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Journal and News Scan

Source: Clinical Therapeutics,
Author(s): Kang S et al.

Effects of aggressive statin therapy on patients with coronary saphenous vein bypass grafts: a systematic review and meta-analysis of randomized, controlled trials – The aim of this study was to investigate the effectiveness and safety of aggressive statin versus moderate statin therapy on patients with saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs). Compared with moderate statin therapy, long–term aggressive statin lowered the LDL–C level significantly, further decreased the atherosclerotic progression of SVG, reduced the risks of repeated myocardial infarction and coronary revascularization after CABG, and revealed similar patient compliance and statin–related adverse effects but slightly increased myopathy events and aminotransferase levels. Methods The authors searched MEDLINE (1980–June 2012), the Cochrane Controlled Trials Register, EMBASE, Science Citation Index, and PubMed (to June 2012), and found 10 relevant RCTs, including 7 substudy analyses from a Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators) and A to Z trial. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes; phase Z of the A to Z trial. Results A total of 6645 of participants, ages ranging from 21 to 75 years old, were treated with coronary artery bypass graft (CABG) and were followed for 2 to 5 years. Eight studies showed that aggressive statin therapy had lower LDL-C levels and a decrease of 39% in graft atherosclerotic progression, 12% in new occlusions, and 19% in new lesions more than moderate statin therapy. Three reports indicated that aggressive statin therapy lowered the risk of repeated myocardial infarction more than moderate statin therapy for coronary revascularization (95% CI, 0.66–0.95; risk ratio [RR] = 0.80; and 95% CI, 0.66–0.85; RR = 0.75) and lowered the risk of cardiac death as well (95% CI, 0.64–1.08; RR = 0.83). Aggressive statin therapy had safety similar to that of moderate statin therapy except for a slight increase in myopathic events and aminotransferase levels. Seventy percent to 90% of patients took statin treatment as prescribed in long-term.

Source: British Medical Journal
Author(s): Hans Van Brabandt,

Catheter ablation is an increasingly used treatment for atrial fibrillation but Hans Van Brabandt, Mattias Neyt, and Carl Devos argue that enthusiasm for the procedure is not justified by the evidence on efficacy and cost effectiveness and its use should be strictly limited

Source: European Heart Journal
Author(s): Petr Budera

Budera P et al. – Surgical ablation improves the likelihood of SR presence post–operatively without increasing peri–operative complications. However, the higher prevalence of sinus rhythm (SR) did not translate to improved clinical outcomes at 1 year.

Source: Daily Echo
Author(s): Melanie Adams

HE was one of the greatest heart surgeons of his generation.

That is how James Monro will be remembered by friends, colleagues and the many thousands of Southampton patients whose lives he saved during his long and prestigious career.

The 73-year-old retired cardiac surgeon has sadly passed away but his legacy is long-lasting having influenced the treatment of heart disease for adults and children throughout the world.

From being at the forefront of medical advances, pioneering many techniques in congenital heart surgery, to playing an instrumental role in transforming Southampton’s cardiac unit into the world-leading facility it is today – Mr Monro always had a passion for his patients and a drive for excellence.

Recruited in Southampton in 1973 by his late colleague Sir Keith Ross, Jim, as he was known to his friends, was a member of a team consisting of one cardiac surgeon and two cardiologists. Over the next 30 years he oversaw the unit’s move from the former Western Hospital to Southampton General in 1983, operating on more than 10,000 adults and 2,000 children. He played a pivotal role in seeing the city’s cardiac unit become a world-leading centre, which went from performing 400 operations a year in 1975 to nearly 2,000 now.

Respected both on the national and international cardiac stage, he pioneered corrective cardiac surgery on small babies and was a role model and mentor to many of today’s top surgeons.

His expertise saw him become the President of the Society for Cardiothoracic Surgery in the UK and also President of the European Association for Cardiothoracic Surgery.

Paying tribute to the dad-of-three, who died at the end of last week after a long battle with cancer, colleague and friend consultant cardiologist Iain Simpson, who is President of the British Cardiovascular Society, said: “Jim was one of the greatest heart surgeons of his generation, passionate about the pursuit of excellence and the care of his patients.

Gentleman “He influenced the treatment of heart disease for adults and children throughout the world as a clinical leader, influential teacher and dedicated surgeon of extraordinary talent.

“Jim was a true gentleman, a wonderful colleague as well as one of the nicest people you could ever hope to meet. His loss will be met by great sadness by all his friends and colleagues across the globe and the thoughts of the whole cardiovascular community are with Jane and his family at this sad time.”

