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<1>
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Accession Number
2014135924
Authors
Lomivorotov V.V. Fominskiy E.V. Efremov S.M. Nepomniashchikh V.A.
Lomivorotov V.N. Chernyavskiy A.M. Shilova A.N. Karaskov A.M.
Institution
(Lomivorotov, Fominskiy, Efremov, Nepomniashchikh, Lomivorotov,
Chernyavskiy, Shilova, Karaskov) Department of Anaesthesiology and
Intensive Care, Academician en Meshalkin Novosibirsk State, Budget
Research Institute of Circulation Pathology, Rechkunovskaya St 15, 630055
Novosibirsk, Russian Federation
Title
Infusion of 7.2% NaCl/6% hydroxyethyl starch 200/0.5 in on-pump coronary
artery bypass surgery patients: A randomized, single-blind pilot study.
Source
Shock. 41 (3) (pp 193-199), 2014. Date of Publication: March 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: NaCl 7.2%/6% hydroxyethyl starch (HES) 200/0.5 (HSH) has shown
its beneficial effects in cardiac surgery and immunomodulatory values in
experiment and human studies. However, there is concern regarding
detrimental renal effects of chloride and HES in the intensive care
setting. Objectives: The objective of this study was to evaluate the
influence of HSH on kidney integrity and the level of inflammatory
mediators in on-pump coronary artery bypass surgery patients. Design: This
was a single-center, prospective, randomized, single-blind pilot study.
Setting: This work was performed at a tertiary cardiothoracic referral
center during the period from February to August 2012. Patients: Forty
patients scheduled for on-pump coronary artery bypass surgery were
included. Interventions: Patients were randomized to receive once either
7.2% NaCl/6% HES 200/0.5 (HSH group, n = 20) or placebo (0.9% NaCl;
control group, n = 20) at a dose of 4 mLkg for 30 min after anesthesia
induction. Main outcome measures: The primary end point was the incidence
of acute kidney injury (AKI) defined according to the Kidney Disease:
Improving Global Outcomes. Secondary end points were peak serum cystatin
C, peak urine neutrophil gelatinase-associated lipocalin, plasma levels of
interleukin 6 (IL-6), IL-10, intercellular adhesion molecule 1, and
endothelial-leukocyte adhesion molecule (E-selectin). Results: The
incidence of AKI within 48 h was similar between the groups (HSH: four
patients [20%]; control: six patients [30%]). There was a significantly
lower peak value for serum cystatin C in the HSH group (0.83 [0.73-0.89]
mgL) compared with the control group (1.02 [0.88-1.15] mgL; P = 0.001).
Patients in both groups had similar peak postoperative urine neutrophil
gelatinase-associated lipocalin concentrations. NaCl 7.2%/6% hydroxyethyl
starch 200/0.5 significantly reduces levels of IL-6 and IL-10 at 4 h after
cardiopulmonary bypass and intercellular adhesion molecule 1 and
E-selectin at 4 h after cardiopulmonary bypass and on postoperative day 1
(P < 0.05 for all). Conclusions: NaCl 7.2%/6% hydroxyethyl starch 200/0.5
does not lead to the increase in AKI incidence when used for the volume
therapy in on-pump coronary artery bypass surgery patients. NaCl 7.2%/6%
hydroxyethyl starch 200/0.5 usage enhanced neither tubular injury nor
alteration of glomerular filtration. In addition, HSH can reduce the level
of the inflammatory mediators after surgery. 2014 by the Shock Society.

<2>
Accession Number
2014123993
Authors
Rogers P.A. Daye J. Huang H. Blaustein A. Virani S. Alam M. Kumar A.
Paniagua D. Kar B. Bozkurt B. Ballantyne C.M. Deswal A. Jneid H.
Institution
(Rogers, Daye, Huang, Blaustein, Virani, Alam, Kumar, Paniagua, Kar,
Bozkurt, Ballantyne, Deswal, Jneid) Division of Cardiology, Department of
Medicine, Baylor College of Medicine, Houston, TX, United States
(Blaustein, Virani, Paniagua, Kar, Bozkurt, Deswal, Jneid) Michael E.
Debakey VA Medical Center, Houston, TX, United States
Title
Revascularization improves mortality in elderly patients with acute
myocardial infarction complicated by cardiogenic shock.
Source
International Journal of Cardiology. 172 (1) (pp 239-241), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<3>
Accession Number
2014123865
Authors
Zhang B. Zhou J. Li H. Zhou M. Chen A. Zhao Q.
Institution
(Zhang, Zhou, Li, Zhou, Chen, Zhao) Department of Cardiac Surgery, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er
Road, Shanghai 200025, China
Title
Remote ischemic preconditioning does not improve the clinical outcomes in
patients undergoing coronary artery bypass grafting: A meta-analysis of
randomized controlled trials.
Source
International Journal of Cardiology. 172 (1) (pp e36-e38), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<4>
Accession Number
2014134453
Authors
Salito C. Bovio D. Mazzuca E. Rivolta I. Brunelli A. Aliverti A.
Miserocchi G.
Institution
(Salito, Bovio, Mazzuca, Aliverti) Tbm Lab, Dipartimento di Elettronica,
Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
(Rivolta, Miserocchi) Dipartimento di Scienze della Salute, Universita
Milano-Bicocca, Monza, Italy
(Brunelli) Section of Minimally Invasive Thoracic Surgery, Division of
Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
Title
Experimental model to evaluate the effect of hydrothorax and lobar
resection on lung compliance.
Source
European Journal of Cardio-thoracic Surgery. 45 (3) (pp 489-495), 2014.
Article Number: ezt480. Date of Publication: March 2014.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
OBJECTIVES: The objective of this study was to evaluate to what extent
lung compliance is affected by the individual and combined action of lung
resection and hydrothorax in an animal model. METHODS: Anaesthetized and
mechanically ventilated rabbits (weight range 2/2.2 kg) were randomized in
two groups: (i) experimental hydrothorax (from 2 to 8 ml) (n = 5) and (ii)
right lower lobe lobectomy (n = 4) and right middle plus lower lobe
resection (n = 2). To obtain lung compliance, we measured alveolar,
oesophageal pressures and lung volume during slow inflation manoeuvres in
control conditions and after hydrothorax or lung resection. Lung
compliance was estimated as the change in lung volume divided by the
change in transpulmonary pressure. Based on the changes in compliance of
the whole lung, we calculated the corresponding changes in compliance of
the right lung, which was directly exposed to unilateral hydrothorax and
lobectomy. RESULTS: Average total lung compliance in the control was 3.3 +
0.8 (SD) ml/cmH₂O. Eight millilitres of hydrothorax
significantly decreased (P < 0.001) lung compliance to 2.7 + 0.7
ml/cmH₂O and increased pleural liquid pressure at the bottom of
the cavity from -1 cmH₂O up to ~2.5-3 cmH₂O.
Resection of the right lower lobe significantly decreased (P < 0.001) lung
compliance to 1.75 + 0.3 ml/cmH₂O. Resection of the right
middle plus lower lobes significantly decreased (P < 0.001) lung
compliance to 1.52 + 0.4 ml/cmH₂O. CONCLUSIONS: Following
hydrothorax, the decrease in right lung compliance (~45%) was much greater
than that expected based on the estimated decrease in right lung volume
(20%). We attribute this difference to the fact that hydrothorax causes
the lung to be exposed to positive, rather than sub-atmospheric, pressure,
causing atelectasis. Following lobectomy, right lung compliance decreased
by 62 and 80% for estimated decreases in lung volume of 30 and 60%. This
difference could reflect inaccuracy in the estimate of lung volume
reduction based on resected weight and/or surgical damage. We conclude
that potential detrimental effects of hydrothorax and lobar resection
decrease lung compliance and expose the lung to the risk of
over-distension when a chest drain is applied. The Author 2013. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2014132710
Authors
Moyce Z. Rodseth R.N. Biccard B.M.
Institution
(Moyce, Rodseth, Biccard) Department of Anaesthesia, Nelson R Mandela
School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal,
South Africa
Title
The efficacy of peri-operative interventions to decrease postoperative
delirium in non-cardiac surgery: A systematic review and meta-analysis.
Source
Anaesthesia. 69 (3) (pp 259-269), 2014. Date of Publication: March 2014.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
The purpose of this meta-analysis was to determine the efficacy of
peri-operative interventions in decreasing the incidence of postoperative
delirium. An electronic search of four databases was conducted. The
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines were adhered to. We included randomised controlled
trials of non-cardiac surgery with a peri-operative intervention and that
reported postoperative delirium, and identified 29 trials. Meta-analysis
revealed that peri-operative geriatric consultation (OR 0.46, 95% CI
0.32-0.67) and lighter anaesthesia (OR 2.66, 95% CI 1.27-5.56) were
associated with a decreased incidence of postoperative delirium. For the
other interventions, the point estimate suggested possible protection with
prophylactic haloperidol (OR 0.62, 95% CI 0.36-1.05), bright light therapy
(OR 0.20, 95% CI 0.03-1.19) and general as opposed to regional anaesthesia
(OR 0.76, 95% CI 0.47-1.23). This meta-analysis has shown that
peri-operative geriatric consultations with multicomponent interventions
and lighter anaesthesia are potentially effective in decreasing the
incidence of postoperative delirium. 2013 The Association of
Anaesthetists of Great Britain and Ireland.

<6>
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Accession Number
2014122461
Authors
Niu Z.-Z. Wu S.-M. Sun W.-Y. Hou W.-M. Chi Y.-F.
Institution
(Niu, Wu, Sun) Department of Cardiac Surgery, Qingdao Municipal Hospital,
Shandong University, 5# Donghai Zhong Rd, Qingdao 266071, China
(Niu, Hou, Chi) Department of Cardiac Surgery, Qingdao Municipal Hospital,
Qingdao, China
Title
Perioperative levosimendan therapy is associated with a lower incidence of
acute kidney injury after cardiac surgery: A meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 63 (2) (pp 107-112), 2014. Date of
Publication: February 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE:: Levosimendan is a calcium sensitizer that enhances myocardial
contractility without increasing myocardial oxygen use. Limited data are
available on its renal-protective effect, and no statistically significant
effects have been found. A meta-analysis was conducted for randomized
studies to show whether perioperative levosimendan use could reduce acute
kidney injury (AKI) in patients undergoing cardiac surgery. DATA SOURCES::
BioMed Central, PubMed EMBASE, and the Cochrane Central Register of
Controlled Trials were searched for pertinent studies. STUDY SELECTION::
Randomized trials that compared levosimendan versus placebo or any other
control in cardiac surgery with data on AKI were included. Exclusion
criteria were duplicate publications, nonadult studies, oral
administration of levosimendan, and studies with no data on AKI. DATA
EXTRACTION:: Study endpoints, study design, population, clinical setting,
levosimendan dosage, and treatment duration were extracted. DATA
SYNTHESIS:: Data from 529 patients in 5 randomized trials were analyzed.
The analysis showed that levosimendan decreased postoperative incidence of
AKI in the levosimendan group. CONCLUSIONS:: This analysis suggests that
levosimendan might reduce renal injury in adult patients undergoing
cardiac surgery. More prospective randomized studies are needed to further
demonstrate the benefits of levosimendan on renal protection in cardiac
surgery. Copyright 2013 by Lippincott Williams & Wilkins.

<7>
Accession Number
2014127539
Authors
Scrascia G. Guida P. Rotunno C. de Luca Tupputi Schinosa L. Paparella D.
Institution
(Scrascia, Guida, Rotunno, de Luca Tupputi Schinosa, Paparella) Department
of Emergency and Organ Transplant, Division of Cardiac Surgery, University
of Bari Aldo Moro, Bari, Italy
Title
Anti-inflammatory strategies to reduce acute kidney injury in cardiac
surgery patients: A meta-analysis of randomized controlled trials.
Source
Artificial Organs. 38 (2) (pp 101-112), 2014. Date of Publication:
February 2014.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Acute kidney injury (AKI) after cardiac operations is a serious
complication associated with postoperative mortality. Multiple factors
contribute to AKI development, principally ischemia-reperfusion injury and
inflammatory response. It is well proven that glucocorticoid
administration, leukocyte filter application, and miniaturized
extracorporeal circuits (MECC) modulate inflammatory response. We
conducted a systematic review of randomized controlled trials (RCTs) in
which one of these inflammatory system modulation strategies was used,
with the aim to evaluate the effects on postoperative AKI. MEDLINE and
Cochrane Library were screened through November 2011 for RCTs in which an
inflammatory system modulation strategy was adopted. Included were trials
that reported data about postoperative renal outcomes. Because AKI was
defined by different criteria, including biochemical determinations, urine
output, or dialysis requirement, we unified renal outcome as worsening
renal function (WRF). We identified 14 trials for steroids administration
(931 patients, WRF incidence [treatment vs. placebo]: 2.7% vs. 2.4%; OR:
1.13; 95% CI: 0.53-2.43; P=0.79), 9 trials for MECC (947 patients, WRF
incidence: 2.4% vs. 0.9%; OR: 0.47; 95% CI: 0.18-1.25; P=0.13), 6 trials
for leukocyte filters (374 patients, WRF incidence: 1.1% vs. 7.5%; OR:
0.18; 95% CI: 0.05-0.64; P=0.008). Only leukocyte filters effectively
reduced WRF incidence. Not all cardiopulmonary bypass-related
anti-inflammatory strategies analyzed reduced renal damage after cardiac
operations. In adult patients, probably other factors are predominant on
inflammation in determining AKI, and only leukocyte filters were
effective. Large multicenter RCTs are needed in order to better evaluate
the role of inflammation in AKI development after cardiac operations.
2013, the Authors.

<8>
Accession Number
2014130563
Authors
Kim B.-K. Yoon J.-H. Shin D.-H. Kim J.-S. Ko Y.-G. Choi D. Lee S.-H. Mintz
G.S. Jang Y. Hong M.-K.
Institution
(Kim, Shin, Kim, Ko, Choi, Jang, Hong) Division of Cardiology, Severance
Cardiovascular Hospital, Yonsei University College of Medicine, Seoul,
South Korea
(Yoon, Lee) Department of Cardiology, Wonju Christian Hospital, Yonsei
University Wonju College of Medicine, Wonju, South Korea
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
(Jang, Hong) Division of Cardiology, Severance Biomedical Science
Institute, Yonsei University College of Medicine, Seoul, South Korea
Title
Prospective and systematic analysis of unexpected requests for non-cardiac
surgery or other invasive procedures during the first year after
drug-eluting stent implantation.
Source
Yonsei Medical Journal. 55 (2) (pp 345-352), 2014. Date of Publication:
March 2014.
Publisher
Yonsei University College of Medicine (Shinchon dong 134, Seodaemoon ku,
Seoul 120-752, South Korea)
Abstract
Purpose: Unexpected requests for non-cardiac surgery requiring
discontinuation of dual antiplatelet therapy (DAPT) frequently occur in
daily clinical practice. The objectives of this study were to evaluate
prevalence, timing and clinical outcomes of such unexpected requests for
non-cardiac surgery or other invasive procedures during the first year
after drug-eluting stents (DESs) implantation. Materials and Methods: We
prospectively investigated the prevalence, timing and clinical outcomes of
unexpected requests for non-cardiac surgery or other procedures during the
first year after DESs implantation in 2117 patients. Results: The
prevalence of requested non-cardiac surgery or invasive procedures was
14.6% in 310 requests and 12.3% in 261 patients. Among 310 requests, those
were proposed in 11.3% <1 month, 30.0% between 1 and 3 months, 36.8%
between 4 and 6 months and 21.9% between 7 and 12 months post-DES
implantation. The rates of actual discontinuation of DAPT and non-cardiac
surgery or procedure finally performed were 35.8% (111 of 310 requests)
and 53.2% (165 of 310 requests), respectively. On multivariate regression
analysis, the most significant determinants for actual discontinuation of
DAPT were Endeavor zotarolimus-eluting stent implantation with 3-month
DAPT (OR=5.54, 95% CI 2.95-10.44, p<0.001) and timing of request (OR=2.84,
95% CI 1.97-4.11, p<0.001). There were no patients with any death,
myocardial infarction, or stent thrombosis related with actual
discontinuation of DAPT. Conclusion: Those unexpected requests with
premature discontinuation of DAPT were relatively common and continuously
proposed during the first year following DES implantation. No death,
myocardial infarction or stent thrombosis occurred in patients with actual
discontinuation of DAPT. Yonsei University College of Medicine 2014.

<9>
Accession Number
2014129258
Authors
Qi D.-Y. Wang K. Zhang H. Du B.-X. Xu F.-Y. Wang L. Zou Z. Shi X.-Y.
Institution
(Qi, Wang) Department of Anesthesiology, Xuzhou Medical College, Xuzhou,
China
(Qi, Wang, Zou, Shi) Jiangsu Province Key Laboratory of Anesthesiology,
Xuzhou Medical College, Xizha, China
(Zhang, Du, Xu, Zou, Shi) Changzheng Hospital, Second Military Medical
University, Department of Anesthesiology, 415 Fengyang Road, Shanghai
200003, China
(Wang) Department of Anesthesiology, Shanghai Eastern Hepatobiliary
Surgery Hospital, Second Military Medical University, Shanghai, China
Title
Efficacy of intravenous lidocaine versus placebo on attenuating
cardiovascular response to laryngoscopy and tracheal intubation: A
systematic review of randomized controlled trials.
Source
Minerva Anestesiologica. 79 (12) (pp 1423-1435), 2013. Date of
Publication: December 2013.
Publisher
Edizioni Minerva Medica (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Cardiovascular response to laryngoscopy and tracheal intubation may be
harmful in surgical patients with cardiovascular and cerebral diseases.
The efficacy of intravenous lidocaine on attenuating the hemodynamic
changes remains controversial. This systematic review aims to determine
the efficacy of lidocaine versus placebo. PubMed, Embase and Cochrane
Library databases were searched for relevant randomized controlled trials
(RCTs). The quality of eligible RCTs was evaluated according to the
modified Jadad scale. Quantitative analyses were carried out using Review
Manager 5 and Stata 10. Thirty-seven trials with 1429 patients of
different age groups were included in our meta-analysis. Additional
lidocaine resulted in fewer changes in systolic blood pressure (SBP) (mean
difference (MD) -4.32 mmHg, 95% confidence interval (CI) -6.21 to -2.43);
diastolic blood pressure (DBP) (MD -4.76 mmHg, 95% CI -5.90 to -3.63);
mean arterial blood pressure (MAP) (MD -2.72 mmHg, 95% CI: -3.65 to -1.80)
and heart rates (HR) (MD -4.28 beats per min, 95% CI -5.83 to -2.72).
Subgroup analysis showed that lidocaine was effective in both the elderly
and children with the exception of failing to reduce HR in children.
Exclusion of poor-quality trials did not change the favor to lidocaine. No
significant publication bias across trials was found. Intravenous
lidocaine helps reduce cardiovascular responses to laryngoscopy and
tracheal intubation in patients of all age groups compared to placebo.
Further studies are needed to clarify the effects of dosage and timing of
lidocaine on hemodynamic changes.

<10>
Accession Number
2014131961
Authors
Tas M.H. Simsek Z. Ayan A. Aksu U. Demirelli S. Koza Y. Lazoglu Z. Seven
B. Senocak H.
Institution
(Tas, Simsek, Aksu, Koza, Lazoglu, Senocak) Department of Cardiology,
Faculty of Medicine, Ataturk University, Erzurum, Turkey
(Ayan, Seven) Department of Nuclear Medicine, Faculty of Medicine, Ataturk
University, Erzurum, Turkey
(Demirelli) Department of Cardiology, Regional Training and Research
Hospital, Erzurum, Turkey
Title
Effects of tirofiban maintenance duration on myocardial perfusion defect
severity in anterior myocardial infarction.
Source
Advances in Therapy. 30 (9) (pp 834-844), 2013. Date of Publication:
September 2013.
Publisher
Springer Healthcare Communications (Lower Makefield Corporate Center
South, 770 Township Line RD, Suite 300, Yardley PA 19067, United States)
Abstract
Introduction: Percutaneous coronary intervention (PCI) does not often
produce optimal results, despite restoration of coronary blood flow at
myocardial recovery, because of impaired microvascular perfusion. This
study aimed to investigate and evaluate with 99mTcsestamibi scan whether
the results of PCI can be changed by maintenance infusion of tirofiban for
24 or 48 h in patients presenting with anterior ST-elevation myocardial
infarction (STEMI). Methods: The study included 84 patients with anterior
STEMI who were candidates for primary PCI and whose occlusion was in the
proximal or mid-left anterior descending artery. Patients were given 25
mug/kg/3 min tirofiban and randomized to receive maintenance infusion at
0.15 mug/kg/min for 24 or 48 h. A resting 99mTc sestamibi scan was
performed on the 5th day post-procedure before discharge. The primary
efficacy endpoint was a patient's score on a 5-point scoring system for
perfusion defect severity. Major adverse cardiac events (MACE) were
defined as death from any cause, re-infarction, and clinically driven
target-vessel revascularization within the first 6 months. Results:
Baseline characteristics of the patients were similar in the two infusion
groups (n = 42 per group). There was no significant difference in the
symptom onset-to-presentation time or door-to-balloon time between the two
groups. With the exception of basal anteroseptal and basal anterior
segments, significant reductions were obtained on the 5-point scoring
system for perfusion defect severity in segments and in the summed rest
scores. No significant differences were observed between the two groups in
the incidence of MACE at 6 months. The safety profile did not differ
between 24 and 48 h infusions of tirofiban. Conclusion: The use of
tirofiban, when administered at a high bolus dose and maintained for 48 h,
was safe and significantly reduced perfusion defect severity in patients
with anterior STEMI presenting early after symptom onset and undergoing
primary PCI. Springer Healthcare 2013.

