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Source: JAMA
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Total 116 results found since Jan 2013.
Blood Pressure Management After Successful Thrombectomy
Despite the success of endovascular therapy (EVT) in acute ischemic stroke due to large vessel occlusion, opportunities to further optimize clinical outcomes remain. One such avenue is to reduce hemorrhagic transformation in the infarcted tissue bed after successful reperfusion, which has been shown to be associated with worsened clinical outcomes. Because higher cerebral perfusion pressures may foster hemorrhagic transformation, it has been hypothesized that lowering systemic blood pressure (BP) after successful reperfusion could decrease cerebral hemorrhagic complications. Reducing systemic BP may also lead to a decrease...
Source: JAMA - September 5, 2023 Category: General Medicine Source Type: research
Door-in-Door-out Times for Transfer of Patients With Stroke
This retrospective study involving patients with acute stroke requiring transfers from hospitals in the Get With the Guidelines –Stroke registry assesses patient and hospital factors associated with door-in-door-out times.
Source: JAMA - August 15, 2023 Category: General Medicine Source Type: research
Treating Coronary Artery Disease With Treat-to-Target or High-Intensity Statin —Reply
In Reply We appreciate Dr Kawada ’s comments about our study, which demonstrated that a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.
Source: JAMA - August 1, 2023 Category: General Medicine Source Type: research
Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction
To the Editor The recent RAPID-HF study explored the important concept of supporting heart rate in patients with heart failure and chronotropic insufficiency. Although the study reached a null conclusion, I believe it is important not to overextrapolate the findings. Cardiac output, by definition, is heart rate × stroke volume. Because these are not independent variables, the authors saw that when exercise heart rate was increased with atrial pacing, they could not measure an increase in cardiac output.
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research
Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction —Reply
In Reply The RAPID-HF study, which was the first randomized trial testing atrial pacing to increase exercise heart rate in patients with HFpEF, demonstrated no benefit in exercise performance, with a decrease in exercise stroke volume preventing gains in cardiac output. Dr Yamamoto speculates that atrial pacing might have been more effective for older patients because diastolic dysfunction worsens with aging. However, shortening of diastole with higher heart rate would be expected to be even more poorly tolerated in these patients. The devices were programmed based on hall walk and each participant ’s prior peak heart ra...
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research
Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy
This retrospective cohort study assesses the association between recent use of oral vitamin K antagonists and symptomatic intracranial hemorrhage among patients with acute ischemic stroke undergoing endovascular thrombectomy.
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research
Accuracy of Stroke Risk Prediction Models by Race, Sex, and Age
This retrospective cohort study compares stroke-specific algorithms with pooled cohort equations developed for atherosclerotic cardiovascular disease for the prediction of new-onset stroke across different subgroups (race, sex, and age) and the added value of novel machine learning techniques.
Source: JAMA - January 24, 2023 Category: General Medicine Source Type: research
Gout Flare and Cardiovascular Events
In this study, more individuals with gout and cardiovascular events had a history of cardiovascular disease and high to very high cardiovascular risk than matched controls with gout who did not have cardiovascular events.
Source: JAMA - January 3, 2023 Category: General Medicine Source Type: research
Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis
To the Editor The recently published CASSISS trial was a prospective randomized study of intracranial artery stenting vs medical therapy for symptomatic intracranial atherosclerotic stenosis. The clinical outcomes of stroke and death in the stenting group at 1 year are similar to the WEAVE and WOVEN trials, which demonstrated an 8.5% stroke and death rate at 1 year in 129 patients who had received stents.
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis —Reply
In Reply We agree with the comments by Drs Zedde and Pascarella and Drs Alexander and Yu that patient selection in our study may have altered the effect on the outcomes of stenting and medical therapy for patients with intracranial stenosis.
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
COVID-19 vs Influenza for Risk of Thrombotic Events in Hospitalized Patients —Reply
In Reply We appreciate the interest in our recent study and the opportunity to share our responses to the comments by Dr Yii and colleagues. We sought to assess whether the risk of arterial and venous thromboembolism among patients hospitalized with COVID-19 differed from those hospitalized with another respiratory viral infection. Patients with influenza in 2018-2019 were selected as the comparator because this pathogen also causes pandemics, results in hospitalization when severe, and is associated with increased risk of acute myocardial infarction, ischemic stroke, and venous thromboembolism. Evaluating outcomes of COVI...
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
Remote Ischemic Conditioning vs Usual Care and Neurologic Function in Acute Moderate Ischemic Stroke
To the Editor The Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) randomized clinical trial shed new light on remote ischemic conditioning (RIC) as a potential treatment in acute ischemic stroke, although there was a 5.4% absolute risk improvement in excellent outcome with a power of 66%. To reproduce these findings with the same protocol using a power of 80%, a sample size of 2458 patients would be required. Previous trials in acute brain infarction and myocardial infarction have delivered 1 cycle of RIC in the first 6 hours of ischemia with the underlying hypothesis of enhanced penumbra salvage....
Source: JAMA - December 20, 2022 Category: General Medicine Source Type: research
Remote Ischemic Conditioning vs Usual Care and Neurologic Function in Acute Moderate Ischemic Stroke —Reply
In Reply We appreciate the interest shown by Dr Pico and colleagues about our trial that investigated the effect of RIC on neurologic function in patients with acute moderate ischemic stroke. A dose-response relationship between the number of days of RIC (or the number of RICs delivered) and excellent outcomes is important information to determine the best protocol for in-hospital RIC. These data will be investigated in our secondary analysis of the RICAMIS study.
Source: JAMA - December 20, 2022 Category: General Medicine Source Type: research
Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention
To the Editor In a recent study, the authors reported 133 ipsilateral ischemic strokes among patients with medically treated asymptomatic severe carotid stenosis who did not undergo surgical intervention after a mean follow-up of 4.1 years. During this follow-up period, 55.6% of the 3737 patients died; however, cause of death was not reported in this study. Could some of these deaths have been caused by major strokes, and is it possible that these events were missed?
Source: JAMA - September 27, 2022 Category: General Medicine Source Type: research
