample size of the discussed trials and the
heterogeneity of the population included in these reports, larger clinical
studies are needed to confirm these observations.

<19>
Accession Number
21619593
Authors
Masiha S. Sundstrom J. Lind L.
Institution
(Masiha) Department of Cardiology, Uppsala University Hospital, Uppsala,
Sweden.
Title
Left ventricular geometric patterns and adaptations to hemodynamics are
similar in elderly men and women.
Source
BMC cardiovascular disorders. 11 (1) (pp 25), 2011. Date of Publication:
2011.
Abstract
Common conditions such as obesity and hypertension result in hemodynamic
alterations that will induce remodeling of the left ventricle (LV).
However, differences between the genders in the relationship of
hemodynamics to LV geometry are not well known.The present study aims to
investigate differences between the genders in this respect, in a sample
of elderly persons. Echocardiography and Doppler was performed in a
population-based sample aged 70 - The Prospective Investigation of the
Vasculature in Uppsala Seniors (PIVUS) study (n = 922).Hemodynamic
patterns obtained by echocardiography and Doppler were evaluated in
relation to four LV geometric groups (normal, concentric remodeling,
eccentric hypertrophy and concentric hypertrophy). No significant
difference between the genders was observed regarding the prevalence of
the LV geometric groups.Mean values of most evaluated echocardiography and
Doppler variables differed between men and women, such as LA, IVS, LVEDD
and IVRT, but the relationship of hemodynamic variables to LV geometric
groups did not differ between the genders. Although mean values of many
echocardiographic variables differed between men and women, the LV
geometric adaptations to a given hemodynamic load appear similar in both
genders.

<20>
Accession Number
22108275
Authors
Cho Y.R. Kim Y.D. Park T.H. Park K. Baek H. Choi S.Y. Kim K.S. Hong T.J.
Yang T.H. Hwang J.Y. Park J.S. Hur S.H. Lee S.G.
Institution
(Cho) Department of Internal Medicine, Dong-A University College of
Medicine, Busan, Korea.
Title
The impact of dose of the angiotensin-receptor blocker valsartan on the
post-myocardial infarction ventricular remodeling: study protocol for a
randomized controlled trial.
Source
Trials. 12 (pp 247), 2011. Date of Publication: 2011.
Abstract
Angiotensin-converting enzyme inhibitors and the angiotensin-receptor
blocker valsartan ameliorate ventricular remodeling after myocardial
infarction (MI). Based on previous clinical trials, a maximum clinical
dose is recommended in practical guidelines. Yet, has not been clearly
demonstrated whether the recommended dose is more efficacious compared to
the lower dose that is commonly used in clinical practice. Valsartan in
post-MI remodeling (VALID) is a randomized, open-label, single-blinded
multicenter study designed to compare the efficacy of different clinical
dose of valsartan on the post-MI ventricular remodeling. This study also
aims to assess neurohormone change and clinical parameters of patients
during the post-infarct period. A total of 1116 patients with left
ventricular dysfunction following the first episode of acute ST-elevation
MI are to be enrolled and randomized to a maximal tolerable dose (up to
320 mg/day) or usual dose (80 mg/day) of valsartan for 12 months in 2:1
ratio. Echocardiographic analysis for quantifying post-MI ventricular
remodeling is to be conducted in central core laboratory. Clinical
assessment and laboratory test are performed at fixed times. VALID is a
multicenter collaborative study to evaluate the impact of dose of
valsartan on the post-MI ventricular remodeling. The results of the study
provide information about optimal dosing of the drug in the management of
patients after MI. The results will be available by 2012. NCT01340326.

<21>
Accession Number
21809148
Authors
D'Alonzo R.C. Bennett-Guerrero E. Podgoreanu M. D'Amico T.A. Harpole D.H.
Shaw A.D.
Institution
(D'Alonzo) Department of Anesthesiology, Pitt Count Memorial Hospital,
Greenville, NC 27858, USA.
Title
A randomized, double blind, placebo controlled clinical trial of the
preoperative use of ketamine for reducing inflammation and pain after
thoracic surgery.
Source
Journal of anesthesia. 25 (5) (pp 672-678), 2011. Date of Publication: Oct
2011.
Abstract
We hypothesized that patients who received ketamine during thoracic
surgery would benefit from suppression of the inflammatory cascade,
represented by lower interleukin (IL)-6 and C-reactive protein (CRP)
plasma levels. This study was a randomized, double blind, placebo
controlled clinical trial of ketamine in patients undergoing thoracic
surgery. The setting was a single university teaching hospital. Forty
patients who presented to the preoperative clinic prior to thoracic
surgery (20 control, 20 treatment) were randomized to receive either a 0.5
mg/kg ketamine bolus or an equivalent volume of normal saline
intravenously prior to chest wall incision. Plasma samples taken prior to
induction of anesthesia and at 24 h following surgery were assayed for
IL-6 and CRP levels. Verbal pain scores were reported at 4 and 24 h
following surgery and at discharge. IL-6 plasma levels did not differ
significantly at 24 h for patients receiving ketamine (245 +/- 287 pg/ml,
mean +/- SD) compared to patients who received placebo (269 +/- 210
pg/ml), p = 0.39. Additionally, CRP levels at 24 h were not significantly
different (8.8 +/- 4.5 mg/dl for ketamine, 9.3 +/- 5.6 mg/dl for placebo
patients), p = 0.37. Finally, verbal pain scores were not significantly
different between patient groups at 4 or 24 h, or at discharge. These
findings suggest that the routine use of a single dose of ketamine prior
to chest wall incision is not effective at reducing pain or inflammation
in thoracic surgery patients at 24 h postoperatively.

<22>
Accession Number
2013449980
Authors
Mohr F.W.
Institution
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
PCI was not as effective as CABG for severe coronary artery disease at 5
years.
Source
Annals of Internal Medicine. 159 (2) (pp 629-638), 2013. Date of
Publication: 16 Jul 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<23>
Accession Number
2013449976
Authors
Taylor F.
Institution
(Taylor) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Title
Review: Statins reduce mortality and major vascular events in patients
with no history of CV disease.
Source
Annals of Internal Medicine. 159 (2) (pp JC2), 2013. Date of Publication:
16 Jul 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<24>
Accession Number
23708173
Authors
Mehta R.H. Harjai K.J. Boura J.A. Tcheng J.E. Dixon S.R. Stone G.W. Grines
C.L.
Institution
(Mehta) Duke Clinical Research Institute and Duke University Medical
Center, Durham, NC, USA.
Title
Short-term outcomes of balloon angioplasty versus stent placement for
patients undergoing primary percutaneous coronary intervention:
Implications for patients requiring early coronary artery bypass surgery.
Source
American heart journal. 165 (6) (pp 1000-1007), 2013. Date of Publication:
Jun 2013.
Abstract
In patients with acute ST-elevation myocardial infarction (STEMI) needing
early coronary artery bypass graft (CABG) surgery, it is unknown whether
primary percutaneous balloon angioplasty (PTCA)-without stent
implantation-allows safe transition to subsequent CABG. We examined acute
STEMI patients enrolled in the Stent-PAMI and CADILLAC trials to study the
differences in the early clinical events between those treated with
primary PTCA (n = 1494) or primary stenting (n = 1488). Baseline clinical
and pre- and post-procedural angiographic features including
post-intervention TIMI 3 flow rates were similar in the 2 groups with the
exception of higher median infarct-artery residual stenosis in the PTCA
group (26% [IQR 19%-34%] vs. 18% [IQR 11-25%], P < .001]. Provisional
stenting was required in 16% of patients in PTCA group, while stents could
not be implanted in 2% of the stent group. Sixty-percent of PTCA patients
had stent-like balloon result. The rate of 30-day ischemia-driven target
vessel revascularization was higher in the PTCA group (4.3% vs. 2.0%, P <
.001 [4.6% vs 2.3%, P < .001 among patients with multivessel disease and
3.4% vs. 2.0%, P = .044 in patients with stent-like balloon results])
while 30-day major adverse cardiac events (6.2% vs 4.9%), death (1.8%
versus 2.8%), and reinfarction (0.9% vs. 0.7%) were similar in the 2
groups. Compared with primary stenting, primary PTCA of infarct artery in
STEMI patients was associated with significant increase in ischemia-driven
target vessel revascularization (ITVR) rate, yet with no increased risk of
major adverse cardiac events, reinfarction or death. Thus, provided close
surveillance is maintained and prompt treatment initiated for early
ischemic events, PTCA (particularly in those with stent-like balloon
result) may be a reasonable and safe option in STEMI patients needing
early CABG. Copyright 2013 Mosby, Inc. All rights reserved.

<25>
Accession Number
23833851
Authors
Naghipour B. Aghamohamadi D. Azarfarin R. Mirinazhad M. Bilehjani E.
Dorosti A. Golzari S.E.J.
Institution
(Naghipour) Department of Anesthesiology, Madani Hospital, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Aghamohamadi) Pain management and palliative care center, Emam Reza
hospital, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Azarfarin) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Mirinazhad, Bilehjani) Department of Anesthesiology, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Dorosti) Alzahra hospital, Tabriz University of Medical Sciences, Tabriz,
Iran, Islamic Republic of
(Golzari) Medical Philosophy and History Research Center, Students'
Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Dexamethasone added to bupivacaine prolongs duration of epidural
analgesia.
Source
Middle East Journal of Anesthesiology. 22 (1) (pp 53-57), 2013. Date of
Publication: February 2013.
Publisher
American University of Beirut (P.O.Box 11-0236, Beirut 1107 2020, Lebanon)
Abstract
Background: Different additives have been used to prolong regional
blockade. We designed a prospective, randomized, double-blind, controlled
clinical trial to evaluate the effect of dexamethasone added to
bupivacaine-fentanyl on the duration of postoperative analgesia via
epidural catheterization. Methods: Seventy two adult patients scheduled
for elective abdominal or thoracic surgery under epidural anesthesia were
randomly allocated into two groups to receive either bupivacaine (0.5%) -
fentanyl (50mug) and dexamethasone (8 mg) in lumbar or thoracic epidural
anesthesia (Dexa group, n=36), or bupivacaine-fentanyl and saline normal
(control group, n=36) via epidural catheter. Duration of analgesia,
postoperative pain score and IV analgesic use at first 24 hours were
recorded and compared. Results: Two patients were excluded (one in each
group) due to unsuccessful blockade. Age, gender and duration of surgery
were similar in the two groups (p>0.05). The duration of analgesia
(372+/-58.1vs. 234.6+/-24.3 min) was significantly longer and pain score
and pentazocine use were less in the Dexa than the control group (37.1+/-
19.7 mg v.s. 73.1 +/- 17.6 mg, respectively; p=0.001). Conclusions: This
study revealed that dexamethasone added to bupivacaine-fentanyl solution
in epidural analgesia prolongs the duration of analgesia in abdominal or
thoracic surgery.

