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Source: Journal of the American College of Cardiology

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Total 177 results found since Jan 2013.

Bariatric Surgery and the Risk of New-Onset Atrial Fibrillation in Swedish  Obese Subjects
BackgroundObesity is a risk factor for atrial fibrillation, which in turn is associated with stroke, heart failure, and increased all-cause mortality.ObjectivesThe authors investigated whether weight loss through bariatric surgery may reduce the risk of new-onset atrial fibrillation.MethodsSOS (Swedish Obese Subjects) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary healthcare centers in Sweden. The cohort was recruited between 1987 and 2001. Among 4,021 obese  individuals with sinus rhythm and no history of atrial fibrillation, 2,000 underwent bariatric surgery (surgery group), a...
Source: Journal of the American College of Cardiology - December 6, 2016 Category: Cardiology Source Type: research

Causes of Death in Anticoagulated Patients With Atrial Fibrillation
ConclusionsIn contemporary AF trials, most deaths were cardiac-related, whereas stroke and bleeding represented  only a small subset of deaths. Interventions beyond anticoagulation are needed to further reduce mortality in AF.
Source: Journal of the American College of Cardiology - December 6, 2016 Category: Cardiology Source Type: research

Anticoagulation Treatment for Stroke Prevention in Atrial Fibrillation Is Increasing, But Further Improvements Needed
A recent paper by Hsu et  al.(1) assessed antithrombotic treatment among atrial fibrillation (AF) patients. The data, from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012, showed that 61.8% of patients with moderate-to-high stroke risk received anticoagulant therapy with either warfarin or newer direct oral anticoagulants (DOACs). The investigators and an editorial commentary noted the alarming prevalence of aspirin-only treatment despite clear evidence that anticoagulants are superior for prevention of thromboembolism in AF (1,2).
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Reply Anticoagulation Treatment for Stroke Prevention in Atrial Fibrillation Is Increasing, But Further Improvements Needed
We are appreciative of Dr. Brown and colleagues and their interest in our recent paper in theJournal(1) regarding prescription of aspirin instead of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) who are at intermediate-to-high thromboembolic risk in the American College of Cardiology National Cardiovascular Data Registry ’s PINNACLE (Practice Innovation and Clinical Excellence) Registry. They appropriately highlight some of our main findings, including that OAC prescription was selected in 61.8% of patients with a CHADS2 score  ≥2 (meaning 38.2% of patients were treated with aspirin alone) and 5...
Source: Journal of the American College of Cardiology - November 29, 2016 Category: Cardiology Source Type: research

Left Atrial Appendage Isolation in Patients  With Longstanding Persistent AF Undergoing Catheter Ablation BELIEF Trial
ConclusionsThis randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications. (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation [BELIEF]; NCT01362738)
Source: Journal of the American College of Cardiology - October 25, 2016 Category: Cardiology Source Type: research

Single Antiplatelet Therapy Following Left Atrial Appendage Closure in Patients With Contraindication to Anticoagulation
Left atrial appendage closure (LAAC) has emerged as an alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Optimal antithrombotic therapy following LAAC is  an unresolved issue and current anticoagulation and antiplatelet strategies after LAAC remain empirical. In the PROTECT-AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial, patients received short-term (45 days) anticoagulation followed by d ual antiplatelet therapy (DAPT) for a period of 6 months and then lifelong aspirin(1). In patients with a contraindication...
Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research

GW27-e1260 The DNAH11 rs12670798 single nucleotide polymorphism is associated with the risk of coronary artery disease and ischemic stroke
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0484 Correlation of platelet function with recurrent ischemic vascular events in stroke patients
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0570 The predictive risk factors of silent ischemic stroke event is nocturnal blood pressure and central aortic systolic blood pressure in Metabolic Syndrome
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0689 Early morning blood pressure, pulse wave velocity, central aortic Pressure and predictive risk factors of Ischemic Stroke in masked hypertensive patients
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0183 Differences in haematological indices in chinese patients with an ischaemic stroke between those with and without a high risk patent
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0870 Is mouth better than nasal approach for brain protection in out-of-hospital cardiac arrest and stroke?
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e1205 Effective cooling by CO2 Expansion for brain protection in out-of-hospital cardiac arrest and stroke- Is a regulator necessary?
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0345 The retrospective analysis of clinical characteristics and risk factors in elderly patients that complicated with pneumonia after ischemic stroke
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

