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Coronary Artery Disease: HELP
Articles from Boston University
Based on 211 articles published since 2010
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These are the 211 published articles about Coronary Artery Disease that originated from Boston University during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
126 Article Efficacy and Safety of Proton-Pump Inhibitors in High-Risk Cardiovascular Subsets of the COGENT Trial. 2016

Vaduganathan, Muthiah / Cannon, Christopher P / Cryer, Byron L / Liu, Yuyin / Hsieh, Wen-Hua / Doros, Gheorghe / Cohen, Marc / Lanas, Angel / Schnitzer, Thomas J / Shook, Thomas L / Lapuerta, Pablo / Goldsmith, Mark A / Laine, Loren / Bhatt, Deepak L / Anonymous5780866. ·Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass; Harvard Clinical Research Institute, Boston, Mass. · University of Texas Southwestern and Veterans Affairs North Texas Health Care System, Dallas. · Harvard Clinical Research Institute, Boston, Mass; Department of Biostatistics, Boston University, Mass. · Harvard Clinical Research Institute, Boston, Mass. · Newark Beth Israel Medical Center, NJ. · University of Zaragoza, Instituto de Investigación Sanitaria Aragón, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Zaragoza, Spain. · Departments of Physical Medicine and Rehabilitation and Internal Medicine-Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Ill. · PAREXEL International, Waltham, Mass. · Lexicon Pharmaceuticals, Basking Ridge, NJ. · Constellation Pharmaceuticals, Cambridge, Mass. · Yale School of Medicine, New Haven, Conn; VA Connecticut Healthcare System, West Haven, Conn. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass. Electronic address: dlbhattmd@post.harvard.edu. ·Am J Med · Pubmed #27143321.

ABSTRACT: BACKGROUND: Proton-pump inhibitors (PPIs) have been demonstrated to reduce rates of gastrointestinal events in patients requiring dual antiplatelet therapy (DAPT). Data are limited regarding the efficacy and safety of PPIs in high-risk cardiovascular subsets after acute coronary syndrome or percutaneous coronary intervention. METHODS: All patients enrolled in COGENT (Clopidogrel and the Optimization of Gastrointestinal Events Trial) were initiated on DAPT (with aspirin and clopidogrel) for various indications within the prior 21 days. These post hoc analyses of the COGENT trial evaluated the efficacy and safety of omeprazole compared with placebo in subsets of patients requiring DAPT for the 2 most frequent indications: 1) patients undergoing percutaneous coronary intervention (for any indication) within 14 days of randomization (n = 2676; 71.2%); and 2) patients presenting with acute coronary syndrome managed with or without percutaneous coronary intervention (n = 1573; 41.8%). Unadjusted Cox proportional hazards models were used to estimate effect sizes through final follow-up. RESULTS: Median follow-up duration was 110 days (interquartile range 55-167). In percutaneous coronary intervention-treated patients, omeprazole significantly reduced rates of composite gastrointestinal events at 180 days (1.2% vs 2.7%; hazard ratio [HR] 0.43; 95% confidence interval [CI], 0.22-0.85; P = .02) without increasing composite cardiovascular events (5.4% vs 6.3%; HR 1.00; 95% CI, 0.67-1.50; P = 1.00). Similarly, omeprazole lowered risk of the primary gastrointestinal endpoint at 180 days in patients presenting with acute coronary syndrome (1.1% vs 2.7%; HR 0.37; 95% CI, 0.13-1.01; P = .05) without a significant excess in cardiovascular events (5.6% vs 4.5%; HR 1.40; 95% CI, 0.77-2.53; P = .27). CONCLUSIONS: PPI therapy attenuates gastrointestinal bleeding risk without significant excess in major cardiovascular events in high-risk cardiovascular subsets, regardless of indication for DAPT. Future studies will be needed to clarify optimal gastroprotective strategies for higher-intensity and longer durations of DAPT.

127 Article What is the optimal approach to a non- culprit stenosis after ST-elevation myocardial infarction - Conservative therapy or upfront revascularization? An updated meta-analysis of randomized trials. 2016

Anantha Narayanan, Mahesh / Reddy, Yogesh N V / Sundaram, Varun / Reddy, Yuvaram N V / Baskaran, Janani / Agnihotri, Kanishk / Badheka, Apurva / Patel, Nilesh / Deshmukh, Abhishek. ·Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA. Electronic address: mahesh_maidsh@yahoo.com. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. · Division of Cardiovascular Diseases, University Hospitals Case Medical Center, Cleveland, OH, USA. · Department of Internal Medicine, Boston University Medical Center, Boston, MA, USA. · Sri Venkateshwaraa Medical College Hospital and Research Center, Puducherry, India. · Department of Internal Medicine, Saint Peters University Hospital, New Brunswick, NJ, USA. · Department of Cardiology, The Everett Clinic, Everett, WA, USA. · Department of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA. ·Int J Cardiol · Pubmed #27135152.

