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Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared to Warfarin among Long-Term Anticoagulated Patients for Atrial Fibrillation
Direct oral anticoagulants (DOACs) have been used in clinical practice in the US for the last 4-6 years. While DOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/TIA, bleeding, major bleeding and dementia among patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation between June 2010-December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score.
Source: The American Journal of Cardiology - May 4, 2016 Category: Cardiology Authors: Victoria Jacobs, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch Source Type: research

Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding, and Mortality in Patients With Atrial Fibrillation on Dialysis
Atrial fibrillation (AF) is common in patients on dialysis. Although randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit patients on dialysis. We thus undertook this systematic review and meta-analysis of observational studies including patients with AF on dialysis that reported associations of anticoagulation use. Twenty studies involving 529,741 subjects and 31,321 patients with AF on dialysis were identified. Anticoagulation was associated with a 45% (95% CI 13% to 88%) increased risk of any stroke, reflecting a nonsignificant 13% (95% CI −4% to 34...
Source: The American Journal of Cardiology - April 12, 2016 Category: Cardiology Authors: Christopher X. Wong, Ayodele Odutayo, Connor A. Emdin, Ned J. Kinnear, Michelle T. Sun Tags: Arrhythmias and Conduction Disturbances Source Type: research

Drug-coated balloon for in-stent restenosis in high risk patients: Another brick in the wall of the challenging settings for interventionists
Recently Miglionico et al. published in this Journal an interesting prospective observational study regarding 82 high-risk patients with in-stent restenosis of bare metal stent (BMS), n=48 (59%) or drug-eluting stent (DES), n=34 (41%) .1 All patients had at least one of the following high-risk features: history of hemorrhagic stroke or gastrointestinal bleeding, ischemic stroke not longer of 3 months before, need for oral anticoagulation or non-cardiac surgery or recent surgery, chronic inflammatory disease or neoplasm.
Source: The American Journal of Cardiology - March 21, 2016 Category: Cardiology Authors: Dario Buccheri, Davide Piraino, Giuseppe Andolina, Bernardo Cortese Source Type: research

Drug-Coated Balloon for Instent Restenosis in Patients at High Risk: Another Brick in the Wall of the Challenging Settings for Interventionists
Recently, Miglionico et al1 published in this journal an interesting prospective observational study regarding 82 patients at high-risk with instent restenosis of bare-metal stent, n = 48 (59%) or drug-eluting stent (DES), n = 34 (41%). All patients had at least one of the following high-risk features: a history of hemorrhagic stroke or gastrointestinal bleeding, ischemic stroke not longer of 3 months before, need for oral anticoagulation or noncardiac surgery or recent surgery, chronic inflammatory disease, or neoplasm.
Source: The American Journal of Cardiology - March 20, 2016 Category: Cardiology Authors: Dario Bucchei, Davide Piraino, Giuseppe Andolina, Bernardo Cortese Tags: Readers' Comments Source Type: research

Effects of Oral Anticoagulant Therapy in Medical In-patients ≥65 Years of Age with Atrial Fibrillation
In this retrospective cohort observational study we investigated mortality, ischemic and hemorrhagic events, in patients ≥65 years of age with atrial fibrillation (AF) consecutively discharged from an Acute Geriatric Ward in the period 2010-2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC and HAS-BLED scores. Comorbidity, cognitive status and functional autonomy were evaluated using standardized scales. Independent associations between clinical variables, including use of Vitamin K Antagonists (VKAs)-based oral anticoagulant therapy (OAT), and all-cause mortality, fatal and non-fatal ischemic and hemorrha...
Source: The American Journal of Cardiology - December 1, 2015 Category: Cardiology Authors: Mario Bo, Irene Sciarrillo, Federica Li Puma, Marco Badinella Martini, Yolanda Falcone, Marina Iacovino, Enrica Grisoglio, Elena Menditto, Gianfranco Fonte, Enrico Brunetti, Guido Maggiani, Giovanni Carlo Isaia, Fiorenzo Gaita Source Type: research

