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Publisher: Elsevier   (Total: 3182 journals)

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Showing 1 - 200 of 3182 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 442, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 319, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 424, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 388, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 482, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 264, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 212, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Cardiology
Journal Prestige (SJR): 1.93
Citation Impact (citeScore): 3
Number of Followers: 66  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9149 - ISSN (Online) 0002-9149
Published by Elsevier Homepage  [3182 journals]
  • Erratum: Cardiovascular Events and Hospital Deaths Among Patients With
           Severe Sepsis
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of CardiologyAuthor(s):
       
  • The Top Most-Cited and Influential Published Articles in Atrial
           Fibrillation from 1900 to 2019
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of CardiologyAuthor(s): Pulwasha Maria Iftikhar, Mohammad Faisal Uddin, Fatima Ali, Azeem Husain Arastu, Javidulla Khan, Maham Munawar, Javaid SulemanAbstractCitation classics are widely being implemented in the field of medical and scientific research assessment. The frequency of citation of a particular article is used to gauge its contribution and impact on the clinical world of practice and research. A thorough search of the literature showed a lack of bibliometric analysis on atrial fibrillation (AF). Thereby the main purpose of this study is to pinpoint the trend of the top 100 cited articles on AF.In June 2019, two databases, Scopus and Web of Science, were used to acquire the articles published on AF, which belonged to various genres including medicine, medical and interventional cardiology, electrophysiology and thoracic surgery. The data was thoroughly reviewed and analyzed by two reviewers with regards to the number of citations for each article, publications per area, document type, first author name, country of origin, Institute of origin and year of publication. Approval of the Institutional Board Review (IRB) was not required as we used publically available data retrospectively. The number of citations in the top 100 articles ranged from 622 to 6,641 times with an average citation of 1041.3 per article. The most significant number of articles was published in the year 2004 which ranged up to 11 in total. All the articles are published in 21 English language journals. Among these 100 articles, the most were from the United States (n=63) followed by Canada (n=24) and other countries (n=17). The top 5 institutions include McMaster University (n=9), Institut de Cardiologie de Montreal (n=8), Population Health Research Institute (n=8), Harvard Medical School (n=7), and Mayo Clinic (n=7). In conclusion, authors seeking to publish a highly referenced article on AF will be determined by source journal, the language of publication, geographic origin, methodology, or research outcome.
       
  • Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis In Women Undergoing
           Transcatheter Aortic Valve Implantation (From the Win-TAVI Registry)
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of CardiologyAuthor(s): Cristina Giannini, Anna Sonia Petronio, Julinda Mehilli, Samantha Sartori, Jaya Chandrasekhar, Michela Faggioni, Thierry Lefèvre, Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas M. Van Mieghem, Emanuele Meliga, Nicolas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, Ghada W. Mikhail, Maria C. Ferrer, Christoph NaberAbstractWe sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n=408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy endpoint was the (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of prior stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs. 4.7%, p=0.007). At 1-year, the crude incidence and adjusted risk of the primary VARC-2 efficacy endpoint was similar between groups (17.1% with SEV and 14.3% with BEV, p=0.25; HR 1.09, 95% CI 0.68-1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs. 8.6%, p=0.001; HR 1.97, 95% CI 1.13-3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the two devices (10.1% vs. 8.0%, p=0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater comorbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy endpoint between the valve types, there was a greater need for permanent pacemakers after SEV implantation.
       
  • “Gambling: Part I of II”
    • Abstract: Publication date: Available online 8 November 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Meta-analysis of Transcatheter Aortic Valve Implantation versus Surgical
           Aortic Valve Replacement in Patients with Low Surgical Risk
    • Abstract: Publication date: Available online 8 November 2019Source: The American Journal of CardiologyAuthor(s): Sharath C Vipparthy, Venkatesh Ravi, Sindhu Avula, Soumyasri Kambhatla, Mobasser Mahmood, Ameer Kabour, Syed Sohail Ali, Marco Barzallo, Sudhir MungeeAbstractTranscatheter aortic valve implantation (TAVI) is the current standard of care for patients with severe aortic stenosis (AS) who are at high risk for surgery. However, several recent studies have demonstrated the comparable safety and efficacy of TAVI in low-risk patients as well. We sought to pool the existing data to further assert its comparability. MEDLINE, Cochrane, and Embase, databases were evaluated for relevant articles published from January 2005 to June 2019. Studies comparing outcomes of TAVI versus surgical aortic valve replacement (SAVR) in patients who are at low risk for surgery were included. Twelve studies (5 randomized controlled trials (RCTs) and 7 observational studies) totaling 27,956 patients were included. Follow-up ranged from 3 months to 5 years. Short-term all-cause mortality, short-term and 1-year cardiac mortality were significantly lower in the TAVI group. 1-Year all-cause mortality, short-term and 1-year stroke and myocardial infarction (MI) were similar in both groups. Rate of acute kidney injury (AKI) and new-onset atrial fibrillation (AF) were lower in the TAVI group, while permanent pacemaker (PPM) implantation and major vascular complications were higher in the TAVI group. Subgroup analysis of RCTs showed significantly lower 1-year all-cause mortality in the TAVI group. In conclusion, among severe AS patients at low surgical risk, TAVI when compared to SAVR, demonstrated a lower rate of short-term all-cause mortality, short-term and 1-year cardiac mortality and similar in terms of 1-year all-cause mortality. TAVI is emerging as a safe and efficacious alternative for low surgical risk patients.
       
  • Meta-Analysis Comparing Results of Transcatheter versus Surgical
           Aortic-Valve Replacement in Patients with Severe Aortic Stenosis
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Xinlin Zhang, Tingyu Wang, Rongfang Lan, Qing Dai, Lina Kang, Lian Wang, Yong Wang, Wei Xu, Biao XuAbstractTranscatheter aortic-valve replacement (TAVR) has emerged as a promising strategy for treating patients with severe aortic stenosis. We aimed to compare TAVR with surgical aortic-valve replacement (SAVR) and determine the performance of TAVR over time and within several subgroups. We included 8 randomized trials comparing TAVR vs. SAVR. Compared with SAVR, TAVR was associated with a lower rate of all-cause mortality or disabling stroke at 30-day (odds ratio [OR], 0.72; P=0.004), 1-year (OR, 0.83; P=0.01) and 2-year (OR, 0.86; P=0.02), but not at long-term follow-up (rate ratio [RR], 1.02 [CI, 0.92 to 1.13]; P=0.67). Notably, 5-year data showed numerically higher incidence in TAVR (RR, 1.11 [CI, 0.97 to 1.27]; P=0.12). The risks associated with TAVR vs. SAVR increased over time, showing a significant interaction (P for interaction=0.01), as were for new-onset atrial fibrillation and rehospitalization. Incidences of major bleeding, new-onset fibrillation and acute kidney injury were lower in TAVR, whereas transient ischemic attack, major vascular complications, permanent pacemaker implantation, reintervention and paravalvular leak were lower in SAVR. Incidences for all-cause and cardiovascular mortality, myocardial infarction and stroke were not statistically different. TAVR with transfemoral approach and new-generation valve was associated with reduction in all-cause mortality or disabling stroke compared with corresponding comparators. In conclusion, TAVR was associated with a lower risk for all-cause mortality or disabling stroke within 2 years, but not at long-term follow-up compared with SAVR; the risks seems to increase over time. More data are needed to determine longer-term performance of TAVR.
       
  • Prevalence and Impact of Having Multiple Barriers to Medication Adherence
           in Non-adherent Patients with Poorly-controlled Cardiometabolic Disease
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Julie Christine Lauffenburger, Thomas Isaac, Romit Bhattacharya, Thomas Dean Sequist, Chandrasekar Gopalakrishnan, Niteesh Kumar ChoudhryABSTRACTAdherence to medications remains poor despite numerous efforts to identify and intervene upon non-adherence. One potential explanation is the limited focus of many interventions on one barrier. Little is known about the prevalence and impact of having multiple barriers in contemporary practice. Our objective was to quantify adherence barriers for patients with poorly-controlled cardiometabolic condition, identify patient characteristics associated with having multiple barriers, and determine its impact on adherence. We used a linked electronic health records and insurer claims dataset from a large health system from a recent pragmatic trial. Barriers to medication-taking before the start of the intervention were elicited by clinical pharmacists using structured interviews. We used multivariable modified Poisson regression models to examine the association between patient factors and multiple barriers and multivariable linear regression to evaluate the relationship between multiple barriers and claims-based adherence. Of the 1,069 patients (mean: 61 years of age) in this study, 25.1% had multiple barriers to adherence; the most common co-occurring barriers were forgetfulness and health beliefs (31%, n=268). Patients with multiple barriers were more likely to be non-white (Relative Risk [RR]:1.57, 95%CI: 1.21-1.74), be single/unpartnered (RR:1.36, 95%CI: 1.06-1.74), use tobacco (RR:1.54, 95%CI: 1.13-2.11), and have poor glycemic control (RR:1.77, 95%CI: 1.31-2.39) versus those with 0 or 1 barrier. Each additional barrier worsened average adherence by 3.1% (95%CI: -4.6%, -1.5%). In conclusion,>25% of non-adherent patients present with multiple barriers to optimal use, leading to meaningful differences in adherence. These findings should inform quality improvement interventions aimed at non-adherence.
       
