The American journal of cardiology
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Randomized Controlled Trial Multicenter Study Comparative Study
Conservative versus liberal red cell transfusion in acute myocardial infarction (the CRIT Randomized Pilot Study).
Red blood cell transfusion is common in patients with acute myocardial infarction (AMI). However, observational data suggest that this practice may be associated with worse clinical outcomes and data from clinical trials are lacking in this population. We conducted a prospective multicenter randomized pilot trial in which 45 patients with AMI and a hematocrit level ≤30% were randomized to a liberal (transfuse when hematocrit <30% to maintain 30% to 33%) or a conservative (transfuse when hematocrit <24% to maintain 24% to 27%) transfusion strategy. ⋯ In conclusion, compared to a conservative transfusion strategy, treating anemic patients with AMI according to a liberal transfusion strategy results in more patients receiving transfusions and higher hematocrit levels. However, this may be associated with worse clinical outcomes. A large-scale definitive trial addressing this issue is urgently required.
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Randomized Controlled Trial Multicenter Study Comparative Study
Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome.
Contemporary series of postpericardiotomy syndrome (PPS) are lacking. The aim of this study was to evaluate the incidence, time course, features at presentation, risk factors, and prognosis of PPS. The study population consisted of 360 consecutive candidates to cardiac surgery enrolled in a prospective cohort study. ⋯ In conclusion, despite advances in cardiac surgery techniques, PPS is a common postoperative complication, generally occurring in the first 3 months after surgery. Severe complications are rare, but the syndrome is responsible for hospital stay prolongation and readmissions. Female gender and pleura incision are risk factors for PPS.
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Multicenter Study Comparative Study
Comparison of long-term clinical and angiographic outcomes following implantation of bare metal stents and drug-eluting stents in aorto-ostial lesions.
Percutaneous coronary intervention (PCI) to aorto-ostial (AO) lesions is technically demanding and associated with high revascularization rates. The aim of this study was to assess outcomes after bare metal stent (BMS) compared to drug-eluting stent (DES) implantation after PCI to AO lesions. A retrospective cohort analysis was conducted of all consecutive patients who underwent PCI to AO lesions at 2 centers. ⋯ Cox regression analysis with propensity score adjustment for baseline differences suggested that DES were associated with a reduction in target lesion revascularization (hazard ratios 0.28, 95% confidence interval 0.15 to 0.52, p <0.001) and major adverse cardiac events (hazard ratio 0.50, 95% confidence interval 0.32 to 0.79, p = 0.003). There was a nonsignificantly higher incidence of Academic Research Consortium definite and probable stent thrombosis with DES (n = 9 [4%] vs n = 1 [1%], p = 0.131). In conclusion, despite differences in baseline characteristics favoring the BMS group, PCI with DES in AO lesions was associated with improved outcomes, with lower restenosis, revascularization, and major adverse cardiac event rates.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project).
Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. ⋯ Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.
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Randomized Controlled Trial Multicenter Study
Diagnosing acute myocardial infarction in patients with left bundle branch block.
We compared the clinical features, laboratory and coronary angiographic findings, treatments, and outcomes among patients with ST-segment elevation myocardial infarction (MI) with and without left bundle branch block (LBBB). We examined 5,742 patients with ST-segment elevation MI with and without LBBB treated with primary percutaneous coronary intervention in the Assessment of Pexelizumab in Acute Myocardial Infarction trial. The main outcome measures were obstructive coronary disease, MI, positive cardiac biomarkers, angiographic Thrombolysis In Myocardial Infarction flow, and death, MI, or congestive heart failure at 90 days. ⋯ Documented MI (elevated biomarkers) with an initially occluded infarct artery was more common in patients with LBBB with concordant ST-segment elevation (71.4%) than in patients without (44.1%; p = 0.027). The use of ST-segment elevation concordance criteria in the presence of LBBB was more often associated with documented MI with an identifiable culprit vessel with an initially occluded infarct-related artery. In conclusion, because a substantial proportion of patients with LBBB have acute MI with a culprit lesion and positive biomarkers, these data support immediate catheterization with the intent for primary percutaneous coronary intervention for all patients presenting with suspected ST-segment elevation myocardial infarction, ischemic symptoms, and presumed new LBBB, particularly if concordant ST-segment elevation is present.