Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease最新文献

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}