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  • 1
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    Online Resource
    Abstract 15366: Cancer Diagnosis Following Bleeding in Patients With Atrial Fibrilation Undergoing Anticoagulation Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Bleeding is frequent in patients with atrial fibrillation (AF) undergoing oral anticoagulation (OAC), and may be the first manifestation of underlying cancer. OAC could be usefull as a screening tool to unveil an occult cancer and enhance early diagnosis. Hypothesis: We aim to analyze whether bleeding represents an useful tool to unmasking an occult cancer in AF patients treated with OAC. Methods: We used a cohort including all patients ≥ 75 years-old from the health area of Vigo (Galicia, Spain) with AF between 2014 and 2017 (CardioCHUVI-AF_75 registry). Results: Of 8,753 AF patients evaluated (mean age, 82.7 years; women, 61.7%), 2,171 (24.8%) experienced any (major or non-major) bleeding and 479 (5.5%) were diagnosed with cancer (mean follow-up of 3 years). Among 2,171 who experienced bleeding, 198 (9.1%) were diagnosed with cancer. Patients with bleeding have a 3-fold higher risk of new cancer diagnosis compared with those without bleeding (4.7 per 100 patient/year vs1.4 per 100/patients year; hazard ratio [HR]: 3,72 [95% CI 3.05-4.55] ). Gastrointestinal bleeding was associated with a 13-fold higher hazard of new gastrointestinal cancer diagnosis (HR 13.44 [95% CI 9.11-19.85]). Genitourinary bleeding was associated with an 18-fold higher hazard of new genitourinary cancer diagnosis (HR 18.11 [95% CI 12.52-26.20] ). And bronchopulmonary bleeding was associated with a 15-fold higher hazard of new bronchopulmonary cancer diagnosis (HR 15.78 [95% CI 6.03-41.28]). For those other bleeding (non-gastrointestinal, non-genitourinary, non-bronchopulmonary), the HR for cancer was 2.31 (95% CI 1.47-3.64). Conclusions: Any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis in AF patients undergoing OAC. These bleeding events behave as an useful screening tool and should encourage prompt investigation for underlying cancers at those sites.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.15366
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 2
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    BleeMACS : rationale and design of the study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of Cardiovascular Medicine Vol. 17, No. 10 ( 2016-10), p. 744-749
    Details
    In: Journal of Cardiovascular Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 17, No. 10 ( 2016-10), p. 744-749
    Type of Medium: Online Resource
    ISSN: 1558-2027
    URL: Article
    DOI: 10.2459/JCM.0000000000000362
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 3
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    Prognostic impact of anemia according to frailty status in elderly patients with acute coronary syndromes
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Cardiovascular Medicine Vol. 21, No. 1 ( 2020-01), p. 27-33
    Details
    In: Journal of Cardiovascular Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 1 ( 2020-01), p. 27-33
    Abstract: Anemia is associated with poorer outcomes in patients with acute coronary syndromes (ACS), but the magnitude of this association in elderly patients remains poorly understood. No study has assessed the prognostic impact of anemia according to frailty status in this setting. Methods The LONGEVO-SCA registry included unselected ACS patients aged at least 80 years. A geriatric assessment was performed during hospitalization, including frailty assessment using the FRAIL scale. Anemia was defined by the WHO criteria. We evaluated the impact of anemia on 6-month mortality according to the presence of frailty. Results A total of 517 patients were assessed. Mean age was 84.3 years, and a total of 236 patients (45.6%) had anemia. Patients with anemia had a higher prevalence of comorbidities and higher prevalence of frailty (30.6 vs. 22.3%, P  = 0.007). A total of 60 patients (12.1%) died at 6 months [40 with anemia (17.5%) and 20 without anemia (7.5%), P  = 0.001]. Anemia was independently associated with mortality at 6 months in the whole cohort (hazard ratio 2.28, 95% CI 1.13–457, P  = 0.021). The association of anemia and mortality was different according to frailty status, being significant in patients without frailty (hazard ratio 3.94, 95% CI 1.84–8.45, P  = 0.001), but not in frail patients (hazard ratio 1.17, 95% CI 0.53–2.57, P  = 0.705), ( P value for interaction = 0.035). Conclusion A high proportion of elderly patients with ACS have anemia, leading to a worse prognosis in the whole cohort. The association between anemia and mortality was especially significant in robust patients, whereas the poorer prognosis in frail patients was not modified by the presence of anemia.
