A. Taha, S. Nielsen, S. Franzén, Mary Rezk, A. Ahlsson, L. Friberg, Staffan Björck, A. Jeppsson, L. Bergfeldt
Background The CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long‐term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new‐onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2‐VASc scoring system for estimating the 1‐year ischemic stroke risk in patients with new‐onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new‐onset postoperative atrial fibrillation and without oral anticoagulation after first‐time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry‐based observational cohort study. The 1‐year ischemic stroke rate at each step of the CHA2DS2‐VASc score was estimated using a Kaplan‐Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow‐up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2‐VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new‐onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2‐VASc score <3 have such a low 1‐year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.
{"title":"Stroke Risk Stratification in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting","authors":"A. Taha, S. Nielsen, S. Franzén, Mary Rezk, A. Ahlsson, L. Friberg, Staffan Björck, A. Jeppsson, L. Bergfeldt","doi":"10.1161/JAHA.121.024703","DOIUrl":"https://doi.org/10.1161/JAHA.121.024703","url":null,"abstract":"Background The CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long‐term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new‐onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2‐VASc scoring system for estimating the 1‐year ischemic stroke risk in patients with new‐onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new‐onset postoperative atrial fibrillation and without oral anticoagulation after first‐time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry‐based observational cohort study. The 1‐year ischemic stroke rate at each step of the CHA2DS2‐VASc score was estimated using a Kaplan‐Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow‐up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2‐VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new‐onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2‐VASc score <3 have such a low 1‐year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74331219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Tjahjadi, S. Butcher, T. Zegkos, C. Sia, K. Hirasawa, V. Kamperidis, J. N. Ngiam, R. Wong, G. Efthimiadis, Jeroen J. Bax, V. Delgado, N. Ajmone Marsan
Hypertrophic cardiomyopathy (HCM) is a common form of inherited cardiomyopathy with a prevalence in the general population reported as 0.2% in different international studies.1 Although differences in disease expression and outcome are described among White and Black patients with HCM,2 it is largely unknown whether Asian patients present also a different HCM phenotype. Only 1 study included 133 Asian patients and highlighted health disparities among ethnicities relating to access to genetic testing and implantable cardioverterdefibrillator (ICDs) use.3 In our study, a total of 1661 consecutive patients (1210 European patients; 451 Asian patients including 308 Chinese, 83 Malay, and 60 South Asian patients) diagnosed with HCM according to current criteria1 were included from 3 centers (Leiden University Medical Center, The Netherlands; National University Hospital, Singapore; Aristoteleio University of Thessaloniki, Greece). This study aimed to evaluate the differences between patients with HCM from the European centers (n=1214, 1% Asian ethnicities) and the Asian center (n=447, 97% Asian ethnicities), to elucidate the influence of ethnicity, differences in care patterns, and sociocultural factors on patient outcome. The institutional review boards approved this retrospective analysis and waived the need for informed consent. The data that support the findings of this study are available from the corresponding author upon reasonable request. At the time of diagnosis, patients from the Asian center were older than those from the European centers (59 [47– 68] years versus 52 [41– 62] years, P<0.001), with similar proportion of men (71% versus 67%, P=0.093) and lower body surface area (1.7±0.2 m2 versus 2.0±0.2 m2, P<0.001). Diabetes (22% versus 16%, P=0.004) was more frequent in European centers, whereas hypertension (23% versus 49%, P<0.001) and coronary artery disease (8% versus 28%, P<0.001) were more prevalent in the Asian center. New York Heart Association functional class (class III– IV 7% versus 10%, P=0.096) at presentation was not significantly different between patients from Asian and European centers. By echocardiography, patients from the Asian center presented with smaller septal wall thickness (16 [13– 19] mm versus 18 [16– 22] mm, P<0.001) but the maximum wall thickness (19 [17– 22] mm versus 19 [16– 22] mm,
