2010 September 11

Coronary stents: current status.

Sep 112010

Coronary stents: current status.

J Am Coll Cardiol. 2010 Aug 31;56(10 Suppl):S1-42

Authors: Garg S, Serruys PW

Coronary artery stents revolutionized the practice of interventional cardiology after they were first introduced in the mid-1980s. Since then, there have been significant developments in their design, the most notable of which has been the introduction of drug-eluting stents. This paper reviews the benefits, risks, and current status of Food and Drug Administration-approved drug-eluting stents.

PMID: 20797502 [PubMed - in process]

Link to Article at PubMed

Evidence of Pre-Procedural Statin Therapy A Meta-Analysis of Randomized Trials.

J Am Coll Cardiol Start a Discussion »

Sep 112010

Evidence of Pre-Procedural Statin Therapy A Meta-Analysis of Randomized Trials.

J Am Coll Cardiol. 2010 Jun 8;

Authors: Winchester DE, Wen X, Xie L, Bavry AA

OBJECTIVES: The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. BACKGROUND: Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. METHODS: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS: Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural myocardial infarction (risk ratio: 0.57, 95% confidence interval: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (risk ratio: 0.66, 95% confidence interval: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (risk ratio: 0.54, 95% confidence interval: 0.43 to 0.68, p < 0.0001). CONCLUSIONS: Statins administered before invasive procedures significantly reduce the hazard of post-procedural myocardial infarction. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered.

PMID: 20825761 [PubMed - as supplied by publisher]

Link to Article at PubMed

New molecular and surrogate biomarker-based tests in the diagnosis of bacterial and fungal infection in febrile neutropenic patients.

Curr Opin Infect Dis Start a Discussion »

Sep 112010

New molecular and surrogate biomarker-based tests in the diagnosis of bacterial and fungal infection in febrile neutropenic patients.

Curr Opin Infect Dis. 2010 Sep 4;

Authors: Chen SC, Kontoyiannis DP

PURPOSE OF REVIEW: Prompt diagnosis of infection in febrile neutropenia hosts with hematological malignancy is essential in directing therapy. We highlight experience using modern molecular and biomarker-based methods to diagnose bacterial and fungal bloodstream infections and invasive aspergillosis in these patients. RECENT FINDINGS: Nucleic acid amplification-based strategies are used to detect and identify pathogens from blood cultures or from blood/clinical specimens; the latter are more likely to influence clinical management. Advances in DNA extraction include standardization of isolation of Aspergillus DNA from blood. Broad-range and/or multiplex PCR generally have greater clinical utility than pathogen-specific assays. However, Aspergillus-PCR assays are useful in confirming/excluding disease and monitoring high-risk patients for invasive aspergillosis. Commercial real-time PCR/peptide nucleic acid fluorescent in-situ hybridization systems, used as adjuncts to blood cultures, to detect bacteria and fungi in blood cultures (or blood), are as sensitive as culture and enable earlier institution of targeted therapy. Yet there are no data indicating that molecular detection of bacterial/fungal pathogens influences patient outcomes. Positive serum Aspergillus galactomannan and 1,3-Î²-D-glucan tests are useful biomarkers in the diagnosis/screening of fungal infection, and have potential as measures of response to antifungal therapy. Serum procalcitonin levels can help differentiate infectious, from noninfectious, fever. Combined molecular and nonmolecular testing likely offers optimal diagnostic accuracy. SUMMARY: Numerous PCR-based and biomarker tools are available for the diagnosis and screening of infection in febrile neutropenia hosts. The optimal approach remains to be resolved by prospective studies examining the impact of one or more of tests on patient outcomes.

PMID: 20827189 [PubMed - as supplied by publisher]

Link to Article at PubMed

Non-tuberculous mycobacterial (NTM) infection as a cause of difficult-to-control asthma: a case control study.

Chest Start a Discussion »

Sep 112010

Non-tuberculous mycobacterial (NTM) infection as a cause of difficult-to-control asthma: a case control study.

Chest. 2010 Sep 9;

Authors: Fritscher LG, Marras TK, Bradi AC, Fritscher CC, Balter MS, Chapman KR

Abstract BACKGROUND: Symptomatic disease due to nontuberculous mycobacteria (NTM) is known to occur commonly in the presence of structural lung disease, but is not described in association with asthma. METHODS: Case-control nested in a cohort. We identified 22 patients with difficult asthma referred to a tertiary academic referral centre and subsequently found to have infection with NTM. We matched each case with 2 controls (next 2 consecutive patients referred for asthma management). RESULTS: It took on average 2.1 years from the onset of new or worsening symptoms to NTM diagnosis. The most common symptoms were worsening cough (77%), sputum production (40.9%) and frequent exacerbations (31.8%). M. avium complex accounted for 63.6% of the infections, M. xenopi the balance. Cases were older (59.8+8.9 vs. 42.6+18 years; p<0.001) and had more severe airflow obstruction (FEV(1) 57% (40-74) vs. 89.5% (80-97); p<0.001). There was no difference between cases and controls in the proportion using inhaled corticosteroids (ICS), nor the average daily dose at the time of presentation, but cases had used ICS for a longer period (17(6.2-20) vs. 4(0.75-6.0) years; p=0.002). Six subjects with NTM were being treated with daily oral steroids while none of the controls was. Of the 22 cases, 10 were treated with antibiotics for NTM, 7 demonstrating clinical improvement or resolution of the presenting symptoms. CONCLUSIONS: NTM infection can be associated with asthma and should be considered in difficult to treat disease, especially in older individuals, with more severe airflow obstruction and greater exposure to inhaled or systemic corticosteroids.

PMID: 20829338 [PubMed - as supplied by publisher]

Link to Article at PubMed

September 2010
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