J. Brent Muhlestein

Warfarin Is Not Needed in Low‐Risk Patients Following Atrial Fibrillation Ablation Procedures

Background: The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low‐risk patients.

Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians

Background: Radiofrequency ablation is an effective treatment for atrial fibrillation (AF). With improved safety, the therapy has been offered to increasingly older populations. Arrhythmia mechanisms, medical comorbidities, and safety may vary in the very elderly population.

Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes

BACKGROUND Many patients who develop atrial fibrillation (AF) will experience a worsening of their arrhythmia over time. The optimal time to proceed with catheter ablation during the disease course is unknown. Further, whether delays in treatment will negatively influence outcomes is unknown. OBJECTIVE The purpose of this study was to examine the impact of delay in treatment after the first clinical diagnosis of AF on ablation-related outcomes. METHODS A total of 4535 consecutive patients who underwent an AF ablation procedure that had long-term established care within an integrated health care system were evaluated. Recursive partitioning was used to determine categories associated with changes in risk from the time of first AF diagnosis to first AF ablation: 1: 30-180 (n = 1152), 2: 181-545 (n = 856), 3: 546-1825 (n = 1326), and 4: >1825 (n = 1201) days. Outcomes evaluated include 1-year AF recurrence, stroke, heart failure hospitalization, and death. RESULTS With increasing time to treatment, surprisingly patients were older (1: 63.7 ± 11.1, 2: 62.6 ± 11.8, 3: 66.4 ± 10.2, 4: 67.6 ± 9.7; P <.0001) and had more hypertension (1: 53.0%, 2: 59.0%, 3: 53.8%, 4: 39.0%; P <.0001). For each strata of time increase, there was a direct increase of 1-year AF recurrence (1: 19.4%, 2: 23.4%, 3: 24.9%, 4: 24.0%: P trend = .02). After adjustment, clinically significant differences in risk of recurrent AF were found when compared to the 30-180 day time category: 181-545: odds ratio (OR) = 1.23, P = .08; 546-1825: OR = 1.27, P = .02; and >1825: OR = 1.25, P = .05. No differences were observed for 1-year stroke among the groups. Death (1: 2.1%, 2: 3.9%, 3: 5.7%, 4: 4.4%: P trend = .001) and heart failure hospitalization (1: 2.6%, 2: 4.1%, 3: 5.4%, 4: 4.4%; P trend = .009) rates at 1 year were higher in the most delayed groups. CONCLUSION Delays in treatment with catheter ablation impact procedural success rates independent of temporal changes to the AF subtype at ablation.

Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study.

Background and objectives We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice. Methods PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90 days, a composite of all‐cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel. Results Of 19,914 patients (mean age 64.4 years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel‐treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90 days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50‐0.67, P < .0001) and bleeding (1.9% vs 2.9%, HR 0.65, 95% CI 0.51‐0.83, P < .001). After propensity stratification, associations were attenuated and no longer significant for either outcome. Results remained consistent using different approaches to adjusting for potential confounders. Conclusions In contemporary clinical practice, patients receiving prasugrel tend to have a lower‐risk profile compared with those receiving clopidogrel. The lower ischemic and bleeding events associated with prasugrel use were no longer evident after accounting for these baseline differences.

GLYCA AND GLYCB, NOVEL NMR BIOMARKERS OF INFLAMMATION, STRONGLY PREDICT FUTURE CARDIOVASCULAR EVENTS, BUT NOT THE PRESENCE OF CORONARY ARTERY DISEASE (CAD), AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY: THE INTERMOUNTAIN HEART COLLABORATIVE STUDY

GlycA and GlycB are novel nuclear magnetic resonance spectroscopy (NMR) signals in plasma arising from the glycosylation of circulating acute phase proteins, especially fibrinogen, a1-antichymotrypsin, haptoglobin-1, a1-antitrypsin, complement C3 and a1-acid glycoprotein. These acute phase proteins

BOTH THE NOVEL NMR BIOMARKER OF INFLAMMATION, GLYCA, AND HS-CRP ARE INDEPENDENT AND ADDITIVE PREDICTORS OF FUTURE CARDIOVASCULAR EVENTS AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY: RESULTS FROM THE INTERMOUNTAIN HEART COLLABORATIVE STUDY

Background: GlycA, a novel marker of inflammation, has been associated with future CV risk among patients with or without pre-existing coronary artery disease (CAD). Whether GlycA is an independent and additive predictor of high sensitivity C-reactive protein (HS-CRP) needs further study. Methods:

