Healthcare Library Current Awareness Bulletin

Percutaneous Coronary Intervention and Cardiology April and May 2015

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Guidelines

Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome NICE technology appraisal guidance [TA335] Published date: March 2015 Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation NICE interventional procedure guidance [IPG516] Published date: March 2015

Cochrane Systematic Reviews

New Reviews – March 2015

Anaesthetic and sedative agents used for electrical cardioversion

Updated Reviews – March 2015

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation

Practice Changing Updates from UpToDate

INTRODUCTION —This section highlights selected specific new recommendations and/or updates that we anticipate may change usual clinical practice. Practice Changing UpDates focus on changes that may have significant and broad impact on practice, and therefore do not represent all updates that affect practice. CARDIOVASCULAR MEDICINE (OCTOBER 2014, MODIFIED MARCH 2015)

Culprit-only or multivessel PCI in patients with STEMI

●For most patients undergoing primary PCI, we suggest performing non-culprit vessel PCI of significant

lesions rather than culprit vessel only PCI (Grade 1B).

For patients with ST-elevation myocardial infarction (STEMI), the evidence is increasing that complete, multi-vessel

percutaneous coronary intervention (PCI) performed prior to hospital discharge leads to better outcomes than a

strategy of culprit vessel only PCI. The CvLPRIT trial randomly assigned 296 patients to complete revascularization

during the hospitalization or infarct related artery-only revascularization [8]. The primary composite end point (all-

cause death, recurrent MI, heart failure, and ischemia-driven revascularization at 12 months) occurred significantly

less often in the complete revascularization group. Based on this trial and the previously published PRAMI trial, we

perform PCI of non-culprit lesions during the index hospitalization in most patients with STEMI. (See "Primary

percutaneous coronary intervention in acute ST elevation myocardial infarction: Periprocedural management", section

on 'Non-culprit PCI'.)

New from UpToDate

What's new in cardiovascular medicine Additions to UpToDate considered by the editors and authors to be of particular interest. You may need your OpenAthens username and password.

Journal Articles Evidence | library.nhs.uk

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Table of Contents

1. Acute myocardial infarction: A comparison of short-term survival in national outcome registries in Sweden and

the UK

2. An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and

a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo

percutaneous coronary intervention (PIONEER AF-PCI)

3. An overview of PCI in the very elderly

4. Association of spontaneous bleeding and myocardial infarction with long-term mortality after percutaneous

coronary intervention 5. Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary

intervention in acute

myocardial infarction : The BRIGHT randomized clinical trial

6. Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: A

systematic review and meta-analysis

7. Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary

percutaneous coronary intervention: a meta-analysis of randomized controlled trials

8. Clinical utility of new bleeding criteria: A prospective study of evaluation for the Bleeding Academic Research

Consortium definition of bleeding in patients undergoing percutaneous coronary intervention

9. Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and

failed percutaneous intervention of coronary chronic total occlusions: A Meta-Analysis of Observational Studies

10. Contrast-induced nephropathy in PCI: An evidence-based approach to prevention

11. Everolimus-eluting stents or bypass surgery for multivessel coronary disease

12. Incidence of cardiac surgery following PCI: Insights from a high volume, non-surgical, UK centre

13. Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass

grafting: A meta-analysis of comparative studies

14. Meta-analysis of randomized controlled trials and adjusted observational results of use of clopidogrel, aspirin,

and oral anticoagulants in patients undergoing percutaneous coronary intervention

15. Meta-analysis of trials on mortality after percutaneous coronary intervention compared with medical therapy

in patients with stable coronary heart disease and objective evidence of myocardial ischemia

16. Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI

in STEMI patients with multivessel disease: A meta-analysis

17. Novel approaches for preventing or limiting events (Naples) III trial: Randomized comparison of bivalirudin

versus unfractionated heparin in patients at increased risk of bleeding undergoing transfemoral elective coronary

stenting

18. Percutaneous coronary invervention versus coronary artery bypass grafting: A meta-Analysis

19. Percutaneous repair of paravalvular prosthetic regurgitation: Patient selection, techniques and outcomes

20. Precision medicine to improve use of bleeding avoidance strategies and reduce bleeding in patients

undergoing percutaneous coronary intervention: Prospective cohort study before and after implementation of

personalized bleeding risks

21. Preventive versus culprit-only percutaneous coronary intervention in ST-elevation myocardial infarction

patients with multivessel disease: A meta-analysis

22. Randomized trial of primary PCI with or without routine manual thrombectomy

23. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over

time: A retrospective study

24. Slender approach and sheathless techniques

25. The transradial approach and antithrombotic therapy. rationale and outcomes

26. Transradial primary percutaneous coronary intervention

27. Trial of everolimus-eluting stents or bypass surgery for coronary disease

1.Title: Acute myocardial infarction: A comparison of short-term survival in national outcome registries in Sweden and the UK Citation: The Lancet, 2015, vol./is. 383/9925(1305-1312), 0140-6736;1474-547X (2015) Author(s): Chung S.-C., Gedeborg R., Nicholas O., James S., Jeppsson A., Wolfe C., Heuschmann P., Wallentin L., Deanfield J., Timmis A., Jernberg T., Hemingway H. Language: English Abstract: Background International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods We used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals providing care for acute coronary syndrome in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 76% (95% CI 74-77) in Sweden and 105% (104-106) in the UK. Mortality was higher in the UK in clinically relevant subgroups defined by troponin concentration, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes mellitus status, and smoking status. In Sweden, compared with the UK, there was earlier and more extensive uptake of primary percutaneous coronary intervention (59% vs 22%) and more frequent use of beta blockers at discharge (89% vs 78%). After casemix standardisation the 30-day mortality ratio for UK versus Sweden was 137 (95% CI 130-145), which corresponds to 11 263 (95% CI 9620-12 827) excess deaths, but did decline over time (from 147, 95% CI 138-158 in 2004 to 120, 112-129 in 2010; p=001). Interpretation We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths. Publication type: Journal: Article Source: EMBASE Full text: Available Lancet at Lancet, The Full text: Available Lancet at Lancet, The 2.Title: An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