肥厚性心肌病(HCM)是一种常见的遗传性心肌病，在不同的国际研究中，一般人群的患病率为0.2%尽管白人和黑人HCM患者的疾病表达和结果存在差异，但亚洲患者是否也存在不同的HCM表型在很大程度上是未知的。只有一项研究纳入了133名亚洲患者，并强调了不同种族在获得基因检测和使用植入式心脏除颤器(icd)方面的健康差异在我们的研究中，共有1661名连续患者(1210名欧洲患者;根据现行标准诊断为HCM的451名亚洲患者，包括308名中国人、83名马来人和60名南亚患者，来自3个中心(荷兰莱顿大学医学中心;新加坡国立大学医院;亚里士多德大学，塞萨洛尼基，希腊)。本研究旨在评估欧洲中心(n=1214, 1%为亚洲种族)和亚洲中心(n=447, 97%为亚洲种族)HCM患者之间的差异，以阐明种族、护理模式差异和社会文化因素对患者预后的影响。机构审查委员会批准了这项回顾性分析，并放弃了知情同意的需要。支持本研究结果的数据可根据通讯作者的合理要求提供。诊断时，来自亚洲中心的患者比来自欧洲中心的患者年龄大(59[47 - 68]岁比52[41 - 62]岁，P<0.001)，男性比例相似(71%比67%，P=0.093)，下体表面积(1.7±0.2 m2比2.0±0.2 m2, P<0.001)。糖尿病(22%对16%，P=0.004)在欧洲中心更为常见，而高血压(23%对49%，P<0.001)和冠状动脉疾病(8%对28%，P<0.001)在亚洲中心更为普遍。来自亚洲和欧洲中心的患者就诊时纽约心脏协会功能分级(III - IV级7% vs 10%， P=0.096)无显著差异。超声心动图显示，亚洲中心患者的间隔壁厚度较小(16 [13 - 19]mm vs 18 [16 - 22] mm, P<0.001)，但最大间隔壁厚度(19 [17 - 22]mm vs 19 [16 - 22] mm)。
{"title":"Differences in Characteristics and Outcomes Between Patients With Hypertrophic Cardiomyopathy From Asian and European Centers","authors":"C. Tjahjadi, S. Butcher, T. Zegkos, C. Sia, K. Hirasawa, V. Kamperidis, J. N. Ngiam, R. Wong, G. Efthimiadis, Jeroen J. Bax, V. Delgado, N. Ajmone Marsan","doi":"10.1161/JAHA.121.023313","DOIUrl":"https://doi.org/10.1161/JAHA.121.023313","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) is a common form of inherited cardiomyopathy with a prevalence in the general population reported as 0.2% in different international studies.1 Although differences in disease expression and outcome are described among White and Black patients with HCM,2 it is largely unknown whether Asian patients present also a different HCM phenotype. Only 1 study included 133 Asian patients and highlighted health disparities among ethnicities relating to access to genetic testing and implantable cardioverterdefibrillator (ICDs) use.3 In our study, a total of 1661 consecutive patients (1210 European patients; 451 Asian patients including 308 Chinese, 83 Malay, and 60 South Asian patients) diagnosed with HCM according to current criteria1 were included from 3 centers (Leiden University Medical Center, The Netherlands; National University Hospital, Singapore; Aristoteleio University of Thessaloniki, Greece). This study aimed to evaluate the differences between patients with HCM from the European centers (n=1214, 1% Asian ethnicities) and the Asian center (n=447, 97% Asian ethnicities), to elucidate the influence of ethnicity, differences in care patterns, and sociocultural factors on patient outcome. The institutional review boards approved this retrospective analysis and waived the need for informed consent. The data that support the findings of this study are available from the corresponding author upon reasonable request. At the time of diagnosis, patients from the Asian center were older than those from the European centers (59 [47– 68] years versus 52 [41– 62] years, P<0.001), with similar proportion of men (71% versus 67%, P=0.093) and lower body surface area (1.7±0.2 m2 versus 2.0±0.2 m2, P<0.001). Diabetes (22% versus 16%, P=0.004) was more frequent in European centers, whereas hypertension (23% versus 49%, P<0.001) and coronary artery disease (8% versus 28%, P<0.001) were more prevalent in the Asian center. New York Heart Association functional class (class III– IV 7% versus 10%, P=0.096) at presentation was not significantly different between patients from Asian and European centers. By echocardiography, patients from the Asian center presented with smaller septal wall thickness (16 [13– 19] mm versus 18 [16– 22] mm, P<0.001) but the maximum wall thickness (19 [17– 22] mm versus 19 [16– 22] mm,","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89481369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bahadir Simsek, Spyridon Kostantinis, J. Karacsonyi, E. Brilakis