  • Usefulness of Visfatin as a Predictor of Atrial Fibrillation Recurrence
           after Ablation Procedure.
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Anna E. Platek, Anna Szymanska, Ilona Kalaszczynska, Filip M. Szymanski, Janusz Sierdzinski, Krzysztof J. FilipiakAbstractVisfatin is an adipokine produced by visceral fat tissue and takes part in fibrosis and inflammatory response. In the heart muscle, it is connected with the progression of atherosclerosis. Currently, there is no data on how visfatin affects atrial fibrillation (AF) onset. The study aimed to establish if baseline visfatin levels are connected with the risk of arrhythmia recurrence after AF ablation. In this prospective, long-term, observational study, we enrolled 290 consecutive patients admitted for AF ablation. All patients were screened for cardiovascular risk factors and had blood serum taken to measure visfatin concentrations before the ablation procedure. The endpoint of the study was a recurrence of the AF, defined as at least one AF episode of at any moment during the follow-up period. The screening included AF of at least 30 s' duration assessed with ECG monitoring, including 24-h ECG Holter monitoring, implantable pacemakers, implantable defibrillators, or subcutaneous ECG monitoring devices. After excluding patients disqualified from the procedure the study population consisted of 236 patients, mean age 57.8 years (64.8% male). Mean body mass index in the population was 29.6 ± 4.8 kg/m2 and arterial hypertension was highly prevalent (73.3% of patients). In 129 (54.7%) cases we observed recurrence of AF during the follow-up period. Patients with AF recurrence had higher visfatin levels (1.7 ± 2.4 vs. 2.1 ± 1.9 ng/mL; p
       
  • Effect of Discontinuing Dabigatran in Patients with Atrial Fibrillation
           (From the Dabigatran Cohort of the GLORIA-AF Registry)
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Miney Paquette, Lionel Riou França, Christine Teutsch, Hans-Christoph Diener, Shihai Lu, Sergio J. Dubner, Chang Sheng Ma, Kenneth J. Rothman, Kristina Zint, Jonathan L. Halperin, Brian Olshansky, Menno V. Huisman, Gregory Y.H. Lip, Robby NieuwlaatAbstractProspective studies evaluating persistence to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation (AF) are needed to improve our understanding of drug discontinuation. The study objective was to evaluate if and when patients with newly diagnosed AF stop dabigatran treatment and to report outcomes following discontinuation. Patients prescribed dabigatran in diverse clinical practice settings were consecutively enrolled and followed for 2 years. Dabigatran persistence over time, reasons for discontinuation, and outcomes post discontinuation were assessed. Of 4,859 patients, aged 70.2 ± 10.4 years, 55.7% were male. Overall 2-year dabigatran persistence was 70.9% (95% confidence interval [CI], 69.6 to 72.2). Persistence probability was lower in the first 6-month period (83.7% [82.7 to 84.8]) than in subsequent periods for patients on dabigatran at the start of each period (6–12 months, 92.5% [91.6 to 93.3]; 12–18 months, 95.1% [94.3 to 95.8]; 18–24 months, 96.3% [95.6 to 96.9]). Of 1,305 patients (26.9%) who discontinued dabigatran, adverse events were reported as the reason for discontinuation in 457 (35.0%). Standardized stroke incidence rate post discontinuation (per 100 patient-years) in patients discontinuing without switching to another oral anticoagulant was 1.76 (95% CI, 0.89 to 2.76) and 1.02 (95% CI, 0.43 to 1.76) in those who switched, consistent with the expected benefit of remaining on treatment. Patients persistent with treatment at 1 year had>90% probability of remaining persistent at 2 years suggesting clinical interventions to improve persistence should be focused on the early period following treatment initiation.
       
  • Impact of Lipoprotein(a) on Long-Term (Mean 6.2 Years) Outcomes in
           Patients with Three-Vessel Coronary Artery Disease
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Na Xu, Lin Jiang, Lianjun Xu, Jian Tian, Ce Zhang, Xueyan Zhao, Xinxing Feng, Dong Wang, Yin Zhang, Kai Sun, Jingjing Xu, Ru Liu, Bo Xu, Wei Zhao, Rutai Hui, Runlin Gao, Zhan Gao, Lei Song, Jinqing YuanABSTRACTThe aim of the cohort study was to investigate the relationship between plasma lipoprotein(a) [Lp(a)] and long-term clinical outcomes in patients with 3-vessel disease (TVD) after the following treatment strategies, including medical therapy (MT) alone, percutaneous coronary intervention(PCI), and coronary artery bypass grafting (CABG). A total of 6,175 consecutive patients with angiographically confirmed TVD and available baseline Lp(a) data were included in this study. Based on the median level of Lp(a) at admission, the patient was divided into two sub-groups. Primary end point was major adverse cardiovascular events (MACE), of which all-cause death, myocardial infarction and unplanned revascularization were all included. In general, the median value of Lp(a) reached 13.76 mg/dl for all patients. The median follow-up time of all patients was 6.2 years. For MACE, a total of 1433 cases were generated, accounting for 23.2%, including 804 (13.0%) all-cause death, 302 (4.9 %) myocardial infarction and 494 (8.0%) unplanned revascularization. For the incidence of MACE, the high Lp (a) and low Lp (a) groups were 24.3% to 22.1% (p = 0.015), respectively. When the risk factors were adjusted, the multivariate analysis showed that high Lp(a) levels was an independent predictor of primary outcome (adjusted hazard ratio 1.169, 95% confidence interval 1.046 to 1.306, p = 0.006). Except for gender group, there is a relatively consistent correlation among the various subgroups. In conclusion, plasma Lp(a) is a potential biomarker for risk stratification and prognosis in patients diagnosed with TVD.
       
  • Relation of Hypoalbuminemia to Response to Aspirin in Patients with Stable
           Coronary Artery Disease
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Arthur Shiyovich, Liat Sasson, Eli Lev, Alejandro Solodky, Ran Kornowski, Leor PerlAbstractSerum albumin (SA) level is a powerful cardiovascular prognostic marker, suggested to be involved in regulation of platelet function. High on-aspirin platelet reactivity (HAPR) is associated with increased risk for deleterious cardiovascular events. The aim of the current study was to evaluate the association between HAPR and albumin levels in patients with stable coronary artery disease (CAD) treated with aspirin. Patients with known stable CAD, who were taking aspirin (75-100 mg qd) regularly for at least one month, were screened for the current study. Exclusion criteria: cancer, sepsis or acute infection, active inflammatory/rheumatic disease, recent major surgery, chronic liver failure, the administration of other anti-platelet drugs, non-adherence with aspirin and thrombocytopenia. Blood was drawn from the participants and sent for SA level and platelet function test (VerifyNow). HAPR was defined as aspirin reaction units (ARU)>550. Overall 116 patients were analyzed; age 69 ±10, 28% women. Twenty (17%) were hypoalbuminemic (≤3.5 g/dL). Hypoalbuminemic patients had similar characteristics to the normal albumin group except mildly higher creatinine in the former. SA levels were significantly lower in the hypoalbuminemic group (3.2±0.2 g/dL vs. 4.2±0.4 g/dL, respectively, p
       
  • Long-Term Efficacy of Extended Dual Antiplatelet Therapy after Left Main
           Coronary Artery Bifurcation Stenting
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Sungsoo Cho, Jung-Sun Kim, Tae Soo Kang, Sung-Jin Hong, Dong-Ho Shin, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Myeong-Ki Hong, Yansoo JangABSTRACTLimited data exist on the long-term efficacy of extended dual antiplatelet therapy (DAPT) after left main coronary artery (LMCA) bifurcation stenting. This study investigated the long-term clinical outcomes associated with long-term DAPT after LMCA bifurcation stenting. Using data from the multicenter KOMATE and COBIS registries, we analyzed 1,142 patients who received a drug-eluting stent (DES) for a LMCA bifurcation lesion and who experienced no adverse events for 12 months after the index procedure. Patients were divided into two groups: DAPT>12 months (N=769) and DAPT ≤12 months (N=373). The primary endpoint was major adverse cardiovascular events (MACEs), as a composite of cardiac death, myocardial infarction, stroke, and stent thrombosis, over 5 years of follow-up. We further performed propensity score adjustment for clinical outcomes. DAPT>12 months afforded a lower MACE rate than DAPT ≤12 months (2.3% vs. 5.4%, adjusted hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.19–0.71; p=0.003). The use of DAPT for>12 months was an independent predictor of a reduced likelihood of MACEs (HR, 0.34; 95% CI, 0.17–0.67; p=0.002). A DAPT score ≥2, chronic kidney disease, and age>75 years were significant independent predictors of MACEs. In subgroup analysis, the use of DAPT for>12 months consistently resulted in better clinical outcomes across all subgroups, especially among patients with ACS, compared with the use of DAPT for ≤12 months. In conclusion, an extended duration of DAPT reduces MACE rates after LMCA bifurcation stenting.
       