ABSTRACT: BACKGROUND: Non-culprit percutaneous coronary intervention (PCI) during a ST-segment elevation myocardial infarction (STEMI) remains controversial. We performed a meta-analysis of the published literature comparing a strategy of complete revascularization (CR) with culprit or target vessel revascularization (TVR)-only after STEMI in patients with multi-vessel disease. METHODS: We searched PubMed/Medline, Cochrane, EMBASE, Web of Science, CINAHL, Scopus and Google-scholar databases from inception to March-2016 for clinical trials comparing CR with TVR during PCI for STEMI. Mantel-Haenszel risk ratio (MH-RR) with 95% confidence intervals (CI) for individual outcomes was calculated using random-effects model. RESULTS: A total of 7 randomized trials with 2004 patients were included in the final analysis. Mean follow-up was 25.4months. Major adverse cardiac events (MACE) (MH-RR: 0.58, 95% CI: 0.43-0.78, P<0.001), cardiac deaths (MH-RR: 0.42, 95% CI: 0.24-0.74, P=0.003) and repeat revascularization (MH-RR: 0.36, 95% CI: 0.27-0.48, P<0.001) were much lower in the CR group when compared to TVR. However, there was no significant difference in the risk of all-cause mortality (0.84, 95% CI: 0.57-1.25, P=0.394) or recurrent MI (MH-RR: 0.66, 95% CI: 0.34-1.26, P=0.205) between the two groups. CR appeared to be safe with no significant increase in adverse events including stroke rates (MH-RR: 2.19, 95% CI: 0.59-8.12, P=0.241), contrast induced nephropathy (MH-RR: 0.73, 95% CI: 0.34-1.57, P=0.423) or major bleeding episodes (MH-RR: 0.72, 95% CI: 0.34-1.54, P=0.399). CONCLUSIONS: CR strategy in STEMI patients with multivessel coronary artery disease is associated with reduction in MACE, cardiac mortality and need for repeat revascularization but with no decrease in the risk of subsequent MI or all-cause mortality. CR was safe however, with no increase in adverse events including stroke, stent thrombosis or contrast nephropathy when compared to TVR.

128 Article Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries: The National Heart, Lung, and Blood Institute Family Heart Study. 2016

Imran, Tasnim F / Patel, Yash / Ellison, R Curtis / Carr, J Jeffrey / Arnett, Donna K / Pankow, James S / Heiss, Gerardo / Hunt, Steven C / Gaziano, J Michael / Djoussé, Luc. ·From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.) · Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.) · Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.) · Department of Epidemiology, University of Alabama at Birmingham (D.K.A.) · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.) · Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.) · and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.). ·Arterioscler Thromb Vasc Biol · Pubmed #27102966.

ABSTRACT: OBJECTIVE: Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification. APPROACH AND RESULTS: In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35-0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52-0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36-0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking-CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking-aortic calcification association was not significant. CONCLUSIONS: Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.

129 Article Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. 2016

Brilakis, Emmanouil S / O'Donnell, Colin I / Penny, William / Armstrong, Ehrin J / Tsai, Thomas / Maddox, Thomas M / Plomondon, Mary E / Banerjee, Subhash / Rao, Sunil V / Garcia, Santiago / Nallamothu, Brahmajee / Shunk, Kendrick A / Mavromatis, Kreton / Grunwald, Gary K / Bhatt, Deepak L. ·VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: emmanouil.brilakis@va.gov. · VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado. · San Diego VA Healthcare System, San Diego, California. · VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas. · Durham VA Medical Center and Duke University, Durham, North Carolina. · Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota. · University of Michigan, Ann Arbor, Michigan. · San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California. · Atlanta VA Medical Center and Emory University, Atlanta, Georgia. · VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. ·JACC Cardiovasc Interv · Pubmed #27085582.

ABSTRACT: OBJECTIVES: The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. BACKGROUND: Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. METHODS: A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). RESULTS: During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). CONCLUSIONS: In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.

