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4. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

Author

Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thomas, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Leclercq C, Lewis BS, Merkely B, Mueller C, Petersen S, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thoma, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Clinical sciences, Cardio-vascular diseases, Cardiology, Knuuti, Juhani [0000-0003-3156-9593], Apollo - University of Cambridge Repository, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), University of Zurich, Knuuti, J., Wijns, W., Achenbach, S., Agewall, S., Barbato, E., Bax, J. J., Capodanno, D., Cuisset, T., Deaton, C., Dickstein, K., Edvardsen, T., Escaned, J., Funck-Brentano, C., Gersh, B. J., Gilard, M., Hasdai, D., Hatala, R., Mahfoud, F., Masip, J., Muneretto, C., Prescott, E., Saraste, A., Storey, R. F., Svitil, P., Valgimigli, M., Windecker, S., Aboyans, V., Baigent, C., Collet, J. -P., Dean, V., Delgado, V., Fitzsimons, D., Gale, C. P., Grobbee, D. E., Halvorsen, S., Hindricks, G., Iung, B., Juni, P., Katus, H. A., Landmesser, U., Leclercq, C., Lettino, M., Lewis, B. S., Merkely, B., Mueller, C., Petersen, S., Petronio, A. S., Richter, D. J., Roffi, M., Shlyakhto, E., Simpson, I. A., Sousa-Uva, M., Touyz, R. M., Benkhedda, S., Metzler, B., Sujayeva, V., Cosyns, B., Kusljugic, Z., Velchev, V., Panayi, G., Kala, P., Haahr-Pedersen, S. A., Kabil, H., Ainla, T., Kaukonen, T., Cayla, G., Pagava, Z., Woehrle, J., Kanakakis, J., Toth, K., Gudnason, T., Peace, A., Aronson, D., Riccio, C., Elezi, S., Mirrakhimov, E., Hansone, S., Sarkis, A., Babarskiene, R., Beissel, J., Cassar Maempel, A. J., Revenco, V., de Grooth, G. J., Pejkov, H., Juliebo, V., Lipiec, P., Santos, J., Chioncel, O., Duplyakov, D., Bertelli, L., Dikic, A. D., Studencan, M., Bunc, M., Alfonso, F., Back, M., Zellweger, M., Addad, F., Yildirir, A., Sirenko, Y., and Clapp, B.

Subjects
anti-ischaemic drug, chronic coronary syndromes, medicine.medical_treatment, [SDV]Life Sciences [q-bio], lipid-lowering drugs, Diagnostic Techniques, Cardiovascular, antithrombotic therapy, Disease, 030204 cardiovascular system & hematology, Guideline, Coronary artery disease, 0302 clinical medicine, Disease management (health), Societies, Medical, ComputingMilieux_MISCELLANEOUS, chronic coronary syndrome, angina pectori, Disease Management, food and beverages, imaging, risk assessment, Syndrome, 3. Good health, Natural history, Europe, Cardiology, Cardiology and Cardiovascular Medicine, coronary artery disease, medicine.medical_specialty, lifestyle modifications, anti-ischaemic drugs, Ischemia, 610 Medicine & health, vasospastic angina, Guidelines, Revascularization, diagnostic testing, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, angina pectoris, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Journal Article, Humans, business.industry, screening, fungi, 030229 sport sciences, medicine.disease, lipid-lowering drug, Angina pectoris, Anti-ischaemic drugs, Antithrombotic therapy, Chronic coronary syndromes, Diagnostic testing, Imaging, Lifestyle modifications, Lipid-lowering drugs, Microvascular angina, Myocardial ischaemia, Myocardial revascularization, Risk assessment, Screening, Vasospastic angina, myocardial ischaemia, myocardial revascularization, Heart failure, microvascular angina, Chronic Disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, lifestyle modification, Coronary Artery Disease/diagnosis, business, Fibrinolytic agent
Abstract

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

Published
2019

5. Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation

Author

Fox, KAA, Velentgas, P, Camm, AJ, Bassand, J-P, Fitzmaurice, DA, Gersh, BJ, Goldhaber, SZ, Goto, S, Haas, S, Misselwitz, F, Pieper, KS, Turpie, AGG, Verheugt, FWA, Dabrowski, E, Luo, K, Gibbs, L, Kakkar, AK, and GARFIELD-AF Investigators

Abstract

Importance: Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. Objective: To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Design, Setting, and Participants: Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Exposure: Participants received either OAC plus AP or OAC alone. Main Outcomes and Measures: Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. Results: A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). Conclusions and Relevance: This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation.