Symptom relief is currently the main indication for CTO PCI.2,5 Several observational studies and 36– 8 of 49 randomizedcontrolled trials showed symptom improvement with CTO PCI compared with optimal medical therapy (OMT) alone. In the EuroCTO (randomized multicenter trial to compare revascularization with OMT for the treatment of chronic total coronary occlusions) trial, 396 patients were randomized to OMT versus OMT+PCI. At 12 months, patients who underwent CTO PCI had greater improvements in angina frequency, quality of life, and physical limitation, as assessed by Seattle Angina Questionnaire.3 In the ImpactorCTO (Impact on Inducible Myocardial Ischemia of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients With Right Coronary Artery Chronic Total Occlusion) trial, 94 patients with angina and isolated dominant right coronary artery CTOs were randomized to OMT versus OMT+PCI. At 12 months, the CTO PCI group had significantly lower myocardial ischemia burden, improved 6minute walk distance, and improved health, as assessed by the 36Item Short Form Survey.4 In the COMETCTO (Randomized Controlled Comparison of Optimal Medical Therapy With Percutaneous Recanalization of Chronic Total Occlusion) trial, 100 patients were randomized to OMT versus OMT+PCI; at 9month followup, patients who underwent CTO PCI had significantly improved physical limitation, angina, treatment satisfaction,
{"title":"Scores for Chronic Total Occlusion Percutaneous Coronary Intervention: A Window to the Future?","authors":"Bahadir Simsek, Spyridon Kostantinis, J. Karacsonyi, E. Brilakis","doi":"10.1161/JAHA.122.026070","DOIUrl":"https://doi.org/10.1161/JAHA.122.026070","url":null,"abstract":"Symptom relief is currently the main indication for CTO PCI.2,5 Several observational studies and 36– 8 of 49 randomizedcontrolled trials showed symptom improvement with CTO PCI compared with optimal medical therapy (OMT) alone. In the EuroCTO (randomized multicenter trial to compare revascularization with OMT for the treatment of chronic total coronary occlusions) trial, 396 patients were randomized to OMT versus OMT+PCI. At 12 months, patients who underwent CTO PCI had greater improvements in angina frequency, quality of life, and physical limitation, as assessed by Seattle Angina Questionnaire.3 In the ImpactorCTO (Impact on Inducible Myocardial Ischemia of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients With Right Coronary Artery Chronic Total Occlusion) trial, 94 patients with angina and isolated dominant right coronary artery CTOs were randomized to OMT versus OMT+PCI. At 12 months, the CTO PCI group had significantly lower myocardial ischemia burden, improved 6minute walk distance, and improved health, as assessed by the 36Item Short Form Survey.4 In the COMETCTO (Randomized Controlled Comparison of Optimal Medical Therapy With Percutaneous Recanalization of Chronic Total Occlusion) trial, 100 patients were randomized to OMT versus OMT+PCI; at 9month followup, patients who underwent CTO PCI had significantly improved physical limitation, angina, treatment satisfaction,","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83841549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Santos-Gallego, J. A. Requena-Ibáñez, J. Badimón
fter drug- eluting stent implantation, the classic therapy was dual antiplatelet therapy (DAPT) for 1 year and then stopping P2Y12 inhibitor while maintaining aspirin forever. The main limitation is the in-creased risk of bleeding with prolonged DAPT strategy might offset the ischemic benefit. Given that ischemic risk is higher in the initial phase whereas bleeding risk is maintained in the long term, deescalation therapies have been proposed, either with shorter DAPT durations or with aspirin- free strategies. 1 In fact, DAPT should follow the Goldilocks principle 2 (not too short, not too long). Recent studies (GLOBAL- LEADERS, 3 TWILIGHT [Ticagrelor with Aspirin or Alone in High- Risk Patients after Coronary Intervention], 4 TICO [Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus- Eluting Stent for Acute Coronary Syndrome], 5 STOP- DAPT [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus- Eluting Cobalt-Chromium Stent], 6 SMART- CHOICE [Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Anti- platelet Therapy in Patients Undergoing Implantation of Coronary Drug- Eluting Stents] 7 ) suggest that the deescalation strategy with an abbreviated DAPT period after percutaneous coronary intervention (1– 3 months) followed by aspirin cessation and P2Y12 inhibitor monotherapy mitigates bleeding risk without losing efficacy for ischemic prevention. Among all these trials, GLOBAL- LEADERS 3 offers the largest sample size and is the only one designed as a superiority trial.
