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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 430, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, 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: 10, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 293, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, 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: 1, 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: 17, 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: 180, 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: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, 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: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, 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: 32, 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: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, 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: 11)
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: 43, 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: 49, 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: 62, 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: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
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: 36, 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: 8, 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: 20, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
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: 4)
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: 17, 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: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 5)
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: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, 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: 414, 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: 36, 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: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 51, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 365, 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: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 468, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, 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: 6, 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: 11)
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: 10, 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: 5, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, 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: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 49)
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: 234, 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: 30, 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: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, 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: 202, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, 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: 24, 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: 208, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, 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 Heart Journal
Journal Prestige (SJR): 3.267
Citation Impact (citeScore): 4
Number of Followers: 57  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-8703 - ISSN (Online) 1097-6744
Published by Elsevier Homepage  [3184 journals]
  • Cardiovascular risk factor reduction by community health Workers in Rural
           India: A cluster randomized trial
    • Abstract: Publication date: Available online 19 June 2019Source: American Heart JournalAuthor(s): Rajnish Joshi, Twinkle Agarwal, Farah Fathima, T Usha, Tinku Thomas, Dominic Misquith, SP Kalantri, N Chidambaram, Tony Raj, Alben Singamani, Shailendra Hegde, Denis Xavier, PJ Devereaux, Prem Pais, Rajeev Gupta, Salim Yusuf BackgroundThere is a need to identify and test low cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy.ObjectiveCommunity health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India.MethodsWe performed an open-label cluster-randomized trial in 28 villages in 3 states of India with the household as a unit of randomization. Households with individuals at intermediate to high CVD risk were randomized to intervention and control groups. In the intervention group, trained CHWs delivered risk-reduction advice and monitored risk factors during 6 household visits over 12 months. Households in the non-intervention group received usual care. Primary outcomes were a reduction in systolic BP (SBP) and adherence to prescribed BP lowering drugs.ResultsWe randomized 2312 households (3261 participants at intermediate or high risk) to intervention (1172 households) and control (1140 households). At baseline prevalence of tobacco use (48.5%) and hypertension (34.7%) were high. At 12 months, there was significant decline in SBP (mmHg) from baseline in both groups- controls 130.3 ± 21 to 128.3 ± 15; intervention 130.3 ± 21 to 127.6 ± 15 (P 
  • Long-term follow-up and safety assessment of angiogenic gene therapy trial
           VIF-CAD: Transcatheter intramyocardial administration of a bicistronic
           plasmid expressing VEGF-A165/bFGF cDNA for the treatment of refractory
           coronary artery disease
    • Abstract: Publication date: Available online 19 June 2019Source: American Heart JournalAuthor(s): Krzysztof Kukuła, Arkadiusz Urbanowicz, Mariusz Kłopotowski, Maciej Dąbrowski, Jerzy Pręgowski, Jacek Kądziela, Zbigniew Chmielak, Adam Witkowski, Witold Rużyłło There have been a number of angiogenic gene therapy trials, yielding mixed results as to efficacy, but demonstrating uniform short-term treatment safety. Data regarding long term safety of angiogenic gene therapy are limited. Double-blind VIF-CAD trial (NCT00620217) assessed myocardial perfusion and clinical data in 52 refractory coronary artery disease (CAD) patients randomized into treatment (VIF; n = 33) and Placebo (n = 19) arms. VIF group received electromechanical system NOGA-guided intramyocardial injections of VEGF-A165/bFGF plasmid (VIF) into ischemic regions, while the Placebo group - placebo plasmid injections. Full 1-year follow-up data have been published. This study presents the results of over 10-year (median 133 months, range 95–149) safety follow-up of VIF-CAD patients. Overall, 12 (36.4%) patients died in VIF and 8 (42.1%) in Placebo group (P = .68). Cardiovascular mortality was 12/33 (36.4%) in the VIF group and 6/19 (31.6%) in Placebo group (P = .73). Two Placebo patients died due to malignancies, but no VIF patients (P = .17). The Kaplan–Meier curves of combined endpoint: cardiovascular mortality, myocardial infarction and stroke were similar for both patient groups (P = .71). Odds ratio of Placebo group increasing (reaching a worse) their CCS class versus VIF was non-significant (OR 1.28, 95% CI = 0.66–2.45; P = .47). However, CCS class improved in time irrespectively of treatment – OR of reaching a less favorable CCS class per each year of follow-up was 0.74 (95% CI 0.685–0.792; P 
  • Design and rationale of the COMPLETE trial: A randomized, comparative
           effectiveness study of complete versus culprit-only percutaneous coronary
           intervention to treat multivessel coronary artery disease in patients
           presenting with ST-segment elevation myocardial infarction
    • Abstract: Publication date: Available online 18 June 2019Source: American Heart JournalAuthor(s): Shamir R. Mehta, David A. Wood, Brandi Meeks, Robert F. Storey, Roxana Mehran, Kevin R. Bainey, Helen Nguyen, Shrikant I. Bangdiwala, John A. Cairns, on Behalf of the COMPLETE Trial Steering Committee and Investigators IntroductionA significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (CAD). Following successful culprit lesion percutaneous coronary intervention (PCI) for STEMI, the question of whether to routinely revascularize non-culprit lesions or manage them conservatively with optimal medical therapy (OMT) alone is a common dilemma facing clinicians.MethodsCOMPLETE is a prospective, randomized, international, multicenter, parallel group, open-label trial with blinded evaluation of outcomes. Following successful PCI (contemporary drug eluting stents recommended) of the culprit lesion for STEMI, a total of 4041 patients from 140 centers in 31 countries were randomized to receive either complete revascularization, consisting of staged PCI of all suitable non-culprit lesions plus optimal medical therapy (OMT), or to culprit lesion-only PCI, consisting of OMT alone. OMT comprises evidence-based therapy for STEMI, including and dual antiplatelet therapy with ticagrelor, HTN and lipid management. All coronary angiograms in the trial are being evaluated in a central angiographic core lab to assess quality and completeness of revacularization. The co-primary outcomes are: (1) the composite of CV death or new non-fatal MI and (2) the composite of CV death, new non-fatal MI or ischemia-driven revascularization at a median follow-up of 3 years.ConclusionsThe COMPLETE trial is an international multicenter randomized trial that will help determine whether complete revascularization involving staged PCI of non-culprit lesions improves outcomes in patients with STEMI and multivessel CAD. ( NCT01740479).
  • Information for Readers
    • Abstract: Publication date: July 2019Source: American Heart Journal, Volume 213Author(s):
  • Financial strain and ideal cardiovascular health in middle-aged and older
           women: Data from the Women's health study
    • Abstract: Publication date: Available online 14 June 2019Source: American Heart JournalAuthor(s): Tomás Cabeza de Baca, Melissa S. Burroughs Peña, Natalie Slopen, David Williams, Julie Buring, Michelle A. Albert BackgroundFinancial strain is a prevalent form of psychosocial stress in the United States; however, information about the relationship between financial strain and cardiovascular health remains sparse, particularly in older women.MethodsThe cross-sectional association between financial strain and ideal cardiovascular health were examined in the Women's Health Study follow-up cohort (N = 22,048; mean age = 72± 6.0 years).Six self-reported measures of financial strain were summed together to create a financial strain index and categorized into 4 groups: No financial strain, 1 stressor, 2 stressors, and 3+ stressors. Ideal cardiovascular health was based on the American Heart Association strategic 2020 goals metric, including tobacco use, body mass index, physical activity, diet, blood pressure, total cholesterol and diabetes mellitus. Cardiovascular health was examined as continuous and a categorical outcome (ideal, intermediate, and poor). Statistical analyses adjusted for age, race/ethnicity, education and income.ResultsAt least one indicator of financial strain was reported by 16% of participants. Number of financial stressors was associated with lower ideal cardiovascular health, and this association persisted after adjustment for potential confounders (1 financial stressor (FS): B = −0.10, 95% Confidence Intervals (CI) = −0.13, −0.07; 2 FS: B = −0.20, 95% CI = −0.26, −0.15; 3+ FS: B = −0.44, 95% CI = −0.50, −0.38).ConclusionFinancial strain was associated with lower ideal cardiovascular health in middle aged and older female health professional women. The results of this study have implications for the potential cardiovascular health benefit of financial protections for older individuals.