Published
2020

8. B-Type Natriuretic Peptide Assessment in Patients Undergoing Revascularization for Left Main Coronary Artery Disease: Analysis From the EXCEL Trial

Author

Redfors, B, Chen, S, Crowley, A, Ben-Yehuda, O, Gersh, BJ, Lembo, NJ, Brown, W M, Banning, AP, Taggart, DP, Serruys, PWJC, Kappetein, Arie-Pieter, Sabik, JF, Stone, GW, Redfors, B, Chen, S, Crowley, A, Ben-Yehuda, O, Gersh, BJ, Lembo, NJ, Brown, W M, Banning, AP, Taggart, DP, Serruys, PWJC, Kappetein, Arie-Pieter, Sabik, JF, and Stone, GW

Published
2018

9. Evolving quality standards for large-scale registries: the GARFIELD-AF experience

Author

Fox, KAA, Gersh, BJ, Traore, S, John Camm, A, Kayani, G, Krogh, A, Shweta, S, Kakkar, AK, and GARFIELD-AF Investigators

Abstract

Aims: Registries have the potential to capture treatment practices and outcomes in populations beyond the constraints of clinical trial settings. The value of data obtained depend critically upon robust quality standards (including source data verification [SDV] and training); features that are commonly absent from registries. This article outlines the quality standards developed for Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF). Methods and Results: GARFIELD-AF comprises ∼57 000 patients prospectively recruited over 6.5 years in 35 countries in five successive cohorts. The registry employs a combination of remote and onsite monitoring to ascertain completeness and accuracy of records and by design, SDV is performed on 20% of cases (i.e. ∼11 400 patients). Four performance measures for ranking sites according to data quality and other performance indicators were evaluated (including data quality for 13 quantifiable variables, late data locking, number of missing critical variables, and history of poor data quality from the previous monitoring phase). These criteria facilitated the identification of sites with potentially suboptimal data quality for onsite monitoring. During early phases of the registry, critical variables for data checking were also identified. SDV using these variables (partial SDV in 902 patients) showed similar concordance to SDV of all fields (110 patients): 94.4% vs. 93.1%, respectively. This standard formed the baseline against which ongoing quality improvements were assessed, facilitating corrective action on data quality issues. In consequence, concordance was improved in the next monitoring phase (95.6%; n = 1172). Conclusion: The quality standards in GARFIELD-AF have the potential to inform a future 'reference' for registries.

Published
2017

11. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy

Author

OMMEN SR, MARON BJ, OLIVOTTO I, MARON MS, CECCHI F, GERSH BJ, ACKERMAN MJ, MCCULLY RB, DEARANI JA, SCHAFF HV, DANIELSON GK, TAJIK AJ, NISHIMURA R.A., BETOCCHI, SANDRO, Ommen, Sr, Maron, Bj, Olivotto, I, Maron, M, Cecchi, F, Betocchi, Sandro, Gersh, Bj, Ackerman, Mj, Mccully, Rb, Dearani, Ja, Schaff, Hv, Danielson, Gk, Tajik, Aj, and Nishimura, R. A.

