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Source: Journal of the American College of Cardiology
Condition: Stroke
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Total 258 results found since Jan 2013.
Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes A Collaborative, Patient-Level Meta-Analysis of 11,310 Patients
BackgroundThere has been conflicting clinical evidence as to the influence of female sex on outcomes after transcatheter aortic valve replacement.ObjectivesThe aim of this study was to evaluate the impact of sex on early and late mortality and safety end points after transcatheter aortic valve replacement using a collaborative meta-analysis of patient-level data.MethodsFrom the MEDLINE, Embase, and the Cochrane Library databases, data were obtained from 5 studies, and a database containing individual patient-level time-to-event data was generated from the registry of each selected study. The primary outcome of interest was...
Source: Journal of the American College of Cardiology - July 13, 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
Premature Atrial Contractions A Wolf in Sheep’s Clothing? ∗
Premature atrial contractions (PACs) have long been considered a benign electrophysiological phenomenon unlikely to result in serious clinical consequence. In 1998, Haïssaguerre et al. (1) challenged this notion by demonstrating that targeted ablation of ectopic atrial activity among patients with atrial fibrillation (AF) reduced arrhythmia recurrence. This finding strongly implicated PACs as the acute trigger for AF initiation among patients previously diagnosed with the arrhythmia. Subsequent studies among patients without known AF identified an association between PACs and incident AF, both in cohorts of patients with...
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
The Incidence and Predictors of Early- and Mid-Term Clinically Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients
ConclusionsTreatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short- and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (CoreValve Advance International Post Market Study; NCT01074658)
Source: Journal of the American College of Cardiology - July 13, 2015 Category: Cardiology Source Type: research
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