130 Article Diagnostic Yield and Clinical Utility of Sequencing Familial Hypercholesterolemia Genes in Patients With Severe Hypercholesterolemia. 2016

Khera, Amit V / Won, Hong-Hee / Peloso, Gina M / Lawson, Kim S / Bartz, Traci M / Deng, Xuan / van Leeuwen, Elisabeth M / Natarajan, Pradeep / Emdin, Connor A / Bick, Alexander G / Morrison, Alanna C / Brody, Jennifer A / Gupta, Namrata / Nomura, Akihiro / Kessler, Thorsten / Duga, Stefano / Bis, Joshua C / van Duijn, Cornelia M / Cupples, L Adrienne / Psaty, Bruce / Rader, Daniel J / Danesh, John / Schunkert, Heribert / McPherson, Ruth / Farrall, Martin / Watkins, Hugh / Lander, Eric / Wilson, James G / Correa, Adolfo / Boerwinkle, Eric / Merlini, Piera Angelica / Ardissino, Diego / Saleheen, Danish / Gabriel, Stacey / Kathiresan, Sekar. ·Center for Human Genetic Research, Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts. · Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea. · Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. · Human Genetics Center and Institute of Molecular Medicine, University of Texas-Houston Health Science Center, Houston, Texas. · Department of Biostatistics, University of Washington, Seattle, Washington. · Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. · Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands. · Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts. · Cardiovascular Health Research Unit, University of Washington, Seattle, Washington. · Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts; Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. · Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, München, Germany, and Munich Heart Alliance, München, Germany. · Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy, and Humanitas Clinical and Research Center, Rozzano, Milan, Italy. · Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington. · Departments of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania. · Public Health and Primary Care, University of Cambridge, Cambridge, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge and National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. · University of Ottawa Heart Institute, Ottawa, Canada. · Division of Cardiovascular Medicine, Radcliffe Department of Medicine and the Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom. · Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi. · Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. · Ospedale Niguarda, Milano, Italy. · Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy, and ASTC: Associazione per lo Studio Della Trombosi in Cardiologia, Pavia, Italy. · Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Center for Human Genetic Research, Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts. Electronic address: skathiresan1@mgh.harvard.edu. ·J Am Coll Cardiol · Pubmed #27050191.

ABSTRACT: BACKGROUND: Approximately 7% of American adults have severe hypercholesterolemia (untreated low-density lipoprotein [LDL] cholesterol ≥190 mg/dl), which may be due to familial hypercholesterolemia (FH). Lifelong LDL cholesterol elevations in FH mutation carriers may confer coronary artery disease (CAD) risk beyond that captured by a single LDL cholesterol measurement. OBJECTIVES: This study assessed the prevalence of an FH mutation among those with severe hypercholesterolemia and determined whether CAD risk varies according to mutation status beyond the observed LDL cholesterol level. METHODS: Three genes causative for FH (LDLR, APOB, and PCSK9) were sequenced in 26,025 participants from 7 case-control studies (5,540 CAD case subjects, 8,577 CAD-free control subjects) and 5 prospective cohort studies (11,908 participants). FH mutations included loss-of-function variants in LDLR, missense mutations in LDLR predicted to be damaging, and variants linked to FH in ClinVar, a clinical genetics database. RESULTS: Among 20,485 CAD-free control and prospective cohort participants, 1,386 (6.7%) had LDL cholesterol ≥190 mg/dl; of these, only 24 (1.7%) carried an FH mutation. Within any stratum of observed LDL cholesterol, risk of CAD was higher among FH mutation carriers than noncarriers. Compared with a reference group with LDL cholesterol <130 mg/dl and no mutation, participants with LDL cholesterol ≥190 mg/dl and no FH mutation had a 6-fold higher risk for CAD (odds ratio: 6.0; 95% confidence interval: 5.2 to 6.9), whereas those with both LDL cholesterol ≥190 mg/dl and an FH mutation demonstrated a 22-fold increased risk (odds ratio: 22.3; 95% confidence interval: 10.7 to 53.2). In an analysis of participants with serial lipid measurements over many years, FH mutation carriers had higher cumulative exposure to LDL cholesterol than noncarriers. CONCLUSIONS: Among participants with LDL cholesterol ≥190 mg/dl, gene sequencing identified an FH mutation in <2%. However, for any observed LDL cholesterol, FH mutation carriers had substantially increased risk for CAD.