  • The low dose colchicine after myocardial infarction (LoDoCo-MI) study: A
           pilot randomized placebo controlled trial of colchicine following acute
           myocardial infarction
    • Abstract: Publication date: Available online 14 June 2019Source: American Heart JournalAuthor(s): Thomas Hennessy, Linda Soh, Mitchell Bowman, Rahul Kurup, Carl Schultz, Sanjay Patel, Graham S. Hillis BackgroundFollowing an acute myocardial infarction (MI), patients with persistently elevated biomarkers of inflammation, in particular C-reactive protein (CRP), are at significantly increased risk of further adverse cardiovascular events. Colchicine is a unique anti-inflammatory medication that has shown promise in reducing such events in patients with stable coronary heart disease. The current study tested the ability of low dose colchicine to reduce CRP levels at 30-days after an acute MI, a key marker of future outcome, and its safety and tolerability in this setting.MethodsWe conducted a randomized, double-blind, trial of low-dose colchicine (0.5 mg daily) or matching placebo in 237 patients admitted with an acute MI. The primary end-point was the proportion of patients with a residual high sensitivity CRP level ≥ 2 mg/L after 30 days of treatment, a threshold associated with a worse prognosis.ResultsAt 30-day follow-up, 44% of patients treated with colchicine had a CRP level ≥ 2 mg/L compared to 50% of those randomized to placebo (P = .35) and the median CRP in patients randomized to colchicine was 1.6 mg/L (interquartile range [IQR] 0.7–3.5) compared to 2.0 mg/L (IQR 0.9–4.0) in patients randomized to placebo (P = .11). The median absolute reduction in CRP levels was −4.3 mg/L (IQR −1.1 to −14.1) among colchicine treated patients and− 3.3 mg/L (IQR −0.9 to −14.4, P = .44) in placebo treated patients. The relative reduction was a fall of 78% compared to a fall of 64% (P = .09). Low dose colchicine was well tolerated and did not reduce compliance with other secondary preventative medications at 30-days.ConclusionTreatment with low dose colchicine was safe and well tolerated, but was not associated with a significantly increased likelihood of achieving a CRP level
  • Left ventricular ejection fraction and adjudicated, cause-specific
           hospitalizations after myocardial infarction complicated by heart failure
           or left ventricular dysfunction
    • Abstract: Publication date: Available online 12 June 2019Source: American Heart JournalAuthor(s): Trygve S. Hall, Thomas G. von Lueder, Faiez Zannad, Patrick Rossignol, Kevin Duarte, Tahar Chouihed, Scott D. Solomon, Kenneth Dickstein, Dan Atar, Stefan Agewall, Nicolas Girerd BackgroundReduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) increases risk of cardiovascular (CV) hospitalizations but evidence regarding its association with non CV outcome is scarce. We investigated the association between LVEF and adjudicated cause-specific hospitalizations following MI complicated with low LVEF or overt heart failure (HF).MethodsIn an individual patient data meta-analysis of 19,740 patients from three large randomized trials, Fine and Gray competing risk modeling was performed to study the association between LVEF and hospitalization types.ResultsThe most common cause of hospitalization was non CV (n = 2368 for HF, n = 1554 for MI, and n = 3703 for non CV). All types of hospitalizations significantly increased with decreasing LVEF. The absolute risk increase associated with LVEF 35%) was 15.5% (95% confidence interval [CI] 13.4–17.5) for HF, 4.7% (95% CI 3.0–6.4) for MI, and 10.4% (95% CI 8.0–12.8) for non CV hospitalization. On a relative scale, after adjusting for confounders, each 5-point decrease in LVEF was associated with an increased risk of HF (hazard ratio [HR] 1.15, 95% CI 1.12–1.18), MI (HR 1.06, 95% CI 1.03–1.10), and non CV hospitalization (HR 1.03, 95% CI 1.01–1.05).ConclusionsIn a high-risk population with complicated acute MI, the absolute risk increase in non CV hospitalizations associated with LVEF
  • Simulation of impact on cardiovascular events due to lipid-lowering
           therapy intensification in a population with atherosclerotic
           cardiovascular disease
    • Abstract: Publication date: Available online 12 June 2019Source: American Heart JournalAuthor(s): Christopher P. Cannon, Irfan Khan, Alexa C. Klimchak, Robert J. Sanchez, William J. Sasiela, Joseph M. Massaro, Ralph B. D'Agostino, Matthew R. ReynoldsBackgroundIn patients with atherosclerotic cardiovascular disease (ASCVD), guidelines recommend statins as first-line lipid-lowering therapy (LLT) with addition of non-statin agents in those with persistently elevated low-density lipoprotein cholesterol (LDL-C) levels.MethodsTo estimate the cardiovascular (CV) risk reduction implications of treatment intensification, we utilized a previously reported simulation model with enhancements. An ASCVD cohort was developed from a US claims database. A Cox model was utilized to estimate baseline risk of CV events: myocardial infarction, ischemic stroke, unstable angina hospitalization, elective coronary revascularization, or cardiovascular death. Patients were sampled with replacement (bootstrapping) and entered the simulation model which applied stepwise LLT intensification logic, with a goal of achieving LDL-C less than 70 mg/dL at each step. CV risk reduction assumptions were based on published data. Two treatment intensification scenarios were investigated: ideal and real-world (which accounted for statin intolerance, non-adherence, and payer restrictions).ResultsIn a cohort of 1000 ASCVD patients, approximately 813 (809–818) would require treatment intensification with LLT under an ideal treatment intensification scenario. Before treatment intensification, 183 (179–187) events would be expected to occur over 5 years. With treatment intensification, 40 (34–45) of these events could be avoided. In a real-world scenario, about 818 (813–823) patients require treatment intensification with LLT, resulting in 29 (24–34) events avoided over 5 years.ConclusionsIntensification of LLT in an ASCVD population translates into a substantial number of CV events avoided. This simulation-based model could assist in assessing the potential benefits of various types of population-level LLT interventions.
  • The role of glucagon-like peptide 1 loading on periprocedural myocardial
           infarction during elective PCI (GOLD-PCI study): A randomized,
           placebo-controlled trial
    • Abstract: Publication date: Available online 9 June 2019Source: American Heart JournalAuthor(s): Joel P. Giblett, Sophie Clarke, Tian Zhao, Liam M. McCormick, Denise M. Braganza, Cameron G. Densem, Michael O'Sullivan, David Adlam, Sarah C. Clarke, Jo Steele, Sarah Fielding, Nick E.J. West, Sofia S. Villar, Stephen P. Hoole BackgroundThe incretin hormone Glucagon-like Peptide 1 (GLP-1) has been shown to protect against lethal ischemia–reperfusion injury in animal models, and against non-lethal ischemia reperfusion injury in humans. Furthermore, GLP-1 receptor agonists have been shown to reduce major adverse cardiovascular and cerebrovascular events (MACCE) in large scale studies. We sought to investigate whether GLP-1 reduced PCI-associated myocardial infarction (PMI) during elective percutaneous coronary intervention (PCI).Methods and ResultsThe study was a randomized, double-blind controlled trial in which patients undergoing elective PCI received an intravenous infusion of either GLP-1 at 1.2 pmol/Kg/min or matched 0.9% saline placebo before and during the procedure. Randomization was performed in 1:1 fashion, with stratification for diabetes mellitus. Six-hour Troponin I (cTnI) was measured with a primary endpoint of PMI defined as rise> x5 ULN (280 ng/L). Secondary endpoints included cTnI rise and MACCE at 12-months. 192 patients were randomized with 152 (79%) male and a mean age of 68.1 ± 8.9 years. No significant differences in patient demographics were noted between the groups. There was no difference in the rate of PMI between GLP-1 and placebo (9 (9.8%) vs. 8 (8.3%), P = 1.0), nor in the secondary endpoints of difference in median cTnI between groups (9.5 [0–88.5] vs. 20 [0–58.5] ng/L, P = .25) and MACCE at 12-months ((7 (7.3%) vs. 9 (9.4%), P = .61).ConclusionsIn this randomized, placebo controlled trial GLP-1 did not reduce the low incidence of PMI or abrogate biomarker rise during elective PCI, nor did it influence the 12-month MACCE rate which also remained low.Clinical trial Number: NCT02127996
  • Lessons learned about stress and the heart after major earthquakes
    • Abstract: Publication date: Available online 6 June 2019Source: American Heart JournalAuthor(s): Robert A. Kloner There is evidence that certain stressors can trigger cardiovascular events. Several studies have now demonstrated an increase in major adverse cardiac events associated with natural disasters such as an earthquake. The purpose of this paper is to review the literature on earthquakes and cardiovascular events. Reports from 13 major quakes were reported. Earthquakes have been associated with a number of cardiac events including sudden cardiac death, fatal myocardial infarction (MI), myocardial infarction, stress cardiomyopathy, heart failure, stroke, arrhythmias, hypertension and pulmonary embolism. Most reports were associated with earthquakes of magnitude 6.0 or greater. Cardiac events were reported within hours of the quakes. In some reports there was a sharp spike in cardiac events followed by a decrease; but in other quakes the increases in cardiac events lasted weeks, months and even years. There often was an association between the cardiac events and amount of personal property loss. The Great East Japan Earthquake was an unusual event in that it was associated with a major tsunami and cardiac events appeared worse in inundated areas due to flooding. Some but not all reports suggested more MIs associated with early morning earthquakes that woke up the population. Hospitals in earthquake-prone areas should consider developing plans for handling increases in myocardial infarctions and other cardiac events that are associated with earthquakes.
