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2. Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)

Author

Benedetto, U, Sinha, S, Mulla, A, Glampson, B, Davies, J, Panoulas, V, Gautama, S, Papadimitriou, D, Woods, K, Elliott, P, Hemingway, H, Williams, B, Asselbergs, FW, Melikian, N, Krasopoulos, G, Sayeed, R, Wendler, O, Baig, K, Chukwuemeka, A, Angelini, GD, Sterne, JAC, Johnson, T, Shah, AM, Perera, D, Patel, RS, Kharbanda, R, Channon, KM, Mayet, J, and Kaura, A

Subjects
Aged, 80 and over, Male, Treatment Outcome, Myocardial Infarction, Humans, Female, Coronary Artery Bypass, Middle Aged, Cardiology and Cardiovascular Medicine, Non-ST Elevated Myocardial Infarction, Medical Informatics, Troponin, Aged
Abstract

Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.

Published
2021

6. Socioeconomic deprivation is a predictor of poor a postoperative cardiovascular outcomes inpatients undergoing coronary artery bypass grafting

Author

Taylor, FC, Ascione, R, Rees, K, Narayan, P, and Angelini, GD

Subjects
Coronary artery bypass -- Analysis, Outcome and process assessment (Health Care) -- Evaluation -- Analysis, Statistics -- Analysis, Surgery -- Complications, Social classes -- Influence -- Analysis, Health
Abstract

Objective: To investigate the effects of socioeconomic deprivation on cardiovascular risk factors and postoperative clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). Design: Retrospective analysis of prospectively collected [...]

Published
2003

11. Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial).

Author

Benedetto, U, Altman, DG, Gerry, S, Gray, A, Lees, B, Angelini, GD, Flather, M, Taggart, DP, ART (Arterial Revascularization Trial) Investigators, Benedetto, U, Altman, DG, Gerry, S, Gray, A, Lees, B, Angelini, GD, Flather, M, Taggart, DP, and ART (Arterial Revascularization Trial) Investigators

Abstract

BACKGROUND: There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the ART patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short-term (in-hospital) and long-term outcomes by performing a post hoc analysis of the ART. METHODS AND RESULTS: Among patients enrolled in the ART (n=3102) from 2004 to 2007, we excluded those who did not undergo surgery (n=18) and those with no information about use of perioperative aprotinin (n=9). Finally, 836 of 3076 patients (27%) received aprotinin. Propensity matching was used to select 536 pairs for final comparison. Aprotinin was also associated with an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds ratio, 9.12; 95% confidence interval [CI], 1.15-72.2; P=0.03), intra-aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds ratio, 2.26; 95% CI, 1.26-4.07; P=0.006), and acute kidney injury (102 [19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95% CI, 1.03-1.97; P=0.03). Aprotinin was not associated with a lower incidence of transfusion (37 [6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95% CI, 0.81-2.23; P=0.25) and reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95% CI, 0.76-2.53; P=0.28). At 5 years, all-cause mortality was significantly increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard ratio, 1.51; 95% CI, 1.0-2.28; P=0.045). CONCLUSIONS: In the present post hoc ART analysis, aprotinin was associated with a significantly increased risk of early and late mortality. CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com. Unique identifier: ISRCTN46552265.

Published
2018

12. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Author

Gaudino, M, Angelini, GD, Antoniades, C, Bakaeen, F, Benedetto, U, Calafiore, AM, Di Franco, A, Di Mauro, M, Fremes, SE, Girardi, LN, Glineur, D, Grau, J, He, G-W, Patrono, C, Puskas, JD, Ruel, M, Schwann, TA, Tam, DY, Tatoulis, J, Tranbaugh, R, Vallely, M, Zenati, MA, Mack, M, Taggart, DP, Gaudino, M, Angelini, GD, Antoniades, C, Bakaeen, F, Benedetto, U, Calafiore, AM, Di Franco, A, Di Mauro, M, Fremes, SE, Girardi, LN, Glineur, D, Grau, J, He, G-W, Patrono, C, Puskas, JD, Ruel, M, Schwann, TA, Tam, DY, Tatoulis, J, Tranbaugh, R, Vallely, M, Zenati, MA, Mack, M, and Taggart, DP

