The American journal of cardiology
-
Comparative Study
A common variant on chromosome 4q25 is associated with prolonged PR interval in subjects with and without atrial fibrillation.
Single nucleotide polymorphisms (SNPs) at chromosome 4q25 (near PITX2) are strongly associated with atrial fibrillation (AF). We assessed whether a 4q25-tagging SNP (rs2200733) is associated with PR interval duration in patients with lone and typical AF and controls. Patients with lone (n = 169) and typical (n = 269) AF enrolled in the Vanderbilt AF registry and controls (n = 1,403) derived from the Vanderbilt DNA Biobank were studied. ⋯ After adjustment for covariates, the association between T allele and PR prolongation persisted, with mean effect size of 10.9, 12.8, and 4.4 ms for patients with lone and typical AF and controls, respectively (p <0.05 for each comparison). We found that a common 4q25 AF susceptibility allele (rs2200733) is associated with PR interval prolongation in patients with lone and typical AF and controls with no AF. Given that prolonged PR interval is an established risk factor for AF, this observation, in the context of previously described functional effects of PITX2 deficiency, provides further knowledge about the pathophysiological link of 4q25 variants with AF.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Impact of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial).
A periprocedural myocardial infarction, defined as the advent of new Q-waves or a creatine kinase-MB elevation >83 normal has been previously validated as predictive of subsequent mortality. We examined the effects of using this clinically relevant definition of periprocedural myocardial infarction instead of the original protocol definition on outcomes in the recent PROTECT II [A Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump (IABP) in Patients Undergoing Non Emergent High Risk PCI] trial. In this trial, patients who were undergoing high-risk percutaneous coronary intervention (PCI) were randomized to either an intraaortic balloon pump (IABP, n[211) or a left ventricular assist device (Impella, n[216). ⋯ There were no differences in death or large myocardial infarction between the 2 arms. By multivariable analysis, treatment with Impella as opposed to IABP was an independent predictor for freedom from MAE (odds ratio[0.75 [95% confidence interval 0.61 to 0.92], p[0.007) andMACCE (odds ratio[0.76 [95% confidence interval 0.61 to 0.96], p[0.020) at 90 days postprocedure. In conclusion, hemodynamic support with Impella compared with IABP during high-risk PCI in the PROTECT-II trial resulted in improved event-free survival at 3-month follow-up; this finding was further supported by multivariate analyses.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] trial).
Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with ST-segment elevation myocardial infarctions. ⋯ Compared with patients without AF after PCI, patients with new-onset AF had higher 3-year rates of net adverse clinical events (46.5% vs 25.7%, p <0.0001), mortality (11.9% vs 6.3%, p = 0.01), reinfarction (16.4% vs 7.0%, p <0.0001), stroke (5.8% vs 1.5%, p <0.0001), and major bleeding (20.9% vs 8.2%, p <0.0001). By multivariate analysis, new-onset AF after PCI was a powerful independent predictor of net adverse clinical events (hazard ratio 1.74, 95% confidence interval 1.30 to 2.34, p = 0.0002) and major adverse cardiac events (hazard ratio 1.73, 95% confidence interval 1.27 to 2.36) at 3 years. In conclusion, new-onset AF after PCI for ST-segment elevation myocardial infarction was associated with markedly higher rates of adverse events and mortality.
-
Multicenter Study Comparative Study
Impact of patients' arrival time on the care and in-hospital mortality in patients with non-ST-elevation myocardial infarction.
Only a few studies have focused on the clinical characteristics and outcomes of non-ST-segment myocardial infarction (NSTEMI) during off-hours. The purpose of this study was to compare the impact of patients' arrival time on the care of NSTEMI and whether this pattern might affect hospital mortality. This study analyzed 4,736 NSTEMI patients included in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. ⋯ Although unadjusted hospital mortality was associated with admission during off-hours (4.5% vs 3.3%, p = 0.023), after adjusting for all patients covariates, the difference in mortality was attenuated and was no longer statistically significant (odds ratio 0.94, 95% confidence interval 0.59 to 1.48, p = 0.793). In conclusion, despite receiving fewer PCIs and having substantially longer waiting times to PCI, patients admitted during off-hours may not be at risk for increased in-hospital mortality. If patients are treated within an appropriate reperfusion strategy according to their clinical risk, arrival time may not influence on mortality.
-
Comparative Study
Relations of plasma total and high-molecular-weight adiponectin to new-onset heart failure in adults ≥65 years of age (from the Cardiovascular Health study).
Adiponectin exhibits cardioprotective properties in experimental studies, but elevated levels have been linked to increased mortality in older adults and patients with chronic heart failure (HF). The adipokine's association with new-onset HF remains less well defined. The aim of this study was to investigate the associations of total and high-molecular weight (HMW) adiponectin with incident HF (n = 780) and, in a subset, echocardiographic parameters in a community-based cohort of adults aged ≥65 years. ⋯ Results were similar for HMW adiponectin. In conclusion, total and HMW adiponectin showed comparable relations with incident HF in this older cohort, with a threshold effect of increasing risk occurring at their median concentrations. High levels of adiponectin may mark or mediate age-related processes that lead to HF in older adults.