  • Restricted mean survival time for the analysis of cardiovascular outcome
           trials assessing non-inferiority: Case studies from Antihyperglycemic drug
    • Abstract: Publication date: Available online 6 June 2019Source: American Heart JournalAuthor(s): David H. Manner, Chakib Battioui, Stefan Hantel, B. Nhi Beasley, Lee-Jen Wei, Mary Jane Geiger, J. Rick Turner, Markus Abt Cardiovascular Outcomes Trials (CVOTs) have been employed in multiple therapeutic areas to explore whether a noncardiovascular drug increases the risk for cardiovascular events. These studies are now a central part of drug development programs for antihyperglycemic drugs. These programs are expected to demonstrate that new antihyperglycemic drugs for patients with Type 2 diabetes do not have unacceptable cardiovascular risk. The hazard ratio, which is usually provided as evidence that patients receiving the investigational treatment are not at statistically significantly greater cardiovascular risk than patients on the control treatment, can be difficult to interpret for various reasons. Therefore, an alternative approach known as the Restricted Mean Survival Time (RMST) or τ-year mean survival time is presented, and its ability to overcome interpretation challenges with the hazard ratio discussed. The RMST approach is applied to five completed CVOTs and is compared with the corresponding hazard ratios. Additionally, detailed considerations are given on how to design a non-inferiority CVOT using the RMST approach. The RMST methodology is shown to be a practical alternative to the hazard ratio methodology for designing a non-inferiority CVOT.
  • Cardiogenic shock during heart failure hospitalizations: Age-, sex-, and
           race-stratified trends in incidence and outcomes
    • Abstract: Publication date: July 2019Source: American Heart Journal, Volume 213Author(s): Srikanth Yandrapalli, Abdallah Sanaani, Prakash Harikrishnan, Wilbert S. Aronow, William H. Frishman, Gregg M. Lanier, Ali Ahmed, Gregg C. FonarowBackgroundThe objectives were to study the overall and age-, sex-, and race-stratified incidence of cardiogenic shock (CS) during heart failure hospitalizations (HFHs) not complicated by acute coronary syndromes (ACS), utilization of short-term mechanical circulatory support (MCS) and in-hospital mortality with non–ACS-related CS, and respective temporal trends. Data are lacking regarding the epidemiology of non–ACS-related CS during HFHs.MethodsRetrospective observational analysis of the National Inpatient Sample 2005-2014 to identify all HFHs in adult patients without concomitant ACS.ResultsOf 8,333,752 HFHs, incidence rate of non–ACS-related CS was 8.7 per thousand HFHs (N = 72,668), a 4-fold increase from 4.1 to 15.6 per thousand HFHs between 2005 and 2014 (Ptrend
  • Hospital participation in clinical trials for patients with acute
           myocardial infarction: Results from the National Cardiovascular Data
    • Abstract: Publication date: Available online 25 May 2019Source: American Heart JournalAuthor(s): Alexander C. Fanaroff, Amit N. Vora, Anita Y. Chen, Robin Mathews, Jacob A. Udell, Matthew T. Roe, Laine Thomas, Tracy Y. Wang BackgroundLittle is known about the proportion of hospitals in the United States that offer clinical trial enrollment opportunities and how patient outcomes differ between hospitals that do and do not participate in clinical trials.MethodsIn the nationwide Chest Pain - MI registry, we described the proportion of hospitals that enrolled patients with acute myocardial infarction (MI) in clinical trials from 2009–2014. Hospital-level adherence to every eligible MI performance measure was compared between hospitals that did and did not enroll patients in clinical trials. Using linked Medicare data, we also compared 1-year major adverse cardiovascular events (MACE: death, MI, heart failure, or stroke) among patients ≥65 years old treated at trial vs. non-trial hospitals.ResultsAmong 766 hospitals, 430 (56.1%) enrolled ≥1 MI patient in a clinical trial during the study period, but the proportion of hospitals enrolling patients in clinical trials declined from 36.8% in 2009 to 26.6% in 2014. Complete adherence to performance measures was delivered to a greater proportion of patients at trial hospitals than non-trial hospitals (72.6% vs. 64.9%, P 
  • Clinical effects of cyclosporine in acute anterior myocardial infarction
           complicated by heart failure: A subgroup analysis of the CIRCUS trial
    • Abstract: Publication date: Available online 30 May 2019Source: American Heart JournalAuthor(s): Marc J Claeys, Patrick Coussement, Philippe Dubois, D. Garcia-Dorado, N. Mewton, C Amaz, M. Ovize The present exploratory substudy of the CIRCUS trial demonstrates that the administration of Cyclosporine prior to PCI did not reduce infarct size and had no clinical effect in acute anterior myocardial infarction complicated by heart failure.
  • Correction to “Sex differences in long-term outcomes of patients across
           the spectrum of coronary artery disease”, [American Heart Journal
           (December 2018) 51-60]
    • Abstract: Publication date: Available online 29 May 2019Source: American Heart JournalAuthor(s):
  • Enhanced radiation exposure associated with anterior–posterior X-ray
           tube position in young women undergoing cardiac computed tomography
    • Abstract: Publication date: Available online 28 May 2019Source: American Heart JournalAuthor(s): Michael Messerli, Anne-Laurène Panadero, Andreas A. Giannopoulos, Moritz Schwyzer, Dominik C. Benz, Christoph Gräni, Ralf W. Bauer, Aju P. Pazhenkottil, Oliver Gaemperli, Ronny R. Buechel, Philipp A. Kaufmann, Cathérine Gebhard Given the current increase in the incidence of coronary artery disease in younger women as well as the high life-time risk of developing an x-ray-induced malignancy in this population, we aimed at assessing chest radiation in 206 women ≤55 years undergoing coronary calcium scoring (CACS) by using a Monte Carlo simulation tool. Our data indicate that the simulated radiation dose of the female breast during CACS depends substantially on the starting position of the x-ray tube, with an almost 2 times excess of breast radiation exposure being measured during anterior–posterior tube positioning. Thus, an additional technical feature taking into account the position of the x-ray tube when acquisition is triggered, might be an important tool to reduce radiation exposure of the female breast during CACS.
  • Canadian-AUSTRALASIAN randomized trial of screening kidney transplant
           candidates for coronary artery disease – A trial protocol for the CARSK
    • Abstract: Publication date: Available online 22 May 2019Source: American Heart JournalAuthor(s): Tracey Ying, Jagbir Gill, Angela Webster, S. Joseph Kim, Rachael Morton, Scott Klarenbach, Patrick Kelly, Tim Ramsay, Greg Knoll, Helen Pilmore, Gillian Hughes, Charles A. Herzog, Steve Chadban, John S. Gill Transplantation is the preferred treatment for patients with kidney failure, but the need exceeds the supply of transplantable kidneys and patients routinely wait over 5 years on dialysis for a transplant. Coronary Artery Disease (CAD) is common in kidney failure and can exclude patients from transplantation or result in death before or after transplantation. Screening asymptomatic patients for CAD using noninvasive tests prior to wait-listing, and at regular intervals (i.e. annually) after wait-listing until transplantation is the established standard of care and is justified by the need to avoid adverse patient outcomes and loss of organs. Patients with abnormal screening tests undergo coronary angiography, and those with critical stenoses are revascularized. Screening is potentially harmful because patients may be excluded or delayed from transplantation, and complications after revascularization are more frequent in this population. The Canadian Australasian Randomized Trial of Screening Kidney Transplant Candidates for CAD (CARSK) will test the hypothesis that eliminating screening tests for occult CAD after wait-listing is not inferior to regular screening for the prevention of Major Adverse Cardiac Events defined as the composite of cardiovascular death, non-fatal myocardial infarction, urgent revascularization, and hospitalization for unstable angina. Secondary outcomes include the transplant rate, safety measures, and the cost-effectiveness of screening. Enrolment of 3306 patients over 3-years is required, with patients followed for up to 5 years during wait-listing, and for one year after transplantation. By validating or refuting the use of screening tests during wait-listing, CARSK will ensure judicious use of health-resources and optimal patient outcomes.