GW27-e0346 The retrospective study of clinical characteristics and risk factors in patients that complicated with pneumonia after stroke
Source: Journal of the American College of Cardiology - October 11, 2016 Category: Cardiology Source Type: research

Association of Systolic Blood Pressure Variability With Mortality, Coronary  Heart Disease, Stroke, and Renal Disease
This study investigated the association of increased visit-to-visit variability and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans.MethodsFrom among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. Systolic blood pressure variability (SBPV) was measured using the SD of all SBP  values (normally distributed) in 1 individual. Associations of SD quartiles (
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research

Thromboembolic, Bleeding, and Mortality  Risks of Rivaroxaban and Dabigatran in Asians With Nonvalvular Atrial Fibrillation
BackgroundIt is unclear whether the non –vitamin K antagonist oral anticoagulant agents rivaroxaban and dabigatran are superior to warfarin for efficacy and safety outcomes in Asians with nonvalvular atrial fibrillation (NVAF).ObjectivesThe aim of this study was to compare the risk for thromboembolic events, bleeding, and mortality associated with rivaroxaban and dabigatran versus warfarin in Asians with NVAF.MethodsA nationwide retrospective cohort study was conducted of consecutive patients with NVAF taking rivaroxaban (n  = 3,916), dabigatran (n = 5,921), or warfarin (n = 5,251) using data collected from the Taiwan...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research

Effect of New Cerebral Ischemic Lesions on the Delirium Occurrence After Transcatheter Aortic Valve Replacement
Although only 2% to 5% of patients develop symptomatic stroke following transcatheter aortic valve replacement (TAVR), new cerebral lesions have been detected among the majority of these patients using diffusion weighted magnetic resonance imaging (DWI-MRI), irrespective of access site strategy(1). According to the published reports, new cerebral DWI lesions have been associated with future neurological and cognitive decline; however, the relationship between these lesions and post-operative delirium (POD) following TAVR remains unknown. By means of this study, we aimed to assess the impact of new cerebral DWI lesions on t...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research

The Challenge of Timing Surgery in Degenerative Mitral Regurgitation Is B-Type Natriuretic Peptide the Solution? ∗
Degenerative mitral regurgitation (MR) with prolapse or flail of mitral leaflets has become the most frequent cause of severe primary MR in Europe and North America (1,2). In its chronic stage, even severe MR is tolerated very well for a surprisingly long time, and patients may remain asymptomatic for years. During this compensated stage of disease, pre-load, afterload, and both contractility and ejection fraction of the left ventricle (LV) remain normal, and the total stroke volume is increased as a result of the compensatory enlargement of the end-diastolic LV volume, which is enabled by an adaptive process of the LV myo...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research

Thrombotic and Embolic Complications Associated With Atrial Arrhythmia After  Fontan Operation Role of Prophylactic Therapy
This study sought to determine the risk of TEC in this population and the role of anticoagulation therapy in TEC prevention.MethodsThis was a retrospective review of adults with atrial arrhythmia after Fontan operation who were evaluated at the Mayo Clinic between 1994 to 2014. TEC was classified into 2 groups: systemic TEC, defined as intracardiac thrombus, ischemic stroke, or systemic arterial embolus; and nonsystemic TEC, defined as Fontan conduit/right atrial thrombus or pulmonary embolus. Patients were divided into 3 groups: anticoagulation, antiplatelet, and no therapy cohorts.ResultsWe followed 278 patients, mean ag...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research

Fontan Anticoagulation A Never-Ending Debate? ∗
Thrombus formation is a significant cause of morbidity and mortality after Fontan operations. Intracardiac thrombus formation can lead to chronic pulmonary embolism (e.g., from system veins or subpulmonary ventricle) or stroke (e.g., from pulmonary veins or the systemic ventricle). Those “right-sided” embolisms may result in a ventilation/perfusion mismatch or an elevation of pulmonary vascular resistance, both of which may seriously hamper the cavopulmonary circulation. Preventing thromboembolism after the Fontan procedure and the role of a proper prophylaxis remains an ongoing discussion. The published reports are fr...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research

Refining Stroke Prediction in Atrial  Fibrillation Patients by Addition of African-American Ethnicity to CHA 2 DS 2 -VASc Score
Conclusions In patients> 65 years of age with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score  significantly improved stroke prediction.
Source: Journal of the American College of Cardiology - July 26, 2016 Category: Cardiology Source Type: research