Dr Tony Salmon, consultant congenital cardiologist, who worked with Mr Monro for 14 years in Southampton, added: “When he came to Southampton having worked in New Zealand’s Greenlane Hospital he took cardiac surgery to another level. He was a gentleman who was totally committed to his patients and their families and he was well respected both nationally and internationally.”

Charity was also a great passion for Mr Monro and he played a vital role in the establishment of Wessex Heartbeat in 1992 with colleague Rob Lamb, for which he was a trustee until last year, having also been chairman.

His expertise and dedication to providing the best patient care saw him play an integral part in the charity securing grants, including one that was crucial to the £1.2m refurbishment of the world-renowned children’s heart unit, Ocean Ward.

Even after his retirement in 2004, aged 65, his links with the city’s cardiac work remained strong, with him joining the fight to save children’s heart surgery in Southampton when it faced the axe.

Alison Farrell, chief executive of Wessex Heartbeat, said: “We had at our helm a man who had been at the forefront of medical advances in the field of cardiac surgery and by all accounts was a brilliant surgeon. His legacy is long-lasting.

“We had all hoped his retirement could have been so much longer and we offer our very sincere condolences to Jane and his family.”
 

Source: New England Journal of Medicine
Author(s): Daniel S. Menees, Eric D. Peterson, Yongfei Wang, Jeptha P. Curtis, John C. Messenger, John S. Rumsfeld, and Hitinder S. Gurm

Hospitals participating in the CathPCI Registry were tracked for performance and outcomes for door-to-balloon times in patients undergoing PCI for acute STEMI.  There were nearly 97,000 admissions for PCI for acute STEMI 2005-2009.  Mean door-to-balloon time decreased from 83 to 67 minutes.  The percent of patients meeting the threshold of 90 min door-to-balloon time increased from 60% to 83%.  Mortality was not affected by these changes. 

Source: New England Journal of Medicine
Author(s): Denise R. Aberle and others

This study reports results from the first 2 of 3 incidence screening rounds of the NLST in patients who had no evidence of cancer on the initial screening CT/CXR.  Abnormal results were identified in 28% and 17% on the 1st and 2nd screening CTs compared to 6% and 5% in the CXR screens.  Among detected lung cancers, 47.5% were stage IA in the CT group and 23.5% were stage IA in the CXR group. 

Source: New England Journal of Medicine
Author(s): Annette McWilliams and others

This study investigated the probability that nodules detected on initial low dose CT screening are malignant by using the PanCan study as a development dataset and results from chemoprevention trials as a validation dataset.  In the two datasets, a total of 12,029 nodules were detected among 2961 pts.  144 nodules were malignant.  Among pts with nodules, 5.5% and 3.7% had cancer in the development and derivation sets.  Predictors of malignancy included older age, female sex, family history of lung cancer, emphysema, larger nodule size, upper lobe location, part solid morphology, lower nodule count, and spiculation.  Predictive ability of the model exceeded 90%.

Source: Annals of Thoracic Surgery
Author(s): Peter B. Licht, Ole Dan Jørgensen, Lars Ladegaard, Erik Jakobsen

The Danish Lung Cancer Registry was queried to assess rates of nodal upstaging in patients resected for clinical stage I lung cancer undergoing open vs VATS resection.  VATS and open resections were equally distributed among over 1,500 pts.  Nodal upstaging was significantly more common after open compared to VATS lobectomy.  Survival rates did not differ.  Differences in nodal upstaging rates were likely related to factors that were not assessed in this study. 

Source: Annals of Thoracic Surgery
Author(s): Hironori Matsuhisa, Naoki Yoshimura, Tomonori Higuma, Takuro Misaki, Yoshiko Onuma, Fukiko Ichida, Yoshihiro Oshima, Yutaka Okita

The author studied 16 children who underwent closer of multiple VSDs using a variety of techniques.  Global and septal function were assessed postoperatively with echo and speckle tracking imaging.  EF was correlated with the total patch area.  Septal function was significantly worse than in control pts.  Areas that were closed with synthetic material had impaired function compared to areas that were closed primarily. 

Source: Annals of Thoracic Surgery
Author(s): Niv Ad, Linda Henry, Sharon Hunt, Sari D. Holmes

Currently fewer than 40% of pts with chronic afib undergo ablation.  This study evaluated nearly 1000 pts with afib who were undergoing cardiac surgery for other indications.  Ablation frequency was positively influenced by mitral valve surgery, lower creatinine, and increasing surgeon experience.  There was an increase in ablation frequency during the period of study. 

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