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Comparison of Characteristics and Outcomes of Versus in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial)
Hypertension is frequent in patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg (D110) and 150 mg twice daily (D150) noninferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed.
Source: The American Journal of Cardiology - July 28, 2015 Category: Cardiology Authors: Rangadham Nagarakanti, Lars Wallentin, Herbert Noack, Martina Brueckmann, Paul Reilly, Andreas Clemens, Stuart J. Connolly, Salim Yusuf, Michael D. Ezekowitz Tags: Arrhythmias and Conduction Disturbances Source Type: research

Is Transcatheter Aortic Valve Implantation as Cost-effective as Surgical Aortic Valve Replacement?
Transcatheter aortic valve implantation (TAVI) has emerged as an efficacious and cost-effective treatment for inoperable patients with severe aortic stenosis.1 For high-risk patients, existing evidence suggests that TAVI has similar peri-procedural mortality and stroke outcomes compared to surgical aortic valve replacement (AVR), with higher incidences of paravalvular leak, permanent pacemaker requirement and vascular injuries after TAVI and higher incidences of major bleeding after AVR.2 Regarding the cost-effectiveness of TAVI, a recent systematic review examining its incremental cost effectiveness ratio in relation to A...
Source: The American Journal of Cardiology - July 16, 2015 Category: Cardiology Authors: Christopher Cao Source Type: research

Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin
We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial.
Source: The American Journal of Cardiology - June 24, 2015 Category: Cardiology Authors: Siqin Ye, Bin Cheng, Gregory Y.H. Lip, Richard Buchsbaum, Ralph L. Sacco, Bruce Levin, Marco R. Di Tullio, Min Qian, Douglas L. Mann, Patrick M. Pullicino, Ronald S. Freudenberger, John R. Teerlink, J.P. Mohr, Susan Graham, Arthur J. Labovitz, Conrado J. Tags: Heart Failure Source Type: research

Problems in addition to stroke and bleeding after left atrial appendage closure
We read the article by Waksman et al. about the discussions between the US Food and Drug Administration (FDA) and the sponsor regarding approval of the WATCHMAN-device for interventional left atrial appendage closure (LAAC).[1] We would like to stimulate the discussion by the following contribution: LAAC is primarily intended as an alternative for stroke prevention in patients with atrial fibrillation (AF) in whom oral anticoagulation (OAC) is not possible because of contraindications about a high bleeding risk.
Source: The American Journal of Cardiology - April 24, 2015 Category: Cardiology Authors: Claudia Stöllberger, Josef Finsterer, Birke Schneider Source Type: research

Balancing the Risk of Bleeding and Stroke in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention (from the AVIATOR-registry)
We describe patterns and determinants of antithrombotic prescriptions in this population. The AVIATOR (Antithrombotic strategy Variability In ATrial fibrillation and Obstructive coronary disease Revascularized with PCI) Registry was an international observational study of 859 consecutive patients with AF undergoing PCI between 2009 and 2011.
Source: The American Journal of Cardiology - April 7, 2015 Category: Cardiology Authors: Marco G. Mennuni, Jonathan L. Halperin, Sameer Bansilal, Mikkel M. Schoos, Kleanthis N. Theodoropoulos, Omar A. Meelu, Samantha Sartori, Daniele Giacoppo, Chiara Bernelli, Pedro R. Moreno, Prakash Krishnan, Usman Baber, Carla Lucarelli, George D. Dangas, Source Type: research

Balancing the Risk of Bleeding and Stroke in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention (from the AVIATOR Registry)
We describe patterns and determinants of antithrombotic prescriptions in this population. The Antithrombotic Strategy Variability in Atrial Fibrillation and Obstructive Coronary Disease Revascularized with PCI Registry was an international observational study of 859 consecutive patients with AF who underwent PCI from 2009 to 2011.
Source: The American Journal of Cardiology - April 7, 2015 Category: Cardiology Authors: Marco G. Mennuni, Jonathan L. Halperin, Sameer Bansilal, Mikkel M. Schoos, Kleanthis N. Theodoropoulos, Omar A. Meelu, Samantha Sartori, Daniele Giacoppo, Chiara Bernelli, Pedro R. Moreno, Prakash Krishnan, Usman Baber, Carla Lucarelli, George D. Dangas, Tags: Coronary Artery Disease Source Type: research