131 Article Genome-Wide Association Study for Incident Myocardial Infarction and Coronary Heart Disease in Prospective Cohort Studies: The CHARGE Consortium. 2016

Dehghan, Abbas / Bis, Joshua C / White, Charles C / Smith, Albert Vernon / Morrison, Alanna C / Cupples, L Adrienne / Trompet, Stella / Chasman, Daniel I / Lumley, Thomas / Völker, Uwe / Buckley, Brendan M / Ding, Jingzhong / Jensen, Majken K / Folsom, Aaron R / Kritchevsky, Stephen B / Girman, Cynthia J / Ford, Ian / Dörr, Marcus / Salomaa, Veikko / Uitterlinden, André G / Eiriksdottir, Gudny / Vasan, Ramachandran S / Franceschini, Nora / Carty, Cara L / Virtamo, Jarmo / Demissie, Serkalem / Amouyel, Philippe / Arveiler, Dominique / Heckbert, Susan R / Ferrières, Jean / Ducimetière, Pierre / Smith, Nicholas L / Wang, Ying A / Siscovick, David S / Rice, Kenneth M / Wiklund, Per-Gunnar / Taylor, Kent D / Evans, Alun / Kee, Frank / Rotter, Jerome I / Karvanen, Juha / Kuulasmaa, Kari / Heiss, Gerardo / Kraft, Peter / Launer, Lenore J / Hofman, Albert / Markus, Marcello R P / Rose, Lynda M / Silander, Kaisa / Wagner, Peter / Benjamin, Emelia J / Lohman, Kurt / Stott, David J / Rivadeneira, Fernando / Harris, Tamara B / Levy, Daniel / Liu, Yongmei / Rimm, Eric B / Jukema, J Wouter / Völzke, Henry / Ridker, Paul M / Blankenberg, Stefan / Franco, Oscar H / Gudnason, Vilmundur / Psaty, Bruce M / Boerwinkle, Eric / O'Donnell, Christopher J. ·Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America. · Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America. · Icelandic Heart Association, Kopavogur, Iceland. · University of Iceland, Reykjavik, Iceland. · Human Genetics Center, and Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America. · Boston University's and National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, United States of America. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands. · Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America. · Department of Biostatistics, University of Washington, Seattle, WA, United States of America. · Department of Statistics, University of Auckland, Auckland, New Zealand. · Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany. · DZHK (German Center for Cardiovascular Research), partner site, Greifswald, Germany. · Department of Pharmacology and Therapeutics, University College, Cork, Ireland. · Department of Internal Medicine, Division of Geriatrics, Wake Forest University, Winston-Salem, North Carolina, United States of America. · Department of Nutrition, Harvard School of Public Health, Boston, MA, United States of America. · Channing Division of Network Medicine, Harvard Medical School, Boston, MA, United States of America. · Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, United States of America. · Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. · Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America. · Department of Epidemiology, Merck Research Laboratories, Merck Sharp & Dohme Corp., Whitehouse Station, NJ, United States of America. · Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom. · Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. · National Institute for Health and Welfare, Helsinki, Finland. · Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America. · Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America. · Department of Preventive Medicine, Boston University School of Medicine, Boston, MA, United States of America. · Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America. · Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America. · Department of Epidemiology and Public Health, Pasteur Institute of Lille, Lille, France. · Department of Epidemiology and Public Health, EA 3430, University of Strasbourg, Strasbourg, France. · Department of Epidemiology, University of Washington, Seattle, WA, United States of America. · Group Health Research Institute, Group Health Cooperative, Seattle, United States of America. · Departments of Cardiology and Epidemiology, Toulouse University Hospital, Toulouse, France. · National Institute of Health and Medical Research (U258), Paris, France. · Seattle Epidemiologic Research and Information Center of the Department of Veterans Affairs Office of Research and Development, Seattle, WA, United States of America. · Novartis Institutes for Biomedical Research, 250 Massachusetts Avenue, Cambridge, MA, United States of America. · The New York Academy of Medicine, New York, NY, United States of America. · Department of Medicine, Umeå University Hospital, Umeå, Sweden. · Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute, Torrance, CA, United States of America. · Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, United States of America. · UKCRC Centre of Excellence for Public Health Research (Northern Ireland), Queen's University of Belfast, Belfast, United Kingdom. · Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland. · Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States of America. · Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States of America. · Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. · Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland. · Department of Epidemiology & Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, United States of America. · Institute of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom. · Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, The Netherlands. · Durrer Center for Cardiogenetic Research, Amsterdam, The Netherlands. · Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Health Services, University of Washington, Seattle, WA, United States of America. · Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America. · Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, United States of America. · Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare, Boston, MA, United States of America. ·PLoS One · Pubmed #26950853.