Effects of Oral Anticoagulant Therapy in Medical Inpatients ≥65 Years With Atrial Fibrillation
In this retrospective cohort observational study, we investigated mortality, ischemic, and hemorrhagic events in patients ≥65 years with atrial fibrillation consecutively discharged from an Acute Geriatric Ward in the period 2010 to 2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC (congestive heart failure/left ventricular dysfunction, hypertension, aged ≥75 years, diabetes mellitus, stroke/transient ischemic attack/systemic embolism, vascular disease, aged 65 to 74 years, gender category) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile in...
Source: The American Journal of Cardiology - December 1, 2015 Category: Cardiology Authors: Mario Bo, Irene Sciarrillo, Federica Li Puma, Marco Badinella Martini, Yolanda Falcone, Marina Iacovino, Enrica Grisoglio, Elena Menditto, Gianfranco Fonte, Enrico Brunetti, Guido Maggiani, Giovanni Carlo Isaia, Fiorenzo Gaita Tags: Arrhythmias and Conduction Disturbances Source Type: research

Usefulness of Holter Monitoring for Detecting Atrial Fibrillation after Stoke or Transient Ischemic Attack
The sensitivity of a diagnostic test is ideally calculated by comparing the test’s assessments to a truth determined by another (perfect) test considered to be the gold standard. However, in many cases, there is no perfect gold standard.1 When it exists, assessment by the gold standard can be inaccessible, costly, or highly invasive. Using the best available but imperfect diagnostic test as gold standard can lead to substantial error in the estimation of its diagnostic accuracy.1 The detection of atrial fibrillation (AF) after ischemic stroke is not an exception to this phenomenon.
Source: The American Journal of Cardiology - November 11, 2015 Category: Cardiology Authors: Lauren E. Cipriano, Luciano A. Sposato Source Type: research

Usefulness of Holter Monitoring for Detecting Atrial Fibrillation After Stroke or Transient Ischemic Attack
The sensitivity of a diagnostic test is ideally calculated by comparing the test assessments to a truth determined by another (perfect) test considered to be the gold standard. However, in many cases, there is no perfect gold standard.1 When it exists, assessment by the gold standard can be inaccessible, costly, or highly invasive. Using the best available but imperfect diagnostic test as gold standard can lead to substantial error in the estimation of diagnostic accuracy.1 The detection of atrial fibrillation (AF) after ischemic stroke is not an exception to this phenomenon.
Source: The American Journal of Cardiology - November 11, 2015 Category: Cardiology Authors: Lauren E. Cipriano, Luciano A. Sposato Tags: Readers' Comments Source Type: research

Estimating the Sensitivity of Holter to Detect Atrial Fibrillation After Stroke or Transient Ischemic Attack Without a Gold Standard is Challenging
The sensitivity of a diagnostic test is ideally calculated by comparing the test assessments to a truth determined by another (perfect) test considered to be the gold standard. However, in many cases, there is no perfect gold standard.1 When it exists, assessment by the gold standard can be inaccessible, costly, or highly invasive. Using the best available but imperfect diagnostic test as gold standard can lead to substantial error in the estimation of diagnostic accuracy.1 The detection of atrial fibrillation (AF) after ischemic stroke is not an exception to this phenomenon.
Source: The American Journal of Cardiology - November 11, 2015 Category: Cardiology Authors: Lauren E. Cipriano, Luciano A. Sposato Tags: Readers' Comments Source Type: research

Diagnosing Paroxysmal Atrial Fibrillation in Patients with Ischemic Strokes and Transient Ischemic Attacks using Echocardiographic Measures of Left Atrium Function
Twenty-five to thirty-five percent of stroke cases are cryptogenic and it has been demonstrated that paroxysmal atrial fibrillation is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal AF in ischemic stroke (IS) and transient ischemic attack (TIA) patients. We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as paroxysmal AF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination.
Source: The American Journal of Cardiology - October 16, 2015 Category: Cardiology Authors: Kristoffer Grundtvig Skaarup, Hanne Christensen, Nis Høst, Masti Mahdy Mahmoud, Christian Ovesen, Flemming Javier Olsen, Tor Biering-Sørensen Source Type: research