  • Practice-level variation in statin use and low-density lipoprotein
           cholesterol control in the United States: Results from the patient and
           provider assessment of lipid management (PALM) registry
    • Abstract: Publication date: Available online 22 May 2019Source: American Heart JournalAuthor(s): Michael G. Nanna, Ann Marie Navar, Tracy Y. Wang, Shuang Li, Salim S. Virani, Zhuokai Li, Jennifer G. Robinson, Veronique L. Roger, Peter W.F. Wilson, Anne C. Goldberg, Andrew Koren, Michael J. Louie, Eric D. Peterson BackgroundAdherence to guideline-recommended statin recommendations in the United States (U.S.) is suboptimal. Patients' likelihood to be treated according to guidelines may vary by the practice in which they are treated.MethodsVariation in the use of statin therapy in 5445 patients, with known or at high risk for atherosclerotic cardiovascular disease (ASCVD) and meeting a statin treatment indication, was examined across 74 U.S. Patient and Provider Assessment of Lipid Management (PALM) Registry clinics. Multivariable generalized linear mixed modeling was used to determine the median odds ratio (MOR) for statin use and 2013 American College of Cardiology/American Heart Association guideline-recommended statin intensity by practice. MOR quantifies between-practice variation by comparing the odds of receiving guideline-recommended statin treatment in a patient from a randomly selected practice with a similar patient from another random practice. Risk-adjusted low-density lipoprotein cholesterol (LDL-C) control (
  • Rationale and design of the PRAETORIAN-DFT trial: A prospective
           r andomized CompArative trial of SubcutanEous ImplanTable
           CardiOverter-DefibrillatoR ImplANtation with and without DeFibrillation
    • Abstract: Publication date: Available online 16 May 2019Source: American Heart JournalAuthor(s): Anne-Floor B.E. Quast, Sarah W.E. Baalman, Tim R. Betts, Lucas V.A. Boersma, Hendrik Bonnemeier, Serge Boveda, Tom F. Brouwer, Martin C. Burke, Peter Paul H.M. Delnoy, Mikhael El-Chami, Juergen Kuschyk, Pier Lambiase, Christelle Marquie, Marc A. Miller, Lonneke Smeding, Arthur A.M. Wilde, Reinoud E. Knops
  • Rational and design of the INtentional COronary revascularization versus
           conservative therapy in patients undergOing successful peripheRAl arTEry
    • Abstract: Publication date: Available online 16 May 2019Source: American Heart JournalAuthor(s): Gabor G. Toth, Marianne Brodmann, Emanuele Barbato, Fabio Mangiacapra, Viktor Orias, Robert Gil, Jacek Bil, Stanislaw Bartus, Zoltan Ruzsa Critical limb ischemia is associated with excessively high risk for cardiovascular events, including myocardial infarction and death. Additionally, in this patient population non-invasive evaluation of coronary artery disease is limited due to (1) inability of exercise testing, (2) frequent occurrence of balanced ischemia and (3) frequent occurrence of diffuse coronary calcification.Intentional Coronary Revascularization Versus Conservative Therapy in Patients Undergoing Peripheral Artery Revascularization Due to Critical Limb Ischemia trial (INCORPORATE trial) is a multicentric international randomized open label clinical trial. Trial will recruit patients, who underwent successful peripheral artery revascularization due to critical limb ischemia and randomize 1:1 to conservative medical therapy versus an immediate invasive strategy to investigate and treat coronary artery disease. The objective is to evaluate whether intentional invasive strategy with ischemia targeted reasonably complete coronary revascularization is superior as compared to conventional primarily conservative approach in terms of spontaneous myocardial infarction and overall survival at 12 months follow-up. The trial is registered at (NCT03712644).
  • Clinical Consequences of Bleeding Among Individuals with a Recent Acute
           Coronary Syndrome: Insights from the APPRAISE-2 Trial
    • Abstract: Publication date: Available online 11 May 2019Source: American Heart JournalAuthor(s): Abhinav Sharma, Emil Hagström, Daniel M. Wojdyla, Megan L. Neely, Robert A. Harrington, Lars Wallentin, John H. Alexander, Shaun G. Goodman, Renato D. Lopes, Apixaban for Prevention of Acute Ischemic Safety Events (APPRAISE)-2 Steering Committee and InvestigatorsBackgroundPatients with a recent acute coronary syndrome (ACS) receiving oral antiplatelets and anticoagulants are at risk for bleeding and subsequent adverse non-bleeding related events.MethodsIn this post-hoc analysis, we evaluated 7392 high-risk patients (median follow-up 241 days) with a recent ACS randomized to apixaban or placebo in APPRAISE-2. Clinical events during a 30-day period after Thrombolysis in Myocardial Infarction (TIMI) major/minor bleeding were analyzed using unadjusted and adjusted Cox proportional hazards models.ResultsIn total, 153 (2.1%) patients experienced TIMI major/minor bleeding during follow-up. Bleeding risk for patients on triple therapy (apixaban, thienopyridine, and aspirin) was increased compared with those on dual therapy (apixaban plus aspirin: hazard ratio [HR] 2.02, 95% CI 1.08–3.79; thienopyridine plus aspirin: HR 1.99, 95% CI 1.41–2.83). Those receiving apixaban/aspirin had similar bleeding risk compared with those receiving thienopyridine/aspirin (HR 1.01, 95% CI 0.53–1.95). Patients who experienced TIMI major/minor bleeding had an increased risk of 30-day all-cause mortality (HR 24.7, 95% CI 15.34–39.66) and ischemic events (HR 6.7, 95% CI 3.14–14.14).ConclusionsIn a contemporary cohort of high-risk patients after ACS, bleeding was associated with a significant increased risk of subsequent ischemic events and mortality, regardless of antithrombotic or anticoagulant strategy. Patients receiving apixaban plus aspirin had a similar bleeding risk compared with those receiving thienopyridine plus aspirin. Interventions to improve outcomes in patients after ACS should include strategies to optimize the reduction in ischemic events while minimizing the risk of bleeding.
    • Abstract: Publication date: Available online 11 May 2019Source: American Heart JournalAuthor(s): Miguel Valderrábano, Leif E. Peterson, Raquel Bunge, Michelle Prystash, Amish S. Dave, Sherif Nagueh, Neal S. Kleiman BackgroundAlthough pulmonary vein isolation (PVI) is effective in the treatment of paroxysmal atrial fibrillation (AF), its success rates in persistent AF are suboptimal. Ablation strategies to improve outcomes including additional lesions beyond PVI have not consistently shown benefit. Recurrence as perimitral flutter (PMF) is a common form of ablation failure. The vein of Marshall (VOM) contains myocardial connections and abundant sympathetic and parasympathetic innervation implicated in the genesis and maintenance of AF, and is anatomically co-localized with the mitral isthmus, the ablation target of PMF. VOM ethanol infusion is effective in targeting these arrhythmia substrates.ObjectiveTo test the safety and efficacy of VOM ethanol infusion when added to PVI in patients undergoing either de novo ablation of persistent AF or after a previous ablation failure.Study designVENUS-AF and MARS-AF are prospective, multicenter, randomized, controlled trials. VENUS-AF will enroll patients undergoing their first catheter ablation of persistent AF. MARS-AF will enroll patients undergoing ablation after previous ablation failure(s). Patients (n=405) will be randomized to PVI alone or in combination with VOM ethanol infusion. The primary endpoints include procedural safety and freedom from AF or atrial tachycardia (AT) of more than 30 seconds on 30-day continuous event monitors at 6 and 12 months after randomization procedure (single-procedure success), off antiarrhythmic drugs. Key secondary endpoints include AF burden, freedom from AF/AT after repeat procedures and quality of life.ConclusionsThe VENUS-AF and MARS-AF will determine the safety and potential rhythm control benefit of VOM ethanol infusion when added to PVI in patients with persistent AF undergoing de novo or repeat ablation, respectively.