Subjects
Cardiomiopatia ipertrofica
Abstract

OBJECTIVES This study sought to determine the impact of surgical myectomy on long-term survival in hypertrophic cardiomyopathy (HCM).BACKGROUND Left ventricular (LV) outflow tract obstruction in HCM increases the likelihood of heart failure and cardiovascular death. Although surgical myectomy is the primary treatment for amelioration of outflow obstruction and advanced drug-refractory heart failure symptoms, its impact on long-term survival remains unresolved.METHODS Total and HCM-related mortality were compared in three subgroups comprised of 1,337 consecutive HCM patients evaluated from 1983 to 2001: 1) surgical myectomy (n = 289); 2) LV outflow obstruction without operation (n = 228), and 3) nonobstructive (n = 820). Mean follow-up duration was 6 6 years.RESULTS Including two operative deaths (procedural mortality, 0.8%), 1-, 5-, and 10-year overall survival after myectomy was 98%, 96%, and 83%, respectively, and did not differ from that of the general U.S. population matched for age and gender (p = 0.2) nor from patients with nonobstructive HCM (p = 0.8). Compared to nonoperated obstructive HCM patients, myectomy patients experienced superior survival free from all-cause mortality (98%, 96%, and 83% vs. 90%, 79%, and 61%, respectively, p < 0.001), HCM-related mortality (99%, 98%, and 95% vs. 94%, 89%, and 73%, respectively, p < 0.001), and sudden cardiac death (100%, 99%, and 99% vs. 97%, 93%, and 89%, respectively, p = 0.003). Multivariate analysis showed myectomy to have a strong, independent association with survival (hazard ratio 0.43; p < 0.001).CONCLUSIONS Surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. In this retrospective study, septal myectomy seems to reduce mortality risk in severely symptomatic patients with obstructive HCM.

Published
2005

12. Discussion

Author

Gersh Bj

Subjects
medicine.medical_specialty, business.industry, media_common.quotation_subject, MEDLINE, Art history, Historical Article, Biography, Portrait, Internal medicine, Cardiology, medicine, Conversation, Cardiology and Cardiovascular Medicine, business, media_common
Published
1998

13. 2013 ESC guidelines on the management of stable coronary artery disease

Author

Sechtem, U, Achenbach, S, Andreotti, F, Budaj, A, Bugiardini, R, Crea, F, Cuisset, T, di Mario, C (Carlo), Ferreira, JR, Gersh, BJ, Gitt, AK, Hulot, JS, Marx, N, Opie, LH, Pfisterer, M, Prescott, E, Ruschitzka, F, Sabate, M, Senior, R, Taggart, DP, van der Wall, EE, Vrints, CJM, Knuuti, J, Valgimigli, M (Marco), Bueno, H, Claeys, MJ, Donner-Banzhoff, N, Erol, C, Frank, H, Funck-Brentano, C, Gaemperli, O, Gonzalez-Juanatey, JR, Hamilos, M, Hasdai, D, Husted, S, James, SK, Kervinen, K, Kolh, P, Kristensen, SD (Steen), Lancellotti, P, Maggioni, AP, Piepoli, MF, Pries, AR, Romeo, F, Ryden, L, Simoons, Maarten, Sirnes, PA, Steg, PG, Timmis, A, Wijns, W (William), Windecker, S, Yildirir, A, Zamorano, JL, and Cardiology

Abstract

ESC Committee for Practice Guidelines (CPG): Jose Luis Zamorano (Chairperson) (Spain), Stephan Achenbach (Germany), Helmut Baumgartner (Germany), Jeroen J. Bax (Netherlands), He ' ctor Bueno (Spain), Veronica Dean (France), Christi Deaton (UK), Cetin Erol (Turkey), Robert Fagard (Belgium), Roberto Ferrari (Italy), David Hasdai (Israel), ArnoW. Hoes (Netherlands), Paulus Kirchhof (Germany/UK), JuhaniKnuuti (Finland), PhilippeKolh (Belgium), Patrizio Lancellotti (Belgium), Ales Linhart (CzechRepublic), Petros Nihoyannopoulos (UK), Massimo F. Piepoli (Italy), Piotr Ponikowski (Poland), Per Anton Sirnes (Norway), Juan Luis Tamargo (Spain), Michal Tendera (Poland), AdamTorbicki (Poland), WilliamWijns (Belgium), StephanWindecker (Switzerland). Document Reviewers: Juhani Knuuti (CPG Review Coordinator) (Finland), Marco Valgimigli (Review Coordinator) (Italy), Hector Bueno (Spain), Marc J. Claeys (Belgium), Norbert Donner-Banzhoff (Germany), Cetin Erol (Turkey), Herbert Frank (Austria), Christian Funck-Brentano (France), Oliver Gaemperli (Switzerland), JoseR. Gonzalez-Juanatey (Spain), Michalis Hamilos (Greece), David Hasdai (Israel), Steen Husted (Denmark), Stefan K. James (Sweden), Kari Kervinen (Finland), Philippe Kolh (Belgium), Ste

