BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

This anatomical-physiological study was undertaken to determine the suitability of the sheep for studies of the bronchial circulation. We designated the terminal portion of the bronchoesophageal artery, which runs to the trachea at the carina, as the "carinal" artery. Postmortem injections of india ink (9 sheep) and Batson's solution (4 sheep) into the carinal artery showed that the carinal artery supplied the bronchi of all lobes except the right apical lobe; the mass of the lung containing bronchi perfused represented 88 +/- 1% of total lung mass. Communications were also found between branches of the carinal artery and branches of the systemic arteries supplying the visceral pleura. In three of six sheep, the carinal artery wedge pressure measured in vivo indicated that patent collaterals were present, but that their incidence is variable. In additional postmortem casts of the aorta made in four sheep after ligation of the carinal artery, the bronchial microcirculation was not entered by the perfusing medium. These data indicate that the collaterals do not contribute significantly to bronchial blood flow and that the carinal artery is the major source of bronchial blood flow in the sheep. In 19 sheep, carinal artery flow, measured electromagnetically, was 0.46 +2- 0.09 ml . min-1 . kg body wt-1. Bronchial blood flow normalized for the weight of the lobes in which bronchi perfused by the carinal artery were located was 3.97 +/- 0.48 ml . min-1 . 100 g lung-1 (n = 11); carinal artery blood flow was 0.39 +/- 0.03% of cardiac output (n = 5). During the 90 min of observation, at normal aortic blood pressure (103 +/- 3.4 Torr), carinal artery blood flow was stable. In conclusion, determination of carinal artery blood flow affords a reliable approach to the bronchial circulation in the sheep.

Background-Because saphenous vein grafts (SVGs) exhibit greater cellular heterogeneity and worse clinical outcomes than arterial grafts (AGs), we examined oxidative stress and lipid retention in different vascular conduits. Methods and Results-In a porcine model of graft interposition into carotid artery, superoxide anion (⅐O 2 Ϫ ) was measured at 2 weeks after surgery. SVGs demonstrated increased ⅐O 2 Ϫ production compared with AGs (SOD-inhibitable nitro blue tetrazolium reduction, PϽ0.01). The NAD(P)H oxidase inhibitor diphenyleneiodonium (PϽ0.01) abolished SVGderived ⅐O 2 Ϫ , whereas the inhibitors of other pro-oxidant enzymes were ineffective. The change in oxidative stress was also reflected by lower activity of the endogenous antioxidant superoxide dismutase in SVGs than in AGs (PϽ0.001). SVG remodeling was associated with increased synthesis of sulfated glycosaminoglycans and augmented expression of a core protein, versican. These changes were accompanied by SVGs retaining significantly more 125 I-labeled LDL than AGs ex vivo (PϽ0.001). In hyperlipemic animals, lipid accumulation and oxidized epitopes were preferentially noted in the intima of SVGs at 1 month after surgery. Conclusions-This study demonstrated significant differences in the biology of SVGs and AGs. SVGs exhibited higher oxidative stress, LDL accumulation, and the presence of oxidized epitopes. These findings suggest that proatherogenic changes in SVGs may commence early after surgical revascularization.

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