<11>
Accession Number
2014126538
Authors
Arroyo D. Togni M. Puricel S. Gerard B. Sonja L. Corpataux N. Villeneuve
H. Boute E. Stauffer J.-C. Goy J.-J. Cook S.
Institution
(Arroyo, Togni, Puricel, Gerard, Sonja, Corpataux, Villeneuve, Boute,
Stauffer, Goy, Cook) Department of Cardiology, University and Hospital,
Fribourg, Switzerland
Title
Comparison of everolimus-eluting and biolimus-eluting coronary stents with
everolimus-eluting bioresorbable scaffold: Study protocol of the
randomized controlled EVERBIO II trial.
Source
Trials. 15 (1) , 2014. Article Number: 9. Date of Publication: 07 Jan
2014.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Second-generation everolimus-eluting stents (EES) and third
generation biolimus-eluting stents (BES) have been shown to be superior to
first-generation paclitaxel-eluting stents (PES) and second-generation
sirolimus-eluting stents (SES). However, neointimal proliferation and very
late stent thrombosis is still an unresolved issue of drug-eluting stent
(DES) implantation overall. The Absorb (Abbott Vascular, Abbott Park, IL,
USA) is the first CE approved DES with a bioresorbable vascular scaffold
(BVS) thought to reduce long-term complication rates. The EVERBIO II trial
was set up to compare the BVS safety and efficacy with both EES and BES in
all patients viable for inclusion.Methods/Design: The EVERBIO II trial is
a single-center, assessor-blinded, randomized trial. The study population
consists of all patients aged >18 years old undergoing percutaneous
coronary intervention. Exclusion criterion is where the lesion cannot be
treated with BVS (reference vessel diameter >4.0 mm). A total of 240
patients will be enrolled and randomly assigned into 3 groups of 80 with
either BVS, EES or BES implantation. All patients will undergo a follow-up
angiography study at 9 months. Clinical follow-up for up to 5 years will
be conducted by telephone. The primary endpoint is in-segment late lumen
loss at 9 months measured by quantitative coronary angiography. Secondary
endpoints are patient-oriented major adverse cardiac event (MACE) (death,
myocardial infarction and target-vessel revascularization),
device-oriented MACE (cardiac death, myocardial infarction and
target-lesion revascularization), stent thrombosis according to ARC and
binary restenosis at follow-up 12 months angiography.Discussion: EVERBIO
II is an independent, randomized study, aiming to compare the clinical
efficacy, angiographic outcomes and safety of BVS, EES and BES in all
comer patients.Trial registration: The trial listed in clinicaltrials.gov
as NCT01711931. 2014 Arroyo et al.; licensee BioMed Central Ltd.

<12>
Accession Number
24303604
Authors
Pirraglia P.A. Peterson J.C. Hartman G.S. Yao F.S. Thomas S.J. Charlson
M.E.
Institution
(Pirraglia) Cornell Coronary Artery Bypass Outcomes Trial Group, NEw York
Hospital-Cornell Medical Center, Department of Medicine, New York, NY,
USA.
Title
The efficacy and safety of a pharmacologic protocol for maintaining
coronary artery bypass patients at a higher mean arterial pressure during
cardiopulmonary bypass. 1998.
Source
The Journal of extra-corporeal technology. 45 (3) (pp 198-206), 2013. Date
of Publication: Sep 2013.

<13>
Accession Number
2014121423
Authors
Graham E.M. Atz A.M. McHugh K.E. Butts R.J. Baker N.L. Stroud R.E. Reeves
S.T. Bradley S.M. McGowan Jr. F.X. Spinale F.G.
Institution
(Graham, Atz, McHugh, Butts) Division of Cardiology, Department of
Pediatrics, Medical University of South Carolina, Charleston, SC, United
States
(Baker) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Stroud, Bradley) Division of Cardiothoracic Surgery, Medical University
of South Carolina, Charleston, SC, United States
(Reeves, McGowan Jr.) Department of Surgery, Anesthesiology and
Perioperative Medicine, Medical University of South Carolina, Charleston,
SC, United States
(Spinale) Departments of Surgery and Cell Biology and Anatomy, USC School
of Medicine, Columbia, SC, United States
(Graham) Medical University of South Carolina, MSC 915, 165 Ashley Ave,
Charleston, SC 29425, United States
Title
Preoperative steroid treatment does not improve markers of inflammation
after cardiac surgery in neonates: Results from a randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (3) (pp 902-908),
2014. Date of Publication: March 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Neonatal cardiac surgery requiring cardiopulmonary bypass
results in a heightened inflammatory response. Perioperative
glucocorticoid administration is commonly used in an attempt to reduce the
inflammatory cascade, although characterization of the cytokine response
to steroids in neonatal cardiac surgery remains elusive because of highly
variable approaches in administration. This randomized trial was designed
to prospectively evaluate the effect of specific glucocorticoid dosing
protocols on inflammatory markers in neonatal cardiac surgery requiring
cardiopulmonary bypass. Methods: Neonates scheduled for cardiac surgery
were randomly assigned to receive either 2-dose (8 hours preoperatively
and operatively, n = 36) or single-dose (operatively, n = 32)
methylprednisolone at 30 mg/kg per dose in a prospective double-blind
trial. The primary outcome was the effect of these steroid regimens on
markers of inflammation. Secondary analyses evaluated the association of
specific cytokine profiles with postoperative clinical outcomes. Results:
Patient demographics, perioperative variables, and preoperative indices of
inflammation were similar between the single- and 2-dose groups.
Preoperative cytokine response after the 2-dose methylprednisolone
protocol was consistent with an anti-inflammatory effect, although this
did not persist into the postoperative period. Premedication baseline
levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis
factor alpha were predictive of postoperative intensive care unit and
hospital length of stay. Only interleukin-8 demonstrated a postoperative
response associated with duration of intensive care unit and hospital
stay. Conclusions: The addition of a preoperative dose of
methylprednisolone to a standard intraoperative methylprednisolone dose
does not improve markers of inflammation after neonatal cardiac surgery.
The routine administration of preoperative glucocorticoids in neonatal
cardiac surgery should be reconsidered. Copyright 2014 by The American
Association for Thoracic Surgery.

<14>
Accession Number
2014096691
Authors
Valipour A. Herth F.J.F. Burghuber O.C. Criner G. Vergnon J.-M. Goldin J.
Sciurba F. Ernst A.
Institution
(Valipour, Burghuber) Dept. of Respiratory and Critical Care Medicine,
Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology,
Otto-Wagner-Hospital, Vienna, Austria
(Herth) Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg,
Germany
(Criner) Temple Lung Center, Pulmonary and Critical Care Medicine, Temple
University, Philadelphia, PA, United States
(Vergnon) Pulmonary Medicine, Sainte Tienne University Hospital,
Saintetienne, France
(Goldin) Center for Computer Vision and Imaging Biomarkers, Dept. of
Radiological Sciences, David Geffen School of Medicine at UCLA, Los
Angeles, CA, United States
(Sciurba) University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Ernst) Interventional Pulmonology, St Elizabeth's Medical Center, Boston,
MA, United States
Title
Target lobe volume reduction and COPD outcome measures after endobronchial
valve therapy.
Source
European Respiratory Journal. 43 (2) (pp 387-396), 2014. Date of
Publication: 01 Feb 2014.
Publisher
European Respiratory Society (4 Ave Sainte-Luce, Lausanne CH-1003,
Switzerland)
Abstract
Endobronchial valve (EBV) therapy may be associated with improvements in
chronic obstructive pulmonary disease-related outcomes and may therefore
be linked to improvements in the body mass index, airflow obstruction,
dyspnoea, exercise capacity (BODE) index. Data from 416 patients with
advanced emphysema and hyperinflation across Europe and USA, who were
randomised to EBV (n5284) or conservative therapy (n5132) were analysed.
Quantitative image analysis was used to compare the volume of the targeted
lobe at baseline and at 6 months to determine target lobe volume reduction
(TLVR). 44% of patients receiving EBV therapy (versus 24.7% of controls)
had clinically significant improvements in the BODE index (p<0.001). BODE
index was significantly reduced by mean+SD 1.4+1.8, 0.2+1.3 and 0.1+1.3
points in patients with TLVR .50%, 20%-50% and ,20%, respectively
(intergroup differences p<0.001), but increased by 0.3+1.2 points in
controls. Changes in BODE were predicted by baseline BODE and correlated
significantly with lobar exclusion and lung volumes at 6 months. A greater
proportion of patients in the treatment group than in the control group
achieved a clinically meaningful improvement in BODE index; however, the
likelihood of benefit was less than half in both groups. Patients in whom
TLVR was obtained had greater improvements in clinical outcomes. Copyright
ERS 2014.

<15>
Accession Number
2014123689
Authors
Chen L. Luo S. Yan L. Zhao W.
Institution
(Chen, Luo, Yan, Zhao) Department of Neurology, First Affiliated Hospital
of Guangxi, Medical University, Shuangyong Road 6, Nanning, Guangxi, China
Title
A systematic review of closure versus medical therapy for preventing
recurrent stroke in patients with patent foramen ovale and cryptogenic
stroke or transient ischemic attack.
Source
Journal of the Neurological Sciences. 337 (1-2) (pp 3-7), 2014. Date of
Publication: 15 Feb 2014.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
The optimal treatment for secondary prevention in patients who have a
patent foramen ovale (PFO) and history of cryptogenic stroke is still
uncertain and controversial. In view of this, we performed a systematic
review of randomized controlled trials (RCTs) to investigate whether PFO
closure was superior to medical therapy for prevention of recurrent stroke
or transient ischemic attack (TIA) in patients with PFO after cryptogenic
stroke. We searched the Cochrane Central Register of Controlled Trials,
Embase, PubMed, Web of Science, and ClinicalTrials.gov. Three randomized
controlled trials with a total of 2303 patients were included and
analyzed. A fixed-effect model was used by Review Manager 5.2 (RevMan 5.2)
software. The pooled risk ratio (RR) of recurrent stroke or TIA was 0.70,
with 95% confidence interval (CI) = 0.47 to 1.04, p = 0.08. The results
were similar in the incidence of death and adverse events, and the pooled
RR was 0.92 (95% CI = 0.34 to 2.45, p = 0.86) and 1.08 (95% CI = 0.93 to
1.26, p = 0.32), respectively. The data of this systematic review did not
show superiority of closure over medical therapy for secondary prevention
after cryptogenic stroke. Due to some limitations of the included studies,
more randomized controlled trials are needed for further investigation
regarding this field. 2013 Elsevier B.V.

<16>
Accession Number
2014050838
Authors
Cox E.G. Knoderer C.A. Jennings A. Brown J.W. Rodefeld M.D. Walker S.G.
Turrentine M.W.
Institution
(Cox, Knoderer) Section of Pediatric Infectious Disease, Indiana
University School of Medicine, Indianapolis, IN, United States
(Knoderer) Department of Pharmacy Practice, College of Pharmacy and Health
Sciences, Butler University, Indianapolis, IN, United States
(Jennings) Department of Nursing, Indianapolis, IN, United States
(Brown, Rodefeld, Turrentine) Division of Cardiothoracic Surgery,
Indianapolis, IN, United States
(Walker) Department of Anesthesia, Indiana University School of Medicine,
Indianapolis, IN, United States
Title
A randomized, controlled trial of catheter-related infectious event rates
using antibiotic-impregnated catheters versus conventional catheters in
pediatric cardiovascular surgery patients.
Source
Journal of the Pediatric Infectious Diseases Society. 2 (1) (pp 67-70),
2013. Article Number: pis066. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
We conducted a randomized, controlled clinical trial to determine whether
a difference in catheterassociated blood stream infection (CABSI)
incidence existed between children who underwent cardiac surgery and had a
central venous catheter impregnated with minocycline and rifampin versus
those who had a conventional, nonimpregnated catheter after cardiac
surgery. Due to a lower number of infections than expected, the study was
terminated early. Among 288 evaluable patients, the rates of CABSI and
line-related complications were similar between the 2 groups. The Author
2012. Published by Oxford University Press on behalf of the Pediatric
Infectious Diseases Society.

<17>
Accession Number
71340566
Authors
Volodarskiy A. Kumar S. Bangalore S.
Institution
(Volodarskiy) Dept of Internal Medicine, New York Univ, Sch of Medicine,
New York, NY, United States
(Kumar) Dept of Cardiology, Univ of Nebraska Med Cntr, Omaha, NE, United
States
(Bangalore) Dept of Cardiology, New York Univ, Sch of Medicine, New York,
NY, United States
Title
Optimal treatment strategies in patients with chronic kidney disease and
coronary artery disease: Insights from a systemic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Chronic kidney disease (CKD) is an independent risk factor for
coronary artery disease (CAD) and is associated with worse outcomes.
However, only 10% to 40% of CAD patients with CKD undergo
revascularization, due to fear of acute complications. However, data
suggests that patients with CKD are more likely to die of cardiovascular
causes than to reach end stage renal disease. The optimal treatment
strategies is therefore unknown. Methods: MEDLINE, EMBASE and CENTRAL were
searched for studies including at least 100 patients with CKD or with a
creatinine clearance of < 60 mL/min and CAD treated with medical therapy
(MT), percutaneous coronary intervention (PCI) or coronary artery bypass
surgery (CABG) and followed for at least 1 month and reporting all-cause
mortality. Analysis was performed to compare MT vs. any revascularization
(PCI or CABG), MT vs. PCI alone, MT vs. CABG alone, and PCI vs. CABG
strategy. Results: 33 studies with 89,307 participants (73,379 revasc and
16,083 MT), fulfilled the criteria and were included in this analysis.
Revascularization (PCI or CABG) was associated with reduced mortality over
MT (OR 0.62; 95% CI 0.51-0.75). Similar lower mortality was found for PCI
vs. MT (OR 0.63; 95% CI 0.51-0.79) and CABG vs. MT (OR 0.57; 95% CI
0.35-0.91). Similarly, CABG was associated with lower odds of death (OR
0.90; 95% CI 0.81-0.99) when compared to PCI (Figure). Conclusions: In CAD
patients with CKD, the current data from non-randomized studies indicate
an association of lower mortality with revascularization, CABG or PCI when
compared with MT. Furthermore, CABG was associated with lower mortality
than PCI. These associations should be tested in future randomized trials.

<18>
Accession Number
71340564
Authors
Volodarskiy A. Kumar S. Bangalore S.
Institution
(Volodarskiy, Bangalore) Dept of Internal Medicine, New York Univ, Sch of
Medicine, New York, NY, United States
(Kumar) Dept of Cardiology, Univ of Nebraska Med Cntr, Omaha, NE, United
States
Title
Drug eluting vs. bare metal stents in patients with chronic kidney disease
and coronary artery disease: Insight from a systematic review and
meta-analysis of trials.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Chronic kidney disease (CKD) is an independent risk factor for
coronary artery disease (CAD) and is associated with an exponential
increase in adverse outcomes. Most large clinical trials of drug eluting
stents (DES) have excluded patients with impaired renal function. The
efficacy of DES in patients with CKD is therefore not known. Methods:
MEDLINE, EMBASE and CENTRAL were searched for studies including at least
100 patients with CKD or with a creatinine clearance of < 60 mL/min and
CAD treated with DES or bare metal stents (BMS) and followed for at least
1 month and reporting outcomes of all-cause mortality, cardiovascular (CV)
mortality, myocardial infarction (MI), target lesion and target vessel
revascularizations. Results: 27 studies with 83,332 participants (47,073
DES and 36,259 BMS) fulfilled the criteria and were included in the
analysis. DES was associated with significant reduction in all-cause
mortality (OR 0.70; 95% CI 0.61-0.80), CV mortality (OR 0.39; 95% CI
0.25-0.60), MI (OR 0.90; 95% CI 0.85-0.95), TLR (OR 0.61; 95% CI
0.48-0.77) and TVR (OR 0.49; 95% CI 0.35-0.69) when compared with BMS
alone (Figure). Conclusions: In CAD patients with CKD undergoing PCI, the
current data from non-randomized studies indicate a significant benefit of
DES when compared with BMS alone. These associations should be tested in
future randomized controlled trials.

<19>
Accession Number
71340099
Authors
Bavry A.A. Petersen J.
Institution
(Bavry, Petersen) Medicine, Univ of Florida, Gainesville, FL, United
States
Title
Is it safe to defer revascularization of coronary lesions without
inducible myocardial ischemia?.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Fractional flow reserve (FFR) is used to detect the presence
of inducible myocardial ischemia. Deferral of revascularization for
abnormal, but non-ischemic lesions is recommended; however, the long-term
outcome of this approach is not known. Methods: A PubMed search of the
MEDLINE database identified studies that reported clinical outcomes among
patients who had FFR-guided revascularization (percutaneous coronary
intervention or coronary artery bypass grafting was left to operatory
discretion). Inducible myocardial ischemia was defined as a FFR value
below a pre-determined threshold (either 0.75 or 0.80 depending on the
study). Baseline demographics and clinical outcome data were extracted by
2 independent reviewers. Random effects summary risk ratios were
constructed using a DerSimonian-Laird model. Results: From 628 potential
studies, 16 were included in the meta-analysis (n = 2,868 participants).
The mean FFR in the no-ischemia/deferral group was 0.88 versus 0.66 in the
ischemia/revascularization group. At a mean follow-up of 29 months, the
incidence of all-cause mortality was 3.7% in the no ischemia/deferral
group versus 4.2% in the ischemia/revascularization group (RR=0.60, 95%CI
0.41-0.88, p = 0.009, I2=0%) (Figure). Outcomes were similar among
patients with left main stenosis (RR=0.57, 95%CI 0.30-1.1, p = 0.094)
versus non-left main stenosis (RR=0.63, 95%CI 0.40-1.00, p = 0.052).
Myocardial infarction: 0.9% versus 3.0% (RR=0.57, 95%CI 0.28-1.17, p =
0.13, I2=0%), and revascularization: 5.9% versus 9.7% (RR=0.85, 95%CI
0.44-1.65, p = 0.63, I2=72.4%), respectively for no-ischemia/deferral
versus ischemia/revascularization. Conclusion: Deferral of
revascularization for abnormal, but non-ischemic lesions was safe compared
with revascularization of ischemic lesions. Future research will need to
determine the optimal FFR threshold, above which revascularization can be
deferred. (Figure Presented).

<20>
Accession Number
71340030
Authors
Patel V.G. Brayton K.M. Kumbhani D.J. Banerjee S. Brilakis E.S.
Institution
(Patel, Brilakis) Cardiology, VA North Texas Healthcare System, Univ of
Texas at Southwestern, Dallas, TX, United States
(Brayton) Cardiology, Stanford Univ, Stanford, CA, United States
(Kumbhani) Cardiology, Univ of Texas at Southwestern, Dallas, TX, United
States
(Banerjee) Cardiology, VA North Texas Health Care System, Univ of Texas at
Southwestern, Dallas, TX, United States
Title
Meta-analysis of stroke after transradial versus transfemoral artery
catheterization.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To assess the risk of stroke after transradial (TR) versus
transfemoral (TF) artery cardiac catheterization. Background: TR
catheterization is gaining popularity due to its association with lower
bleeding and access site complications, improved patient comfort, and
lower costs compared to TF catheterization; however, there is concern that
TR catheterization may be associated with an increased risk of
neurological complications. Methods: We conducted a meta-analysis of
randomized studies published until 2013 reporting risk of stroke in TR vs.
TF catheterization. Results: Data from 11,273 patients in 13 studies were
collated. The majority of patients were men, and 8,987 (79.7%) were
enrolled in acute coronary syndrome trials. Very few patients had a
history of prior coronary artery bypass grafting, and approximately 2/3 of
patients underwent percutaneous coronary intervention. Stroke occurred in
25 of 5,659 patients in the TR group, vs. 24 of 5,614 patients in the TF
group. There was no difference in stroke rates between the TR and TF
groups (Figure , risk difference 0.00%, 95% confidence interval -0.29% -
0.25%, p=0.88). This finding was consistent in a number of sensitivity
analyses (excluding non-ST elevation acute coronary syndrome (ACS) trials,
non-ACS trials, trials reporting in-hospital events or 30-day events,
trials requiring radial expertise). Conclusions: TR catheterization is not
associated with a significant increase in stroke compared to TF
catheterization. (Figure Presented).