Published
2013

14. The results and indications of acute revascularization in myocardial infarction

Author

Gersh Bj and Solomon Aj

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Electrocardiography in myocardial infarction, General Medicine, medicine.disease, Revascularization, Text mining, Internal medicine, medicine, Cardiology, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Published
1993

15. Left ventricular systolic dysfunction, heart failure, and the risk of stroke and systemic embolism in patients with atrial fibrillation insights from the ARISTOTLE trial

Author

McMurray, JJV, Ezekowitz, JA, Lewis, BS, Gersh, BJ, Van Diepen, S, Amerena, John, Bartunek, J, Commerford, P, Oh, BH, Harjola, VP, Al-Khatib, SM, Hanna, M, Alexander, JH, Lopes, RD, Wojdyla, DM, Wallentin, L, Granger, CB, McMurray, JJV, Ezekowitz, JA, Lewis, BS, Gersh, BJ, Van Diepen, S, Amerena, John, Bartunek, J, Commerford, P, Oh, BH, Harjola, VP, Al-Khatib, SM, Hanna, M, Alexander, JH, Lopes, RD, Wojdyla, DM, Wallentin, L, and Granger, CB

Abstract

Background— We examined the risk of stroke or systemic embolism (SSE) conferred by heart failure (HF) and left ventricular systolic dysfunction (LVSD) in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation Trial (ARISTOTLE), as well as the effect of apixaban versus warfarin. Methods and Results— The risk of a number of outcomes, including the composite of SSE or death (to take account of competing risks) and composite of SSE, major bleeding, or death (net clinical benefit) were calculated in 3 patient groups: (1) no HF/no LVSD (n=8728), (2) HF/no LVSD (n=3207), and (3) LVSD with/without symptomatic HF (n=2736). The rate of both outcomes was highest in patients with LVSD (SSE or death 8.06; SSE, major bleeding, or death 10.46 per 100 patient-years), intermediate for HF but preserved LV systolic function (5.32; 7.24), and lowest in patients without HF or LVSD (1.54; 5.27); each comparison P <0.0001. Each outcome was less frequent in patients treated with apixaban: in all ARISTOTLE patients, the apixaban/warfarin hazard ratio for SSE or death was 0.89 (95% confidence interval, 0.81–0.98; P =0.02); for SSE, major bleed, or death it was 0.85 (0.78–0.92; P <0.001). There was no heterogeneity of treatment effect across the 3 groups. Conclusions— Patients with LVSD (with/without HF) had a higher risk of SSE or death (but similar rate of SSE) compared with patients with HF but preserved LV systolic function; both had a greater risk than patients without either HF or LVSD. Apixaban reduced the risk of both outcomes more than warfarin in all 3 patient groups. Clinical Trial Registration— URL:

Published
2013

16. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology

Author

Montalescot, G, Sechtem, U, Achenbach, S, Andreotti, Felicita, Arden, C, Budaj, A, Bugiardini, R, Crea, Filippo, Cuisset, T, Di Mario, C, Ferreira, Jr, Gersh, Bj, Gitt, Ak, Hulot, J, Marx, N, Opie, Lh, Pfisterer, M, Prescott, E, Ruschitzka, F, Sabaté, M, Senior, R, Taggart, Dp, Van Der Wall, Ee, Vrints, Cjm, Zamorano, Jl, Baumgartner, H, Bax, Jj, Bueno, H, Dean, V, Deaton, C, Erol, C, Fagard, R, Ferrari, R, Hasdai, D, Hoes, Aw, Kirchhof, P, Knuuti, J, Kolh, P, Lancellotti, P, Linhart, A, Nihoyannopoulos, P, Piepoli, Mf, Ponikowski, P, Sirnes, Pa, Tamargo, Jl, Tendera, M, Torbicki, A, Wijns, W, Windecker, S, Valgimigli, M, Claeys, Mj, Donner Banzhoff, N, Frank, H, Funck Brentano, C, Gaemperli, O, Gonzalez Juanatey, Jr, Hamilos, M, Husted, S, James, Sk, Kervinen, K, Kristensen, Sd, Maggioni, Ap, Pries, Ar, Romeo, F, Rydén, L, Simoons, Ml, Steg, Pg, Timmis, A, Yildirir, A, Andreotti, Felicita (ORCID:0000-0002-1456-6430), Crea, Filippo (ORCID:0000-0001-9404-8846), Montalescot, G, Sechtem, U, Achenbach, S, Andreotti, Felicita, Arden, C, Budaj, A, Bugiardini, R, Crea, Filippo, Cuisset, T, Di Mario, C, Ferreira, Jr, Gersh, Bj, Gitt, Ak, Hulot, J, Marx, N, Opie, Lh, Pfisterer, M, Prescott, E, Ruschitzka, F, Sabaté, M, Senior, R, Taggart, Dp, Van Der Wall, Ee, Vrints, Cjm, Zamorano, Jl, Baumgartner, H, Bax, Jj, Bueno, H, Dean, V, Deaton, C, Erol, C, Fagard, R, Ferrari, R, Hasdai, D, Hoes, Aw, Kirchhof, P, Knuuti, J, Kolh, P, Lancellotti, P, Linhart, A, Nihoyannopoulos, P, Piepoli, Mf, Ponikowski, P, Sirnes, Pa, Tamargo, Jl, Tendera, M, Torbicki, A, Wijns, W, Windecker, S, Valgimigli, M, Claeys, Mj, Donner Banzhoff, N, Frank, H, Funck Brentano, C, Gaemperli, O, Gonzalez Juanatey, Jr, Hamilos, M, Husted, S, James, Sk, Kervinen, K, Kristensen, Sd, Maggioni, Ap, Pries, Ar, Romeo, F, Rydén, L, Simoons, Ml, Steg, Pg, Timmis, A, Yildirir, A, Andreotti, Felicita (ORCID:0000-0002-1456-6430), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

N/A

Published
2013

17. Strategies for multivessel revascularization in patients with diabetes

Author

Farkouh, Me, Domanski, M, Sleeper, La, Siami, F, Dangas, G, Mack, M, Yang, M, Cohen, Dj, Rosenberg, Y, Solomon, Sd, Desai, A, Gersh, Bj, Magnuson, Ea, Lansky, A, Boineau, R, Weinberger, J, Ramanathan, K, Sousa, Je, Rankin, J, Bhargava, B, Buse, J, Hueb, W, Smith, Cr, Muratov, V, Bansilal, S, King, S, Bertrand, M, Fuster, V, Massetti, Massimo, Massetti, Massimo (ORCID:0000-0002-7100-8478), Farkouh, Me, Domanski, M, Sleeper, La, Siami, F, Dangas, G, Mack, M, Yang, M, Cohen, Dj, Rosenberg, Y, Solomon, Sd, Desai, A, Gersh, Bj, Magnuson, Ea, Lansky, A, Boineau, R, Weinberger, J, Ramanathan, K, Sousa, Je, Rankin, J, Bhargava, B, Buse, J, Hueb, W, Smith, Cr, Muratov, V, Bansilal, S, King, S, Bertrand, M, Fuster, V, Massetti, Massimo, and Massetti, Massimo (ORCID:0000-0002-7100-8478)

Abstract

In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease.

Published
2012

23. Impact of the presence and extent of incomplete angiographic revascularization after percutaneous coronary intervention in acute coronary syndromes: the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.

Author

Rosner GF, Kirtane AJ, Genereux P, Lansky AJ, Cristea E, Gersh BJ, Weisz G, Parise H, Fahy M, Mehran R, Stone GW, Rosner, Gregg F, Kirtane, Ajay J, Genereux, Philippe, Lansky, Alexandra J, Cristea, Ecaterina, Gersh, Bernard J, Weisz, Giora, Parise, Helen, and Fahy, Martin

Published
2012
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26. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

Author

Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, and Yancy CW

Published
2011
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28. CD34(+) cell infusion after ST elevation myocardial infarction is associated with improved perfusion and is dose dependent.