  • Relation of Low Triiodothyronine Syndrome Associated with Aging and
           Malnutrition to Adverse Outcome in Patients with Acute Heart Failure
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Kuniya Asai, Akihiro Shirakabe, Kazutaka Kiuchi, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Hiroki Goda, Shota Shigihara, Kazuhiro Asano, Kenichi Tani, Fumitaka Okajima, Noritake Hata, Wataru ShimizuAbstractLow triiodothyronine (T3) syndrome has recently been evaluated as a prognostic marker of acute heart failure (AHF). However, in which cases low T3 syndrome typically leads to adverse outcomes remain unclear. Of 1432 AHF patients screened, 1190 were enrolled. Euthyroidism was present in 956 patients (80.3%), who were divided into 2 groups: the normal group (n=445, FT3 ≥1.88 µIU/L) and low-FT3 group (n=511, FT3
       
  • Ten-Year Outcomes of Sirolimus-Eluting versus Zotarolimus-Eluting Coronary
           Stents in Patients With versus Without Diabetes Mellitus (SORT OUT III)
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Kevin K.W. Olesen, Manan Pareek, Morten Madsen, Lisette O. Jensen, Evald H. Christiansen, Leif Thuesen, Jens F. Lassen, Steen Dalby Kristensen, Hans Erik Bøtker, Michael MaengABSTRACTWe compared 10-year clinical outcomes in diabetes and non-diabetes patients treated with Endeavor zotarolimus-eluting (ZES) or Cypher sirolimus-eluting coronary stents (SES). A total of 1,162 patients were randomized to ZES (169 with diabetes) and 1,170 patients were randomized to SES (168 with diabetes). Patients were further stratified by diabetes status at the time of inclusion. A subgroup of patients with diabetes (n=88) underwent angiographic re-evaluation 10 months after stent implantation. Endpoints included a combined endpoint of death or myocardial infarction, and the individual endpoints of death, myocardial infarction, and revascularization. Among patients with diabetes, we found no difference in the combined endpoint [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.53-1.24], death (OR 0.80, 95% CI 0.51-1.25), or in MI (OR 1.07, 95% CI 0.60-1.91). However, diabetics with ZES more frequently underwent coronary revascularization compared with SES patients (OR 1.93, 95% CI 1.05-3.66). Among patients without diabetes, ZES and SES had similar 10-year rates of all endpoints (death: OR 1.13, 95% CI 0.93-1.39; MI: OR 0.80, 95% CI 0.61-1.05; revascularization: OR 0.81, 95% CI 0.61-1.09). Landmark analysis from 5-10 years showed no difference in outcomes between SES and ZES in either subgroup. In conclusion, at 10 years, SES and ZES performed similarly in patients with and without diabetes. Although coronary revascularization was more prevalent in diabetes patients with ZES, this may, in part, have been related to the angiographic follow-up that was offered to a subgroup of diabetes patients.
       
  • Effect of Renal Dysfunction on the Risks for Ischemic and Bleeding Events
           in Patients with Atrial Fibrillation Receiving Percutaneous Coronary
           Intervention
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of CardiologyAuthor(s): Ko Yamamoto, Hiroki Shiomi, Takeshi Morimoto, Masahiro Natsuaki, Yasuaki Takeji, Hirotoshi Watanabe, Yusuke Yoshikawa, Yukiko Matsumura-Nakano, Satoshi Shizuta, Kengo Tanabe, Kenji Ando, Kazushige Kadota, Yoshihiro Morino, Ken Kozuma, Yoshihisa Nakagawa, Takeshi KimuraAbstractThere is a paucity of studies exploring whether the ischemia-bleeding trade-off could be different according to the stages of renal dysfunction in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI). Among 19598 patients in a pooled database from 3 Japanese PCI studies (CREDO-Kyoto Cohort-2, RESET, and NEXT), 1547 patients had concomitant AF. Patients were divided into 4 groups according to their renal function (Creatinine clearance [CCr]>60 mL/min: N=703, 60≥ CCr>30 mL/min: N=627, CCr ≤30 mL/min: N=126, Dialysis: N=91). The cumulative 3-year incidences of both the primary ischemic (ischemic stroke/myocardial infarction) and bleeding (GUSTO moderate/severe) outcome increased incrementally with worsening renal function (11.4%, 12.6%, 16.8%, and 31.7%, P30 mL/min and CCr ≤30 mL/min groups (HR 0.89, 95% CI 0.62-1.29, P=0.54, and HR 0.94, 95% CI 0.49-1.69, P=0.83, respectively), while the excess adjusted risk for the primary bleeding outcome was significant in all 3 groups of renal dysfunction (HR 1.66, 95% CI 1.13-2.45, P=0.01, HR 2.70, 95% CI 1.58-4.61, P
       
  • Comparison of Three Atherosclerotic Cardiovascular Disease Risk Scores
           with and without Coronary Calcium for Predicting Revascularization and
           Major Adverse Coronary Events in Symptomatic Patients Undergoing Positron
           Emission Tomography-Stress Testing
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): Jeffrey L. Anderson, Viet T. Le, David B. Min, Santanu Biswas, C. Michael Minder, Raymond O. McCubrey, Stacey Knight, Benjamin D Horne, Steve Mason, Donald L. Lappe, Joseph B. Muhlestein, Kirk U KnowltonABSTRACTAtherosclerotic cardiovascular disease (ASCVD) is the most important cause of morbidity and mortality nationally and internationally. Improving ASCVD risk prediction is a high clinical priority. We sought to determine which of 3 ASCVD risk scores best predicts the need for revascularization and incident major adverse coronary events (MACE) in symptomatic patients at low- intermediate primary ASCVD risk referred for regadenoson-stress positron emission tomography (PET). Risk scores included the standard ASCVD pooled cohort equation (PCE), the Multiethnic Study of Atherosclerosis (MESA) risk equation, and the coronary artery calcium score (CACS), obtained by PET. All qualifying patients in our institution at primary ASCVD risk referred for PET-stress tests in whom PCE, MESA and CAC scores could be calculated were studied. CACS categories were: 0, 1-10, 11-299, 300-999, and 1000+. MESA and PCE scores were divided into quartiles. Logistic regression modeling was used to predict clinical/PET-driven early revascularization (within 90-days) and 1-year MACE (death, myocardial infarction, or any-time revascularization). A total of 981 patients (54% men, age 67 ± 10 y) qualified and were studied. Scores including CAC (MESA, CACS) performed better than PCE for predicting overall 1-year MACE (MESA p
       
  • Usefulness of Social Support in Older Adults After Hospitalization for
           Acute Myocardial Infarction (From the SILVER-AMI Study)
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): Yaakov S. Green, Alexandra M. Hajduk, Xuemei Song, Harlan M. Krumholz, Samir K. Sinha, Sarwat I. ChaudhryAbstractThe availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support – emotional support, informational support, tangible support, positive social interaction, and affectionate support – with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. 3006 participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio [OR], 1.22; 95% CI, 1.01-1.47), and low emotional support with mortality (OR, 1.43; 95% CI, 1.04-1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.
       
  • Usefulness of a Lifestyle Intervention in Patients with Cardiovascular
           Disease
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): Eva R. Broers, Giovana Gavidia, Mart Wetzels, Vicent Ribas, Idowu Ayoola, Jordi Piera-Jimenez, Jos W.M.G. Widdershoven, Mirela Habibović, Do CHANGE consortiumABSTRACTThe importance of modifying lifestyle factors in order to improve prognosis in cardiac patients is well-known. Current study aims to evaluate the effects of a lifestyle intervention on changes in lifestyle- and health data derived from wearable devices. Cardiac patients from Spain (N = 34) and The Netherlands (N = 36) were included in the current analysis. Data were collected for 210 days, using the Fitbit activity tracker, Beddit sleep tracker, Moves app (GPS tracker), and the Careportal home monitoring system. Locally Weighted Error Sum of Squares regression assessed trajectories of outcome variables. Linear Mixed Effects regression analysis was used to find relevant predictors of improvement deterioration of outcome measures. Analysis showed that Number of Steps and Activity Level significantly changed over time (F =58.21, p
       
  • Trends, Outcomes and Predictors of Revascularization in Cardiogenic Shock
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): Muhammad Zia Khan, Muhammad Bilal Munir, Muhammad U. Khan, Mohammed Osman, Pratik Agrawal, Moinuddin Syed, Yasir Abdul Ghaffar, Anas Alharbi, Safi U. Khan, Sudarshan BallaABSTRACTCardiogenic shock (CS) carries high mortality and morbidity. Early revascularization is an important strategy in management of these patients. We sought to determine the outcomes and predictors of revascularization among patients with CS. Patients with CS and acute myocardial infarction were identified using the National Inpatient Sample (NIS) data from January 2002 to December 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Subsequently, patients undergoing revascularization were then selected. A total of 118,618 patients with CS were identified. Out of these, about 55,735 (47%) patients underwent revascularization. Mean age of patients undergoing revascularization was lower when compared to patients not undergoing revascularization (66.40 vs. 72.24 years, p < 0.01). Patients who underwent revascularization had lower mortality when compared to patients not undergoing revascularization (25.1% vs. 52.2%, p < 0.01). Extracorporeal membrane oxygenation and mechanical circulatory support devices were often utilized more in patients undergoing revascularization. Overall, we found modest increased trend of revascularization over our study years with decline in mortality. Female gender, weekend admission, drug abuse, pulmonary hypertension, anemia, renal failure, neurological disorders, malignancy were associated with lower odds of revascularization. In conclusion, in this large nationally represented US population sample of CS patients, we found revascularization rate of about 47% with improvement in overall mortality over our study years.
       