<26>
Accession Number
2013452269
Authors
Alam M. Bandeali S.J. Kayani W.T. Ahmad W. Shahzad S.A. Jneid H. Birnbaum
Y. Kleiman N.S. Coselli J.S. Ballantyne C.M. Lakkis N. Virani S.S.
Institution
(Alam, Jneid, Birnbaum, Ballantyne, Lakkis, Virani) Section of Cardiology,
Baylor College of Medicine, Houston, TX, United States
(Ballantyne, Virani) Section of Cardiovascular Research, Baylor College of
Medicine, Houston, TX, United States
(Alam, Bandeali, Kayani, Jneid, Birnbaum, Ballantyne, Lakkis, Virani)
Department of Medicine, Baylor College of Medicine, Houston, TX, United
States
(Coselli) Section of Cardiothoracic Surgery, Michael E. DeBakey Department
of Surgery, Baylor College of Medicine, Houston, TX, United States
(Ahmad) Nishtar Medical College, Multan, Pakistan
(Shahzad) Al-Noor Specialist Hospital, Makkah, Saudi Arabia
(Jneid, Virani) Michael E. DeBakey Veterans Affairs Medical Center,
Houston, TX, United States
(Kleiman) Methodist DeBakey Heart and Vascular Center, Methodist Hospital,
Houston, TX, United States
(Kleiman) Weill Cornell Medical College, New York, NY, United States
(Ballantyne, Virani) Center for Cardiovascular Disease Prevention,
Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
(Virani) Health Policy and Quality Program, Michael E. DeBakey Veterans
Affairs Medical Center Health Services Research, Development Center of
Excellence, Houston, TX, United States
Title
Comparison by meta-analysis of mortality after isolated coronary artery
bypass grafting in women versus men.
Source
American Journal of Cardiology. 112 (3) (pp 309-317), 2013. Date of
Publication: 01 Aug 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Short- and long-term mortality in women who undergo coronary artery bypass
grafting (CABG) has been evaluated in multiple studies with conflicting
results. The investigators conducted a meta-analysis of all existing
studies to evaluate the impact of female gender on mortality in patients
who undergo isolated CABG. A comprehensive search of studies published
through May 31, 2012 identified 20 studies comparing men and women who
underwent isolated CABG. All-cause mortality was evaluated at short-term
(postoperative period and/or at 30 days), midterm (1-year), and long-term
(5-year) follow-up. Odds ratios (ORs) and 95% confidence interval (CIs)
were calculated using a random-effects model. A total of 966,492 patients
(688,709 men [71%], 277,783 women [29%]) were included in this
meta-analysis. Women were more likely to be older; had significantly
greater co-morbidities, including hypertension, diabetes mellitus,
hyperlipidemia, unstable angina, congestive heart failure, and peripheral
vascular disease; and were more likely to undergo urgent CABG (51% vs 44%,
p <0.01). Short-term mortality (OR 1.77, 95% CI 1.67 to 1.88) was
significantly higher in women. At midterm and long-term follow-up,
mortality remained high in women compared with men. Women remained at
increased risk for short-term mortality in 2 subgroup analyses including
prospective studies (n = 41,500, OR 1.83, 95% CI 1.59 to 2.12) and
propensity score-matched studies (n = 11,522, OR 1.36, 95% CI 1.04 to
1.78). In conclusion, women who underwent isolated CABG experienced higher
mortality at short-term, midterm, and long-term follow-up compared with
men. Mortality remained independently associated with female gender
despite propensity score-matched analysis of outcomes. 2013 Elsevier Inc.
All rights reserved.

<27>
Accession Number
2013452271
Authors
Capodanno D. Dipasqua F. Marcantoni C. Ministeri M. Zanoli L. Rastelli S.
Romano G. Sanfilippo M. Tamburino C.
Institution
(Capodanno, Dipasqua, Ministeri, Romano, Sanfilippo, Tamburino)
Cardiovascular Department, Ferrarotto Hospital, Catania, Italy
(Capodanno, Tamburino) ETNA Foundation, Catania, Italy
(Marcantoni) Division of Nephrology, Cannizzaro Hospital, Catania, Italy
(Zanoli, Rastelli) Department of Internal Medicine, University of Catania,
Catania, Italy
Title
EuroSCORE II versus additive and logistic EuroSCORE in patients undergoing
percutaneous coronary intervention.
Source
American Journal of Cardiology. 112 (3) (pp 323-329), 2013. Date of
Publication: 01 Aug 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of the present study was to externally validate the European
System for Cardiac Operative Risk Evaluation (EuroSCORE) II (ESII) in
patients undergoing percutaneous coronary intervention (PCI) and to
compare its performance with that of its previously released versions,
named additive (addES) and logistic EuroSCORE (logES). A total of 537
patients undergoing PCI were analyzed by different measurements of
discrimination, calibration, and global accuracy. A significant gradient
in all-cause mortality was seen with all the models at 30 days, 1 year,
and 5 years, with the exception of the ESII at 30 days. The ESII had the
lowest area under the receiver operating characteristic curve at all time
points compared with its previous version, being 0.83 (vs 0.90 for both
addES and logES) at 30 days, 0.75 (vs 0.82 for both addES and logES) at 1
year, and 0.69 (vs 0.77 for addES and 0.76 for logES) at 5 years. However,
the ESII displayed a better calibration than the logES at 30 days, whereas
both scores were miscalibrated at 1 and 5 years. The Brier score displayed
similar global accuracy between the ESII and logES. In conclusion, the
ESII is better calibrated than the logES at 30 days but does not represent
a step forward in discrimination and global accuracy compared with its
previous versions for predicting early- and long-term mortality of
patients undergoing PCI. 2013 Elsevier Inc. All rights reserved.

<28>
[Use Link to view the full text]
Accession Number
2013451075
Authors
Murphy B.M. Worcester M.U.C. Higgins R.O. Elliott P.C. Le Grande M.R.
Mitchell F. Navaratnam H. Turner A. Grigg L. Tatoulis J. Goble A.J.
Institution
(Murphy, Worcester, Higgins, Elliott, Le Grande, Mitchell, Navaratnam,
Goble) Heart Research Centre, University of Melbourne, Oyal Melbourne
Hospital, Melbourne, VIC 3050, Australia
(Murphy, Worcester, Elliott, Turner) Department of Psychiatry, University
of Melbourne, Melbourne, VIC, Australia
(Grigg, Tatoulis) Royal Melbourne Hospital, University of Melbourne,
Melbourne, VIC, Australia
Title
Reduction in 2-year recurrent risk score and improved behavioral outcomes
after participation in the "beating heart problems" self-management
program: Results of a randomized controlled trial.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 33 (4) (pp
220-228), 2013. Date of Publication: July-August 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE: While behavior change can improve risk factor profiles and
prognosis after an acute cardiac event, patients need assistance to
achieve sustained lifestyle changes. We developed the "Beating Heart
Problems" cognitive-behavioral therapy and motivational interviewing
program to support patients to develop behavioral and cognitive
self-management skills. We report the results of a randomized controlled
trial of the program. METHODS: Patients (n = 275) consecutively admitted
to 2 Melbourne hospitals after acute myocardial infarction (32%), coronary
artery bypass graft surgery (40%), or percutaneous coronary intervention
(28%) were randomized to treatment (T; n = 139) or control (C; n = 136). T
group patients were invited to participate in the 8-week group-based
program. Patients underwent risk factor screening 6 weeks after hospital
discharge (before randomization) and again 4 and 12 months later. At both
the followups, T and C groups were compared on 2-year risk of a recurrent
cardiac event and key behavioral outcomes, using both intention-to-treat
and "completers only" analyses. RESULTS: Patients ranged in age from 32 to
75 years (mean = 59.0 years; SD-9.1 years). Most patients (86%) were men.
Compared with the C group patients, T group patients tended toward greater
reduction in 2-year risk, at both the 4-and 12-month followups.
Significant benefits in dietary fat intake and functional capacity were
also evident. CONCLUSIONS: The "Beating Heart Problems" program showed
modest but important benefit over usual care at 4 and, to a lesser extent,
12 months. Modifications to the program such as the inclusion of booster
sessions and translation to online delivery are likely to improve
outcomes. Copyright 2013 Wolters Kluwer Health | Lippincott Williams
&Wilkins.

<29>
Accession Number
21638037
Authors
Xia W.F. Liu Y. Zhou Q.S. Tang Q.Z. Zou H.D.
Institution
(Xia) Department of Critic Care Medicine and Cardiology, Renmin Hospital
of Wuhan University, Wuhan 430060, People's Republic of China.
Title
Protective effect of propofol and its relation to postoperation recovery
in children undergoing cardiac surgery with cardiopulmonary bypass.
Source
Pediatric cardiology. 32 (7) (pp 940-946), 2011. Date of Publication: Oct
2011.
Abstract
The aim of this study was to investigate the effect of propofol and its
relation to postoperation recovery in children undergoing cardiac surgery
with cardiopulmonary bypass (CPB). Twenty ASA class I-II children with
congenital heart disease undergoing cardiac surgery were randomly
allocated to a propofol group (n = 10) or a control group (n = 10). Blood
samples were collected at five time points: before operation (T (0)),
before the start of CPB (T (1)), 25 min after the aorta was cross-clamped
(T (2)), 30 min after release of the aortic cross-clamp (T (3)), and 2 h
after the cessation of CPB (T (4)). The myocardial samples were collected
at the time of incubation into the right atrium before CPB and at 30 min
after reperfusion. After CPB, propofol significantly suppressed the
increase of the serum lactate dehydrogenase (LDH), creatine phosphokinase
(CK), and interleukin-6 (IL-6) levels and the decrease of the serum
superoxide dismutase (SOD) level. In addition, propofol inhibited the
increase of myocardial nuclear factor-B (NF-B) expression and inflammatory
cells infiltration after CPB. Furthermore, propofol significantly
shortened the tracheal extubation time. In conclusion, propofol exerts a
protective effect and improves postoperation recovery through its
antioxidant and anti-inflammatory actions in children undergoing cardiac
surgery with CPB.

<30>
Accession Number
2013425972
Authors
Iseki K. Arima H. Kohagura K. Komiya I. Ueda S. Tokuyama K. Shiohira Y.
Uehara H. Toma S.
Institution
(Iseki) Dialysis Unit, University Hospital of the Ryukyus, Nishihara,
Okinawa, Japan
(Arima) George Institute for Global Health, University of Sydney,
Australia
(Kohagura) University of the Ryukyus, Department of Cardiovascular
Medicine, Nephrology and Neurology, Okinawa, Japan
(Komiya) Department of Community Healthcare System, University of the
Ryukyus Hospital, Nishihara, Okinawa, Japan
(Ueda) Department of Clinical Pharmacology and Therapeutics, University of
the Ryukyus, Nishihara, Okinawa, Japan
(Tokuyama) Tokuyama Clinic, Urasoe, Okinawa, Japan
(Shiohira) Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan
(Uehara) Okinawa Prefectural Chubu Hospital, Okinawa, Japan
(Toma) Toma Naika Clinic, Nishihara, Okinawa, Japan
Title
Effects of angiotensin receptor blockade (ARB) on mortality and
cardiovascular outcomes in patients with long-term haemodialysis: A
randomized controlled trial.
Source
Nephrology Dialysis Transplantation. 28 (6) (pp 1579-1589), 2013. Date of
Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundHypertension is a major risk factor for death and cardiovascular
disease (CVD) in patients undergoing chronic haemodialysis (HD), but there
is uncertainty surrounding the effects of blood pressure (BP) lowering on
this high-risk patient group.MethodsIn a multicenter, prospective,
randomized, open-label, blinded-endpoint trial, 469 patients with chronic
HD and elevated BP (140-199/90-99 mmHg) were assigned to receive the
angiotensin receptor blockade (ARB) olmesartan (at a dose of 10-40 mg
daily; n =235) or another treatment that does not include angiotensin
receptor blockers and angiotensin-converting enzyme (ACE) inhibitors (n
=234). The primary outcomes were the following: (i) composite of death,
nonfatal stroke, nonfatal myocardial infarction and coronary
revascularization and (ii) all-cause death.ResultsDuring a mean follow-up
of 3.5 years, the mean BP was 0.9/0.0 mmHg lower in the olmesartan group
than in the control group (not significant). A total of 68 patients
(28.9%) in the olmesartan group and 67 patients (28.6%) in the control
group had subsequent primary composite endpoints [hazard ratio (HR) in the
olmesartan group 1.00, 95% confidence interval (CI) 0.71-1.40, P =0.99].
All-cause deaths occurred in 38 patients (16.2%) in the olmesartan group
and 39 (16.7%) in the control group (HR, 0.97; 95% CI, 0.62-1.52, P
=0.91). Olmesartan did not alter the risks of serious adverse
events.ConclusionsBP-lowering treatment with an ARB did not significantly
lower the risks of major cardiovascular events or death among patients
with hypertension on chronic HD. (Cochrane Renal Group Prospective Trial
Register number CRG010600030). 2013 The Authors.

