1587 results found
Bhatt DL, Kaski JC, Delaney S, et al., 2021, Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention., Int J Cardiol, Vol: 337, Pages: 1-8
AIMS: Choosing an antiplatelet strategy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) at high bleeding risk (HBR), undergoing post-percutaneous coronary intervention (PCI), is complex. We used a unique open-source approach (crowdsourcing) to document if practices varied across a small, global cross-section of antiplatelet prescribers in the post-PCI setting. METHODS AND RESULTS: Five-hundred and fifty-nine professionals from 70 countries (the 'crowd') completed questionnaires containing single- or multi-option and free form questions regarding antiplatelet clinical practice in post-PCI NSTE-ACS patients at HBR. A threshold of 75% defined 'agreement'. There was strong agreement favouring monotherapy with either aspirin or a P2Y12 inhibitor following initial DAPT, within the first year (94%). No agreement was reached on the optimal duration of DAPT or choice of monotherapy: responses were in equipoise for shorter (≤3 months, 51%) or longer (≥6 months, 46%) duration, and monotherapy choice (45% aspirin; 53% P2Y12 inhibitor). Most respondents stated use of guideline-directed tools to assess risk, although clinical judgement was preferred by 32% for assessing bleeding risk and by 46% for thrombotic risk. CONCLUSION: The crowdsourcing methodology showed potential as a tool to assess current practice and variation on a global scale and to achieve a broad demographic representation. These preliminary results indicate a high degree of variation with respect to duration of DAPT, monotherapy drug of choice following DAPT and how thrombotic and bleeding risk are assessed. Further investigations should concentrate on interrogating practice variation between key demographic groups.
Mesnier J, Ducrocq G, Danchin N, et al., 2021, International observational analysis of evolution and outcomes of chronic stable angina: The Multinational Observational CLARIFY Study, Circulation, ISSN: 0009-7322
BACKGROUND: Although angina is common in patients with stable coronary artery disease (CAD), limited data are available on its prevalence, natural evolution, and outcomes in the era of effective cardiovascular drugs and widespread use of coronary revascularization. METHODS: Using data from 32 691 patients with stable CAD from the prospective observational CLARIFY registry, anginal status was mapped each year in patients without new coronary revascularization or new myocardial infarction. The use of medical interventions in the year preceding angina resolution was explored. The effect of 1-year changes in angina status on 5-year outcomes was analyzed using multivariable analysis.RESULTS: Among 7212 (22.1%) patients who reported angina at baseline, angina disappeared (without coronary revascularization) in 39.6% at 1 year, with further annual decreases. In patients without angina at baseline, 2.0–4.8% developed angina each year. During 5-year follow-up, angina was controlled in 7773 patients, in whom resolution of angina was obtained with increased use of antianginal treatment in 11.1%, with coronary revascularization in 4.5%, and without any changes in medication or revascularization in 84.4%. Compared to patients without angina at baseline and 1 year, persistence of angina and occurrence of angina at 1 year with conservative management were each independently associated with higher rates of cardiovascular death or myocardial infarction (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.12−1.55 for persistence of angina; adjusted HR 1.37, 95% CI 1.11−1.70 for occurrence of angina) at 5 years. Patients whose angina had resolved at 1 year with conservative management were not at higher risk of cardiovascular death or myocardial infarction than those who never experienced angina (adjusted HR 0.97, 95% CI 0.82−1.15).CONCLUSIONS: Angina affects almost one-quarter of patients with stable CAD but resolves spontaneously in most patients.