  • Detecting Atrial Fibrillation in Patients with an Embolic Stroke of
           Undetermined Source (From the DAF-ESUS registry)
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): José Manuel Rubio Campal, M Araceli García Torres, Pepa Sánchez Borque, Inmaculada Navas Vinagre, Ivana Zamarbide Capdepón, Ángel Miracle Blanco, Loreto Bravo Calero, Rafael Sáez Pinel, José Tuñón Fernández, José María Serratosa FernándezAbstractAtrial fibrillation (AF) causes a substantial proportion of embolic strokes of undetermided source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least one week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2±1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (P 
       
  • Usefulness of Myocardial Strain and Twist for Early Detection of
           Myocardial Dysfunction in Patients with Autoimmune Diseases
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of CardiologyAuthor(s): Fu-Wei Jia, Jeffrey Hsu, Xiao-Hang Liu, Xiao-Jin Feng, Hai-Yu Pang, Xue Lin, Li-Gang Fang, Hua-Xia Yang, Wei ChenAbstractCardiac involvement in autoimmune diseases (AD) is common but underdiagnosed due to a lack of sensitive imaging methods. We aim to evaluate the characteristics of left ventricular (LV) systolic dysfunction in patients with AD using deformational parameters from two-dimensional speckle-tracking echocardiography (STE). We retrospectively enrolled 86 AD patients and 71 healthy controls. All subjects underwent transthoracic echocardiography and STE to analyze LV strain and twist. A twist-radial displacement loop was constructed to investigate the relationship between LV contractility and dimension. Among AD patients, 68 had preserved LV ejection fraction (EF ≥ 50%), and 18 had reduced LVEF (EF < 50%). The patients with preserved LVEF exhibited significantly lower values of global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) than controls (-19.11 ± 4.18 vs. -21.49 ± 2.53%, -25.17 ± 5.04% vs. -27.37 ± 2.87%, 17.68 ± 5.69% vs. 21.17 ± 6.44%, respectively; all p < 0.01) and a marked attenuation in peak twist (14.24 ± 5.57° vs. 18.10 ± 5.97°, p < 0.01) attributed to impaired apical rotation (9.03 ± 5.17° vs. 12.79 ± 5.99°, p < 0.01). AD patients were more likely to present with abnormal loop types with flat ascending slope and delayed peak twist time. In conclusion, abnormal strain and twist precede deterioration in LVEF, suggesting early myocardial involvement in AD. STE can be used as a good alternative for early detection of myocardial dysfunction in AD patients.
       
  • Incidence of, Associations With and Prognostic Impact of Worsening Renal
           Function in Heart Failure With Different Ejection Fraction Categories
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Ida Löfman, Karolina Szummer, Marie Evans, Juan-Jesus Carrero, Lars H. Lund, Tomas JernbergThere are no studies of long-term worsening renal function (WRF) in heart failure (HF) with different ejection fraction (EF) groups. The aim was to compare incidence of, associations with and prognostic impact of WRF in HF with preserved (HFpEF), mid-range (HFmrEF), and reduced EF (HFrEF). The Swedish Heart Failure Registry (SwedeHF) was merged with the Stockholm Creatinine Measurement (SCREAM) registry 2006 to 2010. The associations between EF and WRF (≥25% decrease in eGFR) and the associations between WRF25-49% and WRF≥50% within year one and subsequent all-cause mortality were all assessed with multiadjusted Cox regression. Of 7,154 patients, 41.6% of HFpEF versus 34.5% and 35.4% of HFmrEF and HFrEF patients developed WRF≥25% during year one. The WRF risk was higher in HFpEF (reference) than in HFmrEF, hazard ratio (95% confidence interval) 0.890 (0.794 to 0.997) and HFrEF 0.870 (0.784 to 0.965). WRF within year one was strongly associated with subsequent long-term mortality in all EF groups, yielding adjusted HRs with WRF25-49% and WRF≥50%: HFpEF, 1.101 (0.913 to 1.328) and 2.096 (1.652 to 2.659), in HFmrEF 1.654 (1.353 to 2.022) and 2.375 (1.807 to 3.122) and in HFrEF 1.212 (1.060 to 1.386) and 1.694 (1.412 to 2.033). In conclusion, the long-term WRF risk was high in HF and highest in HFpEF. WRF was strongly associated with mortality in all EF groups, although in HFpEF only with the most severe WRF.
       
  • Outcomes With Intravascular Ultrasound-Guided Drug Eluting Stent
           Implantation for Unprotected Left Main Coronary Lesions: A Meta-analysis
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Islam Y. Elgendy, Mohamed Gad, Ankur Jain, Ahmed N. Mahmoud, Gary S. Mintz
       
  • A Stricter Approach for Commotio Cordis in Lethal Cases
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Francesco Lupariello, Giancarlo Di Vella
       
  • Treadmill Stress Test in a 56-Year-Old Man
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Mazen M. Kawji, D. Luke GlancySeveral findings on an exercise electrocardiogram predicted left main and/or 3-vessel coronary arterial disease, which was confirmed by coronary arteriography, and the 56-year-old man underwent a multivessel coronary arterial bypass operation the following day.
       
  • “Buying Art”
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Robert M. Doroghazi
       
  • Continuing Use of Inferior Vena Cava Filters Despite Data and
           
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Paul D. Stein, Fadi Matta, Mary J. HughesThe purpose of the present investigation is to determine the response to the evidence and recommendations against the use of inferior vena cava (IVC) filters in patients with deep venous thrombosis (DVT). This was a retrospective cohort study based on administrative data from the National Hospital Discharge Survey 1979 to 2006 and from the National (Nationwide) Inpatient Sample 2007 to 2014. The number of IVC filters inserted in patients with lone DVT peaked in 2009 and then decreased from 2009 to 2014. The proportion of patients with lone DVT who received an IVC filter peaked in 2010 and then decreased from 2010 to 2014. Both the number of IVC filters inserted yearly and the proportion of patients who received an IVC filter remained higher than in 1998 when a randomized controlled trial showed no reduced mortality with permanent IVC filters in patients with DVT. In conclusion, large numbers of patients with lone DVT continue to receive IVC filters despite a randomized controlled trial that showed no reduced mortality with IVC filters in patients with DVT and despite clinical guideline recommendations against the use of IVC filters in such patients.
       
  • Characteristics of Cardiovascular Magnetic Resonance Imaging and Outcomes
           in Adults With Repaired Truncus Arteriosus
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Leena Robinson Vimala, Kate Hanneman, Paaladinesh Thavendiranathan, Elsie T. Nguyen, Candice K. Silversides, Rachel M. WaldThe cardiovascular magnetic resonance imaging (CMR) features of adults with repaired truncus arteriosus (rTA) are largely undefined. We sought to explore CMR characteristics in rTA and to identify associations between imaging findings and cardiovascular outcomes. Adults with rTA and CMR were identified and anatomic subtypes (1-4) were assigned (Collett and Edwards classification). CMR characteristics, clinical data at last follow-up and adverse cardiovascular outcome were recorded. Twenty-seven adults (19% male) were studied (median age at cardiovascular magnetic resonance 26 years [interquartile range 18 to 40]) over 5.2-year duration [interquartile range 2.5 to 7.5]. With the exception of mildly increased RV mass (30 ± 12 g/m2), cardiac chamber measurements were within the normal range. In CMR measurements, only pulmonary artery peak velocity differed in subtypes (highest in subtype 3, 318 ± 26 cm/s, p = 0.029). Number of cardiovascular interventions in adulthood was moderately correlated with left ventricular end-diastolic volume (r = 0.463, p = 0.015), left ventricular ejection fraction (r = 0.425, p = 0.027) and neoaortic root size (r = 0.398, p = 0.039). Cardiovascular events (nonmutually exclusive) in 5 of 27 patients (19%) included death (n = 1), heart failure (n = 1), ventricular tachycardia (n = 1), and atrial tachycardia (n = 3). Increased cardiovascular risk was associated with decreased right ventricular ejection fraction (odds ratio 1.153, confidence interval 1.003 to 1.326, p = 0.046) and smaller ascending aorta diameter (odds ratio 1.758, confidence interval 1.037 to 2.976, p = 0.036). In conclusion, decreased right ventricular ejection fraction and smaller ascending aorta on cardiovascular magnetic resonance were associated with adverse events in rTA.
       
  • Infliximab for Refractory Cardiac Sarcoidosis
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Logan J. Harper, Meghann McCarthy, Manuel L. Ribeiro Neto, Rory Hachamovitch, Karla Pearson, Barbara Bonanno, Josephine Shaia, Richard Brunken, Emer Joyce, Daniel A. CulverCardiac sarcoidosis (CS) is frequently difficult to treat. Infliximab (IFX) is useful for extracardiac sarcoidosis, but its use in CS has been limited due to concerns about cardiotoxicity and an FDA blackbox warning about use in heart failure. We reviewed 36 consecutive patients treated with infliximab for CS refractory to standard therapies. IFX was initiated for patients with refractory dysrhythmias, moderate to severe cardiomyopathy, and evidence of persistent F-18 fluorodeoxyglucose uptake on positron emission tomography scan, despite standard therapies. We compared the prednisone dose, ejection fraction (EF), and dysrhythmias before and after IFX therapy. The prednisone-equivalent steroid dose decreased from a median of 20 mg at initiation of infliximab to 7.5 at 6 months and 5 mg at 12 months postinitiation of infliximab (p
       
  • Meta-analysis of Temporal and Surgical Risk Dependent Associations With
           Outcomes After Transcatheter Versus Surgical Aortic Valve Implantation
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Safi U. Khan, Haris Riaz, Muhammad U. Khan, Muhammad Samsoor Zarak, Muhammad Zia Khan, Muhammad Shahzeb Khan, Sudhakar Sattur, Milind Y. Desai, Edo Kaluski, Mohamad AlkhouliTemporal and surgical risk dependent associations with clinical outcomes in patients receiving transcatheter versus surgical aortic valve implantation (TAVI vs SAVI) are uncertain. In this meta-analysis, 7 randomized controlled trials (7,771 patients) were included to investigate trends in outcomes in TAVI versus SAVI up to 5 years, and variation in outcomes with respect to low-, intermediate-, and high-surgical risk of the patients up to 1 year. Estimates were calculated as random effects hazard ratios (HRs) with 95% confidence intervals (CI). All-cause mortality was similar in TAVI and SAVI at 30 days (HR 0.81, 95% CI 0.55 to 1.21, p = 0.31), 1 year (HR 0.97, 95% CI 0.89 to 1.06, p = 0.49), 2 years (HR 0.96, 95 CI 0.85 to 1.09, p = 0.54), and 5 years (HR 1.04, 95% CI 0.89 to 1.21, p = 0.62). Cardiac mortality, myocardial infarction and stroke were similar in both interventions up to 5 years. TAVI was associated with lower risk of atrial fibrillation, but higher risk of vascular complications, pacemaker implantation, and paravalvular leak up to 5 years. The lower risks of major bleeding and acute kidney injury with TAVI versus SAVI were limited to 1 and 2 years, respectively. Compared with SAVI, TAVI was superior in reducing all-cause mortality in low surgical risk patients at 30 days only, whereas TAVI was noninferior to SAVI in intermediate- and high-risk patients at 30 days and across all risks at 1 year. In conclusion, TAVI was noninferior to SAVI in terms of mortality, myocardial infarction, and stroke up to 5 years. TAVI improved survival versus SAVI in low-risk patients at 30 days.
       