Published
2018

13. Erratum to:Methods for evaluating medical tests and biomarkers

Author

Gopalakrishna, G, Langendam, M, Scholten, R, Bossuyt, P, Leeflang, M, Noel-Storr, A, Thomas, J, Marshall, I, Wallace, B, Whiting, P, Davenport, C, GopalaKrishna, G, De Salis, I, Mallett, S, Wolff, R, Riley, R, Westwood, M, Kleinen, J, Collins, G, Reitsma, H, Moons, K, Zapf, A, Hoyer, A, Kramer, K, Kuss, O, Ensor, J, Deeks, JJ, Martin, EC, Riley, RD, Rücker, G, Steinhauser, S, Schumacher, M, Snell, K, Willis, B, Debray, T, Deeks, J, Di Ruffano, LF, Taylor-Phillips, S, Hyde, C, Taylor, SA, Batnagar, G, STREAMLINE COLON Investigators, STREAMLINE LUNG Investigators, METRIC Investigators, Seedat, F, Clarke, A, Byron, S, Nixon, F, Albrow, R, Walker, T, Deakin, C, Zhelev, Z, Hunt, H, Yang, Y, Abel, L, Buchanan, J, Fanshawe, T, Shinkins, B, Wynants, L, Verbakel, J, Van Huffel, S, Timmerman, D, Van Calster, B, Zwinderman, A, Oke, J, O'Sullivan, J, Perera, R, Nicholson, B, Bromley, HL, Roberts, TE, Francis, A, Petrie, D, Mann, GB, Malottki, K, Smith, H, Billingham, L, Sitch, A, Gerke, O, Holm-Vilstrup, M, Segtnan, EA, Halekoh, U, Høilund-Carlsen, PF, Francq, BG, Dinnes, J, Parkes, J, Gregory, W, Hewison, J, Altman, D, Rosenberg, W, Selby, P, Asselineau, J, Perez, P, Paye, A, Bessede, E, Proust-Lima, C, Naaktgeboren, C, De Groot, J, Rutjes, A, Reitsma, J, Ogundimu, E, Cook, J, Le Manach, Y, Vergouwe, Y, Pajouheshnia, R, Groenwold, R, Peelen, L, Nieboer, D, De Cock, B, Pencina, MJ, Steyerberg, EW, Cooper, J, Parsons, N, Stinton, C, Smith, S, Dickens, A, Jordan, R, Enocson, A, Fitzmaurice, D, Adab, P, Boachie, C, Vidmar, G, Freeman, K, Connock, M, Court, R, Moons, C, Harris, J, Mumford, A, Plummer, Z, Lee, K, Reeves, B, Rogers, C, Verheyden, V, Angelini, GD, Murphy, GJ, Huddy, J, Ni, M, Good, K, Cooke, G, Hanna, G, Ma, J, Moons, KGMC, De Groot, JAH, Altman, DG, Reitsma, JB, Collins, GS, Moons, KGM, Kamarudin, AN, Kolamunnage-Dona, R, Cox, T, Borsci, S, Pérez, T, Pardo, MC, Candela-Toha, A, Muriel, A, Zamora, J, Sanghera, S, Mohiuddin, S, Martin, R, Donovan, J, Coast, J, Seo, MK, Cairns, J, Mitchell, E, Smith, A, Wright, J, Hall, P, Messenger, M, Calder, N, Wickramasekera, N, Vinall-Collier, K, Lewington, A, Damen, J, Cairns, D, Hutchinson, M, Sturgeon, C, Mitchel, L, Kift, R, Christakoudi, S, Rungall, M, Mobillo, P, Montero, R, Tsui, T-L, Kon, SP, Tucker, B, Sacks, S, Farmer, C, Strom, T, Chowdhury, P, Rebollo-Mesa, I, Hernandez-Fuentes, M, Damen, JAAG, Debray, TPA, Heus, P, Hooft, L, Scholten, RJPM, Schuit, E, Tzoulaki, I, Lassale, CM, Siontis, GCM, Chiocchia, V, Roberts, C, Schlüssel, MM, Gerry, S, Black, JA, Van der Schouw, YT, Peelen, LM, Spence, G, McCartney, D, Van den Bruel, A, Lasserson, D, Hayward, G, Vach, W, De Jong, A, Burggraaff, C, Hoekstra, O, Zijlstra, J, De Vet, H, Graziadio, S, Allen, J, Johnston, L, O'Leary, R, Power, M, Johnson, L, Waters, R, Simpson, J, Fanshawe, TR, Phillips, P, Plumb, A, Helbren, E, Halligan, S, Gale, A, Sekula, P, Sauerbrei, W, Forman, JR, Dutton, SJ, Takwoingi, Y, Hensor, EM, Nichols, TE, Kempf, E, Porcher, R, De Beyer, J, Hopewell, S, Dennis, J, Shields, B, Jones, A, Henley, W, Pearson, E, Hattersley, A, MASTERMIND consortium, Scheibler, F, Rummer, A, Sturtz, S, Großelfinger, R, Banister, K, Ramsay, C, Azuara-Blanco, A, Burr, J, Kumarasamy, M, Bourne, R, Uchegbu, I, Murphy, J, Carter, A, Marti, J, Eatock, J, Robotham, J, Dudareva, M, Gilchrist, M, Holmes, A, Monaghan, P, Lord, S, StJohn, A, Sandberg, S, Cobbaert, C, Lennartz, L, Verhagen-Kamerbeek, W, Ebert, C, Horvath, A, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Jenniskens, K, Peters, J, Grigore, B, Ukoumunne, O, Levis, B, Benedetti, A, Levis, AW, Ioannidis, JPA, Shrier, I, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Steele, RJ, Ziegelstein, RC, Bombardier, CH, Osório, FDL, Fann, JR, Gjerdingen, D, Lamers, F, Lotrakul, M, Loureiro, SR, Löwe, B, Shaaban, J, Stafford, L, Van Weert, HCPM, Whooley, MA, Williams, LS, Wittkampf, KA, Yeung, AS, Thombs, BD, Cooper, C, Nieto, T, Smith, C, Tucker, O, Dretzke, J, Beggs, A, Rai, N, Bayliss, S, Stevens, S, Mallet, S, Sundar, S, Hall, E, Porta, N, Estelles, DL, De Bono, J, CTC-STOP protocol development group, and National Institute for Health Research