<21>
Accession Number
71339934
Authors
Benjo A. Garcia D. Kumar S. Garcia W. Macedo F.Y. Benjo C. Herzog E. Aziz
E.F.
Institution
(Benjo, Kumar, Garcia, Herzog, Aziz) Dept of Cardiology, Columbia Univ
Coll of Physicians, St.Lukes-Roosevelt Hosp Ctr, New York, NY, United
States
(Garcia) Dept of Cardiology, Univ of Miami, Miami, FL, United States
(Macedo) Dept of Cardiology, Baylor College of Medicine, Houston, TX,
United States
(Benjo) Dept of Cardiology, Cezar Benjo, Ctr de Diagnostico e Tratamento
Cardiologico, Rio de Janeiro, Brazil
Title
Post-operative biatrial pacing consistently decreases atrial fibrillation
in cardiac surgery: A randomized-controlled trial meta-analysis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Due to the populational aging atrial fibrillation (AF) is
becoming more prevalent disease, it also commonly presents as a cardiac
surgery complication. It is well established that ventricular and even
atrial pacing may increase the incidence of atrial fibrillation but there
is some suggestion that biatrial pacing may prevent it. Methods: All
randomized controlled trials on biatrial pacing for patients undergoing
cardiac surgery were sought in Medline and Cochrane databases during May
2013. Data was extracted by 3 reviewers. We analyzed the data with RevMan
5.2 with fixed effect if P>0.1 and I2<40%, and random effect otherwise.
Results: Twelve studies were found comparing biatrial pacing in post
cardiac surgery patients against other pacing modalities. All the studies
consistently demonstrated a reduced incidence of atrial fibrillation in
the patients receiving the biatrial pacing, an overall 70% reduction in
the chance of having it (Figure 1).

<22>
Accession Number
71339919
Authors
Une D. Al-Atassi T. Kulik A. Voisine P. Le May M. Ruel M.
Institution
(Une, Al-Atassi, Ruel) Div of Cardiac Surgery, Univ of Ottawa Heart
Institute, Ottawa, Canada
(Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional Hosp, Boca
Raton, FL, United States
(Voisine) Dept of Surgery, Hopital Laval, Quebec city, Canada
(Le May) Div of Cardiology, Univ of Ottawa Heart Institute, Ottawa, Canada
Title
The effect of clopidogrel plus aspirin versus aspirin only on progression
of native coronary artery disease 1 year after CABG: Analysis from the
cascade randomized trial.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Clopidogrel improves patient outcomes after acute coronary
syndrome and percutaneous coronary intervention. To this date, the effect
of clopidogrel on native coronary artery disease (CAD) after coronary
artery bypass grafting (CABG) has not been described. The CASCADE
randomized controlled trial was designed to evaluate whether adding
clopidogrel to aspirin inhibits saphenous vein graft hyperplasia and
occlusion. In this secondary analysis, we examined whether adding
clopidogrel to aspirin was protective against the progression of native
CAD after CABG, compared to aspirin alone. Methods: In the CASCADE trial,
113 patients were randomized to receive aspirin 162 mg plus clopidogrel 75
mg daily or aspirin 162 mg plus placebo daily for 1 year after CABG. For
this post-hoc analysis, 2 expert physicians, blinded to patient treatment,
independently reviewed coronary angiograms performed preoperatively and 1
year after CABG. We compared the incidence of progressive CAD and new
stenoses in relation to graft anastomosis site and the existence of bypass
graft failure between the clopidogrel and placebo groups. Results:
Baseline clinical and operative characteristics were similar in the
clopidogrel and placebo groups. A total of 201 stenoses and 24 occlusions
were identified at preoperative angiography, and 5 new stenoses were
detected at postoperative angiography. At 1 year, there were 35 changes of
which 30 were progressive stenoses and 5 were new stenoses. The incidence
of new and progressive stenoses in the clopidogrel + aspirin group was
equivalent to the aspirin only group [20.2% (22/109) vs. 13.4% (13/97),
respectively, p=0.2], and the stenoses were similarly distributed
[proximal to graft: 20.4% (19/93) vs. 14.6%(12/82), distal: 16.7% (1/6)
vs. 0% (0/3), non-grafted segment: 20.0% (2/10) vs. 8.3% (1/12); p > 0.3].
Finally, the incidence of progressive native CAD was equivalent whether
bypass graft failure had developed or not [graft failure 26.1% (6/23) vs.
no graft failure 15.8% (29/183), p = 0.2]. Conclusions: Compared to
aspirin only, adding clopidogrel to aspirin did not reduce the progression
of native coronary artery disease 1 year after CABG. These findings may
help guide post-CABG antiplatelet therapy.

<23>
Accession Number
71339897
Authors
Fanari Z. Weiss S.A. Zhang W. Hadid M. Weintraub W.S.
Institution
(Fanari, Weiss, Zhang, Weintraub) Section of Cardiology, Christiana Care
Health System, Wilmington, DE, United States
(Hadid) Section of Cardiology, St Louis Univ, St. Louis, MO, United States
Title
Meta-analysis of three randomized controlled trials comparing coronary
artery bypass grafting with percutaneous coronary intervention using
drug-eluting stenting in patients with diabetes.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Coronary Artery Bypass Grafting (CABG) was found to be the
preferred strategy of revascularization in patients with diabetes in the
bare metal stent (BMS) era . The introduction of Drug eluting stents (DES)
led to a significant reduction in the rates of repeat revascularization,
death and myocardial infarction in the contemporary era when compared to
BMS. Multiple randomized controlled trials compared the impact of CABG vs.
percutaneous coronary intervention using DES on patients with Diabetes. We
did a collaborative analysis of data from randomized controlled trials in
the contemporary era to compare the modalities in Patients Diabetes.
Methods: We did a systematic review and meta-analysis from randomized
trials in the contemporary era comparing PCI with DES to CABG in diabetic
patients .A comprehensive literature search (01/01/2003 to 05/18/2013)
identified three randomized controlled trial that reported long-term
outcomes comparing PCI using DES and CABG in diabetic patients. Data from
these three trials that included 2854 patients were used to compare the
outcomes at 1 and 5 years respectively. Results: At 1 year PCI was
associated with significant increase incidence in Target Vessel
Revascularization (TVR) (12.84% vs. 4.70%; RR= 2.48 [1.56 - 3.94];
P=<0.0001), and MI (5.98%vs. 3.74%; RR= 1.5; 95% CI: [1.06 - 2.13];
P<0.0215), a lower incidence of stroke (0.75% vs. 1.99%; RR= 0.43 [1.56 -
3.94]; P=0.017), and no difference in death (4.51% vs. 4.23%; RR= 1.05;
95% CI: [0.75 - 1.48]; P= 0.7725). At 5 years PCI was still associated
with lower incidence of stroke (0.75% vs. 1.99%; RR= 0.43; 95% CI: [0.21 -
0.86]; P=0.017), but with a significant increase incidence of death
(13.56% vs. 9.96%; RR= 1.36 (1.11 - 1.66); P= 0.0033) and MI (10.64% vs.
5.30%; RR= 2.01 [1.54 - 2.62]; P=<0.0001). Conclusion: Although PCI is not
associated with a significant difference in incidence of death, it is
associated with a significant increase in incidence of MI in patients with
diabetes when compared to CABG at 1 year. At 5 years PCI is associated
with higher incidence of both death and MI. PCI is associated with
significantly higher incidence of TVR and lower incidence of stroke when
compared with CABG.

<24>
Accession Number
71339895
Authors
Fanari Z. Weiss S.A. Zhang W. Weintraub W.S.
Institution
(Fanari, Weiss, Zhang, Weintraub) Section of Cardiology, Christiana Care
Health System, Wilmington, DE, United States
Title
Coronary artery bypass grafting vs. Percutaneous coronary intervention
using drug-eluting stenting in patients with multivessel coronary artery
disease: A meta-analysis of six randomized controlled trials.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Percutaneous coronary intervention (PCI) and Coronary Artery
Bypass Grafting (CABG) are established strategies for coronary
revascularization in the setting of ischemic heart disease. The use of
drug eluting stents (DES) improved outcome after PCI in the contemporary
era. Multiple randomized controlled trials have compared outcomes of the
two modalities in patients with multivessel coronary artery disease.
Methods: We did a meta-analysis from six randomized trials in the
contemporary era comparing PCI with DES to CABG with a total of 5123
patients to compare the effectiveness of two strategies at 12 months. To
study longer-term outcome we used data from 4 trials of 4498 patients to
compare the outcomes at 1 and 2 years respectively and data from 3 trials
of 4202 patients to compare outcomes at 1 and 5 years respectively.
Results: At 1 year PCI was associated with significant increase incidence
in Target Vessel Revascularization (TVR) (11.59% vs. 4.79%; RR= 2.31; 95%
CI: [1.80 - 2.96]; P=<0.0001), lower incidence of stroke (0.55% vs. 1.86%;
RR= 0.35; 95% CI: [0.19 - 0.62]; P=0.0003), and no difference in either
death (3.70% vs. 3.63%; RR= 1.02; 95% CI: [0.77 - 1.36]; P= 0.8783) or MI
(4.54% vs. 3.29%; RR= 1.16; 95% CI: [0.72 - 1.88]; P= 0.5319). At 2 years
PCI was still associated with lower incidence of stroke , no increase in
the incidence of either death or MI. At 5 years PCI was still associated
with lower incidence of stroke, but with a significant increase incidence
of death (12.99% vs. 9.99%; RR= 1.3; 95% CI: [1.10 - 1.54]; P= 0.0026) and
MI (10.28% vs. 4.63%; RR= 2.21; 95% CI: [1.75 - 2.79]; P=<0.0001).
Conclusion: In patients with multi-vessel coronary artery disease PCI is
associated with no-significant difference in death and MI at 1 and 2 years
respectively. However at 5 years PCI is associated with higher incidence
of death and MI. PCI is associated with significant higher incidence of
TVR and lower incidence of stroke when compared with CABG.

<25>
Accession Number
71339838
Authors
Panchal H.B. Amin P. Patel P. Ladia V. Albalbissi K. Paul T.
Institution
(Panchal, Ladia) Dept of Internal Medicine, East Tennessee State Univ,
Johnson City, TN, United States
(Amin, Albalbissi, Paul) Div of Cardiology, Dept of Internal Medicine,
East Tennessee State Univ, Johnson City, TN, United States
(Patel) Dept of Pathology, Univ of Tennessee, Knoxville, TN, United States
Title
A meta-analysis of major adverse cardiovascular and cerebrovascular events
in patients undergoing transfemoral versus transapical transcatheter
aortic valve implantation using edwards SAPIEN valve for severe aortic
stenosis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In patients with severe aortic stenosis (AS) who are high risk
for surgery, a transcatheter aortic valve implantation (TAVI) is an
emerged alternative procedure using transfemoral (TF) or transapical (TA)
approach. The purpose of this meta-analysis is to compare early major
adverse cardiovascular and cerebrovascular events (MACCE) between TF-TAVI
and TA-TAVI performed using Edwards SAPIEN valve. Methods: PubMed, EMBASE,
and the Cochrane Center Register of Controlled Trials were searched
through April 2013. Eleven studies (n=2221) comparing TF-TAVI (n=1026) and
TA-TAVI (n=1195) procedures using Edwards SAPIEN valve were included. End
points were 1 year all-cause mortality, stroke, MI, bleeding and major
vascular complications. The odds ratio (OR) with 95% confidence interval
(CI) was computed and p<0.05 was considered as a level of significance.
Results: The studies were homogeneous for all outcomes except 1 year
mortality outcome. There was no significant difference between TF-TAVI and
TA-TAVI for 1 year mortality (OR: 0.73, CI: 0.34-1.57, p=0.41) (Figure A),
incidence of stroke (OR: 1, CI: 0.62-1.62, p=0.99), MI (OR: 0.63, CI:
0.22-1.83, p=0.4) and bleeding events (OR: 0.85, CI: 0.54-1.32, p=0.47).
The major vascular complications were significantly higher in TF-TAVI
compared to TA-TAVI (OR: 4.91, CI: 3.43-7.04, p<0.00001) (Figure B).
Conclusion: The results of this meta-analysis of 2221 patients revealed
that TA-TAVI had similar early MACCE as compared to TF-TAVI and was
associated with lower major vascular complications. In patients with
contraindications to TF-TAVI, TA-TAVI is a reasonable option. Further
studies are needed to evaluate long-term clinical outcomes between TF-TAVI
and TA-TAVI.

<26>
Accession Number
71339836
Authors
Panchal H.B. Patel P. Patel B. Shah T. Albalbissi K. Paul T.
Institution
(Panchal, Patel) Dept of Internal Medicine, East Tennessee State Univ,
Johnson City, TN, United States
(Patel) Dept of Pathology, Univ of Tennessee, Knoxville, TN, United States
(Shah) Dept of Cardiology, Chicago Med Sch/RFUMS, North Chicago, IL,
United States
(Albalbissi, Paul) Div of Cardiology, Dept of Internal Medicine, East
Tennessee State Univ, Johnson City, TN, United States
Title
Thirty-day all-cause mortality in patients undergoing transcatheter aoritc
valve implantation using edwards SAPIEN valve for severe aortic stenosis:
A meta-analysis of transfemoral versus transapical approach.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In patients with severe aortic valve stenosis (AS) who are
high risk for surgical aortic valve replacement, transcatheter aortic
valve implantation (TAVI) is an emerged alternative procedure.
Transfemoral (TF) approach is usually used as an initial approach and
Transapical (TA) approach is used when there are contraindications to TF
approach. The objective of this meta-analysis is to compare procedure
related all-cause mortality between TF-TAVI and TA-TAVI performed using
Edwards SAPIEN valve. Methods: PubMed, EMBASE, and the Cochrane Center
Register of Controlled Trials were searched through April 2013. Ten
studies (n=2221) comparing TF-TAVI (n=1026) and TA-TAVI (n=1195)
procedures using Edwards SAPIEN valve were included. End points were
in-hospital and 30 day all-cause mortality. The odds ratio (OR) with 95%
confidence interval (CI) was computed and p<0.05 was considered as a level
of significance. Results: The studies were homogeneous for both outcomes.
There was no significant difference between TF-TAVI and TA-TAVI for
in-hospital all-cause mortality (OR: 1.25, CI: 0.55-2.85, p=0.59). Thirty
day all-cause mortality was significantly lower in TF-TAVI compared to
TA-TAVI (OR: 0.63, CI: 0.47-0.85, p=0.003) (Figure). Conclusion: The
results of our meta-analysis of 2221 patients suggest that TA-TAVI is
associated with higher peri-procedural all-cause mortality compared to
TF-TAVI performed using Edwards SAPIEN valve in patients with severe AS.
The results of this study indicates that TF-TAVI would be the initial
procedure of choice unless contraindicated. Further studies are needed to
evaluate long-term mortality outcomes between TF-TAVI and TA-TAVI.

<27>
Accession Number
71339835
Authors
Panchal H.B. Desai S. Ramu V. Paul T.
Institution
(Panchal) Dept of Internal Medicine, East Tennessee State Univ, Johnson
City, TN, United States
(Desai) Div of Pulmonary Critical Care, Dept of Internal Medicine, East
Tennessee State Univ, Johnson City, TN, United States
(Ramu) Div of Cardiology, Dept of Internal Medicine, East Tennessee State
Univ, Johnson City, TN, United States
(Paul) Div of Cardiology, Dept of Internal Medicineernal Medicine, East
Tennessee State Univ, Johnson City, TN, United States
Title
Improvement of valvular parameters following transcatheter aoritc valve
implantation versus surgical aortic valve replacement in patients with
severe aortic stenosis: A meta-analysis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Surgical aortic valve replacement (SAVR) is the standard of
care for severe aortic valve stenosis (AS). In patients with high risk for
surgery, transcatheter aortic valve implantation (TAVI) is an alternative
approach and has been evolved. The purpose of this meta-analysis is to
compare post-procedural improvement of valvular parameters following TAVI
versus SAVR for severe aortic stenosis. Methods: Nine studies (n=2411)
comparing SAVR (n=1363) and TAVI (n=1048) procedures were included. End
points were baseline logistic EuroSCORE, aortic valve area in
cm² and mean and peak trans-aortic pressure gradients in mm Hg.
The mean difference (MD) with 95% confidence interval (CI) was computed
for each outcome and p<0.05 was considered as a level of significance.
Results: There was no difference in baseline logistic EuroSCORE between
patients in TAVI and SAVR groups (MD: 6.13, CI: -0.14 to 12.41, p=0.06).
There was no significant difference found in aortic valve area between
TAVI and SAVR groups (MD: -0.07, CI: -0.54 to 0.39, p=0.75) (Figure A).
The mean and peak trans-aortic pressure gradients were significantly lower
following TAVI compared to SAVR (MD: -2.19, CI: -3.64 to -0.73, p=0.003
MD: -2.40, CI: -2.65 to -2.14, p<0.00001 respectively) (Figure B).
Conclusion: This meta-analysis of 9 studies in 2411 propensity score
matched patients with severe aortic stenosis demonstrated that replacement
of aortic valve with TAVI procedure may provide better valve performance
compared to SAVR. Long-term echocardiographic assessment of valvular area
and trans-aortic gradients is needed for further evaluation. (Figure
Presented).

<28>
Accession Number
71339826
Authors
Kim C.A. Rasania S.P. Afilalo J. Popma J.J. Lipsitz L.A. Kim D.H.
Institution
(Kim, Rasania, Popma, Lipsitz, Kim) Medicine, Beth Israel Deaconess Med
Cntr, Harvard Med Sch, Boston, MA, United States
(Afilalo) Medicine, Jewish General Hosp, McGill Univ, Montreal, Canada
Title
Transcatheter aortic valve replacement improves functional status and
quality of life in elderly patients with severe aortic stenosis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) prolongs
survival in high-risk patients with severe aortic stenosis. However, the
functional and quality-of-life benefits of TAVR have not been well
established. Methods: We conducted a meta-analysis to evaluate the changes
in functional status and quality-of-life outcomes after TAVR, in
comparison with surgical aortic valve replacement (SAVR) or conservative
treatment (CT). Studies of TAVR with at least 6 month follow-up and
reported New York Heart Association (NYHA) class, Short-Form 12/36
physical and mental component summary scores were included. The mean
change (95% confidence interval) in primary outcomes from baseline to 6-11
or 12-17 months was pooled using a random-effects model. Results: In 52
studies including 6436 TAVR, 574 SAVR and 439 CT patients (Table), there
was a significant improvement in TAVR patients: NYHA class (-1.4 [-1.5,
-1.3]) at 6-11 months and -1.4 [-1.6, -1.2] at 12-17 months) (Figure),
Short-Form12/36 physical component summary (9.1 [5.6, 12.6] at 6-11 months
and 10.5 [5.8, 15.1] at 12 months) and mental component summary (5.6 [2.7,
8.5] and 4.7 [2.8, 6.6]). These changes were comparable to the improvement
in SAVR patients: NYHA class (-1.7 [-1.8, -1.5] at 6-11 months and -0.9
[-1.7, -0.1] at 12-17 months) and Short-Form12/36 physical component
summary (7.1 [5.5, 8.7 at 6-11 months and 5.7 [4.0, 7.4] at 12 months) and
mental component summary (3.9 [2.1, 5.6] and 4.4 [2.6, 6.3]). However, CT
did not result in any meaningful improvement. Conclusions: Current
evidence suggests the functional and quality-of-life benefits of TAVR
among older patients who survive the procedure. (Figure Presented).

<29>
Accession Number
71339815
Authors
Lang C. Shim H.G. Arora R.
Institution
(Lang, Shim) Cardiology, Brown Univ, Alpert Sch of Medicine, Providence,
RI, United States
(Arora) Cardiology, Chicago Med Sch, North Chicago, IL, United States
Title
Aggregate bayesian meta-analysis of percutaneous coronary intervention
versus coronary artery bypass grafting in patients with diabetes.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The recent results from the FREEDOM trial indicate the
superiority of coronary artery bypass grafting (CABG) over percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) in patients
with multivessel disease and diabetes. However, previous studies examining
this population did not find significant differences with respect to
composite endpoints of death, myocardial infarction or stroke. We sought
to examine the impact of this difference by conducting a Bayesian
meta-analysis of randomized control trials investigating PCI versus CABG
in patients with diabetes and multivessel disease. Methods: A literature
search was performed and identified 3 RCTs with patients with diabetes and
CAD randomized to CABG or PCI with DES. Major endpoints evaluated were the
combination of death from any cause, non-fatal stroke, and myocardial
infarction. Using this data, an aggregate, sequential Bayesian
meta-analysis was performed, and probabilities of benefit, along with
magnitude of therapeutic effect, were calculated. Results: Posterior
probabilities for the combined endpoint of stroke, myocardial infarction
and all cause mortality indicate a 90.3% probability of benefit for CABG
over PCI, driven primarily by results from the FREEDOM trial. However,
magnitude of therapeutic effect analysis shows a probability of benefit of
greater than 10% odds ratio benefit of 63.8%, where 50% is equivocal.
Conclusions: The results of the Bayesian meta-analysis of PCI versus CABG
in patients with diabetes and multivessel CAD suggest overall benefit to
the use of CABG in this patient population in terms of the combined
endpoint of mortality, MI and stroke. However, the results of previous
trials temper the magnitude of benefit illustrated in the FREEDOM trial.
This supports the notion that PCI remains a viable alternative to CABG,
and should prompt balanced treatment discussions in patients with diabetes
found to have multivessel coronary disease. (Figure Presented).