  • Impact of Chronic Thrombocytopenia on Outcomes After Transcatheter
           Valvular Intervention and Cardiac Devices Implantation (From a National
           Inpatient Sample)
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Mohamed Shokr, Oluwole Adegbala, Adel Elmoghrabi, Mohammed Saleh, Mustafa Ajam, Abdelrahman Ali, Ahmed S. Yassin, Tomo Ando, Bianka Eperjesiova, Ahmed Aly, Mohit Pahuja, Said Ashraf, Hossam Abubakar, Abdelrahman Ahmed, Ahmed Subahi, Randy Lieberman, Luis AfonsoTo evaluate the impact of chronic thrombocytopenia (cTCP) on outcomes of transcatheter valvular procedures such as aortic valve implantation (TAVI), MitraClip, permanent pacemaker (PPM), implantable-cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left atrial appendage closure, and pericardiocentesis. Impact of cTCP on clinical outcomes following TAVI, Mitraclip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis procedures is not well described. Utilizing the National Inpatient Sample and (ICD-9-CM) procedural codes, we evaluated patients (age ≥18 years) who underwent these procedures, from January 1, 2009 to December 31, 2014, with or without cTCP as a chronic condition variable indicator. Propensity score matching model implemented to derive 2 matched groups. Propensity score matching created 47,292 and 47,351 hospitalizations matched pairs with and without cTCP, respectively. Patients with cTCP were older (mean age, 74.27 vs 72.26 years; absolute standardized differences [ASD] = 15.6) and less likely to be female (36.76% vs 43.74%, ASD = −14.31). They experienced higher in-hospital mortality (3.0% vs 2.0%; odds ratio [OR], 1.53; 95% confidence interval [CI], 1.27 to 1.83) and higher odds of vascular injury requiring surgery (2.63% vs 1.10%; OR, 2.43; 95% CI, 1.93 to 3.05). Postoperative hematoma and bleeding were 2-fold higher (4.57% vs 2.24%; OR, 2.08; 95% CI, 1.77 to 2.45) and 3-fold higher (6.34% vs 2.45%; OR, 2.69; 95% CI, 2.31 to 3.13) respectively among cTCP patients. They had greater health-care cost ($47,163 vs $35,763, p
       
  • Prognostic Impact of the Ratio of Acceleration Time to Ejection Time in
           Patients With Low Gradient Severe Aortic Stenosis and Preserved Ejection
           Fraction
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Alexandre Altes, Nicolas Thellier, Yohann Bohbot, Wassima Marsou, Gagandeep Chadha, Camille Binda, Anne Ringle, Amandine Mailliet, Nathalie Marotte, Clemence Riolet, Christophe Tribouilloy, Sylvestre MaréchauxThe clinical management of patients with low gradient severe aortic stenosis (LG-SAS) and preserved left ventricular ejection fraction (LVEF) remains challenging owing to their heterogeneity. The aim to this study was to evaluate the relation between an ejection dynamic parameter linked to AS severity and outcome, the ratio of acceleration time (AT) to ejection time (ET), in a cohort of patients with LG-SAS and preserved LVEF. Three hundred and fifty-six patients with LG-AS (defined by AVA ≤1 cm² and/or AVAi ≤0.6 cm²/m² and mean aortic pressure gradient 0.36 versus 43 ± 4%, 16 ± 3% for patients with AT/ET ≤0.36 (p = 0.024 and p 0.36 (adjusted hazard ratio 2.04 [95% confidence interval, 1.32 to 3.13]; p = 0.001) and cardiac mortality risk (adjusted hazard ratio 2.89 [95% confidence interval, 1.54 to 5.43]; p0.36 and all-cause or cardiac mortality risk was consistent in subgroups of patients with LG-SAS and preserved EF. In conclusion, an AT/ET ratio of more than 0.36 is an independent predictor of mortality in patients with LG-SAS and preserved EF.
       
  • Relation Between Mitral Valve Prolapse and Erectile Dysfunction (from a
           Nationwide Case-Control Study)
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Shiu-Dong Chung, Ju-Chi Liu, Tsai-Ning Lou, Ben-Chang Shia, Herng-Ching Lin, Li-Ting KaoSome previous literature indicated an association between cardiovascular diseases and erectile dysfunction (ED). This case-control study purposed to evaluate the association between prior mitral valve prolapse (MVP) and ED using data from the Taiwan National Health Insurance Research Dataset. In this study, 48,755 patients with ED were identified as cases, and 195,020 propensity score-matched patients without ED were selected as controls. Conditional logistic regressions were conducted to evaluate the odds ratios (ORs) for previous MVP between cases and the matched controls. In all sampled patients, 4,565 (1.87%) patients had MVP before the index date. MVP was found in 1,304 (2.67%) cases and in 3,261 (1.67%) matched controls. Patients with ED had a significantly higher occurrence of MVP than the controls. In addition, after propensity score matching, a conditional logistic regression analysis showed that the OR of previous MVP for patients with ED was 1.63 (95% confidence interval [CI] 1.52 to 1.74) compared to the matched controls. The ORs of previous MVP for patients with ED aged ≤65 years and those>65 years were 1.68 (95% CI 1.56 to 1.81) and 1.49 (95% CI 1.30 to 1.70), respectively, compared with the matched controls. We found that patients with erectile dysfunction had significantly higher odds of previous MVP compared with matched control subjects without ED regardless of the age group.
       
  • Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial
           Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With
           Heart Failure and Preserved Left Ventricular Ejection Fraction
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Adrián I. Löffler, Jonathan A. Pan, Pelbreton C. Balfour, Peter W. Shaw, Yang Yang, Moiz Nasir, Daniel A. Auger, Frederick H. Epstein, Christopher M. Kramer, Li-Ming Gan, Michael SalernoHeart failure with preserved ejection fraction (HFpEF) is frequently accompanied by co-morbidities and a systemic proinflammatory state, resulting in coronary microvascular dysfunction (CMD), as well as myocardial fibrosis. The purpose of this study is to examine the relation between myocardial perfusion reserve (MPR) and diffuse myocardial fibrosis in patients with HFpEF using cardiovascular magnetic resonance. A single center study was performed in 19 patients with clinical HFpEF and 15 healthy control subjects who underwent quantitative first-pass perfusion imaging to calculate global MPR. T1 mapping was used to assess fibrosis and to calculate extracellular volume. Spiral cine displacement encoded stimulated echo was used to calculate myocardial strain. Comprehensive 2D echocardiograms with speckle tracking, cardiopulmonary exercise testing, and brain natriuretic peptide levels were also obtained. In patients with HFpEF, mean left ventricular EF was 61% ± 9% and left ventricular mass index 45 ± 12 g/m2. Compared with controls, HFpEF patients had reduced global MPR (2.29 ± 0.64 vs 3.38 ± 0.76, p = 0.002) and VO2 max (16.5 ± 6.8 vs 30.9 ± 7.7 ml/kg min, p
       
  • Defining Commotio Cordis
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Barry J. Maron, Cooper S. Sheppard
       
  • Meta-analysis of Effect of Modest (≥10%) Weight Loss in Management of
           Overweight and Obese Patients With Atrial Fibrillation
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Omar M. Aldaas, Florentino Lupercio, Frederick T. Han, Kurt S. Hoffmayer, David Krummen, Gordon Ho, Farshad Raissi, Ulrika Birgersdotter-Green, Gregory K. Feld, Jonathan C. HsuObesity and atrial fibrillation (AF) are growing epidemics with significant overlap in co-morbidities. Multiple smaller studies have evaluated the effects of weight loss and risk factor modification on recurrence of AF, reduction in AF burden and improvement in AF symptom severity. The objective of this study was to determine if a modest weight loss of ≥10% of initial body weight is enough to improve outcomes in overweight or obese patients with established AF. We performed an extensive literature search and systematic review of studies that compared weight loss of ≥10% versus weight loss of less than 10% or weight gain and assessed outcomes including recurrence of AF as determined through a Holter monitor, AF burden and improvement in AF symptom severity. Risk ratio 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where MD>0 favors the group with ≥10% weight loss. Five studies with a total of 548 patients were included. Patients who lost ≥10% of their initial body weight experienced less recurrence of AF (risk ratio 0.29; 95% CI 0.19 to 0.44) and a larger reduction in reported event frequency (MD 1.74; 95% CI 0.70 to 2.79), episode duration (MD 2.14; 95% CI 0.04 to 4.23), global episode severity (MD 1.89; 95% CI 1.34 to 2.45), and symptom severity (MD 5.36; 95% CI 3.75 to 6.97). In conclusion, weight loss is associated with less risk of recurrent AF, reduction in AF burden, and improvement in AF symptom severity.
       
