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Clydebank, United Kingdom

Reynolds R.M.,University of Edinburgh | Walker B.R.,University of Edinburgh | Haw S.,NHS Health Scotland | Newby D.E.,University of Edinburgh | And 11 more authors.
Critical Care Medicine | Year: 2010

Objective: To determine whether low serum cortisol concentrations are associated with adverse prognosis in patients with acute myocardial infarction. Low serum cortisol concentrations have been associated with adverse prognosis in critical illness of diverse etiology. Design: Nested case-control study. Setting: Prospective cohort study of consecutive patients admitted with acute myocardial infarction to nine Scottish hospitals. Patients: A total of 100 patients who survived 30 days (controls) and 100 patients who died within 30 days (cases). Measurements and Main Results: Admission cortisol concentrations were lower in patients who died than those who survived (median, 1189 nmol/L vs. 1355 nmol/L; p <.001). A cortisol concentration in the bottom quartile (<1136 nmol/L) was a strong predictor of death within 30 days and reMained so after adjustment for age and cardiac troponin concentration (adjusted odds ratio, 8.78; 95% confidence interval, 3.09-24.96; p <.001). Conclusions: Patients who mount a lesser cortisol stress response to acute myocardial infarction have a poorer early prognosis. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Carrick D.,University of Glasgow | Carrick D.,West of Scotland Heart and Lung Center | Oldroyd K.G.,University of Glasgow | McEntegart M.,West of Scotland Heart and Lung Center | And 24 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573) © © 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.

Eldawlatly A.,King Saud University | Turkistani A.,King Saud University | El-Tahan M.,University of Dammam | Kinsella J.,University of Glasgow | And 4 more authors.
Saudi Journal of Anaesthesia | Year: 2012

Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, P<0.05); 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube (DLT) as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker (BB) in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice.

Hastie C.E.,University of Glasgow | Padmanabhan S.,University of Glasgow | Slack R.,University of Glasgow | Pell A.C.H.,Monklands Hospital | And 7 more authors.
European Heart Journal | Year: 2010

AimsWe sought to investigate the impact of body mass index (BMI) on long-term all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI).Methods and resultsWe used the Scottish Coronary Revascularisation Register to undertake a cohort study of all patients undergoing elective PCI in Scotland between April 1997 and March 2006 inclusive. We excluded patients who had previously undergone revascularization. There were 219 deaths within 5 years of 4880 procedures. Compared with normal weight individuals, those with a BMI ≥27.5 and <30 were at reduced risk of dying (HR 0.59, 95 CI 0.39-0.90, 95, P = 0.014). There was no attenuation of the association after adjustment for potential confounders, including age, hypertension, diabetes, and left ventricular function (adjusted HR 0.59, 95 CI 0.39-0.90, P = 0.015), and there were no statistically significant interactions. The results were unaltered by restricting the analysis to events beyond 30 days of follow-up.ConclusionAmong patients undergoing percutaneous intervention for coronary artery disease, increased BMI was associated with improved 5 year survival. Among those with established coronary disease, the adverse effects of excess adipose tissue may be offset by beneficial vasoactive properties.

Shelley B.,West of Scotland Heart and Lung Center | Shelley B.,Royal Infirmary | MacFie A.,West of Scotland Heart and Lung Center | Kinsella J.,Royal Infirmary
Journal of Cardiothoracic and Vascular Anesthesia | Year: 2011

Objective: The authors sought to provide a snapshot of contemporary thoracic anesthetic practice in the United Kingdom and Ireland. Design: An online survey. Setting: United Kingdom. Participants: An invitation to participate was e-mailed to all members of the Association of Cardiothoracic Anaesthetists. Intervention: None. Measurements and Main Results: A total of 132 responses were received; 2 were excluded because they did not originate from the United Kingdom. Values are number (percent). Anesthetic Technique: The majority of respondents (109, 85%) maintain anesthesia with a volatile anesthetic agent, with a lesser proportion (20, 15%) reporting use of a total intravenous anesthetic technique. The majority of respondents (78, 61%) favor pressure control ventilation over volume control (50, 39%); just under half (57, 45%) report the routine use of positive end-expiratory pressure (median = 5 cmH 2O [interquartile range (IQR), 4-5]). Fifty-two (40%) respondents report ventilating to a target tidal volume (median = 6 mL/kg [IQR, 5-7]). Most (114, 89%) respondents routinely ventilate with an F IO 2 less than 1.0. Thoracic epidural blockade (TEB) is favored by nearly two thirds of respondents (80, 62%) compared with paravertebral block (39, 30%) and other analgesic techniques (10, 8%). Anesthesiologists favoring TEB are significantly less likely to prescribe systemic opioids (17, 21% v 39, 100% [p < 0.001]). Proponents of TEB are significantly more likely to "routinely" use vasopressor infusions both intra- and postoperatively (16, 20% v 0, 0% [p = 0.003] and 28, 35% v 4, 11% [p =0.013], respectively). Most respondents (127, 98%) report a double-lumen tube as their first choice. Many (82, 64%) report "rarely" using bronchial blockers. Conclusions: The authors hope this survey both provides interest and serves as a useful resource reflecting the current practice of thoracic anesthesia. © 2011 Elsevier Inc. All rights reserved.

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