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Percutaneous Coronary Intervention and Cardiology February-March 2015

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Table of Contents

1. Bypass Grafting Versus Percutaneous Intervention in Multivessel Coronary Disease: the Current State 2. Clopidogrel Response Variability: Etiology and Clinical Relevance 3. Culprit vessel only vs immediate complete revascularization in patients with acute ST-segment elevation myocardial infarction: systematic review and meta-analysis. 4. Drug-Eluting Stents: the Past, Present, and Future 5. Dysautonomic responses during percutaneous carotid intervention: Principles of physiology and management 6. Effect of high-dose clopidogrel according to CYP2C19*2 genotype in patients undergoing percutaneous coronary intervention- a systematic review and meta-analysis. 7. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis. 8. Furosemide with saline hydration for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: A meta-analysis of randomized controlled trials 9. High dose statin loading prior to percutaneous coronary intervention decreases cardiovascular events: a meta-analysis of randomized controlled trials. 10. Infarct size reduction in acute myocardial infarction 11. Ischaemic postconditioning reduces infarct size: Systematic review and meta-analysis of randomized controlled trials 12. Management of Coronary Disease in the Era of Transcatheter Aortic Valve Replacement: Comprehensive Review of the Literature 13. Management of multivessel coronary disease in STEMI patients: A systematic review and meta-analysis 14. Management of multivessel coronary disease in STEMI patients: a systematic review and meta-analysis. 15. Meta-analysis appraising high maintenance dose clopidogrel in patients who underwent percutaneous coronary intervention with and without high on-clopidogrel platelet reactivity 16. Meta-analysis of deferral versus performance of coronary intervention based on coronary pressure-derived fractional flow reserve 17. Meta-analysis of short-term high versus low doses of atorvastatin preventing contrast-induced acute kidney injury in patients undergoing coronary angiography/percutaneous coronary intervention 18. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients+ 19. Optimal anticoagulation duration of unfractionated and low molecular weight heparin in non-ST elevation acute coronary syndrome: a systematic review of the literature 20. ORAl iMmunosuppressive therapy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials 21. Paclitaxel-eluting versus bare metal stents in primary PCI: a pooled patient-level meta-analysis of randomized trials. 22. Predicting and preventing vascular complications following percutaneous coronary intervention in women 23. Preventive stenting in acute myocardial infarction 24. Radial Artery Occlusion After Transradial Approach to Cardiac Catheterization 25. Remote ischemic preconditioning reduces perioperative cardiac and renal events in patients undergoing elective coronary intervention: a meta-analysis of 11 randomized trials 26. Revascularization in Patients with Diabetes: PCI or CABG or None at All 27. Role of Pre-procedural C-reactive Protein Level in the Prediction of Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention: a Meta-analysisof Longitudinal Studies. 28. Statins for the prevention of contrast-induced nephropathy after coronary angiography/percutaneous interventions: A meta-analysis of randomized controlled trials 29. Systematic review of health-related quality of life in older people following percutaneous coronary intervention. 30. The transradial approach during transcatheter structural heart disease interventions: A review 31. Worse outcome in women with STEMI: A systematic review of prognostic studies 1.Title: Bypass Grafting Versus Percutaneous Intervention in Multivessel Coronary Disease: the Current State Citation: Current Cardiology Reports, 2015, vol./is. 17/2(1-8), 1523-3782;1534-3170 (2015) Author(s): Sipahi I. Language: English Abstract: Whether stenting or coronary artery bypass grafting (CABG) is the best revascularization strategy in patients with multivessel disease has been a heavily debated controversy. The trials comparing the two methods were unfortunately underpowered for mortality. Moreover, results of clinical trials appeared to contradict with each other. Because CABG is unequivocally a more cumbersome method, stenting became commonly preferred in the

absence of evidence for mortality difference. Meta-analysis is a powerful tool, especially when several high-quality randomized trials are available on the same issue. In these instances, meta-analyses can overcome the power limitation of the individual trials. Our recent meta-analysis reveals that, as compared to stenting, CABG leads to unequivocal reductions in mortality and myocardial infarctions in patients with multivessel disease. These benefits are seen regardless of whether patients are diabetic or not and also do not depend on whether bare-metal or drug-eluting stents are used. Publication type: Journal: Review Source: EMBASE 2.Title: Clopidogrel Response Variability: Etiology and Clinical Relevance Citation: Current Cardiovascular Risk Reports, 2015, vol./is. 9/3, 1932-9520;1932-9563 (2015) Author(s): Bonello L., Gaubert M., Laine M., Barragan P., Pinto J., Iloud A., Lemesle G., Roch A., Dignat-George F., Paganelli F., Kerbaul F., Thuny F. Language: English Abstract: Antiplatelet therapy is key to the care of coronary artery disease. Continuous improvement in the understanding of athero-thrombosis and the pathways of platelet activation has led to tremendous enhancement in the care of patients. The addition of a P2Y12-ADP receptor blocker in particular was a great leap forward in the care of acute coronary syndrome patients and those undergoing percutaneous coronary intervention (PCI). However, the development of platelet assays has demonstrated that the one fits it all dosing of clopidogrel resulted in various levels of platelet reactivity (PR) inhibition which translated into varying clinical outcomes. Clopidogrel resistance or high on-clopidogrel platelet reactivity (high on-treatment platelet reactivity, HTPR) was identified and correlated with poor clinical outcome. In addition further to this early finding, researchers have also demonstrated that low on-clopidogrel platelet reactivity was associated with bleedings. In the present review, we aimed to summarize the mechanism and etiologies of HTPR in clopidogrel-treated patients and its clinical importance. Publication type: Journal: Review Source: EMBASE 3.Title: Culprit vessel only vs immediate complete revascularization in patients with acute ST-segment elevation myocardial infarction: systematic review and meta-analysis. Citation: Clinical Cardiology, December 2014, vol./is. 37/12(765-72), 0160-9289;1932-8737 (2014 Dec) Author(s): Sekercioglu N, Spencer FA, Lopes LC, Guyatt GH Language: English Abstract: Although multivessel coronary artery disease has been associated with poor health outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI), the optimal approach to revascularization remains uncertain. The objective of this review was to determine the benefits and harms of culprit vessel only vs immediate complete percutaneous coronary intervention (PCI) in patients with acute STEMI. We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomized controlled trials (RCTs). Teams of 2 reviewers, independently and in duplicate, screened titles and abstracts, completed full-text reviews, and abstracted data. We calculated pooled risk ratios (RRs) and associated 95% confidence intervals (CIs) using random-effect models for nonfatal myocardial infarction (MI), revascularization, cardiovascular mortality, all-cause mortality, and adverse events, and used the GRADE approach to rate confidence in estimates of effect. Of 341 patients randomized to complete revascularization and followed to study conclusion, 31 experienced revascularization, as did 80 of 324 randomized to culprit vessel only revascularization (RR: 0.35, 95% CI: 0.24-0.53). Ten patients in the complete revascularization group and 28 patients in the culprit vessel only revascularization group experienced nonfatal MI (RR: 0.35, 95% CI: 0.17-0.72). All-cause mortality and cardiac deaths did not differ between groups (RR: 0.69, 95% CI: 0.40-1.21 for all-cause mortality; RR: 0.48, 95% CI: 0.22-1.04 for cardiac deaths). Pooled data from 3 RCTs suggest that immediate complete revascularization probably reduces revascularization in patients with acute STEMI; although results suggest possible benefits on MI and death, confidence in estimates is low. Copyright &#xa9; 2014 Wiley Periodicals, Inc. Publication type: Journal Article Source: MEDLINE 4.Title: Drug-Eluting Stents: the Past, Present, and Future Citation: Current Atherosclerosis Reports, 2015, vol./is. 17/3, 1523-3804;1534-6242 (2015) Author(s): Katz G., Harchandani B., Shah B. Language: English Abstract: Since the advent of percutaneous coronary intervention, enormous advances have been made in the