<31>
Accession Number
2013448337
Authors
Xu B. Yang Y. Yuan Z. Du Z. Wong S.C. Genereux P. Lu S.
Institution
(Xu, Yang) Fu Wai Hospital, National Center for Cardiovascular Diseases of
China, 167 Bei Li Shi Road, Xicheng District, Beijing 100037, China
(Yuan) First Affiliated Hospital of Medical College, Xi'An Jiaotong
University, Xi'an, China
(Du) First Affiliated Hospital Sun Yat-sen University, New York, NY,
United States
(Wong) New York Presbyterian-Weill Cornell Medical Center, New York, NY,
United States
(Genereux) Cardiovascular Research Foundation, New York, NY, United States
(Lu) Affiliated An Zhen Hospital of Capital Medical University, Beijing,
China
Title
Zotarolimus- and paclitaxel-eluting stents in an all-comer population in
China: The RESOLUTE China randomized controlled trial.
Source
JACC: Cardiovascular Interventions. 6 (7) (pp 664-670), 2013. Date of
Publication: July 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to compare clinical outcomes and
angiographic findings using the Resolute zotarolimus-eluting stent (R-ZES)
(Medtronic, Santa Rosa, California) versus the Taxus Liberte
paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts)
in an all-comer Chinese population. Background: Concerns regarding
restenosis risk led to new-generation drug-eluting stents (DES) designed
for use in patients with complex clinical or lesion characteristics.
In-stent late lumen loss (LLL) is a measure of restenosis risk. Methods:
Patients with an indication for treatment with a DES were randomized in a
1:1 ratio to placement of at least 1 R-ZES or PES with minimal exclusions.
The primary endpoint was angiographic in-stent LLL at 9 months
post-procedure. Clinical endpoints at 12 months are compared between the 2
stents. Results: A total of 198 patients received a R-ZES, and 202
patients received a PES. Most patients were male; 25.8% and 29.2% of R-ZES
and PES patients, respectively, had diabetes. Over 70% of lesions in both
cohorts were American College of Cardiology/American Heart Association
lesion classification Type B2 and C (B2/C). In-stent LLL was 0.16 +/- 0.38
mm for R-ZES and 0.33 +/- 0.52 mm for PES at 9 months (p < 0.001; 95%
confidence interval [CI]: -0.26 to -0.08). The rates of clinically driven
target lesion revascularization were 1.5% for R-ZES and 7.0% for PES (p =
0.011). The rate of target lesion failure was 5.6% for R-ZES and 11% for
PES (p = 0.068). Conclusions: In an all-comers Chinese population, 9-month
in-stent LLL was significantly less with R-ZES compared with PES, which
was reflected in lower revascularization rates at 12 months for the R-ZES
patients. Results are consistent with previous clinical trials of the
R-ZES in all-comer populations. (Resolute Zotarolimus-Eluting Stent Versus
the Taxus Liberte Paclitaxel-Eluting Stent for Percutaneous Coronary
Intervention in China [R-China RCT]; NCT01334268). 2013 American College
of Cardiology Foundation.

<32>
Accession Number
2013433751
Authors
Vanek T. Straka Z.
Institution
(Vanek, Straka) Kardiochirurgicka Klinika, Kardiocentrum, 3, LF UK, FNKV,
Ruska 87, 100 00 Praha 10, Czech Republic
Title
Topical use of tranexamic acid in cardiac surgery - A review and
meta-analysis of four randomized controlled trials.
Source
Cor et Vasa. 55 (2) (pp E184-E189), 2013. Date of Publication: April 2013.
Publisher
Elsevier Science B.V. (P.O. Box 1527, Amsterdam 1000 BM, Netherlands)
Abstract
The article deals with the issue of topical use of tranexamic acid in
cardiac surgery. Four randomized, double-blind trials comparing tranexamic
acid vs. placebo were identified in the available literature (371 patients
in total). In all of these studies the topical application of tranexamic
acid significantly reduced postoperative blood loss, whereas a significant
reduction of transfusion requirements was only described in one of these
studies. A meta-analytic approach confirmed a significant reduction in
blood loss (in 24 h) by 321.6 mL on average (95% confidence interval
-530.3 mL, -112.9 mL; p=0.003). Another trial was performed to examine a
possible augmentation of systemic administration of tranexamic acid by the
additional topical application. Despite an evident tendency toward lower
blood loss in the group treated also topically, the differences between
groups in this study did not reach statistical significance. There is an
apparent need for further controlled trials with larger groups of
patients. 2012 The Czech Society of Cardiology. Published by Elsevier
Urban & Partner Sp. z o.o. All rights reserved.

<33>
Accession Number
2013448332
Authors
Farooq V. Vergouwe Y. Genereux P. Bourantas C.V. Palmerini T. Caixeta A.
Garcia-Garcia H.M. Diletti R. Morel M.-A. McAndrew T.C. Kappetein A.P.
Valgimigli M. Windecker S. Dawkins K.D. Steyerberg E.W. Serruys P.W. Stone
G.W.
Institution
(Farooq, Bourantas, Garcia-Garcia, Diletti, Serruys) Department of
Interventional Cardiology, Erasmus University Medical Centre,
Thoraxcenter, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
(Vergouwe, Steyerberg) Department of Public Health, Erasmus University
Medical Center, Rotterdam, Netherlands
(Genereux, Palmerini, Caixeta, McAndrew, Stone) Columbia University
Medical Center, New York-Presbyterian Hospital, Cardiovascular Research
Foundation, New York, NY, United States
(Morel) Cardialysis BV, Rotterdam, Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(Valgimigli) Department of Interventional Cardiology, Cardiovascular
Institute, University of Ferrara, Ferrara, Italy
(Windecker) Cardiology Department, Bern University Hospital, Bern,
Switzerland
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
Title
Prediction of 1-year mortality in patients with acute coronary syndromes
undergoing percutaneous coronary intervention: Validation of the logistic
clinical syntax (synergy between percutaneous coronary interventions with
taxus and cardiac surgery) score.
Source
JACC: Cardiovascular Interventions. 6 (7) (pp 737-745), 2013. Date of
Publication: July 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to validate the Logistic Clinical SYNTAX
(Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac
Surgery) score in patients with non-ST-segment elevation acute coronary
syndromes (ACS), in order to further legitimize its clinical application.
Background The Logistic Clinical SYNTAX score allows for an individualized
prediction of 1-year mortality in patients undergoing contemporary
percutaneous coronary intervention. It is composed of a "Core" Model
(anatomical SYNTAX score, age, creatinine clearance, and left ventricular
ejection fraction), and "Extended" Model (composed of an additional 6
clinical variables), and has previously been cross validated in 7
contemporary stent trials (>6,000 patients). Methods One-year all-cause
death was analyzed in 2,627 patients undergoing percutaneous coronary
intervention from the ACUITY (Acute Catheterization and Urgent
Intervention Triage Strategy) trial. Mortality predictions from the Core
and Extended Models were studied with respect to discrimination, that is,
separation of those with and without 1-year all-cause death (assessed by
the concordance [C] statistic), and calibration, that is, agreement
between observed and predicted outcomes (assessed with validation plots).
Decision curve analyses, which weight the harms (false positives) against
benefits (true positives) of using a risk score to make mortality
predictions, were undertaken to assess clinical usefulness. Results In the
ACUITY trial, the median SYNTAX score was 9.0 (interquartile range 5.0 to
16.0); approximately 40% of patients had 3-vessel disease, 29% diabetes,
and 85% underwent drug-eluting stent implantation. Validation plots
confirmed agreement between observed and predicted mortality. The Core and
Extended Models demonstrated substantial improvements in the
discriminative ability for 1-year all-cause death compared with the
anatomical SYNTAX score in isolation (C-statistics: SYNTAX score: 0.64,
95% confidence interval [CI]: 0.56 to 0.71; Core Model: 0.74, 95% CI: 0.66
to 0.79; Extended Model: 0.77, 95% CI: 0.70 to 0.83). Decision curve
analyses confirmed the increasing ability to correctly identify patients
who would die at 1 year with the Extended Model versus the Core Model
versus the anatomical SYNTAX score, over a wide range of thresholds for
mortality risk predictions. Conclusions Compared to the anatomical SYNTAX
score alone, the Core and Extended Models of the Logistic Clinical SYNTAX
score more accurately predicted individual 1-year mortality in patients
presenting with non-ST-segment elevation acute coronary syndromes
undergoing percutaneous coronary intervention. These findings support the
clinical application of the Logistic Clinical SYNTAX score. 2013 by the
American College of Cardiology Foundation.

<34>
[Use Link to view the full text]
Accession Number
23558843
Authors
Feltracco P. Barbieri S. Rizzi S. Ori C. Groppa F. De Rosa G. Frigo A.C.
Padrini R.
Institution
(Feltracco) Department of Anesthesia and Intensive Care, University
Hospital of Padova, via Cesare Battisti 256, Padua, Italy.
Title
Brief report: perioperative analgesic efficacy and plasma concentrations
of S+ -ketamine in continuous epidural infusion during thoracic surgery.
Source
Anesthesia and analgesia. 116 (6) (pp 1371-1375), 2013. Date of
Publication: Jun 2013.
Abstract
In our study, we evaluated the analgesic effect and plasma level time
course of subanesthetic doses of intraoperative S(+)-ketamine administered
by continuous epidural infusion for postthoracotomic pain. A study
population of 140 patients undergoing thoracic surgery was randomly
assigned to either S(+)-ketamine or ropivacaine by continuous epidural
infusion. The outcome measures were as follows: (a) intraoperative
fentanyl requirements; (b) postoperative pain intensity; and (c)
postoperative rescue analgesics. Intraoperative fentanyl consumption was
significantly lower (median of difference: -58.6 mug; 95% confidence
interval [CI], -97.2 to -19.6 mug; P = 0.0032) in patients in the ketamine
group than those in the ropivacaine group. Postoperative visual analog
scale scores were significantly lower in the ketamine group than in
controls (Wilcoxon-Mann-Whitney odds at 24 hours = 6.25; 95% CI, 4.07 to
1.97; P < 0.0001). Rescue analgesics were required more frequently in
controls than in the ketamine group (percentage difference: 58.6%; 95% CI,
43.3% to 69.6%; P < 0.0001). The mean plasma level of ketamine declined
rapidly during continuous epidural infusion and decayed slowly after it
had stopped. Our data show that epidural infusion of subanesthetic doses
of S(+)-ketamine during thoracic surgery provides better postoperative
analgesia than epidural ropivacaine.

<35>
Accession Number
23189301
Authors
Montebugnoli L. Venturi M. Cervellati F.
Institution
(Montebugnoli) Department of Oral Science, University of Bologna, Bologna,
Italy.
Title
Bone response to submerged implants in organ transplant patients: a
prospective controlled study.
Source
The International journal of oral & maxillofacial implants. 27 (6) (pp
1494-1500), 2012. Date of Publication: 2012 Nov-Dec.
Abstract
To compare the short-term outcome of dental implant therapy in a group of
organ transplant patients with that of a control group. The study
population included consecutive organ transplant patients and consecutive
normal (healthy) subjects as controls. Two films were taken of all
patients: one at baseline (implant placement) and one after 3 months of
healing. All radiographs were analyzed twice (15 days apart) blindly by
two independent trained radiologists. Crestal bone level (CBL) was
measured, defined as the perpendicular distance from the reference point
on the implant to the first visible apical bone-to-implant contact. The
study population included 10 organ transplant patients (eight hearts, two
livers) and 10 control patients, who received 20 and 12 submerged dental
implants, respectively. At the 3-month follow-up visit, no implants showed
any exposed cover screws. CBL increased in both groups, without any
significant difference between the groups (CBL increased from 0.08+/-0.09
mm to 0.28+/-0.20 mm in transplant patients and from 0.11+/-0.16 mm to
0.42+/-0.32 mm in controls). Multiple analysis of variance showed that the
mean bone loss of 0.21+/-0.18 mm observed in the group of transplant
patients was not statistically different from that (0.32+/-0.25 mm) seen
in the control group and was not influenced by any of the variables
considered. The present pilot study seems to indicate that the bone
response around submerged dental implants in immunocompromised organ
transplant patients does not differ from that observed in control patients
and that this particular population of patients may be successfully
rehabilitated with dental implants.