  • Role of diabetes and insulin use in the risk of stroke and acute
           myocardial infarction in patients with atrial fibrillation: A Medicare
    • Abstract: Publication date: Available online 10 May 2019Source: American Heart JournalAuthor(s): Amgad Mentias, Ghanshyam Shantha, Oluwaseun Adeola, Geoffrey D Barnes, Bharat Narasimhan, Konstantinos C. Siontis, Deborah A. Levine, Rajan Sah, Michael C. Giudici, Mary Vaughan-Sarrazin BackgroundAtrial fibrillation (AF) is associated with elevated risk for ischemic stroke and myocardial infarction (MI). The aim of the study is to assess the role of insulin use on the risk of stroke and MI in AF patients with diabetes.MethodsWe identified Medicare beneficiaries with new AF in 2011–2013. Primary outcomes were ischemic stroke and MI. Multivariate Cox regression models were used to assess the association between AF and time to stroke and MI. We adjusted for anticoagulant as a time-dependent covariate.ResultsOut of 798,592 AF patients, 53,212 (6.7%) were insulin-requiring diabetics (IRD), 250,214 (31.3%) were non-insulin requiring diabetics (NIRD) and 495,166 (62%) were non-diabetics (ND). IRD had a higher risk of stroke when compared to NIRD (adjusted HR: 1.15, 95% CI 1.10–1.21) and ND (aHR 1.24, 95% CI 1.18–1.31) (P 
  • Spironolactone and perioperative atrial fibrillation occurrence in cardiac
           surgery patients: Rationale and design of the ALDOCURE trial
    • Abstract: Publication date: Available online 9 May 2019Source: American Heart JournalAuthor(s): Joachim Alexandre, Pierre Ollitrault, Marc-Olivier Fischer, Jean-Luc Fellahi, Bertrand Rozec, Bernard Cholley, Charles Dolladille, Mathieu Chequel, Stéphane Allouche, Damien Legallois, Vladimir Saplacan, Dimitrios Buklas, Farzin Beygui, Jean-Jacques Parienti, Paul Milliez BackgroundAfter artery bypass grafting (CABG), the presence of perioperative AF (POAF) is associated with greater short- and long-term cardiovascular morbidity. Underlying POAF mechanisms are complex and include the presence of an arrhythmogenic substrate, cardiac fibrosis and electrical remodeling. Aldosterone is a key component in this process. We hypothesize that perioperative mineralocorticoid receptor (MR) blockade may decrease the POAF incidence in patients with a left ventricular ejection fraction (LVEF) ≥50% who are referred for CABG with or without aortic valve replacement (AVR).Study designThe ALDOCURE trial (NCT03551548) will be a multicenter, randomized, double-blind, placebo-controlled trial testing the superiority of a low-cost MR antagonist (MRA, spironolactone) on POAF in 1500 adults referred for on-pump elective CABG surgery with or without AVR, without any history of heart failure or atrial arrhythmia.The primary efficacy end point is the occurrence of POAF from randomization to within 5 days after surgery, assessed in a standardized manner. The main secondary efficacy end points include the following: postoperative AF occurring within 5 days after cardiac surgery, perioperative myocardial injury, major cardiovascular events and death occurring within 30 days of surgery, hospital and intensive care unit length of stay, need for readmission, LVEF at discharge and significant ventricular arrhythmias within 5 days after surgery. Safety end points, including blood pressure, serum potassium levels and renal function, will be monitored regularly throughout the trial duration.ConclusionThe ALDOCURE trial will assess the effectiveness of spironolactone in addition to standard therapy for reducing POAF in patients undergoing CABG.Clinical trial registrationNCT03551548
  • ORBITA and coronary stents: A case study in the analysis and reporting of
           clinical trials
    • Abstract: Publication date: Available online 7 May 2019Source: American Heart JournalAuthor(s): Andrew Gelman, John B. Carlin, Brahmajee K Nallamothu
  • Modeling the cost effectiveness and budgetary impact of Polypills for
           secondary prevention of cardiovascular disease in the United States
    • Abstract: Publication date: Available online 7 May 2019Source: American Heart JournalAuthor(s): Thomas A. Gaziano, Ankur Pandya, Stephen Sy, Thiago Veiga Jardim, Jenna M. Ogden, Anthony Rodgers, Milton C. Weinstein BackgroundThere is underutilization of appropriate medications for secondary prevention of cardiovascular disease (CVD).MethodsUsual care (UC) was compared to polypill-based care with 3 versions using a validated micro-simulation model in the NHANES population with prior CVD. UC included individual prescription of up to 4 drug classes (antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone inhibitors and statins). The polypills modeled were aspirin 81 mg, atenolol 50 mg, ramipril 5 mg, and either simvastatin 40 mg (Polypill I), atorvastatin 80 mg (Polypill II), or rosuvastatin 40 mg (Polypill III). Baseline medication use and adherence came from United Healthcare claims data.ResultsWhen compared to UC, there were annual reductions of 130,000–178,000 myocardial infarctions and 54,000–74,000 strokes using Polypill I and II, respectively. From a health sector perspective, in incremental analysis the ICERs for Polypill I and II were $20,073/QALY and $21,818/QALY respectively; Polypill III was dominated but had a similar cost-effectiveness ratio to Polypill II when compared directly to usual care. From a societal perspective, Polypill II was cost-saving and dominated all strategies. Over a 5-year period, those taking Polypill I and II compared to UC saved approximately $12 and $6 per-patient-per-year alive, respectively. Polypill II was the preferred strategy in 98% of runs at a willingness to pay of $50,000 in the probability sensitivity analysis.ConclusionsUse of a polypill has a favorable cost profile for secondary CVD prevention in the U.S. Reductions in CVD-related healthcare costs outweighed medication cost increases on a per-patient-per-year basis, suggesting that a polypill would be economically advantageous to both patients and payers.
  • Risk factors and prognostic impact of left ventricular assist
           device-associated infections
    • Abstract: Publication date: Available online 6 May 2019Source: American Heart JournalAuthor(s): Pierre Tattevin, Erwan Flécher, Vincent Auffret, Christophe Leclercq, Stéphane Boulé, André Vincentelli, Camille Dambrin, Clément Delmas, Laurent Barandon, Vincent Veniard, Michel Kindo, Thomas Cardi, Philippe Gaudard, Philippe Rouvière, Thomas Sénage, Nicolas Jacob, Pascal Defaye, Olivier Chavanon, Constance Verdonk, Marylou Para BackgroundLeft ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors and prognosis of LVAD-associated infections.MethodsPatients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD associated infection (driveline infection, pocket infection or pump/cannula infection) during follow-up.ResultsOf the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infection, diagnosed 6.5 months after implantation, and including 171 (26.2%), 51 (7.8%) and 26 (4.0%) percutaneous driveline infection, pocket infection or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%), or HeartWare (13.4%). Most patients (62%) had implantable cardioverter defibrillators (ICD) prior to LVAD and 104 (16.0%) had ICD implantation, extraction or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113, 45.4%), Enterobacteriaceae (n = 61, 24.6%), Pseudomonas aeruginosa (n = 34, 13.7%), coagulase-negative staphylococci (n = 13, 5.2%), and Candida sp. (n = 13, 5.2%). In multivariable analysis, HeartMate II (sub hazard-ratio (sHR): 1.56, 95% CI:1.03–2.36; P = .031) and ICD-related procedures post-LVAD (sHR: 1.43, 95% CI: 1.03–1.98; P = .031), were significantly associated with LVAD infections. Infections had no detrimental impact on survival.ConclusionsLVAD-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and Gram-negative bacilli, with increased risk with HeartMate II, as compared to HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.
  • Rationale and design of the Onyx ONE global randomized trial: A randomized
           controlled trial of high-bleeding risk patients after stent placement with
           1 month of dual antiplatelet therapy
    • Abstract: Publication date: Available online 6 May 2019Source: American Heart JournalAuthor(s): Elvin Kedhi, Azeem Latib, Alexandre Abizaid, David Kandzari, Ajay J. Kirtane, Roxana Mehran, Matthew J. Price, Daniel Simon, Stephen Worthley, Azfar Zaman, Sandeep Brar, Minglei Liu, Gregg W. Stone, Stephan Windecker Background and Rationale.Polymer-free drug-eluting stent (DES) implantation in combination with 1-month DAPT has shown superior safety and efficacy outcomes compared with bare metal stents among patients with high-bleeding risk (HBR) treated with 1-month dual antiplatelet therapy (DAPT). The safety and efficacy of the newer generation durable-polymer DES Resolute Onyx™ compared with polymer-free DES among HBR patients treated with 1-month DAPT is unknown.Trial Design.The Onyx ONE Global Randomized Trial is an international, prospective, randomized, blinded, controlled study enrolling HBR patients undergoing percutaneous coronary intervention (PCI). The trial will randomize up to 2000 patients in a 1:1 fashion to receive either the durable-polymer Resolute Onyx DES or the polymer-free Biosensors BioFreedom™⁎ DES. Post-index procedure, patients in both arms will be treated with 1 month of DAPT (aspirin and oral P2Y12 inhibitor), followed by single antiplatelet therapy (SAPT) thereafter. The primary endpoint is the composite endpoint of cardiac death, myocardial infarction, or stent thrombosis at 1-year follow-up. The powered secondary endpoint is target lesion failure (defined as the composite of cardiac death, target vessel myocardial infarction, or clinically-driven target lesion revascularization) at 1 year. Patient follow-up is planned for 1, 2 and 6 months and 1 and 2 years post-procedure.ConclusionsThe Onyx ONE Global Randomized Trial is the first study to directly compare the safety and efficacy of a durable polymer DES (Resolute Onyx) with a polymer-free DES (BioFreedom) in HBR patients treated with 1 month of DAPT.
  • Corrigendum to “A prospective 5-year study of exercise performance
           following melody valve implant”, American Heart Journal. 2018 Dec 29;
    • Abstract: Publication date: Available online 6 May 2019Source: American Heart JournalAuthor(s): B Priromprintr, MJ Silka, J Rhodes, Anjan S Batra
  • Assessing cardiac safety in oncology drug development
    • Abstract: Publication date: Available online 4 May 2019Source: American Heart JournalAuthor(s): Jonathan Seltzer, Gary Gintant, Laleh Amiri-Kordestani, Jack Singer, Luana Pesco Koplowitz, Javid Moslehi, Ana Barac, Anthony F. Yu
  • Outcomes of left Main revascularization in patients with acute coronary
           syndromes and stable ischemic heart disease: Analysis from the EXCEL trial
    • Abstract: Publication date: Available online 4 May 2019Source: American Heart JournalAuthor(s): Serge Doucet, E. Marc Jolicœur, Patrick W. Serruys, Michael Ragosta, Irving L. Kron, Werner Scholtz, Jochen Börgermann, Yiran Zhang, Thomas McAndrew, Joseph F. Sabik, Arie Pieter Kappetein, Gregg W. Stone BackgroundPrompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial.MethodsWe used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL.ResultsAt baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70–1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73–1.48]) or with ACS (HR 0.82; 95% CI 0.54–1.26) (pinteraction = 0.34).ConclusionsThe acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.