{"title":"Per‐Protocol Versus Intention‐to‐Treat in Clinical Trials: The Example of GLOBAL‐LEADERS Trial","authors":"C. Santos-Gallego, J. A. Requena-Ibáñez, J. Badimón","doi":"10.1161/JAHA.122.025561","DOIUrl":"https://doi.org/10.1161/JAHA.122.025561","url":null,"abstract":"fter drug- eluting stent implantation, the classic therapy was dual antiplatelet therapy (DAPT) for 1 year and then stopping P2Y12 inhibitor while maintaining aspirin forever. The main limitation is the in-creased risk of bleeding with prolonged DAPT strategy might offset the ischemic benefit. Given that ischemic risk is higher in the initial phase whereas bleeding risk is maintained in the long term, deescalation therapies have been proposed, either with shorter DAPT durations or with aspirin- free strategies. 1 In fact, DAPT should follow the Goldilocks principle 2 (not too short, not too long). Recent studies (GLOBAL- LEADERS, 3 TWILIGHT [Ticagrelor with Aspirin or Alone in High- Risk Patients after Coronary Intervention], 4 TICO [Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus- Eluting Stent for Acute Coronary Syndrome], 5 STOP- DAPT [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus- Eluting Cobalt-Chromium Stent], 6 SMART- CHOICE [Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Anti- platelet Therapy in Patients Undergoing Implantation of Coronary Drug- Eluting Stents] 7 ) suggest that the deescalation strategy with an abbreviated DAPT period after percutaneous coronary intervention (1– 3 months) followed by aspirin cessation and P2Y12 inhibitor monotherapy mitigates bleeding risk without losing efficacy for ischemic prevention. Among all these trials, GLOBAL- LEADERS 3 offers the largest sample size and is the only one designed as a superiority trial.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83938131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Guérin, Z. Jalal, R. Le Ruz, C. Cueff, S. Hascoet, H. Bouvaist, M. Ladouceur, F. Levy, N. Hugues, S. Malekzadeh-Milani, L. Leroux, T. Modine, A. Silini, J. Gallet, C. Saunier, Karine Warin Fresse, N. Karam, P. Vouhé, L. Iserin, S. Ghostine, X. Iriart, Laurianne Le Gloan, J. Thambo
{"title":"Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort","authors":"P. Guérin, Z. Jalal, R. Le Ruz, C. Cueff, S. Hascoet, H. Bouvaist, M. Ladouceur, F. Levy, N. Hugues, S. Malekzadeh-Milani, L. Leroux, T. Modine, A. Silini, J. Gallet, C. Saunier, Karine Warin Fresse, N. Karam, P. Vouhé, L. Iserin, S. Ghostine, X. Iriart, Laurianne Le Gloan, J. Thambo","doi":"10.1161/JAHA.122.025628","DOIUrl":"https://doi.org/10.1161/JAHA.122.025628","url":null,"abstract":"Patrice Guerin , MD, PhD; Zakaria Jalal , MD, PhD; Robin Le Ruz , MD; Caroline Cueff, MD; Sebastien Hascoet , MD, PhD; Hélène Bouvaist, MD; Magalie Ladouceur , MD, PhD; Franck Levy, MD; Nicolas Hugues, MD; SophieGuiti MalekzadehMilani, MD, PhD; Lionel Leroux, MD, PhD; Thomas Modine , MD, PhD; Alexandre Silini, MD; Jean Gallet, MD; Carole Saunier, MD; Karine Warin Fresse, MD; Nicole Karam, MD, PhD; Pascal Vouhe, MD, PhD; Laurence Iserin , MD; Said Ghostine, MD, PhD; Xavier Iriart , MD; Laurianne Le Gloan, MD; Jean Benoit Thambo, MD, PhD","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81091645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Tse, C. Chandramouli, H. Li, Siyun Yu, Mei-Zhen Wu, Q. Ren, Yan Chen, P. Wong, Ko-Yung Sit, D. Chan, C. K. Ho, W. Au, Xin-li Li, H. Tse, C. Lam, K. Yiu
Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery.
