Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

In standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies ("pill in the pocket") are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF.From January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS) was calculated. Patients with previously diagnosed or previously excluded CAD were excluded.The overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001), had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001), were more frequent smokers (26% vs 13%, p = 0.017) and suffered from angina more often (37% vs 2%, p<0.001). There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001).The overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD--which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3&nbsp;years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0&nbsp;years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores &gt;2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores &gt;2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score &gt;2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores &gt;2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores &gt;2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

Final report on the Seventh International Comparison of Absolute Gravimeters (ICAG 2005)

The Bureau International des Poids et Mesures (BIPM), Sevres, France, hosted the 7th International Comparison of Absolute Gravimeters (ICAG) and the associated Relative Gravity Campaign (RGC) from August to September 2005.;ICAG 2005 was prepared and performed as a metrological pilot study, which aimed:;(1) To determine the gravity comparison reference values;;(2) To determine the offsets of the absolute gravimeters; and;(3) As a pilot study to accumulate experience for the CIPM Key Comparisons.;This document presents a complete and extensive review of the technical protocol and data processing procedures. The 1st ICAG-RGC comparison was held at the BIPM in 1980-1981 and since then meetings have been organized every 4 years.;In this paper, we present an overview of how the meeting was organized, the conditions of BIPM gravimetric sites, technical specifications, data processing strategy and an analysis of the final results. This 7th ICAG final report supersedes all previously published reports.;Readings were obtained from participating instruments, 19 absolute gravimeters and 15 relative gravimeters. Precise levelling measurements were carried out and all measurements were performed on the BIPM micro-gravity network which was specifically designed for the comparison

Results of the Seventh International Comparison of Absolute Gravimeters ICAG-2005 at the Bureau International des Poids et Mesures, Sèvres

The International Comparison of Absolute Gravimeters ICAG-2005 was held at the Bureau International des Poids et Mesures (BIPM), Sèvres, France in September 2005. The organization of ICAG-2005, measurement strategy, calculation and presentation of the results were described in a technical protocol pre-developed to the comparison. Nineteen absolute gravimeters carried out 96 series of measurements of free-fall acceleration g at the sites of the BIPM gravity network. The vertical gravity gradients were measured by relative gravimeters. For the first time the budgets of uncertainties were presented. The g-values for the sites A and B of the BIPM gravity network at a height of 0.90 m are (980,925,702.2 ± 0.7) μGal and (980,928,018.5 ± 0.7) μGal, respectively. This result is in a good agreement with that obtained in ICAG-2001

The Seventh International Comparison of Absolute Gravimeters ICAG-2005 at the BIPM. Organization and preliminary results

ICAG-2005, an international comparison of absolute gravimeters, was held in September 2005 at the Bureau International des Poids et Mesures (BIPM), Sèvres, France. Nineteen absolute gravimeters performed measurements of free-fall acceleration g at eleven sites of the BIPM gravity network. Fifteen relative gravimeters were used to measure the vertical gravity gradients and to provide gravity ties between the sites. The maximum g-difference was about 9 mGal. The status of a pilot study was agreed for this comparison by the Consultative Committee for Mass and Related Quantities. For the first time in the ICAG series, a technical protocol specifying the organization, measurement strategy, data processing, calculation of the uncertainties and presentation of the results, was developed for the ICAG 2005. The unweighted mean value of the results of absolute measurements referred to the site A is presented and compared with the similar values obtained in ICAG-1997 and ICAG-2001