Background: Meticulous implantation strategies (i.e. lesion predilatation, stent sizing and postdilatation) are known to decrease lesion-oriented adverse events (LOCE) following percutaneous coronary intervention (PCI) with bioresorbable scaffolds.
View Article and Find Full Text PDFBackground: Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI.
View Article and Find Full Text PDFCirc Arrhythm Electrophysiol
December 2024
Objectives: To evaluate real-time (day-to-day) adaptation of randomized controlled trials (RCTs) with delayed endpoints - a "forward-looking optimal-experimentation" form of response-adaptive randomization. To identify the implied tradeoffs between lowered mortality, CIs, statistical power, potential arm misidentification, and endpoint rate change during the trial.
Study Design And Setting: Using data from RCTs in acute myocardial infarction (30,732 patients in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries, GUSTO-1) and coronary heart disease (12,218 patients in the EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease, EUROPA), we resample treatment-arm assignments and expected endpoints to simulate (1) real-time assignment, (2) forward-looking assignments adapted after observing a fixed number of patients ("blocks"), and (3) a variant that balances RCT and real-time assignments.
Eur J Heart Fail
November 2024
Aims: Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). Cardiovascular mortality, driven by sudden cardiac death, is the main reason for dying while waiting for heart transplantation (HTx). The purpose of the Preventive Catheter Ablation for ventricular arrhythmiaS in patients with end-sTage heart faiLure rEferred for heart transplantation eValuaTion (CASTLE-VT) trial is to test the hypothesis that prophylactic catheter ablation of arrhythmogenic ventricular scar tissue will reduce mortality, need for LVAD implantation, and urgent HTx in patients with end-stage HF related to ischaemic cardiomyopathy (ICM).
View Article and Find Full Text PDFAims: Inflammatory lipoprotein(a) [Lp(a)] and oxidized phospholipids (OxPLs) on lipoproteins convey residual cardiovascular disease risk. The LoDoCo2 (low-dose colchicine 2) trial showed that colchicine reduced the risk for cardiovascular events occurring on standard therapies in patients with chronic coronary disease (CCS). We explored the effects of colchicine on Lp(a) and oxidized lipoprotein associated risk in a LoDoCo2 biomarker subpopulation.
View Article and Find Full Text PDFBackground: The Low Dose Colchicine 2 (LoDoCo2) trial randomized 5,522 patients with chronic coronary disease to colchicine 0.5mg daily or placebo in a 1:1 ratio and demonstrated the cardiovascular benefits of colchicine. In the trial, which was conducted in Australia and The Netherlands, a prespecified subgroup analysis suggested a difference in magnitude of treatment effect of colchicine by region (Australia: HR 0.
View Article and Find Full Text PDFAims: Digoxin is the oldest drug in cardiovascular (CV) medicine, and one trial conducted >25 years ago showed a reduction in heart failure (HF) hospitalizations but no effect on mortality. However, later studies suggested that the dose of digoxin used in that trial (and other studies) may have been too high. The DECISION (Digoxin Evaluation in Chronic heart failure: Investigational Study In Outpatients in the Netherlands) trial will examine the efficacy and safety of low-dose digoxin in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with a background of contemporary HF treatment.
View Article and Find Full Text PDFBackground: The CASTLE-HTx trial demonstrated the benefit of atrial fibrillation (AF) ablation compared with medical therapy in decreasing mortality, need for left ventricular assist device implantation, or heart transplantation (HTx) in patients with end-stage heart failure (HF).
Objective: This analysis aimed to identify risk factors related to adverse outcomes in patients with end-stage HF and to assess the impact of ablation.
Methods: The CASTLE-HTx protocol randomized 194 patients with end-stage HF and AF to ablation vs medical therapy.
Introduction: Long-term endurance exercise is suspect to elevate the risk of atrial fibrillation (AF), but little is known about cardiovascular outcome and disease progression in this subgroup of AF patients. We investigated whether previous exercise level determines cardiovascular outcome.
Methods: In this post hoc analysis of the RACE 4 randomized trial, we analyzed all patients with a completed questionnaire on sports participation.
Eur Heart J Qual Care Clin Outcomes
January 2025
Aims: Recent trials have shown that low-dose colchicine (0.5 mg once daily) reduces major cardiovascular events in patients with acute and chronic coronary syndromes. We aimed to estimate the cost-effectiveness of low-dose colchicine therapy in patients with chronic coronary disease when added to standard background therapy.
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