treatment of coronary artery disease. Angioplasty and bare metal stents were plagued by high rates of restenosis leading to repeat revascularization procedures. Examination of the underlying pathophysiology of restenosis led to the development of drug-eluting stents to reduce neointimal hyperplasia. However, as restenosis rates declined, length of dual antiplatelet therapy use and risk of long-term stent thrombosis associated with drug-eluting stents increased. Subsequent generations have improved each facet of stent design. Novel alloys maintain durability and reduce strut thickness to increase deliverability, biocompatible polymers decrease the inflammatory response and improve drug elution kinetics, and new generations of drugs predictably inhibit restenosis. Developments on the horizon include stents with bioabsorbable polymers and platforms. The purpose of this review is to assess the evolution of stent design and the evidence behind each generation and to peer into the future of stent technology. Publication type: Journal: Review Source: EMBASE 5.Title: Dysautonomic responses during percutaneous carotid intervention: Principles of physiology and management Citation: Catheterization and Cardiovascular Interventions, February 2015, vol./is. 85/2(282-291), 1522-1946;1522-726X (01 Feb 2015) Author(s): Bujak M., Stilp E., Meller S.M., Cal N., Litsky J., Setaro J.F., Mena C. Language: English Abstract: Percutaneous carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy for the treatment of carotid atherosclerotic disease. The main risk of CAS is the occurrence of neuro-vascular complications; however, carotid artery stenting-related dysautonomia (CAS-D) (hypertension, hypotension, and bradycardia) is the most frequently reported problem occurring in the periprocedural period. Alterations in autonomic homeostasis result from baroreceptor stimulation, which occurs particularly at the time of balloon inflation in the region of the carotid sinus. The response can be profound enough to induce asystole or even complete cessation of postganglionic sympathetic nerve activity. Frequency and factors predisposing a patient to CAS-D have been investigated in several studies; however, there are significant discrepancies in results among reports. Lack of consistent findings may arise from using different methods and definitions, as well as other factors discussed in detail in this review. Furthermore, a correlation of CAS-D with short and long-term outcomes has been investigated only in small and mostly retrospective studies, explaining why its prognostic significance remains uncertain. In this manuscript, we have focused on risk factors, pathophysiology and management of periprocedural autonomic dysfunction. As there is no standardized approach to the treatment of CAS-D, we present an algorithm for the periprocedural management of patients undergoing CAS. The proposed algorithm was developed based on our procedural experience as well as data from the available literature. The Yale Algorithm was successfully implemented at our institution and we are currently collecting data for short- and long-term safety. Publication type: Journal: Review Source: EMBASE 6.Title: Effect of high-dose clopidogrel according to CYP2C19*2 genotype in patients undergoing percutaneous coronary intervention- a systematic review and meta-analysis. Citation: Thrombosis Research, March 2015, vol./is. 135/3(449-58), 0049-3848;1879-2472 (2015 Mar) Author(s): Zhang L, Yang J, Zhu X, Wang X, Peng L, Li X, Cheng P, Yin T Language: English Abstract: INTRODUCTION: High-dose clopidogrel has been recommended to overcome clopidogrel non-responsiveness in patients undergoing percutaneous coronary intervention (PCI), especially those with CYP2C19 loss-of-function genotypes. However, there is controversy over the pharmacodynamics and clinical effects of the strategy. This meta-analysis was conducted to evaluate the antiplatelet effects of high-dose clopidogrel according to CYP2C19*2 alleles in patients undergoing PCI.METHODS: Based on PubMed, Cochrane, and EMBASE prior to June 1st, 2014, a systematic review and meta-analysis was conducted to evaluate the antiplatelet effects of high-dose clopidogrel on platelet reactivity and clinical outcomes in PCI treated patients according to CYP2C19*2 genotypes. The reported outcomes including on-treatment platelet reactivity (OTPR), high on-treatment platelet reactivity (HTPR), major adverse cardiovascular events (MACE), stent thrombosis and composite cardiovascular events.RESULTS: Nineteen studies involving 10,960 patients were included. After high-dose clopidogrel administration (600/900mg loading dose and/or 150mg/day maintenance dose), compared with non-carriers, carriers of CYP2C19*2 genotype had significantly increased OTPR (SMD for VASP assay: 0.69, 95% CI: 0.48-0.90, p=4x10(-4); for VerifyNow P2Y12 assay: 0.70, 95% CI: 0.54-0.85, p<10(-5); for LTA assay:0.58, 95% CI: 0.48-0.69, p=4x10(-4)). The incidence rate of HTPR was higher in CYP2C19*2 carriers after high-dose clopidogrel treatment (RR: 1.21, 95% CI:1.05-1.39, p=0.008 for cutoff PRI >50% by VASP assay; RR: 1.69, 95% CI: 1.44-1.98, p<1x10(-4) for cutoff