Citation: American Heart Journal, April 2015, vol./is. 169/4(472-478.e5), 0002-8703;1097-6744 (01 Apr 2015) Author(s): Gibson C.M., Mehran R., Bode C., Halperin J., Verheugt F., Wildgoose P., Van Eickels M., Lip G.Y.H., Cohen M., Husted S., Peterson E., Fox K. Language: English Abstract: Background Guidelines recommendations regarding anticoagulant therapy after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF) rely on retrospective, nonrandomized observational data. Currently, patients are treated with triple-therapy (dual antiplatelet therapy [DAPT] + oral anticoagulation therapy), but neither the duration of DAPT nor the level of anticoagulation has been studied in a randomized fashion. Recent studies also suggest dual pathway therapy with clopidogrel plus oral anticoagulation therapy may be superior, and other studies suggest that novel oral anticoagulants such as rivaroxaban may further improve patient outcomes. Design PIONEER AF-PCI (ClinicalTrials.gov NCT01830543) is an exploratory, open-label, randomized, multicenter clinical study assessing the safety of 2 rivaroxaban treatment strategies and 1 vitamin K antagonist (VKA) treatment strategy in subjects who have paroxysmal, persistent, or permanent nonvalvular AF and have undergone PCI with stent placement. Approximately 2,100 subjects will be randomized in a 1:1:1 ratio to receive either rivaroxaban 15 mg once daily plus clopidogrel 75 mg daily for 12 months (a WOEST trial-like strategy), or rivaroxaban 2.5 mg twice daily (with stratification to a prespecified duration of DAPT 1, 6, or 12 months, an ATLAS trial-like strategy), or dose-adjusted VKA once daily (with stratification to a prespecified duration of DAPT 1, 6, or 12 months, traditional triple therapy). All patients will be followed up for 12 months for the primary composite end point of Thrombolysis in Myocardial Infarction major bleeding, bleeding requiring medical attention, and minor bleeding (collectively, clinically significant bleeding). Conclusion The PIONEER AF-PCI study is the first randomized comparison of VKA vs novel oral anticoagulant therapy in patients with NVAF receiving antiplatelet therapy after PCI to assess the relative risks of bleeding complications. Publication type: Journal: Article Source: EMBASE 3.Title: An overview of PCI in the very elderly Citation: Journal of Geriatric Cardiology, 2015, vol./is. 12/2(174-184), 1671-5411 (2015) Author(s): Shanmugam V.B., Harper R., Meredith I., Malaiapan Y., Psaltis P.J. Language: English Abstract: Cardiovascular disease, and in particular ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly (> 80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now con-stituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indicates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI settings: elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients. Publication type: Journal: Review Source: EMBASE 4.Title: Association of spontaneous bleeding and myocardial infarction with long-term mortality after percutaneous coronary intervention Citation: Journal of the American College of Cardiology, April 2015, vol./is. 65/14(1411-1420), 0735-1097;1558-3597 (14 Apr 2015) Author(s): Kazi D.S., Leong T.K., Chang T.I., Solomon M.D., Hlatky M.A., Go A.S. Language: English Abstract: Background Platelet inhibition after percutaneous coronary intervention (PCI) reduces the risk of myocardial infarction (MI) but increases the risk of bleeding. MIs and bleeds during the index hospitalization for PCI

are known to negatively affect long-term outcomes. The impact of spontaneous bleeding occurring after discharge on long-term mortality is unknown. Objectives This study sought to examine, in a real-world cohort, the association between spontaneous major bleeding or MI after PCI and long-term mortality. Methods We conducted a retrospective cohort study of patients >30 years of age who underwent a PCI between 1996 and 2008 in an integrated healthcare delivery system. We used extended Cox regression to examine the associations of spontaneous bleeding and MI with all-cause mortality, after adjustment for time-updated demographics, comorbidities, periprocedural events, and longitudinal medication exposure. Results Among 32,906 patients who had a PCI and survived the index hospitalization, 530 had bleeds and 991 had MIs between 7 and 365 days post-discharge. There were 4,048 deaths over a mean follow-up of 4.42 years. The crude annual death rate after a spontaneous bleed (9.5%) or MI (7.6%) was higher than among patients who experienced neither event (2.6%). Bleeding was associated with an increased rate of death (adjusted hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.30 to 2.00), similar to that after an MI (HR: 1.91; 95% CI: 1.62 to 2.25). The association of bleeding with death remained significant after additional adjustment for the longitudinal use of antiplatelet agents. Conclusions Spontaneous bleeding after a PCI was independently associated with higher long-term mortality, and conveyed a risk comparable to that of an MI during follow-up. This tradeoff between efficacy and safety bolsters the argument for personalizing antiplatelet therapy after PCI on the basis of the patient's long-term risk of both thrombotic and bleeding events. Publication type: Journal: Review Source: EMBASE 5.Title: Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: The BRIGHT randomized clinical trial Citation: JAMA - Journal of the American Medical Association, April 2015, vol./is. 313/13(1336-1346), 0098-7484;1538-3598 (07 Apr 2015) Author(s): Han Y., Guo J., Zheng Y., Zang H., Su X., Wang Y., Chen S., Jiang T., Yang P., Chen J., Jiang D., Jing Q., Liang Z., Liu H., Zhao X., Li J., Li Y., Xu B., Stone G.W., Qi X., Liu C., Yuan J. Language: English Abstract: Importance: The safety and efficacy of bivalirudin compared with heparin with or without glycoprotein IIb/IIIa inhibitors in patients with acutemyocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are uncertain. OBJECTIVE To determine if bivalirudin is superior to heparin alone and to heparin plus tirofiban during primary PCI. Design, Setting, and Participants: Multicenter, open-label trial involving 2194 patients with AMI undergoing primary PCI at 82 centers in China between August 2012 and June 2013. Interventions: Patients were randomly assigned to receive bivalirudin with a post-PCI infusion (n = 735), heparin alone (n = 729), or heparin plus tirofiban with a post-PCI infusion (n = 730). Among patients treated with bivalirudin, a postprocedure 1.75mg/kg/h infusion was administered for a median of 180 minutes (IQR, 148-240 minutes). Main outcomes and Measures: The primary end pointwas 30-day net adverse clinical events, a composite of major adverse cardiac or cerebral events (all-cause death, reinfarction, ischemia-driven target vessel revascularization, or stroke) or bleeding. Additional prespecified safety end points included the rates of acquired thrombocytopenia at 30 days, and stent thrombosis at 30 days and 1 year. Results: Net adverse clinical events at 30 days occurred in 65 patients (8.8%) of 735 who were treated with bivalirudin compared with 96 patients (13.2%) of 729 treated with heparin (relative risk [RR], 0.67; 95%CI, 0.50-0.90; difference, -4.3%, 95%CI, -7.5%to -1.1%; P = .008); and 124 patients (17.0%) of 730 treated with heparin plus tirofiban (RR for bivalirudin vs heparin plus tirofiban, 0.52; 95%CI, 0.39-0.69; difference, -8.1%, 95%CI, -11.6%to -4.7%; P < .001). The 30-day bleeding rate was 4.1%for bivalirudin, 7.5%for heparin, and 12.3%for heparin plus tirofiban (P < .001). There were no statistically significant differences between treatments in the 30-day rates of major adverse cardiac or cerebral events (5.0%for bivalirudin, 5.8% for heparin, and 4.9% for heparin plus tirofiban, P = .74), stent thrombosis (0.6%vs 0.9%vs 0.7%, respectively, P = .77), acquired thrombocytopenia (0.1%vs 0.7%vs 1.1%; P = .07), or in acute (<24-hour) stent thrombosis (0.3%in each group). At the 1-year follow-up, the results remained similar. Conclusions and Relevance: Among patients with AMI undergoing primary PCI, the use of bivalirudin with a median 3-hour postprocedure PCI-dose infusion resulted in a decrease in net adverse clinical events compared with both heparin alone and heparin plus tirofiban. This finding was primarily due to a reduction in bleeding events with bivalirudin, without significant differences in major adverse cardiac or cerebral events or stent thrombosis. Publication type: Journal: Article Source: EMBASE Full text: Available American Medical Association at JAMA 6.Title: Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: A