Subjects
medicine.medical_specialty, Astrophysics::High Energy Astrophysical Phenomena, MEDLINE, 030204 cardiovascular system & hematology, BTC (Bristol Trials Centre), MASTERMIND consortium, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, Intensive care medicine, CTC-STOP protocol development group, lcsh:R5-920, business.industry, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Published Erratum, STREAMLINE COLON Investigators, 3. Good health, STREAMLINE LUNG Investigators, Centre for Surgical Research, Family medicine, METRIC Investigators, High Energy Physics::Experiment, Erratum, business, lcsh:Medicine (General)
Abstract

[This corrects the article DOI: 10.1186/s41512-016-0001-y.].

Published
2017
Full Text
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14. Erratum to: Methods for evaluating medical tests and biomarkers.

Author

Gopalakrishna, G, Langendam, M, Scholten, R, Bossuyt, P, Leeflang, M, Noel-Storr, A, Thomas, J, Marshall, I, Wallace, B, Whiting, P, Davenport, C, GopalaKrishna, G, de Salis, I, Mallett, S, Wolff, R, Riley, R, Westwood, M, Kleinen, J, Collins, G, Reitsma, H, Moons, K, Zapf, A, Hoyer, A, Kramer, K, Kuss, O, Ensor, J, Deeks, JJ, Martin, EC, Riley, RD, Rücker, G, Steinhauser, S, Schumacher, M, Snell, K, Willis, B, Debray, T, Deeks, J, di Ruffano, LF, Taylor-Phillips, S, Hyde, C, Taylor, SA, Batnagar, G, STREAMLINE COLON Investigators, STREAMLINE LUNG Investigators, METRIC Investigators, Di Ruffano, LF, Seedat, F, Clarke, A, Byron, S, Nixon, F, Albrow, R, Walker, T, Deakin, C, Zhelev, Z, Hunt, H, Yang, Y, Abel, L, Buchanan, J, Fanshawe, T, Shinkins, B, Wynants, L, Verbakel, J, Van Huffel, S, Timmerman, D, Van Calster, B, Zwinderman, A, Oke, J, O'Sullivan, J, Perera, R, Nicholson, B, Bromley, HL, Roberts, TE, Francis, A, Petrie, D, Mann, GB, Malottki, K, Smith, H, Billingham, L, Sitch, A, Gerke, O, Holm-Vilstrup, M, Segtnan, EA, Halekoh, U, Høilund-Carlsen, PF, Francq, BG, Dinnes, J, Parkes, J, Gregory, W, Hewison, J, Altman, D, Rosenberg, W, Selby, P, Asselineau, J, Perez, P, Paye, A, Bessede, E, Proust-Lima, C, Naaktgeboren, C, de Groot, J, Rutjes, A, Reitsma, J, Ogundimu, E, Cook, J, Le Manach, Y, Vergouwe, Y, Pajouheshnia, R, Groenwold, R, Peelen, L, Nieboer, D, De Cock, B, Pencina, MJ, Steyerberg, EW, Cooper, J, Parsons, N, Stinton, C, Smith, S, Dickens, A, Jordan, R, Enocson, A, Fitzmaurice, D, Adab, P, Boachie, C, Vidmar, G, Freeman, K, Connock, M, Court, R, Moons, C, Harris, J, Mumford, A, Plummer, Z, Lee, K, Reeves, B, Rogers, C, Verheyden, V, Angelini, GD, Murphy, GJ, Huddy, J, Ni, M, Good, K, Cooke, G, Hanna, G, Ma, J, Moons, KGMC, de Groot, JAH, Altman, DG, Reitsma, JB, Collins, GS, Moons, KGM, Kamarudin, AN, Kolamunnage-Dona, R, Cox, T, Borsci, S, Pérez, T, Pardo, MC, Candela-Toha, A, Muriel, A, Zamora, J, Sanghera, S, Mohiuddin, S, Martin, R, Donovan, J, Coast, J, Seo, MK, Cairns, J, Mitchell, E, Smith, A, Wright, J, Hall, P, Messenger, M, Calder, N, Wickramasekera, N, Vinall-Collier, K, Lewington, A, Damen, J, Cairns, D, Hutchinson, M, Sturgeon, C, Mitchel, L, Kift, R, Christakoudi, S, Rungall, M, Mobillo, P, Montero, R, Tsui, T-L, Kon, SP, Tucker, B, Sacks, S, Farmer, C, Strom, T, Chowdhury, P, Rebollo-Mesa, I, Hernandez-Fuentes, M, Damen, JAAG, Debray, TPA, Heus, P, Hooft, L, Scholten, RJPM, Schuit, E, Tzoulaki, I, Lassale, CM, Siontis, GCM, Chiocchia, V, Roberts, C, Schlüssel, MM, Gerry, S, Black, JA, van