PRU >230 by VerifyNow P2Y12 assay). As for clinical outcomes, CYP2C19*2 was associated with higher risk for MACE (RR: 1.68, 95% CI: 1.19- 2.37, p=0.003), stent thrombosis (RR: 1.75, 95% CI: 1.31-2.34, p=0.0001), as well as composite cardiovascular events (RR: 1.82, 95% CI: 1.42- 2.34, p<10(-5)) after treated by high-dose clopidogrel.CONCLUSION: High-dose clopidogrel could not overcome the variability of clopidogrel antiplatelet effects between the CYP2C19 *2 carriers and non-carriers in patients treated with PCI.Copyright &#xa9; 2014 Elsevier Ltd. All rights reserved. Publication type: Journal Article Source: MEDLINE 7.Title: Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis. Citation: Heart, March 2015, vol./is. 101/6(455-62), 1355-6037;1468-201X (2015 Mar 15) Author(s): Zhang D, Lv S, Song X, Yuan F, Xu F, Zhang M, Yan S, Cao X Language: English Abstract: OBJECTIVES: The purpose of this study was to investigate whether fractional flow reserve (FFR) should be performed for patients with coronary artery disease (CAD) to guide the percutaneous coronary intervention (PCI) strategy.BACKGROUND: PCI is the most effective method to improve the outcomes of CAD. However, the proper usage of PCI has not been achieved in clinical practice.METHODS: A meta-analysis was performed on angiography-guided PCI and FFR-guided PCI strategies. Prospective and retrospective studies were included when research subjects were patients with CAD undergoing PCI. The primary endpoint was the rate of major adverse cardiac events (MACE) or major adverse cardiac and cerebrovascular events (MACCE). Secondary endpoints included death, myocardial infarction (MI), repeat revascularisation and death or MI.RESULTS: Four prospective and three retrospective studies involving 49 517 patients were included. Absolute risks of MACE/MACCE, death, MI, revascularisation and death or MI for angiography-guided PCI and FFR-guided PCI were 34.8% vs 22.5%, 15.3% vs 7.6%, 8.1% vs 4.2%, 20.4% vs 14.8%, and 21.9% vs 11.8%, respectively. The meta-analysis demonstrated that FFR-guided PCI was associated with lower MACE/MACCE (OR: 1.71, 95% CI 1.31 to 2.23), death (OR: 1.64, 95% CI 1.37 to 1.96), MI (OR: 2.05, 95% CI 1.61 to 2.60), repeat revascularisation (OR: 1.25, 95% CI 1.09 to 1.44), and death or MI (OR: 1.84, 95% CI 1.58 to 2.15) than angiography-guided PCI strategy.CONCLUSIONS: This meta-analysis supports current guidelines advising the FFR-guided PCI strategy for CAD. PCI should only be performed when haemodynamic significance is found.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Publication type: Journal Article Source: MEDLINE Full text: Available Highwire Press at Heart 8.Title: Furosemide with saline hydration for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: A meta-analysis of randomized controlled trials Citation: Medical Science Monitor, January 2015, vol./is. 21/(292-297), 1234-1010;1643-3750 (23 Jan 2015) Author(s): Duan N., Zhao J., Li Z., Dong P., Wang S., Zhao Y., Wang L., Wang H. Language: English Abstract: Background: The clinical efficacy of furosemide administration in preventing contrast-induced nephropathy (CIN) remains uncertain. This meta-analysis was designed to update data on the incidence of CIN with additional furosemide treatment beyond saline hydration in comparison with hydration alone in patients undergoing percutaneous coronary intervention (PCI). Material/Methods: A computerized literature search of MEDLINE, EMBASE, and Cochrane databases was performed. Trials were eligible if they enrolled patients undergoing coronary angiography and randomly allocated participants to receive furosemide administration in addition to saline hydration or saline hydration alone. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for combinations of studies. Results: Five trials involving 1294 patients (640 for additional furosemide treatment and 654 for hydration alone) were included in the meta-analysis. In the synthesis of data, additional furosemide administration had little impact on the incidence of CIN post-PCI compared with peri-procedural saline hydration alone (OR=0.96; 95% CI 0.33-2.84, p=0.95). Moreover, as for the subsequent need for dialysis, there was no statistical significant difference between the 2 groups (OR=1.01; 95% CI 0.38-2.67, p=0.99). Sensitivity analyses did not show any relevant influence on the overall results. There was no publication bias in the meta-analysis. Conclusions: Furosemide administration did not achieve additional benefit beyond saline hydration in reducing the incidence of CIN in patients undergoing PCI. Publication type: Journal: Article Source: EMBASE

9.Title: High dose statin loading prior to percutaneous coronary intervention decreases cardiovascular events: a meta-analysis of randomized controlled trials. Citation: Catheterization & Cardiovascular Interventions, January 2015, vol./is. 85/1(53-60), 1522-1946;1522-726X (2015 Jan 1) Author(s): Benjo AM, El-Hayek GE, Messerli F, DiNicolantonio JJ, Hong MK, Aziz EF, Herzog E, Tamis-Holland JE Language: English Abstract: OBJECTIVE: We performed a meta-analysis of randomized controlled trials of statin loading prior to percutaneous coronary intervention (PCI).BACKGROUND: Statin loading prior to PCI has been shown to decrease peri-procedural myocardial infarction (pMI) but less is known regarding the clinical benefit of pre-procedural statin loading.METHODS: We searched for trials of statin naive patients presenting with stable angina or NSTE-ACS and treated with statins prior to PCI. We evaluated the incidence of pMI and major cardiac events including spontaneous myocardial infarction, death, and target vessel revascularization.RESULTS: Out of 1,210 articles, 14 randomized controlled trials were included in this meta-analysis. Among 3,146 patients, 1,591 patients were randomized to a loading dose of statin before PCI and 1,555 patients were given statin therapy initiated only after the PCI. Statin loading prior to PCI was associated with a 56% relative reduction in pMI (OR: 0.44, 95% CI: 0.35-0.56; P<0.00001). There was a 41% reduction in clinical events in follow-up in the group of patients treated with statin loading prior to PCI (OR: 0.59, 95% CI: 0.38-0.92, P=0.02). When stratified according to the clinical presentation, the results were only significant for those patients with NSTE-ACS (OR: 0.18, 95% CI: 0.07-0.47; P=0.0005) and was not noted in the group of patients who underwent PCI for stable angina (OR: 0.92, 95% CI: 0.53-1.61; P=0.78).CONCLUSIONS: High dose statin therapy given prior to PCI in patients with NSTE-ACS is associated with a reduction in pMI and short-term clinical events. &#xa9; 2013 Wiley Periodicals, Inc.Copyright &#xa9; 2013 Wiley Periodicals, Inc. Publication type: Journal Article Source: MEDLINE 10.Title: Infarct size reduction in acute myocardial infarction Citation: Heart, January 2015, vol./is. 101/2(155-160), 1355-6037;1468-201X (01 Jan 2015) Author(s): McAlindon E., Bucciarelli-Ducci C., Suleiman M.S., Baumbach A. Language: English Abstract: Blood and imaging biomarkers are tools used in clinical practice to assess infarct size and can be adopted in clinical trials. Among the imaging techniques, CMR represents the most promising technique due to its unique myocardial tissue characterisation, high resolution, and accurate quantitative assessment of myocardial damage. Many agents/interventions have been, and continue to be, investigated in trials to reduce infarct size following STEMI, with the aim of reducing mortality and morbidity. Some have been adopted into clinical care while others are more controversial, and ongoing studies will hopefully determine the best strategy to reduce infarct size in STEMI. Whatever the outcome, such a strategy is likely to involve a combination of pharmacotherapy and interventions. Publication type: Journal: Review Source: EMBASE Full text: Available Highwire Press at Heart 11.Title: Ischaemic postconditioning reduces infarct size: Systematic review and meta-analysis of randomized controlled trials Citation: Archives of Cardiovascular Diseases, January 2015, vol./is. 108/1(39-49), 1875-2136;1875-2128 (01 Jan 2015) Author(s): Touboul C., Angoulvant D., Mewton N., Ivanes F., Muntean D., Prunier F., Ovize M., Bejan-Angoulvant T. Language: English Abstract: Background. - Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aimed at reducing reperfusion injury, such as cardiac ischaemic postconditioning (IPost), may reduce IS and improve clinical outcomes. IPost has been shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI). Aims. - To provide an updated summary of the efficacy of IPost, assessed by analysing accuratesurrogate markers of IS. Methods. - We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. The main outcome was area under thecurve of serum creatine kinase release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution, direct measurement of IS by single-photon emission computed tomography and estimation of IS by cardiac magnetic resonance (CMR-IS).Results. - Eleven studies were retrieved, including 1313 STEMI patients undergoing PPCI with or without IPost. Compared with controls, we observed a significant reduction in CK-AUC (standard mean difference [SMD] -2.84 IU/L, 95% CI -5.43 to

