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Kaul U.,Fortis Escorts Heart Institute | Bangalore S.,New York University | Seth A.,Fortis Escorts Heart Institute | Arambam P.,Fortis Escorts Heart Institute | And 9 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND The choice of drug-eluting stent in the treatment of patients with diabetes mellitus and coronary artery disease who are undergoing percutaneous coronary intervention (PCI) has been debated. Previous studies comparing paclitaxel-eluting stents with stents eluting rapamycin (now called sirolimus) or its analogues (everolimus or zotarolimus) have produced contradictory results, ranging from equivalence between stent types to superiority of everolimus-eluting stents. METHODS We randomly assigned 1830 patients with diabetes mellitus and coronary artery disease who were undergoing PCI to receive either a paclitaxel-eluting stent or an everolimus-eluting stent. We used a noninferiority trial design with a noninferiority margin of 4 percentage points for the upper boundary of the 95% confidence interval of the risk difference. The primary end point was target-vessel failure, which was defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization at the 1-year follow-up. RESULTS At 1 year, paclitaxel-eluting stents did not meet the criterion for noninferiority to everolimus-eluting stents with respect to the primary end point (rate of targetvessel failure, 5.6% vs. 2.9%; risk difference, 2.7 percentage points [95% confidence interval, 0.8 to 4.5]; relative risk, 1.89 [95% confidence interval, 1.20 to 2.99]; P = 0.38 for noninferiority). There was a significantly higher 1-year rate in the paclitaxeleluting stent group than in the everolimus-eluting stent group of target-vessel failure (P = 0.005), spontaneous myocardial infarction (3.2% vs. 1.2%, P = 0.004), stent thrombosis (2.1% vs. 0.4%, P = 0.002), target-vessel revascularization (3.4% vs. 1.2%, P = 0.002), and target-lesion revascularization (3.4% vs. 1.2%, P = 0.002). CONCLUSIONS In patients with diabetes mellitus and coronary artery disease undergoing PCI, paclitaxel-eluting stents were not shown to be noninferior to everolimus-eluting stents, and they resulted in higher rates of target-vessel failure, myocardial infarction, stent thrombosis, and target-vessel revascularization at 1 year. © 2015 Massachusetts Medical Society.

Puddu P.E.,University of Rome La Sapienza | Menotti A.,Associazione per le Ricerca Cardiologica | Tolonen H.,Finnish National Institute for Health and Welfare | Nedeljkovic S.,Institute of Cardiovascular Diseases | Kafatos A.G.,University of Crete
European Journal of Epidemiology | Year: 2011

If a few risk factors had predictive power for all-cause mortality in different geographical-cultural areas, then preventive efforts might be concentrated on these. Thirteen potential risk factors were measured in 6,554 men aged 40-59 around 1960 in Northern, Southern and Eastern European areas of the Seven Countries Study. In 40 years 85.3% of men died in the pooled areas (87.9, 81.8 and 87.9% in Northern, Southern and Eastern Europe, respectively). Six risk factors were significant predictors of events in all three areas: directly for age, smoking habits, mean blood pressure, heart rate and ECG abnormalities; inversely for forced expiratory volume. In a pooled model also father and mother life status, socio-economic status, and arm circumference (the last one in an inverse way) had significant coefficients that were not heterogeneous across areas (except for socio-economic status). Serum cholesterol was around significance. ROC curves had values of 0.833, 0.806 and 0.819 respectively in Northern, Southern and Eastern Europe, and 0.827 in the pooled areas. Correlation coefficients between observed and expected cases in deciles of estimated risk were between 0.98 and 0.99. Survivors after 40 years in the lower half of the estimated risk were 10.7, 23.6 and 13.3% in Northern, Southern and Eastern Europe, respectively. Under- or over-estimate of cross-applying risk functions did not exceed 15%. All-cause mortality and survival in middle aged men during 40 years were strongly associated with a few, mainly cardiovascular, risk factors, whose predictive power was similar in different cultures across Europe. © 2011 Springer Science+Business Media B.V.

Okonta K.E.,University of Ibadan | Agarwal V.,Institute of Cardiovascular Diseases
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Does Warden's procedure reduce sinus node dysfunction (SND) after surgery for partial anomalous pulmonary venous connection?' Altogether 101 papers were found using the reported search; of which 10 papers provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, length of follow-up and results of these studies were tabulated. There was a particular reference to Warden's procedure, avoidance of incision across the cavoatrial junction and the postoperative sinus node status. There was a direct reference to the adoption of Warden's procedure in nine studies while one study emphasized the careful use of incision across the cavoatrial junction as a way of averting postoperative SND. The evidence supports the notion that preservation of the sinus node and its blood supply through the adoption of Warden's technique results in near-absent SND during long-term follow-up. The incidence of SND ranged from 0 to 6.5% when Warden's procedure was used, increasing to 18.1% when the atrial incision was extended across the cavoatrial junction into the superior vena cava and reaching as high as 55% in double-patch repair. The study limitations include the lack of randomized controlled trial, absence of 24 h Holter monitoring in most of the patients and shorter periods of follow-up. © 2012 The Author.