Stroke Prediction in Atrial Fibrillation Is it Black and White? ∗
Atrial fibrillation (AF) is a common arrhythmia that predisposes patients to risk of stroke (1) that can be prevented with anticoagulation (2) . However, a minority of patients with AF and risk of stroke are treated with anticoagulants (3) , with undertreatment being due to a variety of factors. Optimizing treatment depends, in part, on the ability to understand risks, benefits, and personal preferences of individual patients. The CHADS 2 (congestive heart failure, hypertension, age  ≥75 years, diabetes, and 2 points for prior stroke or transient ischemic attack) scoring system has been useful for stratifying risk of ...
Source: Journal of the American College of Cardiology - July 26, 2016 Category: Cardiology Source Type: research

Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

Stroke and Bleeding Risks in NOAC- and Warfarin-Treated Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation
Hypertrophic cardiomyopathy (HCM) affects>600,000 patients in the United States, and approximately 1 in 5 of them have atrial fibrillation (AF) (1). The incidence of stroke in patients with HCM is markedly increased when complicated by AF, with an annualized risk of nearly 4% (2). AF is an indication for warfarin in nearly all patients with HCM (3,4). Non–vitamin K antagonist oral anticoagulants (NOACs) may be reasonable alternatives to warfarin, but there are no explicit data to support their use (3,4).
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

Acute Ischemic Stroke Intervention
Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evol...
Source: Journal of the American College of Cardiology - May 31, 2016 Category: Cardiology Source Type: research

Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care
Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 “positive” trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines. We discuss the ongoing and future changes in stroke systems of care, w...
Source: Journal of the American College of Cardiology - May 31, 2016 Category: Cardiology Source Type: research

Comparing the ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Scores for Stroke Prediction in Atrial Fibrillation
Van den Ham et al. (1) recently compared the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack), and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) stroke risk scores in a primary care community cohort of patients with first-diagnosed atrial fibrillation (AF) not using oral anticoagulation (OAC) for undefined reasons. They concluded that improved risk ...
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research

Reply Comparing the ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Scores for Stroke Prediction in Atrial Fibrillation
We tested the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke), and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) stroke risk scores in the CPRD (Clinical Practice Research Datalink) cohort of incident atrial fibrillation (AF) patients not using oral anticoagulants (OAC) because these are the patients for whom physicians must make the OAC treatment decision (1). The mean patient follo...
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research

Predicting Stroke in Patients With Atrial Fibrillation An Incomplete Picture Without Considering Quality of Anticoagulation
Van den Ham et al. (1) nicely compare the new stroke risk stratification tool anticoagulation and risk factors in atrial fibrillation (ATRIA) with CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Prior stroke, TIA, or thromboembolism) and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Prior stroke, TIA, or thromboembolism, Vascular disease, Age 65–74 years, Sex category [female]) in patients with atrial fibrillation.
Source: Journal of the American College of Cardiology - May 3, 2016 Category: Cardiology Source Type: research

Considerations When Evaluating Cost-Effectiveness Analyses of Novel Stroke Prevention Therapies
The study by Reddy et al. (1) adds to the growing body of work evaluating the cost effectiveness of stroke prevention therapies from a U.S. perspective. We applaud their use of decision analytical models to inform practitioners and payers. We highlight 3 important considerations for readers of this work.
Source: Journal of the American College of Cardiology - May 3, 2016 Category: Cardiology Source Type: research

Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke
ConclusionsIndividuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies.
Source: Journal of the American College of Cardiology - March 29, 2016 Category: Cardiology Source Type: research

Device Closure of Patent Foramen Ovale After Stroke Pooled Analysis of Completed Randomized Trials
ConclusionsAmong patients with PFO and cryptogenic stroke, closure reduced recurrent stroke and had a statistically significant effect on the composite of stroke, transient ischemic attack, and death in adjusted but not unadjusted analyses.
Source: Journal of the American College of Cardiology - February 23, 2016 Category: Cardiology Source Type: research

Effect of Diabetes and Glycemic Control on Ischemic Stroke Risk in AF Patients ATRIA Study
BackgroundDiagnosed diabetes mellitus (DM) is a consistently documented risk factor for ischemic stroke in patients with atrial fibrillation (AF).ObjectivesThe purpose of this study was to assess the association between duration of diabetes and elevated hemoglobin A1c (HbA1c) with risk of stroke among diabetic patients with AF.MethodsWe assessed this association in the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) California community-based cohort of AF patients (study years 1996 to 2003) where all events were clinician adjudicated. We used Cox proportional hazards regression to estimate the rate of isc...
Source: Journal of the American College of Cardiology - January 19, 2016 Category: Cardiology Source Type: research