-0.25 IU/L; P = 0.03). Other surrogate markers, such as CMR-IS (SMD -0.36, 95% CI -0.88 to 0.15; P = 0.16), showed a non-significant IS reduction in the IPost group. Conclusions. - This meta-analysis, dealing with accurate surrogate markers of IS, suggests that IPost reduces IS. However, results should be interpreted cautiously because of limited sample sizes and significant heterogeneity. Whether this translates into improvements in cardiac function and patient prognosis still needs to be demonstrated in larger prospective randomized controlled studies that are powered sufficiently. Publication type: Journal: Review Source: EMBASE 12.Title: Management of Coronary Disease in the Era of Transcatheter Aortic Valve Replacement: Comprehensive Review of the Literature Citation: Interventional Cardiology Clinics, January 2015, vol./is. 4/1(13-21), 2211-7458 (01 Jan 2015) Author(s): Poulin A., Rodes-Cabau J., Paradis J.-M. Language: English Abstract: Among the cohort of complex and multifaceted patients undergoing transcatheter aortic valve replacement (TAVR), the prevalence of coronary artery disease (CAD) ranges from 48% to 75%. However, optimal management of CAD in this setting has not been established. This article provides a comprehensive review of the literature to depict the actual knowledge on the subject of aortic stenosis and concomitant CAD. This article also aids heart teams in their decision-making process to appropriately manage these challenging patients with aortic stenosis and CAD. Upcoming randomized studies will clarify the influence of CAD, the best timing for percutaneous coronary intervention, and its impact on TAVR results. Publication type: Journal: Review Source: EMBASE 13.Title: Management of multivessel coronary disease in STEMI patients: A systematic review and meta-analysis Citation: International Journal of Cardiology, January 2015, vol./is. 179/(552-557), 0167-5273;1874-1754 (20 Jan 2015) Author(s): Moretti C., D'Ascenzo F., Quadri G., Omede P., Montefusco A., Taha S., Cerrato E., Colaci C., Chen S.-L., Biondi-Zoccai G., Gaita F. Language: English Abstract: Background Appropriate management for patients with multivessel coronary disease presenting with ST segment Elevation Myocardial Infarction (STEMI) remains to be defined. Methods and results Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis, reporting about STEMI patients with multivessel coronary disease treated with either a culprit only or complete revascularization strategy, excluding patients in cardiogenic shock. Prespecified analysis was performed according to the strategy of complete revascularization, either during the same procedure of primary percutaneous coronary intervention (PCI) or during the index hospitalization. MACE (a composite and mutually exclusive end point of death or myocardial infarction or revascularization) at follow-up of at least one year was the primary end point. 9 studies with 4686 patients compared culprit only versus complete PCI performed during the primary PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27], I² = 0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03], I² = 0%). No significant difference was found for the components of the primary outcome, apart from a reduction in repeated revascularization for patients undergoing complete PCI during the STEMI procedure (OR 0.62 [0.39, 0.98], I² = 0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions versus complete PCI performed during index hospitalization. 90 day risk of MACE did not differ nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I² = 0%), with a similar reduction in repeated revascularization (0.60 [0.40, 0.90], I² = 0%). Conclusions Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow-up and offers a reduction in repeated revascularization at one year. Publication type: Journal: Review Source: EMBASE 14.Title: Management of multivessel coronary disease in STEMI patients: a systematic review and meta-analysis. Citation: International Journal of Cardiology, January 2015, vol./is. 179/(552-7), 0167-5273;1874-1754 (2015 Jan 20) Author(s): Moretti C, D'Ascenzo F, Quadri G, Omede P, Montefusco A, Taha S, Cerrato E, Colaci C, Chen SL, Biondi-Zoccai G, Gaita F Language: English Abstract: BACKGROUND: Appropriate management for patients with multivessel coronary disease presenting with ST

segment Elevation Myocardial Infarction (STEMI) remains to be defined.METHODS AND RESULTS: Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis, reporting about STEMI patients with multivessel coronary disease treated with either a culprit only or complete revascularization strategy, excluding patients in cardiogenic shock. Prespecified analysis was performed according to the strategy of complete revascularization, either during the same procedure of primary percutaneous coronary intervention (PCI) or during the index hospitalization. MACE (a composite and mutually exclusive end point of death or myocardial infarction or revascularization) at follow-up of at least one year was the primary end point. 9 studies with 4686 patients compared culprit only versus complete PCI performed during the primary PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27], I(2)=0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03], I(2)=0%). No significant difference was found for the components of the primary outcome, apart from a reduction in repeated revascularization for patients undergoing complete PCI during the STEMI procedure (OR 0.62 [0.39, 0.98], I(2)=0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions versus complete PCI performed during index hospitalization. 90 day risk of MACE did not differ nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I(2)=0%), with a similar reduction in repeated revascularization (0.60 [0.40, 0.90], I(2)=0%).CONCLUSIONS: Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow-up and offers a reduction in repeated revascularization at one year.Copyright &#xa9; 2014 Elsevier Ireland Ltd. All rights reserved. Publication type: Journal Article Source: MEDLINE 15.Title: Meta-analysis appraising high maintenance dose clopidogrel in patients who underwent percutaneous coronary intervention with and without high on-clopidogrel platelet reactivity Citation: American Journal of Cardiology, March 2015, vol./is. 115/5(592-601), 0002-9149;1879-1913 (01 Mar 2015) Author(s): Ma W., Liang Y., Zhu J., Wang Y., Wang X. Language: English Abstract: The CURRENT-OASIS 7 (Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organization to Assess Strategies in Ischemic Symptoms) trial showed that a 7-day 150-mg maintenance dose (MD) clopidogrel could reduce cardiovascular events in subgroup patients who underwent percutaneous coronary intervention (PCI) compared with the 75 mg/day regimen, although whether prolonging the high MD clopidogrel (>150 mg) treatment period to at least 4 weeks can reduce major adverse cardiac events in the patients who underwent PCI with and without high on-clopidogrel platelet reactivity (HPR) is still controversial. We searched Pubmed, Embase, and Cochrane Library from inception until September 2014 for randomized controlled trials that compared high versus standard MD clopidogrel in patients who underwent PCI. Seventeen trials involving 4,822 patients who underwent PCI included 2,879 patients who were allocated to the "HPR patients" subgroup and 1,943 to the "native patients" subgroup without paying attention to the clopidogrel reactivity before randomization. Compared with the standard therapy, the high MD clopidogrel was associated with a significant reduction in the risk of major adverse cardiac events (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39 to 0.71, p <0.0001) in patients who underwent PCI. The HPR patients subgroup was also benefited from such high MD treatment (OR 0.54, 95% CI 0.38 to 0.77, p = 0.0007). The observed benefits were mainly attributed to treatment-associated reduction in stent thrombosis (OR 0.43, 95% CI 0.23 to 0.78, p = 0.006) and target vessel revascularization (OR 0.38, 95% CI 0.20 to 0.74, p = 0.004). There was no difference in the rate of major/minor bleeding event between the high and standard MD group (OR 0.80, 95% CI 0.56 to 1.13, p = 0.21). In conclusion, the efficacy and safety of at least 4 weeks' high MD clopidogrel is greater than that of standard therapy for patients who underwent PCI with and without HPR. Publication type: Journal: Article Source: EMBASE 16.Title: Meta-analysis of deferral versus performance of coronary intervention based on coronary pressure-derived fractional flow reserve Citation: American Journal of Cardiology, February 2015, vol./is. 115/3(385-391), 0002-9149;1879-1913 (01 Feb 2015) Author(s): Nascimento B.R., Belfort A.F.L., Macedo F.A.C., Sant'Anna F.M., Pereira G.T.R., Costa M.A., Ribeiro A.L.P. Language: English Abstract: Fractional flow reserve (FFR) has been proposed as the gold standard to assess functional severity of coronary artery stenosis and to stratify which lesions should be subjected to intervention (percutaneous coronary intervention [PCI]). A systematic review was performed in MEDLINE and EMBASE including studies indexed until November 2013 that used FFR for deferral or performance of PCI. Outcomes of interest were death, acute myocardial infarction (AMI), and new revascularization (RV). Nineteen studies were included, totaling 3,097 patients

