60 research outputs found
Large, sustained cardiac lipid peroxidation and reduced antioxidant capacity in the coronary circulation after brief episodes of myocardial ischemia
AbstractOBJECTIVESWe sought to investigate whether a brief episode of myocardial ischemia produces a detectable cardiac oxidative stress in patients undergoing elective coronary angioplasty (PTCA).BACKGROUNDAlthough cardiac oxidative stress has been clearly demonstrated in experimental models of ischemia-reperfusion, its presence in patients after transient myocardial ischemia is still unclear.METHODSIn order to evaluate oxidative stress in ischemic cardiac regions, plasma conjugated dienes (CD), lipid hydroperoxides (ROOHs) and total antioxidant capacity (TRAP), independent indexes of oxidative stress, were measured in the aorta and great cardiac vein (GCV) before (t0), 1, (t1), 5 (t5) and 15 min (t15) after first balloon inflation in 15 patients undergoing PTCA on left anterior descending coronary artery (Group 1); six patients with right coronary artery stenosis (Group 2), which is not drained by the GCV, were studied as controls.RESULTSIn Group 1 at baseline, CD and ROOHs levels were higher in GCV than in aorta (p < 0.01 for both), and TRAP levels were lower (p < 0.01). Aortic levels of CD, ROOHs and TRAP did not change at any time after t0; venous levels of CD and ROOHs levels markedly increased at t1, at t5and remained elevated at t15(p < 0.01 for all comparisons vs. t0); venous levels of TRAP decreased at t1and t5(p < 0.01 vs. t0) and returned to normal at t15. In Group 2, CD, ROOHs and TRAP levels were similar in the aorta and GCV and did not change throughout the study.CONCLUSIONSShort episodes of myocardial ischemia during PTCA induce a sustained oxidative stress, which is detectable in the venous effluent of reperfused myocardium
Meta-Analysis of Impact of Different Types and Doses of Statins on New-Onset Diabetes Mellitus
Recent reports indicate that statins are associated with an increased risk for new-onset
diabetes mellitus (DM) compared with placebo and that this relation is dose dependent. The
aim of this study was to perform a comprehensive network meta-analysis of randomized
controlled trials (RCTs) investigating the impact of different types and doses of statins on
new-onset DM. RCTs comparing different types and doses of statins with placebo were
searched for using the MEDLINE, Embase, and Cochrane databases. A search of RCTs
pertinent to this meta-analysis covering the period from November 1994 to October 2012
was conducted by 2 independent investigators using the MEDLINE, Cochrane, Google
Scholar, and Embase databases as well as abstracts and presentations from major cardiovascular
meetings. Seventeen RCTs reporting the incidence of new-onset DM during statin
treatment and including a total of 113,394 patients were identified. The RCTs compared
either a statin versus placebo or high-dose versus moderate-dose statin therapy. Among
different statins, pravastatin 40 mg/day was associated with the lowest risk for new-onset
DM compared with placebo (odds ratio 1.07, 95% credible interval 0.86 to 1.30).
Conversely, rosuvastatin 20 mg/day was numerically associated with 25% increased risk for
DM compared with placebo (odds ratio 1.25, 95% credible interval 0.82 to 1.90). The impact
on DM appeared to be intermediate with atorvastatin 80 mg/day compared with placebo
(odds ratio 1.15, 95% credible interval 0.90 to 1.50). These findings were replicated at
moderate doses. In conclusion, different types and doses of statins show different potential
to increase the incidence of DM. 2013 Elsevier Inc. All rights reserved. (Am J Cardiol
2013;111:1123e1130
Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis
Summary. Background: The aim of the current study was to
perform two separate meta-analyses of available studies
comparing low-molecular-weight heparins (LMWHs) vs.
unfractionated heparin (UFH) in ST-elevation myocardial
infarction (STEMI) patients treated (i) with primary percutaneous
coronary intervention (pPCI) or (ii) with PCI after
thrombolysis. Methods: All-cause mortality was the prespecified
primary endpoint and major bleeding complications
were recorded as the secondary endpoints. Relative risk (RR)
with a 95%confidence interval (CI) and absolute risk reduction
(ARR) were chosen as the effect measure. Results: Ten studies
comprising 16 286 patients were included. The median followup
was 2 months for the primary endpoint. Among LMWHs,
enoxaparin was the compound most frequently used. In the
pPCI group, LMWHs were associated with a reduction in
mortality [RR (95% CI) = 0.51 (0.41–0.64), P < 0.001,
ARR = 3%] and major bleeding [RR (95% CI) = 0.68
(0.49–0.94), P = 0.02, ARR = 2.0%] as compared with
UFH. Conversely, no clear evidence of benefits with LWMHs
was observed in the PCI group after thrombolysis. Metaregression
showed that patients with a higher baseline risk had
greater benefits from LMWHs (r = 0.72, P = 0.02). Conclusions:
LMWHs were associated with greater efficacy and safety
than UFH in STEMI patients treated with pPCI, with a
significant relationship between risk profile and clinical benefits.