    Type of Medium: Online Resource
    ISSN: 1558-2027 , 1558-2035
    URL: Article
    DOI: 10.2459/JCM.0000000000000884
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of the American Heart Association Vol. 9, No. 22 ( 2020-11-17)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 22 ( 2020-11-17)
    Abstract: Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI‐AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow‐up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3‐fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient‐years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6–3.9] ). Gastrointestinal bleeding was associated with a 13‐fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1–19.8); genitourinary bleeding was associated with an 18‐fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5–26.2); and bronchopulmonary bleeding was associated with a 15‐fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0–41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5–3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.120.016836
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non–ST-Segment Elevation Acute Myocardial Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation Vol. 121, No. 22 ( 2010-06-08), p. 2419-2426
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 121, No. 22 ( 2010-06-08), p. 2419-2426
    Abstract: Background— The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) model provides a risk score that predicts the likelihood of major bleeding in patients hospitalized for non–ST-elevation acute myocardial infarction. The aim of the present work was to evaluate the performance of this model in a contemporary cohort of patients hospitalized for non–ST-elevation acute myocardial infarction in Spain. Methods and Results— The study subjects were 782 consecutive patients admitted to our center between February 2004 and June 2009 with non–ST-elevation acute myocardial infarction. For each patient, we calculated the CRUSADE risk score and evaluated its discrimination and calibration by the C statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The performance of the CRUSADE risk score was evaluated for the patient population as a whole and for groups of patients treated with or without ≥2 antithrombotic medications and who underwent cardiac catheterization or not. The median CRUSADE score was 30 points (range, 18 to 45). A total of 657 patients (84%) were treated with ≥2 antithrombotic, of whom 609 (92.7%) underwent cardiac catheterization. The overall incidence of major bleeding was 9.5%. This incidence increased with the risk category: very low, 1.5%; low, 4.3%; moderate, 7.8%; high, 11.8%; and very high, 28.9% ( P 〈 0.001). For the patients as a whole, for the groups treated with or without ≥2 antithrombotics, and for the subgroup treated with ≥2 antithrombotics who did or did not undergo cardiac catheterization, the CRUSADE score showed adequate calibration and excellent discriminatory capacity (Hosmer-Lemeshow P 〉 0.3 and C values of 0.82, 0.80, 0.70, and 0.80, respectively). However, it showed little capacity to discriminate bleeding risk in patients treated with ≥2 antithrombotics who did not undergo cardiac catheterization (C=0.56). Conclusions— The CRUSADE risk score was generally validated and found to be useful in a Spanish cohort of patients treated with or without ≥2 antithrombotics and in those treated with or without ≥2 antithrombotics who underwent cardiac catheterization. More studies are needed to clarify the validity of the CRUSADE score in the subgroup treated with ≥2 antithrombotics who do not undergo cardiac catheterization.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.109.925594
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 6
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    Tobacco, illicit drugs use and risk of cardiovascular disease in patients living with HIV
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Current Opinion in HIV and AIDS Vol. 12, No. 6 ( 2017-11), p. 523-527
    Details
    In: Current Opinion in HIV and AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 6 ( 2017-11), p. 523-527
    Type of Medium: Online Resource
    ISSN: 1746-630X
    URL: Article
    DOI: 10.1097/COH.0000000000000407
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 7
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    Abstract 10623: Validation of Embolic and Bleeding Risk Scores in Patients with Atrial Fibrillation and Cancer
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Atrial fibrillation (AF) is common among cancer patients. Anticoagulation can reduce the risk of stroke and systemic embolism in AF patients. However, anticoagulation in patients with cancer can be difficult given unpredictable changes in thrombosis and bleeding risk. Although CHA 2 DS 2 -VASc and HAS-BLED are useful, their predictive performance in patients with cancer is unknown. Hypothesis: CHA 2 DS 2 -VASc and HAS-BLED scores in AF patients with cancer could lead to misclassification. Methods: Overall, 16,056 AF patients between 2014 and 2018 were followed during a median follow-up of 4.9 years, including 1,137 with cancer history. We used C statistic and Brier score for assessing the performance of both scores. Results: Discrimination, assessed