(3,796 lesions). Mean follow-up was 21.2 months. In indirect comparisons, FFR-PCI and FFR-defer groups had similar death (2.2% vs 2.0%, respectively, p = 0.86) and AMI rates (1.9% vs 1.9%, respectively, p = 1.00). RV rates were higher in the FFR-PCI group (14.0% vs 4.4%, p = 0.002). Direct comparisons (2-arm trials) also showed no differences in death (odds ratio [OR] 1.86 [95% CI 0.81 to 4.27], I² = 11.5, p = 0.14) and AMI rates (OR 0.75 [95% CI 0.21 to 2.69], I² = 47.1, p = 0.66); RV rates were again higher in the FFR-PCI (OR 3.10 [95% CI 1.25 to 7.70], I² = 72.2, p = 0.015). Meta-regression suggests influence of male gender on RV rates (beta = 0.058, p = 0.026). In conclusion, deferral of PCI based on FFR is a safe strategy. Considerable heterogeneity was observed, however. Publication type: Journal: Article Source: EMBASE 17.Title: Meta-analysis of short-term high versus low doses of atorvastatin preventing contrast-induced acute kidney injury in patients undergoing coronary angiography/percutaneous coronary intervention Citation: Journal of Clinical Pharmacology, February 2015, vol./is. 55/2(123-131), 0091-2700;1552-4604 (February 2015) Author(s): Wu H., Li D., Fang M., Han H., Wang H. Language: English Abstract: This study aimed to investigate the impact of different doses of atorvastatin on contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) requiring contrast media by performing a meta-analysis. We searched the PubMed, EMBASE, Cochrane Library, Wanfang database, China National Knowledge Infrastructure, and VIP database through April 2014. Only randomized controlled trials (RCTs) comparing short-term high-dose atorvastatin with low-dose atorvastatin on CI-AKI were selected. The main outcomes were the change of acute kidney injury markers and the incidence of contrast-induced nephropathy (CIN). We combined 14 RCTs consisting of 1,689 patients. Compared with the low-dose atorvastatin, high-dose atorvastatin treatment was associated with a reduction in serum creatinine levels (weighted mean differences [WMD]-0.1 mg/dL; 95%CI -0.14 to -0.05). In addition, high-dose atorvastatin treatment was also associated with a lower incidence of CIN (risk ratios 0.41; 95%CI 0.29-0.56). This meta-analysis suggests that short-term high-dose atorvastatin therapy appears to be superior to the low-dose atorvastatin in preventing CI-AKI among patients undergoing CAG/PCI requiring contrast media. Publication type: Journal: Review Source: EMBASE 18.Title: Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients+. Citation: European Journal of Cardio-Thoracic Surgery, March 2015, vol./is. 47/3(397-406), 1010-7940;1873-734X (2015 Mar) Author(s): Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH, Rahmanian PB, Wahlers T Language: English Abstract: Percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) grafting are both established therapeutic options for single-vessel disease of the left anterior descending artery (LAD). The present systematic review with meta-analysis aims to determine the current strength of evidence for or against PCI and MIDCAB for revascularization of the LAD. Therefore, we performed a meta-analysis of randomized, controlled trials (RCTs) and observational trials (OTs) that reported clinical outcome after isolated LAD revascularization. Analysed postoperative outcomes included major adverse cardiac and cerebrovascular events (MACCEs), all-cause mortality, myocardial infarction and stroke. Pooled treatment effects [odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95% CI)] were assessed using a fixed- or random-effects model. A total of 2885 patients from 12 studies (6 RCTs, 6 OTs) were identified after a literature search of major databases using a predefined list of keywords. PCI of the LAD was performed in 60.7% (n = 1751) and MIDCAB in 39.3% of patients (n = 1126). Pooled-effect estimates revealed an increased incidence for MACCEs after PCI (OR 1.98; 95% CI 1.45-2.69; P < 0.0001) 6 months after the procedure. Especially, PCI was particularly associated with an increased odds for target vessel revascularization (OR 2.11; 95% CI 1.00-4.47; P = 0.0295). No differences with regard to stroke, myocardial infarction and all-cause mortality were observed between both revascularization strategies. Patients after PCI had a shorter length of hospital stay (WMD -3.37 days; 95% CI (-)4.92 to (-)1.81; P < 0.0001). In conclusion, the present systematic review underscores the superiority of MIDCAB over PCI for treatment of single-vessel disease of the LAD. Copyright &#xa9; The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Publication type: Journal Article

Source: MEDLINE Full text: Available Highwire Press at European Journal of Cardio-Thoracic Surgery Full text: Available Highwire Press at European Journal of Cardio-Thoracic Surgery 19.Title: Optimal anticoagulation duration of unfractionated and low molecular weight heparin in non-ST elevation acute coronary syndrome: a systematic review of the literature. Citation: International Journal of Cardiology, December 2014, vol./is. 177/2(461-6), 0167-5273;1874-1754 (2014 Dec 15) Author(s): Riaz IB, Asawaeer M, Riaz H, Gabriel WM, Tabash IK, Bilal J, Alpert JS Language: English Abstract: INTRODUCTION: In this PCI era, non-invasive management for patients presenting with non-ST elevation acute coronary syndrome continues to be relevant in several clinical circumstances. The duration of anticoagulation in non-invasively treated group is not clear. The use of heparin can be associated with fatal side effects. Thus, defining the optimal duration of therapy has significant implications for patient safety and cost.METHODS: Literature search was conducted using Medline (PubMed and Ovid SP), Embase, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) and Cochrane Database of Systematic Review (CDSR) from the inception of these databases till present (August 2013). Only studies on humans and in English language were included. We included only published clinical trials which used UFH or LMWH as the anticoagulation agent.RESULTS: Initial search revealed 548 studies with 182 meeting inclusion criteria for full review. The duration of therapy was reported in 20 of 182 studies with an average treatment duration of 2-8 days. There was a trend towards increased bleeding without significant improvement in cardiovascular outcomes when anticoagulation was continued for more than 5-7 days. No single trial directly analyzed the composite end point outcome or adverse events in correlation with the duration of anticoagulation.CONCLUSION: There is a lack of good quality evidence to define the optimal duration of anticoagulation in the management of NSTE ACS. Well-designed, methodologically rigorous database studies are required to determine the shortest duration of therapy which achieves the benefits of anticoagulants while minimizing the costs and risks associated with prolonged anticoagulant use.Copyright &#xa9; 2014 Elsevier Ireland Ltd. All rights reserved. Publication type: Journal Article Source: MEDLINE 20.Title: ORAl iMmunosuppressive therapy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials. Citation: Atherosclerosis, December 2014, vol./is. 237/2(410-7), 0021-9150;1879-1484 (2014 Dec) Author(s): Cassese S, De Luca G, Ribichini F, Cernigliaro C, Sansa M, Versaci F, Proietti I, Stankovic G, Stojkovic S, Fernandez-Pereira C, Tomai F, Vassanelli C, Antoniucci D, Serruys PW, Kastrati A, Rodriguez AE Language: English Abstract: OBJECTIVE: The role of oral immunosuppressive therapy (OIT) to prevent restenosis after percutaneous coronary intervention (PCI) and stenting is still controversial. This study evaluates the impact of oral administration of prednisone or sirolimus to prevent restenosis.METHODS: We conducted a meta-analysis of trials in which PCI-patients were randomized to bare metal stents (BMS) plus OIT (BMS + OIT group) versus BMS or drug-eluting stents alone (BMS/DES group). Primary endpoints were target lesion revascularization and death/myocardial infarction (MI). Secondary endpoints were death, MI, stent thrombosis and in-stent late lumen loss. Hazard ratio and weighted geometric mean difference [95% confidence intervals] served as summary statistics.RESULTS: Individual data of seven trials (1246 patients [BMS + OIT, n = 608 versus BMS/DES, n = 638] with 1456 coronary lesions) were merged. At a median follow-up of 360 days, BMS + OIT versus BMS/DES significantly reduced the risk of revascularization (0.49 [0.24-0.98], P = 0.04). In particular, BMS + OIT reduced the risk of revascularization (0.38 [0.21-0.67], P < 0.001) and late lumen loss (-0.39 mm [-0.67, -0.11], P < 0.001) as compared with BMS alone. BMS + OIT versus BMS/DES showed a similar risk of death/MI (0.67 [0.29-1.53], P = 0.34), death (0.82 [0.25-2.69], P = 0.71), MI (0.58 [0.24-1.39], P = 0.22) and stent thrombosis (0.43 [0.10-1.87], P = 0.26).CONCLUSION: In patients undergoing PCI the use of BMS and oral immunosuppressive therapy reduces the risk of revascularization as compared with BMS alone but not as compared with DES alone, while these therapies display a similar risk of death/MI. The advantage of adding oral immunosuppressive therapy to BMS is due to a lower risk of restenosis as compared with BMS alone.Copyright &#xa9; 2014 Elsevier Ireland Ltd. All rights reserved. Publication type: Journal Article Source: MEDLINE 21.Title: Paclitaxel-eluting versus bare metal stents in primary PCI: a pooled patient-level meta-analysis of