systematic review and meta-analysis Citation: JACC: Cardiovascular Interventions, March 2015, vol./is. 8/3(436-446), 1936-8798;1876-7605 (01 Mar 2015) Author(s): Kwok C.S., Sherwood M.W., Watson S.M., Nasir S.B., Sperrin M., Nolan J., Kinnaird T., Kiatchoosakun S., Ludman P.F., De Belder M.A., Rao S.V., Mamas M.A. Language: English Abstract: Objectives This study sought to define the prevalence and prognostic impact of blood transfusions in contemporary percutaneous coronary intervention (PCI) practice. Background Although the presence of anemia is associated with adverse outcomes in patients undergoing PCI, the optimal use of blood products in patients undergoing PCI remains controversial. Methods A search of EMBASE and MEDLINE was conducted to identify PCI studies that evaluated blood transfusions and their association with major adverse cardiac events (MACE) and mortality. Two independent reviewers screened the studies for inclusion, and data were extracted from relevant studies. Random effects meta-analysis was used to estimate the risk of adverse outcomes with blood transfusions. Statistical heterogeneity was assessed by considering the I² statistic. Results Nineteen studies that included 2,258,711 patients with more than 54,000 transfusion events were identified (prevalence of blood transfusion 2.3%). Crude mortality rate was 6,435 of 50,979 (12.6%, 8 studies) in patients who received a blood transfusion and 27,061 of 2,266,111 (1.2%, 8 studies) in the remaining patients. Crude MACE rates were 17.4% (8,439 of 48,518) in patients who had a blood transfusion and 3.1% (68,062 of 2,212,730) in the remaining cohort. Meta-analysis demonstrated that blood transfusion was independently associated with an increase in mortality (odds ratio: 3.02, 95% confidence interval: 2.16 to 4.21, I² = 91%) and MACE (odds ratio: 3.15, 95% confidence interval: 2.59 to 3.82, I² = 81%). Similar observations were recorded in studies that adjusted for baseline hematocrit, anemia, and bleeding. Conclusions Blood transfusion is independently associated with increased risk of mortality and MACE events. Clinicians should minimize the risk for periprocedural transfusion by using available bleeding-avoidance strategies and avoiding liberal transfusion practices. Publication type: Journal: Review Source: EMBASE 7.Title: Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials Citation: Journal of Zhejiang University: Science B, 2015, vol./is. 16/3(198-207), 1673-1581;1862-1783 (2015) Author(s): Hu X.-Q., Cheng J., Tang B., Zhang Z.-H., Huang K., Yang Y.-P., Mao Y.-Y., Zhong M., Fu S.-W. Language: English Abstract: Objective: To evaluate the clinical effect of postconditioning on patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).Methods: Randomized controlled trials were identified by searching relevant databases published up to April 2nd, 2014. A meta-analysis of eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a fixed-effect model.Results: Ten studies providing adverse cardiac events in a total of 1346 STEMI patients treated with primary PCI were identified. The occurrence of heart failure was significantly reduced in patients treated with postconditioning compared with usual care (risk ratio (RR) 0.533; 95% confidence intervals (CI) 0.368-0.770), whereas non-fatal reinfarction slightly increased in the postconditioning group (RR 2.746; 95% CI 1.007-7.488). No significant difference in total major adverse cardiac events (MACEs) was observed between the two groups (RR 0.876; 95% CI 0.671-1.144).Conclusions: Postconditioning in STEMI patients undergoing primary PCI significantly reduces the risk of heart failure, but fails to decrease the incidence of total MACEs and the risk of non-fatal reinfarction. Publication type: Journal: Article Source: EMBASE Full text: Available Journal of Zhejiang University. Science. B. at Journal of Zhejiang University. Science. B 8.Title: Clinical utility of new bleeding criteria: A prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention Citation: Journal of Cardiology, April 2015, vol./is. 65/4(324-329), 0914-5087;1876-4738 (01 Apr 2015) Author(s): Choi J.-H., Seo J.-M., Lee D.H., Park K., Kim Y.-D. Language: English Abstract: Objectives: The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). Background: The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of