De Luca L, Steg PG, Bhatt DL, et al., 2021, Cangrelor: Clinical Data, Contemporary Use, and Future Perspectives, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 10, ISSN: 2047-9980
Eccleston DS, Kim JM, ten Berg JM, et al., 2021, The effect of sex on the efficacy and safety of dual antithrombotic therapy with dabigatran versus triple therapy with warfarin after PCI in patients with atrial fibrillation (a RE-DUAL PCI subgroup analysis and comparison to other dual antithrombotic therapy trials), CLINICAL CARDIOLOGY, Vol: 44, Pages: 1002-1010, ISSN: 0160-9289
Puymirat E, Cayla G, Simon T, et al., 2021, Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction, NEW ENGLAND JOURNAL OF MEDICINE, ISSN: 0028-4793
Olshansky B, Bhatt DL, Miller M, et al., 2021, REDUCE-IT INTERIM: accumulation of data across prespecified interim analyses to final results, EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY, Vol: 7, Pages: E61-E63, ISSN: 2055-6837
Schwartz GG, Gabriel Steg P, Bhatt DL, et al., 2021, Clinical Efficacy and Safety of Alirocumab After Acute Coronary Syndrome According to Achieved Level of Low-Density Lipoprotein Cholesterol A Propensity Score-Matched Analysis of the ODYSSEY OUTCOMES Trial, CIRCULATION, Vol: 143, Pages: 1109-1122, ISSN: 0009-7322
Magnani G, Ardissino D, Im K, et al., 2021, Predictors, Type, and Impact of Bleeding on the Net Clinical Benefit of Long-Term Ticagrelor in Stable Patients With Prior Myocardial Infarction, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 10, ISSN: 2047-9980
Marston NA, Patel PN, Kamanu FK, et al., 2021, Clinical Application of a Novel Genetic Risk Score for Ischemic Stroke in Patients With Cardiometabolic Disease, CIRCULATION, Vol: 143, Pages: 470-478, ISSN: 0009-7322
Marston NA, Melloni GEM, Gurmu Y, et al., 2021, Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease, CIRCULATION-GENOMIC AND PRECISION MEDICINE, Vol: 14, ISSN: 2574-8300
Leonardi S, Branca M, Franzone A, et al., 2021, Comparison of Investigator-Reported and Clinical Event Committee-Adjudicated Outcome Events in GLASSY, CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, Vol: 14, Pages: 144-151, ISSN: 1941-7705
Bhatt DL, Szarek M, Steg PG, et al., 2021, Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 384, Pages: 117-128, ISSN: 0028-4793
Bhatt DL, Szarek M, Pitt B, et al., 2021, Sotagliflozin in patients with diabetes and chronic kidney disease., New England Journal of Medicine, Vol: 384, Pages: 129-139, ISSN: 0028-4793
BACKGROUND: The efficacy and safety of sodium-glucose cotransporter 2 inhibitors such as sotagliflozin in preventing cardiovascular events in patients with diabetes with chronic kidney disease with or without albuminuria have not been well studied. METHODS: We conducted a multicenter, double-blind trial in which patients with type 2 diabetes mellitus (glycated hemoglobin level, ≥7%), chronic kidney disease (estimated glomerular filtration rate, 25 to 60 ml per minute per 1.73 m2 of body-surface area), and risks for cardiovascular disease were randomly assigned in a 1:1 ratio to receive sotagliflozin or placebo. The primary end point was changed during the trial to the composite of the total number of deaths from cardiovascular causes, hospitalizations for heart failure, and urgent visits for heart failure. The trial ended early owing to loss of funding. RESULTS: Of 19,188 patients screened, 10,584 were enrolled, with 5292 assigned to the sotagliflozin group and 5292 assigned to the placebo group, and followed for a median of 16 months. The rate of primary end-point events was 5.6 events per 100 patient-years in the sotagliflozin group and 7.5 events per 100 patient-years in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.63 to 0.88; P<0.001). The rate of deaths from cardiovascular causes per 100 patient-years was 2.2 with sotagliflozin and 2.4 with placebo (hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.35). For the original coprimary end point of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, the hazard ratio was 0.84 (95% CI, 0.72 to 0.99); for the original coprimary end point of the first occurrence of death from cardiovascular causes or hospitalization for heart failure, the hazard ratio was 0.77 (95% CI, 0.66 to 0.91). Diarrhea, genital mycotic infections, volume depletion, and diabetic ketoacidosis were more common with sotagliflozin than with placebo. CO
Ducrocq G, Calvo G, Ramon Gonzalez-Juanatey J, et al., 2021, Restrictive vs liberal red blood cell transfusion strategies in patients with acute myocardial infarction and anemia: Rationale and design of the REALITY trial, CLINICAL CARDIOLOGY, Vol: 44, Pages: 143-150, ISSN: 0160-9289
Hoshino T, Uchiyama S, Wong LKS, et al., 2021, Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian Populations., Neurology, Vol: 96, Pages: e54-e66
OBJECTIVE: To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies. METHODS: This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. RESULTS: No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88-1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09-4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11-3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; p = 0.037) patients. CONCLUSION: The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.
