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Source: Journal of the American College of Cardiology
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Total 269 results found since Jan 2013.
2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement
BackgroundThe U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis.ObjectivesLonger-term clinical outcomes were examined to confirm if this mortality benefit is sustained.MethodsPatients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve repl...
Source: Journal of the American College of Cardiology - July 6, 2015 Category: Cardiology Source Type: research
Mode of Death Prevention by Serelaxin
We read with interest the article by Felker et al. (1) regarding the effect of serelaxin on the mode of death prevention in acute heart failure. This paper was a subgroup analysis of the RELAX-AHF (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure) study intended to assess the effect of serelaxin on the specific mode of death in acute heart failure patients enrolled in the trial. The RELAX-AHF study demonstrated a reduction in the secondary endpoint of 180-day mortality in patients receiving a 48-h continuous infusion of 30 μg/kg/day serelaxin compared with placebo (2). Although designed for the tre...
Source: Journal of the American College of Cardiology - June 29, 2015 Category: Cardiology Source Type: research
Reply Mode of Death Prevention by Serelaxin
We thank Dr. Henry and colleagues for their interest in our study on the mode of death in the RELAX-AHF (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure) study of serelaxin in acute heart failure (1). The authors provide very interesting data from their own laboratory on the possible role of serelaxin in modulating cardiac fibrosis, myocyte hypertrophy, and cardiac conduction (2) and speculate that these mechanisms may be potential explanations for the reduction in sudden death and fatal stroke observed with serelaxin treatment in the RELAX-AHF study.
Source: Journal of the American College of Cardiology - June 29, 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
Left Atrial Appendage Closure to Reduce the Risk of Thromboembolic Complications in Atrial Fibrillation Pay Now and Possibly Pay Later? ∗
Atrial fibrillation (AF) is the most common sustained arrhythmia and currently afflicts 5 million Americans (1). The treatment of AF and its complications costs the United States healthcare system $26 billion annually (2). Due to aging of the population and an increasing incidence of AF risk factors, by the year 2050,>12 million Americans will have this arrhythmia (2). Thromboembolism and its associated morbidity and mortality is the most dreaded complication of AF, and AF has been implicated in up to one quarter of all strokes in patients>80 years of age (2). Anticoagulation has been shown to reduce the risk of AF-associ...
Source: Journal of the American College of Cardiology - June 15, 2015 Category: Cardiology Source Type: research
Atrial Fibrillation and Renal Function How High Is the Price of Anticoagulation? ∗
For over a half century, vitamin K antagonists, chiefly warfarin, were the exclusive oral anticoagulants available for long-term anticoagulation. Being “the only game in town,” the emphasis of the accompanying clinical research was focused on determining the most appropriate method to measure anticoagulant effects, define the most efficacious and safe target range for anticoagulation, and identify strategies to maintain and reverse therapeutic anticoagulation. This emphasis came at the expense of turning a blind eye to rare concerns raised about the potential for warfarin to cause or worsen renal dysfunction (1,2). Th...
Source: Journal of the American College of Cardiology - June 8, 2015 Category: Cardiology Source Type: research
Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas
ConclusionsIn patients with echocardiographically suspected PFE who do not undergo surgical removal, rates of cerebrovascular accident and mortality are increased.
Source: Journal of the American College of Cardiology - June 1, 2015 Category: Cardiology Source Type: research
Retrograde Recanalization of Chronic Total Occlusions in Europe Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry
BackgroundA retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).ObjectivesThe authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs.MethodsFollow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.ResultsThe mean patient age wa...
Source: Journal of the American College of Cardiology - June 1, 2015 Category: Cardiology Source Type: research
Fibrotic Atrial Cardiomyopathy, Atrial Fibrillation, and Thromboembolism Mechanistic Links and Clinical Inferences
The association of atrial fibrillation (AF) with ischemic stroke has long been recognized; yet, the pathogenic mechanisms underlying this relationship are incompletely understood. Clinical schemas, such as the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score, incompletely account for thromboembolic risk, and emerging evidence suggests that stroke can occur in patients with AF even after sinus rhythm is restored. Atrial fibrosis correlates with both the persistence and burden of AF, and gadol...
Source: Journal of the American College of Cardiology - May 18, 2015 Category: Cardiology Source Type: research
Double Antiplatelet Therapy Duration Standardize or Personalize? ∗
The duration of dual antiplatelet therapy is the subject of debate. Prolonged dual antiplatelet therapy may prevent recurrence of thrombotic events, such as stroke or myocardial infarction (MI), caused by either iterative plaque rupture or complications related to previous revascularization, with increased risk of bleeding. Multiple factors have to be integrated: type of stent, clinical presentation, type of dual antiplatelet therapy, coronary lesion complexity, and patient compliance. The current European guidelines (1) recommend 6 months’ dual antiplatelet therapy in stable patients with coronary artery disease underg...
Source: Journal of the American College of Cardiology - May 18, 2015 Category: Cardiology Source Type: research
Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease 5-Year Outcomes of the PRECOMBAT Study
ConclusionsDuring 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)
Source: Journal of the American College of Cardiology - May 18, 2015 Category: Cardiology Source Type: research
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis 1-Year Results From the All-Comers NOTION Randomized Clinical Trial
ConclusionsIn the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve Intervention Trial [NOTION]; NCT01057173)
Source: Journal of the American College of Cardiology - May 18, 2015 Category: Cardiology Source Type: research
Is CABG Superior to DES for Repeat Revascularization in Patients With Isolated Proximal LAD Disease?
We read with great interest the paper by Hannan et al. (1) comparing the clinical outcomes in a large number of patients with isolated proximal left anterior descending (PLAD) coronary artery disease who underwent coronary artery bypass graft (CABG) surgery and percutaneous coronary interventions (PCIs) with drug-eluting stents (DES). They showed that there were no statistically significant differences in mortality or mortality, myocardial infarction (MI), and/or stroke between the CABG and PCI-DES groups, whereas CABG patients had significantly lower repeat revascularization rates.
Source: Journal of the American College of Cardiology - April 20, 2015 Category: Cardiology Source Type: research
Impact of Type 1 and 2 Diabetes Mellitus on Long-Term Outcomes After CABG ∗
It is well-established both that the prevalence of diabetes mellitus (DM) is rising rapidly in the developed world and that its presence is a significant risk factor for cardiovascular disease and death (1). Over the last decade, it also has become increasingly clear that for patients with diabetes who require coronary artery revascularization, in addition to optimal medical therapy, that the results of coronary artery bypass grafting (CABG) are superior to percutaneous coronary intervention in terms of significant reductions in mortality, myocardial infarction, and the need for repeat interventions but at the cost of a sl...
Source: Journal of the American College of Cardiology - April 20, 2015 Category: Cardiology Source Type: research
Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation The ISAR-TRIPLE Trial
ConclusionsSix weeks of triple therapy was not superior to 6 months with respect to net clinical outcomes. These results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter or longer duration of triple therapy. (Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation [ISAR-TRIPLE]; NCT00776633)
Source: Journal of the American College of Cardiology - April 20, 2015 Category: Cardiology Source Type: research