der Schouw, YT, Peelen, LM, Spence, G, McCartney, D, van den Bruel, A, Lasserson, D, Hayward, G, Vach, W, de Jong, A, Burggraaff, C, Hoekstra, O, Zijlstra, J, de Vet, H, Graziadio, S, Allen, J, Johnston, L, O'Leary, R, Power, M, Johnson, L, Waters, R, Simpson, J, Fanshawe, TR, Phillips, P, Plumb, A, Helbren, E, Halligan, S, Gale, A, Sekula, P, Sauerbrei, W, Forman, JR, Dutton, SJ, Takwoingi, Y, Hensor, EM, Nichols, TE, Kempf, E, Porcher, R, de Beyer, J, Hopewell, S, Dennis, J, Shields, B, Jones, A, Henley, W, Pearson, E, Hattersley, A, MASTERMIND consortium, Scheibler, F, Rummer, A, Sturtz, S, Großelfinger, R, Banister, K, Ramsay, C, Azuara-Blanco, A, Burr, J, Kumarasamy, M, Bourne, R, Uchegbu, I, Murphy, J, Carter, A, Marti, J, Eatock, J, Robotham, J, Dudareva, M, Gilchrist, M, Holmes, A, Monaghan, P, Lord, S, StJohn, A, Sandberg, S, Cobbaert, C, Lennartz, L, Verhagen-Kamerbeek, W, Ebert, C, Horvath, A, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Jenniskens, K, Peters, J, Grigore, B, Ukoumunne, O, Levis, B, Benedetti, A, Levis, AW, Ioannidis, JPA, Shrier, I, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Steele, RJ, Ziegelstein, RC, Bombardier, CH, Osório, FDL, Fann, JR, Gjerdingen, D, Lamers, F, Lotrakul, M, Loureiro, SR, Löwe, B, Shaaban, J, Stafford, L, van Weert, HCPM, Whooley, MA, Williams, LS, Wittkampf, KA, Yeung, AS, Thombs, BD, Cooper, C, Nieto, T, Smith, C, Tucker, O, Dretzke, J, Beggs, A, Rai, N, Bayliss, S, Stevens, S, Mallet, S, Sundar, S, Hall, E, Porta, N, Estelles, DL, de Bono, J, CTC-STOP protocol development group, Gopalakrishna, G, Langendam, M, Scholten, R, Bossuyt, P, Leeflang, M, Noel-Storr, A, Thomas, J, Marshall, I, Wallace, B, Whiting, P, Davenport, C, GopalaKrishna, G, de Salis, I, Mallett, S, Wolff, R, Riley, R, Westwood, M, Kleinen, J, Collins, G, Reitsma, H, Moons, K, Zapf, A, Hoyer, A, Kramer, K, Kuss, O, Ensor, J, Deeks, JJ, Martin, EC, Riley, RD, Rücker, G, Steinhauser, S, Schumacher, M, Snell, K, Willis, B, Debray, T, Deeks, J, di Ruffano, LF, Taylor-Phillips, S, Hyde, C, Taylor, SA, Batnagar, G, STREAMLINE COLON Investigators, STREAMLINE LUNG Investigators, METRIC Investigators, Di Ruffano, LF, Seedat, F, Clarke, A, Byron, S, Nixon, F, Albrow, R, Walker, T, Deakin, C, Zhelev, Z, Hunt, H, Yang, Y, Abel, L, Buchanan, J, Fanshawe, T, Shinkins, B, Wynants, L, Verbakel, J, Van Huffel, S, Timmerman, D, Van Calster, B, Zwinderman, A, Oke, J, O'Sullivan, J, Perera, R, Nicholson, B, Bromley, HL, Roberts, TE, Francis, A, Petrie, D, Mann, GB, Malottki, K, Smith, H, Billingham, L, Sitch, A, Gerke, O, Holm-Vilstrup, M, Segtnan, EA, Halekoh, U, Høilund-Carlsen, PF, Francq, BG, Dinnes, J, Parkes, J, Gregory, W, Hewison, J, Altman, D, Rosenberg, W, Selby, P, Asselineau, J, Perez, P, Paye, A, Bessede, E, Proust-Lima, C, Naaktgeboren, C, de