<30>
Accession Number
71339809
Authors
Garzillo C.L. Rezende P.C. Lima E.G. Uchida A.H. Santos C.D. Cesar L.A.
Costa L.M. Hueb W. Ramires J.A. Filho R.K.
Institution
(Garzillo, Rezende, Lima, Uchida, Santos, Cesar, Costa, Hueb, Ramires,
Filho) Atherosclerosis, Heart Institute, Univ of Sao Paulo, Sao Paulo,
Brazil
Title
Prognostic value of exercise stress testing in patients with multivessel
coronary disease undergoing medicine, angioplasty or surgery: 10-year
follow-up of the mass II trial.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Exercise stress testing (EST) is used routinely to estimate
prognosis of patients with coronary artery disease (CAD). We evaluated the
relation of ischemic EST with arterial pattern and occurrence of adverse
events in patients with CAD submitted to coronary bypass surgery (CABG),
percutaneous coronary intervention (PCI) and medical therapy alone (MT) as
a post-hoc analysis of a randomized controlled trial with a follow-up of
10 years. METHODS: EST was performed in patients with stable multivessel
CAD participants of MASS II trial before randomization to CABG, PCI, or
MT. Stress-induced ischemia (SII) was considered present when exertional
angina developed and/or documentation of ST ischemic changes. The relation
of SII with the primary composite endpoint (overall mortality, Q-wave
myocardial infarction, or refractory angina that required
revascularization) and arterial pattern was analyzed. RESULTS: Of the 611
participants of MASS II trial, 535 performed EST at baseline: 176 patients
from MT, 179 from CABG and 180 from PCI. There was no difference of
arterial pattern among patients with or without SII (113 of 224 with
double vessel and 157 of 311 patients with triple vessel disease had SII,
P=0.943; 243 of 481 and 27 of 54 patients respectively with and without
proximal left anterior descending coronary artery involvement presented
SII, P=0.784). Among patients with SII, those in CABG group evolved less
often with the primary composite endpoint compared to PCI and MT groups
(79 of 81, 46 of 98 and 75 of 91 patients respectively for MT, RM and PCI;
P=0.003). Additionally, patients without SII in CABG group had less
adverse events than PCI and MT groups (84 of 95, 39 of 81 and 70 of 89
patients respectively for MT, CABG and PCI;P= 0.0001). CONCLUSION: The
presence of ischemic changes in EST at baseline was not associated with
coronary pattern severity and occurrence of adverse events in MASS II
trial.

<31>
Accession Number
71339791
Authors
Yi G. Shine B. Rehman S. Altman D. Taggart D.
Institution
(Yi) Cardiovascular Surgery, Yonsei Univ, College of Medicine, Seoul,
South Korea
(Shine) Clinical Pathology, Univ of Oxford, Oxford, United Kingdom
(Rehman) Cardiac Surgery, John Radcliffe Hosp, Oxford, United Kingdom
(Altman) Statistics, Univ of Oxford, Oxford, United Kingdom
(Taggart) Cardiac Surgery, Univ of Oxford, Oxford, United Kingdom
Title
Effect of bilateral internal mammary artery on long-term survival: A
meta-analysis approach.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although the potential survival benefit of bilateral internal
mammary artery (BIMA) grafting compared to single internal mammary artery
(SIMA) has been emphasized by many investigators, use of BIMA is still low
in clinical practice in the absence of randomized trials and long-term
results. In the current study, we aimed to assess if there is a long-term
survival benefit of BIMA up to ten years after coronary bypass surgery.
Methods and Results: We selected published articles comparing survival
between SIMA and BIMA patients with follow-up duration of more than a mean
of nine years. We evaluated the log hazard ratio with 95% CI for included
studies using a random-effects meta-analysis. Nine eligible observational
studies provided 15,583 patients (8,270 SIMA and 7,313 BIMA) for
meta-analysis. Five studies used propensity score methods for statistical
adjustment, two with propensity score-based patient matching method and
three with quintile based stratification. A significant reduction in
mortality by using BIMA was observed (hazard ratio 0*79, 95% CI 0*75-0*84)
with no study showing any significantly harmful effect of BIMA on
survival. Subgroups of studies using different statistical approaches -
'unmatched', 'quintile' based propensity score analysis, and propensity
score based 'exact' patient matching - all showed survival benefit of BIMA
grafting. Conclusions: BIMA grafting appears to have better survival with
up to ten years follow-up compared to SIMA grafting. Long-term survival
benefit of BIMA seems to continue in the second decade after surgery. An
ongoing randomised trial comparing SIMA and BIMA group will add evidence
on this issue. (Figure Presented).

<32>
Accession Number
71339777
Authors
Kannan A. Balamuthusamy S. Poongkunran M. Ramanujam V. Medina R. Nagajothi
N. Borgstrom M.
Institution
(Kannan) Inpatient Medicine, Univ of Arizona, Tucson, AZ, United States
(Balamuthusamy, Medina) Nephrology, Angiocare, Tucson, AZ, United States
(Poongkunran, Ramanujam) Inpatient Medicine, Mohan Diabetes Cntr, Chennai,
India
(Nagajothi) Cardiology, Cardiovascular Consultants, Canton, OH, United
States
(Borgstrom) Univ Information Technology Services, Univ of Arizona, Tucson,
AZ, United States
Title
Cardiovascular mortality in ESRD patients undergoing coronary artery
bypass grafting vs percutaneous coronary intervention-a meta analysis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Patients with End Stage Renal Disease on dialysis have an
increased risk for cardiovascular mortality secondary to occlusive
coronary artery disease. Optimal revascularization strategy is unclear in
this high-risk population. OBJECTIVE: We have performed a meta- analysis
to compare mortality in ESRD patients who have undergone CABG vs PCI.
METHODS: Clinical trials evaluating the mortality in patients with ESRD
undergoing CABG and PCI were considered. Studies were obtained using
search words in Medline, Pubmed, EMBASE, CINAHL and Cochrane databases.
The relative risk across all study groups was computed using
Mantel-Hanszel random effects model. Results were calculated with 95% CI
and was considered statistically significant if 2-sided alpha error was
<.05. RESULTS: Clinical outcomes in ESRD patients were analyzed. Fifteen
trials (n= 53,579) were used for analysis in the ESRD arm. Average age in
this group was 62. Average follow-up duration was 25 months. Patients
undergoing CABG had a decreased overall mortality compared to PCI in ESRD
(0.92 (0.85- 1.00); p=0.0001) patients. CONCLUSIONS: In patients with
ESRD, CABG is associated with decreased mortality when compared to
percutaneous coronary intervention. (Figure Presented).

<33>
Accession Number
71339761
Authors
Alam M. Hira R. Kar B. Jneid H. Virani S. Goswami R. Bandeali S.J.
Rosengart T. Coselli J. Kleiman N. Ballantyne C.M. Lakkis N.M.
Institution
(Alam, Hira, Jneid, Virani, Goswami, Ballantyne, Lakkis) Medicine, Section
of Cardiology, Baylor College of Medicine, Houston, TX, United States
(Kar) Section of Cardiology, Houston VA Med Cntr, Houston, TX, United
States
(Bandeali) Medicine, Baylor College of Medicine, Houston, TX, United
States
(Rosengart, Coselli) Cardiovascular Surgery, Baylor College of Medicine,
Houston, TX, United States
(Kleiman) Cardiology, Methodist DeBakey Heart and Vascular Cntr,
Weill-Cornell Med College, Houston, TX, United States
Title
Comparison of clinical outcomes after trans-catheter aortic valve
implantation in men and women for severe aortic stenosis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Comparison of Clinical Outcomes after Trans-catheter Aortic Valve
Implantation in Men and Women for Severe Aortic Stenosis Objectives: To
evaluate sex related differences in clinical outcomes after transcatheter
aortic valve implantation (TAVI) for aortic stenosis by means of a
meta-analysis. Background: Sex-related disparities in clinical outcomes
after TAVI have been reported in a limited number of patients. We
conducted a meta-analysis of all available literature to assess pooled
outcomes in men and women after TAVI. Methods: A comprehensive literature
search from 01/01/2000 till 05/21/2013 identified 7 studies comparing men
and women who underwent TAVI for severe aortic stenosis. All-cause
mortality was evaluated at 30-days,12 & 24 months follow-up. Odds
ratio(OR) and 95% confidence interval(CI) were calculated using random
effects model. Results: A total of 3555 patients[55% women] were included.
Women were more likely to be older & had higher prevalence of HTN,
porcelain aorta, pulmonary hypertension, CHF and NYHA class III-IV. Men
had higher prevalence of prior CAD, MI, PAD and tobacco use.
Echocardiographic and hemodynamic studies revealed smaller aortic valve
area & aortic annulus diameter with higher peak(85.8+8.8mmHg vs.
76.4+3.2mmHg) and mean(47.6+6.0mmHg vs. 43.7+3.1mmHg) gradient across LVOT
in women.At 30-day follow-up, women experienced lower all-cause mortality
compared to men(4.6% vs. 8.0%;OR 0.59 95% CI 0.39-0.91). All-cause
mortality remained lower in women at 12 & 24 month follow-up(Table). Women
suffered from higher rates of major vascular and major bleeding
complications. The two groups had comparable rates of MI, stroke &
pacemaker implantation. Conclusion: In this meta-analysis of all available
data comprising 3,555 patients, women exhibited lower all-cause mortality
up to 24-months post-TAVI despite higher rates of major vascular and
bleeding complications. (Figure Presented).

<34>
Accession Number
71339715
Authors
Verma S. Yanagawa B. Ahsan M. Fitchett D.H. Gupta M. Singh S. Gupta N.
Latter D.A. Ruel M. Farkouh M.E. Friedrich J.O.
Institution
(Verma, Ahsan, Singh, Gupta, Latter) Cardiac Surgery, St Michael's Hosp,
Toronto, Canada
(Yanagawa) Cardiac Surgery, Univ of Toronto, Toronto, Canada
(Fitchett) Cardiology, St Michael's Hosp, Toronto, Canada
(Gupta) Cardiology, Canadian Cardiovascular Rsch Network, Brampton, Canada
(Ruel) Cardiac Surgery, Univ of Ottawa, Ottawa, Canada
(Farkouh) Cardiology, Univ Health Network, Toronto, Canada
(Friedrich) Critical Care, St Michael's Hosp, Toronto, Canada
Title
CABG versus PCI in patients with diabetes: A metaanalysis of randomized
controlled trials in the era of stents.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite results of recent trials, controversy still exists as
to whether coronary artery bypass graft (CABG) surgery is superior to
percutaneous coronary intervention (PCI) in diabetic patients with
multivessel coronary artery disease (CAD), particularly in the setting of
drug eluting stents (DES). Methods: A systematic review and metaanalysis
identified randomized controlled trials (RCTs) comparing CABG vs. PCI in
diabetic patients with with both stable CAD and Post ACS, limited to RCTs
where >80% were treated either with arterial conduits (CABG) or stents
(PCI). Risk ratios (RR) and random effects models were used to pool
results. Heterogeneity was expressed using I2. Results: We identified 4
RCTs using bare metal stents (BMS) (ERACI II, ARTS, SoS, MASS II) and 4
using DES (FREEDOM, SYNTAX, VA CARDS, CARDia) enrolling a total 3612
diabetic patients. Mean age of mainly male patients was 60-65 years (y)
with minimal left ventricular dysfunction overall. At 1y follow up, there
was no difference in mortality, RR 0.99 (95% CI 0.72-1.37; p=0.97, I2=0%);
however, by 5y follow up, CABG patients had lower mortality than PCI
patients, RR 0.67 (95% confidence interval [CI] 0.52-0.86; p=0.002,
I2=25%). Rates of repeat revascularization were significantly lower in
CABG vs. PCI groups by 1y, and at 5y RR was 0.41 (95% CI 0.29-0.59;
p0.001, I2=66%). There was no difference in pooled non-fatal MI rates but
results depended on how periprocedural events were defined. Rates of
stroke were higher in CABG vs. PCI after both 1y (RR 2.41, 95% CI
1.22-4.76; p=0.01, I2=0%) and 5y (RR 1.72, 95% CI 1.18-2.53; p=0.005,
I2=0%). RCTs using BMS vs. DES showed similar results. Where heterogeneity
was present, no clearly identifiable causes were identified. Conclusions:
We report the first metaanalysis of RCTs comparing CABG vs. PCI in
diabetic patients in the DES era. CABG in diabetic patients is associated
with an ~35% lower mortality and 60% lower rates of repeat
revascularization compared to PCI with about a doubling in the risk of
stroke. Importantly, these benefits are seen irrespective of use of BMS or
DES. These data argue strongly in favor of CABG as the preferred strategy
for revascularization in diabetic patients.

<35>
Accession Number
71339653
Authors
Yang J. Yang L. Yu S.
Institution
(Yang, Yu) Cardiovascular Surgery, Xijing Hosp, Xi'an, China
(Yang) Anesthesiology, Xijing Hosp, Xi'an, China
Title
Randomized, controlled trial of transcatheter versus surgical closure of
perimembranous ventricular septal defects in children.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Perimembranous ventricular septal defect (pmVSD) is the most
common form of congenital heart disease in childhood. The optimal
treatment for this defect must be evaluated. Methods and Results: From Jan
2009 to July 2010, 229 children with congenital pmVSD were randomized into
a surgical or transcatheter group with matched baseline characteristics.
Data from clinical records, lab exams and follow-up results from the past
2 years were compared between the groups. One major adverse event and 34
minor adverse events were observed in the surgical group while only 8
minor adverse events were recorded in the transcatheter group (p=0.006).
Statistical comparisons between the surgical and transcatheter groups
showed a difference (p<0.01) in the amount of blood transfusion
(276.0+231.7 VS 0 mL), procedural duration (180.5+ 66.1 VS 38.2+24.6 min),
median hospital stay (7.2+5.7 VS 3.3+1.6 d), median ICU stay (1.2+1.7 VS 0
d), median hospitalization cost (4846.3+1628.1 VS 3550.4+745.9 $) and
median blood loss (186.5+151.3 VS 54.2 +18.9 mL). The 0-72 hours area
under curve (AUC0-72) of Creatine Kinase-MB (CK-MB) and cardiac troponin I
(cTnI) release of the surgical group were significantly higher than those
of the transcatheter group (3415.8 VS 425.1 and 597.6 VS 4.7,
respectively, p<0.01). At a median follow-up period of 2 years, both
groups achieved similar results with regards to the closure rate, adverse
events and complications (p>0.05). Conclusions: Transcatheter device
closure and surgical repair are both effective methods in treating pmVSD
children with excellent mid-term results. Transcatheter device closure has
the benefit of causing less myocardial injury, not requiring a blood
transfusion, a shorter hospital stay, decreased medical expenses, and a
faster recovery.

<36>
Accession Number
71338771
Authors
Natt P. Saxena R. Dib P. Ralhan S. Wander G.S. Stowell D. Peyton M.
Sanghera D.
Institution
(Natt, Sanghera) Pediatrics, Oklahoma Univ, Health Sciences Centre,
Oklahoma city, OK, United States
(Saxena) Centre for Human Genetic Research, Massachusetts General Hosp,
Harvard Med Sch, Boston, MA, United States
(Dib) Pharmacy Instructional Science, Oklahoma Univ Health Sciences
centre, Oklahoma city, OK, United States
(Ralhan, Wander) Cardiology, Hero Dayanand Med College, Ludhiana, Punjab,
India
(Stowell, Peyton) Surgery, Oklahoma Univ Health Sciences centre, Oklahoma
City, OK, United States
Title
Casein kinase II (CSNK2A2) is associated with leucocyte telomere
shortening and increased cardiovascular disease risk in diabetes.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
The shorter telomere length has been linked to the pathology of
cardiovascular disease (CVD) and type 2 diabetes (T2D), and is widely
considered as a marker for biological aging. A genome-wide association
scan (GWAS) analysis of shorter leucocyte telomere length (LTL) conducted
on 1,616 participants from the Sikh Diabetes Study (SDS) identified 338
top independent signals (p<10-4) to be significantly associated with a
shorter LTL independent of T2D. Most promising 48 SNPs were further
replicated through genotyping in an additional Punjabi Sikh sample
(n=2,397). In combined meta-analysis in the Punjabi Sikh populations
(n=4,013/1,946 T2D cases), we identified a novel locus in association with
LTL at 16q21 represented by an intronic SNP in the CSNK2A2 (p=4.4x10-8).
Our findings also revealed an independent association of shorter LTL with
T2D and cardio metabolic risk. The mean LTL showed a gradual decline from
healthy subjects to individuals with T2D and CHD with respective mean LTL
being 2.10 in healthy, 1.95 in T2D, 1.69 in CHD, and 1.59 in T2D+CHD.
Interestingly, the telomeric repeat binding factor 1(TRF1) serves as a
substrate for CSNK2A2, which phosphorylates and initiates its binding to
telomere. CSNK2A2 also interacts with multiple genes and miRNAs in pathway
controlling LTL and CVD. To further understand the functional significance
of the genetic variation CSNK2A2 and other genes in association with CHD
and telomere replication pathway, we analyzed the expression of 84 miRNA
in carotid aortic plaque and muscle tissues obtained from CHD patients who
had undergone coronary artery bypass graft (CABG) using miScript miRNA
Human CVD arrays (Qiagen, Chatsworth, CA). Our initial analysis revealed a
significant difference (p<0.05) in expression of miR208 that regulates
CSNK2A2. Additionally, expression of miR155 associated with TERF1 and miR1
associated with TERF2 were down-regulated, and expression of
miR185/miR27a/miR183- associated with POT1 was elevated in atherosclerotic
plaque compared to muscle. Future functional studies may provide
clinically important insights on the interplay between genetic variants in
CSNK2A2 and other LTL pathway genes and their interaction with miRNA in
atherosclerotic tissues for affecting CVD risk in diabetes.

<37>
Accession Number
71338687
Authors
Aragam K.G. Zhao W. Shah O. Rasheed A. Wolfe M. Reilly M. Danesh J. Rader
D.J. Saleheen D.
Institution
(Aragam) Internal Medicine, Univ of Pennsylvania, Philadelphia, PA, United
States
(Zhao, Shah, Wolfe, Reilly, Rader) Div of Translational Medicine and Human
Genetics, Univ of Pennsylvania, Philadelphia, PA, United States
(Rasheed) Cntr for Non-Communicable Diseases, Karachi, Pakistan
(Danesh) Dept of Public Health and Primary Care, Univ of Cambridge,
Cambridge, United Kingdom
(Saleheen) Dvision of Translational Medicine and Human Genetics, Univ of
Pennsylvania, Philadelphia, PA, United States
Title
Serum Gamma glutamyl transferase and risk of coronary artery disease: A
causal assessment by mendelian randomization.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Gamma glutamyl transferase (GGT) is a ubiquitous cell-surface
enzyme that mediates oxidative stress and is elevated in persons with
hepatic steatosis. Observational data have suggested a positive
association between GGT and incident coronary artery disease (CAD),
although the potential causal nature of this association remains
unexplored. Objective: To determine whether serum levels of GGT are
causally associated with incident CAD by using a genetic instrument
exclusively associated with serum GGT. Methods: A meta-analysis was
conducted of studies assessing the association between serum GGT and
incident CAD, defined as CAD-related death, non-fatal MI, coronary artery
bypass graft surgery and angioplasty. In addition, 26 single nucleotide
polymorphisms (SNPs) associated with GGT at a genome wide significance
level (p<5x10-8) were evaluated for pleiotropy against a panel of 25
vascular and non-vascular risk factors in publicly available databases and
the Pakistan Risk of Myocardial Infarction Study (PROMIS). SNPs
exclusively associated with serum GGT were combined to create a genetic
risk score, which was further used to assess causality in 60,919 CAD cases
and 80,243 controls from the CARDIoGRAMplusC4D consortium and the PROMIS
study. Results: In a meta-analysis of seven studies (total N = 1,111,751;
total incident cases = 16,092), higher serum GGT was significantly
associated with an increased risk of incident CAD (OR 1.44; 95% CI:
1.09-1.89; top v. bottom quintile). Of the 26 SNPs assessed, pleiotropic
analysis identified 17 GGT-specific SNPs, which were combined to create a
genetic risk score for causal assessment. Genetically-raised serum GGT
levels were not significantly associated with incident CAD (OR 1.00; 95%
CI: 0.99-1.00). Conclusions: Higher levels of serum GGT are associated
with increased risk of incident CAD, although the association does not
appear to be causally mediated.

<38>
Accession Number
71338639
Authors
Liaw N.Y. Looi J.Y. Konstantinov I.E. Cheung M.M. Pepe S.
Institution
(Liaw, Looi, Cheung, Pepe) Dept of Cardiology, Murdoch Childrens Rsch
Institute, Royal Children's Hosp, Melbourne, Australia
(Konstantinov) Dept of Cardiac Surgery, Murdoch Childrens Rsch Institute,
Royal Children's Hosp, Melbourne, Australia
Title
Chronic hypoxia augments availability of pro-survival metabolic regulatory
signalling kinases in immature cardiomyocytes.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Our recent randomized controlled trial of remote ischemic
preconditioning (RIPC), induced by four 5-min cycles of
ischemia-reperfusion of the lower limb prior to cardiac surgery for
tetralogy of Fallot, showed no effect compared to sham control.
RIPC-linked pro-survival kinase signalling was markedly elevated in
controls similar to RIPC treatment. Aims: To test in cultured immature
cardiomyocytes whether chronic hypoxia affects fentanyl-evoked (opiate)
pro-survival intracellular protein kinase signalling, previously shown to
be triggered by RIPC in adult hearts. Methods and Results: Spontaneously
beating immature cardiomyocytes with neonatal-like properties were
differentiated from murine P19-CRL1825 cells. Total and phosphorylated
Akt, p38MAPK, GSK3beta[[Unable to Display Character: ]] in addition to
markers for apoptosis and autophagy, were assessed by western immunoblot
assays. Cardiomyocyte cultures (mean+SEM, n=3 per treatment) were
confirmed by alpha-, beta- myosin heavy chain, actin, NKX2.5, GATA4, and
MEF2C immunohistochemistry. Acute fentanyl (100nM) treatment of normoxic
cardiomyocytes augmented protein expression levels for total Akt,
(increased by 16+4%), total p38MAPK (30+5%), and autophagic markers (i.e.
beclin 17+6%), but did not affect total GSK3beta or caspase-3 activity.
Almost all total Akt, total p38MAPK, and total GSK3beta were
phosphorylated, including untreated controls. In contrast, cardiomyocytes
grown only in hypoxia (5%O2, 5%CO2, 12 days), compared to normoxic
controls, exhibited augmented expression of total Akt, (22+9%), total
p38MAPK (60+8%), and total GSK3beta(40+6%), with <50% of each in
phosphorylated form. Acute fentanyl (100nM) had no effect on protein
expression levels of Akt, p38MAPK and GSK3beta in hypoxic cells. Extended
exposure of hypoxic cells to fentanyl (100nM, 12 days) markedly augmented
total Akt, (143+23%), total p38MAPK (228+16%), and total GSK3beta (150+9%)
compared to hypoxic controls. Conclusions: Metabolic adaptation by
immature myocytes to chronic hypoxia involves key protein kinase
signalling proteins that are also evoked by opioid-evoked preconditioning
signalling. The total pool of these signalling proteins is augmented thus
increasing the capacity for regulating tolerance of metabolic injury.