  • Usefulness of Red Cells Distribution Width to Predict Worse Outcomes in
           Patients With Atrial Fibrillation
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Vincenzo Livio Malavasi, Marco Proietti, Stefano Spagni, Anna Chiara Valenti, Antonella Battista, Daniele Pettorelli, Jacopo Colella, Marco Vitolo, Gregory YH Lip, Giuseppe BorianiRed cells distribution width (RDW) is a measure of red cell size variability, but little is known about the relation between RDW and outcomes in atrial fibrillation (AF).The aims of our study were to evaluate the association between RDW values, AF patients’ profile and outcomes. Consecutive patients with ECG-confirmed AF were divided in 3 groups according to tertiles of RDW values (≤13.5%, 13.6% to 14.6%,>14.6%).We enrolled 457 patients, 61.9% males, median (interquartile range) age 74 (66 to 80). Both CHA2DS2-VASc and HAS-BLED scores increased progressively according to RDW tertiles. During follow-up, there was an increased risk for all-cause death and the composite end point in the highest RDW tertile (p
       
  • Prevalence and Incidence of Atrial Fibrillation in Ambulatory Patients
           With Heart Failure
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Pierpaolo Pellicori, Alessia Urbinati, Kuldeep Kaur, Jufen Zhang, Parin Shah, Syed Kazmi, Alessandro Capucci, John G.F. Cleland, Andrew L. ClarkHeart failure (HF) and atrial fibrillation (AF) commonly co-exist. We aimed to determine the prevalence and incidence of AF in ambulatory patients with HF. HF was defined by the presence of symptoms or signs supported by objective evidence of cardiac dysfunction: either a left ventricular ejection fraction (LVEF) ≤45% (HF and a reduced ejection fraction, HFrEF), or LVEF>45% and a raised plasma concentration of amino-terminal pro-B type natriuretic peptide (NT-proBNP>220 ng/L; HFpEF). Of 3,570 patients with HF, 1,164 were in AF at baseline (33%), with a higher prevalence among patients with HFpEF compared with HFrEF (40% vs 26%, respectively, p
       
  • Comparison of In-Hospital Outcomes in Patients Having
           Limb-Revascularization With Versus Without Atrial Fibrillation
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Homam Moussa Pacha, Yasser Al-khadra, Fahed Darmoch, Mohamad Soud, Anwar Zaitoun, Chun Shing Kwok, Mamas A. Mamas, Amir Kaki, Santiago Garcia, Subhash Banerjee, Salman A. Arain, George W. Vetrovec, James J. Glazier, M Chadi AlraiesThe impact of atrial fibrillation (AF) on clinical outcomes among patients with peripheral artery disease (PAD) who undergo limb revascularization procedures is not well understood. We aim to compare in-hospital outcomes for patients with and without AF who underwent limb revascularization. We identified patients with PAD aged ≥18 years that underwent limb revascularization using endovascular or surgical approaches in the National Inpatient Sample between 2002 and 2014. Multivariate logistic regression analysis was performed to examine in-hospital outcomes. A total of 2,283,568 patients underwent limb revascularization during the study duration and 294,469 (12.9%) had AF. Patients with AF were older (mean age 76.1 ± 10.0 years), more likely to be women and white, compared with non-AF group. Among patients who had surgical revascularization, AF was associated with a higher rates of in-hospital mortality (6.4% vs 2.5%, adjusted odds ratio [aOR]: 1.09 [95% confidence interval {CI}: 1.05 to 1.12]) and major amputation (5.2% vs 3.8%, aOR: 1.05 [95% CI: 1.02 to 1.08]), compared with non-AF group. Among patients who had endovascular intervention (EVI), AF was associated with a higher rates of in-hospital mortality (3.8% vs 1.6%, aOR: 1.29 [95% CI: 1.24 to 1.33]) and major amputation (5.2% vs 3.9%, aOR: 1.07 [95% CI: 1.04 to 1.10]), compared with non-AF group. Within study period, EVI utilization increased in patients with and without AF (Ptrend
       
  • Impact of Insulin-Treated and Noninsulin-Treated Diabetes Mellitus in
           All-Comer Patients Undergoing Percutaneous Coronary Interventions With
           Polymer-Free Biolimus-Eluting Stent (from the RUDI-FREE Registry)
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Martino Pepe, Gennaro Sardella, Giulio G. Stefanini, Nicola Corcione, Palma Luisa Nestola, Alberto Morello, Carlo Briguori, Corrado Tamburino, Franco Fabbiocchi, Francesco Luigi Rotolo, Fabrizio Tomai, Anita Paggi, Mario Lombardi, Gaetano Gioffrè, Rocco Sclafani, Andrea Rolandi, Alessandro Sciahbasi, Francesco Scardaci, Nicola Signore, Massimo ManconePatients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI). Recent evidences suggest a differential impact of insulin-treated and noninsulin-treated DM on prognosis. We evaluated the clinical outcome of diabetic patients after PCI with polymer-free biolimus-eluting stent from the RUDI-FREE Registry, investigating a possible different prognostic impact of insulin-treated and noninsulin-treated DM. A total of 1,104 consecutive patients who underwent PCI with polymer-free biolimus-eluting stent, enrolled in the RUDI-FREE observational, multicenter, single-arm registry, were stratified by diabetic status; diabetic population was further divided on the basis of insulin treatment. Primary end points of the study were target lesion failure (TLF; composite of cardiac death, target vessel myocardial infarction, target lesion revascularization) and major adverse cardiac and cerebrovascular events (composite of cardiac death, stroke, and myocardial infarction). Multiple ischemic adverse events were also single-handedly considered as secondary end points. At 1 year, TLF was significantly higher in the diabetic cohort, as compared with nondiabetic patients (6.0% vs 3.1%, p 0.022). None of the end points resulted significantly different between nondiabetics and noninsulin-treated diabetic patients. Divergently, compared with nondiabetic, insulin-treated diabetic patients faced significant higher rates of TLF (10.8% vs 3.1%, p 0.003), major adverse cardiac and cerebrovascular events (10.8% vs 3.4%, p 0.004), and of most of the analyzed adverse events. In conclusion, patients with DM had a higher risk of TLF compared with nondiabetics; nonetheless, the worse outcome of the diabetic population seems to be driven by the insulin-treated diabetic subpopulation. This finding suggests a different risk profile of insulin-treated and noninsulin-treated diabetic patients in the modern era of PCI.
       
  • Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial
           Revascularization for Patients With Non-ST-Segment Elevation Acute
           Coronary Syndromes
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Vincent R. Siebert, Sanket Borgaonkar, Xiaoming Jia, Hong Loan Nguyen, Yochai Birnbaum, Nasser M. Lakkis, Mahboob AlamWe present a systematic review and meta-analysis comparing efficacy and safety outcomes between single procedure multivessel revascularization (MVR) and culprit vessel only revascularization in patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS), and multivessel disease is common. There is no consensus on the most efficacious single procedure revascularization strategy for patients undergoing percutaneous coronary intervention not meeting coronary artery bypass grafting criteria. Studies in PubMed and EMBASE databases were systematically reviewed, and 15 studies met criteria for inclusion in the meta-analysis. Baseline characteristics between the groups were similar. A random effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins I2 tests. For short-term outcomes, patients who underwent MVR had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to 1.29; p = 0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; p = 0.05), but lower rates of urgent or emergent coronary artery bypass grafting (OR 0.35; 95% CI 0.29 to 0.43; p
       
  • Comparison of Two-Year Outcomes of Acute Myocardial Infarction Caused by
           Coronary Artery Spasm Versus that Caused by Coronary Atherosclerosis
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Ju Yeol Baek, Byoung Geol Choi, Seung-Woon Rha, Cheol Ung Choi, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Tae Hoon Ahn, Kiyuk Chang, Shung-Chull Chae, Seung Ho Hur, Kwang-Soo Cha, In-Ho Choi, Hyo-Soo Kim, Hyeon Cheol Gwon, Young Jo Kim, Seok Kyu Oh, Jei Keon Chae, In Whan Seong, Kyung-Kook HwangThe study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by coronary artery atherosclerosis and AMI caused by coronary artery spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories—(1) AMI due to coronary artery spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by coronary artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p
       
  • Temporal Trends in the Use of Intravascular Imaging Among Patients
           Undergoing Percutaneous Coronary Intervention for ST Elevation Myocardial
           Infarction in the United States
    • Abstract: Publication date: 15 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 10Author(s): Gbolahan O. Ogunbayo, Rachel P. Goodwin, Ayman Elbadawi, Mohamed Omar, Dustin Hillerson, Elliott M Goodwin, Robert Pecha, Ahmed Abdel-Latif, Claude S Elayi, Adrian W Messerli
       
  • Some Tips on Insurance: Part II of II
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of CardiologyAuthor(s): Robert M. Doroghazi
       
  • Age-Specific Impact of Atrial Fibrillation on Cardiovascular Mortality
           Among Japanese Men and Women (The Ibaraki Prefectural Health Study [IPHS])
           
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Toshimi Sairenchi, Kazumasa Yamagishi, Hiroyasu Iso, Fujiko Irie, Ai Koba, Mitsumasa Umesawa, Yasuo Haruyama, Hiroshi Watanabe, Gen Kobashi, Hitoshi OtaThe age-specific impact of atrial fibrillation (AF) on cardiovascular diseases remains unclear. A total of 90,629 participants who were from 40 to 79 years of age in 1993 were followed up until 2013 as part of the Ibaraki Prefectural Health Study. Hazard ratios for mortality stratified by gender and age groups were calculated using Cox's proportional hazards regression models. A total of 22,794 patients (11,329 men and 11,465 women) died during the follow-up period, including 6,684 patients who died of cardiovascular causes (2,951 men and 3,733 women). On multivariable analysis, participants with AF had an increased risk of cardiovascular-related mortality compared with those without AF. Among participants aged 40 to 64 years, the adjusted hazard ratios were 3.2 (95% confidence interval [CI] 2.0 to 5.3) for men and 7.1 (95% CI 3.2 to 16.0) for women; the corresponding adjusted hazard ratios among participants aged 65 to 79 years were 3.0 (95% CI 2.2 to 4.0) for men and 3.7 (95% CI 2.5 to 5.4) for women. No significant difference in hazard ratios between age groups was found for either gender. AF was significantly associated with all-cause mortality in each age and gender group; again, no significant difference in hazard ratios between the age groups was found in terms of AF. AF may be an independent risk factor for cardiovascular and all-cause mortalities regardless of age.
       