Meta-analysis Of Randomized Controlled Trials and Adjusted Observational Results Of Use Of Clopidogrel, Aspirin and Oral Anti-coagulants In Patients Undergoing Percutaneous Coronary Intervention
The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulation (OAC) is currently debated. Medline and Cochrane Library were searched for studies reporting outcomes of patients undergoing PCI and who were on triple therapy (TT)or dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy(DT) with OAC and clopidogrel. Major bleeding was the primary end point, while all-cause death, myocardial infarction (MI), stent thrombosis and stroke were secondary ones.
Source: The American Journal of Cardiology - February 11, 2015 Category: Cardiology Authors: Fabrizio D’Ascenzo, Salma Taha, Claudio Moretti, Pierluigi Omedè, Walter Grossomarra, Jonas Persson, Morten Lamberts, Willem Dewilde, Andrea Rubboli, Sergio Fernández, Enrico Cerrato, Ilaria Meynet, Flavia Ballocca, Umberto Barbero, Giorgio Quadri, Fr Source Type: research

Factors Driving Anticoagulant Selection in Patients with Atrial Fibrillation in the United States
With the introduction of novel oral anticoagulants (NOACs), the factors driving anticoagulant selection in atrial fibrillation (AF) in real-world practice are unclear. The goal was to examine whether and to what extent utilization has been driven by predictions of stroke risk (treatment benefit), bleeding risk (treatment harm), or prescription benefits’ coverage. We extracted a cohort of non-valvular AF patients initiating anticoagulation from Oct 2010-Dec 2012 from a large US database of commercial and Medicare supplement claims.
Source: The American Journal of Cardiology - February 2, 2015 Category: Cardiology Authors: Julie C. Lauffenburger, Joel F. Farley, Anil K. Gehi, Denise H. Rhoney, M. Alan Brookhart, Gang Fang Source Type: research

Antithrombotic Strategies and Outcomes in Acute Coronary Syndrome with Atrial Fibrillation
Atrial fibrillation (AF) frequently occurs with acute coronary syndromes (ACS) and adds complexity to the selection of an appropriate antithrombotic strategy. We determined whether associations of antithrombotic treatment with bleeding, stroke, and death differ between ACS patients with and without AF. Olmsted County, MN residents hospitalized with incident ACS during 2005-2010 were classified according to the presence or absence of AF either prior to or during the index ACS hospitalization. Antithrombotic strategy at discharge was categorized as double/triple agents vs.
Source: The American Journal of Cardiology - January 31, 2015 Category: Cardiology Authors: Alanna M. Chamberlain, Bernard J. Gersh, Roger M. Mills, Winslow Klaskala, Alvaro Alonso, Susan A. Weston, Véronique L. Roger Source Type: research

Meta-analysis of Net Long-term Benefit of Different Therapeutic Strategies in Patients with Cryptogenic Stroke and Patent Foramen Ovale
We pooled available data on follow-up events in patients with patent foramen ovale and cryptogenic stroke to evaluate the net clinical benefit of different therapeutic strategies (percutaneous closure vs antiplatelet vs anticoagulant therapy). MEDLINE/Pubmed and Cochrane databases and reviewed cited references to identify relevant studies were used; 3,311 patients from 21 clinical studies, both observational and randomized, with follow-up ≥12 months were overall included. Net clinical benefit was evaluated considering the cumulative incidence of both stroke/transient ischemic attack and major bleeding events.
Source: The American Journal of Cardiology - January 5, 2015 Category: Cardiology Authors: Giuseppe Patti, Francesco Pelliccia, Carlo Gaudio, Cesare Greco Source Type: research

Effect of an Invasive Strategy on Outcome in Patients ≥75 Years of Age with Non-ST-Elevation Acute Coronary Syndrome
The Italian Elderly ACS study was the first randomized trial (RCT) comparing an early aggressive (EA) with an initially conservative strategy in patients with NSTEACS aged ≥75 years, with the results showing no significant benefit of EA. We evaluated the outcomes of study patients, according to the treatment actually received during hospitalization. The RCT enrolled 313 patients. The primary endpoint was the composite of death, myocardial infarction (MI), disabling stroke, and repeat hospital stay for cardiovascular causes or bleeding within 1 year.
Source: The American Journal of Cardiology - December 17, 2014 Category: Cardiology Authors: Gennaro Galasso, Stefano De Servi, Stefano Savonitto, Teresa Strisciuglio, Raffaele Piccolo, Nuccia Morici, Ernesto Murena, Claudio Cavallini, Anna Sonia Petronio, Federico Piscione Source Type: research