randomized trials. Citation: Journal of Thrombosis & Thrombolysis, January 2015, vol./is. 39/1(101-12), 0929-5305;1573-742X (2015 Jan) Author(s): De Luca G, Dirksen MT, Kelbaek H, Thuesen L, Vink MA, Kaiser C, Chechi T, Spaziani G, Di Lorenzo E, Suryapranata H, Stone GW Language: English Abstract: Concerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Therefore, we performed a meta-analysis based on individual patient data to evaluate long-term safety and effectiveness of paclitaxel-eluting stent (PES) as compared to bare metal stents (BMS) in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. We examined all completed randomized trials on PES for STEMI. Individual patient data were obtained from six trials. We performed survival analyses with the use of Cox-regression analysis stratified according to trial. Kaplan-Meier survival curves are presented with event rates reported as estimated probabilities. A subsequent landmark analysis was performed for patients who were event-free at 1-year follow-up in order to define outcome in terms of early (<1 year) and late (>1 year) events. A total of six trials were finally included in the meta-analysis with 4435 patients, 2875 (64.8 %) assigned to PES and 1560 (35.2 %) to BMS. No significant differences in baseline characteristics were observed between the two groups. However, a significantly higher percentage of patients in the DES group were on dual antiplatelet therapy during 3-year follow-up, as compared to BMS. At long-term follow-up (1,095 [1,090-1,155] days), no significant difference between PES and BMS was observed in mortality (9.2 vs 11.9 %, respectively, HR [95 % CI] = 0.84 [0.67, 1.06], p = 0.15, pheterogeneity = 0.59), reinfarction (8.8 vs 7 %, respectively; HR [95 % CI] = 1.10 [0.84, 1.44], p = 0.51, pheterogeneity = 0.32), stent thrombosis (6.7 vs 4.0 % respectively, HR [95 % CI] = 1.13 [0.82, 1.55], p = 0.45, pheterogeneity = 0.99) and TVR (11.9 vs 20.0 %; HR [95 % CI] = 0.64 [0.54, 0.77], p < 0.0001, pheterogeneity = 0.25). Landmark analysis showed that PES was associated with a significantly higher rate of very late reinfarction (>1 year) (5.6 vs 3.9 %, HR [95 % CI] = 1.61 [1.05-2.47], p = 0.03, pheterogeneity = 0.51], very late ST (2.9 vs 1.1 %, HR [95 % CI] = 1.88 [1.00-3.54], p = 0.05, pheterogeneity = 0.94]. The present pooled patient-level meta-analysis demonstrates that among STEMI patients undergoing primary PCI, PES compared to BMS is associated with a significant reduction in TVR at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with PES. Publication type: Journal Article Source: MEDLINE 22.Title: Predicting and preventing vascular complications following percutaneous coronary intervention in women Citation: Expert Review of Cardiovascular Therapy, February 2015, vol./is. 13/2(163-172), 1477-9072;1744-8344 (01 Feb 2015) Author(s): Kim M., Chu A., Khan Y., Malik S. Language: English Abstract: The development of vascular complications is associated with increased morbidity and mortality in patients undergoing percutaneous coronary intervention. While the incidence of percutaneous coronary intervention-related vascular complications has greatly improved over time, female sex still persists as a significant and independent predictor of periprocedural vascular complications, which in turn is associated with a greater risk of short- and long-term mortality. This review provides a contemporary overview of the data on the important issues regarding the risk of percutaneous coronary intervention in women. It examines the intrinsic sex-related factors that may be contributing to women's heightened bleeding risk while also examining the various pharmacologic and procedural bleeding avoidance strategies currently in the literature, with a focus on their potential role and benefit in women specifically. Publication type: Journal: Review Source: EMBASE 23.Title: Preventive stenting in acute myocardial infarction Citation: JACC: Cardiovascular Interventions, January 2015, vol./is. 8/1(131-138), 1936-8798;1876-7605 (01 Jan 2015) Author(s): Pollack A., Mohanty B.D., Handa R., Looser P.M., Fuster V., King S.B., Sharma S.K. Language: English Abstract: Current practice guidelines advocate culprit vessel intervention alone in patients with ST-segment elevation myocardial infarction (STEMI) found to have multivessel coronary disease during primary percutaneous coronary intervention (PCI). The debate on the timing of noninfarct artery intervention has recently been