Left Atrial Appendage Closure for Stroke Prevention in AF The Quest for the Holy Grail ∗
Strokes resulting from embolization of left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) account for up to 25% of the 700,000 cerebrovascular accidents occurring annually in the United States. LAA, a complex structure with considerable anatomic variability, has been appropriately described as the “most lethal human attachment” (1). Stasis, hypercoagulability, and endothelial dysfunction (Virchow triad) contribute to LAA thrombus formation in AF patients. This pathophysiological process results in a 5-fold increased risk for cerebral embolization (2). Stroke is currently the major cause of di...
Source: Journal of the American College of Cardiology - December 14, 2015 Category: Cardiology Source Type: research

Time to Cost-Effectiveness Following Stroke Reduction Strategies in AF Warfarin Versus NOACs Versus LAA Closure
ConclusionsBoth NOACs and LAAC with the Watchman device were cost-effective relative to warfarin, but LAAC was also found to be cost-effective and to offer better value relative to NOACs. The results of this analysis should be considered when formulating policy and practice guidelines for stroke prevention in AF.
Source: Journal of the American College of Cardiology - December 14, 2015 Category: Cardiology Source Type: research

Standards and Barriers in Acute Stroke Therapy A Leap Forward in the Evolution of Endovascular Interventions for Stroke ∗
Whether interventional approaches to stroke neurology have lagged behind those aimed at heart attack—for reasons biological or practical—are topics for another day. However, the balance has changed. Tissue plasminogen activator (tPA) was first approved in the United States for intravenous administration to patients with acute stroke in 1996 (1), and a study for catheter-directed intra-arterial infusion of a thrombolytic agent for this indication was first published in 1998 (2). The first positive randomized controlled study using mechanical thrombectomy devices for stroke came from the Netherlands just last year (3), ...
Source: Journal of the American College of Cardiology - November 30, 2015 Category: Cardiology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke A Meta-Analysis of Randomized Trials
This study systematically determined if mechanical thrombectomy after usual care would be associated with better outcomes in patients with acute ischemic stroke caused by large artery occlusion.MethodsThe authors included randomized trials that compared mechanical thrombectomy after usual care versus usual care alone for acute ischemic stroke. Random effects summary risk ratios (RR) were constructed using a DerSimonian and Laird model.ResultsNine trials with 2,410 patients were available for analysis. Compared with usual care alone, mechanical thrombectomy was associated with a higher incidence of achieving good functional...
Source: Journal of the American College of Cardiology - November 30, 2015 Category: Cardiology Source Type: research

Carotid Stiffness Is Associated With Incident Stroke A Systematic Review and Individual Participant Data Meta-Analysis
ConclusionsCarotid stiffness is associated with incident stroke independently of CV factors and aortic stiffness. In addition, carotid stiffness improves stroke risk prediction beyond Framingham and aortic stiffness.
Source: Journal of the American College of Cardiology - November 2, 2015 Category: Cardiology Source Type: research

Comparative Performance of ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation Results From a National Primary Care Database
ConclusionsThe ATRIA score performed better in the U.K. Clinical Practice Research Datalink AF cohort. It more accurately identified low-risk patients than the CHA2DS2-VASc score, which assigned these patients to higher-risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with AF.
Source: Journal of the American College of Cardiology - October 19, 2015 Category: Cardiology Source Type: research

Age, Ethnicity, and Stroke Risk in Patients With Atrial Fibrillation Another Stitch in the Patchwork ∗
The frequency with which clinicians encounter patients with nonvalvular atrial fibrillation (AF) and its association with ischemic stroke make estimation of the risk borne by individuals a daily issue in contemporary cardiology practice across the globe. In the balance lies the decision to employ long-term anticoagulation therapy with its attendant risk of severe bleeding. A variety of clinical risk scores are available to guide this decision, most prominently the CHA2DS2-VASc score, which cumulates the widely accepted, if unequally validated, clinical risk factors: heart failure (or impaired left ventricular function), hy...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research

Age Threshold for Increased Stroke Risk Among Patients With Atrial Fibrillation A Nationwide Cohort Study From Taiwan
This study hypothesized that the age threshold (65 years) used in the CHA2DS2-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians.MethodsWe used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA2DS2-VASc score of 0 and 6,390 females with a CHA2DS2-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age.ResultsThe annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and contin...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research

