Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Apr 2014
Comparative Study Clinical TrialNew-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches.
This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. ⋯ AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.
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J. Am. Coll. Cardiol. · Apr 2014
Randomized Controlled TrialElevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease.
The aim of the present study was to evaluate whether elevated cardiac troponin T (cTnT) was independently associated with an increased all-cause mortality or risk of cardiovascular events and amputation among patients with peripheral arterial disease (PAD). ⋯ cTnT is frequently elevated in PAD patients and is associated with higher event rates in terms of total mortality and amputation. Even small cTnT elevations predict a markedly increased risk that is independent of an impaired renal function. (Troponin T as Risk Stratification Tool in Patients With Peripheral Arterial Occlusive Disease; NCT01087385).
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J. Am. Coll. Cardiol. · Apr 2014
Polypills: essential medicines for cardiovascular disease secondary prevention?
In 1977, the World Health Organization (WHO) developed its first Model List of Essential Medicines to guide countries in the creation of national formularies and policies for access, quality, and use of essential medicines as part of achieving the right to health. In 2012, the WHO announced its goal of reducing the number of premature deaths (<70 years) due to noncommunicable chronic diseases by 25% by the year 2025, including the indicator that 50% of eligible people receive drugs to prevent myocardial infarction and stroke. Despite the large body of evidence supporting the use of pharmacological treatment for the secondary prevention of cardiovascular diseases (CVD), substantial gaps in coverage of secondary interventions for prevention of CVD are widespread globally. ⋯ In November 2012, along with 5 other scientists, we submitted an application to the Model List of Essential Medicines to include polypill therapy for secondary CVD prevention. In July 2013, the updated 18th Model List of Essential Medicines was released without inclusion of polypill therapy for secondary CVD prevention. In this article, we argue that polypill therapy meets the criteria for essential medicines and that inclusion in the Model List of Essential Medicines will facilitate its access and has the potential to avoid a few million premature deaths and related morbidity from CVD at low cost.
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J. Am. Coll. Cardiol. · Apr 2014
Randomized Controlled Trial Multicenter StudyA prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly).
The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina. ⋯ BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent-Management of Angina in the Elderly [XIMA]; ISRCTN92243650).