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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
CHA 2 DS 2 -VASc Score for Predicting Stroke and Thromboembolism in Patients With AF and Biological Valve Prosthesis
Patients with valvular atrial fibrillation (AF), as defined in the 2012 European Society of Cardiology guidelines (those with a valvular prosthesis or rheumatic mitral disease) should receive anticoagulation regardless of the CHA2DS2-VASc score, with vitamin K antagonist being recommended (1–3). Whether thromboembolic risk related to bioprosthetic valve implantation differs from other forms of AF is not established with certainty. We evaluated the prognostic value of the CHA2DS2-VASc score for thromboembolic in AF patients with aortic or mitral bioprosthesis.
Source: Journal of the American College of Cardiology - January 19, 2016 Category: Cardiology Source Type: research
Outcomes After Transcatheter Aortic Valve Replacement With Balloon-Expandable Versus Self-Expandable Valves CHOICE Trial Results
We read with interest the paper by Abdel-Wahab et al. (1) on 1-year outcomes of the CHOICE (Randomized Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis: Medtronic CoreValve Versus Edwards SAPIEN XT Trial) randomized clinical trial comparing transcatheter aortic valve replacement (TAVR) with the balloon-expandable (BE) Edwards SAPIEN XT valve (Edwards Lifesciences, Irvine, California) versus self-expandable (SE) Medtronic CoreValve (Medtronic, Minneapolis, Minnesota). Of interest, the authors concluded that mortality was not statistically different between the 2 groups, but there w...
Source: Journal of the American College of Cardiology - January 12, 2016 Category: Cardiology Source Type: research
Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment
ConclusionsCAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers.
Source: Journal of the American College of Cardiology - January 12, 2016 Category: Cardiology Source Type: research
Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement The Randomized BRAVO-3 Trial
BackgroundAnticoagulation is required during transcatheter aortic valve replacement (TAVR) procedures. Although an optimal regimen has not been determined, heparin is mainly used. Direct thrombin inhibition with bivalirudin may be an effective alternative to heparin as the procedural anticoagulant agent in this setting.ObjectivesThe goal of this study was to determine whether bivalirudin offers an alternative to heparin as the procedural anticoagulant agent in patients undergoing TAVR.MethodsA total of 802 patients with aortic stenosis were randomized to undergo transfemoral TAVR with bivalirudin versus unfractionated hepa...
Source: Journal of the American College of Cardiology - December 21, 2015 Category: Cardiology Source Type: research
Annual Outcomes With Transcatheter Valve Therapy From the STS/ACC TVT Registry
ConclusionsThe TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.
Source: Journal of the American College of Cardiology - December 21, 2015 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
Selecting Patients for Statin Therapy in Primary Prevention If We Could Only Predict the Future ∗
Statins are effective in the primary and secondary prevention of coronary heart disease and stroke. Although many would agree that primary prevention of atherosclerotic cardiovascular disease (ASCVD) is preferable to secondary prevention, no consensus exists on how to best identify individuals at risk for the disease, when to commence screening and risk assessment, at what age to start (or stop) treatment, how to treat, and how intensively to treat. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines concluded that net benefit was sufficient to recommend statin treatment for ...
Source: Journal of the American College of Cardiology - December 14, 2015 Category: Cardiology Source Type: research
Fully Magnetically Levitated Left Ventricular Assist System for Treating Advanced HF A Multicenter Study
ConclusionsThe results show that the fully magnetically levitated centrifugal-flow chronic LVAS is safe, with high 30-day and 6-month survival rates, a favorable adverse event profile, and improved quality of life and functional status. (HeartMate 3™ CE Mark Clinical Investigation Plan [HM3 CE Mark]; NCT02170363)
Source: Journal of the American College of Cardiology - December 7, 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
Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension A Scientific Statement from the American Heart Association and the American College of Cardiology
An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athle...
Source: Journal of the American College of Cardiology - November 23, 2015 Category: Cardiology Source Type: research
Matching the NOAC to the Patient Remember the Modifiable Bleeding Risk Factors ∗
Approximately 5 years ago, when deciding on oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), we did not have a choice; only the vitamin K antagonists (VKA; e.g., warfarin) were available. In 2015, in addition to VKAs, we currently have 4 licensed non-VKA oral anticoagulants (NOACs), and therefore have the opportunity to fit the most appropriate drug to the patient’s risk profile, and vice versa.
Source: Journal of the American College of Cardiology - November 23, 2015 Category: Cardiology Source Type: research
Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin ROCKET AF Trial
ConclusionsIn the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients on oral anticoagulation.
Source: Journal of the American College of Cardiology - November 23, 2015 Category: Cardiology Source Type: research
Carotid Stiffness and Cerebrovascular Disease The Physiology Beyond the Anatomy ∗
Stroke is a leading cause of morbidity, mortality, and disability worldwide, and the disease burden has progressively increased over the past decades. A rising interest in identifying risk factors for cerebrovascular disease may finally shift the focus to prevention of future events (1). Several studies have investigated carotid disease, and specifically carotid stiffness, as a risk factor for the development of cerebrovascular disease and incident stroke. These studies have been limited, however, by inconsistent results. Some reported a significant association between carotid stiffness and stroke, whereas others failed to...
Source: Journal of the American College of Cardiology - November 2, 2015 Category: Cardiology Source Type: research