<39>
Accession Number
71338585
Authors
Hepponstall J.M. Ignjatovic V. Binos S. Attard C. Karlaftis V. D'Udekem Y.
Monagle P. Konstantinov I.
Institution
(Hepponstall, Monagle) Dept of Paediatrics, Univ of Melbourne, Melbourne,
Australia
(Ignjatovic, Attard, Karlaftis) Haematology Rsch, Murdoch Childrens Rsch
Institute, Melbourne, Australia
(Binos) Dept of Primary Industries, Biosciences Rsch Div, Melbourne,
Australia
(D'Udekem, Konstantinov) Dept of Cardiac Surgery, Royal Children's Hosp,
Melbourne, Australia
Title
Remote ischemic preconditioning modifies the plasma proteome in children
undergoing repair of tetralogy of fallot: A randomized controlled trial.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Remote ischemic preconditioning (RIPC) has been applied in
paediatric cardiac surgery. We have demonstrated that RIPC stimulus
induced proteomic response in plasma of healthy volunteers. Herein we
tested the hypothesis that RIPC modifies the plasma proteomic response in
children undergoing repair of Tetralogy of Fallot (TOF). Methods: Children
(n=40) undergoing TOF repair were double-blind randomized to RIPC (n=20)
and control (n=20) groups. Blood samples were taken at baseline, at the
end of CPB and at 6, 12 and 24 hours post-CPB. Plasma samples were
fractionated and analysed by liquid chromatography mass spectrometry (MS)
in a label free, untargeted approach. Data were analyzed using Genedata
software. Peptides that demonstrated differential expression (p<0.01) were
selected as targets for tandem MS. Corresponding proteins were identified
using the NCBI human protein database. Results: There was no difference in
mean age (7.3+3.5 vs 6.8+3.6 months) (p=0.89), weight (7.7+1.8 vs 7.5+1.9
kg) (p=0.71), CPB time (104+7 vs 94+7 min) (p=0.98) or aortic cross-clamp
time (83+22 vs 75+20 min) (p=0.36) between the groups. There were no
differences in clinical outcomes. No peptides were differentially
expressed between 2 groups at baseline or at the end of CPB. There were 48
peptides with higher expression levels in the RIPC group 6 hours post-CPB.
This was no longer evident in the RIPC group at 12 or 24 hours, with only
1 peptide down-regulated at each of these time points. The proteins
identified from the 48 peptides of interest included: inter-alpha
(globulin) inhibitor (42.0 + 11.8 vs 820.8 + 181.1, p=0.006), fibrinogen
preproprotein (59.3 + 11.2 vs 1192.6 + 278.3, p=0.007), complement C3
precursor (391.2 + 160.9 vs 5385.1 + 689.4, p=0.0005), complement C4B
(151.5 + 17.8 vs 4587.8 + 799.2, p=0.003), apolipoprotein B100 (53.4 + 8.3
vs 1364.5 + 278.2, p=0.005) and urinary proteinase inhibitor (358.6 + 74.9
vs 5758.1 + 1343.1, p=0.009). These proteins are involved in metabolism,
haemostasis, immunity and inflammation. Conclusion: We provided the first
comprehensive analysis of RIPC-induced proteomic changes in children
undergoing heart surgery. The proteomic changes peak at 6 hours post-CPB
and return to baseline within the first 24 hours of surgery.

<40>
Accession Number
71338532
Authors
Costello J.M. Masterson C.D. Allan C.K. Gauvreau K. Newburger J.W. McGowan
F.X. Wessel D.L. Mayer J.E. Salvin J.W. Dionne R.E. Laussen P.C.
Institution
(Costello, Masterson, Allan, Newburger, McGowan, Wessel, Salvin, Laussen)
Cardiology, Boston Children's Hosp, Boston, MA, United States
(Gauvreau, Dionne) Pediatrics / Cardiology, Boston Children's Hosp,
Boston, MA, United States
(Mayer) Cardiac Surgery, Boston Children's Hosp, Boston, MA, United States
Title
Impact of empiric nesiritide or milrinone infusion on early postoperative
recovery following fontan surgery: A randomized, double-blind,
placebo-controlled clinical trial.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Nesiritide has vasodilatory, lusitropic and natriuretic
properties and may decrease myocardial ischemia-reperfusion injury.
Milrinone is an inodilator with lusitropic effects. Although such
properties make both drugs attractive for perioperative use, their
efficacy has not been prospectively studied in children undergoing a
Fontan operation. We sought to determine whether empiric nesiritide or
milrinone would improve the early postoperative course after Fontan
surgery. We hypothesized that when compared to milrinone or placebo,
patients assigned to receive nesiritide would have more days alive and out
of the hospital within the first 30 days after surgery. Methods: In a
single center, randomized, double-blinded, placebo-controlled clinical
trial, patients undergoing primary Fontan surgery were assigned to receive
nesiritide, milrinone or placebo. A loading dose of study drug was
administered in the operating room prior to the onset of rewarming from
CPB, and a continuous infusion was then administered for at least 12 hours
after CICU admission and up to five days. The primary outcome was the
number of days alive and out of the hospital within 30 days of surgery
(for this outcome, more days alive and out of the hospital is favorable).
Secondary outcomes included measures of cardiac index, resource
utilization, renal function, and adverse events. Results: Among 106
enrolled subjects, 35, 36 and 35 were assigned to the nesiritide,
milrinone, and placebo groups, respectively. Demographics, patient factors
and operative characteristics were similar among treatment groups. No
significant treatment-group differences were found for median days alive
and out of the hospital within 30 days of surgery [nesiritide, 20 (range
0-24); milrinone, 18 (0-23); placebo, 20 (0-23); p = 0.38]. Treatment
groups did not differ in postoperative cardiac index, hemodynamics,
arrhythmias, peak lactate, inotropic scores, fluid balance, urine output,
renal function, hours of mechanical ventilation, days of intensive care or
chest tube drainage, or adverse events. Conclusions: When compared to
placebo, empiric perioperative infusions of nesiritide or milrinone are
not associated with improved early clinical outcomes following Fontan
surgery.

<41>
Accession Number
71338033
Authors
Berg S.K. Zwisler A.-D. Koch M.B. Svendsen J.H. Christensen A.V. Pedersen
P.U. Thygesen L.C.
Institution
(Berg, Zwisler, Svendsen, Christensen) Heart Cntr, Unit 2151, Copenhagen
Univ Hosp, Rigshospitalet, Copenhagen, Denmark
(Koch, Thygesen) National Institute of Public Health, Univ of Southern
Denmark, Copenhagen, Denmark
(Pedersen) Cntr of Clinical Guidelines, Institute of Public Health, Univ
of Aarhus, Aarhus, Denmark
Title
Comprehensive cardiac rehabilitation for patients with implantable
cardioverter defibrillator seems cost-saving: Three year follow-up results
from the cope-icd randomized controlled trial.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The COPE-ICD trial tested comprehensive cardiac
rehabilitation (CCR) consisting of exercise training and
psycho-educational interventions (n=99) compared to usual care (n=97) in
implantable cardioverter defibrillator (ICD) patients. After CCR
significant differences were found between groups: VO2; intervention
23.01mL/min/kg compared to control 20.79 mL/min/kg (p=0.004), general
health (SF-36); intervention mean 63.5 points versus 62.1 in the usual
care group (p=0.015) and explorative analyses showed significant
differences in mental component score (SF-36) in favour of the CCR group.
Three years after randomization economic costs of the CCR program and
health care use were investigated. Hypothesis: Based on improvements in
physical and mental health CCR is cost-saving in reducing health care
utilization? Methods: Costs attributable to the intervention were
calculated by measuring recorded time spend on the included patients
priced by salaries to nurses, physicians and physiotherapists. Other
variable costs were included. Calculation only considers operational
costs. The three year costs of health care use were extracted from The
Danish National Patient Register and The Danish National Health Service
Register based on identifiers of the patients included in the trial.
Results: The cost of the CCR program was 490 US$ per person. Costs of
hospitalization, visits to GP and use of physiotherapists were higher in
the usual care group than in the CCR group. A difference in costs of
health care of 7112 US$ per person was estimated in favour of the CCR
group (Table 1). Conclusions: The cost of the CCR program was outweighed
by savings in the use of health care. In conclusion, the CCR program seems
to be cost-saving. The effect was primarily carried by four patients
receiving heart transplantation or LVAD. Discussion: Does rehabilitation
prevent progression in heart failure or should these cases be extracted as
outliers? (Figure Presented).

<42>
Accession Number
71338013
Authors
Pack Q.R. Rodriguez-Escudero J.P. Thomas R.J. Ades P.A. West C.P. Somers
V. Lopez-Jimenez F.
Institution
(Pack, Rodriguez-Escudero, Thomas, West, Somers, Lopez-Jimenez)
Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Ades) Cardiovascular Diseases, Univ of Vermont, South Burlington, VT,
United States
Title
The prognostic importance of weight loss in coronary artery disease: A
systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Although obesity is a risk factor for coronary artery disease
(CAD), several studies suggest that weight loss among patients with
established CAD may lead to adverse long-term outcomes. These
controversial findings cast significant doubt on American Heart
Association guidelines which recommend weight loss for all overweight and
obese patients with CAD. METHODS: We performed a systematic review and
meta-analysis of the prognostic effects of weight loss in patients with
CAD on all-cause death, cardiovascular death, myocardial infarction, and
other major adverse cardiac events. We searched PubMed, EMBASE, Web of
Science, and bibliographies of selected articles through February 2013.
Studies were divided according to weight loss intention. We considered
weight loss "presumably intentional" when it occurred in the presence of
programmed therapeutic lifestyle changes (TLC), and "observational" when
no such intervention was specified. We excluded studies of heart failure,
cardiac cachexia, bariatric surgery, or of populations composed only of
diabetes, peripheral vascular disease, or stroke. RESULTS: We searched
1,185 abstracts of which 12 studies with 15 cohorts met inclusion
criteria. A total of 35,211 patients (age 64 years old, 70% male, BMI 30,
primarily USA and Europe, 2.9 years of follow-up) were included. When all
cohorts were combined, weight loss was associated with worse long-term
outcomes, RR (95% CI), 1.28 (1.06 to 1.55), p = 0.01. However,
heterogeneity was high, I2 = 76%, and was primarily explained by weight
loss intention (p < 0.001.) While observational weight loss (n = 11)
worsened outcomes (RR 1.49 [1.26 to 1.77], p <0.001,) presumed intentional
weight loss (n = 4) improved outcomes (RR of 0.65 [0.48 to 0.87], p =
0.004.) There was marked variability in study populations, outcomes,
representativeness, and weight loss definitions. CONCLUSIONS:
Observational weight loss in patients with CAD is associated with long
term adverse cardiovascular events, but presumed intentional weight loss
in the setting of TLC is associated with lower event rates. These results
suggest that the underlying mechanism of weight loss (i.e., intentional or
unintentional) may affect its impact on mortality risk in persons with
known CAD.

<43>
Accession Number
71337741
Authors
Langkilde A.M. Johansson P. Ptasynska A. Johnsson E.
Institution
(Langkilde, Johansson, Johnsson) Rsch and Development, AstraZeneca,
Molndal, Sweden
(Ptasynska) GCR-CV / Metabolics, Bristol-Myers Squibb, Princeton, NJ,
United States
Title
Cardiovascular safety of the SGLT2 inhibitor dapagliflozin: Meta-analysis
with >6000 patient-years exposure.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Cardiovascular disease (CVD) risk is increased in patients with type 2
diabetes mellitus (T2DM). Dapagliflozin (DAPA), a selective SGLT2
inhibitor, is approved treatment for T2DM in several countries. DAPA
promotes renal glucose excretion and mild osmotic diuresis, thereby
reducing hyperglycemia, weight, and blood pressure. Data from 21 clinical
studies, including 2 that exclusively enrolled patients with a history of
CVD, were included in a prespecified meta-analysis (n=9339) to assess the
CV safety of dapagliflozin (2.5 to >10 mg/d; n=5936) vs comparators (COMP;
placebo or active, n=3403). Potential CV end points were systematically
identified from investigator reports of adverse events based on a
prespecified list of terms, and were independently adjudicated in a
blinded manner. The prespecified primary end point was a composite of time
to CV death, myocardial infarction (MI), stroke or hospitalization for
unstable angina. The secondary end point included the primary end point
plus unplanned coronary revascularization and hospitalization for heart
failure. Baseline characteristics were similar for DAPA and COMP groups
(mean age=56.9, 58.1 years (y); age >65 y=24.0%, 28.8%; body mass
index=31.3, 31.6 kg/m²; T2DM duration=6.9, 7.6 y, respectively)
and reflected CV risk in the general T2DM population (history of CVD:
DAPA: 31.3% and COMP: 39.9%). Total patient exposures with respect to the
primary end point were 6514 y in the DAPA group and 3777 y in the COMP
group. For this end point, 176 events occurred (DAPA: 95; COMP: 81) and
the incidence rates/1000 subject y were 14.6 for DAPA vs 21.5 for COMP.
The estimated hazard ratio (HR) using a Cox proportional hazards method
was 0.787 (95% CI: 0.579, 1.070). Analyses of the secondary end point (HR:
0.758; 95% CI: 0.581, 0.988) and of an ad-hoc major adverse CV events
composite end point of CV death, MI and stroke (HR: 0.772; 95% CI: 0.543,
1.097) were consistent with the primary end point results. These results
are comparable to findings from a previously reported shorter follow-up
period. These findings suggest that there is no increase in CV risk
associated with DAPA in an updated CV risk analysis that includes more
patients and a substantial proportion of older patients (>20%) and
patients with established CVD (>30%).

<44>
Accession Number
71337675
Authors
Sipahi I. Blitz A. Akay M.H. Dagdelen S. Alhan C.
Institution
(Sipahi, Dagdelen) Cardiology, Acibadem Univ Med Sch, Istanbul, Turkey
(Blitz) Cardiac Surgery, Case Western Reserve Univ, Cleveland, OH, United
States
(Akay, Alhan) Cardiovascular Surgery, Acibadem Univ Med Sch, Istanbul,
Turkey
Title
Evidence for mortality benefit of bypass surgery over stenting before
publication of the syntax and freedom trials: Value of meta-analyses.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The recently published FREEDOM trial and the long-term results
of the SYNTAX trial demonstrated significant unequivocal reductions in
all-cause mortality with coronary artery bypass grafting (CABG) compared
to percutaneous coronary intervention (PCI) in patients with multivessel
disease. We sought to examine whether such mortality benefit of CABG over
PCI with stenting was evident before these two landmark trials were
published by performing a meta-analysis of antedating randomized
controlled trials (RCTs). Methods: A systematic literature search using
PUBMED was conducted for all RCTs directly comparing CABG vs. PCI. To
reflect the current practice, RCTs with > 1 arterial graft use in > 90% of
the cases in the CABG arm and >70% stent use in the PCI arm that reported
mortality in patients with multivessel disease were included. Trials using
either bare-metal or drug-eluting stents could be included. Numbers of
events at the longest possible follow-up and sample sizes were extracted.
Fixed effect models were used to obtain meta-analytic risk ratios and 95%
confidence intervals (CI). Results: A total of 4 randomized trials
published before SYNTAX and FREEDOM were identified (total n=3,060). On
cumulative meta-analysis, the mortality benefit of CABG over PCI became
statistically significant in 2008 with the publication of the SOS trial
(Figure). Similarly, a statistically significant reduction in myocardial
infarctions with CABG compared to PCI was apparent on cumulative
meta-analysis before the publication of the 3-year results of SYNTAX and
FREEDOM trials (RR=0.72 [95% CI: 0.54-0.96], p=0.027). Conclusions: The
mortality benefit of CABG over stenting in patients with multivessel
disease was evident on meta-analysis even before the publication of SYNTAX
and FREEDOM trials. Skillfully and timely performed meta-analysis of RCTs
can provide invaluable information and can accurately predict the results
of subsequent large-scale trials. (Figure Presented).

<45>
Accession Number
71337603
Authors
Romero J. Lopez F.L. Husain S.A. Chavez P. Garcia M.J.
Institution
(Romero, Garcia) Medicine, Montefiore Med Cntr, Bronx, NY, United States
(Lopez, Husain) Medicine, Jacobi Med Cntr, Bronx, NY, United States
(Chavez) Medicine, St. Lukes Med Cntr, Manhattan, NY, United States
Title
Left ventricle reverse remodeling after acute myocardial infarction
predicted by MVO (CE-CMR). A meta-analysis of prospective trials.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Microvascular obstruction (MVO) is a predictor for reverse
remodeling as evidenced by an increase in left ventricle end diastolic
volume index (LVEDVi) and left end systolic volume index (LVESVi) in
patients following acute myocardial infarction (AMI). Contrast Enhanced
CMR (CE-CMR) is the leading diagnostic modality to access the presence and
extent of MVO. Objective: To determine the predictive value of MVO
detected by CE-CMR as a predictor for Reverse remodeling in patients with
AMI Methods: A systemic review of Medline, Cochrane, and Embase for all
the clinical trials using CMR to detect MVO and assessing its association
reverse remodeling was performed. Given the high heterogeneity (i.e. I2 >
25), we used a random effect model. Results: A total of 6 studies with 423
patients (male: 83%, mean age 61 years (SD=+/-4) and average EF of 40%
(SD+/-3) fulfilled the inclusion criteria. The overall incidence for MVO
was 57% (230) (SD= +/- 7). Head to head comparison of patients with and
without evidence of MVO on initial CMR with in 1 week for AMI showed a
higher incidence of reverse remodeling on the follow up CMR at a mean time
of 6 months (SD+/-1). Patients with evidence of MVO had significantly
higher volumes. The mean difference in LVEDVi and LVESVi between the
initial and follow up MRI was 8.11 (95% CI 4.49-11.73) and 9.10 (95% CI
6.21-12.18) respectively. Conclusion: MVO detected by CE-CMR is a strong
predictor for LV reverse remodeling in patients suffering from acute
myocardial infarction.

<46>
Accession Number
71337369
Authors
Nielsen L.H. Ortner N. Noorgaard B.L. Abdulla J.
Institution
(Nielsen) Cardiology, Lillebaelt Hosp Vejle, Vejle, Denmark
(Ortner, Abdulla) Cardiology, Glostrup Univ Hosp, Glostrup, Denmark
(Noorgaard) Cardiology B, Aarhus Univ Hosp Skejby, Aarhus N, Denmark
Title
Coronary computed tomography angiography versus conventional functionally
testing in patients with stable angina pectoris-a systematic review and
meta-analysis of diagnostic test performance and post-test outcomes.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: In the evaluation of patients with suspected coronary artery
disease (CAD), the role of non-invasive testing plays an important role in
risk stratification and selection of further treatment strategies. For
this purpose, coronary computed tomography angiography (CCTA) has been
proposed as an alternative. However, hitherto few studies have compared
the modalities directly. We aimed by a systematic literature review and
meta-analyses to evaluate the diagnostic accuracy and post-test outcomes
of conventional exercise electrocardiography (XECG) and single positron
emission computed tomography (SPECT) compared to CCTA in stable patients
suspected of CAD. Methods: We searched online databases (PubMed, Embase
and Cochrane) for studies published between January 2002 and February 2013
examining the diagnostic accuracy [using invasive coronary angiography
(ICA) as reference standard] and outcomes [downstream test utilization
defined as ICA, SPECT, CCTA or XECG (DTU), coronary revascularization and
acute myocardial infarction (AMI)] after CCTA (> 16-slice), compared to
XECG and SPECT. Results: Combined results of11 studies including 1575
patients demonstrated a higher diagnostic sensitivity of CCTA vs. XECG and
SPECT, 98% (95% CI, 93-99) vs. 67% (95% CI, 54-78) (p < 0.001) and 99%
(95% CI, 96-100) vs. 73% (95% CI 59-83) (p = 0.001), respectively.
Specificity of CCTA was 82% (95% CI, 63-93) vs. 46% (95% CI, 30-64) (p <
0.001) for XECG, and 71% (95% CI, 60-80) vs. 48% (95% CI, 31-64) (p =
0.14) for SPECT. Seven non-randomized studies comprising 216.603 patients
with a mean follow-up period of 20 months assessed post-test outcomes. The
odds ratio (OR) of DTU for CCTA vs. XECG/SPECT testing was 1.38 (95% CI,
1.33-1.43, p < 0.001), for revascularization OR=2.63 (CI=95%, 2.50-2.77, p
< 0.001) and for AMI OR=0.53 (95% CI, 0.39-0.72, p < 0.001). Conclusion:
The diagnostic performance of CCTA was substantially higher than for XECG
and SPECT, respectively. CCTA testing was associated with increased risk
of DTU and coronary revascularization but a decreased risk of AMI as
compared to XECG/SPECT.