Groot, J, Rutjes, A, Reitsma, J, Ogundimu, E, Cook, J, Le Manach, Y, Vergouwe, Y, Pajouheshnia, R, Groenwold, R, Peelen, L, Nieboer, D, De Cock, B, Pencina, MJ, Steyerberg, EW, Cooper, J, Parsons, N, Stinton, C, Smith, S, Dickens, A, Jordan, R, Enocson, A, Fitzmaurice, D, Adab, P, Boachie, C, Vidmar, G, Freeman, K, Connock, M, Court, R, Moons, C, Harris, J, Mumford, A, Plummer, Z, Lee, K, Reeves, B, Rogers, C, Verheyden, V, Angelini, GD, Murphy, GJ, Huddy, J, Ni, M, Good, K, Cooke, G, Hanna, G, Ma, J, Moons, KGMC, de Groot, JAH, Altman, DG, Reitsma, JB, Collins, GS, Moons, KGM, Kamarudin, AN, Kolamunnage-Dona, R, Cox, T, Borsci, S, Pérez, T, Pardo, MC, Candela-Toha, A, Muriel, A, Zamora, J, Sanghera, S, Mohiuddin, S, Martin, R, Donovan, J, Coast, J, Seo, MK, Cairns, J, Mitchell, E, Smith, A, Wright, J, Hall, P, Messenger, M, Calder, N, Wickramasekera, N, Vinall-Collier, K, Lewington, A, Damen, J, Cairns, D, Hutchinson, M, Sturgeon, C, Mitchel, L, Kift, R, Christakoudi, S, Rungall, M, Mobillo, P, Montero, R, Tsui, T-L, Kon, SP, Tucker, B, Sacks, S, Farmer, C, Strom, T, Chowdhury, P, Rebollo-Mesa, I, Hernandez-Fuentes, M, Damen, JAAG, Debray, TPA, Heus, P, Hooft, L, Scholten, RJPM, Schuit, E, Tzoulaki, I, Lassale, CM, Siontis, GCM, Chiocchia, V, Roberts, C, Schlüssel, MM, Gerry, S, Black, JA, van der Schouw, YT, Peelen, LM, Spence, G, McCartney, D, van den Bruel, A, Lasserson, D, Hayward, G, Vach, W, de Jong, A, Burggraaff, C, Hoekstra, O, Zijlstra, J, de Vet, H, Graziadio, S, Allen, J, Johnston, L, O'Leary, R, Power, M, Johnson, L, Waters, R, Simpson, J, Fanshawe, TR, Phillips, P, Plumb, A, Helbren, E, Halligan, S, Gale, A, Sekula, P, Sauerbrei, W, Forman, JR, Dutton, SJ, Takwoingi, Y, Hensor, EM, Nichols, TE, Kempf, E, Porcher, R, de Beyer, J, Hopewell, S, Dennis, J, Shields, B, Jones, A, Henley, W, Pearson, E, Hattersley, A, MASTERMIND consortium, Scheibler, F, Rummer, A, Sturtz, S, Großelfinger, R, Banister, K, Ramsay, C, Azuara-Blanco, A, Burr, J, Kumarasamy, M, Bourne, R, Uchegbu, I, Murphy, J, Carter, A, Marti, J, Eatock, J, Robotham, J, Dudareva, M, Gilchrist, M, Holmes, A, Monaghan, P, Lord, S, StJohn, A, Sandberg, S, Cobbaert, C, Lennartz, L, Verhagen-Kamerbeek, W, Ebert, C, Horvath, A, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Jenniskens, K, Peters, J, Grigore, B, Ukoumunne, O, Levis, B, Benedetti, A, Levis, AW, Ioannidis, JPA, Shrier, I, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Steele, RJ, Ziegelstein, RC, Bombardier, CH, Osório, FDL, Fann, JR, Gjerdingen, D, Lamers, F, Lotrakul, M, Loureiro, SR, Löwe, B, Shaaban, J, Stafford, L, van Weert, HCPM, Whooley, MA, Williams, LS, Wittkampf, KA, Yeung, AS, Thombs, BD, Cooper, C, Nieto, T, Smith, C, Tucker, O, Dretzke, J, Beggs, A, Rai, N, Bayliss, S, Stevens, S, Mallet, S, Sundar, S, Hall, E, Porta, N, Estelles, DL, de Bono, J, and CTC-STOP protocol development group

