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Titolo:
ANALYSES OF CORONARY GRAFT PATENCY AFTER APROTININ USE - RESULTS FROMTHE INTERNATIONAL MULTICENTER APROTININ GRAFT PATENCY EXPERIENCE (IMAGE) TRIAL
Autore:
ALDERMAN EL; LEVY JH; RICH JB; NILI M; VIDNE B; SCHAFF H; URETZKY G; PETTERSSON G; THIIS JJ; HANTLER CB; CHAITMAN B; NADEL A;
Indirizzi:
STANFORD UNIV,MED CTR,DIV CARDIOVASC MED,CVRC-CV261,300 PASTEUR DR STANFORD CA 94305 EMORY UNIV,SCH MED,DEPT ANESTHESIOL ATLANTA GA 30322 SENTARA HOSP NORFOLK VA 00000 BEILINSON MED CTR,DIV CARDIOTHORAC SURG IL-49100 PETAH TIQWA ISRAEL MAYO CLIN ROCHESTER MN 00000 CARMEL HOSP HAIFA ISRAEL UNIV COPENHAGEN HOSP DK-2100 COPENHAGEN DENMARK UNIV TEXAS,HLTH SCI CTR SAN ANTONIO TX 00000 ST LOUIS UNIV HOSP ST LOUIS MO 00000 BAYER CORP,DEPT STAT & DATA SYST W HAVEN CT 00000
Titolo Testata:
Journal of thoracic and cardiovascular surgery
fascicolo: 5, volume: 116, anno: 1998,
pagine: 716 - 729
SICI:
0022-5223(1998)116:5<716:AOCGPA>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
AUTOGENOUS VEIN GRAFTS; ENDOTHELIAL PRESERVATION; CARDIOPULMONARY BYPASS; BLOOD-TRANSFUSION; SAPHENOUS VEINS; PREDICTORS; INHIBITORS; TRASYLOL; NOVACODE; SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
30
Recensione:
Indirizzi per estratti:
Citazione:
E.L. Alderman et al., "ANALYSES OF CORONARY GRAFT PATENCY AFTER APROTININ USE - RESULTS FROMTHE INTERNATIONAL MULTICENTER APROTININ GRAFT PATENCY EXPERIENCE (IMAGE) TRIAL", Journal of thoracic and cardiovascular surgery, 116(5), 1998, pp. 716-729

Abstract

Objective: We examined the effects of aprotinin on graft patency, prevalence of myocardial infarction? and blood loss in patients undergoing primary coronary surgery with cardiopulmonary bypass. Methods: Patients from 13 international sites were randomized to receive intraoperative aprotinin (n = 436) or placebo (n = 434). Graft angiography was obtained a mean of 10.8 days after the operation. Electrocardiograms, cardiac enzymes, and blood loss and replacement were evaluated. Results:In 796 assessable patients, aprotinin reduced thoracic drainage volume by 43% (P < .0001) and requirement for red blood cell administrationby 49% (P < .0001), Among 703 patients with assessable saphenous veingrafts, occlusions occurred in 15.4% of aprotinin-treated patients and 10.9% of patients receiving placebo (P = .03). After we had adjustedfor risk factors associated with vein graft occlusion, the aprotinin versus placebo risk ratio decreased from 1.7 to 1.05 (90% confidence interval, 0.6 to 1.8). These factors included female gender, lack of prior aspirin therapy, small and poor distal vessel quality, and possibly use of aprotinin-treated blood as excised vein perfusate, At United States sites, patients had characteristics more favorable for graft patency, and occlusions occurred in 9.4% of the aprotinin group and 9.5%of the placebo group (P = .72). At Danish and Israeli sites, where patients had more adverse characteristics, occlusions occurred in 23.0% of aprotinin- and 12.4% of placebo-treated patients (P = .01). Aprotinin did not affect the occurrence of myocardial infarction (aprotinin: 2.9%; placebo: 3.8%) or mortality (aprotinin: 1.4%; placebo: 1.6%). Conclusions: In this study, the probability of early vein graft occlusion was increased by aprotinin, but this outcome was promoted by multiple risk factors for graft occlusion.

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Documento generato il 29/11/20 alle ore 00:28:22