<36>
Accession Number
21794114
Authors
Pituskin E. Haykowsky M. Mackey J.R. Thompson R.B. Ezekowitz J. Koshman S.
Oudit G. Chow K. Pagano J.J. Paterson I.
Institution
(Pituskin) University of Alberta, Edmonton, Alberta, Canada.
Title
Rationale and design of the Multidisciplinary Approach to Novel Therapies
in Cardiology Oncology Research Trial (MANTICORE 101--Breast): a
randomized, placebo-controlled trial to determine if conventional heart
failure pharmacotherapy can prevent trastuzumab-mediated left ventricular
remodeling among patients with HER2+ early breast cancer using cardiac
MRI.
Source
BMC cancer. 11 (pp 318), 2011. Date of Publication: 2011.
Abstract
MANTICORE 101 - Breast (Multidisciplinary Approach to Novel Therapies in
Cardiology Oncology Research) is a randomized trial to determine if
conventional heart failure pharmacotherapy (angiotensin converting enzyme
inhibitor or beta-blocker) can prevent trastuzumab-mediated left
ventricular remodeling, measured with cardiac MRI, among patients with
HER2+ early breast cancer. One hundred and fifty-nine patients with
histologically confirmed HER2+ breast cancer will be enrolled in a
parallel 3-arm, randomized, placebo controlled, double-blind design. After
baseline assessments, participants will be randomized in a 1:1:1 ratio to
an angiotensin-converting enzyme inhibitor (perindopril), beta-blocker
(bisoprolol), or placebo. Participants will receive drug or placebo for 1
year beginning 7 days before trastuzumab therapy. Dosages for all groups
will be systematically up-titrated, as tolerated, at 1 week intervals for
a total of 3 weeks. The primary objective of this randomized clinical
trial is to determine if conventional heart failure pharmacotherapy can
prevent trastuzumab-mediated left ventricular remodeling among patients
with HER2+ early breast cancer, as measured by 12 month change in left
ventricular end-diastolic volume using cardiac MRI. Secondary objectives
include 1) determine the evolution of left ventricular remodeling on
cardiac MRI in patients with HER2+ early breast cancer, 2) understand the
mechanism of trastuzumab mediated cardiac toxicity by assessing for the
presence of myocardial injury and apoptosis on serum biomarkers and
cardiac MRI, and 3) correlate cardiac biomarkers of myocyte injury and
extra-cellular matrix remodeling with left ventricular remodeling on
cardiac MRI in patients with HER2+ early breast cancer. Cardiac toxicity
as a result of cancer therapies is now recognized as a significant health
problem of increasing prevalence. To our knowledge, MANTICORE will be the
first randomized trial testing proven heart failure pharmacotherapy in the
prevention of trastuzumab-mediated cardiotoxicity. We expect the findings
of this trial to provide important evidence in the development of
guidelines for preventive therapy. ClinicalTrials.gov: NCT01016886.

<37>
Accession Number
22035351
Authors
Roes S.D. Dehnavi R.A. Westenberg J.J. Lamb H.J. Mertens B.J. Tamsma J.T.
de Roos A.
Institution
(Roes) Department of Radiology, Leiden University Medical Center, Leiden,
The Netherlands.
Title
Effect of lifestyle intervention plus rosiglitazone or placebo therapy on
left ventricular mass assessed with cardiovascular magnetic resonance in
the metabolic syndrome.
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. 13 (pp 65), 2011. Date of
Publication: 2011.
Abstract
To evaluate the effect of lifestyle intervention in conjunction with
rosiglitazone or placebo therapy on left ventricular (LV) mass, using
cardiovascular magnetic resonance (CMR) in the metabolic syndrome. The
present study was a pre-specified substudy of a double-blind randomized
controlled trial evaluating the effect of lifestyle intervention in
conjunction with rosiglitazone or placebo therapy on carotid artery
atherosclerosis in the metabolic syndrome. From this original study
population, 10 subjects from the placebo group and 10 from the
rosiglitazone group were randomly selected. At baseline and follow-up (52
weeks), clinical and laboratory measurements were assessed and a
CMR-examination was performed to evaluate LV mass indexed for body surface
area (LV mass-I). Subsequently, the effect of therapy (rosiglitazone vs.
placebo) and clinical and laboratory variables on LV mass-I was evaluated.
In both groups, body mass index, waist circumference, systolic and
diastolic blood pressure significantly decreased during follow-up.
Interestingly, LV mass-I significantly decreased in the placebo group
(48.9 +/- 5.3 g/m2 vs. 44.3 +/- 5.6 g/m2, p < 0.001) indicating reverse
remodeling, whereas LV mass-I remained unchanged in the rosiglitazone
group (54.7 +/- 9.9 g/m2 vs. 53.7 +/- 9.2 g/m2, p = 0.3). After correction
for systolic and diastolic blood pressure and triglyceride, the kind of
therapy (rosiglitazone vs. placebo) remained the only significant
predictor of LV mass-I reduction. Lifestyle intervention resulted in a
reduction of LV mass-I in the metabolic syndrome, indicating reverse
remodeling. However, rosiglitazone therapy may have inhibited this
positive reverse remodeling. Current Controlled Trials ISRCTN54951661.

<38>
Accession Number
71121466
Title
European Association of Psychosomatic Medicine, EAPM 2013 Annual Meeting.
Source
Journal of Psychosomatic Research. Conference: European Association of
Psychosomatic Medicine, EAPM 2013 Annual Meeting Cambridge United Kingdom.
Conference Start: 20130704 Conference End: 20130706. Conference
Publication: (var.pagings). 74 (6) , 2013. Date of Publication: June 2013.
Publisher
Elsevier Inc.
Abstract
The proceedings contain 77 papers. The topics discussed include: is
cognitive behavior therapy effective for older cardiac surgery patients?;
randomized controlled trial of a telephone-based peer support intervention
to reduce depressive symptoms and improve social support in women with
CHD; cognitive and perceptual processes in somatoform disorders and
physical symptom reporting symposium (paper 1): physical symptom reporting
may be associated with a general deficit in attention rather than
excessive body-focus; a brief psychological intervention for prevention of
self-harm: RCT from Pakistan; somatization and traumatic life events: the
relevance of dysfunction of autobiographical memory; 'mind-body'
educational project in primary school; face transplantation: four year
psychological outcomes; state of the art in CL face transplant evaluation;
and can appropriate training improve the empathic capacities of medical
students?.

<39>
Accession Number
71119505
Authors
Ali M. Ahmad S. Kumar N.
Title
Outcomes of cardiothoracic surgery in cirrhosis.
Source
Gastroenterology. Conference: Digestive Disease Week 2013, DDW 2013
Orlando, FL United States. Conference Start: 20130518 Conference End:
20130521. Conference Publication: (var.pagings). 144 (5 SUPPL. 1) (pp
S999), 2013. Date of Publication: May 2013.
Publisher
W.B. Saunders
Abstract
Background: A recent meta-analysis reported poor outcomes in patients with
cirrhosis undergoing coronary artery bypass graft (CABG). Although
previous studies have reported higher mortality and morbidity in patients
with cirrhosis undergoing CABG, however studied patient populations have
been limited to data from academic and specialized centers. We analyzed
the outcomes of cardiothoracic surgery in cirrhotic patients on a national
inpatient sample. Methods: Using the Nationwide Inpatient Sample 2008,
patients older than 18 years, discharged with any diagnosis of cirrhosis
were identified through appropriate ICD- 9-CM codes. The patients with
major cardiac surgeries involving sternotomy or thoracotomy were similarly
identified using the ICD-9 procedure codes. The lung and heart transplant
patients were excluded from the study. Outcome variables included
frequency, inhospital mortality and length of stay (LOS) of cardiac
surgeries in cirrhotic patients. Using the STATA software, multivariate
logistic regression was performed to adjust for age, sex, race and
Elixhauser co-morbidity index. Chi square test and T- test were used for
comparing categorical and continuous variable respectively. The outcomes
were also evaluated using Baveno classification of compensated (Class I &
II) and uncompensated cirrhosis (Class III & IV). Results: There were
438,306 estimated adult discharges with cirrhosis in 2008. The frequency
of admissions requiring cardiothoracic surgery was 0.33% in cirrhotics
when compared to 1.0% in non-cirrhotic hospitalization. Compensated
cirrhotics comprised 91% of the surgeries. Cirrhotic patients had higher
mortality rates when compared to non cirrhotic patient (10.3% vs. 3.1%,
p<0.001). After age and sex adjusted analysis, patients with cirrhosis had
3.9 times higher odds of dying when compared to non cirrhotics. The rates
of prolonged mechanical ventilation were significantly higher in the
cirrhotics (OR 2.0, 95%CI 1.4-2.7, p<0.001). Similarly the need for blood
and platelet transfusion was 1.3 times and 2 times higher respectively.
The LOS in cirrhosis patients undergoing cardio-thoracic surgeries was 2
days (Median LOS: 10 days vs. 8 days; p <0.001) longer than non cirrhosis
patients. Conclusion: This observational study confirms that
cardiothoracic surgery carries a significantly higher mortality even in
patients with compensated cirrhosis. In addition postoperative
complications like prolonged mechanical ventilation are common.
Identification of high risk patients and appropriate pre/post operative
management is of vital importance to reduce the mortality and morbidity of
patients with cirrhosis undergoing surgical procedures.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 22

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<1>
Accession Number
2013445115
Authors
Whitlock R. Mathew J. Eikelboom J. Al-Saleh A.M. Yuan F. Teoh K.
Institution
(Whitlock, Mathew, Eikelboom, Al-Saleh, Yuan, Teoh) McMaster Univ.,
Canada; the Pop. Hlth. Res. Inst., Canada; and Hamilton Hlth. Sci. Ctr.,
Hamilton, Ontario, Canada
Title
Processed residual pump blood in cardiac surgery: The Processed Residual
Blood in Cardiac surgery trial.
Source
Transfusion. 53 (7) (pp 1487-1492), 2013. Date of Publication: July 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background Processing residual cardiopulmonary bypass (CPB) volume via
ultrafiltration may improve hemostasis and reduce transfusion through
clearing activated complement, activated coagulation components, and
proinflammatory cytokines. We sought to establish if processing residual
CPB volume with ultrafiltration reduces homologous blood transfusion and
bleeding. Study Design and Methods Adult patients undergoing isolated
coronary artery bypass grafting (CABG) surgery were randomly assigned to
receive processed (n = 99) or unprocessed (control; n = 98) residual CPB
volume in this single-center randomized controlled trial. The intensive
care unit team, patients, and assessors were blinded to treatment
assignment and a transfusion protocol was followed. Surgeons were
permitted to use retrograde autologous priming to minimize crystalloid
pump prime. Results The processed study bag was of a smaller volume (280
[0, 550] mL vs. 590 [215, 726] mL; p < 0.01) but a higher hematocrit (29%
[0%, 34%] vs. 23% [20%, 25%]; p < 0.01) than control. The rate of
transfusion with homologous blood was 39% in both groups (p = 0.92). There
was no difference in the volume transfused (processed 323 +/- 585 mL vs.
control 276 +/- 520 mL; p = 0.56). There was also no difference in the
proportion of patients transfused with any blood product (processed 44%
vs. control 45%; p = 0.95) or in the volume of chest tube output
(processed 600 [500, 940] mL vs. control 670 [490, 932] mL; p = 0.62).
Conclusion Ultrafiltration of residual CPB volume in adults undergoing
isolated CABG surgery does not reduce the need for transfusion or
bleeding. 2012 American Association of Blood Banks.

