Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Oct 2018
Randomized Controlled Trial Multicenter StudyNeurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients.
Neurological events after aortic valve interventions are associated with increased mortality and morbidity. Transcatheter aortic valve replacement (TAVR) is increasingly offered for lower-risk patients with severe aortic stenosis, previously considered candidates for surgical aortic valve replacement (SAVR). Differences in post-procedural neurological events have important implications in treatment allocation. ⋯ The early stroke rate was lower after TAVR than SAVR. In patients with early strokes, QOL improved earlier after TAVR. At 12-month follow-up, stroke rates and QOL were not different between TAVR and SAVR patients. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910).
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J. Am. Coll. Cardiol. · Oct 2018
Randomized Controlled Trial Multicenter StudyLosartan Versus Atenolol for Prevention of Aortic Dilation in Patients With Marfan Syndrome.
Beta-blockers are the standard treatment in Marfan syndrome (MFS). Recent clinical trials with limited follow-up yielded conflicting results on losartan's effectiveness in MFS. ⋯ Long-term outcome of Marfan syndrome patients randomly assigned to losartan or atenolol showed no differences in aortic dilation rate or presence of clinical events between treatment groups. Therefore, losartan might be a useful, low-risk alternative to beta-blockers in the long-term management of these patients.
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J. Am. Coll. Cardiol. · Sep 2018
Randomized Controlled Trial Multicenter StudyCardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease.
Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. ⋯ In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676).
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J. Am. Coll. Cardiol. · Jul 2018
Randomized Controlled Trial Comparative StudyFatal or Irreversible Bleeding and Ischemic Events With Rivaroxaban in Acute Coronary Syndrome.
Net clinical outcome analyses of acute coronary syndrome (ACS) mingle fatal or irreversible events with survivable or reversible events that vary significantly in clinical impact. ⋯ Both fatal or irreversible ischemia and bleeding are clinically significant events that can be compared to assess the net clinical outcomes associated with therapy. Rivaroxaban therapy at an oral dose of 2.5 mg twice daily in patients treated with aspirin and clopidogrel is associated with a net reduction in fatal or irreversible events. (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction [ATLAS ACS 2-TIMI 51]; NCT00809965).
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J. Am. Coll. Cardiol. · Jul 2018
Randomized Controlled Trial Multicenter Study Comparative StudyEpinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction.
Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking. ⋯ In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743).