<47>
Accession Number
71337156
Authors
Benedetto U. Ruggiero D. De Robertis F.
Institution
(Benedetto, Ruggiero, De Robertis) Cardiothoracic Surgery, Brompton and
Harefield Hosp NHS Foundation Trust, Harefield, Uxbridge, London, United
Kingdom
Title
Preventing postoperative atrial fibrillation in cardiac surgery. A network
meta-analysis to identify the best prophylactic strategy.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation (POAF) remains a major
concern following cardiac surgery. Several
anti-arrhythmic/anti-inflammatory drugs have been proposed to prevent its
occurrance but these strategies remain largely underutilized due to the
lack of clear guidance. We aimed to provide the basis for a rational
decision in the use of a particular therapy by means of network
benefit-risk meta-analysis. Methods: A systematic review of RCTs on
arrhythmic/anti-inflammatory drugs used for the prevention of POAF was
conducted. Only treatments investigated in more than 3 trials were
included. Treatment withdrawal due to adverse side effect was considered
in the benefit-risk analysis. Direct and indirect evidence were combined
through a Markov Chain Monte Carlo network meta-analysis. Results:
Fifty-six RCTs were included in the final analysis enrolling a total of
9,913 patients treated with beta blockers, amiodarone, sotalol, magnesium,
atorvastatin and n-3 polyunsaturated fatty acids. All but n-3
polyunsaturated fatty acids (risk ratio 0.70, 0.48-1.0) were effective to
prevent POAF when compared to placebo (Figure, Rank probability for
effectiveness). Sotalol was more effective in preventing POAF than beta
blockers (0.64, 0.45-0.91), magnesium (0.57, 0.34-0.99) and amiodarone
(0.68, 0.46-0.98) but it was not significantly superior to atorvastatin
(0.93, 0.51-1.74). A trend towards an increased risk for treatment
withdrawal was found for sotalol (0.05, 0.02-0.10), beta blockers (0.05,
0.02-0.14) and amiodarone (0.04, 0.01-0.12) when compared to atorvastatin
(0.0, 0.0-1.0), magnesium (0.0, 0.0-1.0) and n-3 PUFAs (0.0, 0.0-0.96). In
the benefit-risk analysis, atorvastatin achieved the highest probability
(73%) to be the preferred alternative followed by sotalol (47%) and
magnesium (9%). Conclusions: Among proposed treatments for preventing
POAF, atorvastatin should be used as first line strategy due to its
favorable benefit-risk profile.

<48>
Accession Number
71337079
Authors
Kolek M.J. Muehlschlegel J.D. Parvez B. Bush W.S. Murray K.T. Stein C.M.
Shoemaker M.B. Blair M.A. Kor K.C. Roden D.M. Fox A.A. Shernan S.K.
Collard C.D. Body S.C. Darbar D.
Institution
(Kolek, Parvez, Shoemaker) Cardiovascular Medicine, Vanderbilt Univ. Med
Cntr, Nashville, TN, United States
(Muehlschlegel, Fox, Shernan, Body) Anesthesiology, Brigham and Women's
Hosp, Boston, MA, United States
(Bush) Biomedical Informatics, Vanderbilt Univ. Med Cntr, Nashville, TN,
United States
(Murray) Cardiovascular Medicine, Clinical Pharmacology, Vanderbilt Univ.
Med Cntr, Nashville, TN, United States
(Stein, Roden, Darbar) Cardiovascular Medicine and Clinical Pharmacology,
Vanderbilt Univ. Med Cntr, Nashville, TN, United States
(Blair, Kor) Clinical Pharmacology, Vanderbilt Univ. Med Cntr, Nashville,
TN, United States
(Collard) Anesthesiology, Texas Heart Institute, St. Luke's Hosp, Houston,
TX, United States
Title
A combined clinical and genetic risk model for predicting postoperative
atrial fibrillation.
Source
Circulation. Conference: American Heart Association 2013 Scientific
Sessions and Resuscitation Science Symposium Dallas, TX United States.
Conference Start: 20131116 Conference End: 20131120. Conference
Publication: (var.pagings). 128 (22 SUPPL. 1) , 2013. Date of Publication:
26 Nov 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Postoperative atrial fibrillation (PoAF) is a common adverse
event following CABG. We evaluated whether single nucleotide polymorphisms
(SNPs) linked to AF susceptibility in a recent meta-analysis of
genome-wide association studies improve the clinical risk prediction model
for PoAF. Methods: The Discovery cohort included 645 patients in the
Vanderbilt Cardiac Surgery Registry undergoing CABG without concurrent
valve surgery. The Validation cohort consisted of 644 patients in the CABG
Genomics Program at Brigham and Women's Hospital and the Texas Heart
Institute. PoAF up to 7 days following surgery was determined. Clinical
variables included age, race, sex, previous AF, diabetes, HTN, heart
failure, MI, LVEF, PR interval, and use of beta-blockers, ACE inhibitors,
statins, aspirin, and COX inhibitors. Thirteen SNPs were included:
rs13376333 and rs6666258 at 1q21; rs3903239 at 1q24; rs2200733, rs10033464
and rs6817105 at 4q25; rs3807989 at 7q31; rs10821415 at 9q22; rs10824026
at 10q22; rs1152591 at 14q23; rs7164883 at 15q24; rs2106261 and rs7193343
at 16q22. Results: The incidence of PoAF was 15% in the Discovery and
Validation cohorts. A multiple logistic regression model for predicting
PoAF containing 11 SNPs and all clinical covariates was highly significant
(P<0.001). In the Discovery cohort, the combined genetic/clinical model
was superior to the clinical-only model [areas under the receiver operator
characteristic (ROC) curves 0.816 and 0.759, respectively, P<0.001
(Figure)]. When applied to the Validation cohort, the areas under the ROC
curves were 0.701 and 0.651 for the combined and clinical-only models,
respectively (P<0.001). Conclusion: We found that a combined clinical and
genetic risk model was not only predictive for the development of PoAF but
was superior to a model using only clinical risk factors. Pre-procedural
genotyping of AF susceptibility alleles may improve risk stratification in
patients undergoing CABG.

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Total documents retrieved: 22

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<1>
Accession Number
2014101198
Authors
Tanaka M. Sagawa M. Usuda K. Machida Y. Ueno M. Motono N. Sakuma T.
Institution
(Tanaka, Sagawa, Usuda, Machida, Ueno, Motono, Sakuma) Department of
Thoracic Surgery, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa,
Japan
Title
Postoperative drainage with one chest tube is appropriate for pulmonary
lobectomy: A randomized trial.
Source
Tohoku Journal of Experimental Medicine. 232 (1) (pp 55-61), 2014. Date of
Publication: 2014.
Publisher
Tohoku University Medical Press (2-1 Seiryomachi, Aoba-ku, Sendai
980-8575, Japan)
Abstract
To expand postoperative residual lungs after pulmonary lobectomy, thoracic
drainage with two chest tubes has been recommended. Several studies
recently demonstrated that postoperative drainage with one chest tube
(PD1) was as safe as that with two chest tubes (PD2). However, most of the
patients in those studies underwent lobectomy by standard thoracotomy.
Although the number of pulmonary lobectomies by video-assisted thoracic
surgery (VATS) has been increasing in recent years, there have been no
reports that compared PD1 with PD2 after pulmonary lobectomy, including
that by VATS. To elucidate whether postoperative management with PD1 is as
safe as that with PD2, we conducted a randomized controlled trial. Lung
cancer patients who underwent lobectomies with mediastinal nodal
dissection in our hospital were assigned to one of two groups: one chest
tube placed in PD1 group and two chest tubes placed in PD2 group. A total
of 108 patients were registered in the study. There were no signifcant
differences in the age, gender, pathological stage or histological type
between two groups. Since the residual lung expansion was good in both
groups, there were no patients who needed thoracentesis. There were no
signifcant differences in the number of cases with pleurodesis, the
amount/duration of drainage or the pain of the patients between two
groups. In conclusion, since PD1 has advantages in saving cost and time
and in low risk of transcutaneous infection, PD1 is appropriate after
pulmonary lobectomy by VATS and by open thoracotomy. 2014 Tohoku
University Medical Press.

<2>
Accession Number
2014115123
Authors
Ozaydin M. Peker T. Akcay S. Uysal B.A. Yucel H. Icli A. Erdogan D. Varol
E. Dogan A. Okutan H.
Institution
(Ozaydin, Akcay, Uysal, Icli, Erdogan, Varol, Dogan) Department of
Cardiology, Suleyman Demirel University, 122 Hatice Halici No. 126, 32040
Isparta, Turkey
(Peker) Department of Anesthesiology, Suleyman Demirel University,
Isparta, Turkey
(Okutan) Department of Cardiovascular Surgery, Suleyman Demirel
University, Isparta, Turkey
Title
Addition of N-acetyl cysteine to carvedilol decreases the incidence of
acute renal injury after cardiac surgery.
Source
Clinical Cardiology. 37 (2) (pp 108-114), 2014. Date of Publication:
February 2014.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background Oxidative stress and inflammation during cardiac surgery may be
associated with acute renal injury (ARI). N-acetyl cysteine (NAC) and
carvedilol have antioxidant and anti-inflammatory properties. Hypothesis A
combination of carvedilol and NAC should decrease the incidence of ARI
more than metoprolol or carvedilol. Methods Patients undergoing cardiac
surgery were randomized to metoprolol, carvedilol, or carvedilol plus NAC.
End points were occurrence of ARI and change in preoperative to
postoperative peak creatinine levels. Results ARI incidence was lower in
the carvedilol plus NAC group compared with the metoprolol (21.0% vs
42.1%; P = 0.002) or carvedilol (21.0% vs 38.6%; P = 0.006) groups, but
was similar between the metoprolol and carvedilol groups (P = 0.62).
Preoperative and postoperative day 1 creatinine levels were similar among
the metoprolol (1.02 [0.9-1.2] and 1.2 [0.92-1.45]) the carvedilol (1.0
[0.88-1.08] and 1.2 [0.9-1.5]) and the carvedilol plus NAC groups (1.06
[0.9-1.18] and 1.1 [1.0-1.21] mg/dL; all P values >0.05). Postoperative
day 3, day 5, and peak creatinine levels were lower in the carvedilol plus
NAC group (1.11 [1.0-1.23], 1.14 [1.0-1.25] and 1.15 [1.0-1.25]) as
compared with the metoprolol (1.4 [1.3-1.49], 1.3 [1.0-1.54] and 1.3
[1.0-1.54]) or carvedilol groups (1.2 [1.0-1.52], 1.25 [1.0-1.52] and 1.25
[1.0-1.55] mg/dL; all P values <0.05), but were similar between the
metoprolol and carvedilol groups (all P values >0.05). Conclusions
Combined carvedilol and NAC decreased ARI incidence as compared with
carvedilol or metoprolol. No difference was detected between carvedilol
and metoprolol. 2013 Wiley Periodicals, Inc.

<3>
Accession Number
2014095808
Authors
Harsoor S. Rani D. Lathashree S. Nethra S. Sudheesh K.
Institution
(Harsoor, Rani, Lathashree, Nethra, Sudheesh) Department of Anaesthesia,
Bangalore Medical College and Research Institute, Bangalore, Karnataka,
India
Title
Effect of intraoperative Dexmedetomidine infusion on Sevoflurane
requirement and blood glucose levels during entropy-guided general
anesthesia.
Source
Journal of Anaesthesiology Clinical Pharmacology. 30 (1) (pp 25-30), 2014.
Date of Publication: January-March 2014.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Dexmedetomidine has been shown to blunt the stress response to
surgery. Hence a study was designed to evaluate the effect of intravenous
(IV) Dexmedetomidine infusion during general anesthesia for abdominal
surgeries on blood glucose levels and on Sevoflurane requirements during
anesthesia. Materials and Methods: Forty patients scheduled for abdominal
surgery under general anesthesia were divided into Dexmedetomidine (D)
group and Placebo (P) group of 20 each. Group D received a loading dose of
Inj. Dexmedetomidine at 1 mug/kg/10 min diluted to 20 mL, followed by
maintenance with 0.5 mug/kg/h., till the end of surgery. Group P received
similar volume of IV normal saline. Anesthesia was maintained with nitrous
oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data
were analyzed using students t test, chi square test and Fisher Exact test
as applicable. Results: During the first postoperative hour,
Dexmedetomidine group showed blood glucose levels of 118.2 + 16.24 mg/dL,
compared to placebo group which was 136.95 + 19.76 mg/dL and it was
statistically significant (P < 0.01). Mean hourly Sevoflurane requirement
in Group D was 11.10 + 2.17 mL, compared to 15.45 + 3.97 mL in placebo
group. In peri-operative period, the heart rate and MAP were significantly
lower in Group D, when compared to placebo. Patients in Group D were
better sedated and post-operative pain score was better in Group D
compared to Group P. Conclusion: IV Dexmedetomidine was effective in
blunting stress response to surgical trauma as indicated by lower blood
glucose levels, and reduces Sevoflurane requirements during entropy guided
general anesthesia without affecting time for extubation.

<4>
Accession Number
2014115798
Authors
Garikipati N.V. Mittal S. Chaudhry F. Musat D.L. Sichrovsky T. Preminger
M. Arshad A. Steinberg J.S.
Institution
(Garikipati) Division of Cardiology, Wright State University Boonshoft
School of Medicine, Dayton, OH, United States
(Mittal, Musat, Sichrovsky, Preminger, Arshad, Steinberg) Arrhythmia
Institute, Valley Health System, Ridgewood, NJ, United States
(Mittal, Musat, Sichrovsky, Preminger, Arshad, Steinberg) Columbia
University, College of Physicians and Surgeons, New York, NY, United
States
(Chaudhry) Division of Cardiology, Mount Sinai Hospital, New York, NY,
United States
Title
Comparison of endovascular versus epicardial lead placement for
resynchronization therapy.
Source
American Journal of Cardiology. 113 (5) (pp 840-844), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cardiac resynchronization therapy (CRT) has been shown to improve survival
and symptoms in patients with severe left ventricular (LV) dysfunction,
congestive heart failure, and prolonged QRS duration. LV lead placement is
achieved by placing the lead in the coronary sinus, an endovascular
approach, or by a minimally invasive robotic-assisted thoracoscopic
epicardial approach. There are no data directly comparing the 2 methods.
Patients eligible for CRT were randomized to the endovascular and
epicardial arms. Coronary sinus lead placement was achieved using the
standard technique, and epicardial leads were placed using a minimally
invasive robotic-assisted thoracoscopic approach. The primary end point
was a decrease in LV end-systolic volume index at 6 months. The secondary
end points included 30-day mortality rate, measures of clinical
improvement, 1-year electrical lead performance, and 1-year survival rate.
The relative improvement of LV end-systolic volume index from baseline to
6 months was similar between the arms (28.8% for the transvenous [n = 12]
vs 30.5% for the epicardial (n = 9) arm, p = 0.93). There were no
significant differences in the secondary end points between the 2 groups.
In conclusion, there were no differences in echocardiographic and clinical
outcomes comparing a conventional endovascular approach versus
robotic-assisted surgical epicardial LV lead placement for CRT in patients
with heart failure. Surgical approaches are still a viable alternative
when a transvenous procedure has failed or is not technically feasible.
2014 Elsevier Inc. All rights reserved.

<5>
Accession Number
2014111390
Authors
Lorut C. Lefebvre A. Planquette B. Quinquis L. Clavier H. Santelmo N.
Hanna H.A. Bellenot F. Regnard J.-F. Riquet M. Magdeleinat P. Meyer G.
Roche N. Huchon G. Coste J. Rabbat A.
Institution
(Lorut, Lefebvre, Roche, Huchon, Rabbat) Department of Respiratory and
Intensive Care Medicine, Cochin-Broca-Hotel, University Paris5, 27 rue du
Faubourg Saint Jacques, 75679 Paris cedex 14, France
(Regnard) Department of Thoracic Surgery, Cochin-Broca-Hotel-Dieu Hospital
Group, University Paris5, Paris, France
(Quinquis, Coste) Department of Biostatistics and Epidemiology, Hotel-Dieu
Hospital, University Paris5, Paris, France
(Planquette, Meyer) Department of Respiratory and Intensive Care Medicine,
European Georges Pompidou Hospital, University Paris5, Paris, France
(Riquet) Department of Thoracic Surgery, European Georges Pompidou
Hospital, University Paris5, Paris, France
(Clavier) Department of Intensive Care Medicine, Institut Montsouris
Hospital, Paris, France
(Magdeleinat) Department of Thoracic Surgery, Institut Montsouris
Hospital, Paris, France
(Santelmo) Department of Thoracic Surgery, University Hospital,
Strasbourg, France
(Hanna) Department of Thoracic Surgery, University Hospital, Dijon, France
(Bellenot) Department of Thoracic Surgery, University Hospital, Pontoise,
France
Title
Early postoperative prophylactic noninvasive ventilation after major lung
resection in COPD patients: A randomized controlled trial.
Source
Intensive Care Medicine. 40 (2) (pp 220-227), 2014. Date of Publication:
February 2014.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Objectives: To investigate whether prophylactic postoperative NIV prevents
respiratory complications following lung resection surgery in COPD
patients. Methods: In seven thoracic surgery departments, 360 COPD
patients undergoing lung resection surgery were randomly assigned to two
groups: conventional postoperative treatment without (n = 179) or with (n
= 181) prophylactic NIV, applied intermittently during 6 h per day for 48
h following surgery. The primary endpoint was the rate of acute
respiratory events (ARE) at 30 days postoperatively (ITT analysis).
Secondary endpoints were acute respiratory failure (ARF), intubation rate,
mortality rate, infectious and non-infectious complications, and duration
of ICU and hospital stay. Measurements and main results: ARE rates did not
differ between the prophylactic NIV and control groups (57/181, 31.5 vs.
55/179, 30.7 %, p = 0.93). ARF rate was 18.8 % in the prophylactic NIV
group and 24.5 % in controls (p = 0.20). Re-intubation rates were similar
in the prophylactic NIV and control group [10/181 (5.5 %) and 13/179 (7.2
%), respectively, p = 0.53]. Mortality rates were 5 and 2.2 % in the
control and prophylactic NIV groups, respectively (p = 0.16). Infectious
and non-infectious complication rates, and duration of ICU and hospital
stays were similar between groups. Conclusions: Prophylactic postoperative
NIV did not reduce the rate of ARE in COPD patients undergoing lung
resection surgery and did not influence other postoperative complications
rates, mortality rates, and duration of ICU and hospital stay. 2013
Springer-Verlag Berlin Heidelberg and ESICM.

<6>
Accession Number
2014096131
Authors
Holper E.M. Kim R.J. Mack M. Brown D. Brinkman W. Herbert M. Stewart W.
Vance K. Bowers B. Dewey T.
Institution
(Holper, Herbert, Bowers, Dewey) Division of Cardiology, Medical City
Hospital, Dallas, TX, United States
(Kim, Stewart, Vance) Cardiopulmonary Research Science and Technology
Institute, Baylor, Plano, TX, United States
(Mack, Brown, Brinkman) Heart Hospital, Baylor, Plano, TX, United States
Title
Randomized trial of surgical cutdown versus percutaneous access in
transfemoral TAVR.
Source
Catheterization and Cardiovascular Interventions. 83 (3) (pp 457-464),
2014. Date of Publication: 15 Feb 2014.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives To compare iliofemoral arterial complications with transfemoral
transcatheter aortic valve replacement (TF-TAVR) utilizing surgical
cutdown versus percutaneous access with closure devices in a randomized
trial. Background Major vascular complications following TAVR are a
significant risk of the procedure. There are no randomized data comparing
whether access method in TF-TAVR influences the risk of such
complications. Methods From June to December 2011, 30 consecutive patients
undergoing TF-TAVR were randomized to either surgical cutdown (C) or
percutaneous (P) access. Subjects underwent preoperative CT scans, pre-
and post-operative bilateral femoral arterial ultrasound and angiography.
The primary endpoint was the composite of major and minor vascular
complications at 30 days, as defined by the Valve Academic Research
Consortium-2. Multivariate predictors of vascular complications were
identified. Results Of the 30 subjects enrolled, 27 were treated with the
randomized method of access as randomized. Iliofemoral complications were
observed in eight patients (26.7%; C = 4, P = 4), all of which were
dissections and/or stenoses that required percutaneous and/or surgical
intervention. There were two (13.3%) major and two (13.3%) minor
complications in each group. Two covariates that were significantly
associated with vascular complications included female sex and baseline
femoral arterial velocity on ultrasound. Conclusions While surgical
cutdown in TF-TAVR is the recommended access for new centers initiating a
TAVR program, this small randomized pilot study suggests the lesser
invasive percutaneous method in an experienced center is equivalent in
safety to the surgical method. Doppler ultrasound may be useful in
predicting complications prior to the procedure. 2013 Wiley Periodicals,
Inc. Copyright 2013 Wiley Periodicals, Inc.