Peterson BE, Bhatt DL, Steg PG, et al., 2021, Reduction in Revascularization With Icosapent Ethyl: Insights From REDUCE-IT Revascularization Analyses, COGENT SOCIAL SCIENCES, Vol: 7, Pages: 33-44, ISSN: 2331-1886
Dillinger J-G, Ducrocq G, Elbez Y, et al., 2021, Sex Differences in Ischemic and Bleeding Outcomes in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Insights From the TAO Trial, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 14, Pages: 29-38, ISSN: 1941-7640
Darmon A, Ducrocq G, Jasilek A, et al., 2020, Use of risk scores to identify lower and higher risk subsets among COMPASS-eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: WILEY, Pages: 58-65, ISSN: 0160-9289
Hara H, Takahashi K, Kogame N, et al., 2020, Impact of Bleeding and Myocardial Infarction on Mortality in All-Comer Patients Undergoing Percutaneous Coronary Intervention, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 13, ISSN: 1941-7640
Boccara F, Mary-Krause M, Potard V, et al., 2020, HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 9, ISSN: 2047-9980
Amarenco P, Hobeanu C, Labreuche J, et al., 2020, Carotid Atherosclerosis Evolution When Targeting a Low-Density Lipoprotein Cholesterol Concentration < 70 mg/dL After an Ischemic Stroke of Atherosclerotic Origin, CIRCULATION, Vol: 142, Pages: 748-757, ISSN: 0009-7322
Sinnaeve PR, Schwartz GG, Wojdyla DM, et al., 2020, Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: an ODYSSEY OUTCOMES trial analysis, EUROPEAN HEART JOURNAL, Vol: 41, Pages: 2248-2258, ISSN: 0195-668X
Furtado RHM, Nicolau JC, Magnani G, et al., 2020, Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54, EUROPEAN HEART JOURNAL, Vol: 41, Pages: 1625-+, ISSN: 0195-668X
ten Berg JM, Steg PG, Bhatt DL, et al., 2020, Comparison of the Effect of Age (< 75 Versus >= 75) on the Efficacy and Safety of Dual Therapy (Dabigatran plus Clopidogrel or Ticagrelor) Versus Triple Therapy (Warfarin plus Aspirin plus Clopidogrel or Ticagrelor) in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention (from the RE-DUAL PCI Trial), AMERICAN JOURNAL OF CARDIOLOGY, Vol: 125, Pages: 735-743, ISSN: 0002-9149
Vidal-Petiot E, Greenlaw N, Kalra PR, et al., 2020, Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry, JOURNAL OF CLINICAL MEDICINE, Vol: 9
Akerblom A, Wojdyla D, Steg PG, et al., 2019, Prevalence and relevance of abnormal glucose metabolism in acute coronary syndromes: insights from the PLATelet inhibition and patient Outcomes (PLATO) trial, Journal of Thrombosis and Thrombolysis, Vol: 48, Pages: 563-569, ISSN: 0929-5305
Diabetes mellitus (DM) and abnormal glucose metabolism are associated with cardiovascular (CV) disease. We investigated the prevalence and prognostic importance of dysglycaemia in patients with acute coronary syndromes (ACS) in the PLATelet inhibition and patient Outcomes (PLATO) trial. Diabetes was defined as known diabetes or HbA1c ≥ 6.5% or non-fasting glucose ≥ 11.1 mmol/L on admission, prediabetes as HbA1c ≥ 5.7% but < 6.5%, and no diabetes as HbA1c < 5.7%. The primary endpoint was the composite of CV death, spontaneous myocardial infarction type 1 (sMI) or stroke at 12 months. Multivariable Cox regression models, adjusting for baseline characteristics, and biomarkers NT-proBNP and troponin I, were used to explore the association between glycaemia and outcome. On admission, 16,007 (86.1%) patients had HbA1c and/or glucose levels available and were subdivided into DM 38.5% (6160) (1501 patients had no previous DM diagnosis), prediabetes 38.8% (6210), and no DM 22.7% (3637). Kaplan Meier event rates at 12 months for CV death, sMI or stroke per subgroups were 14.5% (832), 9.0% (522), and 8.5% (293), respectively with multivariable adjusted HRs, versus no diabetes, for diabetes: 1.71 (1.50–1.95) and for prediabetes 1.03 (0.90–1.19). Corresponding event rates for CV death were 6.9% (391), 3.4% (195) and 3.0% (102), respectively, with adjusted HRs for patients with DM of: 1.92 (1.42–2.60) and for prediabetes 1.02 (0.79–1.32). Abnormal glucose metabolism is common in ACS patients, but only patients with definite DM have an increased CV risk, indicating that prediabetes is not immediately associated with worse CV outcomes.
Akerblom A, James SK, Lakic TG, et al., 2019, Interleukin-18 in patients with acute coronary syndromes, CLINICAL CARDIOLOGY, ISSN: 0160-9289
Sorbets E, Fox KM, Elbez Y, et al., 2019, Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry, European Heart Journal, Vol: 41, Pages: 347-356, ISSN: 0195-668X
AimsOver the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants.Methods and resultsData from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7–8.3] overall [male 8.1% (7.8–8.5); female 7.6% (7.0–8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9–12.9) vs. 8.2% (95% CI 7.8–8.7) in patients with no angina, P < 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4–7.3)] or without angina [6.4% (95% CI 5.9–7.0)], P > 0.99. Prescription rates of evidence-based secondary prevention therapies were high.ConclusionThis description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment.
White HD, Steg PG, Szarek M, et al., 2019, Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial, European Heart Journal, Vol: 40, Pages: 2801-2809, ISSN: 0195-668X
Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI.Methods and results Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI.Conclusion After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.
Picard F, Van Ganse E, Ducrocq G, et al., 2019, EvaluatioN of ApiXaban in strOke and systemic embolism prevention in patients with non-valvular atrial fibrillation in clinical practice Setting in France, rationale and design of the NAXOS: SNIIRAM study, CLINICAL CARDIOLOGY, Vol: 42, Pages: 851-859, ISSN: 0160-9289
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