<2>
Accession Number
22011515
Authors
Wittwer T. Choi Y.H. Neef K. Schink M. Sabashnikov A. Wahlers T.
Institution
(Wittwer) Department of Cardiothoracic Surgery, Heart Center, University
Hospital of Cologne, Germany.
Title
Off-pump or minimized on-pump coronary surgery--initial experience with
Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue
damage.
Source
Journal of cardiothoracic surgery. 6 (pp 142), 2011. Date of Publication:
2011.
Abstract
Off-pump-coronary-artery-bypass-grafting (OPCAB) and
minimized-extracorporeal-circulation (Mini-HLM) have been proposed to
avoid harmful effects of cardiopulmonary-bypass (CPB). Controversies exist
whether OPCAB is still superior in perioperative outcome. Circulating
endothelial cells (CEC) are sensitive markers of endothelial damage and
are significantly elevated in conventional-CPB-procedures as compared to
Mini-HLM-revascularisation. Therefore, CEC might be of specific value in
evaluating effectiveness of Mini-HLM and OPCAB as currently applied
less-invasive coronary procedures. 76 coronary patients were randomly
assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe, Terumo Inc., n
= 42) procedures. Perioperative data, clinical and serological outcome and
measurements of CEC-release and parameters of endothelial function
(v.Willebrand-Factor, soluble-thrombomodulin) perioperatively
(pre-operative-baseline, post-Mini-HLM/release of OPCAB-stabilizer, 6 h,
12 h, 24 h and 5 days postoperatively) were obtained and compared by ANOVA
models including repeated-measures-analysis. Mean graft-number was 3.06
+/- 0.72 in Mini-HLM-patients and 1.89 +/- 0.74 in OPCAB-patients (p <
0.001). However, ventilation-, ICU- and total-hospital duration were
comparable between groups as well as chest-tube-drainage, transfusion
requirements, hemodynamics and catecholaminergic support (p > 0.05).
CEC-release did not differ between groups (p = 0.274) and was generally
within normal limits, Troponin-T levels where not significanty different
(p = 0.108). No myocardial infarctions, strokes or deaths occurred, neuron
specific enolase (NSE) did not show any differences between groups (p =
0.194). Conceptional advantages of minimized CPB systems (ROCsafe) result
in morbidity and mortality comparable with OPCAB procedures. Mini-HLM
therefore minimizes CPB-related systemic and organ injury as demonstrated
by low CEC-values which indicates intact endothelial integrity.
Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in
high-risk patients while facilitating more complete revascularization in
complex patients.

<3>
Accession Number
21992565
Authors
Doss M. Wood J.P. Kiessling A.H. Moritz A.
Institution
(Doss) Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang
Goethe University, Frankfurt am Main, Germany.
Title
Comparative evaluation of left ventricular mass regression after aortic
valve replacement: a prospective randomized analysis.
Source
Journal of cardiothoracic surgery. 6 (pp 136), 2011. Date of Publication:
2011.
Abstract
We assessed the hemodynamic performance of various prostheses and the
clinical outcomes after aortic valve replacement, in different age groups.
One-hundred-and-twenty patients with isolated aortic valve stenosis were
included in this prospective randomized randomised trial and allocated in
three age-groups to receive either pulmonary autograft (PA, n = 20) or
mechanical prosthesis (MP, Edwards Mira n = 20) in group 1 (age < 55
years), either stentless bioprosthesis (CE Prima Plus n = 20) or MP
(Edwards Mira n = 20) in group 2 (age 55-75 years) and either stentless
(CE Prima Plus n = 20) or stented bioprosthesis (CE Perimount n = 20) in
group 3 (age > 75). Clinical outcomes and hemodynamic performance were
evaluated at discharge, six months and one year. In group 1, patients with
PA had significantly lower mean gradients than the MP (2.6 vs. 10.9 mmHg,
p = 0.0005) with comparable left ventricular mass regression (LVMR).
Morbidity included 1 stroke in the PA population and 1 gastrointestinal
bleeding in the MP subgroup. In group 2, mean gradients did not differ
significantly between both populations (7.0 vs. 8.9 mmHg, p = 0.81). The
rate of LVMR and EF were comparable at 12 months; each group with one
mortality. Morbidity included 1 stroke and 1 gastrointestinal bleeding in
the stentless and 3 bleeding complications in the MP group. In group 3,
mean gradients did not differ significantly (7.8 vs 6.5 mmHg, p = 0.06).
Postoperative EF and LVMR were comparable. There were 3 deaths in the
stented group and no mortality in the stentless group. Morbidity included
1 endocarditis and 1 stroke in the stentless compared to 1 endocarditis, 1
stroke and one pulmonary embolism in the stented group. Clinical outcomes
justify valve replacement with either valve substitute in the respective
age groups. The PA hemodynamically outperformed the MPs. Stentless valves
however, did not demonstrate significantly superior hemodynamics or
outcomes in comparison to stented bioprosthesis or MPs.

<4>
Accession Number
21854625
Authors
Sun J. Ding Z. Qian Y.
Institution
(Sun) Department of Anesthesiology, First Affiliated Hospital with Nanjing
Medical University/Jiangsu province hospital, Nanjing, P.R.,China.
Title
Effect of short-acting beta blocker on the cardiac recovery after
cardiopulmonary bypass.
Source
Journal of cardiothoracic surgery. 6 (pp 99), 2011. Date of Publication:
2011.
Abstract
The objective of this study was to investigate the effect of beta blocker
on cardiac recovery and rhythm during cardiac surgeries. Sixty surgical
rheumatic heart disease patients were received esmolol 1 mg/kg or the same
volume of saline prior to removal of the aortic clamp. The incidence of
cardiac automatic re-beat, ventricular fibrillation after reperfusion, the
heart rate after steady re-beat, vasoactive drug use during weaning from
bypass, the posterior parallel time and total bypass time were decreased
by esmolol treatment. In conclusion: Esmolol has a positive effect on the
cardiac recovery in cardiopulmonary bypass surgeries.

<5>
Accession Number
2013433721
Authors
Miller C.D. Case L.D. Little W.C. Mahler S.A. Burke G.L. Harper E.N.
Lefebvre C. Hiestand B. Hoekstra J.W. Hamilton C.A. Hundley W.G.
Institution
(Miller, Mahler, Harper, Lefebvre, Hiestand, Hoekstra) Department of
Emergency Medicine, Wake Forest School of Medicine, Medical Center
Boulevard, Winston-Salem, NC 27157, United States
(Case, Hundley) Department of Biostatistical Sciences, Wake Forest School
of Medicine, Winston-Salem, NC, United States
(Little) Department of Internal Medicine/Cardiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Mahler) Department of Epidemiology and Prevention, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Burke) Division of Public Health Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Hamilton) Department of Biomedical Engineering, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Hundley) Department of Radiology, Wake Forest School of Medicine,
Winston-Salem, NC, United States
Title
Stress CMR reduces revascularization, hospital readmission, and recurrent
cardiac testing in intermediate-risk patients with acute chest pain.
Source
JACC: Cardiovascular Imaging. 6 (7) (pp 785-794), 2013. Date of
Publication: July 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The aim of this study was to determine the effect of stress
cardiac magnetic resonance (CMR) imaging in an observation unit (OU) on
revascularization, hospital readmission, and recurrent cardiac testing in
intermediate-risk patients with possible acute coronary syndromes (ACS).
Background Intermediate-risk patients commonly undergo hospital admission
with high rates of coronary revascularization. It is unknown whether
OU-based care with CMR is a more efficient alternative. Methods A total of
105 intermediate-risk participants with symptoms of ACS but without
definite ACS on the basis of the first electrocardiogram and troponin were
randomized to usual care provided by cardiologists and internists (n = 53)
or to OU care with stress CMR (n = 52). The primary composite endpoint of
coronary artery revascularization, hospital readmission, and recurrent
cardiac testing at 90 days was determined. The secondary endpoint was
length of stay from randomization to index visit discharge; safety was
measured as ACS after discharge. Results The median age of participants
was 56 years (range 35 to 91 years), 54% were men, and 20% had
pre-existing coronary disease. Index hospital admission was avoided in 85%
of the OU CMR participants. The primary outcome occurred in 20 usual care
participants (38%) versus 7 OU CMR participants (13%) (hazard ratio: 3.4;
95% confidence interval: 1.4 to 8.0, p = 0.006). The OU CMR group
experienced significant reductions in all components: revascularizations
(15% vs. 2%, p = 0.03), hospital readmissions (23% vs. 8%, p = 0.03), and
recurrent cardiac testing (17% vs. 4%, p = 0.03). Median length of stay
was 26 h (interquartile range: 23 to 45 h) in the usual care group and 21
h (interquartile range: 15 to 25 h) in the OU CMR group (p < 0.001). ACS
after discharge occurred in 3 usual care participants (6%) and no OU CMR
participants. Conclusions In this single-center trial, management of
intermediate-risk patients with possible ACS in an OU with stress CMR
reduced coronary artery revascularization, hospital readmissions, and
recurrent cardiac testing, without an increase in post-discharge ACS at 90
days. (Randomized Investigation of Chest Pain Diagnostic Strategies;
NCT01035047). 2013 by The American College of Cardiology Foundation.

<6>
[Use Link to view the full text]
Accession Number
2013436737
Authors
Ware J.H. Vetrovec G.W. Miller A.B. Van Tosh A. Gaffney M. Yunis C.
Arteaga C. Borer J.S.
Institution
(Ware) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Vetrovec) Division of Cardiology, VCU Medical Center, Richmond, VA,
United States
(Miller) Department of Medicine, Division of Cardiology, University of
Florida-Jacksonville, Jacksonville, FL, United States
(Van Tosh) Division of Cardiovascular Research, St. Francis Hospital,
Roslyn, NY, United States
(Gaffney, Yunis, Arteaga) Pfizer Inc., 235 East 42nd St, New York, NY,
United States
(Borer) Department of Medicine, Division of Cardiovascular Medicine, State
University of New York, Brooklyn and New York, NY, United States
Title
Cardiovascular safety of varenicline: Patient-level meta-analysis of
randomized, blinded, placebo-controlled trials.
Source
American Journal of Therapeutics. 20 (3) (pp 235-246), 2013. Date of
Publication: May-June 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Smoking is a major modifiable risk factor for cardiovascular (CV) disease.
Varenicline is a pharmacological aid for smoking cessation. To explore the
CV safety of varenicline, we investigated the incidence of CV events in
varenicline-treated subjects across all phase 2-4 randomized
placebo-controlled clinical trials of $12-week treatment duration
conducted in smokers aged $18 years and sponsored by the drug
manufacturer. This manuscript reports a subject-level meta-analysis of
time to major adverse cardiovascular events (MACE; defined as CV-related
death, nonfatal myocardial infarction, nonfatal stroke) and time to MACE+
(defined as MACE plus worsening or any procedure for peripheral vascular
disease, hospitalization for angina, or performance of coronary
revascularization). All events were adjudicated by an independent
adjudication committee, blind to treatment assignment. Events were
assessed during treatment and up to 30 days after the last treatment dose.
The primary analytical method was a stratified logrank time-to-event
analysis; secondary analyses were meta-analyses of incidence rate ratios
and rate differences. Overall, 7002 subjects were included (varenicline:
4190; placebo: 2812) from 15 studies. MACE were reported by 13 varenicline
subjects (0.31%) and 6 placebo subjects (0.21%) [hazard ratio, 1.95; 95%
confidence interval (CI): 0.79-4.82; P = 0.15; risk difference, 0.006
events per subject-year; 95% CI: 20.003, 0.015, P 5 0.19]. MACE+ were
reported by 26 varenicline subjects (0.62%) and 12 placebo subjects
(0.43%) (hazard ratio, 1.74; 95% CI: 0.91-3.34, P = 0.10; risk difference,
0.010; 95% CI: 20.002, 0.022, P = 0.11). This subject-level meta-analysis
of MACE or MACE+ up to 30 days posttreatment in placebo-controlled
clinical trials of varenicline found a trend toward increased incidence of
these events in varenicline-treated patients that did not reach
statistical significance. The overall number of events was low and the
absolute risk of CV events with varenicline was small. 2013 Lippincott
Williams & Wilkins.