  • Authors' Reply to “Underlying Differences in the Treatment of Left
           
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Adam M. Fleddermann, Charles Hayes, Anthony Magalski, Michael L. Main
       
  • Clinical Outcomes of Nonagenarians After Transcatheter Aortic Valve
           Implantation
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Tomoyuki Kawada
       
  • Extracorporeal Membrane Oxygenation (ECMO): A Promising Option for
           Treating Adult Down Syndrome Patients'
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Mohammed Faisal Uddin, Pulwasha Maria Iftikhar, Roopam Bansal, Azeem Husain Arastu, Javidulla Khan
       
  • Changes in Mental Status and Dyspnea Followed by Pulseless Electrical
           Activity
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Mazen M. Kawji, David Luke GlancyFollowing back surgery a man developed extensive pulmonary emboli that proved fatal.
       
  • “Buying Jewelry: Gold and Diamonds”
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Robert M. Doroghazi
       
  • Impact of Multidisciplinary Pulmonary Embolism Response Team Availability
           on Management and Outcomes
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Pulkit Chaudhury, Shruti Gadre, Erika Schneider, Rahul Renapurkar, Marcelo Gomes, Ihab Haddadin, Gustavo Heresi, Michael ZY Tong, John R BartholomewTreatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant nonmajor bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability.
       
  • Impact of Pulmonary Hypertension on Survival Following Device Closure of
           Atrial Septal Defects
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Lauren S. Ranard, Wael El Mallah, Jordan D. Awerbach, Abraham Abernethy, Mohamed Halane, Athar M. Qureshi, Richard A. KrasuskiPulmonary hypertension (PH), defined as mean pulmonary arterial pressure ≥25 mm Hg, may be a complication of a secundum atrial septal defect (ASD). This study sought to evaluate the impact of PH at time of ASD device closure on patient survival. A prospectively collected database of ASD closures was utilized. Patients were stratified by age above and below the cohort median (48 years). Survival was analyzed by preprocedural PH status, age cohort, and echocardiographic resolution of PH at 3 months postdevice closure. PH was present in 48 of 228 patients (21.1%) and was more common in the older cohort (31.3% vs 10.6%, p
       
  • Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+)
           for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip
           
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Wei Chen, Andrew Berke, William Chung, Elena Koss, Aarsha Gopal, Jie Jane Cao, Lin WangThe goal of this study was to determine the predictors of adverse clinical outcomes in patients treated with the MitraClip for significant mitral regurgitation (MR) with a focus on acute changes in hemodynamics and cardiac function. This retrospective study included 63 patients (mean age 82 ± 8 years, 48% male) with moderate to severe or severe MR. Cardiac catheterization was performed before and immediately after MitraClip repair. Volumetric and functional changes were assessed in both ventricles. A major adverse cardiac event was defined as a composite of cardiac death and readmission for heart failure. Patients were followed up on average for 380 days. MR was improved in 92% of patients after MitraClip therapy from an average grade of 4+ to
       
  • Prevalence and Clinical Impact of Iron Deficiency in Patients With Severe
           Aortic Stenosis Referred for Transcatheter Aortic Valve Implantation
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Tobias Rheude, Costanza Pellegrini, Leonie Lessmann, Jens Wiebe, N. Patrick Mayr, Jonathan Michel, Teresa Trenkwalder, Albert M. Kasel, Heribert Schunkert, Adnan Kastrati, Michael Joner, Oliver Husser, Christian HengstenbergPatients referred for transcatheter aortic valve implantation (TAVI) are typically elderly with several co-morbidities, which might limit prognosis despite successful procedural outcome. To date, the prevalence and clinical impact of iron deficiency (ID) in patients with severe aortic stenosis who underwent TAVI remains poorly defined. This study included 495 patients who underwent transfemoral TAVI for severe symptomatic aortic stenosis. ID was defined as ferritin
       
  • Ventricular Dysrhythmias During Long-Term Follow-Up in Patients With
           Inherited Cardiac Arrhythmia
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Gustaf D.S. Sitorus, Ahmed A.Y. Ragab, Charlotte A. Houck, Eva A.H. Lanters, Annejet Heida, Virgilla E. van Gastel, Agnes J.Q.M. Muskens, Natasja M.S. de GrootReports on development of frequent ventricular premature complexes (fVPC), (non)sustained ventricular tachycardias ([n]sVT), or ventricular fibrillation (VF) and their interrelationship in patients with different inherited cardiac arrhythmia (ICA) have sofar not been reported. The aim of this study is therefore to examine incidences and recurrences rates of sVT and VF (“malignant ventricular tachyarrhythmias, VTA”) in addition to the incidence of fVPC and nsVT (“ventricular dysrhythmias, VDR”) in patients with various ICA during long-term follow up. Patients (N = 167, 88 male, age 45 ± 15 years) with ICA including definite/borderline arrhythmogenic right ventricular cardiomyopathy (ARVC, N = 47), Brugada syndrome (BrS, N = 71), catecholaminergic polymorphic ventricular tachycardia (CPVT, N = 7), long QT syndrome (LQTS, N = 41) or short QT syndrome (SQTS, N = 1) who had frequent 24-hour Holter monitoring during a follow-up period of 4.6 ± 4.4 years. During the initial screening visit, 15 patients had a history of malignant VTA. fVPC and nsVT was observed in respectively 19% (OHCA/VF/sVT: N = 9) and 13% (OHCA/VF/sVT: N = 4) of all patients. Compared with the ARVC group, patients with BrS and LQTS had less frequent fVPC and nsVT (fVPC: odds ratio [OR] 0.20, 95% confidence interval [CI] 0.08 to 0.49, p
       
  • Usefulness of Left Atrial Volume as an Independent Predictor of
           Development of Heart Failure in Patients With Atrial Fibrillation
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Naoki Taniguchi, Yoko Miyasaka, Yoshinobu Suwa, Shoko Harada, Eri Nakai, Kohei Kawazoe, Ichiro ShiojimaLeft atrial (LA) volume is known as a robust predictor of heart failure (HF) development in patients with sinus rhythm. However, among patients with atrial fibrillation (AF), the utility of LA volume for prediction of HF development has not been determined. The objective of this study was to investigate the utility of LA volume for prediction of HF development in patients with AF. Among adult patients who were referred for transthoracic echocardiography, those with AF at the baseline echocardiography were included and prospectively followed up to new-onset HF events. Patients who had significant valvular heart disease, congenital heart disease, or reduced left ventricular (LV) ejection fraction were excluded. Cox-proportional hazards models were used to assess the risk of HF development. Of a total of 562 patients, 422 (mean age 69.6 ± 9.7 years, 66.1% men) met study criteria, and 52 (12.3%) developed HF during a mean follow-up of 55 ± 43 months. Patients with HF events had larger indexed LA volume, compared with those without HF events (69 ± 46 vs 50 ± 23 ml/m2, p
       
  • Interatrial Block: Thromboembolism Risk in the Absence of Atrial
           Fibrillation
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Lovely Chhabra
       
  • Characteristics and Outcomes of Atrial Fibrillation in Patients With
           Thyroid Disease (from the ARISTOTLE Trial)
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Sarah A. Goldstein, Jennifer Green, Kurt Huber, Daniel M. Wojdyla, Renato D. Lopes, John H. Alexander, Dragos Vinereanu, Lars Wallentin, Christopher B. Granger, Sana M. Al-KhatibWhether patients with atrial fibrillation (AF) and thyroid disease are clinically distinct from those with AF and no thyroid disease is unknown. Furthermore, the effectiveness of anticoagulation for prevention of AF-related thromboembolic events in patients with thyroid disease has not been adequately studied. Patients enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, which compared apixaban with warfarin in patients with AF (n = 18,201), were categorized by thyroid disease history at randomization (hypothyroidism, hyperthyroidism, and no thyroid disease). Adjusted hazard ratios derived from Cox models were used to compare outcomes by thyroid disease history. Associations between randomized treatment and outcomes by thyroid disease history were examined using Cox models with interaction terms. A total of 18,021/18,201 (99%) patients had available thyroid disease history at randomization: 1,656 (9%) had hypothyroidism, 321 (2%) had hyperthyroidism, and 16,044 (89%) had no thyroid disease. When compared with those without a history of thyroid disease, patients with hypo- or hyperthyroidism were more likely to be female (60.4% vs 32.1%; 52.0% vs 32.1%; both p
       
  • Effect of Diabetes Mellitus on Complication Rates of Coronary Artery
           Bypass Grafting
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): John E. Brush, Elias S. Siraj, Clinton D. Kemp, Deborah P. Liverman, Brittany Y. McMichael, Rajan Lamichhane, Brynn E. SheehanPrevious studies have shown that diabetes mellitus (DM) is a risk factor for postoperative coronary artery bypass grafting (CABG) complications. More contemporary studies are needed to guide revascularization decisions in DM patients. We performed a single-center study of patients who underwent CABG. Patients with no DM were compared with patients with DM, subgrouped according to whether or not DM was treated with insulin before admission (Insulin and No Insulin Groups). Multivariable logistic regression was used to determine whether DM was a significant predictor of mortality, combined postoperative events, and specific postoperative complications after controlling for other predictive clinical variables. Of 11,590 consecutive patients who underwent CABG, 5,013 (43%) had DM and 6,577 (57%) had no DM. Of the patients with DM, 3,433 (68%) were not treated with insulin and 1,580 (32%) were treated with insulin before admission. Multivariable logistic regression analyses showed that DM was not significantly associated with in-hospital mortality or combined postoperative events after considering other clinical variables. The No Insulin Group was significantly associated with stroke, and the Insulin Group was significantly associated with surgical site infection and new renal failure. In conclusion, this study of consecutively treated CABG patients shows that DM is not a predictor of in-hospital mortality or combined in-hospital postoperative events after adjusting for other clinical factors. DM is a predictor of permanent stroke, surgical site infection, and new renal failure. These findings may help with case selection and management of DM patients undergoing CABG.
       