reinvigorated by the PRAMI (Preventive Angioplasty in Acute Myocardial Infarction) trial, in which patients undergoing preventive PCI of significant nonculprit lesions at the time primary PCI for STEMI had reduced rates of cardiac death, nonfatal myocardial infarction, and refractory angina. Given that previous literature has cautioned against multivessel PCI during STEMI, this raises the question of whether technical and pharmacological advances in PCI may have opened the door to safely revisit this issue with additional clinical rigor. The impact of STEMI pathophysiology on nonculprit vessel plaque, how treatment of nonculprit lesions alters the natural history of coronary disease after STEMI, and whether this results in a clinical benefit remain unclear, and much of the existing data are retrospective. Additionally, the PRAMI trial did not include a staged PCI, leaving questions as to how this approach might fare compared with simultaneous preventive PCI. In this review, we discuss the pathophysiology of nonculprit vessel plaque in STEMI, provide a summary of the existing literature on the topic, and discuss the PRAMI trial in the face of previous data and possible future directions for further study. Publication type: Journal: Review Source: EMBASE 24.Title: Radial Artery Occlusion After Transradial Approach to Cardiac Catheterization Citation: Current Atherosclerosis Reports, 2015, vol./is. 17/3, 1523-3804;1534-6242 (2015) Author(s): Wagener J.F., Rao S.V. Language: English Abstract: Radial artery occlusion (RAO) is the most common complication of the transradial approach (TRA) to cardiac catheterization, with a reported incidence between 0.8 % and 30 %. RAO is likely the result of acute thrombus formation and complicated by neointimal hyperplasia. Most RAO are asymptomatic with rare cases of acute hand or digit ischemia reported in the literature. The role of testing for dual circulation to the hand in determining the safety of TRA as it relates to symptomatic RAO is controversial; however, modifiable risk factors like low sheath-to-artery ratio, adequate anticoagulation, and non-occlusive ("patent") hemostasis are likely to prevent RAO. This review examines the incidence of RAO, potential mechanisms leading to RAO, and strategies to prevent and treat RAO. Publication type: Journal: Review Source: EMBASE 25.Title: Remote ischemic preconditioning reduces perioperative cardiac and renal events in patients undergoing elective coronary intervention: a meta-analysis of 11 randomized trials. Citation: PLoS ONE [Electronic Resource], 2014, vol./is. 9/12(e115500), 1932-6203;1932-6203 (2014) Author(s): Pei H, Wu Y, Wei Y, Yang Y, Teng S, Zhang H Language: English Abstract: BACKGROUND: Results from randomized controlled trials (RCT) concerning cardiac and renal effect of remote ischemic preconditioning(RIPC) in patients with stable coronary artery disease(CAD) are inconsistent. The aim of this study was to explore whether RIPC reduce cardiac and renal events after elective percutaneous coronary intervention (PCI).METHODS AND RESULTS: RCTs with data on cardiac or renal effect of RIPC in PCI were searched from Pubmed, EMBase, and Cochrane library (up to July 2014). Meta-regression and subgroup analysis were performed to identify the potential sources of significant heterogeneity(I(2) > 40%). Eleven RCTs enrolling a total of 1713 study subjects with stable CAD were selected. Compared with controls, RIPC significantly reduced perioperative incidence of myocardial infarction (MI) [odds ratio(OR) = 0.68; 95% CI, 0.51 to 0.91; P = 0.01; I(2) = 41.0%] and contrast-induced acute kidney injury(AKI) (OR = 0.61; 95% CI, 0.38 to 0.98; P = 0.04; I(2) = 39.0%). Meta-regression and subgroup analyses confirmed that the major source of heterogeneity for the incidence of MI was male proportion (coefficient = -0.049; P = 0.047; adjusted R(2) = 0.988; P = 0.02 for subgroup difference).CONCLUSIONS: The present meta-analysis of RCTs suggests that RIPC may offer cardiorenal protection by reducing the incidence of MI and AKI in patients undergoing elective PCI. Moreover, this effect on MI is more pronounced in male subjects. Future high-quality, large-scale clinical trials should focus on the long-term clinical effect of RIPC. Publication type: Journal Article, Research Support, Non-U.S. Gov't Source: MEDLINE Full text: Available ProQuest at PLoS ONE Full text: Available ProQuest at PLoS One 26.Title: Revascularization in Patients with Diabetes: PCI or CABG or None at All Citation: Current Cardiology Reports, 2015, vol./is. 17/3(1-12), 1523-3782;1534-3170 (2015) Author(s): Mavromatis K., Samady H., King S.B. Language: English

Abstract: Patients with diabetes have a high incidence of coronary artery disease, with particularly high rates of acute coronary syndromes and mortality. Revascularization by coronary artery bypass grafting was found to be effective in reducing angina and mortality in patients with extensive coronary artery disease over 30 years ago. Percutaneous coronary intervention, particularly with drug-eluting stents, has more recently been demonstrated to reduce recurrent angina and improve quality of life in diabetic patients with less extensive coronary artery disease. Most recently, coronary artery bypass grafting has been shown to be superior to percutaneous coronary intervention in improving mortality in patients with diabetes and three-vessel coronary artery disease who are not at high surgical risk. The role of coronary artery bypass grafting vs. percutaneous coronary intervention in patients who have less extensive coronary artery disease and/or higher surgical risk has not been fully elucidated. Newer treatment strategies, such as percutaneous coronary intervention with second-generation drug-eluting stents, use of fractional flow reserve guidance, or hybrid revascularization combining minimally invasive coronary artery bypass grafting with percutaneous coronary intervention, may result in further improvements in outcomes in patients with diabetes and coronary artery disease. Publication type: Journal: Review Source: EMBASE 27.Title: Role of Pre-procedural C-reactive Protein Level in the Prediction of Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention: a Meta-analysisof Longitudinal Studies. Citation: Inflammation, February 2015, vol./is. 38/1(159-69), 0360-3997;1573-2576 (2015 Feb) Author(s): Bibek SB, Xie Y, Gao JJ, Wang Z, Wang JF, Geng DF Language: English Abstract: Numerous studies have reported the relation between pre-procedural C-reactive protein (CRP) levels and the risk of major adverse cardiac events (MACEs) in patients undergoing percutaneous coronary intervention (PCI). However, the results across the studies were inconsistent. The aim of this study was to evaluate the predictive effect of pre-procedural CRP levels and the risk of MACEs in patients undergoing PCI. Longitudinal studies on the association between pre-procedural CRP levels and MACEs were identified by electronic and manual searches. Summary risk ratios (RRs) and 95 % confidence intervals (CI) were calculated employing an inverse variance random-effects model irrespective of between-study heterogeneity. Thirty-three studies involving 34,367 patients with 4119 MACEs were included in this study. High CRP level was associated with increased incidences of MACEs, all-cause death, myocardial infarction, coronary revascularization, and clinical restenosis, with pooled RRs of 1.97 (95 % CI, 1.65, 2.35), 2.88 (95 % CI, 2.15, 3.86), 1.81 (95 % CI, 1.48, 2.21), 1.31 (95 % CI, 1.11, 1.56), and 1.45 (95 % CI, 1.07, 1.96), respectively. Dose-response analysis showed that every 1 mg/L increment in pre-procedural serum CRP level was associated with a significant 12 % increase in the risk of MACEs. In spite of heterogeneity across the included studies, this meta-analysis suggests that pre-procedural serum CRP level is a valuable predictor of MACEs in patients undergoing PCI. Publication type: Journal Article Source: MEDLINE 28.Title: Statins for the prevention of contrast-induced nephropathy after coronary angiography/percutaneous interventions: A meta-analysis of randomized controlled trials Citation: Journal of Cardiovascular Pharmacology and Therapeutics, March 2015, vol./is. 20/2(181-192), 1074-2484;1940-4034 (14 Mar 2015) Author(s): Liu Y.-H., Liu Y., Duan C.-Y., Tan N., Chen J.-Y., Zhou Y.-L., Li L.-W., He P.-C. Language: English Abstract: Background: Statins have been demonstrated to prevent the development of contrast-induced nephropathy (CIN). Nevertheless, clinical research has indicated conflicting results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effects of statins on CIN and the requirement of renal replacement therapy (RRT) in patients undergoing coronary angiography/percutaneous interventions. Methods: PubMed, MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central RCTs were searched for RCTs from inception to February 2014 to compare statins with placebo treatment for preventing CIN in patients undergoing coronary angiography/percutaneous interventions. Results: Nine RCTs were identified and analyzed in a total of 5143 patients involving 2560 patients with statin pretreatment and 2583 patients as control. Patients who received statin therapy had a 53% lower risk of CIN with different definitions (within 48 or 72 hours) compared to the control group based on a fixed effect model (risk ratio = 0.47, 95% confidence interval = 0.37-0.60, P <.0001) and were less likely to require RRT based on Peto fixed effect. Subgroup analysis showed that statin pretreatment could decrease the incidence of CIN in patients with preexisting renal dysfunction or diabetes mellitus. In addition, patients on rosuvastatin had a similar reduced incidence of CIN compared to patients on atorvastatin. Conclusion: This