<7>
Accession Number
2013437041
Authors
Palmerini T. Biondi-Zoccai G. Riva D.D. Mariani A. Savini C. Di Eusanio M.
Genereux P. Frati G. Marullo A.G.M. Landoni G. Greco T. Branzi A. De Servi
S. Di Credico G. Taglieri N. Williams M.R. Stone G.W.
Institution
(Palmerini, Riva, Mariani, Branzi, Taglieri) Dipartimento Cardiovascolare,
Policlinico S.Orsola, Bologna, Italy
(Biondi-Zoccai, Frati, Marullo) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Savini, Di Eusanio) Department of Cardiac Surgery, Policlinico S.Orsola,
Bologna, Italy
(Genereux, Stone) Columbia University Medical Center and the
Cardiovascular Research Foundation, New York, NY, United States
(Frati) Department of Angiocardioneurology, IRCCS 'Neuromed,' Pozzilli
(IS), Italy
(Marullo) Eleonora Lorillard-Spencer-Cenci Foundation, Rome, Italy
(Landoni, Greco) Department of Anesthesia and Intensive Care, Universita'
Vita-Salute San Raffaele, Milano, Italy
(De Servi) Dipartimento di Malattie Cardiovascolari, Ospedale Civile,
Legnano, Italy
(Di Credico) Dipartimento di Cardiochirurgia, Ospedale Civile, Legnano,
Italy
(Williams) Department of Surgery, Columbia University Medical Center, New
York, NY, United States
(Stone) Columbia University Medical Center, New York- Presbyterian
Hospital, Cardiovascular Research Foundation, 111 E. 59th St, 11th Floor,
New York, NY 10022, United States
Title
Risk of stroke with percutaneous coronary intervention compared with
on-pump and off-pump coronary artery bypass graft surgery: Evidence from a
comprehensive network meta-analysis.
Source
American Heart Journal. 165 (6) (pp 910-917.e14), 2013. Date of
Publication: June 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Although some trials have reported that on-pump coronary artery
bypass graft (CABG) surgery may be associated with higher rates of stroke
than percutaneous coronary intervention (PCI), whether stroke is more
common after offpump CABG compared with PCI is unknown. We therefore
sought to determine whether off-pump CABG is associated with an increased
risk of stroke compared with PCI by means of network meta-analysis.
Methods Randomized controlled trials (RCTs) comparing CABG vs PCI were
searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of
international meetings. Results Eighty-three RCTs with 22,729 patients
randomized to on-pump CABG (n = 10,957), off-pump CABG (n = 7,119), or PCI
(n = 4,653) were analyzed. Thirty-day rates of stroke were significantly
lower in patients treated with PCI compared with either off-pump CABG
(odds ratio [OR]; 0.39, 95% CI, 0.19-0.83) or on-pump CABG (OR, 0.26; 95%
CI, 0.12-0.47). Compared with on-pump CABG, off-pump CABG was associated
with significantly lower 30-day risk of stroke (OR, 0.67; 95% CI,
0.41-0.95). However, in sensitivity analyses restricted to high-quality
studies, studies with more than either 100 or 1,000 patients, or studies
with protocol definition or adjudication of stroke by a clinical events
committee, the precision of the point estimate for the 30-day risk of
stroke between off-pump vs on-pump CABG was markedly reduced. Conclusions
Percutaneous coronary intervention is associated with lower 30-day rates
of stroke than both off-pump and on-pump CABG. Further studies are
required to determine whether the risk of stroke is reduced with off-pump
CABG compared with on-pump CABG. (Am Heart J 2013;165:910-917.e14.). 2013,
Mosby, Inc. All rights reserved.

<8>
[Use Link to view the full text]
Accession Number
2013438884
Authors
Ghoorah K. De Soyza A. Kunadian V.
Institution
(Ghoorah) Newcastle University Medical School, United Kingdom
(De Soyza) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University, Newcastle-upon-Tyne NE2 4HH, United Kingdom
(De Soyza) Respiratory Medicine, United Kingdom
(Kunadian) Interventional Cardiology Cardiothoracic Centre, Freeman
Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United
Kingdom
Title
Increased cardiovascular risk in patients with chronic obstructive
pulmonary disease and the potential mechanisms linking the two conditions:
A review.
Source
Cardiology in Review. 21 (4) (pp 196-202), 2013. Date of Publication:
July-August 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Cardiovascular diseases, especially coronary artery disease (CAD), are the
leading causes of death in patients with chronic obstructive pulmonary
disease (COPD). There is a high prevalence of common risk factors in the
COPD/CAD patient population including smoking, sedentary lifestyle and low
socio-economic status. However, various studies have shown that airflow
limitation is an independent risk factor for cardiovascular diseases.
Chronic low-grade systemic inflammation, oxidative stress and increased
platelet activation have been widely reported to be pathophysiological
links between COPD and atherosclerosis. Statins and inhaled
corticosteroids have been investigated as potential therapeutic
interventions in COPD that may lower cardiovascular risk. The goals of
this review are to examine the evidence for increased cardiovascular risk
in COPD patients, the possible mechanisms linking these two chronic
conditions, to discuss possible predictors or markers of poor outcomes
among patients diagnosed with both COPD and CAD, and the therapeutic
options aimed at reducing cardiovascular risks associated with COPD. 2012
Lippincott Williams & Wilkins.

<9>
Accession Number
22877317
Authors
Durdu S. Sirlak M. Cetintas D. Inan M.B. Eryilmaz S. Ozcinar E. Yazicioglu
L. Elhan A.H. Akar A.R. Uysalel A.
Institution
(Durdu) Department of Cardiovascular Surgery, Heart Center, Ankara
University School of Medicine, Dikimevi-Ankara, Turkey.
Title
The efficacies of modified mechanical post conditioning on myocardial
protection for patients undergoing coronary artery bypass grafting.
Source
Journal of cardiothoracic surgery. 7 (pp 73), 2012. Date of Publication:
2012.
Abstract
Coronary artery bypass grafting (CABG) with cardioplegic cardiac arrest
and cardiopulmonary bypass (CPB) is associated with myocardial injury. The
aim of this study was to investigate whether a modified mechanical
post-conditioning (MMPOC) technique has a myocardial protective effect by
enhancing early metabolic recovery of the heart following
revascularization. A prospective, randomized trial was conducted at a
single-center university hospital performing adult cardiac surgery.
Seventy-nine adult patients undergoing first-time elective isolated
multivessel coronary artery bypass grafting were prospectively randomized
to MMPOC or control group. Anesthetic, cardiopulmonary bypass, myocardial
protection, and surgical techniques were standardized. The post
reperfusion cardiac indices, inotrope use and
biochemical-electrocardiographic evidence of myocardial injury were
recorded. The incidence of postoperative complications was recorded
prospectively. Operative characteristics, including CPB and aortic
cross-clamp time, were similar between the two groups (p>0.05). The MMPOC
group had lower troponin I and other cardiac biomarkers level post CPB and
postoperatively, with greater improvement in cardiac indices (p<0.001).
MMPOC shortened post surgery hospitalization from 9.1 +/- 2.1 to 7.5 +/-
1.6 days (p<0.001). MMPOC technique promotes early metabolic recovery of
the heart during elective CABG, leading to better myocardial protection
and functional recovery.

<10>
Accession Number
20340049
Authors
van Mastrigt G.A. Joore M.A. Nieman F.H. Severens J.L. Maessen J.G.
Institution
(van Mastrigt) Clinical Epidemiology and Medical Technology Assessment,
University Hospital Maastricht, Maastricht, Netherlands.
Title
Health-related quality of life after fast-track treatment results from a
randomized controlled clinical equivalence trial.
Source
Quality of life research : an international journal of quality of life
aspects of treatment, care and rehabilitation. 19 (5) (pp 631-642), 2010.
Date of Publication: Jun 2010.
Abstract
This randomized clinical equivalence trial was designed to evaluate
health-related quality of life (HRQoL) after fast-track treatment for
low-risk coronary artery bypass (CABG) patients. Four hundred and ten CABG
patients were randomly assigned to undergo either short-stay intensive
care treatment (SSIC, 8 h of intensive care stay) or control treatment
(care as usual, overnight intensive care stay). HRQoL was measured at
baseline and 1 month, and one year after surgery using the
multidimensional index of life quality (MILQ), the EQ-5D, the Beck
Depression Inventory and the State-Trait Anxiety Inventory. At one month
after surgery, no statistically significant difference in overall HRQoL
was found (MILQ-score P-value=.508, overall MILQ-index P-value=.543, EQ-5D
VAS P-value=.593). The scores on the MILQ-domains, physical, and social
functioning were significantly higher at one month postoperatively in the
SSIC group compared to the control group (P-value=.049; 95%CI: 0.01-2.50
and P-value=.014, 95% CI: 0.24-2.06, respectively). However, these
differences were no longer observed at long-term follow-up. According to
our definition of clinical equivalence, the HRQoL of SSIC patients is
similar to patients receiving care as usual. Since safety and the
financial benefits of this intervention were demonstrated in a previously
reported analysis, SSIC can be considered as an adequate fast-track
intensive care treatment option for low-risk CABG patients.

<11>
Accession Number
23687144
Authors
Hao X.-Q. Zhang S.-Y. Cheng X.-C. Li M. Sun T.-W. Zhang J.-L. Guo W. Li L.
Institution
(Hao, Zhang, Guo, Li) Department of Pharmacy, College of Animal Science
and Technology, Henan University of Science and Technology, Luoyang
471003, China
(Zhang) Department of Cardiology, Luoyang Central Hospital Affiliated to
Zhengzhou University, Luoyang 471000, China
(Cheng) Department of Animal Science, College of Animal Science and
Technology, Henan University of Science and Technology, Luoyang 471003,
China
(Li) Luoyang Entry-Exit Inspection and Quarantine Bureau, Luoyang 471003,
China
(Sun) Department of Integrated ICU, The First Affiliated Hospital of
Zhengzhou University, Zhengzhou 450052, China
Title
Imidapril inhibits right ventricular remodeling induced by low ambient
temperature in broiler chickens.
Source
Poultry Science. 92 (6) (pp 1492-1497), 2013. Date of Publication: June
2013.
Publisher
Poultry Science Association (1800 South Oak Str.,Str 100, champaign,
Illinois 61820, United States)
Abstract
This study explored the effect of imidapril on the right ventricular
remodeling induced by low ambient temperature in broiler chickens.
Twenty-four broiler chickens were randomly divided into 3 groups (n = 8),
including the control group, low temperature group, and imidapril group.
Chickens in the control group were raised at normal temperature, whereas
chickens in the low temperature group and imidapril group were exposed to
low ambient temperature (12 to 18degreeC) from 14 d of age until 45 d of
age. At the same time, chickens in the imidapril group were gavaged with
imidapril at 3 mg/kg once daily for 30 d. The thickness of the right
ventricular wall was observed with echocardiography. The BW and wet lung
weight as well as weight of right and left ventricles and ventricular
septum were measured. Both wet lung weight index and right ventricular
hypertrophy index were calculated. Pulmonary arterial systolic pressure
was assessed according to echocardiography. The expression of ACE and ACE2
mRNA in the right ventricular myocardial tissue was quantified by
real-time PCR. Proliferating cell nuclear antigen-positive cells were
detected by immunohistostaining. The concentration of angiotensin (Ang) II
and Ang (1-7) in the right ventricular myocardial tissue was measured with
ELISA. The results showed that right ventricular hypertrophy index, wet
lung weight index, pulmonary arterial systolic pressure, expression of ACE
mRNA in the right ventricular tissue, Ang II concentration, and the
thickness of the right ventricular wall in the low temperature group
increased significantly compared with those in the control group and
imidapril group. The ACE2 mRNA expression increased 36%, whereas Ang (1-7)
concentration decreased significantly in the low temperature group
compared with that in the control group and imidapril group. In
conclusion, imidapril inhibits right ventricular remodeling induced by low
ambient temperature in broiler chickens. 2013 Poultry Science Association
Inc.