{"title":"Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure","authors":"Y. Tse, C. Chandramouli, H. Li, Siyun Yu, Mei-Zhen Wu, Q. Ren, Yan Chen, P. Wong, Ko-Yung Sit, D. Chan, C. K. Ho, W. Au, Xin-li Li, H. Tse, C. Lam, K. Yiu","doi":"10.1161/JAHA.121.024060","DOIUrl":"https://doi.org/10.1161/JAHA.121.024060","url":null,"abstract":"Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80752454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Godown, Darlene Fountain, N. Bansal, R. Ameduri, Susan Anderson, G. Beasley, D. Burstein, K. Knecht, K. Molina, S. Pye, M. Richmond, J. Spinner, Kae Watanabe, S. West, Z. Reinhardt, J. Scheel, S. Urschel, C. Villa, S. Hollander
Background Children with Down syndrome (DS) have a high risk of cardiac disease that may prompt consideration for heart transplantation (HTx). However, transplantation in patients with DS is rarely reported. This project aimed to collect and describe waitlist and post– HTx outcomes in children with DS. Methods and Results This is a retrospective case series of children with DS listed for HTx. Pediatric HTx centers were identified by their participation in 2 international registries with centers reporting HTx in a patient with DS providing detailed demographic, medical, surgical, and posttransplant outcome data for analysis. A total of 26 patients with DS were listed for HTx from 1992 to 2020 (median age, 8.5 years; 46% male). High‐risk or failed repair of congenital heart disease was the most common indication for transplant (N=18, 69%). A total of 23 (88%) patients survived to transplant. All transplanted patients survived to hospital discharge with a median posttransplant length of stay of 22 days. At a median posttransplant follow‐up of 2.8 years, 20 (87%) patients were alive, 2 (9%) developed posttransplant lymphoproliferative disorder, and 8 (35%) were hospitalized for infection within the first year. Waitlist and posttransplant outcomes were similar in patients with and without DS (P=non‐significant for all). Conclusions Waitlist and post‐HTx outcomes in children with DS selected for transplant listing are comparable to pediatric HTx recipients overall. Given acceptable outcomes, the presence of DS alone should not be considered an absolute contraindication to HTx.
{"title":"Heart Transplantation in Children With Down Syndrome","authors":"J. Godown, Darlene Fountain, N. Bansal, R. Ameduri, Susan Anderson, G. Beasley, D. Burstein, K. Knecht, K. Molina, S. Pye, M. Richmond, J. Spinner, Kae Watanabe, S. West, Z. Reinhardt, J. Scheel, S. Urschel, C. Villa, S. Hollander","doi":"10.1161/JAHA.121.024883","DOIUrl":"https://doi.org/10.1161/JAHA.121.024883","url":null,"abstract":"Background Children with Down syndrome (DS) have a high risk of cardiac disease that may prompt consideration for heart transplantation (HTx). However, transplantation in patients with DS is rarely reported. This project aimed to collect and describe waitlist and post– HTx outcomes in children with DS. Methods and Results This is a retrospective case series of children with DS listed for HTx. Pediatric HTx centers were identified by their participation in 2 international registries with centers reporting HTx in a patient with DS providing detailed demographic, medical, surgical, and posttransplant outcome data for analysis. A total of 26 patients with DS were listed for HTx from 1992 to 2020 (median age, 8.5 years; 46% male). High‐risk or failed repair of congenital heart disease was the most common indication for transplant (N=18, 69%). A total of 23 (88%) patients survived to transplant. All transplanted patients survived to hospital discharge with a median posttransplant length of stay of 22 days. At a median posttransplant follow‐up of 2.8 years, 20 (87%) patients were alive, 2 (9%) developed posttransplant lymphoproliferative disorder, and 8 (35%) were hospitalized for infection within the first year. Waitlist and posttransplant outcomes were similar in patients with and without DS (P=non‐significant for all). Conclusions Waitlist and post‐HTx outcomes in children with DS selected for transplant listing are comparable to pediatric HTx recipients overall. Given acceptable outcomes, the presence of DS alone should not be considered an absolute contraindication to HTx.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85201383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Sezer, J. Escaned, C. Broyd, B. Umman, Z. Bugra, I. Ozcan, M. R. Sonsoz, Alp Ozcan, A. Atıcı, Emre K Aslanger, Z. I. Sezer, J. Davies, N. van Royen, S. Umman
