55 research outputs found
Evaluating Real-World Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology Final 2-Year Outcome Data of the EWOLUTION Trial Focusing on History of Stroke and Hemorrhage
BACKGROUND: Left atrial appendage occlusion with WATCHMAN has emerged
as viable alternative to vitamin K antagonists in randomized controlled trials.
Evaluating real-life clinical outcomes in atrial fibrillation patients receiving the
WATCHMAN left atrial appendage closure technology was designed to collect
prospective multicenter outcomes of thromboembolic events, bleeding, and
mortality for patients implanted with a WATCHMAN in routine daily practice.
METHODS: One thousand twenty patients with a WATCHMAN implant procedure
were prospectively followed in 47 centers. Left atrial appendage occlusion indication
was based on the European Society of Cardiology guidelines. Follow-up and
imaging were performed per local practice up to a median follow-up of 2 years.
RESULTS: Included population was old (age 73.4±8.9 years), at high risk for stroke
(311 prior ischemic stroke/transient ischemic attack and 153 prior hemorrhagic
stroke) and bleeding (318 prior major bleeding), with CHA2
DS2
-VASc score ≥5
in 49%, hypertension, abnormal renal/liver function, stroke, bleeding history
or predisposition, Labile international normalized ratio, elderly, drugs/alcohol
concomitantly ≥3 in 40% and oral anticoagulation contraindication in 72%.
During follow-up, 161 patients (16.4%) died, 22 strokes were observed (1.3/100
patient-years, 83% reduction versus historic data), and 47 major nonprocedural
bleeding events (2.7/100 patient-years, 46% reduction versus historic data).
Stroke and bleeding rates were consistently lower than historic data in those
with prior ischemic (−76% and −41%) or hemorrhagic (−81% and 67%) stroke
and prior bleeding (−85% and −30%). Lowest bleeding rates were seen in
patients with early discontinuation of dual antiplatelet therapy. Patients with early
discontinuation of antithrombotic therapy showed lower bleeding rates, while they
were highest for those with prior bleeding. Device thrombus was observed in 34
patients (4.1%) and was not correlated to drug regimen during follow-up (P=0.28).
CONCLUSIONS: During the complete 2-year follow-up of Evaluating RealLife Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN
Left Atrial Appendage Closure Technology, patients with a WATCHMAN
left atrial appendage occlusion device had consistently low rates of stroke
and nonprocedural bleeding, although most were contraindicated to oral
anticoagulation and used only single antiplatelet therapy or nothing
Relation between the frequency of CD34+ bone marrow derived circulating progenitor cells and the number of diseased coronary arteries in patients with myocardial ischemia and diabetes
<p>Abstract</p> <p>Background</p> <p>Bone marrow-derived circulating progenitor cells (BM-CPCs) in patients with coronary heart disease are impaired with respect to number and mobilization. However, it is unknown whether the mobilization of BM-CPCs depends on the number of diseased coronary arteries. Therefore, in our study, we analysed the correlation between the diseased coronary arteries and the frequency of CD34/45+ BM-CPCs in peripheral blood (PB) in patients with ischemic heart disease (IHD).</p> <p>Methods</p> <p>The frequency of CD34/45<sup>+ </sup>BM-CPCs was measured by flow cytometry in 120 patients with coronary 1 vessel (IHD1, n = 40), coronary 2 vessel (IHD2, n = 40), coronary 3 vessel disease (IHD3, n = 40) and in a control group of healthy subjects (n = 40). There was no significant difference of the total number of cardiovascular risk factors between IHD groups, beside diabetes mellitus (DM), which was significantly higher in IHD3 group compared to IHD2 and IHD1 groups.</p> <p>Results</p> <p>The frequency of CD34/45<sup>+ </sup>BM-CPCs was significantly reduced in patients with IHD compared to the control group (CD34/45<sup>+</sup>; p < 0.001). The frequency of BM-CPCs was impaired in patients with IHD3 compared to IHD1 (CD34/45<sup>+</sup>; p < 0.001) and to IHD2 (CD34/45<sup>+</sup>; p = 0.001). But there was no significant difference in frequency of BM-CPCs between the patients with IHD2 and IHD1 (CD34/45<sup>+</sup>; p = 0.28). In a subgroup we observed a significant negative correlation between levels of hemoglobin AIc (HbAIc) and the frequency of BM-CPCs (CD34/45<sup>+</sup>; p < 0.001, r = -0.8).</p> <p>Conclusions</p> <p>The frequency of CD34/45<sup>+ </sup>BM-CPCs in PB is impaired in patients with IHD. This impairment may augment with an increased number of diseased coronary arteries. Moreover, the frequency of CD34/45<sup>+ </sup>BM-CPCs in ischemic tissue is further impaired by diabetes in patients with IHD.</p
Changes in androstenedione, dehydroepiandrosterone, testosterone, estradiol, and estrone over the menopausal transition
Surface and intracardiac ECG for discriminating conduction disorders after CoreValve implantation
Improved Functional Activity of Bone Marrow Derived Circulating Progenitor Cells After Intra Coronary Freshly Isolated Bone Marrow Cells Transplantation in Patients with Ischemic Heart Disease
Comparison of clinical outcomes between Magmaris and Orsiro drug eluting stent at 12 months: Pooled patient level analysis from BIOSOLVE II–III and BIOFLOW II trials
Background: The aim of this study was to compare the 12-month clinical outcomes of patients treated with Magmaris or Orsiro. Second generation drug-eluting absorbable metal scaffold Magmaris (Dreams 2G) has proved to be safe and effective in the BIOSOLVE-II study. Similarly, biodegradable polymer sirolimus-eluting stent, Orsiro has shown notable clinical results even in all-comer populations. Methods: Magmaris group patients were taken from the BIOSOLVE-II and BIOSOLVE-III trials, while the patients from Orsiro group were enrolled in BIOFLOW-II trial. The primary outcome was explored using a time-to-event assessment of the unadjusted clinical outcomes for target lesion failure (TLF) at 12 months, followed by a multivariate analysis adjusting for all the significantly different covariates between the groups. Results: The study population consisted of 482 patients (521 lesions), 184 patients (189 lesions) in Magmaris group and 298 patients (332 lesions) in Orsiro group. The mean age was 65.5 ± 10.8 and 62.7 ± 10.4 years in Magmaris and Orsiro groups, respectively (p = 0.005). Magmaris and Orsiro unadjusted TLF rates were 6.0 and 6.4% with no significant difference between the groups (p = 0.869). In the multivariate analysis, there were no meaningful differences between Magmaris and Orsiro groups. Finally, none of the groups presented device thrombosis cases at 12 months. Conclusion: At 12 months there were no significant differences between Magmaris and Orsiro groups neither in the unadjusted assessment nor in the multivariate analysis for target lesion failure. These results should be taken as hypothesis generating and may warrant a head to head comparison on a randomized fashion
Clinical outcomes of conventional surgery versus MitraClip® therapy for moderate to severe symptomatic mitral valve regurgitation in the elderly population: an institutional experience
Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial
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