Nandakumar V.,Indian Institute of Technology Madras | Chittaranjan S.,Christian Medical College | Kurian V.M.,Institute of Cardiovascular Diseases | Doble M.,Indian Institute of Technology Madras
Polymer Journal | Year: 2013

Colonization of bacteria around native host cells or polymeric implant surfaces results in a dense growth on the surface, which leads to infection. The change of a bacterium from a motile planktonic to a nonmotile long chain of growing cells is a complex, regulated process that depends on several factors. The probability of a biofilm-related infection occurrence is between 65 and 80%. This review critically evaluates the mode of biofilm formation on native tissues and orthopedics, dental, cardiac, and urological implants and vascular grafts. The combination of biochemical advancements with conventional microbiological techniques and the use of radio-labeled monoclonal antibodies in imaging techniques, with recent developments in the detection of these biofilm in vivo, would help in designing biomaterials that prevent bacterial adhesion and biofilm formation, and dislodge the formed biofilm, thereby accelerating the product development phase. © 2013 The Society of Polymer Science, Japan (SPSJ) All rights reserved.

Victor S.M.,Institute of Cardiovascular Diseases
Indian heart journal | Year: 2012

To assess the factors causing delay in attaining DTB time of <90 min. Eighty-five patients who underwent primary PCI from August 2008 to July 2009 were studied. From door-to-balloon, time was divided into 6 stages; any reason for delay was studied. The mean DTB time was 80.5 min (SD = 34.4, median time 75 min, range 30-195). DTB time was <90 min in 76.5%, and DTB time >90 min occurred in 23.5%. Mean door to ECG - 6.5 min (SD = 2.7), mean time for the decision of PCI - 7.5 min (SD = 10.5), mean time taken for the patient's consent - 19.6 min (SD = 17.6), for STEMI team activation - 6.7 min (SD = 7.6), average time for financial process - 39.2 min (SD = 22.9). Average time for sheath to balloon - 5.2 min (SD = 1.7). Hospital related delay occurred in 5%, patient related delay in 80%, both together in 15%. 89.5% of patient related delay was due to delay in giving consent and financial reasons. There was no statistically significant delay for patients presented at morning or night and during the weekdays or weekend. Total mortality was 4.7%. Mortality among <90 min was 3.1%, mortality among >90 min was 10% ('p' = 0.2). With effective hospital strategies, the DTB time of 90 min can be achieved in majority of patients. The chief delay in DTB time in this study was due to a delay in obtaining consent and financial reasons. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Pavithran S.,Institute of Cardiovascular Diseases | Sivakumar K.,Institute of Cardiovascular Diseases
Annals of Pediatric Cardiology | Year: 2015

Background : Embolization might complicate device closure of large atrial septal defects (ASDs) with deficient margins. When margins are deficient, a precariously placed device can appear to be held in good position by the rigid delivery cable. Once the cable is unscrewed, the device adopts the natural lie of the interatrial septum. This can occasionally expose the inadequately captured margins and lead to device embolization. Most embolizations occur immediately after release. Retrieval of the embolized device required prolonged fluoroscopy and sometimes open heart surgery. Objective : To evolve a new strategy of retrieval of a malpositioned device after unscrewing the cable before impending embolization. Materials and Methods : After deploying the device in place, a snare is passed through the delivery sheath around the cable to grip the screw on the right atrial disc of the device. With the snare holding the screw end, the device is released by unscrewing the cable. The device position is reconfirmed on echocardiography. The snare is subsequently removed if the device was stable. In case of device migration, the same snare is used to retrieve the device before it embolizes completely. Results : Snare assistance was used in 24 patients considered as high-risk for device embolization. Its usefulness was demonstrated in two patients with deficient posterior margin and small inferior margin where the device got malpositioned immediately after release. As the snare was still holding on to the screw end, the device could be retrieved into the sheath easily. Conclusion : This novel snare assisted device release strategy safeguards against device embolization in large ASDs with deficient rims and allows simplified retrieval.