A Comparison of Atrial Fibrillation Monitoring Strategies After Cryptogenic Stroke (from the Cryptogenic Stroke and Underlying AF Trial)
Ischemic stroke cause remains undetermined in 30% of cases, leading to a diagnosis of cryptogenic stroke. Paroxysmal atrial fibrillation (AF) is a major cause of ischemic stroke but may go undetected with short periods of ECG monitoring. The Cryptogenic Stroke and Underlying Atrial Fibrillation trial (CRYSTAL AF) demonstrated that long-term electrocardiographic monitoring with insertable cardiac monitors (ICM) is superior to conventional follow-up in detecting AF in the population with cryptogenic stroke.
Source: The American Journal of Cardiology - June 24, 2015 Category: Cardiology Authors: William C. Choe, Rod S. Passman, Johannes Brachmann, Carlos A. Morillo, Tommaso Sanna, Richard A. Bernstein, Vincenzo Di Lazzaro, Hans-Christoph Diener, Marilyn M. Rymer, Frank Beckers, Jodi Koehler, Paul D. Ziegler, CRYSTAL AF Investigators Tags: Arrhythmias and Conduction Disturbances Source Type: research

A Comparison of Atrial Fibrillation Monitoring Strategies after Cryptogenic Stroke (From the CRYSTAL AF Trial)
Ischemic stroke etiology remains undetermined in 30% of cases, leading to a diagnosis of cryptogenic stroke. Paroxysmal atrial fibrillation (AF) is a major cause of ischemic stroke but may go undetected with short periods of ECG monitoring. The Cryptogenic Stroke and Underlying Atrial Fibrillation trial (CRYSTAL AF) demonstrated that long-term ECG monitoring with insertable cardiac monitors (ICM) is superior to conventional follow-up in detecting AF in the cryptogenic stroke population. We evaluated the sensitivity and negative predictive value (NPV) of various external monitoring techniques within a cryptogenic stroke cohort.
Source: The American Journal of Cardiology - June 24, 2015 Category: Cardiology Authors: William C. Choe, Rod S. Passman, Johannes Brachmann, Carlos A. Morillo, Tommaso Sanna, Richard Bernstein, Vincenzo Di Lazzaro, Hans-Christoph Diener, Marilyn Rymer, Frank Beckers, Jodi Koehler, Paul D. Ziegler, CRYSTAL AF Investigators Source Type: research

Impact of Heart Disease on Maternal and Fetal Outcomes in Pregnant Women
In this study, we sought to identify the risk and risk factors for adverse maternal and fetal events in pregnant women with underlying heart disease. Pregnant women referred for echocardiogram with known or suspected heart disease were categorized into those with: (1) cardiomyopathy, (2) other heart disease (HD; congenital, coronary, arrhythmia, or valvular), and (3) no HD. Primary outcome was major adverse cardiovascular events (MACE), defined as a composite of death, sustained arrhythmia, myocardial infarction, heart failure, and transient ischemic attack/stroke.
Source: The American Journal of Cardiology - May 8, 2015 Category: Cardiology Authors: Paraskevi Koutrolou-Sotiropoulou, Puja B. Parikh, Charles Miller, Fabio Vasconcelos Lima, Javed Butler, Kathleen Stergiopoulos Source Type: research

Earlobe Crease Shapes and Cardiovascular Events
The objectives were to define the ELC using a single-blind approach and to determine through multivariate analysis its association with cardiovascular events (CVEs) comprising coronary, ischaemic cerebrovascular and peripheral vascular diseases. A single-blind cross-sectional study was performed in 2 phases: (1) an initial study (n=300) to define ELC classification criteria and (2) a confirmation stage (n=1000) to analyse ELC association with CVEs.
Source: The American Journal of Cardiology - April 22, 2015 Category: Cardiology Authors: Claudia Rodríguez-López, Hugo Garlito-Díaz, Raquel Madroñero-Mariscal, Pablo Jesús Sánchez-Cervilla, Auxiliadora Graciani, José Luis López-Sendón, Esteban López-de-Sá 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

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