multiple trials and registries. Methods: All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. Results: A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type >2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type >2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (p < 0.001), compared with TIMI (sensitivity, 21.4%; specificity, 100%; p < 0.001), and GUSTO (sensitivity, 39.3%; specificity, 100%; p < 0.001). Conclusions: Compared with TIMI and GUSTO, the BARC definition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Publication type: Journal: Article Source: EMBASE 9.Title: Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and failed percutaneous intervention of coronary chronic total occlusions: A Meta-Analysis of Observational Studies Citation: Catheterization and Cardiovascular Interventions, April 2015, vol./is. 85/5(781-794), 1522-1946;1522-726X (01 Apr 2015) Author(s): Khan M.F., Brilakis E.S., Wendel C.S., Thai H. Language: English Abstract: Background Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. Methods We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44% versus 0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI] (1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus 3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03] and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI (4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful PCI arm. Conclusions As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes. Publication type: Journal: Article Source: EMBASE 10.Title: Contrast-induced nephropathy in PCI: An evidence-based approach to prevention Citation: British Journal of Cardiology, January 2015, vol./is. 22/1(34), 0969-6113 (01 Jan 2015) Author(s): Shabbir A., Kitt J., Ali O. Language: English Abstract: Contrast-induced nephropathy is the third most common cause of in-hospital acute kidney injury and accounts for 10% of total cases. It is commonly encountered following coronary angiography and this systematic review aims to use current evidence to ascertain which treatment modalities are most effective in the prevention of the disease. A PubMed literature search was conducted in March 2014 using search terms, 'contrast nephropathy and coronary angiography'. The data analysed included 15 trials and two meta-analyses in order to determine whether patients given N-acetylcysteine (NAC), sodium chloride or sodium bicarbonate had better clinical outcomes. Study data were reviewed and quality of data discussed. Current data indicate that sodium bicarbonate is as effective as sodium chloride when used in patients with estimated glomerular filtration rate (eGFR) <60 ml/min. NAC adds no statistically significant benefit in mild-to-moderate renal disease regardless of whether it is used in isolation or as an adjunct therapy with fluid. Publication type: Journal: Article Source: EMBASE

11.Title: Everolimus-eluting stents or bypass surgery for multivessel coronary disease Citation: New England Journal of Medicine, March 2015, vol./is. 372/13(1213-1222), 0028-4793;1533-4406 (26 Mar 2015) Author(s): Bangalore S., Guo Y., Samadashvili Z., Blecker S., Xu J., Hannan E.L. Language: English Abstract: BACKGROUND: Results of trials and registry studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. These previous analyses did not evaluate PCI with second-generation drug-eluting stents. METHODS: In an observational registry study, we compared the outcomes in patients with multivessel disease who underwent CABG with the outcomes in those who underwent PCI with the use of everolimus-eluting stents. The primary outcome was all-cause mortality. Secondary outcomes were the rates of myocardial infarction, stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS: Among 34,819 eligible patients, 9223 patients who underwent PCI with everolimus-eluting stents and 9223 who underwent CABG had similar propensity scores and were included in the analyses. At a mean follow-up of 2.9 years, PCI with everolimus-eluting stents, as compared with CABG, was associated with a similar risk of death (3.1% per year and 2.9% per year, respectively; hazard ratio, 1.04; 95% confidence interval [CI], 0.93 to 1.17; P = 0.50), higher risks of myocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio, 1.51; 95% CI, 1.29 to 1.77; P<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year; hazard ratio, 2.35; 95% CI, 2.14 to 2.58; P<0.001), and a lower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). The higher risk of myocardial infarction with PCI than with CABG was not significant among patients with complete revascularization but was significant among those with incomplete revascularization (P = 0.02 for interaction). CONCLUSIONS: In a contemporary clinical-practice registry study, the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but a lower risk of stroke. (Funded by Abbott Vascular.) Publication type: Journal: Article Source: EMBASE Full text: Available The New England journal of medicine at New England Journal of Medicine 12.Title: Incidence of cardiac surgery following PCI: Insights from a high volume, non-surgical, UK centre Citation: British Journal of Cardiology, January 2015, vol./is. 22/1(27-30), 0969-6113 (01 Jan 2015) Author(s): Whittaker A., Green P., Coverdale G., Rana O., Levy T. Language: English Abstract: Percutaneous coronary intervention (PCI) has established itself as an effective alternative to coronary artery bypass graft surgery (CABG) in appropriate patients. However, the proportion of patients that undergo CABG and/or valve surgery (VS) following PCI in the short and long term is currently unknown. We conducted a single-centre, retrospective study examining the indications and number of patients requiring CABG and or VS following successful PCI between 2009 and 2012. The surgical procedure was categorised as early (referred within <1 month of the index PCI), mid-term (referred 1-12 months after index PCI) and remote (referred >1 year and up to four years following the index PCI). During each three-year period (2008-2010, 2009-2011), 5,244 PCIs were performed at our centre. The total number of patients referred for cardiac surgery post-PCI was 63 (1.2%). The number of patients referred for early, mid-term and remote cardiac surgery was 21 (0.4%), 14 (0.26%) and 28 (0.53%), respectively. Within the early group, eight patients had extensive three- vessel disease stabilised with emergency/ urgent PCI to allow subsequent CABG, while 10 patients had failed PCI to a chronic total occlusion. In the mid-term group, the main reason for surgery was rapid progression in coronary disease. In the remote group, the majority of patients underwent surgery for progression of valve disease. Our data suggest that the number of patients requiring CABG and/or VS following PCI is small, and the indications differ with time following the index PCI. We hope that these results will provide reassurance and interest to our interventional colleagues. Publication type: Journal: Article Source: EMBASE 13.Title: Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: A meta-analysis of comparative studies Citation: Interactive Cardiovascular and Thoracic Surgery, April 2015, vol./is. 20/4(531-537), 1569-9293;1569-9285 (01 Apr 2015) Author(s): Ueki C., Sakaguchi G., Akimoto T., Shintani T., Ohashi Y., Sato H. Language: English