George T.,Institute of Cardiovascular Diseases
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2011

A 70-year-old lady with recurrent flash pulmonary edema and acute coronary syndrome was detected to have bilateral renal artery disease and uncontrolled hypertension. Her right kidney size was 9.3 Χ 3.2 cm [glomerular filtration rate (GFR) 32.65 mL/min], left kidney size was 6.8 Χ 2.9 cm (GFR 12.78 mL/min), with a total GFR of 45.43 mL/min. Angiogram showed significant bilateral atherosclerotic renal artery stenosis and 90% right coronary artery lesion. She underwent successful percutaneous transluminal angioplasty of right renal artery lesion. Her serum creatinine of 1.6 mg/dL (GFR 45.43 mL/min) came down to 1.3 mg/dL (GFR 63 mL/min) post procedure and her blood pressure was controlled. She then underwent percutaneous transluminal coronary angioplasty of right coronary artery lesion. Renal artery stenosis is an important cause of uncontrolled hypertension and progression to chronic kidney disease. An early intervention and prompt revascularization prevents recurrent flash pulmonary edema and end stage kidney failure.

Subban V.,Institute of Cardiovascular Diseases
Indian heart journal | Year: 2012

Apical ballooning syndrome (Takotsubo cardiomyopathy) is an unusual stress-related reversible cardiomyopathy occurring commonly in postmenopausal females. Genetic etiology of this condition is uncertain. A 68-year-old female and her daughter aged 43 got admitted to our institute simultaneously with acute chest pain following demise of one of their close relative. Both had features typical of Takotsubo cardiomyopathy and recovered completely. This reports point to the possible genetic predisposition to this abnormality. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Mornos C.,Institute of Cardiovascular Diseases
Romanian journal of internal medicine = Revue roumaine de médecine interne | Year: 2011

Coronary artery disease is the underlying cause in approximately two-thirds of patients with heart failure. Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. Electric conduction defects can reduce LV ejection fraction (LVEF) and decrease cardiac output. To investigate the influence of left bundle branch-block (LBBB) and cardiac dyssynchrony on 2D-strain parameters in patients with HF complicating ischemic cardiomyopathy. We analyzed 106 consecutive patients with HF complicating ischemic cardiomyopathy, in sinusal rhythm. LV strain, LV twist and LV torsion were measured by echocardiographic 2D-strain imaging. LV dyssynchrony was assessed using validated tissue Doppler parameters. Patients were divided into three groups: HF with normal LVEF (group 1), HF with reduced LVEF without LBBB (group 2) and with LBBB (group 3). LVEF, LV strain, LV torsion and LV twist were significantly better in group 1 (each p < 0.01). In group 3, LV torsion and LV twist were significantly lower compared to group 2 (0.80 +/- 0.4 vs. 1.21 +/- 0.23 degrees/cm, p = 0.007, and 5.18 +/- 2.4 vs. 8.31 +/- 1.5 degrees, p = 0.004, respectively), but LV strain and LVEF were not different between group 3 and 2 (-4.91 +/- 2.3 vs. -6.28 +/- 1.8%, p = 0.056, and 30.6 +/- 8.8 vs. 34.4 = 8.3%, p = 0.11, respectively). Cardiac dyssynchrony induces a reduction of all 2D-strain analyzed parameters (each p < 0.05). In HF complicating ischemic cardiomyopathy, LBBB and cardiac dyssynchrony induce a reduction of LV strain, torsion and twist. In patients with reduced LVEF, LBBB induces predominantly a significant reduction ofLV torsion and LV twist, while LV strain was apparently not influenced.

Lal P.S.,Institute of Cardiovascular Diseases
Asian cardiovascular & thoracic annals | Year: 2013

only a few studies have compared surgical outcomes in children with and without Down's syndrome. The purpose of this study was to investigate the surgical outcome in children with Down's syndrome and congenital heart disease and to compare it with that in age- and sex-matched non-Down controls. the charts of 32 consecutive Down's syndrome patients who underwent surgery for congenital heart disease in a single center from January 2006 to May 2010, were compared with the data of 32 age- and sex-matched non-Down controls, focusing on comparative echocardiographic details, surgical outcome, and intensive care unit data. The data were compared using the 2-group t test. The children were followed up for a median period of 48 months. the most common cardiac lesion in the study group was ventricular septal defect (41%) followed by atrioventricular septal defect (28%). Ventilation and intensive care unit stay were significantly longer in Down's syndrome children, with a trend towards more respiratory complications. At a median follow-up of 48 months, there were no cardiac events or mortality in the study group. Simple lesions were more common than atrioventricular septal defect in Down's syndrome. children with Down's syndrome can be operated on with negligible mortality and good functional outcome, but with a higher surgical morbidity.

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