DIFFERENTIAL ASSOCIATION OF HIGH-DENSITY LIPOPROTEIN PARTICLE SUBCLASSES AND GLYCA, A NOVEL INFLAMMATORY MARKER, IN PREDICTING CARDIAC DEATH AMONG PATIENTS UNDERGOING ANGIOGRAPHY: THE INTERMOUNTAIN HEART COLLABORATIVE STUDY

HDL particle (HDL-P) concentrations are comprised of particles that vary in size and composition, and potentially, in risk prediction. Inflammation is known to modulate HDL function. Whether increased inflammation alters associations of HDL subclasses with CAD needs further study. Pts (N=2,848) of

TCT-271 Sex-related differences in outcomes after percutaneous coronary intervention (PCI) in patients with diabetes presenting with acute coronary syndrome (ACS): Results from the PROMETHEUS study

While overall mortality in cardiovascular disease has declined, some groups such as females with diabetes are still at increased risk for worse outcome after ACS. We aimed to compare 1-year outcomes between female and male ACS patients after PCI stratified by the presence of diabetes mellitus (DM

TCT-221 Predictors of optimal medical therapy on discharge after percutaneous coronary intervention for acute coronary syndrome: An analysis of the PROMETHEUS registry.

TCT-221 Predictors of optimal medical therapy on discharge after percutaneous coronary intervention for acute coronary syndrome: An analysis of the PROMETHEUS registry Serdar Farhan, Usman Baber, Jaya Chandrasekhar, Samantha Sartori, Melissa Aquino, Gennaro Giustino, Annapoorna Kini, William Weintraub, Sunil Rao, Samir Kapadia, Sandra Weiss, Craig Strauss, Catalin Toma, J. Brent Muhlestein, Anthony DeFranco, Mark Effron, Stuart Keller, Brian Baker, Stuart Pocock, Timothy Henry, Roxana Mehran Icahn School of Medicine at Mount Sinai; Mount Sinai Medical Center, New York, New York, United States; Mount Sinai Hospital, New York, New York, United States; The Icahn School of Medicine at Mount Sinai, New York, New York, United States; Mount Sinai Medical Center; The Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, United States; Unknown, New York, New York, United States; Christiana Care Health Services, Newark, Delaware, United States; Duke University Medical Center, Chapel Hill, North Carolina, United States; Cleveland Clinic, Cleveland, Ohio, United States; Christiana Care, Glen Mills, Pennsylvania, United States; National Heart Foundation Hospital and Research Institue; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Intermountain Medical Center, Murray, Utah, United States; Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; Ochsner Medical Center, New Orleans, Louisiana, United States; Eli Lilly and Company, Indianapolis, Indiana, United States; Daiichi Sankyo, Inc., Parsippany, New Jersey, United States; London School of Hygiene and Tropical Medicine, London, United Kingdom; Cedars Sinai Heart Institute, Los Angeles, California, United States; Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States

TCT-105 Prevalence of prasugrel use and associations between type of acute coronary syndrome and 1-year clinical outcomes.

TCT-105 Prevalence of prasugrel use and associations between type of acute coronary syndrome and 1-year clinical outcomes Asim Rafique, Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Samir Kapadia, Sunil Rao, J. Brent Muhlestein, Catalin Toma, Craig Strauss, William Weintraub, Sandra Weiss, Anthony DeFranco, Stuart Pocock, Mark Effron, Stuart Keller, Brian Baker, Annapoorna Kini, Roxana Mehran, Timothy Henry Cedars-Sinai Medical Center, Los Angeles, California, United States; Mount Sinai Hospital, New York, New York, United States; Mount Sinai Medical Center, New York, New York, United States; The Icahn School of Medicine at Mount Sinai, New York, New York, United States; Mount Sinai Medical Center; Cleveland Clinic, Cleveland, Ohio, United States; Duke University Medical Center, Chapel Hill, North Carolina, United States; Intermountain Medical Center, Murray, Utah, United States; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; National Heart Foundation Hospital and Research Institue; Christiana Care Health Services, Newark, Delaware, United States; Christiana Care, Glen Mills, Pennsylvania, United States; Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; London School of Hygiene and Tropical Medicine, London, United Kingdom; Ochsner Medical Center, New Orleans, Louisiana, United States; Eli Lilly and Company, Indianapolis, Indiana, United States; Daiichi Sankyo, Inc., Parsippany, New Jersey, United States; Unknown, New York, New York, United States; Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; Cedars Sinai Heart Institute, Los Angeles, California, United States BACKGROUND Prasugrel is a potent antiplatelet agent with limited uptake due to bleeding concerns. Comparison of clinical outcomes by type of acute coronary syndrome (ACS) can guide treatment strategies. We compared the associations between prasugrel or clopidogrel use for all clinical outcomes by type and severity of ACS.