Abstract

[This corrects the article DOI: 10.1186/s41512-016-0001-y.].

Published
2017

15. Impact of multiple arterial grafts in off-pump and on-pump coronary artery bypass surgery.

Author

Benedetto, U, Caputo, M, Mariscalco, G, Gaudino, Mario Fulvio Luigi, Chivasso, P, Bryan, A, Angelini, Gd, Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X), Benedetto, U, Caputo, M, Mariscalco, G, Gaudino, Mario Fulvio Luigi, Chivasso, P, Bryan, A, Angelini, Gd, and Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X)

Abstract

OBJECTIVES: There is growing concern that off-pump coronary artery bypass (OPCAB) is associated with reduced long-term survival compared with traditional on-pump coronary artery bypass (ONCAB); however, most of available comparisons between OPCAB and ONCAB focus on single-artery (SA) revascularization. We sought to investigate the impact of using multiple arterial (MA) conduits in the comparison between OPCAB versus ONCAB by performing a single-center, long-term propensity score base analysis. METHODS: The study population included 5195 SA-ONCAB, 1208 MA-ONCAB, 4412 SA-OPCAB, and 1818 MA-OPCAB procedures. Late survival was available for all cases (100%). Inverse propensity score weighting and a time-segmented Cox model were used for multiple treatments comparison. RESULTS: No significant differences were found between the 4 groups in terms of 30-day mortality, postoperative cerebrovascular accident, and renal replacement therapy. After a mean follow-up time of 8.2 ± 4.7 years, in the propensity score-weighted sample, survival probabilities at 10 years were 74.5 ± 0.4, 79.7 ± 0.4, 73.4 ± 0.5, and 79.0 ± 0.5 in the SA-ONCAB, MA-ONCAB, SA-OPCAB, and MA-OPCAB groups respectively. Propensity-weighted analysis confirmed that MA-OPCAB (hazard ratio, 0.81; 95% confidence interval, 0.69-0.98) and MA-ONCAB (hazard ratio, 0.81; 95% confidence interval, 0.65-0.99) were associated with a lower late mortality compared with standard SA-ONCAB. CONCLUSIONS: OPCAB with multiple arterial grafts is as safe as the conventional ONCAB and achieves excellent long term survival rates which are superior to those observed after standard SA-ONCAB and comparable with MA-ONCAB

Published
2016

17. Microparticles: Induced Exosomes in Cardiovascular Pathology255Exosomes from human cardiac-resident progenitor cells are more cardioprotective than exosomes from bone marrow mesenchymal stem cells via a pregnancy-associated plasma protein-a-dependent mechanism256The human pericardial fluid is enriched with cardiovascular-expressed microRNAs and exosomes with therapeutic potential257Circulating microparticles of healthy origins protect against atherosclerotic vascular disease via microRNA transfer to endothelial progenitor cells

Author

Barile, L, primary, Beltrami, C, primary, Georgescu, A, primary, Cervio, E, additional, Lionetti, V, additional, Milano, G, additional, Ciullo, A, additional, Altomare, C, additional, Torre, T, additional, Demertzis, S, additional, Moccetti, T, additional, Mauri, P, additional, Vassalli, G, additional, Shantikumar, S, additional, Laftha, A, additional, Besnier, M, additional, Rajakaruna, C, additional, Shearn, A, additional, Angelini, GD, additional, Emanueli, C, additional, Alexandru, N, additional, Andrei, E, additional, Dragan, E, additional, Safciuc, F, additional, Daraban, AM, additional, and Badila, E, additional

Published
2016
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24. Changes in the intracellular free amino acid pool in human saphenous vein tissue culture

Author

Angelini Gd, S. Birkett, D. Wallace, and M.-S. Suleiman

Subjects
Proline, Taurine, Glutamine, Glycine, Glutamic Acid, Biology, Free amino, Tissue culture, Coronary artery bypass surgery, Cytosol, Culture Techniques, medicine, Serine, Humans, Saphenous Vein, Surgical preparation, Asparagine, Amino Acids, Vein, Aged, Aspartic Acid, Alanine, Glutamate receptor, General Medicine, Middle Aged, Molecular biology, medicine.anatomical_structure, Biochemistry, Intracellular
Abstract

The aim of this work was to investigate the effect of tissue culture on the intracellular amino acid pool in both freshly isolated and surgically prepared saphenous vein segments taken from patients undergoing coronary artery bypass surgery (number of patients, n = 8). Viability of freshly isolated vein rings, indicated by ATP concentration, was maintained in culture (321 +/- 41 vs. 277 +/- 31 nmol (g wet wt)-1, 0 vs. 14 days). The initial decrease in ATP concentration in surgically prepared rings was significantly reversed following 14 days in culture from 135 +/- 26 to 201 +/- 18 nmol (g wet wt)-1 (P0.05). Freshly isolated vein rings maintained their intracellular free amino acid pool during the 14 days in culture (from 166 +/- 25 to 166 +/- 23 mumol (g protein)-1). Surgical preparation of vein rings induced a decrease in the intracellular free amino acid pool (from 166 +/- 25 to 87 +/- 15 mumol (g protein)-1, P0.05). This decrease was partially reversed after 14 days in culture (140 +/- 19 mumol (g protein)-1). Although the total amino acid pool in both types of vein rings after 14 days in culture was similar, there were variations in individual amino acid concentrations. Freshly isolated rings showed an increase in glutamine concentration and a decrease in alanine and aspartate concentrations after 14 days in culture. Surgically prepared vein rings showed a decrease in aspartate concentration and an increase in concentrations of glutamine, asparagine, glutamate and glycine. The changes in individual intracellular free amino acid concentrations, which were largely determined by the corresponding concentrations in the medium, indicates that culture media should be supplemented with taurine, aspartate and alanine.