Comparison of Safety of Left Atrial Catheter Ablation Procedures for Atrial Arrhythmias under Continuous Anticoagulation with Apixaban versus Phenprocoumon
Apixaban is increasingly used for stroke prevention in patients with atrial fibrillation (AF). Data about the safety of left atrial radiofrequency ablation procedures under continuous apixaban therapy are lacking. We performed a matched cohort study of patients undergoing LA ablation procedures for AF or left atrial flutter. For each patient on apixaban, two patients on phenprocoumon were matched by age, sex, and type of arrhythmia. The primary safety endpoint was a composite of bleeding, thromboembolic events and death.
Source: The American Journal of Cardiology - October 11, 2014 Category: Cardiology Authors: Bernhard M. Kaess, Sonia Ammar, Tilko Reents, Roger Dillier, Carsten Lennerz, Verena Semmler, Christian Grebmer, Felix Bourier, Alessandra Buiatti, Christof Kolb, Isabel Deisenhofer, Gabriele Hessling Source Type: research

Usefulness and Safety of Vorapaxar in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (from the TRACER Trial)
In conclusion, among patients with PCI, the effect of vorapaxar is consistent with the overall TRACER results. Patients who received a BMS underwent shorter courses of clopidogrel therapy and displayed trends toward greater ischemic benefit from vorapaxar and lesser bleeding risk, compared with patients who received a DES.
Source: The American Journal of Cardiology - June 20, 2014 Category: Cardiology Authors: Marco Valgimigli, Pierluigi Tricoci, Zhen Huang, Philip E. Aylward, Paul W. Armstrong, Frans Van de Werf, Sergio Leonardi, Harvey D. White, Petr Widimsky, Robert A. Harrington, Angel Cequier, Edmond Chen, Yuliya Lokhnygina, Lars Wallentin, John Strony, Ke Tags: Coronary Artery Disease Source Type: research

Optimal Blood Pressure in Patients With Atrial Fibrillation (from the AFFIRM Trial)
Many medications used to treat atrial fibrillation (AF) also reduce blood pressure (BP). The relation between BP and mortality is unclear in patients with AF. We performed a post hoc analysis of 3,947 participants from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management trial. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at baseline and follow-up were categorized by 10-mm Hg increments. The end points were all-cause mortality (ACM) and secondary outcome (combination of ACM, ventricular tachycardia and/or fibrillation, pulseless electrical activity, significant bradycardia, stroke, major...
Source: The American Journal of Cardiology - June 20, 2014 Category: Cardiology Authors: Apurva O. Badheka, Nileshkumar J. Patel, Peeyush M. Grover, Neeraj Shah, Nilay Patel, Vikas Singh, Abhishek J. Deshmukh, Kathan Mehta, Ankit Chothani, Ghanshyambhai T. Savani, Shilpkumar Arora, Ankit Rathod, George R. Marzouka, James Lafferty, Jawahar L. Tags: Systemic Hypertension Source Type: research

Meta-Analysis of Efficacy and Safety of Rivaroxaban Compared With Warfarin or Dabigatran in Patients Undergoing Catheter Ablation for Atrial Fibrillation
In conclusion, our study suggests that patients treated with rivaroxaban during periprocedural catheter ablation have similar rates of thromboembolic events and major hemorrhage. Similar results were seen in direct comparisons between dabigatran and rivaroxaban.
Source: The American Journal of Cardiology - June 9, 2014 Category: Cardiology Authors: Madan Raj Aryal, Anene Ukaigwe, Anil Pandit, Paras Karmacharya, Rajesh Pradhan, Naba Raj Mainali, Ranjan Pathak, Leena Jalota, Yashoda Bhandari, Anthony Donato Tags: Arrhythmias and Conduction Disturbances Source Type: research

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