<7>
Accession Number
2014111137
Authors
Mcconnachie A. Walker A. Robertson M. Marchbank L. Peacock J. Packard C.J.
Cobbe S.M. Ford I.
Institution
(Mcconnachie, Walker, Robertson, Ford) Robertson Centre for Biostatistics,
University of Glasgow, Glasgow G12 8QQ, United Kingdom
(Marchbank) Information Services Division (ISD), NHS National Services
Scotland, Paisley PA3 2SJ, United Kingdom
(Peacock) Information Services Division (ISD), NHS National Services
Scotland, Edinburgh EH12 9EB, United Kingdom
(Packard) Tennent Building, Western Infirmary, Glasgow G11 6NT, United
Kingdom
(Cobbe) Department of Medical Cardiology, Glasgow Royal Infirmary, Glasgow
G4 0SF, United Kingdom
Title
Long-term impact on healthcare resource utilization of statin treatment,
and its cost effectiveness in the primary prevention of cardiovascular
disease: A record linkage study.
Source
European Heart Journal. 35 (5) (pp 290-298), 2014. Date of Publication: 01
Feb 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsTo assess the impact on healthcare resource utilization, costs, and
quality of life over 15 years from 5 years of statin use in men without a
history of myocardial infarction in the West of Scotland Coronary
Prevention Study (WOSCOPS).MethodsSix thousand five hundred and
ninety-five participants aged 45-54 years were randomized to 5 years
treatment with pravastatin (40 mg) or placebo. Linkage to routinely
collected health records extended follow-up for secondary healthcare
resource utilization to 15 years. The following new results are reported:
cause-specific first and recurrent cardiovascular hospital admissions
including myocardial infarction, heart failure, stroke, coronary
revascularization and angiography; non-cardiovascular hospitalization;
days in hospital; quality-adjusted life years (QALYs); costs of
pravastatin treatment, treatment safety monitoring, and hospital
admissions.ResultsFive years treatment of 1000 patients with pravastatin
(40 mg/day) saved the NHS 710 000 (P < 0.001), including the cost of
pravastatin and lipid and safety monitoring, and gained 136 QALYs (P =
0.017) over the 15-year period. Benefits per 1000 subjects, attributable
to prevention of cardiovascular events, included 163 fewer admissions and
a saving of 1836 days in hospital, with fewer admissions for myocardial
infarction, stroke, heart failure and coronary revascularization. There
was no excess in non-cardiovascular admissions or costs (or in admissions
associated with diabetes or its complications) and no evidence of
heterogeneity of effect over sub-groups defined by baseline cardiovascular
risk.ConclusionFive years' primary prevention treatment of middle-aged men
with a statin significantly reduces healthcare resource utilization, is
cost saving, and increases QALYs. Treatment of even younger, lower risk
individuals is likely to be cost-effective. The Author 2013.

<8>
Accession Number
2014115791
Authors
Rodriguez A.E. Palacios I. Rodriguez-Granillo A.M. Mieres J.R. Tarragona
S. Fernandez-Pereira C. Solorzano L. Pauletto R. Serruys P.W. Antoniucci
D.
Institution
(Rodriguez, Rodriguez-Granillo) Centro de Estudios en Cardiologia
Intervencionista, Buenos Aires, Argentina
(Rodriguez, Mieres, Solorzano, Pauletto) Department of Cardiology,
Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
(Rodriguez, Mieres, Pauletto) Department of Cardiology, Sanatorio Las
Lomas, Buenos Aires, Argentina
(Palacios) Department of Cardiology, Massachusetts General Hospital,
Boston, MA, United States
(Tarragona) Argentina Association in Health and Economics, Buenos Aires,
Argentina
(Fernandez-Pereira, Solorzano) Department of Cardiology, Clinica IMA,
Buenos Aires, Argentina
(Serruys) Department of Cardiology, Erasmus Thoraxcenter, Rotterdam,
Netherlands
(Antoniucci) Department of Cardiology, Careggi Hospital, Florence, Italy
Title
Comparison of cost-effectiveness of oral rapamycin plus bare-metal stents
versus first generation of drug-eluting stents (from the Randomized Oral
Rapamycin in Argentina [ORAR] 3 Trial).
Source
American Journal of Cardiology. 113 (5) (pp 815-821), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of this study was to compare 5-year cost-effectiveness and
clinical outcomes of patients with oral rapamycin (OR) plus bare-metal
stent versus the drug-eluting stent (DES) strategy. During 2006 to 2007, a
total of 200 patients were randomized to OR (n = 100) and DES (n = 100).
Primary end point was to compare costs of initial procedure and
cost-effectiveness of both revascularization strategies. Safety was
evaluated by the composite of death, myocardial infarction, and
cerebrovascular accident. Efficacy was assessed by target vessel and
target lesion revascularizations. The 2 groups had similar baseline
demographic, clinical, and angiographic characteristics. In the DES group,
paclitaxel-, zotarolimus-, and sirolimus-eluting stents were used.
Five-year clinical follow-up was accomplished in 99% patients. The DES
group had significantly higher procedural (p <0.001), discharge to
first-year (p = 0.02), and 1- to 5-year costs (p <0.001) compared with the
OR group. At 5 years, the composite end point of death, myocardial
infarction, and cerebrovascular accident (12% in the OR group vs 25% in
the DES group, p = 0.01) was significantly less in the OR group. Target
vessel revascularization (14.5% in the OR group vs 21% in the DES group, p
= 0.16) and target lesion revascularization (10% in the OR group vs 17.6%
in the DES group, p = 0.05) were not significantly different. In
conclusion, a strategy of OR plus bare-metal stent was cost saving than a
first-generation DES. 2014 Elsevier Inc. All rights reserved.

<9>
Accession Number
2014115782
Authors
Shimony A. Grandi S.M. Pilote L. Joseph L. O'Loughlin J. Paradis G.
Rinfret S. Sarrafzadegan N. Adamjee N. Yadav R. Gamra H. Diodati J.G.
Eisenberg M.J.
Institution
(Shimony, Grandi, Eisenberg) Divisions of Cardiology and Clinical
Epidemiology, Jewish General Hospital, McGill University, Montreal, QC,
Canada
(Grandi, Pilote, Joseph, Paradis, Eisenberg) Department of Epidemiology,
Biostatistics and Occupational Health, McGill University, Montreal, QC,
Canada
(Pilote, Joseph) Division of Clinical Epidemiology, McGill University
Health Centre, Montreal, QC, Canada
(Pilote) Division of General Internal Medicine, McGill University Health
Centre, Montreal, QC, Canada
(O'Loughlin) Department of Social and Preventive Medicine, Universite de
Montreal, Montreal, QC, Canada
(Rinfret) Multidisciplinary Cardiology Department, Quebec Heart-Lung
Institute, Quebec City, QC, Canada
(Sarrafzadegan) Isfahan Cardiovascular Research Center, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Adamjee) Interactive Research and Development Center, Karachi, Pakistan
(Yadav) Department of Cardiology, All India Institute of Medical Sciences,
New Delhi, India
(Gamra) Cardiac Thrombosis Research Unit, Department of Cardiology A,
Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Diodati) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
Montreal, QC, Canada
Title
Utilization of evidence-based therapy for acute coronary syndrome in
high-income and low/middle-income countries.
Source
American Journal of Cardiology. 113 (5) (pp 793-797), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Limited data exist regarding the management of patients with acute
coronary syndrome (ACS) in high-income countries compared with
low/middle-income countries. We aimed to compare in-hospital trends of
revascularization and prescription of medications at discharge in patients
with ACS from high-income (Canada and United States) and low/middle-income
(India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind,
placebo-controlled, randomized trial investigating the effect of bupropion
on smoking cessation in patients after an enzyme-positive ACS was used for
our study. A total of 392 patients, 265 and 127 from high-income and from
low/middle-income countries, respectively, were enrolled. Patients from
high-income countries were older, and were more likely to have diagnosed
hypertension and dyslipidemia. During the index hospitalization, patients
from high-income countries were more likely to be treated by percutaneous
coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI]
10.5 to 37.0). Patients with ST elevation myocardial infarction from
high-income countries were more often treated by primary percutaneous
coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with
thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from
high-income countries were also more likely to receive evidence-based
medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of
aspirin, clopidogrel, and statin). In conclusion, patients with ACS in
low/middle-income countries were less likely to be revascularized and to
receive evidence-based medications at discharge. Further studies are
needed to understand the underutilization of procedures and evidence-based
medications in low/middle-income countries. 2014 Elsevier Inc. All rights
reserved.

<10>
[Use Link to view the full text]
Accession Number
23934169
Authors
Van der Linden P. De Ville A. Hofer A. Heschl M. Gombotz H.
Institution
(Van der Linden) * Professor, Department of Anesthesia, Centre hospitalier
Universi taire Brugmann, Hopital Universitaire des Enfants Reine Fabiola,
Brussels, Belgium. + Staff Member, ++ Professor, Department of Anesthesia
and Intensive Care, Algemeines Krankenhaus der Stadt Linz, Linz, Austria.
Title
Six percent hydroxyethyl starch 130/0.4 (Voluven) versus 5% human serum
albumin for volume replacement therapy during elective open-heart surgery
in pediatric patients.
Source
Anesthesiology. 119 (6) (pp 1296-1309), 2013. Date of Publication: Dec
2013.
Abstract
Although 5% albumin (human serum albumin [HSA]) is widely used in cardiac
surgery children, synthetic colloids may provide a valuable alternative.
This study compared 6% hydroxyethyl starch (HES) 130/0.4 with HSA for
volume replacement in this population. The study was a two-center,
randomized, controlled, parallel-group, double-blind trial performed in
children aged 2-12 yr undergoing elective surgery for congenital heart
disease under extracorporeal circulation. The primary objective was to
demonstrate equivalence between HES and HSA with regard to the total
volume of colloid infusion for intraoperative volume replacement including
priming of the extracorporeal circuitery. In the per-protocol population,
mean volume of colloid required until end of surgery was (mean + SD) 36.6
+ 11.8 ml/kg body weight in the HES group (N = 29) and 37.0 + 11.9 ml/kg
body weight in the HSA group (N = 26; ratio of means HES/HSA = 0.98 [95%
CI, 0.84-1.16]). Intraoperative fluid balance was less positive in the HES
group (P = 0.047). No difference was found regarding hemodynamics, the use
of vasoactive and inotropic drugs. Blood loss, erythrocytes transfusion,
and renal function were not different between groups. The incidence of
adverse events up to postoperative day 28 did not differ between the
groups. In pediatric cardiac surgery, HES showed equivalence to HSA with
regard to volume replacement therapy in children aged from 2 to 12 yr.
Although there was no suggestion of an imbalance of safety measures
between HES and HSA, the study was not powered to provide any firm
conclusions about safety of tetrastarch in this population.

<11>
Accession Number
23716291
Authors
Malago R. Pezzato A. Barbiani C. Tezza M. Sala G. Alfonsi U. Mucelli R.P.
Institution
(Malago) Istituto di Radiologia, Azienda Ospedaliero Universitaria
Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134,
Verona, Italy,
Title
Learning curve in multidetector CT coronary angiography (MDCT-CA).
Source
La Radiologia medica. 118 (8) (pp 1281-1293), 2013. Date of Publication:
Dec 2013.
Abstract
Coronary angiography using multidetector computed tomography (MDCT-CA) is
a recent technique for the nonivasive study of coronary arteries. This
study assessed the diagnostic accuracy of coronary artery stenosis
evaluation obtained by three readers at different levels of training or at
different points of the learning curve proposed by the international
guidelines. Three radiologists in training with different levels of
experience in MDCT-CA scored 50 cases at various time points of the
learning curve: baseline, 4 weeks, 8 weeks and 6 months. The trainee
radiologists evaluated the degree of stenosis on each coronary segment,
and overall accuracy was calculated on a per-segment, pervessel and
per-patient basis. All readers improved analysis accuracy per segment
(range, 73-90%); sensitivity reached 45% per segment, 84% per vessel and
93% per patient; specificity was 99% per segment and vessel and 98% per
patient. Positive and negative predictive values increased to 94% and 92%,
respectively. Although all readers improved in diagnostic performance with
growing experience with MDCT-CA, a longer training period may be necessary
to achieve adequate levels of expertise in MDCT-CA to be able to perform
as independent readers.

<12>
Accession Number
2013422453
Authors
Abid Shah M. Suleman S. Hussain Munir A.
Institution
(Abid Shah, Suleman) Department of Pharmacology, Khyber Medical College,
Peshawar, Pakistan
(Hussain Munir) Department of Pathology, Khyber Medical College, Peshawar,
Pakistan
Title
Comparative efficacy and safety profile of 5 MG rosuvastatin versus 10 MG
rosuvastatin in patients with ischemic heart disease.
Source
Journal of Medical Sciences (Peshawar). 21 (1) (pp 35-39), 2013. Date of
Publication: January 2013.
Publisher
Khyber Medical College (PeshawarPakistan)
Abstract
Objectives: To compare the efficacy and clinical profile of 5 mg
rosuvastatin versus 10 mg rosuvastatin in improving the management of
patients with IHD. Material and Methods: This study was jointly conducted
by Department of Pharmacology, Khyber Medical College, and Cardiology
Department of Khyber Teaching Hospital from January 2011 to August 2011.
The patients presenting to coronary care unit and cardiology OPD were
randomized into a two groups; Group A and Group B each comprising 50
patients. Group A recieved 5 mg of rosuvastatin and Group B received 10 mg
of resovuastatin for three months. National cholesterol Education
programme adult treat panel III (NCEP ATP III) guideline for LDL-C was
chosen as the primary objective while assessing the safety profile and
toxicity was considered the secondary end point. A rise in HDL-C was also
anticipated. Results: Thirty-four (68%) patients in group A and 41 (82%)
patients in group B were male. All the patients were resident of Peshawar.
Their mean ages were 51.4 + 7.6 and 49.35 + 5.65 years respectively in
group A and B. The LDL-C dropped to NCEP ATP III value of < 100 mg% in 3
(26%) patients in group A compared to 4 (88%) in group B P < 0.0004. LDL-C
levels after the 3 month treatment showed a mean reduction of 66.2 + 3.8
and 84.1 + 4.3 in group A and B respectively implying 39.02% and 48.38 %
reduction with a P value < 0.0001. The reduction to total cholesterol
(TLC) was 31.69% (mean 83.2 + 7.5) and 41.28% (mean 107.0 + 3.3) in the
respective groups with a P value of < 0.0001. The significant value for
triglycerids was a P < 0.04 for group B while the HDL-C improvement was
0.0006 in group B (receiving 10 mg rosuvastatin). The reported increased
in the incidence of myalgia and muscle weakness was statistically
insignificant P < 0.06. Conclusion: Rosuvastatin; clinically proven
antilipidemic agent for the management of IHD has a better efficacy with
almost identical adverse effects in 10 mg doses as compared with 5 mg
doses and this satisfies the NCEPATP III guidelines.

<13>
Accession Number
2014100864
Authors
Borji R. Reza Khatami M. Reza Abbasi M. Meysamie A. Barkhordari K.
Ayatollah Esfahani F. Pashang M. Ghadirian L.
Institution
(Borji) Department of Internal Medicine, Imam Khomeini Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Reza Khatami, Reza Abbasi) Department of Nephrology, Nephrology Research
Center, Imam Khomeini hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Meysamie) Department of Community Community Medicine, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Barkhordari) Department of Anesthesiology and Critical Care Medicine,
Tehran heart center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ayatollah Esfahani, Pashang) Nurse, Cardiovascular Research Department,
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ghadirian) Community Based Participatory Research Centre, Center for
Academic and Health Policy, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Prophylactic dialysis in non-dialysis-dependent patients with renal
failure after CABG.
Source
Tehran University Medical Journal. 71 (12) (pp 800-806), 2014. Date of
Publication: 2014.
Publisher
Tehran University of Medical Sciences (202 Amouzesh Building, Poursina
Ave., Ghods St, Keshavarz Blvd, Tehran, Iran, Islamic Republic of)
Abstract
Background: The mortality due to Coronary Artery Bypass Graft (CABG) in
patients with chronic renal failure is more common than normal population.
This study evaluates the impacts of prophylactic dialysis on decreasing
mortality and morbidity of nondialysis- dependent patients with renal
failure after CABG surgery. Methods: In this study, fifty
non-dialysis-dependent patients who were suffering from renal failure and
needed to CABG, were selected by convenience sampling method.
Sequentially, they were allocated to prophylactic dialysis (n=20) and no
prophylactic dialysis (n=30) groups, using a randomized block design.
Exclusion criteria were under 18 year old patients and doing CABG for
second time. Mortality rate and some complications such as acute renal
failure, brain accident and atrial arrhythmias were compared between two
groups after CABG. All cardiac surgeries were performed in a single centre
and through a median sternotomy. P value less than 0.05 was considered as
significant. Results: The mean age of patients was (65.3+9.9). The
patients included %16 (n.8) of women and %84 (n.42) of men. There were 20
patients in intervention and 30 patients in control groups. Baseline
characteristics were similar in two groups. Comparison between
intervention and control groups after surgery did not show any difference
in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular
accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due
to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization
(P=1), duration of ventilator use (P=0.4), duration of need to
hospitalization (P=0.11), duration of a patients stay in the Intensive
Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion:
According the results of this study, prophylactic dialysis, before
conducting CABG, does not have any significant effect on mortality and
other complications. The only exception is lung complications in
non-dialysis-dependent patients with renal failure.

<14>
Accession Number
2014100862
Authors
Sarzaeem M. Shayan N.
Institution
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Shayan) Transplantation Research Center, Dr. Shariati Hospital, Tehran,
Iran, Islamic Republic of
Title
Vitamin C in prevention of atrial fibrillation after coronary artery
bypass graft: Double blind randomized clinical trial.
Source
Tehran University Medical Journal. 71 (12) (pp 787-793), 2014. Date of
Publication: 2014.
Publisher
Tehran University of Medical Sciences (202 Amouzesh Building, Poursina
Ave., Ghods St, Keshavarz Blvd, Tehran, Iran, Islamic Republic of)
Abstract
Background: Atrial fibrillation is the most common arrhythmia after
cardiac surgery. Vitamin C as an antioxidant has an important role in
reducing the incidence of postoperative atrial fibrillation. The present
study aimed at administrating vitamin C as a way to reduce the incidence
of post-CABG atrial fibrillation. Methods: In this double-blind, parallel
clinical trial, 170 patients with coronary artery disease who underwent
CABG surgery, by using a table of random numbers are divided into
intervention and control groups to receive placebo or vitamin C. The
clinical and surgical characteristics of the patients in the two groups
were similar. The intervention group received 2 mg of vitamin C
intravenously, the night before surgery. This drug followed by 500 mg,
twice a day for five days after surgery. On the other hand patients in the
control group received placebo (normal saline intravenously). After
operation two groups were compared regarding Important outcomes such as
postoperative arrhythmia, ICU stay and hospital stay. Results: One hundred
eighteen men and fifty two women with a mean age of 59.1+9.8 years were
enrolled in the study in two vitamin C and placebo groups (each consisting
of 85 patients). The incidence of postoperative atrial fibrillation was
12.9% in the vitamin C group and 29.4% in the control group (P=0.009). ICU
stay in the vitamin C group were 2.5+1.4 days versus 3.0+1.6 days in
controls (P=0.035) and hospital stay in the vitamin C group were 6.6+1.5
days versus 8.2+2.3 days in controls (P<0.001). Conclusion: Vitamin C is
relatively safe, inexpensive, well tolerated and has a low complication.
According to the 44% reduction in the incidence of atrial fibrillation in
vitamin C patients undergoing coronary artery bypass grafting surgery,
this drug can be prescribed as a prophylaxis for prevention of post-CABG
atrial fibrillation.

<15>
Accession Number
2014095932
Authors
Turner A. Murphy B.M. Higgins R.O. Elliott P.C. Le Grande M.R. Goble A.J.
Worcester M.U.C.
Institution
(Turner, Murphy, Higgins, Elliott, Le Grande, Goble, Worcester) Heart
Research Centre, Royal Melbourne Hospital, PO Box 2137, VIC 3050,
Australia
(Turner, Murphy, Elliott, Worcester) University of Melbourne, VIC,
Australia
Title
An integrated secondary prevention group programme reduces depression in
cardiac patients.
Source
European Journal of Preventive Cardiology. 21 (2) (pp 153-162), 2014. Date
of Publication: February 2014.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objective: Depression is common following an acute cardiac event and can
occur at a time when behaviour change is strongly recommended to reduce
the risk of further cardiovascular events. The 'Beating Heart Problems'
programme was designed to support cardiac patients in behaviour change and
mood management. Methods: The programme was based on cognitive behaviour
therapy and motivational interviewing. A randomized controlled trial (RCT)
comparing the 8-week group programme with usual care was undertaken
between 2007 and 2010. All patients attended a hospital-based clinic for
assessment of physiological risk factors at baseline (6 weeks after their
acute event), and at 4- and 12-month follow up. Psychological and
behavioural indicators were assessed by self-report questionnaires. Of the
275 patients enrolled into the RCT, 42 (15%) had Beck Depression
Inventory-II scores >13 at baseline. Treatment and control group
comparisons were undertaken for this subgroup, using growth curve
modelling and testing for group differences over time in psychological,
physiological, health behaviour, and self-efficacy measures. Results:
Significantly greater improvements (p<0.01) in depression symptoms and
self-rated health were reported for the intervention group, as well as
significantly larger gains in confidence in managing depression (p<0.05)
and anger (p<0.01). Trends (0.05<p<0.10) for larger treatment group
improvements were also seen for anxiety symptoms and confidence in
managing anxiety. Conclusion: A group secondary-prevention programme that
integrates behavioural and mood management strategies leads to decreased
depression, increased confidence, and improved health perceptions in
depressed cardiac patients. The European Society of Cardiology 2012.

