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Koletsis E.N.,University of Patras | Prokakis C.,University of Patras | Crockett J.R.,Athens Medical Center | Dedeilias P.,Evangelismos General Hospital | And 5 more authors.
Journal of Cardiothoracic Surgery | Year: 2011

Background: Atrial fibrillation (AF) occurs in 28-33% of the patients undergoing coronary artery revascularization (CABG). This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG.Patients and methods: Two patient cohorts undergoing CABG were retrospectively studied. The first group (group A) consisted of 157 patients presenting AF after elective CABG. The second group (group B) consisted of 191 patients without AF postoperatively.Results: Preoperative factors presenting significant correlation with the incidence of post-operative AF included: 1) age > 65 years (p = 0.029), 2) history of AF (p = 0.022), 3) chronic obstructive pulmonary disease (p = 0.008), 4) left ventricular dysfunction with ejection fraction < 40% (p = 0.015) and 5) proximal lesion of the right coronary artery (p = 0.023). The intraoperative factors that appeared to have significant correlation with the occurrence of postoperative AF were: 1) CPB-time > 120 minutes (p = 0.011), 2) myocardial ischemia index < 0.27 ml.m 2/Kg.min (p = 0.011), 3) total positive fluid-balance during ICU-stay (p < 0.001), 4) FiO 2/PO 2> 0, 4 after extubation and during the ICU-stay (p = 0.021), 5) inotropic support with doses 15-30 μg/Kg/min (p = 0.016), 6) long ICU-stay recovery for any reason (p < 0.001) and perioperative myocardial infarction (p < 0.001).Conclusions: Our results suggest that the incidence of post-CABG atrial fibrillation can be predicted by specific preoperative and intraoperative measures. The intraoperative myocardial ischemia can be sufficiently quantified by the myocardial ischemia index. For those patients at risk we would suggest an early postoperative precautionary anti-arrhythmic treatment. © 2011 Koletsis et al; licensee BioMed Central Ltd.

Kontopidou F.V.,U.S. Center for Disease Control and Prevention | Antoniadou A.,National and Kapodistrian University of Athens | Tsirigotis P.,National and Kapodistrian University of Athens | Venetis E.,1st IKA Hospital | And 2 more authors.
Journal of Chemotherapy | Year: 2013

Antibiotic cycling has been proposed as a strategy to combat the emergence of antimicrobial resistance but has been implemented with conflicting results. A cycling strategy including four broad-spectrum antimicrobial regimens administrated sequentially over 3-month cycles in patients with febrile neutropenia was implemented in a haematology unit, during a 2-year period (2001-2003). Compliance to the strategy ranged between 57 and 100% and overall successful clinical response was 83%. Resistance rates of Gram negatives remained either stable or decreased (for Pseudomonas aeruginosa) at the end of the cycling period and no rectal colonization with resistant pathogens was recorded during the study period. The incidence of Gram-negative infections showed a decreasing trend while Gram-positive infections and resistance rates remained unaffected and at low rates. © 2013 Edizioni Scientifiche per l'Informazione su Farmaci e Terapia.

Mitsos S.,Onassion Cardiac Surgery Center | Katsanos K.,University of Patras | Koletsis E.,University of Patras | Kagadis G.C.,University of Patras | And 4 more authors.
Angiogenesis | Year: 2012

Therapeutic angiogenesis is based on the premise that the development of new blood vessels can be augmented by exogenous administration of the appropriate growth factors. Over the last years, successful preclinical studies and promising results of early clinical trials have created great excitement about the potential of therapeutic angiogenesis for patients with advanced ischemic heart disease. The authors provide an overview of the biology of angiogenesis, the basic characteristics of angiogenic factors, and the different routes of their delivery. They discuss experimental studies in animal models of myocardial ischemia and outline available clinical studies on therapeutic angiogenesis for myocardial ischemia. Related safety issues are also addressed followed by a critical perspective about the future of proangiogenic therapies for ischemic cardiovascular disorders. Despite the established proof of concept and reasonable safety, however, results of the latest trials on therapeutic angiogenesis for myocardial ischemia have provided inconsistent results and the definite means of inducing clinically useful therapeutic angiogenesis remain elusive. More studies are required to gain further insights into the biology of angiogenesis and address pharmacological limitations of current approaches of angiogenic therapy. The authors hope and envisage that in the not-too-distant future, these investigative efforts will lead to important new strategies for treatment of myocardial ischemic syndromes. Means of non-invasive individualized pharmacological therapeutic neovascularization may be the next major advance in the treatment of ischaemic heart disease. © Springer Science+Business Media B.V. 2011.

Routoulas T.,1st IKA Hospital | Bratis K.,1st IKA Hospital | Mavrogeni S.,Onassis Cardiac Surgery Center | Smigadis N.,1st IKA Hospital | And 2 more authors.
Acta Cardiologica | Year: 2013

We described the rare case of a 54-year-old male patient with an anomalous left main coronary artery, originating from the right sinus with a retro-aortic course. A significant distal left main coronary artery (LM) atherosclerotic lesion was identified and a successful PCI with direct stenting was performed. Coronary artery abnormalities represent the most technically challenging cases for interventional cardiologists. However, in selected cases, a percutaneous intervention can offer an effective and safe therapeutic option.

Rallidis L.S.,National and Kapodistrian University of Athens | Gialeraki A.,National and Kapodistrian University of Athens | Merkouri E.,National and Kapodistrian University of Athens | Liakos G.,Biochemistry Laboratory | And 5 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2010

There are limited and controversial data regarding the impact of 4G/5G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene in the pathogenesis of premature myocardial infarction (MI). We explored whether 4G/5G polymorphism of the PAI-1 gene is associated with the development of MI ≤ 35 years of age. We recruited 201 consecutive patients who had survived their first acute MI ≤ 35 years of age (mean age = 32.2 ±3.4 years). The control group consisted of 140 healthy individuals matched with cases for age and sex, without a family history of premature coronary heart disease. 4G/5G polymorphism of PAI-1 was tested with polymerase chain reaction and reverse hybridization. 4G allele carriers (4G/4G and 4G/5G genotypes) of PAI-1 were less frequent in patients than in controls (69.6 vs. 83.6%, P = 0.007). 4G carriership of the polymorphism of PAI-1 was associated with lower risk for acute MI (odds ratio 0.45, 95% confidence interval 0.23-0.88, P = 0.02) after adjusting for major cardiovascular risk factors. Patients possessing the 4G allele had higher PAI-1 plasma levels (32.2 ± 25 vs. 22.2 ± 11.3 ng/ml, P = 0.006) but lower lipoprotein(a) levels (10.1 [2.1-29.9] vs. 15.3 [8.2-57.1] mg/dl, P = 0.03) compared to 5G/5G homozygotes. Our data indicate that the 4G allele of the PAI-1 4G/5G polymorphism is less frequent among survivors of MI at very young age compared with matched controls. © Springer Science+Business Media, LLC 2009.

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