with C statistics (assuming death as a competing risk), was similar between cancer and non-cancer anticoagulated patients. However, in non-anticoagulated patients, c-statistic of CHA 2 DS 2 -VASc was poor and significantly lower in non-cancer patients. The overall precision of the CHA 2 DS 2 -VASc score was good throughout the follow-up (Brier score 〈 0.1), both in patients with and without cancer history. Regarding to HAS-BLED score, calibration and discrimination were poor in cancer patients, although without significant differences in comparison with non-cancer patients. In non-anticoagulated cancer patients and in those with active cancer, the embolic risk of CHA 2 DS 2 -VASc score = 1 was similar to CHA 2 DS 2 -VASc score ≥ 2. Only AF patients with cancer and CHA 2 DS 2 -VASc score = 0 presented a truly low risk of embolic events (negative predictive value 100%). A HAS-BLED score 〉 3 did not identify AF patients with cancer at higher bleeding risk. Conclusions: In AF patients with cancer, neither the CHA2DS2-VASC score nor the HASBLED score were useful for predicting embolic and hemorrhagic events, respectively. However, a CHA 2 DS 2 -VASc score 0 is useful to identify low embolic risk patients with AF and cancer.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.10623
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 8
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    In-hospital and long-term outcomes of HIV-positive patients undergoing PCI according to kind of stent: a meta-analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Cardiovascular Medicine Vol. 20, No. 5 ( 2019-05), p. 321-326
    Details
    In: Journal of Cardiovascular Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 20, No. 5 ( 2019-05), p. 321-326
    Abstract: Pathogenesis of cardiovascular disease in HIV-positive patients is related to the interaction between traditional and HIV-specific factors. Limited data are available regarding the prognosis of HIV-positive patients undergoing percutaneous coronary intervention (PCI). Methods All observational studies evaluating the prognosis of HIV-positive patients treated with PCI were included. In-hospital and long-term major adverse cardiac events (MACE) [composite endpoint of all-cause death or myocardial infarction (MI)] were the primary endpoints, whereas in-hospital and long-term all-cause death, cardiovascular death, MI, stent thrombosis, target vessel revascularization (TVR), target lesion revascularization (TLR), and bleeding complications were the secondary ones. Findings In all, 1243 patients in nine studies were included, with a mean age of 54 years. Among them, 12% were female and 91% were admitted for acute coronary syndromes. In-hospital MACE occurred in 6.0% (5.4–6.6), death in 4.2% (2.6–5.9), and MI in 1.3% (0–2.8), whereas major bleeding occurred in 2.0% (1.7–2.3) of the patients. After 2 years (1.6–3.1), long-term MACE occurred in 17.4% (11.9–22.3), all-cause death in 8.7% (3.2–14.2), and MI in 7.8% (5.5–10.1) of the patients, whereas stent thrombosis and TVR in 3.4% (1.5–5.3) and 10.5% (7.5–13.4), respectively. In patients treated with drug-eluting stents (DES), the rate of long-term MACE was 22.3% (10.1–34.4), with an incidence of 4.9% (0.0–11.4) of MI and 5.7% (2.3–13.7, all 95% confidence intervals of TLR. Interpretation HIV-positive patients have a high risk of in-hospital and long-term MACE after PCI, partially reduced by the use of DES. Further studies on the risk of recurrent ischemic events with current generation stents are needed, to offer a tailored therapy in this high-risk population.
    Type of Medium: Online Resource
    ISSN: 1558-2027 , 1558-2035
    URL: Article
    DOI: 10.2459/JCM.0000000000000767
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 9
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    Impact of Complete Revascularization on Development of Heart Failure in Patients With Acute Coronary Syndrome and Multivessel Disease: A Subanalysis of the CORALYS Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American Heart Association Vol. 12, No. 15 ( 2023-08)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 15 ( 2023-08)
    Abstract: The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy‐three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow‐up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51–0.85] ), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49–0.90]) along with all‐cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56–0.97] and HR, 0.56 [95% CI, 0.38–0.84], respectively). The results were consistent in the propensity‐score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39–0.89] for ST‐segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50–0.99] for non‐ST‐elevation acute coronary syndrome) and in patients with left ventricular ejection fraction 〉 40% (HR, 0.52 [95% CI, 0.37–0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37–1.10] , P for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST‐segment elevation myocardial infarction and non‐ST‐elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 04895176.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.122.028475
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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