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.
Patients with IBS appear to experience symptoms that may be the result of changes in ANS functioning. HRV measures in clinical routine may allow assessing these changes, but further studies performed in a standardized fashion should improve the validity of HRV measures for clinical research first.
Abstract. Wellens’ syndrome is an extremely relevant issue in modern cardiology. Wellens’ syndrome is quite often untimely diagnosed, and the patient’s management is the same as in case of unstable angina. Since without myocardial revascularization, widespread myocardial infarction develops within the following days or weeks, myocardial revascularization is needed as soon as possible. Characteristic changes on the electrocardiogram in case of Wellens’ syndrome include biphasic (type A) or inverted (type B) T waves in leads V2-V3, which sometimes are seen in other precordial leads. There must be a history of recent angina in addition to these electrocardiogram changes. Troponin is usually negative; however, it can be slightly elevated. Sometimes, patients with classic electrocardiogram changes and clinical picture typical for Wellens’ syndrome do not show hemodynamically significant stenosis of the left anterior descending artery typical for this syndrome. In such cases, “pseudo-Wellens’ syndrome” is observed. Three cases of angiographically confirmed Wellens’ syndrome and one case of pseudo-Wellens’ syndrome are presented in this paper. All the patients with Wellens’ syndrome had significant lesions of the left anterior descending artery. One patient had a triple-vessel lesion, and the other two had a single-vessel lesion. Troponin I was within normal limits in one patient, and slightly elevated and in the other two. These patients underwent successful myocardial revascularization (percutaneous coronary intervention); pharmacological therapy was prescribed.
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