  • Association Between Hypertension, Platelet Reactivity, and the Risk of
           Adverse Events After Percutaneous Coronary Intervention (From the
           ADAPT-DES Study)
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Björn Redfors, Shmuel Chen, Ori Ben-Yehuda, Xin Huang, Bernhard Witzenbichler, Giora Weisz, Yangbo Liu, Bruce R. Brodie, Michael J. Rinaldi, Franz-Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Roxana Mehran, Thomas D. Stuckey, Ajay J. Kirtane, Gregg W. StoneHypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis. We sought to assess whether the risk of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in patients with on-clopidogrel residual high platelet reactivity (HPR) varies in patients with versus without hypertension. Assessment of dual antiplatelet therapy with drug eluting stents (ADAPT-DES) was a prospective, multicenter registry of patients successfully treated with coronary drug-eluting stents (DES). HPR was defined as P2Y12 reaction units (PRU)>208, as assessed by the VerifyNow point-of-care assay. Multivariable Cox proportional hazards regression was used to assess whether the adjusted association between HPR and 2-year risk of MACE (cardiac death, myocardial infarction [MI], or stent thrombosis) was different in patients with versus without hypertension. A total of 6833 of 8582 patients (79.6%) had a history of hypertension. Patients with compared with those without hypertension were older, more likely to have other cardiovascular risk factors, and had higher PRU (190.1 ± 97.3 vs 179.5 ± 94.3; p
       
  • Comparison of Outcomes After Percutaneous Coronary Interventions in
           
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Yasser Al-khadra, Marvin Kajy, Amr Idris, Fahed Darmoch, Homam Moussa Pacha, Amjad Kabach, Santiago Garcia, Rodrigo Bagur, Chun Shing Kwok, Amir Kaki, James J. Glazier, Samir Kapadia, Mamas Mamas, M Chadi AlraiesLife expectancy in the United States has increased due to advances in health care. Despite increased utilization of percutaneous coronary intervention (PCI), octogenarian patients are less likely to be referred to the catheterization laboratory for coronary interventions. This is in part due to multiple patient co-morbidities and lack of established guidelines. We examined in-hospital clinical outcomes of octogenarian and nonoctogenarian patients who underwent PCI in the United States. Using the National Inpatient Sampling database, we identified all adult patients who are older than 18 years and underwent PCI. Patient were stratified by age into 2 groups, ≥80 years old and
       
  • Relationship Between Stent Diameter, Platelet Reactivity, and Thrombotic
           Events After Percutaneous Coronary Artery Revascularization
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Björn Redfors, Shmuel Chen, Philippe Généreux, Bernhard Witzenbichler, Giora Weisz, Thomas D. Stuckey, Akiko Maehara, Thomas McAndrew, Roxana Mehran, Ori Ben-Yehuda, Ajay J. Kirtane, Gregg W. StoneSmall vessel diameter and residual platelet reactivity are independent predictors of thrombotic events after percutaneous coronary intervention (PCI). We sought to determine whether an interaction exists between residual platelet reactivity and stent diameter regarding the occurrence of stent thrombosis and other adverse events after PCI. We stratified patients in the prospective ADAPT-DES registry who underwent single-lesion PCI according to if they received a small diameter stent (SDS, defined as a stent with a diameter of 2.25 mm). Patients receiving an SDS were compared with patients receiving a stent ≥2.5 mm using Kaplan-Meier rates and multivariable Cox proportional hazards regression. We defined major adverse cardiac events (MACE) as the composite of cardiac death, myocardial infarction, and stent thrombosis (ST). Among 5,608 patients who underwent single-lesion PCI in ADAPT-DES, 222 (4.0%) patients received an SDS. Patients with an SDS were more likely than patients without an SDS to have 3-vessel disease but received, on average, fewer stents and were less likely to present with a thrombotic lesion. Receiving versus not receiving an SDS was associated with increased risk of ST (adjusted hazard ratio 4.35, 95% confidence interval 1.95 to 9.73, p
       
  • Impact of Coronary Computerized Tomography Angiography-Derived Plaque
           Quantification and Machine-Learning Computerized Tomography Fractional
           Flow Reserve on Adverse Cardiac Outcome
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Philipp L. von Knebel Doeberitz, Carlo N. De Cecco, U. Joseph Schoepf, Moritz H. Albrecht, Marly van Assen, Domenico De Santis, Jeffrey Gaskins, Simon Martin, Maximilian J. Bauer, Ullrich Ebersberger, Dante A. Giovagnoli, Akos Varga-Szemes, Richard R. Bayer, Stefan O. Schönberg, Christian TescheThis study investigated the impact of coronary CT angiography (cCTA)-derived plaque markers and machine-learning-based CT-derived fractional flow reserve (CT-FFR) to identify adverse cardiac outcome. Data of 82 patients (60 ± 11 years, 62% men) who underwent cCTA and invasive coronary angiography (ICA) were analyzed in this single-center retrospective, institutional review board-approved, HIPAA-compliant study. Follow-up was performed to record major adverse cardiac events (MACE). Plaque quantification of lesions responsible for MACE and control lesions was retrospectively performed semiautomatically from cCTA together with machine-learning based CT-FFR. The discriminatory value of plaque markers and CT-FFR to predict MACE was evaluated. After a median follow-up of 18.5 months (interquartile range 11.5 to 26.6 months), MACE was observed in 18 patients (21%). In a multivariate analysis the following markers were predictors of MACE (odds ratio [OR]): lesion length (OR 1.16, p = 0.018), low-attenuation plaque (
       
  • Causes, Trends, and Predictors of 90-Day Readmissions After Spontaneous
           Coronary Artery Dissection (from A Nationwide Readmission Database)
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Hafeez Ul Hassan Virk, Byomesh Tripathi, Varun Kumar, Vladimir Lakhter, Muhammed Shahzeb Khan, Sardar Hassan Ijaz, Saima Dean, Shuchita Gupta, Purnima Sharma, Rohi Mishra, Jon C. George, Radha Gopalan, David Zidar, Sean JanzerSpontaneous coronary artery dissection (SCAD) is a frequently missed diagnosis in patients presenting with acute coronary syndrome (ACS). Our aim was to evaluate the causes, trends, and predictors of 90-day hospital readmission in patients presenting with SCAD. The Nationwide Readmissions Database (2013 to 2014) was utilized to identify patients with primary discharge diagnosis of SCAD using the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic code 414.12. The primary outcome was 90-day readmission. Among 11,228 patients admitted with the primary diagnosis of SCAD, 2,424 patients (21.6%) were readmitted within 90 days (68% women, 82%
       
  • Characteristics, Management, and Short-Term Outcomes of Adults ≥65 Years
           Hospitalized With Acute Myocardial Infarction With Prior Anemia and Heart
           Failure
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Mayra Tisminetzky, Jerry H. Gurwitz, Ruben Miozzo, Joel M. Gore, Darleen Lessard, Jorge Yarzebski, Robert J. GoldbergOur study objectives were to examine the impact of anemia and heart failure (HF) on in-hospital complications, and postdischarge outcomes (7 and 30-day rehospitalizations and mortality) in adults ≥65 years hospitalized with acute myocardial infarction (AMI). We used multivariable-adjusted logistic regression models to examine the association between the presence of anemia and/or HF, and the examined outcomes. The study population consisted of 3,863 patients ≥65 years hospitalized with AMI at the 3 major medical centers in Worcester, MA, during 6 annual periods between 2001 and 2011. Individuals were categorized into 4 groups based on the presence of previously diagnosed anemia (hemoglobin ≤10 mg/dl) and/or HF: Those without these conditions (n = 2,300), those with anemia only (n = 382), those with HF only (n = 837), and those with both conditions (n = 344). The median age of the study population was 79 years and 49% were men. Individuals who had been previously diagnosed with anemia and HF had the highest proportion of older adults (≥85 years) and the lowest proportion of those who had received any cardiac interventional procedure during hospitalization. After multivariable adjustment, individuals who presented with both previously diagnosed conditions were at the greatest risk for experiencing adverse events. Patients who presented with HF only were at higher risk for developing several clinical complications during hospitalization, whereas those with anemia only were at slightly higher risk of being rehospitalized within 7-days of their index hospitalization. In conclusion, anemia and HF are prevalent chronic conditions that increased the risk of adverse events in older adults hospitalized with AMI.
       
  • Meta-Analysis for the Use of Renin-Angiotensin Inhibitors in Post-TAVR
           Patients
    • Abstract: Publication date: 1 November 2019Source: The American Journal of Cardiology, Volume 124, Issue 9Author(s): Aaqib H. Malik, Suchith S. Shetty, Srikanth Yandrapalli, Wilbert S. Aronow, El Accaoui Ramzi, Gilbert H.L. Tang, MAGIC (Meta-analysis And oriGinal Investigations in Cardiology) investigators
       
 
 
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