  • Ablation verses anti-arrhythmic therapy for reducing all hospital episodes
           from recurrent atrial fibrillation (AVATAR-AF): Design and rationale
    • Abstract: Publication date: Available online 3 May 2019Source: American Heart JournalAuthor(s): Ian Mann, Thiagarajah Sasikaran, Belinda Sandler, Daphne Babalis, Nicholas Johnson, Emanuela Falaschetti, Andrew Copley, Muzahir Tayebjee, Derick Todd, Ewen Shepherd, James McCready, Neil Poulter, Prapa KanagaratnamBackgroundAtrial Fibrillation (AF) ablation using the cryoballoon is effective at reducing symptomatic AF episodes. The prevalence of AF is increasing with the aging population and access to such treatment would be enhanced by reducing the resource requirements. Relinquishing electrical mapping of the pulmonary veins (PV) removes the need for PV catheters, electrical recording equipment and staff trained in using this equipment. Moreover, the majority of complications are peri-procedural so overnight hospitalization maybe unnecessary. We tested this streamlined approach to AF ablation against medical therapy using the endpoint of time to all hospital episodes.MethodsThe AVATAR-AF study is a prospective, multicenter, randomized controlled trial testing the primary hypothesis that AF ablation done without PV mapping or overnight hospitalization is more effective than anti-arrhythmic drugs at reducing all hospital episodes related to recurrent atrial arrhythmias. We included a third arm to test a secondary hypothesis that confirming PV entrance block as per consensus guidelines can improve outcomes. 321 patients with documented paroxysmal AF will be randomized in a 1:1:1 manner to one of three investigation arms: (1) AVATAR protocol cryoballoon ablation without assessment of acute PV isolation or overnight hospitalization; (2) medical therapy with anti-arrhythmic drugs; or (3) conventional cryoballoon ablation with assessment of acute PV isolation. The primary endpoint is defined as the time to all hospital episodes (including outpatient consultation) related to treatment for atrial arrhythmia.ConclusionThe AVATAR-AF study will determine whether the resource utilization for AF ablation can be reduced whilst maintaining superiority over medical therapy.
  • Hemodynamic-GUIDEd Management of Heart Failure (GUIDE-HF)
    • Abstract: Publication date: Available online 3 May 2019Source: American Heart JournalAuthor(s): JoAnn Lindenfeld, William T. Abraham, Alan Maisel, Michael Zile, Frank Smart, Maria Rosa Costanzo, Mandeep R. Mehra, Anique Ducharme, Samuel F. Sears, Akshay S. Desai, Sara Paul, Poornima Sood, Nessa Johnson, Greg Ginn, Philip B. Adamson
  • Rivaroxaban, a direct factor Xa inhibitor versus acetylsalicylic acid as
           thromboprophylaxis in children post-Fontan procedure: Rationale and design
           of a prospective, randomized trial (the UNIVERSE study)
    • Abstract: Publication date: Available online 1 May 2019Source: American Heart JournalAuthor(s): Liza Miriam Pina, Xiangwen Dong, Liping Zhang, Mahesh N. Samtani, Alan D. Michelson, Henri Justino, Damien Bonnet, Kevin C. Harris, John Jefferies, Brian W. McCrindle, Jennifer S. Li BackgroundThe Fontan procedure is the final step of the 3-stage palliative procedure commonly performed in children with single ventricle physiology. Thrombosis remains an important complication in children after this procedure. To date, guideline recommendations for the type and duration of thromboprophylaxis after Fontan surgery are mainly based on extrapolation of knowledge gained from adults at risk for thrombosis in other clinical settings. Warfarin is being used off-label and, because of its multiple interactions with other drugs and food, a new alternative is highly desirable. Rivaroxaban, a direct Factor Xa inhibitor with a predictable pharmacokinetic profile, is a candidate to address this medical need.Study designThe UNIVERSE study is a prospective, open-label, active-controlled, multicenter study in children 2 to 8 years of age who have single ventricle physiology, and had the Fontan procedure within the 4 months preceding enrollment. This study consists of 2 parts. In Part A, rivaroxaban pharmacokinetics, pharmacodynamics, safety, and tolerability are assessed to validate the pediatric dosing selected. In Part B, safety and efficacy of rivaroxaban versus acetylsalicylic acid (ASA) are evaluated for thromboprophylaxis in children post-Fontan procedure. Children in each part will receive study drug for 12 months. Part A has been completed with 12 children enrolled. Enrollment into Part B is currently ongoing.ConclusionsThe UNIVERSE study aims to provide dosing, pharmacokinetics/pharmacodynamics, safety, and efficacy information on the use of rivaroxaban, an oral anticoagulant, versus ASA, an antiplatelet agent, in children with single ventricle physiology after the Fontan procedure.
  • A protocol update of the FAME 3 trial: A comparison of fractional flow
           reserve–guided percutaneous coronary intervention and coronary artery
    • Abstract: Publication date: Available online 29 April 2019Source: American Heart JournalAuthor(s): Frederik M. Zimmermann, Bernard De Bruyne, Nico H.J. Pijls, Manisha Desai, Keith G. Oldroyd, Michael J. Reardon, Olaf Wendler, Joseph Woo, Alan C. Yeung, William F. Fearon
  • De-escalation of antianginal medications after successful chronic Total
           occlusion percutaneous coronary intervention: Frequency and relationship
           with health status
    • Abstract: Publication date: Available online 26 April 2019Source: American Heart JournalAuthor(s): Mohammed Qintar, Taishi Hirai, Suzanne V. Arnold, Justin Sheehy, James Sapontis MBBCh, Phil Jones, Yuanyuan Tang, William Lombardi, Dimitri Karmpaliotis, Jeffery Moses, Christian Patterson, William J. Nicholson, David J. Cohen, John A. Spertus, J. Aaron Grantham, Adam C. Salisbury BackgroundSuccessful CTO PCI can markedly reduce angina symptom burden, but many patients often remain on multiple AAMs after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent side effects or limit polypharmacy. We examined the association of de-escalation of antianginal medications (AAMs) after CTO PCI with long-term health status.MethodsIn a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Scale (RDS). Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for c revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation.ResultsOf 669 patients with technical success of CTO PCI, AAM were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAM were reduced (any angina: 22.5% vs. 20%, P = .43; any dyspnea: 51.8% vs. 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea or worse health status at 6 months.ConclusionsAmong patients with successful CTO PCI, de-escalation of AAMs occurred in ~1/3 of patients at 1 month and was not associated with worse long-term health status.
  • Smoking cessation and risk of recurrent cardiovascular events and
           mortality after a first manifestation of arterial disease
    • Abstract: Publication date: Available online 25 April 2019Source: American Heart JournalAuthor(s): M. Johanneke van den Berg, Yolanda van der Graaf, Jaap W. Deckers, Wanda de Kanter, Ale Algra, L. Jaap Kappelle, Gert J. de Borst, Maarten-Jan M. Cramer, Frank L.J. Visseren, SMART study group AimsTo quantify the relation between smoking cessation after a first cardiovascular (CV) event and risk of recurrent CV events and mortality.MethodsData were available from 4673 patients aged 61 ± 8.7 years, with a recent (≤1 year) first manifestation of arterial disease participating in the SMART-cohort. Cox models were used to quantify the relation between smoking status and risk of recurrent major atherosclerotic cardiovascular events (MACE including stroke, MI and vascular mortality) and mortality. In addition, survival according to smoking status was plotted, taking competing risk of non-vascular mortality into account.ResultsA third of the smokers stopped after their first CV event. During a median of 7.4 (3.7–10.8) years of follow-up, 794 patients died and 692 MACE occurred. Compared to patients who continued to smoke, patients who quit had a lower risk of recurrent MACE (adjusted HR 0.66, 95%CI 0.49–0.88) and all-cause mortality (adjusted HR 0.63, 95%CI 0.48–0.82). Patients who reported smoking cessation on average lived 5 life years longer and recurrent MACE occurred 10 years later. Patients with a first CV event>70 years, cessation of smoking had improved survival which on average was comparable to former or never smokers.ConclusionsIrrespective of age at first CV event, cessation of smoking after a first CV event is related to a substantial lower risk of recurrent vascular events and all-cause mortality. Since smoking cessation is more effective in reducing CV risk than any pharmaceutical treatment of major risk factors, it should be a key objective for patients with vascular disease.