Abstract: The prognostic significance of previous percutaneous coronary intervention (PCI) in patients undergoing coronary artery bypass grafting (CABG) is still unclear. Although many studies have reported adverse effects of previous PCI on postoperative mortality in CABG, as yet no meta-analysis has been carried out. We conducted this first meta-analysis to assess whether previous PCI increases postoperative mortality in CABG. MEDLINE and EMBASE were searched for relevant articles up to and including April 2014. Studies published in English satisfying the following criteria were included in the meta-analysis: (i) comparing CABG patients with previous PCI versus without previous PCI; and (ii) reporting hospital mortality. Our search identified 23 comparative studies, including 174 777 patients: 19 179 with previous PCI and 155 598 without previous PCI. Pooled analysis demonstrated that previous PCI had an adverse effect on hospital mortality: odds ratio (OR) 1.187, 95% confidence interval (CI) 1.075-1.312. Furthermore, subgroup analysis stratified by the proportion of multiple previous PCI (i.e. number of patients with multiple previous PCI/number of patients with single or multiple previous PCI) was performed. In the subgroup of studies with the proportion <40%, the adverse effect was not significant: OR 0.897 (95% CI 0.723-1.113); however, in the subgroup of studies with the proportion a 40%, the adverse effect of previous PCI was significant: OR 1.987 (95% CI 1.563-2.526). A meta-regression coefficient was significantly positive for the proportion of patients with a history of multiple PCI (coefficient 0.841; 95% CI 0.457-1.226; P < 0.001). This meta-analysis would argue that as the proportion of patients with multiple previous PCI in the CABG cohort increases, postoperative mortality also increases. This result re-emphasizes the importance of the heart team approach to coronary revascularization. Publication type: Journal: Article Source: EMBASE Full text: Available Highwire Press at Interactive CardioVascular and Thoracic Surgery 14.Title: Meta-analysis of randomized controlled trials and adjusted observational results of use of clopidogrel, aspirin, and oral anticoagulants in patients undergoing percutaneous coronary intervention Citation: American Journal of Cardiology, May 2015, vol./is. 115/9(1185-1193), 0002-9149;1879-1913 (01 May 2015) Author(s): D'Ascenzo F., Taha S., Moretti C., Omede P., Grossomarra W., Persson J., Lamberts M., Dewilde W., Rubboli A., Fernandez S., Cerrato E., Meynet I., Ballocca F., Barbero U., Quadri G., Giordana F., Conrotto F., Capodanno D., Dinicolantonio J., Bangalore S., Reed M., Meier P., Zoccai G., Gaita F. Language: English Abstract: The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulants (OACs) is currently debated. MEDLINE and Cochrane Library were searched for studies reporting outcomes of patients who underwent PCI and who were on triple therapy (TT) or dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy (DT) with OAC and clopidogrel. Major bleeding was the primary end point, whereas all-cause death, myocardial infarction (MI), stent thrombosis, and stroke were secondary ones. Results were reported for all studies and separately for those deriving from randomized controlled trials or multivariate analysis. In 9 studies, 1,317 patients were treated with DAPT and 1,547 with TT. DAPT offered a significant reduction of major bleeding at 1 year for overall studies and for the subset of observational works providing adjusted data (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.39 to 0.68, I² 60% and OR 0.36, 95% CI 0.28 to 0.46) compared to TT. No increased risk of major adverse cardiac events (MACE: death, MI, stroke, and stent thrombosis) was reported (OR 0.71, 95% CI 0.46 to 1.08), although not deriving from randomized controlled trials or multivariate analysis. Six studies tested OAC and clopidogrel (1,263 patients) versus OAC, aspirin, and clopidogrel (3,055 patients) with a significant reduction of bleeding (OR 0.79, 95% CI 0.64 to 0.98), without affecting rates of death, MI, stroke, and stent thrombosis (OR 0.90, 95% CI 0.69 to 1.23) also when including clinical data from randomized controlled trials or multivariate analysis. In conclusion, compared to TT, both aspirin and clopidogrel and clopidogrel and OAC reduce bleeding. No difference in major adverse cardiac events is present for clopidogrel and OAC, whereas only low-grade evidence is present for aspirin and clopidogrel. Publication type: Journal: Article Source: EMBASE 15.Title: Meta-analysis of trials on mortality after percutaneous coronary intervention compared with medical therapy in patients with stable coronary heart disease and objective evidence of myocardial ischemia Citation: American Journal of Cardiology, May 2015, vol./is. 115/9(1194-1199), 0002-9149;1879-1913 (01 May 2015) Author(s): Gada H., Kirtane A.J., Kereiakes D.J., Bangalore S., Moses J.W., Genereux P., Mehran R., Dangas G.D., Leon M.B., Stone G.W. Language: English Abstract: Outcomes of percutaneous coronary intervention (PCI) versus medical therapy (MT) in the management of stable ischemic heart disease (SIHD) remain controversial, with some but not all studies showing improved results in patients with ischemia. We sought to elucidate whether PCI improves mortality compared to MT in patients with

objective evidence of ischemia (assessed using noninvasive imaging or its invasive equivalent). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PCI to MT in patients with SIHD. To maintain a high degree of specificity for ischemia, studies were only included if ischemia was defined on the basis of noninvasive stress imaging or abnormal fractional flow reserve. The primary outcome was all-cause mortality. We identified 3 RCTs (Effects of Percutaneous Coronary Interventions in Silent Ischemia After Myocardial Infarction II, Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2, and a substudy of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial) enrolling a total of 1,557 patients followed for an average of 3.0 years. When compared with MT in this population of patients with objective ischemia, PCI was associated with lower mortality (hazard ratio 0.52, 95% confidence interval 0.30 to 0.92, p = 0.02). There was no evidence of study heterogeneity or bias among included trials. In this meta-analysis of published RCTs, PCI was shown to have a mortality benefit over MT in patients with SIHD and objective assessment of ischemia using noninvasive imaging or its invasive equivalent. In conclusion, this study provides insight into the management of a higher-risk SIHD population that is the focus of the ongoing International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial. Publication type: Journal: Article Source: EMBASE 16.Title: Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI in STEMI patients with multivessel disease: A meta-analysis Citation: Netherlands Heart Journal, 2015, vol./is. 23/4(224-231), 1568-5888;1876-6250 (2015) Author(s): Rasoul S., van Ommen V., Vainer J., Ilhan M., Veenstra L., Erdem R., Ruiters L.A.W., Theunissen R., Hoorntje J.C.A. Language: English Abstract: Background There are controversial data regarding infarct-related artery only (IRA-PCI) revascularisation versus mul-tivessel revascularisation (MV-PCI) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary percutaneous coronary intervention (PCI). We performed a meta-analysis comparing outcome in same stage MV-PCI versus IRA-PCI in STEMI patients with multivessel disease. Methods Systematic searches of studies comparing MV-PCI with IRA-PCI in the MEDLINE and the Cochrane Database of systematic reviews were conducted. A meta-analysis was performed of all available studies. Primary outcome was all-cause mortality. Secondary endpoints were re-infarction, revascularisation, bleeding and major adverse cardiac events (MACE). Results A total of 15 studies were identified with a total number of 35,975 patients. Mortality rate was significantly higher in the MV-PCI group compared with the IRA-PCI group, odds ratio (OR): 1.64 (1.46-1.85). Both the incidence of re-infarction and re-PCI were significantly lower in the MV-PCI group compared with the IRA-PCI group: OR 0.54 (0.34-0.88) and OR 0.67 (0.48-0.93), respectively. Bleeding complications occurred more often in the MV-PCI group as compared with the IRA-PCI group: OR 1.24 (1.08-1.42). Rates of MACE were comparable between the two groups. Conclusions MV-PCI during the index of primary PCI in STEMI patients is associated with a higher mortality rate, a higher risk of bleeding complications, but lower risk of re-intervention and re-infarction and comparable rates of MACE. Publication type: Journal: Article Source: EMBASE Full text: Available Netherlands Heart Journal at Netherlands Heart Journal 17.Title: Novel approaches for preventing or limiting events (Naples) III trial: Randomized comparison of bivalirudin versus unfractionated heparin in patients at increased risk of bleeding undergoing transfemoral elective coronary stenting Citation: JACC: Cardiovascular Interventions, March 2015, vol./is. 8/3(414-423), 1936-8798;1876-7605 (01 Mar 2015) Author(s): Briguori C., Visconti G., Focaccio A., Donahue M., Golia B., Selvetella L., Ricciardelli B. Language: English Abstract: Objectives This study sought to assess the safety and the efficacy of bivalirudin compared with unfractionated heparin (UFH) alone in the subset of patients at increased risk of bleeding undergoing transfemoral elective percutaneous coronary intervention (PCI). Background Bivalirudin, a synthetic direct thrombin inhibitor, determines a significant decrease of in-hospital bleeding following PCI. Methods This is a single-center, investigator-initiated, randomized, double-blind, controlled trial. Consecutive biomarker-negative patients at increased bleeding risk undergoing PCI through the femoral approach were randomized to UFH (UFH group; n = 419) or bivalirudin (bivalirudin group; n = 418). The primary endpoint was the rate of in-hospital major bleeding. Results The primary endpoint occurred in 11 patients (2.6%) in the UFH group versus 14 patients (3.3%) in the bivalirudin group (odds ratio: 0.78; 95% confidence interval: 0.35 to 1.72; p = 0.54). Distribution of access-site and non-access-site bleeding