<12>
Accession Number
23241361
Authors
Martorella G. Cote J. Racine M. Choiniere M.
Institution
(Martorella) Faculty of Nursing, University of Montreal, Montreal, QC,
Canada.
Title
Web-based nursing intervention for self-management of pain after cardiac
surgery: pilot randomized controlled trial.
Source
Journal of medical Internet research. 14 (6) (pp e177), 2012. Date of
Publication: 2012.
Abstract
Most adults undergoing cardiac surgery suffer from moderate to severe pain
for up to 6 days after surgery. Individual barriers and attitudes
regarding pain and its relief make patients reluctant to report their pain
and ask for analgesic medication, which results in inadequate pain
management. More innovative educational interventions for postoperative
pain relief are needed. We developed a Web-based nursing intervention to
influence patient's involvement in postoperative pain management. The
intervention (SOULAGE-TAVIE) includes a preoperative 30-minute Web-based
session and 2 brief face-to-face postoperative booster sessions. The Web
application generates reflective activities and tailored educational
messages according to patients' beliefs and attitudes. The messages are
transmitted through videos of a virtual nurse, animations, stories, and
texts. The aim of this single-blinded pilot randomized trial was to
investigate the preliminary effects of a virtual nursing intervention
(SOULAGE-TAVIE) to improve pain relief in patients undergoing cardiac
surgery. Participants (N = 60) were adults scheduled for their first
cardiac surgery. They were randomly assigned to the experimental group
using SOULAGE-TAVIE (n = 30) or the control group using usual care,
including an educational pamphlet and postoperative follow-up (n = 30).
Data were collected through questionnaires at the time of admission and
from day 1 to day 7 after surgery with the help of a blinded research
assistant. Outcomes were pain intensity, pain interference with daily
activities, patients' pain barriers, tendency to catastrophize in face of
pain, and analgesic consumption. The two groups were comparable at
baseline across all demographic measures. Results revealed that patients
in the experimental group did not experience less intense pain, but they
reported significantly less pain interference when breathing/coughing (P =
.04). A severe pain interference with breathing/coughing (pain ranked >=
7/10) was reported on day 3 after surgery by 15% of the patients in the
experimental group (4/27), as compared to 44% (7/16) in the control group.
On day 7 after surgery, participants in the experimental group also
exhibited fewer pain-related barriers as measured by the Barriers
Questionnaire-II (mean 10.6, SD 8.3) than patients in the control group
(mean 15.8, SD 7.3, P = .02). No difference was found for pain
catastrophizing. However, in both groups, means revealed a lower tendency
to catastrophize pain before surgery as measured by the Pain
Catastrophizing Scale (control group mean 1.04, SD 0.74; experimental
group mean 1.10, SD 0.95) and after surgery (control group mean score
1.19, SD 0.94; experimental group mean score 1.08, SD 0.99). Finally, the
experimental group consumed more opioid medication (mean 31.2 mg, SD 23.2)
than the control group (mean 18.8 mg, SD 15.3, P = .001). This pilot study
provides promising results to support the benefits of this new
Web-tailored approach that can increase accessibility to health education
and promote pain relief without generating more costs. Clinicaltrials.gov
NCT01084018; http://www.clinicaltrials.gov/ct2/show/NCT01084018 (Archived
by WebCite at http://www.webcitation.org/6CoTBkIoT).

<13>
Accession Number
21943128
Authors
Krzych L.J. Lees B. Nugara F. Banya W. Bochenek A. Cook J. Taggart D.
Flather M.D.
Institution
(Krzych) Clinical Trials and Evaluation Unit, Royal Brompton and Harefield
NHS Foundation Trust, London, UK.
Title
Assessment of data quality in an international multi-centre randomised
trial of coronary artery surgery.
Source
Trials. 12 (pp 212), 2011. Date of Publication: 2011.
Abstract
ART is a multi-centre randomised trial of cardiac surgery which provided a
unique opportunity to evaluate the data from a large number of centres
from a variety of countries. We attempted to assess data quality,
including recruitment rates, timeliness and completeness of the data
obtained from the centres in different socio-economic strata. The analysis
was based on the 2-page CRF completed at the 6 week follow-up. CRF pages
were categorised into "clean" (no edit query) and "dirty" (any incomplete,
inconsistent or illegible data). The timelines were assessed on the basis
of the time interval from the visit and receipt of complete CRF. Data
quality was defined as the number of data queries (in percent) and time
delay (in days) between visit and receipt of correct data. Analyses were
stratified according to the World Bank definitions into: "Developing"
countries (Poland, Brazil and India) and "Developed" (Italy, UK, Austria
and Australia). There were 18 centres in the "Developed" and 10 centres in
the "Developing" countries. The rate of enrolment did not differ
significantly by economic level ("Developing":4.1 persons/month,
"Developed":3.7 persons/month). The time interval for the receipt of data
was longer for "Developing" countries (median:37 days) compared to
"Developed" ones (median:11 days) (p < 0.001). The median number of data
queries was 23% in "Developed" countries compared to 19% in "Developing"
ones (p = ns). In this study we showed that data quality was comparable
between centres from "Developed" and "Developing" countries. Data was
received in a less timely fashion from Developing countries and
appropriate systems should be instigated to minimize any delays. Close
attention should be paid to the training of centres and to the central
management of data quality. ISRCTN46552265.

<14>
Accession Number
21918956
Authors
Hirao M. Ando N. Tsujinaka T. Udagawa H. Yano M. Yamana H. Nagai K.
Mizusawa J. Nakamura K. Japan Esophageal Oncology Group - Japan Clinical
Oncology Group
Institution
(Hirao) Department of Surgery, National Hospital Organization, Osaka
National Hospital, Osaka, Japan.
Title
Influence of preoperative chemotherapy for advanced thoracic oesophageal
squamous cell carcinoma on perioperative complications.
Source
The British journal of surgery. 98 (12) (pp 1735-1741), 2011. Date of
Publication: Dec 2011.
Abstract
The Japan Clinical Oncology Group (JCOG) 9907 trial has changed the
standard of care for advanced thoracic oesophageal cancer in Japan from
postoperative chemotherapy to preoperative chemotherapy. The impact of
preoperative chemotherapy on the risk of developing postoperative
complications remains controversial. This article reports the safety
analysis of JCOG9907, focusing on risk factors for postoperative
complications. Patients with potentially resectable advanced thoracic
oesophageal squamous cell carcinoma were randomized to either
postoperative or preoperative chemotherapy followed by transthoracic
oesophagectomy with D2-3 lymphadenectomy. Chemotherapy consisted of two
cycles of cisplatin and 5-fluorouracil. Clinical baseline data,
intraoperative complications, postoperative complications and in-hospital
mortality, collected on the case report forms in a predetermined format,
were analysed. Univariable and multivariable analyses were used to explore
the risk of postoperative complications in relation to treatment group,
age, sex, tumour depth, nodal metastasis, stage and location. Of 330
patients randomized, 166 were assigned to receive postoperative
chemotherapy and 164 preoperative chemotherapy; 162 and 154 patients
respectively underwent surgery. The incidence of intraoperative
complications, postoperative complications and in-hospital mortality was
similarly low in both groups. Multivariable analysis showed that age, sex
and tumour location were independently associated with an increase in
postoperative complications, but preoperative chemotherapy was not.
Preoperative chemotherapy does not increase the risk of complications or
hospital mortality after surgery for advanced thoracic oesophageal cancer.
Copyright 2011 British Journal of Surgery Society Ltd. Published by John
Wiley & Sons, Ltd.

<15>
Accession Number
20702510
Authors
Pluss C.E. Billing E. Held C. Henriksson P. Kiessling A. Karlsson M.R.
Wallen H.N.
Institution
(Pluss) Karolinska Institute, Department of Clinical Sciences, Division of
Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden.
Title
Long-term effects of an expanded cardiac rehabilitation programme after
myocardial infarction or coronary artery bypass surgery: a five-year
follow-up of a randomized controlled study.
Source
Clinical rehabilitation. 25 (1) (pp 79-87), 2011. Date of Publication: Jan
2011.
Abstract
To investigate the long-term effect of expanded cardiac rehabilitation on
a composite end-point, consisting of cardiovascular death, myocardial
infarction or readmission for cardiovascular disease, in patients with
coronary artery disease. Single-centre prospective randomized controlled
trial. University hospital. Two hundred and twenty-four patients with
acute myocardial infarction or undergoing coronary artery by-pass
grafting. Patients were randomized to expanded cardiac rehabilitation (a
one-year stress management programme, increased physical training, staying
at a 'patient hotel' for five days after the event, and cooking sessions),
or to standard cardiac rehabilitation. Data on cardiovascular death,
myocardial infarction, readmission for cardiovascular disease and days at
hospital for cardiovascular reasons were obtained from national registries
of the Swedish National Board of Health and Welfare. The primary end-point
occurred in 121 patients altogether (54%). The number of cardiovascular
events were reduced in the expanded rehabilitation group compared with the
standard cardiac rehabilitation (53 patients (47.7%) versus 68 patients
(60.2%); hazard ratio 0.69; P =0.049). This was mainly because of a
reduction of myocardial infarctions in the expanded rehabilitation group.
During the five years 12 patients (10.8%) versus 23 patients (20.3%);
hazard ratio 0.47; P =0.047 had a myocardial infarction. Days at hospital
for cardiovascular reasons were significantly reduced in patients who
received expanded cardiac rehabilitation (median 6 days) compared with
standard cardiac rehabilitation (median 10 days; P =0.02). Expanded
cardiac rehabilitation after acute myocardial infarction or coronary
artery bypass grafting reduces cardiovascular morbidity and days at
hospital for cardiovascular reasons.

<16>
Accession Number
20524462
Authors
Bakhsh M. Abbas S. Hussain R.M. Ali Khan S. Naqvi S.M.
Institution
(Bakhsh) Department of Anaesthesia, Armed Forces Institute of Cardiology,
Rawalpindi, Pakistan.
Title
Role of magnesium in preventing post-operative atrial fibrillation after
coronary artery bypass surgery.
Source
Journal of Ayub Medical College, Abbottabad : JAMC. 21 (2) (pp 27-29),
2009. Date of Publication: 2009 Apr-Jun.
Abstract
To assess the role of 3 days of magnesium infusion after coronary artery
bypass graft (CABG) surgery in preventing postoperative atrial
fibrillation (AF). Place and Duration of Study: Armed Forces Institute of
Cardiology (AFIC) & National Institute of Heart Diseases (NIHD),
Rawalpindi, from July 2006 to June 2007. Prospective, randomized,
non-blinded. All patients undergoing isolated, initial CABG surgery, and
having sinus rhythm before surgery were alternatively randomized into the
study or the control group. The exclusion criteria included: history of
AF, implanted pacemaker, myocardial infarction postoperatively, use of
left ventricular assist devices and renal failure. The patients in the
study group received 10 mmol of magnesium sulphate (2.47 gm) dissolved in
100 ml of saline solution infused intravenously over 4 hours, for 3 days.
The end point was development of AF for at least 15 minutes or more, or if
an episode of AF had to be treated because of symptoms. A total of 220
patients were included in the study, 110 in each group. The incidence of
AF was 9% in patients who received the three days of magnesium infusion.
The patients without magnesium had an AF incidence of 23% (p < 0.001). The
hospital stay was also less in the treated group (p = 0.055). A 3-days
postoperative infusion of magnesium is safe and effective in reduction of
possibly life-threatening AF, in patients undergoing primary coronary
artery bypass surgery.