  • Comorbidities and the decision to undergo or forego destination therapy
           left ventricular assist device implantation: An analysis from the
           DECIDE-LVAD study
    • Abstract: Publication date: Available online 25 April 2019Source: American Heart JournalAuthor(s): Haider J Warraich, Larry A Allen, Laura J Blue, Erin L Chaussee, Jocelyn S Thompson, Colleen K McIlvennan, Kelsey M Flint, Daniel D Matlock, Chetan B. Patel BackgroundPatients considering destination therapy left ventricular assist devices (DT LVAD) often have high comorbid burden but the association between these comorbidities and post-decision outcomes is unknown.MethodsWe included subjects in DECIDE-LVAD (NCT02344576), a stepped-wedge multicenter trial of patients considering LVADs, recording comorbidities per INTERMACS protocol. We compared decisional conflict, regret, perceived stress, quality of life (EQ-VAS), depression (PHQ-2), struggle with- and acceptance of illness by comorbid burden and amongst the most common comorbidities.ResultsOf 239 patients, LVAD recipients (n = 164) and non-recipients (n = 75) had a similar proportion with ≥1 comorbidity (70% v. 80%, P = .09). Patients with comorbidities were younger regardless of LVAD implantation status. After adjusting for age, overall and amongst LVAD recipients, patients with ≥1 comorbidity had higher mean decision conflict at baseline (23.2 ± 1.5 vs. 17.4 ± 2.2), and at 6 months, higher stress (13.0 ± 0.6 vs. 10.4 ± 1.0) and struggle with illness (13.3 ± 0.4 vs. 11.1 ± 0.6) than those without comorbidities (P 
  • Treatment of atrial fibrillation with concomitant coronary or peripheral
           artery disease: Results from the outcomes registry for better informed
           treatment of atrial fibrillation II
    • Abstract: Publication date: Available online 24 April 2019Source: American Heart JournalAuthor(s): Taku Inohara, Peter Shrader, Karen Pieper, Rosalia G. Blanco, Larry A. Allen, Gregg C. Fonarow, Bernard J. Gersh, Alan S. Go, Michael D. Ezekowitz, Peter R. Kowey, James A. Reiffel, Gerald V. Naccarelli, Paul S. Chan, Kenneth W. Mahaffey, Daniel E. Singer, James V. Freeman, Benjamin A. Steinberg, Eric D. Peterson, Jonathan P. Piccini, on behalf of the ORBIT AF Patients and Investigators
  • Ticagrelor in patients with Heart failure after acute coronary syndromes
           – Insights from the PLATelet inhibition and patient outcomes (PLATO)
    • Abstract: Publication date: Available online 18 April 2019Source: American Heart JournalAuthor(s): Axel Åkerblom, Daniel M. Wojdyla, Lars Wallentin, Stefan K. James, Flávio de Souza Brito, Philippe Gabriel Steg, Christopher P. Cannon, Hugo A. Katus, Anders Himmelmann, Robert F. Storey, Richard C. Becker, Renato D. Lopes, on behalf of the PLATO Investigators BackgroundHeart failure (HF) following acute coronary syndromes (ACS) is associated with worse prognosis, however the efficacy and safety of ticagrelor in patients with HF, and if ticagrelor influences the risk of new-onset HF are unknown.MethodsWe examined the efficacy and safety of ticagrelor, compared to clopidogrel, in patients with ACS, in the randomized PLATelet inhibition and patient Outcomes (PLATO) trial, subdivided by strata: 1, previous HF and/or clinical signs of HF on admission, or 2, no HF on admission.The primary outcome was the combination of cardiovascular death, myocardial infarction or stroke, evaluated by multivariable Cox-regression models. The safety outcome was major bleeding. New-onset HF was defined as an HF event after discharge in patients without previous HF.ResultsData was available in 18,556 patients, whom 2862 (15.4%) patients had HF, including 1584 (8.5%) patients with previous HF.Patients randomized to ticagrelor had lower risk of the composite endpoint, regardless of HF status: hazard ratio (HR) 0.87 (95%CI: 0.73–1.03) in patients with HF and HR 0.84 (95%CI: 0.75–0.93) in patients with no HF (P = .76). Corresponding HR for major bleeding were: HR 1.08 (0.87–1.34) and HR 1.03 (95%CI: 0.94–1.14) (P = .71). There was no difference in new-onset HF at 12 months between patients randomized to ticagrelor 4.1% (n = 278) or clopidogrel 4.0% (n = 276).ConclusionsIn patients with ACS, ticagrelor is more efficacious in protecting against new ischemic events and mortality than clopidogrel, irrespective of the presence of HF. There is no difference between ticagrelor or clopidogrel treatment in new-onset HF post-ACS.
  • Racial differences in long-term outcomes among black and white patients
           with drug eluting stents
    • Abstract: Publication date: Available online 15 April 2019Source: American Heart JournalAuthor(s): Lonnie T. Sullivan, Hillary Mulder, Karen Chiswell, Linda K. Shaw, Tracy Y. Wang, Larry R. Jackson, Kevin L. ThomasObjectiveTo compare long-term outcomes between black and white patients after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation.BackgroundSome studies suggest that black patients may have worse outcomes after DES placement. There is limited data characterizing long-term outcomes by race.MethodsWe analyzed 915 black and 3559 white (n = 4474) consecutive patients who underwent DES placement at Duke University Medical Center from 2005 through 2013. Over 6-year follow up, we compared rates of myocardial infarction (MI), all cause mortality, revascularization, and major bleeding between black and white patients. A multivariable Cox regression model was fit to adjust for potentially confounding variables. Dual-antiplatelet therapy use over time was determined by patient follow up surveys and compared by race.ResultsBlack patients were younger, more often female, had higher BMIs, had more diabetes mellitus, hypertension, and renal disease, and lower median household incomes than white patients (P 
  • Increased hepatocyte growth factor levels over 2 years are associated with
           coronary heart disease
    • Abstract: Publication date: Available online 13 April 2019Source: American Heart JournalAuthor(s): Paul A. Decker, Nicholas B. Larson, Elizabeth J. Bell, James S. Pankow, Naomi Q. Hanson, Christina L. Wassel, Michael Y. Tsai, Suzette J. Bielinski Hepatocyte growth factor (HGF) is associated with subclinical and clinical atherosclerosis. However, the significance of change in HGF and development of atherosclerotic disease is unknown. In a large and diverse population-based cohort, we report that change in the biomarker HGF is an independent predictor of incident CHD.
  • Incidence and predictors of target lesion failure in patients undergoing
           contemporary DES implantation – Individual patient data pooled analysis
           from 6 randomized controlled trials
    • Abstract: Publication date: Available online 12 April 2019Source: American Heart JournalAuthor(s): Maayan Konigstein, Mahesh V. Madhavan, Ori Ben-Yehuda, Hussein Rahim, Iva Srdanovic, Fotis Gkargkoulas, Ghazaleh Mehdipoor, Evan Shlofmitz, Akiko Maehara, Björn Redfors, Ankita K. Gore, Thomas McAndrew, Gregg W. Stone, Ziad A. Ali BackgroundDrug-eluting stents (DES) have improved clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Nevertheless, adverse events related to previously treated lesion still occur. We sought to evaluate the incidence and predictors of target lesion failure (TLF) in patients undergoing contemporary DES implantation.MethodsPatient-level data from 6 prospective, randomized trials were pooled, and DES treatment outcomes were analyzed at up to 5 years. Primary outcome was TLF (cardiac death, target lesion revascularization [TLR], or target vessel myocardial infarction [TV-MI]). Cox proportional hazards model was used to identify predictors of TLF.ResultsOverall, 10,072 patients were included in the analysis. TLF rate was 1.7%, 4.3%, and 11.9% at 30 days, 1 year, and 5 years, respectively. The only independent predictor of TLF at 30 days was stent length (hazard ratio [HR] 1.017, 95% confidence interval [CI] 1.011–1.024, P 
  • FFR guided PCI optimization directed by high-definition IVUS versus
           standard of care: Rationale and study design of the prospective randomized
           FFR-REACT trial
    • Abstract: Publication date: Available online 10 April 2019Source: American Heart JournalAuthor(s): Laurens J.C. van Zandvoort, Kaneshka Masdjedi, Maria Natalia Tovar Forero, Mattie J. Lenzen, RT Jurgen Ligthart, Roberto Diletti, Miguel E. Lemmert, Jeroen Wilschut, Peter P.T. de Jaegere, Felix Zijlstra, Nicolas M. van Mieghem, Joost Daemen BackgroundPost percutaneous coronary intervention (PCI) fractional flow reserve (FFR) is a significant predictor of major adverse cardiac events (MACE). The rationale for low post procedural FFR values often remains elusive based on angiographic findings alone, warranting further assessment using an FFR pullback or additional intravascular imaging. It is currently unknown if additional interventions intended to improve the PCI, decrease MACE rates.Study designThe FFR REACT trial is a prospective, single-center randomized controlled trial in which 290 patients with a post PCI FFR
  • Rationale and design of the school-based SI! Program to face obesity and
           promote health among Spanish adolescents: A cluster-randomized controlled
    • Abstract: Publication date: Available online 10 April 2019Source: American Heart JournalAuthor(s): Rodrigo Fernandez-Jimenez, Gloria Santos-Beneit, Anna Tresserra-Rimbau, Patricia Bodega, Mercedes de Miguel, Amaya de Cos-Gandoy, Carla Rodríguez, Vanesa Carral, Xavier Orrit, Domènech Haro, Isabel Carvajal, Borja Ibañez, Carolina Storniolo, Mónica Domènech, Ramón Estruch, Juan Miguel Fernández-Alvira, Rosa Maria Lamuela-Raventós, Valentin Fuster
  • Design and rationale for the stimulation of the left ventricular
           endocardium for cardiac resynchronization therapy in non-responders and
           previously untreatable patients (SOLVE-CRT) trial
    • Abstract: Publication date: Available online 9 April 2019Source: American Heart JournalAuthor(s): Jagmeet P. Singh, William T. Abraham, Angelo Auricchio, Peter Paul Delnoy, Michael Gold, Vivek Y. Reddy, Prashanthan Sanders, JoAnn Lindenfeld, Christopher A Rinaldi BackgroundCardiac resynchronization therapy (CRT) improves outcomes, functional capacity and quality of life in patients with heart failure. Despite two decades of experience with CRT, the rate of non-response remains approximately 30%. CRT efficacy is impacted by pacing location, which is anatomically limited in conventional systems. A new wireless endocardial left ventricular (LV) pacing system allows CRT without such limitations and has shown promise in open-label studies. The purpose of this study is to evaluate its use in a patient population with poor therapeutic alternatives.MethodsThe SOLVE CRT study is an international, multi-center, randomized, double-blind, sham-controlled trial of patients with Class I and IIa indications for CRT who have either failed to respond to or have been unable to receive conventional CRT. Enrollment will comprise 350 patients implanted with the wireless CRT system randomized 1:1 to therapy on (Treatment) or therapy off (Control) for the six-month period over which trial primary endpoints will be evaluated. The primary safety endpoint will measure the proportion of patients free from system- and procedure-related complications. Primary efficacy endpoints will assess absolute change in LV end-systolic volume LVESV, proportion of patients reducing LVESV by ≥15% and clinical composite score for Treatment versus Control patients. Primary endpoints will be evaluated on an intention-to-treat basis, though per-protocol and as-treated analysis will also be performed.ConclusionSOLVE-CRT will quantify the safety and effectiveness of wireless CRT in non-responders to conventional CRT and indicated patients who have been unable to receive CRT via the usual transvenous approach.
