Established data describing the optimal duration of dual antiplatelet therapy (DAPT) after endovascular therapy (EVT) for patients with peripheral artery disease (PAD) are limited. This study is a prospective, multi-center single-arm study evaluating 1-month DAPT on clinical outcomes following EVT using drug-coated balloon (DCB) for patients with symptomatic femoropopliteal artery (FPA) disease. A total of 151 patients with de novo FPA lesions which planned DCB therapy were enrolled from seven centers. DAPT (aspirin 100 mg/day and clopidogrel 75 mg/day) was started prior to EVT and continued 1-month after EVT, and subsequent aspirin monotherapy was continued during follow-up period. The primary endpoint was 1-year primary patency, as assessed by duplex ultrasound. Secondary endpoints included re-occlusion, target lesions revascularization (TLR), major amputation, acute limb ischemia (ALI), and bleeding events at one year. Mean age was 74.6 ± 8.8 and critical limb ischemia were observed in 48 patients (31.8
Soluble T-cadherin (sT-cad), which is a circulating form of membrane T-cadherin, is present in human serum. We examined the relationships among sT-cad levels, adiponectin (APN) levels, and the number of metabolic risk factors in individuals undergoing medical health checkups. A total of 1,144 Japanese individuals (811 males and 333 females, average age: 56.3 ± 9.9 years in males and 53.7 ± 10.1 years in females) were analyzed. Serum levels of sT-cad and APN were measured by enzyme-linked immunosorbent assay (ELISA). Associations of sT-cad and APN levels with the number of metabolic risk factors (abdominal obesity, diabetes, hypertension, and dyslipidemia) were evaluated. Serum 130-kDa sT-cad levels were significantly lower in males than in females, and were positively correlated with APN levels. Individuals with low APN levels exhibited more metabolic risk factors. Notably, among males with high APN levels, those with low 130-kDa sT-cad levels had a greater number of metabolic risk factors than those with high 130-kDa sT-cad levels. Serum 130-kDa sT-cad levels were significantly correlated with APN levels in individuals undergoing medical health checkups. Even among males with high APN levels, low sT-cad levels were indicative of the presence of more metabolic risk factors.
Background Transcatheter aortic valve replacement (TAVR) recipients frequently have an indication for long-term oral anticoagulation, including atrial fibrillation or systemic thromboembolic disease. It remains unclear if there are differences in safety and effectiveness between direct oral anticoagulants (DOAC) and warfarin in this patient population. Methods Clinical outcomes were compared between TAVR recipients receiving DOACs or warfarin using data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry linked with Centers for Medicare & Medicaid Services claims data. The analysis included patients from the TVT registry who underwent successful TAVR and were discharged on either a DOAC or warfarin between January 2013 and May 2018. The primary outcome was any bleeding requiring hospitalization from discharge to 1 year. Secondary outcomes included all-cause mortality and stroke from discharge to 1 year. Multivariable Cox proportional hazards regression models were used to compare these outcomes between the 2 groups. Results A total of 29,142 patients underwent TAVR and were discharged on oral anticoagulation, among whom 10,973 (37.7%) were discharged on a DOAC. The use of DOACs increased throughout the study period and exceed the use of warfarin by the final year (2018). The cumulative incidence of bleeding requiring hospitalization at 1 year (11.8% vs 15.2%, P < . 001) and all-cause mortality (15.5% vs 17.5%, P < . 001) was significantly lower in DOAC group while stroke (2.47% vs 2.39%, P = . 64) was not statistically different between groups. In an adjusted model, the use of a DOAC as opposed to warfarin was associated with a significantly lower risk of bleeding requiring hospitalization (adjusted hazard ratio 0.49, 95% confidence interval 0.43-0.56), all-cause mortality (adjusted hazard ratio 0.61, 95% confidence interval 0.57-0.66), and stroke (adjusted hazard ratio 0.86, 95% confidence interval 0.81-0.92) (all P < . 001). Conclusions In this analysis of TAVR recipients discharged on oral anticoagulation in a large U.S. registry, the use of a DOAC rather than warfarin was associated with a lower risk of bleeding requiring hospitalization, all-cause mortality, and stroke from discharge to 1 year. Future randomized studies will be necessary to establish the optimal choice of anticoagulant
Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel’s circumferential or > 270° visualization along > 70