<16>
Accession Number
2014106052
Authors
Migliore A. Jefferson T. Cerbo M. Abraha I. Montedori A.
Institution
(Migliore, Jefferson, Cerbo, Abraha) Agenas Sperimentazione e Sviluppo,
Agenzia Nazionale per i Servizi Sanitari Regionali, ISS-Innovazione, via
Puglie, 23-00187 Rome, Italy
(Abraha, Montedori) Office of Regional Health Planning, Regional Health
Authority of Umbria, via M. Angeloni, 61-06124 Perugia, Italy
Title
Implantable devices for the closure of patent foramen ovale in adults: An
Italian rapid health technology assessment.
Source
Expert Review of Medical Devices. 11 (2) (pp 151-161), 2014. Date of
Publication: March 2014.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Percutaneous closure of patent foramen ovale (PFO) is offered to patients
suffering from cryptogenic stroke, transient ischemic attack or persistent
migraine. Several PFO closure devices are CE marked but none have yet been
approved by the FDA. On the Italian market 11 different PFO closure
devices are available and more than 2500 PFO procedures were reported in
2012. We report findings of a systematic review and meta-analysis of
studies in which patients with PFO and transient ischemic attacks,
cryptogenic stroke or persistent migraine who underwent PFO closure were
compared to patients treated by usual care. We included five controlled
clinical trials and one randomized controlled trial. Included studies had
poor methodological quality and heterogeneity. In the included randomized
controlled trial, 4.7% of procedure-related serious adverse events were
observed. Large multicenter, sufficiently powered, and properly randomized
trials need to be conducted in Europe with particular attention to patient
selection. 2014 Informa UK Ltd.

<17>
Accession Number
71331366
Authors
Gough A. O'Sullivan K. Barry M. Hurley J. Sugrue D.
Institution
(Gough, O'Sullivan, Barry, Hurley, Sugrue) Mater Misericordiae University
Hospital, Dublin, Ireland
Title
Is valve choice the main determinant of paravalvular leak post
transcatheter aortic valve implantation?.
Source
Irish Journal of Medical Science. Conference: 64th Irish Cardiac Society
Annual Scientific Meeting Co. Kerry Ireland. Conference Start: 20131004
Conference End: 20131005. Conference Publication: (var.pagings). 182 (pp
S376), 2013. Date of Publication: October 2013.
Publisher
Springer London
Abstract
Background: Significant paravalvular regurgitation (PVR) following
transcatheter aortic valve implantation (TAVI) is associated with poor
survival. Unfavourable anatomic and pathological factors contribute. There
is considerable variability in PVR rates reported. The two most popular
valve delivery systems,MedtronicCorevalve (MCV)and Edwards Sapien (ES),
differ significantly in structure and deployment technique. Methods: A
systematic review of literature looking at PVR at timepoints up to 1 year,
using different valve types was performed through Pubmed and bibliographic
searches from 2008-2013. One analysis consisted of immediate,
post-procedure and 30 day rates of PVR with 6 months and 1 year separately
reviewed. A systematic review and meta-analysis of studies of PVR in MCV
and ES was performed. Results: Over 8000 patients from over 20 studies
looking at PVR up to 1 year were examined; focusing on 9 studies comparing
MCV versus ES outcomes, and other factors predisposing to PVR to ascertain
if valve choice is the main determinant of PVR. Pooled rate of significant
PVR was 9.0 % (95 % confidence interval: 5.5, 13.0). Rates at 6 months and
1 year were 10.2 %(95 %CI: 1.5, 24.9) and 7.0 %(95 % CI: 0, 26.5)
respectively. Examining valve types; MCV displayed more PVR; 15.75 % >95 %
CI 12.48-19.32] versus ES 3.93 % >95 % CI 1.05-8.38]. Comparing PVR rates
by mixed-effects meta-regression with fixed-effect moderator variable for
valve type, suggesting statistically significant difference inPVRrates
between valves (p = 0.0002). Conclusion: Approximately 10 % of patients
develop PVR post TAVI, impacting on survival. There's no universally
accepted method of reporting rates of PVR between studies which would be
useful to ensure consistency in reporting. Numerous factors including
valve choice impact on PVR. Evidence suggests that valve choice remains
the most modifiable factor in reducing PVR post TAVI.

<18>
Accession Number
71331345
Authors
McKavanagh P. Lusk L. Ball P.A. Trinick T.R. Duly E. Verghis R M. Agus
A.M. Walls G.M. McCusker S. Orr C. Hamilton A. Harbinson M.T. Donnelly
P.M.
Institution
(McKavanagh, Lusk, Ball, Trinick, Duly, Verghis R, Agus, Walls, McCusker,
Orr, Hamilton, Harbinson, Donnelly) Ulster Hospital, Dundonald, Belfast,
United Kingdom
Title
One year follow up of the CAPP study: A randomised controlled trial
comparing EST to cardiac CT.
Source
Irish Journal of Medical Science. Conference: 64th Irish Cardiac Society
Annual Scientific Meeting Co. Kerry Ireland. Conference Start: 20131004
Conference End: 20131005. Conference Publication: (var.pagings). 182 (pp
S368), 2013. Date of Publication: October 2013.
Publisher
Springer London
Abstract
Purpose: This is the 1 year follow-up of The Cardiac Computerised
Tomography (CT) for the Assessment of Pain and Plaque (CAPP) study.
[ISRCTN52480460]. The study compared the economic and clinical outcomes of
using cardiac CT compared to Exercise Stress Test (EST) in stable troponin
negative chest pain. Method: CAPP is a cost-utilisation analysis
randomised controlled trial. 500 patients without known coronary artery
disease received either EST or cardiac CT. All patients were followed up
for re-hospitalisations rates and adverse events and for angina symptoms
with the well established Seattle Angina Questionnaires (SAQ). Results: Of
the 500 patients randomised 12 withdrew over the year, resulting in 245 in
the EST arm and 243 in CT arm receiving follow up. The mean age was 58.3
years and a mean Diamond Forrester score of 46.4 %. There were with no
significant differences in the pretest probabilities, age, sex or risk
factors. Over the 1 year follow up period there were 29 Emergency
Department (ED) chest pain attendances in the EST arm, with 13 unplanned
admissions, compared to 8 ED attendances with 2 unplanned admissions in
the CT arm. There were also more cardiology outpatient attendances in the
EST arm. In the EST arm there were 7 patients who underwent Coronary
Artery Bypass Grafting (CABG) and 12 who had Percutaneous Coronary
Intervention (PCI), compared to 9 CABG and 29 PCI in the CT arm. At 1 year
408 (81.6 %) patients had returned the SAQ, 210 in the CT arm and 198 in
the EST. There were significant improvements in the SAQ angina stability
and quality of life scores at 1 year in the CT arm (p B 0.05).
Conclusions: Cardiac CT as an index investigation for stable chest pain
improved angina stability and quality of life, resulting in fewer planned
and unplanned hospital attendances.

<19>
Accession Number
71326247
Authors
Healy D.A. Boyle E.M. McCartan D. Bourke M. Dowdall J. Cross S. Manning B.
Fulton G. Kavanagh E. Burke P. Grace P.A. Clarke Moloney M. Walsh S.R.
Institution
(Healy, Kavanagh, Burke, Grace, Clarke Moloney, Walsh) Department of
Vascular Surgery, University Hospital Limerick, Limerick, Ireland
(Boyle, Manning, Fulton) Department of Vascular Surgery, Cork University
Hospital, Cork, Ireland
(McCartan, Bourke, Dowdall, Cross) Department of Vascular Surgery,
Waterford Regional Hospital, Waterford, Ireland
Title
Preconditioning shields against vascular events in surgery
(preconditioning-SAVES): Pilot results.
Source
Irish Journal of Medical Science. Conference: 21st Sylvester O'Halloran
Meeting Co. Limerick Ireland. Conference Start: 20130301 Conference End:
20130302. Conference Publication: (var.pagings). 182 (pp S32), 2013. Date
of Publication: March 2013.
Publisher
Springer London
Abstract
Strategies are needed to reduce cardiovascular complications following
major arterial surgery. Remote ischaemic preconditioning (RIPC) has been
shown to reduce myocardial damage in cardiac surgery. Whether RIPC can
improve clinical outcomes in vascular surgery is unclear. Preconditioning
SAVES is a multi-centre randomized controlled trial, aiming to evaluate
the effect of RIPC on patients who are undergoing open abdominal aortic
aneurysm (AAA) repair, endovascular aneurysm repair (EVAR), lower limb
revascularization or carotid endarterectomy procedures. Patients are
randomized to either a period of tourniquet-induced upper limb
ischaemia/reperfusion (RIPC arm) or no intervention (control arm).
Recruitment to the pilot phase of the trial began in January 2012. The
primary endpoint combines death, cardiac arrest, myocardial infarction,
new arrhythmia, unstable angina, congestive cardiac failure, transient
ischaemic attack, renal failure requiring dialysis, mesenteric ischaemia
and respiratory failure. For the pilot trial, perioperative troponin leak
is a surrogate primary outcome. Secondary endpoints include duration of
hospital and intensive care unit stay and several other perioperative
complications. Outcomes are assessed 1 month following surgery. The
results of the first 50 patients are presented. Primary clinical outcomes
incidences were 4/26 (15.4 %) in the RIPC arm and 4/24 (16.7 %) in the
control arm. Secondary clinical outcome incidences were 10/26 (38.5 %) and
10/24 (41.7 %), respectively. There were no significant differences in
clinical outcomes or troponin values. Preconditioning SAVES aims to
establish whether RIPC confers a clinical benefit when used in major
vascular surgery. Our initial results confirm the feasibility of
conducting a large trial to establish the role of RIPC.

<20>
Accession Number
71326050
Authors
Fitzmaurice G. McWilliams B. Nolke L. Redmond M. McGuinness J. O'Donnell
M.
Institution
(Fitzmaurice, Nolke, Redmond, McGuinness) Department of Cardiothoracic
Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
(McWilliams) Department of Anaesthetics and Intensive Care Medicine,
Cardiff University, Heath Park, Cardiff, United Kingdom
(O'Donnell) Department of Life and Health Sciences, University of Ulster,
Jordanstown, Ireland
Title
Do statins have a role in the promotion of post-operative wound healing
amongst cardiac surgical patients?.
Source
Irish Journal of Medical Science. Conference: 37th Sir Peter Freyer
Memorial Lecture and Surgical Symposium 2012 Galway Ireland. Conference
Start: 20120907 Conference End: 20120908. Conference Publication:
(var.pagings). 181 (pp S184-S185), 2012. Date of Publication: September
2012.
Publisher
Springer London
Abstract
Introduction: Statins are amongst the most widely prescribed medications
in the world and they may have a number of potential pleiotropic effects
including a possible role in the promotion of wound healing. Cardiac
surgical patients represent a patient population with significant
associated co-morbidities that can impede normal wound healing. Aim: To
evaluate statins in the promotion of post-operative wound healing with the
aim of consolidating the current evidence base, to elucidate an underlying
mechanism of action, and assess whether further investigations would be
appropriate. Methods: A systematic review was conducted using MEDLINE, The
Cochrane Library, and Embase with the keywords "statins", "wound", and
"neutrophil migration". A total of 326 articles were identified and
following review, twenty articles were deemed relevant for inclusion.
Results: Given the infancy of the topic, the majority of studies related
to animal research, however a number of significant findings could be
reported. Statins improved wound healing (32 % faster rate of
epithelialisation) and tensile strength (33 % greater wound breaking
strength) while modulating the various inflammatory mediators involved.
Topical statins appeared to provide enhanced outcomes in comparison to
systemic statin use, with an optimal timeframe for treatment benefit of
14-days, and that benefit related to the duration of treatment rather than
dosage. In addition the evidence would suggest that inhibition of Farnesyl
Pyrophosphate formation may underpin the overall pleiotropic effects of
statins on wound healing. Conclusion: Topical statins may provide a
valuable adjunct to cardiac surgeons in the augmentation of wound healing
and further evaluation would be appropriate.

<21>
Accession Number
71323214
Authors
Berczi V.
Institution
(Berczi) Department of Radiology and Oncotherapy, Semmelweis University,
Budapest, Hungary
Title
Upper limb DVT-which patients should we treat and how?.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2013 Barcelona
Spain. Conference Start: 20130914 Conference End: 20130918. Conference
Publication: (var.pagings). 36 (pp S182-S183), 2013. Date of Publication:
September 2013.
Publisher
Springer New York
Abstract
INTRODUCTION, BACKGROUND Primary upper extremity deep-vein thrombosis
(UEDVT) is defined as spontaneously developed thrombosis without any
clinically apparent risk factors or after strenuous exercise (effort
thrombosis). Screening for occult cancer should be performed in idiopathic
thrombosis, while effort thrombosis (Paget-Schrotter syndrome) typically
occurs in young and physically active patients because of repetitive
injury to the vein due to a tight thoracic outlet. Repetitive use of the
arms above the shoulder level is frequent. Primary UEDVT is responsible
for approximately 20%-30% UEDVTs. Secondary UEDVT develops in the setting
of central venous catheter, pregnancy, malignancy, recent surgery or
recent trauma. The main complication of effort UEDVT is post-thrombotic
syndrome (venous distension, swelling of the arm, blue discoloration, pain
with exercise). UEDVT, particularly secondary UEDVT, carries a substantial
risk of pulmonary embolism (3%-12%). Symptomatic PE with lower limb DVT
was three times more frequent than that for UEDVT in the RIETE registry
(29% vs. 9%); however, three-month mortality rate was higher in the UEDVT
group (11% vs. 7%). Recurrence rate is smaller in UEDVT than in lower limb
DVT. DIAGNOSIS Clinical presentation: The most common signs and syndromes
include unilateral arm swelling, erythema, discomfort, dilated superficial
veins, superior vena cava syndrome, low-grade fever, dyspnea. Clinical
evaluation has low specificity (30%-60%). The D-dimer test has only
limited usefulness in suspected UEDVT, probably being more efficient in
outpatients compared with in-hospital patients. Therefore, imaging studies
are required. Ultrasound: On B-mode imaging, echogenicity may vary in
acute thrombosis. As usual, non-compressibility defines the presence of
DVT. This evaluation technique cannot be used for the centrallysituated
veins (i.e. brachiocephalic veins and superior vena cava) or for the
medial segment of the subclavian veins near the clavicle. Absence of flow
and of the normal biphasic pattern on pulsed-wave Doppler can also suggest
DVT (75% sensitivity, 100% specificity). A recent guideline suggested the
use of compressions and Doppler US ('combined modality US') as an initial
diagnostic test. Contrast venography (CV): Earlier, CV has been the
reference standard for suspected lower limb DVT. Contrast medium is
injected into a distal vein of the upper extremity. A thrombus is
identified as a filling defect present in more than one view. However,
interobserver agreement on venogram interpretation in suspected DVT is
only 70%-80%. This technique is reserved when initial non-invasive imaging
is insufficient for a conclusive diagnosis or is negative in case of high
clinical suspicion of DVT. CV visualises veins at the thoracic outlet.
However, it requires radiation exposure and intravenous contrast and is
technically demanding. CO₂ venography has been used in small
studies with acceptable results (97% sensitivity and 85% specificity
against standard contrast venography). Computed tomography venography
(CTV): Pooled sensitivity of 96% and specificity of 95% was found in a
recent study against US or CV in lower limb studies; upper extremity
investigations are scarce. Obvious disadvantages of CTV include ionising
radiation and the risk associated with intravenous iodinated contrast
medium. Magnetic resonance venography (MRV): There are very few studies on
MR diagnosis of UEDVT; most of our current experience is from lower
extremity publications. Pooled sensitivity and specificity of CE-MRV was
91% and 95%, respectively, against CV as a reference standard in the lower
limb veins. TOF MRV is also promising. Magnetic resonance direct thrombus
imaging (MRDTI) can distinguish recent from chronic thrombus in case of
recurrent DVT in the lower extremity. TREATMENT POSSIBILITIES
Anticoagulation The mainstay therapy is therapeutically-dosed parenteral
anticoagulant bridged to an oral anticoagulant. INR should reach 2.0 or
higher on two measurements with a difference in time of at least 24 h.
Acute phase therapy is for three months. Complication rate of
anticoagulation therapy includes 2%-4% major bleeding. No
randomised-controlled trials exist for the anticoagulation treatment of
UEDVT. However, a retrospective analysis reported increased symptomatic
resolution (48% vs. 70%). Indications of anticoagulation therapy beyond
three months are uncertain; provoked situations (e.g. cancer, central
venous catheter) or UEDVT with tight thoracic outlet (surgically not
corrected) may justify long-term anticoagulation treatment. Endovascular
therapies Thrombolysis Systemic thrombolysis has been largely replaced by
catheter-directed thrombolysis in lower limb DVT because of smaller number
of bleeding complications and better rates of valvular competence.
Catheter-directed thrombolysis uses a multiport catheter placed directly
into the thrombus using image guidance. For lower limb treatment, typical
regimen consists of continuous high-volume drip regimen with dilute
thrombolytics and concomitant unfractionated heparin. Clearance rates are
70%-90%. Clots older than two weeks are generally less susceptible for
thrombolysis. No published guidelines are available for UEDVT. Most common
complications are typically access site bleeding (major bleeding rate is
approximately 10%). Appropriate case selection is challenging. High level
evidence showed benefit for low-dose thrombolytic treatment of
catheter-dysfunction due to thrombotic luminal occlusion with negligible
bleeding risk. Percutaneous mechanical thrombectomy The next, separate
lecture of this session will address this question in details. Angioplasty
and stenting Limited data are available in literature. Stent placement for
central and peripheral limb obstruction in 65 patients showed a clinical
success rate of 75% and 42% at 12 and 24 months, respectively, with a high
rate of reintervention. A smaller study (22 patients) reported occlusion
of the stents in patients with Paget-Schrotter syndrome. Indications for
these interventions are uncertain and long-term data are lacking. Unless
contraindicated, anticoagulation should follow all interventional
treatments. Superior vena cava filter A recent systematic review analysis
on 209 SVC filter placements showed a complication rate of 3.8% (mainly
filter strut perforation causing cardiac tamponade, pneumothorax and
aortic perforation). The benefit is yet uncertain. SCV filter has
currently a small role in the management of UEDVT. CONCLUSIONS Clinical
prediction score and D-dimer assays are of limited use in UEDVT;
therefore, diagnosis is based on imaging methods, primarily
ultrasonography. The cornerstone of UEDVT treatment is anticoagulation.
Because severe post-thrombotic syndrome is rarely observed after
conservative treatment of UEDVT, the long-term benefit of thrombolysis is
currently unclear. Selective patients with acute thrombosis having severe
syndromes and low bleeding risk may be considered. Placement of the
superior vena cava filter may only be considered in patients with
contraindications for anticoagulation therapy and pulmonary embolism.
Clear indications for endovascular therapies warrants more randomised
trials.

<22>
Accession Number
71322786
Authors
Backes A. Rizos A. Pricor L.
Institution
(Backes, Rizos, Pricor) Sharp HealthCare, United States
Title
Primary medication adherence among patients transitioning from hospital to
home care.
Source
Journal of the American Pharmacists Association. Conference: APhA2012 New
Orleans, LA United States. Conference Start: 20120309 Conference End:
20120312. Conference Publication: (var.pagings). 52 (2) (pp 205-206),
2012. Date of Publication: March-April 2012.
Publisher
American Pharmacists Association
Abstract
Objective: The objective is to determine the effect of a pharmacy
resident- led intervention on primary medication adherence among patients
transitioning from hospital to home care (HC). Methods: This is a
randomized, controlled trial. Patients discharged from the hospital and
admitted to HC will be eligible if they have congestive heart failure or
take >10 medications. Patients being evaluated for heart transplants will
be excluded. Eligible patients will be visited by the pharmacy resident
prior to discharge. Written informed consent and pharmacy information will
be obtained. The control group will receive usual care, which consists of
discharge medication counseling by a nurse and medication reconciliation
by a HC clinician. The intervention group will be visited by the pharmacy
resident prior to discharge (phase I) and at home within 5 days after
discharge (phase II). Phase I will consist of reviewing the discharge
medication list for drugrelated problems (DRPs), discussing DRPs with
hospitalist, and medication counseling. Phase II will consist of comparing
medication bottles to discharge medication list and identifying DRPs to
address with the primary care provider. The primary outcome will be
primary medication adherence within 5 days of discharge. The pharmacy
resident will call patients' pharmacies to determine whether newly
prescribed medications were picked up by the patients. For intervention
patients, this will be physically confirmed during the home visit. For
control patients, this will be electronically confirmed by the assessment
done by the HC clinician. Secondary outcomes will be frequency of 30-day
readmissions and 30-day emergency department visits. All data analyses
will be performed using Stata. Continuous variables will be compared using
the student's t test, and categorical data will be compared using
chi-square test. Data analyses will include descriptive analyses of
patient demographics, rate of primary medication non-adherence, and
factors associated with primary medication non-adherence.