Author

Quyyumi AA, Waller EK, Murrow J, Esteves F, Galt J, Oshinski J, Lerakis S, Sher S, Vaughan D, Perin E, Willerson J, Kereiakes D, Gersh BJ, Gregory D, Werner A, Moss T, Chan WS, Preti R, Pecora AL, and Quyyumi, Arshed A

Abstract

Background: the objective of the study was to determine whether the effects of infarct-related artery (IRA) infusion of autologous bone marrow-derived CD34(+) cells after ST elevation myocardial infarction (STEMI) are dependent on the dose (quantity and mobility) of the cells infused. Beneficial effects of IRA infusion of mononuclear cells after STEMI have been inconsistent, possibly because of differences in timing, cell type, quantity, and mobility of infused cells.Methods: patients were randomized to bone marrow harvest (n = 16) or control (n = 15). At a median of 8.3 days after coronary stenting for STEMI, CD34(+) cells were infused via the IRA at 3 dose levels (5, 10, and 15 × 10(6)) in cohorts of 5 patients each. Baseline and follow-up imaging and ex vivo CD34(+) cell mobility were performed.Results: Cell harvest and infusion were safe. Quantitative rest hypoperfusion score measured by single-photon emission computed tomography improved at 6 months in the ≥ 10 million cohorts compared with controls (-256 vs +14, P = .02). There was a trend toward improved ejection fraction at 6 months (+4.5%) in the ≥ 10 million cohorts compared with no change in the controls and 5 million cohort (+0.7%). Improved perfusion and infarct size reduction correlated with the quantity and mobility of the infused CD34(+) cells.Conclusions: the effects of CD34(+) cell IRA infusion during the repair phase after STEMI are dose dependent and, at a threshold dose of 10 million CD34(+) cells, associated with a significant improvement in perfusion that may limit deterioration in cardiac function (IRA infusion of CD34(+) cells in patients with acute myocardial infarction [AMR-01] NCT00313339). [ABSTRACT FROM AUTHOR]

Published
2011
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32. Cardiac cell repair therapy: a clinical perspective.

Author

Gersh BJ, Simari RD, Behfar A, Terzic CM, Terzic A, Gersh, Bernard J, Simari, Robert D, Behfar, Atta, Terzic, Carmen M, and Terzic, Andre

Abstract

From bone marrow transplants 5 decades ago to the most recent stem cell-derived organ transplants, regenerative medicine is increasingly recognized as an emerging core component of modern practice. In cardiovascular medicine, innovation in stem cell biology has created curative solutions for the treatment of both ischemic and nonischemic cardiomyopathy. Multiple cell-based platforms have been developed, harnessing the regenerative potential of various natural and bioengineered sources. Clinical experience from the first 1000 patients (approximately) who have received stem cell therapy worldwide indicates a favorable safety profile with modest improvement in cardiac function and structural remodeling in the setting of acute myocardial infarction or chronic heart failure. Further investigation is required before early adoption and is ongoing. Broader application in practice will require continuous scientific advances to match each patient with the most effective reparative phenotype, while ensuring optimal cell delivery, dosing, and timing of intervention. An interdisciplinary effort across the scientific and clinical community within academia, biotechnology, and government will drive the successful realization of this next generation of therapeutic agents for the "broken" heart. [ABSTRACT FROM AUTHOR]

Published
2009
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39. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial.

Author

Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM, Molhoek P, Verheugt FW, Gersh BJ, McCabe CH, and Braunwald E

Published
2007

45. Addendum to 'Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations: a medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology': public safety issues in patients with implantable defibrillators: a scientific statement from the American Heart Association and the Heart Rhythm Society.

Author

Epstein AE, Baessler CA, Curtis AB, Estes NA 3rd, Gersh BJ, Grubb B, Mitchell LB, and American Heart Association

Published
2007

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