Background Intramyocardial edema and hemorrhage are key pathological mechanisms in the development of reperfusion‐related microvascular damage in ST‐segment–elevation myocardial infarction. These processes may be facilitated by abrupt restoration of intracoronary pressure and flow triggered by primary percutaneous coronary intervention. We investigated whether pressure‐controlled reperfusion via gradual reopening of the infarct‐related artery may limit microvascular injury in patients undergoing primary percutaneous coronary intervention. Methods and Results A total of 83 patients with ST‐segment–elevation myocardial infarction were assessed for eligibility and 53 who did not meet inclusion criteria were excluded. The remaining 30 patients with totally occluded infarct‐related artery were randomized to the pressure‐controlled reperfusion with delayed stenting (PCRDS) group (n=15) or standard primary percutaneous coronary intervention with immediate stenting (IS) group (n=15) (intention‐to‐treat population). Data from 5 patients in each arm were unsuitable to be included in the final analysis. Finally, 20 patients undergoing primary percutaneous coronary intervention who were randomly assigned to either IS (n=10) or PCRDS (n=10) were included. In the PCRDS arm, a 1.5‐mm balloon was used to achieve initial reperfusion with thrombolysis in myocardial infarction grade 3 flow and, subsequently, to control distal intracoronary pressure over a 30‐minute monitoring period (MP) until stenting was performed. In both study groups, continuous assessment of coronary hemodynamics with intracoronary pressure and Doppler flow velocity was performed, with a final measurement of zero flow pressure (primary end point of the study) at the end of a 60‐minute MP. There were no complications associated with IS or PCRDS. PCRDS effectively led to lower distal intracoronary pressures than IS over 30 minutes after reperfusion (71.2±9.37 mm Hg versus 90.13±12.09 mm Hg, P=0.001). Significant differences were noted between study arms in the microcirculatory response over MP. Microvascular perfusion progressively deteriorated in the IS group and at the end of MP, and hyperemic microvascular resistance was significantly higher in the IS arm as compared with the PCDRS arm (2.83±0.56 mm Hg.s.cm−1 versus 1.83±0.53 mm Hg.s.cm−1, P=0.001). The primary end point (zero flow pressure) was significantly lower in the PCRDS group than in the IS group (41.46±17.85 mm Hg versus 76.87±21.34 mm Hg, P=0.001). In the whole study group (n=20), reperfusion pressures measured at predefined stages in the early reperfusion period showed robust associations with zero flow pressure values measured at the end of the 1‐hour MP (immediately after reperfusion: r=0.782, P<0.001; at the 10th minute: r=0.796, P<0.001; and at the 20th minute: r=0.702, P=0.001) and peak creatine kinase MB level (immediately after reperfusion: r=0.653, P=0.002; at the 10th minute: r=0.597, P=0.007; and at the 20th minute: r=0.5
心内水肿和出血是ST段抬高型心肌梗死再灌注相关微血管损伤发展的关键病理机制。初次经皮冠状动脉介入治疗引起的冠状动脉内压力和血流的突然恢复可能促进这些过程。我们研究了通过逐渐重开梗死相关动脉的压力控制再灌注是否可以限制初次经皮冠状动脉介入治疗患者的微血管损伤。方法和结果共对83例ST段抬高型心肌梗死患者进行了资格评估，排除了53例不符合纳入标准的患者。其余30例梗死相关动脉完全闭塞的患者随机分为压控再灌注延迟支架置入术(PCRDS)组(n=15)或标准经皮冠状动脉介入即刻支架置入术(IS)组(n=15)(意向治疗人群)。每组5例患者的数据不适合纳入最终分析。最后，20名接受初级经皮冠状动脉介入治疗的患者被随机分配到IS组(n=10)或PCRDS组(n=10)。在PCRDS组中，使用1.5 mm球囊在心肌梗死3级血流中实现初始再灌注溶栓，随后在30分钟的监测周期(MP)内控制冠状动脉远端压力，直到进行支架植入。在两个研究组中，连续评估冠状动脉血流动力学与冠状动脉内压力和多普勒血流速度，并在60分钟MP结束时测量零流压(研究的主要终点)。没有与IS或PCRDS相关的并发症。再灌注后30分钟内，PCRDS有效降低了远端冠状动脉内压(71.2±9.37 mm Hg vs 90.13±12.09 mm Hg, P=0.001)。在MP的微循环反应中，研究组之间存在显著差异。IS组微血管灌注逐渐恶化，MP结束时微血管充血阻力明显高于PCDRS组(2.83±0.56 mm Hg.s)。对比1.83±0.53 mm Hg.s。厘米−1,P = 0.001)。PCRDS组的主要终点(零流压)明显低于IS组(41.46±17.85 mm Hg vs 76.87±21.34 mm Hg, P=0.001)。在整个研究组(n=20)中，在再灌注期早期预定阶段测量的再灌注压力与1小时MP结束时测量的零流量压力值(再灌注后立即:r=0.782, P<0.001;第10分钟:r=0.796, P<0.001;第20分钟:r=0.702, P=0.001)和肌酸激酶MB峰值(再灌注后即刻:r=0.653, P=0.002;第10分钟:r=0.597, P=0.007;第20分钟:r=0.538, P=0.017)。酶促心肌梗死大小PCRDS组低于IS组，肌钙蛋白T峰值(5395±2991 ng/mL vs 8874±1927 ng/mL, P=0.006)和肌酸激酶MB峰值(163.6±93.4 IU/L vs 542.2±227.4 IU/L, P<0.001)。结论:在ST段抬高型心肌梗死患者中，与IS相比，通过逐渐重新开放闭塞的梗死相关动脉(PCRDS)对罪魁祸首血管进行压力控制再灌注，可以更好地保存冠状动脉微血管的完整性和更小的心肌梗死面积，且不会增加手术并发症。注册网址:https://www.clinicaltrials.gov;唯一标识符:NCT02732080。