Based on this meta-analysis, LMWHs may be considered as a
preferred anticoagulant among STEMI patients undergoing
pPCI
Drug-coated balloons in treatment of in-stent restenosis: a meta-analysis of randomised controlled trials
Background Drug-coated balloons (DCBs) have been
developed for the percutaneous treatment of coronary
artery disease. An initial focus has been the management of
in-stent restenosis (ISR) but randomised controlled trials
(RCTs) have been small and powered only for angiographic
endpoints.
Objective The aim of the work was to assess the clinical
and angiographic outcomes of patients treated for ISR with
DCB versus control (balloon angioplasty or drug-eluting
stents) by a meta-analysis of RCTs.
Methods A comprehensive search was performed of
RCTs where patients with ISR were randomly assigned to
either DCB or alternative coronary intervention. Outcome
measurements were death, myocardial infarction (MI),
target lesion revascularisation (TLR), binary definition of
restenosis and in-lesion late luminal loss (LLL).
Results Four studies were identified that fulfilled the
inclusion criteria. Pooled odds ratios (ORs) were calculated
for patients treated for ISR (n = 399). Mean follow-up
duration was 14.5 months. DCBs were associated with
lower rates of TLR [8.8 vs. 29.7 % OR (95 % confidence
interval, CI) 0.20 (0.11–0.36), p\0.0001], binary restenosis
[10.3 vs. 41.3 % OR (95 % CI) 0.13 (0.07–0.24),
p\0.00001] and MI [0.5 vs. 3.8 %, OR (95 % CI) 0.21
(0.04–1.00), p = 0.05]. No significant heterogeneity was
identified.
Conclusion Drug-coated balloons appear to be effective
versus control in reducing TLR and possibly MI versus
balloon angioplasty or drug-eluting stents in the management
of ISR
Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures : a systematic review and network meta-analysis
BACKGROUND: Interventional diagnostic and therapeutic procedures requiring intravascular iodinated contrast steadily increase patient exposure to the risks of contrast-induced acute kidney injury (CIAKI), which is associated with death, nonfatal cardiovascular events, and prolonged hospitalization. The aim of this study was to investigate the efficacy of pharmacological and non-pharmacological treatments for CIAKI prevention in patients undergoing cardiovascular invasive procedures with iodinated contrast.METHODS AND FINDINGS: MEDLINE, Google Scholar, EMBASE and Cochrane databases as well as abstracts and presentations from major cardiovascular and nephrology meetings were searched, up to 22 April 2016. Eligible studies were randomized trials comparing strategies to prevent CIAKI (alone or in combination) when added to saline versus each other, saline, placebo, or no treatment in patients undergoing cardiovascular invasive procedures with administration of iodinated contrast. Two reviewers independently extracted trial-level data including number of patients, duration of follow-up, and outcomes. Eighteen strategies aimed at CIAKI prevention were identified. The primary outcome was the occurrence of CIAKI. Secondary outcomes were mortality, myocardial infarction, dialysis and heart failure. The data were pooled using network meta-analysis. Treatment estimates were calculated as odds ratios (ORs) with 95% credible intervals (CrI). 147 RCTs involving 33,463 patients were eligible. Saline plus N-acetylcysteine (OR 0.72, 95%CrI 0.57-0.88), ascorbic acid (0.59, 0.34-0.95), sodium bicarbonate plus N-acetylcysteine (0.59, 0.36-0.89), probucol (0.42, 0.15-0.91), methylxanthines (0.39, 0.20-0.66), statin (0.36, 0.21-0.59), device-guided matched hydration (0.35, 0.12-0.79), prostaglandins (0.26, 0.08-0.62) and trimetazidine (0.26, 0.09-0.59) were associated with lower odds of CIAKI compared to saline. Methylxanthines (0.12, 0.01-0.94) or left ventricular end-diastolic pressure-guided hydration (0.09, 0.01-0.59) were associated with lower mortality compared to saline.CONCLUSIONS: Currently recommended treatment with saline as the only measure to prevent CIAKI during cardiovascular procedures may not represent the optimal strategy. Vasodilators, when added to saline, may significantly reduce the odds of CIAKI following cardiovascular procedures
Effect of alpha lipoic acid on cardiac autonomic dysfunction and platelet reactivity in type 1 diabetes: rationale and design of the AUTOnomic function and platelet REACTivity trial (AUTO-REACT protocol)
The aim of this study is to assess the relationship between cardiac autonomic dysfunction and increased platelet reactivity in patients with type 1 diabetes and whether alpha lipoic acid therapy (ALA) might improve both abnormalities in these patients
‘Might Imperial Caesar, dead and turned to clay, stop a hole to keep the wind away?’
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