<17>
Accession Number
2013425904
Authors
Farkouh M.E. Domanski M. Sleeper L.A. Fuster V.
Institution
(Fuster) Mount Sinai School of Medicine, New York, NY, United States
Title
PCI using drug-eluting stents had higher mortality than CABG in diabetes
and multivessel CAD.
Source
Annals of Internal Medicine. 158 (6) (pp JC8), 2013. Date of Publication:
2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<18>
[Use Link to view the full text]
Accession Number
2013436689
Authors
De Vecchis R. Di Biase G. Esposito C. Ciccarelli A. Cioppa C. Giasi A.
Ariano C. Cantatrione S.
Institution
(De Vecchis, Cioppa, Giasi, Cantatrione) Cardiology Unit, Presidio
Sanitario Intermedio Elena d'Aosta, Napoli, Italy
(Di Biase, Ariano) Neurorehabilitation Unit, Clinica S. Maria Del Pozzo,
Somma Vesuviana, Italy
(Esposito) Institute of Hygiene and Preventive Medicine, Second University
of Napoli, Napoli, Italy
(Ciccarelli) Italian College of General Practitioners, ASL NA 2 Nord
Public Health Company, Monterusciello Pozzuoli, Italy
Title
Statin use for nonrheumatic calcific aortic valve stenosis: A review with
meta-analysis.
Source
Journal of Cardiovascular Medicine. 14 (8) (pp 559-567), 2013. Date of
Publication: August 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
AIMS: To synthesize by meta-analysis the findings of recent experimental
studies focusing on possible therapeutic effectiveness of statins for
nonrheumatic calcific aortic stenosis METHODS: Observational studies and
randomized controlled trials (RCTs) were selected from the Pubmed database
to evaluate the hemodynamic progression of aortic stenosis in
statin-treated patients compared with controls (i.e. patients with aortic
stenosis taking placebo or no treatment). The endpoints were the
annualized changes in one or more of the following ultrasonographic
measurements: peak aortic valve jet velocity, peak aortic valve pressure
gradient, mean aortic valve pressure gradient aortic valve area (AVA). For
estimating the overall effect of statin therapy on each of the
above-mentioned continuous variables across the considered studies, we
used the weighted mean difference (WMD) as effect size measure. In
addition, we calculated the odds of aortic valve replacement surgery and
cardiovascular death in both statin-treated patients and controls for
subsequently estimating the appropriate odds ratios. RESULTS: Nine studies
were selected. A lower annualized increase in peak aortic valve jet
velocity was found in statin-treated patients compared with controls
(overall WMD: -0.09m/s per year, 95% CI -0.16, -0.01 P=0.018). Similarly,
a smaller annualized increase in peak aortic valve pressure gradient was
found in the statin group (overall WMD: -2.04mmHg/year 95% CI: -3.56,
-0.52, P=0.0085).However, the overall effects in statin-treated patients
on both annualized increases in mean aortic valve pressure gradient and
decreases in AVA were not significantly different from those found in
controls. Moreover, there was no significant difference in cardiovascular
outcomes in the statin groups compared with placebo groups in each of the
three analyzed RCTs and overall. CONCLUSION: Significant benefit of statin
therapy in retarding hemodynamic deterioration was identified by favorable
effects concerning annualized changes in peak aortic valve jet velocity
and peak aortic valve pressure gradient; on the contrary, in
statin-treated patients with aortic stenosis, no significant improvement
was found for annualized changes in mean aortic valve pressure gradient
and AVA and clinical outcomes. 2013 Italian Federation of Cardiology.

<19>
Accession Number
22412081
Authors
de Macedo R.M. Neto J.R. Costantini C.O. Olandoski M. Casali D. de Macedo
A.C. Muller A. Costantini C.R. do Amaral V.F. de Carvalho K.A.
Guarita-Souza L.C.
Institution
(de Macedo) Pontificia Universidade Catolica do Parana, Brazil.
Title
A periodized model for exercise improves the intra-hospital evolution of
patients after myocardial revascularization: a pilot randomized controlled
trial.
Source
Clinical rehabilitation. 26 (11) (pp 982-989), 2012. Date of Publication:
Nov 2012.
Abstract
To compare models of the postoperative hospital treatment phase after
myocardial revascularization. Design: A pilot randomized controlled trial.
Setting: Hospital patients in a hospital setting. Thirty-two patients with
indications for myocardial revascularization were included between January
2008 and December 2009, with a left ventricular ejection fraction (LVEF)
>=50%, 1-second forced expiratory volume (FEV(1)) >=60 and forced vital
capacity (FVC) >=60% of predicted value. Patients were randomly placed
into two groups: one performed prescribed exercises according to the model
proposed by the American College of Sports Medicine (ACSM) and the other
according to a periodized model. Main measures: Partial pressure of O(2)
(P o (2)) and arterial O(2) saturation (Sao (2)), percentage of predicted
FVC and total distance on the six-minute walking test (6MWT). Twenty-seven
patients were re-evaluated upon release from the hospital (ACSM = 14 and
PP = 13). Five patients extubated for more than 6 hours in the
postoperative period were excluded from the sample. In the preoperative
period the variables P o (2), Sao (2), % FVC and 6MWT were similar. In the
postoperative period, a reduction was observed for all parameters in both
groups. Upon comparison of the groups, a difference was observed in P o
(2) (ACSM = 68.0 +/- 4.3 vs. PP = 75.9 +/- 4.8 mmHg; P < 0.001), Sao (2)
(ACSM = 93.5 +/- 1.4 vs. PP = 94.8 +/- 1.2%; P = 0.018) and 6MWT (ACSM =
339.3 +/- 41.7 vs. PP = 393.8 +/- 25.7 m; P < 0.001). There was no
difference in % FVC. Patients after myocardial revascularization following
a periodized model of exercise presented a better intra-hospital evolution
when compared to those using the ACSM model.

<20>
Accession Number
21169142
Authors
Adluri R.K. Singh A.V. Skoyles J. Robins A. Parton J. Baker M. Mitchell
I.M.
Institution
(Adluri) Department of Cardiac Surgery, Nottingham City Hospital,
Nottingham, UK.
Title
The effect of fenoldopam and dopexamine on cytokine and endotoxin release
following on-pump coronary artery bypass grafting: a prospective
randomized double-blind trial.
Source
The heart surgery forum. 13 (6) (pp E353-361), 2010. Date of Publication:
1 Dec 2010.
Abstract
Surgical trauma, exposure to an external circuit, and reduced organ
perfusion contribute to the systemic inflammatory response following
cardiopulmonary bypass (CPB). Reduced splanchnic perfusion causes
disruption of the gastrointestinal mucosal barrier and the release of
endotoxins. Fenoldopam (a new dopamine 1 receptor agonist) has been shown
to be a specific renosplanchnic vasodilator in animal and human studies.
We studied the effects of fenoldopam on the systemic inflammatory response
and the release of endotoxins after CPB and compared the results with
those for dopexamine. Our prospective randomized study included 42
consecutive patients with good to moderate left ventricular function who
were to undergo elective or inpatient coronary artery bypass grafting. We
used closed envelope method to randomize patients to receive 0.2 mug/kg
per minute of fenoldopam (n = 14), 2 mug/kg per minute of dopexamine (n =
14), or normal saline (n = 14). Patients received their respective
treatments continuously from anesthesia induction until the end of the
first 24 postoperative hours. Interleukin 1beta (IL-1beta), IL-6, IL-8,
IL-10, IL-12, tumor necrosis factor alpha, complement 3a (C3a), C4a, C5a,
and endotoxins were measured during the perioperative period.
Repeated-measures analysis of variance was used to evaluate the results
for the timed samples. There were no statistical differences between the
groups with respect to pre- and intraoperative variables. Release of C3a
was attenuated in the fenoldopam group (P = .002), and release of IL-6 and
IL-8 was attenuated in the postoperative period in the fenoldopam group (P
= .012 and .015, respectively). The other interleukins showed no uniform
release in any of the 3 groups. There were no statistically significant
differences in serum endotoxin elevation between the 3 groups. A partial
attenuation in the inflammatory response is possible with fenoldopam
infusion. The elevation in serum endotoxin levels was not affected by
dopexamine or fenoldopam infusion.

<21>
Accession Number
2013426385
Authors
Zhong H. Gao Z. Chen M. Zhao J. Wang F. Li L. Dong H. Liu L. Wang Q. Xiong
L.
Institution
(Zhong, Gao, Chen, Zhao, Wang, Li, Dong, Wang, Xiong) Department of
Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an
710032, Shaanxi, China
(Liu) Department of Anesthesiology, Stony Brook University, School of
Medicine, Stony Brook NY, United States
Title
Cardioprotective effect of remote ischemic postconditioning on children
undergoing cardiac surgery: A randomized controlled trial.
Source
Paediatric Anaesthesia. 23 (8) (pp 726-733), 2013. Date of Publication:
August 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: Remote ischemic postconditioning (RPostC) is a noninvasive
intervention that has demonstrated cardioprotection and neuroprotection in
animal studies. Objective: Our goal was to investigate the cardio-cerebral
protective effects of RPostC on children undergoing open-heart surgery for
repair of congenital heart defects (CHD). Methods: Children undergoing
open-heart repair of CHD were randomly assigned to a RPostC or control
group. RPostC was induced by three 5-min cycles of lower limb ischemia and
reperfusion using a blood pressure cuff (200 mmHg) at the onset of aortic
unclamping. Serum cardiac troponin I (cTnI), creatine kinase-MB (CK-MB),
neuron-specific enolase (NSE), S100beta, cytokines, and clinical outcomes
were assessed. Results: There were 35 children in the control group and 34
in the RPostC group. The mean age (3.64 +/- 1.95 years vs. 3.45 +/- 3.02
years, P = 0.80), weight (15.11 +/- 6.91 kg vs. 13.40 +/- 6.33 kg, P =
0.37), surgical time (144.82 +/- 38.51 min vs. 129.92 +/- 30.76 min, P =
0.15), and bypass time (78.01 +/- 27.22 min vs. 72.52 +/- 26.05 min, P =
0.49) were not different. Compared with the control group, the
postoperative levels of cTnI (P = 0.037) and CK-MB (P = 0.046) were
significantly reduced in the RPostC group. Furthermore, the MAP was higher
(P = 0.008), and ICU stay (36.87 +/- 3.30 h vs. 60.57 +/- 7.35 h, P =
0.006) and postoperative hospital stay (8.56 +/- 1.50 days vs. 10.06 +/-
2.41 days, P = 0.048) were shorter in the RPostC group than in the control
group. However, the postoperative CVP and the concentrations of NSE,
S100beta, CRP, TNF-alpha, IL-1beta, IL-6, and IL-10 were not significantly
different. Conclusion: RPostC significantly alleviates cardiac injury in
children undergoing open-heart repair of CHD and may also reduce cerebral
injury. 2013 John Wiley & Sons Ltd.

<22>
Accession Number
22090660
Authors
Becker R.C. Bassand J.P. Budaj A. Wojdyla D.M. James S.K. Cornel J.H.
French J. Held C. Horrow J. Husted S. Lopez-Sendon J. Lassila R. Mahaffey
K.W. Storey R.F. Harrington R.A. Wallentin L.
Institution
(Becker) Duke University School of Medicine, Duke Clinical Research
Institute, Durham, NC 27715, USA.
Title
Bleeding complications with the P2Y12 receptor antagonists clopidogrel and
ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial.
Source
European heart journal. 32 (23) (pp 2933-2944), 2011. Date of Publication:
Dec 2011.
Abstract
AIMS More intense platelet-directed therapy for acute coronary syndrome
(ACS) may increase bleeding risk. The aim of the current analysis was to
determine the rate, clinical impact, and predictors of major and fatal
bleeding complications in the PLATO study. METHODS AND RESULTS PLATO was a
randomized, double-blind, active control international, phase 3 clinical
trial in patients with acute ST elevation and non-ST-segment elevation
ACS. A total of 18 624 patients were randomized to either ticagrelor, a
non-thienopyridine, reversibly binding platelet P2Y(12) receptor
antagonist, or clopidogrel in addition to aspirin. Patients randomized to
ticagrelor and clopidogrel had similar rates of PLATO major bleeding (11.6
vs. 11.2%; P = 0.43), TIMI major bleeding (7.9 vs. 7.7%, P = 0.56) and
GUSTO severe bleeding (2.9 vs. 3.1%, P = 0.22). Procedure-related bleeding
rates were also similar. Non-CABG major bleeding (4.5 vs. 3.8%, P = 0.02)
and non-procedure-related major bleeding (3.1 vs. 2.3%, P = 0.05) were
more common in ticagrelor-treated patients, primarily after 30 days on
treatment. Fatal bleeding and transfusion rates did not differ between
groups. There were no significant interactions for major bleeding or
combined minor plus major bleeding between treatment groups and age >=75
years, weight <60 kg, region, chronic kidney disease, creatinine clearance
<60 mL/min, aspirin dose >325 mg on the day of randomization,
pre-randomization clopidogrel administration, or clopidogrel loading dose.
CONCLUSION Ticagrelor compared with clopidogrel was associated with
similar total major bleeding but increased non-CABG and
non-procedure-related major bleeding, primarily after 30 days on study
drug treatment. Fatal bleeding was low and did not differ between groups.