  • Right ventricular function in patients with pulmonary regurgitation with
           versus without tetralogy of Fallot
    • Abstract: Publication date: Available online 8 April 2019Source: American Heart JournalAuthor(s): Guillermo Larios, Deane Yim, Andreea Dragulescu, Luc Mertens, Lars Grosse-Wortmann, Mark K. Friedberg BackgroundRight ventricular(RV) dilation from pulmonary valve regurgitation(PR) is common after intervention(s) for pulmonary stenosis(PS) or atresia and intact ventricular septum(PA/IVS). It is not well established whether PR and RV dilation have similar effects on RV function and exercise capacity in these patients compared to patients after repair of tetralogy of Fallot(rToF). The aims of this study were to compare exercise tolerance, RV function and myocardial mechanics in non-ToF versus rToF children with significant and comparable RV volumes.MethodsThirty PS or PA/IVS children after intervention(s) with significant PR and RV dilation (non-ToF group) were retrospectively matched for RV end-diastolic volume index(RVEDVi) and age with 30 rToF patients. Clinical characteristics, RV function by echocardiography and CMR, ECG and exercise capacity were compared between groups.ResultsThe groups were well matched for RVEDVi and age. Global RV function (RVEF:48.7 ± 6.4% vs. 48.5 ± 7.2%, P = .81) and exercise capacity (%predicted peak VO2:82.5 ± 17.7% vs. 75.6 ± 20.4%, P = .27) were similarly reduced between groups. RVEDVi correlated inversely with RVEF in both groups (non-ToF:r = −0.39, P = .04, rToF:r = −0.40, P = .03). QRS duration was wider in rToF patients, and in both groups inversely correlated with RVEF (non-ToF:r = −0.77, P 
  • Participation in thrill-seeking activities by patients with hypertrophic
           cardiomyopathy: Individual preferences, adverse events and physician
    • Abstract: Publication date: Available online 8 April 2019Source: American Heart JournalAuthor(s): Nikolaos Papoutsidakis, Stephen Heitner, Jodie Ingles, Christopher Semsarian, Meghan Mannello, Lisa Salberg, Cynthia Waldman, Benjamin Vaccaro, Niccolo Maurizi, Iacopo Olivotto, Daniel Jacoby BackgroundThrill-seeking activities are a favorite pastime for people of all ages. Patients with hypertrophic cardiomyopathy (HCM) are often barred from participation on the basis of danger for arrhythmias. Our aim was to collect information regarding the safety of thrill-seeking activities for HCM patients.MethodsAn anonymous online survey invited adult HCM patients to report participation in 11 activities (rollercoaster riding, jet skiing, rafting, bungee jumping, rappelling, paragliding, kayaking/canoeing, motor racing, snowboarding, BASE jumping and skydiving) before and after HCM diagnosis, along with major (ICD shock, syncope) or minor (nausea, dizziness, palpitations, chest pain) adverse events related to participation, and relevant physician advice.Results.647 HCM patients completed the survey, with 571 (88.2%) reporting participation in ≥1 TSAs (participant age 50.85 ± 14.21, 56.6% female, 8143 post-diagnosis participations). At time of survey, 457 participants (70.6%) were ICD-carriers or had> = 1 risk factor for sudden cardiac death. Nine (1.5%) participants reported a major event during or immediately after (60 minutes) of surveyed activity. Minor adverse events were reported by 181 participants (31.6%). In addition, 8 participants reported a major adverse event>60 minutes later but within the same day. Regarding physician advice, of the 213 responders (32.9%) receiving specific advice, 56 (26.2%) were told safety data is absent with no definitive recommendation, while 24 (11.2%) and 93 (43.6%) were told TSAs were respectively safe or dangerous.ConclusionsIn this cohort, participation in thrill-seeking activities rarely caused major adverse events. This information can be used for shared-decision making between providers and patients. word count: 249Keywords: hypertrophic cardiomyopathy, thrill-seeking activities, rollercoaster.
  • Temporal evolution of myeloperoxidase and galectin 3 during 1 year after
           acute coronary syndrome admission
    • Abstract: Publication date: Available online 6 April 2019Source: American Heart JournalAuthor(s): Maxime M. Vroegindewey, Victor J. van den Berg, Elke Bouwens, K. Martijn Akkerhuis, Rohit M. Oemrawsingh, Folkert W Asselbergs, Timo Lenderink, Pim van der Harst, Eelco Ronner, Victor A.W.M. Umans, Isabella Kardys, Eric Boersma Prior studies reported that Myeloperoxidase and Galectin-3, which are biomarkers of coronary plaque vulnerability, are elevated in acute coronary syndrome (ACS) patients. We studied the temporal evolution of these biomarkers early after ACS admission and prior to a recurrent ACS event during 1 year follow-up.
  • Response to the letter to the editor regarding the results of the
           retrospective study “predictors of intra-aortic balloon pump hemodynamic
           failure in non-acute myocardial infarction cardiogenic shock” published
           in the American heart journal
    • Abstract: Publication date: Available online 6 April 2019Source: American Heart JournalAuthor(s): Steven Hsu
  • Letter to the editor regarding the results of the retrospective study
           “Predictors of intra-aortic balloon pump hemodynamic failure in
           non-acute myocardial infarction cardiogenic shock” published in the
           American Heart Journal
    • Abstract: Publication date: Available online 23 March 2019Source: American Heart JournalAuthor(s): Alice Sacco, Nuccia Morici, Fabrizio Oliva
  • Comparison of the polymer-free biolimus-coated BioFreedom stent with the
           thin strut biodegradable polymer sirolimus-eluting Orsiro stent in an
           all-comers population treated with percutaneous coronary intervention:
           Rationale and design of the randomized SORT OUT IX trial
    • Abstract: Publication date: Available online 14 March 2019Source: American Heart JournalAuthor(s): Lisette Okkels Jensen MD DMSci, Michael Maeng, Bent Raungaard, Thomas Engstrøm MD DMSci, Henrik Steen Hansen MD DMSci, Svend Eggert Jensen, Hans Erik Bøtker MD DMSci, Johnny Kahlert, Jens Flensted Lassen, Evald Høj Christiansen BackgroundIn patients with increased bleeding risk during dual antiplatelet therapy, the Biolimus A9-coated BioFreedom, a stainless steel drug-coated stent devoid of polymer, has shown superiority compared to a bare metal stent. The aim of this study was to investigate whether the polymer free biolimus A9-coated BioFreedom is non-inferior to a modern thin strut biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population treated with percutaneous coronary intervention.MethodsThe multicenter SORT OUT IX trial (NCT02623140) randomly assigned all-comers patients to treatment with the BioFreedom drug-coated stent or the biodegradable polymer Orsiro stent in 4 Danish University Hospitals. The primary endpoint target lesion failure (TLF) is a composite of cardiac death, myocardial infarction (not related to other than index lesion) or target lesion revascularization within 12 months. Clinically driven event detection based on Danish registries will be used and continue through five years. Assuming an event rate of 4.2% in each stent group, 1563 patients in each treatment arm will provide 90% power to detect non-inferiority of the drug-coated BioFreedom stent with a non-inferiority margin of 2.1%.Results3150 patients have been randomized and enrolled in the study.ConclusionThe SORT OUT IX trial will determine whether the drug-coated BioFreedom stent is non-inferior to a modern biodegradable polymer Orsiro stent.
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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