Direct Catheter-Based Thrombectomy for Acute Ischemic Stroke Outcomes of Consecutive Patients Treated in Interventional Cardiology Centers in Close Cooperation With Neurologists
We sought to evaluate the outcomes of acute stroke patients, who did not undergo thrombolysis, and who were treated by direct catheter-based thrombectomy (CBT) in 3 interventional cardiology centers without pre-existing onsite programs for neurovascular interventions. Neurologists routinely selected patients for intervention. Their selection was on the basis of clinical presentation and computed tomography (CT) imaging. The decision not to use thrombolysis was on the basis of the presence of a contraindication or on a predicted short CT-to-sheath insertion time.
Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research

Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation
ConclusionsESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research

Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation A Patient-Level Meta-Analysis
ConclusionsIn patients with NVAF at increased risk for stroke or bleeding who are candidates for chronic anticoagulation, LAAC resulted in improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin.
Source: Journal of the American College of Cardiology - June 15, 2015 Category: Cardiology Source Type: research

Oral Anticoagulation, Aspirin, or No Therapy in Patients With Nonvalvular AF With 0 or 1 Stroke Risk Factor Based on the CHA 2 DS 2 -VASc Score
ConclusionsLow-risk patients (CHA2DS2-VASc = 0 [male], 1 [female]) have a truly low risk for stroke and bleeding. With 1 additional stroke risk factor (CHA2DS2-VASc = 1 [male], = 2 [female]), there was a significant increase in event rates (particularly mortality) if nonanticoagulated.
Source: Journal of the American College of Cardiology - April 6, 2015 Category: Cardiology Source Type: research

Patients With Atrial Fibrillation and a CHA 2 DS 2 -VASc Score of 1 Are They at Low or High Stroke Risk? ∗
Nonvalvular atrial fibrillation carries a risk for developing ischemic stroke that is lowered by anticoagulant therapy (1). This risk is not uniform and depends on whether a patient has either none or ≥1 of the following factors, known as the CHA2DS2-VASc stroke risk score: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category. Both European (2) and U.S. (3) guidelines advocate estimation of a patient’s stroke risk by use of the CHA2DS2-VASc score for initial risk stratification. The European Society of Cardiol...
Source: Journal of the American College of Cardiology - April 6, 2015 Category: Cardiology Source Type: research

Adding Rigor to Stroke Risk Prediction in Atrial Fibrillation ∗
Guidelines recommend oral anticoagulant (OAC) therapy for patients with atrial fibrillation (AF) on the basis of ischemic stroke risk. Guidelines from both the United States (American College of Cardiology/American Heart Association/Heart Rhythm Society [AHA/ACC/HRS]) (1) and from Europe (European Society of Cardiology [ESC]) (2) use the CHA2DS2-VASc risk score (3) and recommend a low threshold for OAC use. The ESC guideline proposes anticoagulation therapy for patients with ≥1 risk factor (≥1 point), whereas the AHA/ACC/HRS guideline uses a threshold of 2 points. Because ESC does not consider female sex as a stand-al...
Source: Journal of the American College of Cardiology - January 20, 2015 Category: Cardiology Source Type: research

Vorapaxar, Combination Antiplatelet Therapy, and Stroke ∗
Drugs that inhibit platelet activation and aggregation reduce vascular events, notably myocardial infarction (MI) and ischemic stroke, and are generally associated with low rates of bleeding (1). Available agents inhibit platelets via distinct mechanisms (Table 1) (2), and combining antiplatelet drugs with different mechanisms of action should enhance net antithrombotic activity. For over a decade, the standard of care in patients with acute coronary syndromes, particularly those undergoing coronary stent implantation, has been dual antiplatelet therapy with aspirin plus an adenosine diphosphate receptor antagonist. When ...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research

New Ischemic Stroke and Outcomes With Vorapaxar Versus Placebo Results From the TRA 2°P-TIMI 50 Trial
BackgroundVorapaxar, a novel antiplatelet therapy, reduces thrombotic events in patients with a history of myocardial infarction (MI) or peripheral artery disease (PAD); however, because of an increased risk of intracranial hemorrhage, it is contraindicated in patients with a history of stroke.ObjectivesThe aim of this study was to investigate the incidence of new ischemic stroke and subsequent death or intracerebral hemorrhage in patients with MI or PAD and no cerebrovascular disease (CVD) treated with vorapaxar.MethodsThe TRA 2°P-TIMI 50 (Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in ...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research