was 18% and 82% in the UFH group versus 50% and 50% in the bivalirudin group (p = 0.10). Conclusions The results of this randomized study, carried out at a single institution, suggest that there is no difference in major bleeding rate between bivalirudin and UFH in increased-risk patients undergoing transfemoral PCI. (Novel Approaches in Preventing and Limiting Events III Trial: Bivalirudin in High-Risk Bleeding Patients [NAPLES III]; NCT01465503) Publication type: Journal: Article Source: EMBASE 18.Title: Percutaneous coronary invervention versus coronary artery bypass grafting: A meta-Analysis Citation: Journal of Thoracic and Cardiovascular Surgery, March 2015, vol./is. 149/3(831-838.e13), 0022-5223;1097-685X (01 Mar 2015) Author(s): Smit Y., Vlayen J., Koppenaal H., Eefting F., Kappetein A.P., Mariani M.A. Language: English Abstract: Objective To compare the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with coronary artery disease. Methods MEDLINE, Embase, and Cochrane Central were searched, and randomized controlled trials were included. Outcomes were assessed at maximum available follow-up. Results This meta-Analysis includes 31 trials with 15,004 patients. As regards death, more patients died after PCI compared with CABG across all types of patients (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.3; P =.05) as well as in patients with multivessel disease (OR, 1.2; 95% CI, 1.0-1.4; P =.02) or diabetes (OR, 1.6; 95% CI, 1.2-2.1; P <.01). Myocardial infarction occurred as frequently after PCI (OR, 1.2; 95% CI, 0.9-1.5; P =.28). Repeat revascularization was more common after PCI (OR, 4.5; 95% CI, 3.5-5.8; P <.01), with a progressive decline in ORs from the pre-stent era (OR, 7.0; 95% CI, 5.1-9.7; P <.01), to the bare metal stent era (OR, 4.5; 95% CI, 3.6-5.5; P <.01), and to the drug-eluting stent era (OR, 2.5; 95% CI, 1.8-3.4; P <.01). Stroke was more common after CABG (OR, 0.7; 95% CI, 0.5-0.9; P =.01). Conclusions Compared with PCI, CABG had a lower risk of death in multivessel disease or diabetes patients eligible for either intervention, a lower risk of repeat revascularization, but a higher risk of stroke. Publication type: Journal: Article Source: EMBASE 19.Title: Percutaneous repair of paravalvular prosthetic regurgitation: Patient selection, techniques and outcomes Citation: Heart, May 2015, vol./is. 101/9(665-673), 1355-6037;1468-201X (01 May 2015) Author(s): Sorajja P., Bae R., Lesser J.A., Pedersen W.A. Language: English Abstract: Paravalvular prosthetic regurgitation is common, affecting 5 -10% of surgical prostheses and 40-70% of transcatheter valves. While many patients may suffer no significant morbidity, paravalvular prosthetic regurgitation can lead to heart failure and haemolytic anaemia, and, in some studies, has been associated with impaired survival. Over the past several years, percutaneous repair of paravalvular prosthetic regurgitation has been demonstrated to be a highly efficacious therapy. When performed in experienced centres, procedural success with percutaneous repair occurs in 90% of patients. Due to the complex nature of the techniques, there is a significant learning curve with a high potential for prolonged procedures (~2.5 h) and complications (~5%), although death is rare (~0.5%). Percutaneous repair of paravalvular prosthetic regurgitation requires a close collaboration between imaging specialists, surgeons and the interventional operators. Importantly, successful percutaneous repair obviates the need for open surgical correction, which can be high risk or prohibitive due to the need for reoperation in the setting of comorbidities. Herein, we discuss appropriate patient selection, the catheter-based techniques and outcomes of percutaneous repair for symptomatic paravalvular prosthetic regurgitation. Publication type: Journal: Review Source: EMBASE Full text: Available Highwire Press at Heart 20.Title: Precision medicine to improve use of bleeding avoidance strategies and reduce bleeding in patients undergoing percutaneous coronary intervention: Prospective cohort study before and after implementation of personalized bleeding risks Citation: BMJ (Online), March 2015, vol./is. 350/, 0959-8146;1756-1833 (24 Mar 2015) Author(s): Spertus J.A., Decker C., Gialde E., Jones P.G., McNulty E.J., Bach R., Chhatriwalla A.K. Language: English Abstract: Objective To examine whether prospective bleeding risk estimates for patients undergoing percutaneous coronary intervention could improve the use of bleeding avoidance strategies and reduce bleeding. Design Prospective cohort study comparing the use of bleeding avoidance strategies and bleeding rates before and after implementation of prospective risk stratification for peri-procedural bleeding. Setting Nine hospitals in the United