{"title":"Gradual Versus Abrupt Reperfusion During Primary Percutaneous Coronary Interventions in ST‐Segment–Elevation Myocardial Infarction (GUARD)","authors":"M. Sezer, J. Escaned, C. Broyd, B. Umman, Z. Bugra, I. Ozcan, M. R. Sonsoz, Alp Ozcan, A. Atıcı, Emre K Aslanger, Z. I. Sezer, J. Davies, N. van Royen, S. Umman","doi":"10.1161/JAHA.121.024172","DOIUrl":"https://doi.org/10.1161/JAHA.121.024172","url":null,"abstract":"Background Intramyocardial edema and hemorrhage are key pathological mechanisms in the development of reperfusion‐related microvascular damage in ST‐segment–elevation myocardial infarction. These processes may be facilitated by abrupt restoration of intracoronary pressure and flow triggered by primary percutaneous coronary intervention. We investigated whether pressure‐controlled reperfusion via gradual reopening of the infarct‐related artery may limit microvascular injury in patients undergoing primary percutaneous coronary intervention. Methods and Results A total of 83 patients with ST‐segment–elevation myocardial infarction were assessed for eligibility and 53 who did not meet inclusion criteria were excluded. The remaining 30 patients with totally occluded infarct‐related artery were randomized to the pressure‐controlled reperfusion with delayed stenting (PCRDS) group (n=15) or standard primary percutaneous coronary intervention with immediate stenting (IS) group (n=15) (intention‐to‐treat population). Data from 5 patients in each arm were unsuitable to be included in the final analysis. Finally, 20 patients undergoing primary percutaneous coronary intervention who were randomly assigned to either IS (n=10) or PCRDS (n=10) were included. In the PCRDS arm, a 1.5‐mm balloon was used to achieve initial reperfusion with thrombolysis in myocardial infarction grade 3 flow and, subsequently, to control distal intracoronary pressure over a 30‐minute monitoring period (MP) until stenting was performed. In both study groups, continuous assessment of coronary hemodynamics with intracoronary pressure and Doppler flow velocity was performed, with a final measurement of zero flow pressure (primary end point of the study) at the end of a 60‐minute MP. There were no complications associated with IS or PCRDS. PCRDS effectively led to lower distal intracoronary pressures than IS over 30 minutes after reperfusion (71.2±9.37 mm Hg versus 90.13±12.09 mm Hg, P=0.001). Significant differences were noted between study arms in the microcirculatory response over MP. Microvascular perfusion progressively deteriorated in the IS group and at the end of MP, and hyperemic microvascular resistance was significantly higher in the IS arm as compared with the PCDRS arm (2.83±0.56 mm Hg.s.cm−1 versus 1.83±0.53 mm Hg.s.cm−1, P=0.001). The primary end point (zero flow pressure) was significantly lower in the PCRDS group than in the IS group (41.46±17.85 mm Hg versus 76.87±21.34 mm Hg, P=0.001). In the whole study group (n=20), reperfusion pressures measured at predefined stages in the early reperfusion period showed robust associations with zero flow pressure values measured at the end of the 1‐hour MP (immediately after reperfusion: r=0.782, P<0.001; at the 10th minute: r=0.796, P<0.001; and at the 20th minute: r=0.702, P=0.001) and peak creatine kinase MB level (immediately after reperfusion: r=0.653, P=0.002; at the 10th minute: r=0.597, P=0.007; and at the 20th minute: r=0.5","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79425883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Musleh, P. Schlattmann, T. Caldonazo, H. Kirov, O. Witte, T. Doenst, A. Günther, M. Diab
Background Intracranial hemorrhage (ICH) is one of the main causes for lack of surgery in patients with infective endocarditis (IE), despite the presence of surgical indications. We aimed to evaluate the impact of early surgery in patients with IE and with ICH on postoperative neurological deterioration and all‐cause mortality and to elucidate the risk of 30‐day mortality in patients who were denied surgery. Methods and Results Three libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The primary outcome was all‐cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed. We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early versus late) and were included in the meta‐analysis. Only one study examined the fate of patients with IE and with ICH who were treated conservatively despite having an indication for cardiac surgery, showing higher mortality rates than those who underwent surgery (11.8% versus 2.5%). We found no significant association between early surgery, regardless of its definition, and a higher mortality (odds ratio [OR], 1.69; 95% CI, 0.95–3.02). Early surgery was associated with higher risk for neurological deterioration (OR, 2.00; 95% CI, 1.10–3.65). Conclusions Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with an increased rate of neurological deterioration. The 30‐day mortality in patients with IE and with ICH who were denied surgery has not yet been sufficiently investigated. This patient group should be analyzed in future studies in more detail.