updated meta-analysis demonstrated that preprocedural statin treatment could reduce the risk of CIN and the need for RRT in patients undergoing coronary angiography/ percutaneous interventions. Moreover, statin therapy would be helpful in reducing the incidence of CIN in high-risk patients with preexisting renal dysfunction or diabetes mellitus. Additionally, rosuvastatin and atorvastatin had similar efficacies in preventing CIN development. Publication type: Journal: Article Source: EMBASE 29.Title: Systematic review of health-related quality of life in older people following percutaneous coronary intervention. Citation: Nursing & Health Sciences, December 2014, vol./is. 16/4(415-27), 1441-0745;1442-2018 (2014 Dec) Author(s): Soo Hoo SY, Gallagher R, Elliott D Language: English Abstract: People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care. Copyright &#xa9; 2014 Wiley Publishing Asia Pty Ltd. Publication type: Journal Article Source: MEDLINE 30.Title: The transradial approach during transcatheter structural heart disease interventions: A review Citation: European Journal of Clinical Investigation, February 2015, vol./is. 45/2(215-225), 0014-2972;1365-2362 (01 Feb 2015) Author(s): Allende R., Ribeiro H.B., Puri R., Urena M., Abdul-Jawad O., del Trigo M., Veiga G., del Rosario Ortas M., Paradis J.-M., De Larochelliere R., Rodes-Cabau J. Language: English Abstract: Aims: To review the safety and feasibility of a transradial (TR) approach during transcatheter structural or congenital heart disease interventions when utilized as either as a primary or secondary arterial access site. Methods and Results: Studies and case reports published between 2002 and 2014 utilizing the TR access during transcatheter structural and congenital heart disease interventions during alcohol septal ablation (ASA), ventricular septal defect (VSD), renal denervation (RD), paravalvular leak (PVL) closure, transcatheter aortic valve implantation (TAVI, secondary access) and endovascular repair of aortic coarctation (ERAC, secondary access) were evaluated. Access-site (femoral vs. TR) vascular and bleeding complications were assessed. Femoral access complications ranged from 016% to 40%, with an overall incidence of 22% (56/2521). There were 18 reports or studies specifically evaluating the utility of TR access in the context of transcatheter structural heart disease interventions (ASA: 3; VSD: 1; RD: 3; PVL closure: 1; TAVI: 7, ERAC: 3). The use of TR access either as primary or secondary access site was feasible and allowed the completion of the procedure in all cases. The overall incidence of access-site complications following a TR approach was 05% (2/406 patients), with no major vascular or bleeding complications. Conclusions: A TR approach during transcatheter structural heart disease interventions appears to be a safe, effective means of delivering high procedural success accompanied by lower bleeding complications compared with the transfemoral approach. Publication type: Journal: Review Source: EMBASE 31.Title: Worse outcome in women with STEMI: A systematic review of prognostic studies Citation: European Journal of Clinical Investigation, February 2015, vol./is. 45/2(226-235), 0014-2972;1365-2362 (01 Feb 2015) Author(s): van der Meer M.G., Nathoe H.M., van der Graaf Y., Doevendans P.A., Appelman Y. Language: English Abstract: Background: Treatment of ST elevation myocardial infarction (STEMI) has improved enormously since the introduction of primary percutaneous coronary intervention (pPCI). It remains unclear whether differences in

survival between women and men treated with pPCI exist and whether these potential differences can be explained by gender or by differences in baseline- or procedural characteristics. Therefore we systematically reviewed the available evidence. Materials and methods: On 10 May 2013 PubMed, Embase and Cochrane were searched for studies comprising original data on STEMI patients treated with pPCI. A separate gender analysis including > 100 women was a requirement. Data were extracted and pooled whenever possible. Results: 21 studies were included from 2001 to 2013 comprising 47439 men and 16927 women. Women were older, had more diabetes (women 24%, men 15%) and hypertension (women 58%, men 45%), and were less current smokers (women 30%, men 54%). The procedural characteristics were comparable except for a longer symptom-to-balloon time (women 266 min, men 240 min) and less use of GP IIb/IIIa inhibitors in women (women 51%, men 57%). Crude short- and long-term mortality was higher in women. Although we could not pool adjusted mortality proportions due to heterogeneity, generally the difference in mortality disappeared after adjustment for baseline- and procedural characteristics. Conclusion: Mortality is higher in women with STEMI and can be explained by their unfavourable risk profile and longer symptom-to-balloon time. Publication type: Journal: Review Source: EMBASE lbra.nhs.uk

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Nanoparticles used to treat damaged arteries Thursday Feb 19 2015 "New trials suggest microscopic stealth drones could be used to seek and repair damaged arteries," The Daily Telegraph, somewhat overexcitedly, reports. A study in mice has found promising results for a targeted treatment…

Statin use may be widening health inequalities in England Friday Jan 23 2015 'Mass prescription of statins ‘will widen social inequalities’' The Independent report. A UK analysis of heart disease deaths from 2000 to 2007 found that statins were far more effective for the richest 20% of the population compared to the poorest 20%...

Angry Twitter communities linked to heart deaths Friday Jan 23 2015 "Angry tweeting 'could increase your risk of heart disease','' is the poorly reported headline in The Daily Telegraph. The study it reports on found there is a link between angry tweets and levels of heart disease deaths…

New heart attack test shows promise for women Thursday Jan 22 2015 "Doctors could spot twice as many heart attacks in women by using a newer, more sensitive blood test," BBC News reports. In women, for reasons that are unclear, a heart attack often doesn't trigger the symptom most people associate with the condition…

Does moderate drinking reduce heart failure risk? Tuesday Jan 20 2015 "Seven alcoholic drinks a week can help to prevent heart disease," the Daily Mirror reports. A US study suggests alcohol consumption up to this level may have a protective effect against heart failure…

Disclaimer and Feedback

This current awareness bulletin contains a selection of information which is not intended to be exhaustive, and although library staff have made every effort to link only to reputable and reliable websites, the information contained in this bulletin has not been critically appraised by library staff. It is therefore the responsibility of the reader to appraise this information for accuracy and relevance.

This bulletin was produced by Caroline Thomas, Librarian, Salisbury NHS Foundation Trust Healthcare Library. If you have any comments to make about this bulletin please contact Caroline.Thomas@salisbury.nhs.uk