Published
1996

26. Arterial blood pressure and vascular function in human saphenous vein.

Author

Momin, A, Sharabiani, MTA, Wendler, O, Angelini, GD, and Desai, J

Subjects
SAPHENOUS vein, SODIUM nitroferricyanide, ACETYLCHOLINE, PHENYLEPHRINE, ARTERIES, ATHEROSCLEROSIS, BLOOD pressure, BLOOD sugar, C-reactive protein, CORONARY artery bypass, STATISTICAL correlation, ENDOTHELIUM, HIGH density lipoproteins, HYPERTENSION, LONGITUDINAL method, LOW density lipoproteins, PROBABILITY theory, RESEARCH funding, TRIGLYCERIDES, TUMOR necrosis factors, VASOCONSTRICTION, DATA analysis software, PHYSIOLOGY, TRANSPLANTATION of organs, tissues, etc., THERAPEUTICS
Abstract

Hypertension is a risk factor for accelerated saphenous vein (SV) graft disease and endothelial dysfunction in a number of vascular territories. We examined the relationship between blood pressure (BP) and vascular function in SV from 94 male patients undergoing coronary artery bypass grafting (CABG). Patients were pretreated with respect to cholesterol (3.4±1.2 mmol/L) and BP (systolic 139±22 mmHg, diastolic 74±13 mmHg). All patients were taking aspirin, 85% statins, 50% angiotensin-converting enzyme inhibitors and 70% beta-blockers. We demonstrate in human SV rings ex vivo that increased BP has no effect on acetylcholine-mediated vasodilatation (p=0.58), nor on the constrictor response to L-NMMA (p=0.98), but has a positive association with the constrictor response to phenylephrine (p=0.008) and a negative correlation with the vasodilator response to sodium nitroprusside (p=0.03). These results may provide further explanation for the high incidence of early vein graft failure after CABG in hypertensive patients and support an aggressive approach to optimize BP before surgery. [ABSTRACT FROM PUBLISHER]

Published
2015
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42. Influence of concomitant coronary artery bypass graft on outcome of surgery of the ascending aorta/arch.

Author

Narayan P, Rogers CA, Caputo M, Angelini GD, Bryan AJ, Narayan, P, Rogers, C A, Caputo, M, Angelini, G D, and Bryan, A J

Abstract

Background: Surgery of the ascending aorta with or without arch is being performed in an increasingly elderly population with risks of coexisting coronary artery disease. Aim: To define specific groups requiring coronary artery bypass graft (CABG) and to analyse the influence of concomitant CABG on outcome. Design: Over a 10-year period in a single institution, 296 consecutive procedures on the ascending aorta with or without arch were carried out in 291 patients. CABG was required in 42 (14.2%) procedures. In 24 (57%) patients, CABG was planned preoperatively and in 18 (43%) patients, on a salvage basis. Results: In-hospital mortality for patients undergoing concomitant CABG was higher (21.4% v 11%, p<0.06). Adjusting for baseline and operative characteristics, this was attributable to operative priority, and was not a consequence of concomitant CABG (adjusted OR 0.30, 95% CI 1.1 to 8.31; p = 0.48). However, in-hospital mortality was significantly higher when CABG was performed as salvage rather than as a planned procedure (38.9% v 8.9%, p = 0.025), and this difference remained after adjusting for confounding variables (adjusted OR 16.2, 95% CI 1.03 to >200; p = 0.047). The 3-year survival was significantly lower with concomitant CABG (59% v 81.9%, p<0.001). Conclusions: In association with surgery of the ascending aorta with or without arch planned concomitant CABG did not entail any added operative risk. However, salvage CABG, which occurred almost exclusively in association with emergency cases, was associated with a higher early mortality. Patients needing concomitant CABG had worse survival at 3 years compared with those requiring isolated surgery of the ascending aorta with or without arch. [ABSTRACT FROM AUTHOR]

Published
2007

44. Side effects of cardiopulmonary bypass: what is the reality?

Author

Murphy GJ and Angelini GD

Abstract

Despite many years of clinical and experimental research, the contribution of cardiopulmonary bypass (CPB) and cardioplegic arrest to morbidity and mortality following cardiac surgery remains unclear. This is due, in part, to lack of suitable control group against which bypass and cardioplegic arrest can be compared. The recent success of beating heart coronary artery bypass grafting has, however, for the first time, provided an opportunity to compare the same operation, in similar patient groups, with, or without CPB and cardioplegic arrest. CPB is associated with an acute phase reaction of protease cascades, leucocyte, and platelet activation that result in tissue injury. This is largely manifest as subclinical organ dysfunction that produces a clinical effect in those patients that generate an excessive inflammatory response or in those with limited functional reserve. The contribution of myocardial ischemia/reperfusion, secondary to aortic cross-clamping, and cardioplegic arrest, to the systemic inflammatory response and wider organ dysfunction is unknown, and requires further evaluation in clinical trials. [ABSTRACT FROM AUTHOR]

Published
2004
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47. A comparative study of median sternotomy and standard thoracotomy wound skin closure methods

Author

Angelini Gd, Passani Sp, and Kulatilake En

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Sternum, Heart Diseases, medicine.medical_treatment, Polyurethanes, Suture (anatomy), Edema, Adhesives, medicine, Humans, Surgical Wound Infection, Prospective randomized study, Thoracotomy, Wound Healing, Sutures, business.industry, Suture Techniques, Thoracic Surgery, Middle Aged, Surgery, Nylons, Cardiothoracic surgery, Median sternotomy, Anesthesia, Female, Wound skin, medicine.symptom, Cardiology and Cardiovascular Medicine, Wound healing, business, Polyglycolic Acid
Abstract