{"title":"Surgical Timing in Patients With Infective Endocarditis and With Intracranial Hemorrhage: A Systematic Review and Meta‐Analysis","authors":"R. Musleh, P. Schlattmann, T. Caldonazo, H. Kirov, O. Witte, T. Doenst, A. Günther, M. Diab","doi":"10.1161/JAHA.121.024401","DOIUrl":"https://doi.org/10.1161/JAHA.121.024401","url":null,"abstract":"Background Intracranial hemorrhage (ICH) is one of the main causes for lack of surgery in patients with infective endocarditis (IE), despite the presence of surgical indications. We aimed to evaluate the impact of early surgery in patients with IE and with ICH on postoperative neurological deterioration and all‐cause mortality and to elucidate the risk of 30‐day mortality in patients who were denied surgery. Methods and Results Three libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The primary outcome was all‐cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed. We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early versus late) and were included in the meta‐analysis. Only one study examined the fate of patients with IE and with ICH who were treated conservatively despite having an indication for cardiac surgery, showing higher mortality rates than those who underwent surgery (11.8% versus 2.5%). We found no significant association between early surgery, regardless of its definition, and a higher mortality (odds ratio [OR], 1.69; 95% CI, 0.95–3.02). Early surgery was associated with higher risk for neurological deterioration (OR, 2.00; 95% CI, 1.10–3.65). Conclusions Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with an increased rate of neurological deterioration. The 30‐day mortality in patients with IE and with ICH who were denied surgery has not yet been sufficiently investigated. This patient group should be analyzed in future studies in more detail.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90502819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Umer Butt, N. Okumus, A. Jabri, Charles L Thomas, Y. Tarabichi, Saima Karim
Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF timing and need for PPM in sick sinus syndrome has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross‐sectional analysis of 66, 595 patients with AF and sick sinus syndrome to assess the need of PPM implantation temporally, with AF performed divided into earlier within 5 years (group 1), 5 to 10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest among those who had catheter ablation within 5 years of sick sinus syndrome diagnosis: group 1 versus group 2 (18.15% versus 27.21%) and group 1 versus group 3 (18.15% versus 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21% versus 27.22%; odds ratio [OR], 1.00 [95% CI, 0.85–1.20]). Conclusions Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted OR of PPM was lower if patients had catheter ablation within 5 years of diagnosis compared with later than 5 years (adjusted OR, 0.64 [95% CI, 0.59–0.70]).
{"title":"Early Versus Late Catheter Ablation of Atrial Fibrillation and Risk of Permanent Pacemaker Implantation in Patients With Underlying Sinus Node Dysfunction","authors":"Muhammad Umer Butt, N. Okumus, A. Jabri, Charles L Thomas, Y. Tarabichi, Saima Karim","doi":"10.1161/JAHA.121.023333","DOIUrl":"https://doi.org/10.1161/JAHA.121.023333","url":null,"abstract":"Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF timing and need for PPM in sick sinus syndrome has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross‐sectional analysis of 66, 595 patients with AF and sick sinus syndrome to assess the need of PPM implantation temporally, with AF performed divided into earlier within 5 years (group 1), 5 to 10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest among those who had catheter ablation within 5 years of sick sinus syndrome diagnosis: group 1 versus group 2 (18.15% versus 27.21%) and group 1 versus group 3 (18.15% versus 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21% versus 27.22%; odds ratio [OR], 1.00 [95% CI, 0.85–1.20]). Conclusions Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted OR of PPM was lower if patients had catheter ablation within 5 years of diagnosis compared with later than 5 years (adjusted OR, 0.64 [95% CI, 0.59–0.70]).","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80240520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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