States. Participants All patients undergoing percutaneous coronary intervention for indications other than primary reperfusion for ST elevation myocardial infarction. Main outcome measures Use of bleeding avoidance strategies, including bivalirudin, radial approach, and vascular closure devices, and peri-procedural bleeding rates, stratified by bleeding risk. Observed changes were adjusted for changes observed in a pool of 1135 hospitals without access to pre-procedural risk stratification. Hospital level and physician level variability in use of bleeding avoidance strategies was examined. Results In a comparison of 7408 pre-intervention procedures with 3529 post-intervention procedures, use of bleeding avoidance strategies within intervention sites increased with pre-procedural risk stratification (odds ratio 1.81, 95% confidence interval 1.44 to 2.27), particularly among higher risk patients (2.03, 1.58 to 2.61; 1.41, 1.09 to 1.83 in low risk patients, after adjustment for control sites; P for interaction=0.05). Bleeding rates within intervention sites were significantly lower after implementation of risk stratification (1.0% v 1.7%; odds ratio 0.56, 0.40 to 0.78; 0.62, 0.44 to 0.87, after adjustment); the reduction in bleeding was greatest in high risk patients. Marked variability in use of bleeding avoidance strategies was observed across sites and physicians, both before and after implementation. Conclusions Prospective provision of individualized bleeding risk estimates was associated with increased use of bleeding avoidance strategies and lower bleeding rates. Marked variability between providers highlights an important opportunity to improve the consistency, safety, and quality of care. Publication type: Journal: Article Source: EMBASE Full text: Available BMJ (Clinical research ed.) at The BMJ 21.Title: Preventive versus culprit-only percutaneous coronary intervention in ST-elevation myocardial infarction patients with multivessel disease: A meta-analysis Citation: Journal of Interventional Cardiology, February 2015, vol./is. 28/1(1-13), 0896-4327;1540-8183 (01 Feb 2015) Author(s): Song Y.-J., Shin H.O.-C., Yang J.-I.I., Ho-Young L.E.E., Han-Young J.I.N., Jeong-Sook S.E.O., Yang T.-H., Dae-Kyeong K.I.M., Dong-Soo K.I.M., Jang J.-S. Language: English Abstract: Background: Although previous studies have suggested clinical benefits of complete revascularization in patients with multivessel coronary artery disease, it is still controversial whether preventive percutaneous coronary intervention (PCI) leads to better clinical outcomes in the clinical setting of ST-segment elevation myocardial infarction (STEMI). Methods: Relevant studies through September 2014 were searched and identified in the electronic databases. Primary endpoint was all-cause mortality at the longest follow-up. Secondary endpoints included myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). Results: From 836 initial citations, 7 randomized trials, and 23 observational studies with 44,256 patients (8,087 preventive and 36,169 culprit-only) were included in this study. Preventive PCI was associated with a significant reduction in repeat revascularization (odds ratios [OR]: 0.71; 95% CI: 0.51-0.99) with no differences in all-cause mortality (OR: 0.99; 95% CI: 0.76-1.29) or MI (OR: 1.08; 95% CI: 0.62-1.87) as compared with culprit-only PCI. Comparison of preventive PCI to the culprit-only PCI group revealed OR for MACE of 0.80 (95% CI: 0.57-1.12). Stratified analysis according to revascularization strategy demonstrated a significant survival benefit of culprit-only PCI over multivessel PCI during the index procedure and a significantly lower incidence of all-cause mortality with staged PCI as compared with culprit-only or multivessel PCI during the index procedure. Conclusions: Preventive PCI strategy appears to be effective in reducing the risk of repeat revascularization without significant benefits for mortality or MI when compared with culprit-only revascularization in STEMI patients with multivessel disease. Publication type: Journal: Article Source: EMBASE 22.Title: Randomized trial of primary PCI with or without routine manual thrombectomy Citation: New England Journal of Medicine, April 2015, vol./is. 372/15(1389-1398), 0028-4793;1533-4406 (09 Apr 2015) Author(s): Jolly S.S., Cairns J.A., Yusuf S., Meeks B., Pogue J., Rokoss M.J., Kedev S., Thabane L., Stankovic G., Moreno R., Gershlick A., Chowdhary S., Lavi S., Niemela K., Steg P.G., Bernat I., Xu Y., Cantor W.J., Overgaard C.B., Naber C.K., Cheema A.N., Welsh R.C., Bertrand O.F., Avezum A., Bhindi R., Pancholy S., Rao S.V., Natarajan M.K., Ten Berg J.M., Shestakovska O., Gao P., Widimsky P., Dzavik V. Language: English Abstract: Background: During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. Methods: We randomly

assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. Results: The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P = 0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P = 0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P = 0.02). Conclusions: In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. Publication type: Journal: Article Source: EMBASE Full text: Available The New England journal of medicine at New England Journal of Medicine 23.Title: Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: A retrospective study Citation: The Lancet, March 2015, vol./is. 385/9973(1114-1122), 0140-6736;1474-547X (21 Mar 2015) Author(s): Nallamothu B.K., Normand S.-L.T., Wang Y., Hofer T.P., Brush J.E., Messenger J.C., Bradley E.H., Rumsfeld J.S., Krumholz H.M. Language: English Abstract: Background Recent reductions in average door-to-balloon (D2B) times have not been associated with decreases in mortality at the population level. We investigated this seemingly paradoxical finding by assessing components of this association at the individual and population levels simultaneously. We postulated that the changing population of patients undergoing primary percutaneous coronary intervention (pPCI) contributed to secular trends toward an increasing mortality risk, despite consistently decreased mortality in individual patients with shorter D2B times. Methods This was a retrospective study of ST-elevation myocardial infarction (STEMI) patients who underwent pPCI between Jan 1, 2005, and Dec 31, 2011, in the National Cardiovascular Data Registry (NCDR) CathPCI Registry. We looked for catheterisation laboratory visits associated with STEMI. We excluded patients not undergoing pPCI, transfer patients for pPCI, patients with D2B times less than 15 min or more than 3 h, and patients at hospitals that did not consistently report data across the study period. We assessed in-hospital mortality in the entire cohort and 6-month mortality in elderly patients aged 65 years or older matched to data from the Centers for Medicare and Medicaid Services. We built multilevel models to assess the relation between D2B time and in-hospital and 6-month mortality, including both individual and population-level components of this association after adjusting for patient and procedural factors. Findings 423 hospitals reported data on 150 116 procedures with a 55% increase in the number of patients undergoing pPCI at these facilities over time, as well as many changes in patient and procedural factors. Annual D2B times decreased significantly from a median of 86 min (IQR 65-109) in 2005 to 63 min (IQR 47-80) in 2011 (p<00001) with a concurrent rise in risk-adjusted in-hospital mortality (from 47% to 53%; p=006) and risk-adjusted 6-month mortality (from 129% to 144%; p=0001). In multilevel models, shorter patient-specific D2B times were consistently associated at the individual level with lower in-hospital mortality (adjusted OR for each 10 min decrease 092; 95% CI 091-093; p<00001) and 6-month mortality (adjusted OR for each 10 min decrease, 094; 95% CI 093-095; p<00001). By contrast, risk-adjusted in-hospital and 6-month mortality at the population level, independent of patient-specific D2B times, rose in the growing and changing population of patients undergoing pPCI during the study period. Interpretation Shorter patient-specific D2B times were consistently associated with lower mortality over time, whereas secular trends suggest increased mortality risk in the growing and changing pPCI population. The absence of association of annual D2B time and changes in mortality at the population level should not be interpreted as an indication of its individual-level relation in patients with STEMI undergoing primary PCI. Funding National Heart, Lung, and Blood Institute. Publication type: Journal: Article Source: EMBASE Full text: Available Lancet at Lancet, The Full text: Available Lancet at Lancet, The 24.Title: Slender approach and sheathless techniques