Complications from skin closure after median sternotomy or standard thoracotomy incision, although uncommon, may be the source of undesireable morbidity and even death. A prospective randomized study of 3 different methods of wound skin closure has been carried out in 205 patients undergoing cardiothoracic surgery. These methods were: 1. continuous nylon vertical mattress suture; 2. continuous subcuticular absorbable (Dexon) suture; 3. adhesive sutureless skin closure (Op-Site). All wounds were examined by independent observers at 5, 10 and 45 days after operation, and the findings were graded from 0 to 4. At 5 days, assessments were made of inflammation, edema, discharge and infection. At 10 days, attention was paid to the state of wound healing, and at 45 days to the final cosmetic appearance. The use of continuous subcuticular Dexon suture resulted in less discharge than Op-site (p less than 0.001) and less swelling or redness than nylon (p less than 0.001). Assessment of the final cosmetic appearance of the wound 6 weeks following surgery showed subcuticular Dexon to be superior to either nylon (p less than 0.01) or Op-site (p less than 0.01).

Published
1985

48. Pseudocoarctation of the Aortic Arch Associated with Bicuspid Aortic Valve Lesion: Is it a Surgical Entity?

Author

Angelini Gd, Kulatilake En, Ruttley Ms, and Hayward M

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Aortic arch, Aortic valve, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Aortography, Aortic Valve Insufficiency, Hemodynamics, Coronary Disease, Aortic Coarctation, Bicuspid aortic valve, Calcinosis, Internal medicine, medicine.artery, medicine, Humans, cardiovascular diseases, Angiocardiography, Coronary Artery Bypass, Aged, medicine.diagnostic_test, business.industry, Aortic Valve Stenosis, Middle Aged, medicine.disease, medicine.anatomical_structure, Aortic Valve, Heart Valve Prosthesis, Aortic valve stenosis, cardiovascular system, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Three patients with bicuspid aortic valve lesion associated with pseudocoarctation of the aortic arch are presented. At operation, 2 had a bicuspid calcified stenotic aortic valve, and one a bicuspid non-calcified incompetent aortic valve. All required replacement of the diseased aortic valve. The pseudocoarctation was not corrected because it caused no hemodynamic abnormality.

Published
1985
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50. P422 Cardiac ischemic stress during remote ischemic preconditioning.

Author

Abdul Ghani, S, Angelini, GD, and Suleiman, MS

Subjects
*CARDIAC patients, *ISCHEMIA, *PHYSIOLOGICAL stress, *REMOTE sensing, *REPERFUSION injury, *MYOCARDIUM physiology
Abstract

Background: Remote ischemic preconditioning (RIPC) induced by brief ischemia/reperfusion (I/R) cycles of remote organ (e.g. limb) is cardio-protective. The myocardial cellular changes during RIPC that are responsible for this phenomenon are not currently known. However, it is widely accepted that unlike classical ischemic preconditioning, RIPC does not induce ischemic stress in the myocardium. To address this issue we developed a novel RIPC mouse model and monitored myocardial changes in energy-rich phosphates.Methods: Treatment of animals and all procedures were in accordance with Home office guidance (Scientific Procedures) Act of 1986. Male C57/Bl6 mice were anesthetized by an intra-peritoneal injection of Tribromoethanol. A suitably designed cuff was placed around the hind limb and inflated at 200mmHg to prevent blood flow as confirmed by Laser Doppler Flowmetry. RIPC was induced by 4 cycles of 5min of limb ischemia followed by 5min of reperfusion. Hearts were extracted and used for either measurement of metabolites or perfused in the Langendorff mode. Injury and recovery of function were obtained for RIPC and sham operated mice. Myocardial metabolites (e.g. adenine and guanine nucleotides and by-products) from excised hearts following RIPC were extracted and measured using HPLC.Results: RIPC significantly reduces infarct size (34% vs. 59%; P<0.05), total creatine kinase release and end diastolic tension following I/R. RIPC was associated with significant ischemic stress as shown by a fall in ATP/AMP (1.324± 0.124 vs. 0.965± 0.036 P<0.05), ATP/ADP (0.917 ± 0.03 vs. 0.805± 0.025 P<0.05 ), GTP/GMP (2.71± 0.162 vs. 2.019± 0.103 P<0.005) and GTP/GDP (0.87 ± 0.017 vs. 0.749± 0.021 P<0.005 ). There was also a significant increase in myocardial adenosine (0.21± 0.032 vs. 0.127± 0.01 nmol/mg wet weight, P<0.05).Conclusions: RIPC is associated with myocardial ischemic stress. This effect is likely to contribute to RIPC-induced protection against sustained ischemic insult. [ABSTRACT FROM PUBLISHER]

Published
2014
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