Citation: Interventional Cardiology Clinics, April 2015, vol./is. 4/2(161-166), 2211-7458 (01 Apr 2015) Author(s): Sanon S., Gulati R. Language: English Abstract: Most radial arteries cannot accommodate 7- and 8-French introducer sheaths for large-bore percutaneous coronary intervention without overstretch. In addition to being uncomfortable, radial artery overstretch is associated with spasm and higher rates of procedure-related radial artery occlusion. Methods for the transradial interventionist to overcome the limitation of radial artery-sheath size mismatch include both sheath-based and sheathless approaches. In this article we discuss a variety of techniques that can be used to minimize radial artery stretch for straightforward and complex coronary procedures. Publication type: Journal: Review Source: EMBASE 25.Title: The transradial approach and antithrombotic therapy. rationale and outcomes Citation: Interventional Cardiology Clinics, April 2015, vol./is. 4/2(213-223), 2211-7458 (01 Apr 2015) Author(s): Perez A.B., Rimac G., Plourde G., Poirier Y., Costerousse O., Bertrand O.F. Language: English Abstract: This article reviews antithrombotic strategies for percutaneous coronary interventions according to the access site and the current evidence with the aim of limiting ischemic complications and preventing radial artery occlusion (RAO). Prevention of RAO should be part of the quality control of any radial program. The incidence of RAO postcatheterization and interventions should be determined initially using the echo-duplex and then frequently assessed using the more cost-effective pulse oximetry technique. Any evidence of higher risk of RAO should prompt internal analysis and multidisciplinary mechanisms to be put in place. Publication type: Journal: Review Source: EMBASE 26.Title: Transradial primary percutaneous coronary intervention Citation: Interventional Cardiology Clinics, April 2015, vol./is. 4/2(167-177), 2211-7458 (01 Apr 2015) Author(s): Kedev S. Language: English Abstract: Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Many bleeding events are related to the access site. Transradial access (TRA) PPCI is associated with significant reduction in bleeding and vascular complications and reduced cardiac mortality compared with the transfemoral approach (TFA). High-risk patients might particularly benefit from TRA. Radial skills providing procedural times and success rates comparable with those of the TFA are strongly recommended before using this technique in the STEMI PPCI setting. Publication type: Journal: Review Source: EMBASE 27.Title: Trial of everolimus-eluting stents or bypass surgery for coronary disease Citation: New England Journal of Medicine, March 2015, vol./is. 372/13(1204-1212), 0028-4793;1533-4406 (26 Mar 2015) Author(s): Park S.-J., Ahn J.-M., Kim Y.-H., Park D.-W., Yun S.-C., Lee J.-Y., Kang S.-J., Lee S.-W., Lee C.W., Park S.-W., Choo S.J., Chung C.H., Lee J.W., Cohen D.J., Yeung A.C., Hur S.H., Seung K.B., Ahn T.H., Kwon H.M., Lim D.-S., Rha S.-W., Jeong M.-H., Lee B.-K., Tresukosol D., Fu G.S., Ong T.K. Language: English Abstract: BACKGROUND: Most trials comparing percutaneous coronary intervention (PCI) with coronaryartery bypass grafting (CABG) have not made use of second-generation drug-eluting stents. METHODS: We conducted a randomized noninferiority trial at 27 centers in East Asia. We planned to randomly assign 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary end point was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years after randomization. Event rates during longer-term follow-up were also compared between groups. RESULTS: After the enrollment of 880 patients (438 patients randomly assigned to the PCI group and 442 randomly assigned to the CABG group), the study was terminated early owing to slow enrollment. At 2 years, the primary end point had occurred in 11.0% of the patients in the PCI group and in 7.9% of those in the CABG group (absolute risk difference, 3.1 percentage points; 95% confidence interval [CI], -0.8 to 6.9; P = 0.32 for noninferiority). At longer-term follow-up (median, 4.6 years), the primary end point had occurred in 15.3% of the patients in the PCI group and in 10.6% of those in the CABG

group (hazard ratio, 1.47; 95% CI, 1.01 to 2.13; P = 0.04). No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke. However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG. CONCLUSIONS: Among patients with multivessel coronary artery disease, the rate of major adverse cardiovascular events was higher among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. Publication type: Journal: Article Source: EMBASE Full text: Available The New England journal of medicine at New England Journal of Medicine

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Is long-term paracetamol use not as safe as we thought? Tuesday Mar 3 2015 "Daily paracetamol could raise the risk of heart attacks, stroke and early death," the Mail Online reports. A new review of previous data found that long-term use was linked with a small increased risk of adverse events, such as heart attack…

Coffee can 'cut risks of heart attack' claims Tuesday Mar 3 2015 "Three coffees a day cuts the risk of heart disease and strokes," the Daily Mirror reports. A large study of 25,000 adults from South Korea has found that people who drink between three and five cups of coffee per day were less likely…

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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