ABSTRACT: BACKGROUND: Data are limited on genome-wide association studies (GWAS) for incident coronary heart disease (CHD). Moreover, it is not known whether genetic variants identified to date also associate with risk of CHD in a prospective setting. METHODS: We performed a two-stage GWAS analysis of incident myocardial infarction (MI) and CHD in a total of 64,297 individuals (including 3898 MI cases, 5465 CHD cases). SNPs that passed an arbitrary threshold of 5×10-6 in Stage I were taken to Stage II for further discovery. Furthermore, in an analysis of prognosis, we studied whether known SNPs from former GWAS were associated with total mortality in individuals who experienced MI during follow-up. RESULTS: In Stage I 15 loci passed the threshold of 5×10-6; 8 loci for MI and 8 loci for CHD, for which one locus overlapped and none were reported in previous GWAS meta-analyses. We took 60 SNPs representing these 15 loci to Stage II of discovery. Four SNPs near QKI showed nominally significant association with MI (p-value<8.8×10-3) and three exceeded the genome-wide significance threshold when Stage I and Stage II results were combined (top SNP rs6941513: p = 6.2×10-9). Despite excellent power, the 9p21 locus SNP (rs1333049) was only modestly associated with MI (HR = 1.09, p-value = 0.02) and marginally with CHD (HR = 1.06, p-value = 0.08). Among an inception cohort of those who experienced MI during follow-up, the risk allele of rs1333049 was associated with a decreased risk of subsequent mortality (HR = 0.90, p-value = 3.2×10-3). CONCLUSIONS: QKI represents a novel locus that may serve as a predictor of incident CHD in prospective studies. The association of the 9p21 locus both with increased risk of first myocardial infarction and longer survival after MI highlights the importance of study design in investigating genetic determinants of complex disorders.

132 Article Optimal medical therapy with or without percutaneous coronary intervention in women with stable coronary disease: A pre-specified subset analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial. 2016

Acharjee, Subroto / Teo, Koon K / Jacobs, Alice K / Hartigan, Pamela M / Barn, Kulpreet / Gosselin, Gilbert / Tanguay, Jean-Francois / Maron, David J / Kostuk, William J / Chaitman, Bernard R / Mancini, G B John / Spertus, John A / Dada, Marcin R / Bates, Eric R / Booth, David C / Weintraub, William S / O'Rourke, Robert A / Boden, William E / Anonymous5470859. ·Einstein Medical Center Philadelphia, Philadelphia, PA. · Hamilton General Hospital/Master University, Hamilton, Canada. · Boston Medical Center, Boston, MA. · VA Connecticut Healthcare System, West Haven, CT. · Geisinger Medical Center, Danville, PA. · Montreal Heart Institute/Université de Montréal, Montreal, QC, Canada. · Vanderbilt University Medical Center, Nashville, TN. · London Health Science Centre, London, ON, Canada. · Saint Louis University School of Medicine, St. Louis, MT. · Vancouver Hospital and Health Science Centre, Vancouver, BC, Canada. · Mid America Heart Institute, Kansas City, MO. · Hartford Hosp, Hartford, CT. · University of Michigan, Ann Arbor, MI. · University of Kentucky Med Center, Lexington, KY. · Christiana Healthcare System and Center for Outcomes Research, Newark, DE. · South Texas Veterans Health Care System-Audie Murphy Campus, San Antonio, TX. · Stratton VA Medical Center, Albany Medical College, Albany, NY. Electronic address: william.boden@va.gov. ·Am Heart J · Pubmed #26920603.

ABSTRACT: OBJECTIVES: To determine whether sex-based differences exist in clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in patients with stable coronary artery disease. BACKGROUND: A prior pre-specified unadjusted analysis from COURAGE showed that women randomized to PCI had a lower rate of death or myocardial infarction during a median 4.6-year follow-up with a trend for interaction with respect to sex. METHODS: We analyzed outcomes in 338 women (15%) and 1949 men (85%) randomized to PCI plus OMT versus OMT alone after adjustment for relevant baseline characteristics. RESULTS: There was no difference in treatment effect by sex for the primary end point (death or myocardial infarction; HR, 0.89; 95% CI, 0.77-1.03 for women and HR, 1.02, 95% CI 0.96-1.10 for men; P for interaction = .07). Although the event rate was low, a trend for interaction by sex was nonetheless noted for hospitalization for heart failure, with only women, but not men, assigned to PCI experiencing significantly fewer events as compared to their counterparts receiving OMT alone (HR, 0.59; 95% CI, 0.40-0.84, P < .001 for women and HR, 0.86; 95% CI, 0.74-1.01, P = .47 for men; P for interaction = .02). Both sexes randomized to PCI experienced significantly reduced need for subsequent revascularization (HR, 0.72; 95% CI, 0.62-0.83, P < .001 for women; HR, 0.84; 95% CI, 0.79-0.89, P < .001 for men; P for interaction = .02) with evidence of a sex-based differential treatment effect. CONCLUSION: In this adjusted analysis of the COURAGE trial, there were no significant differences in treatment effect on major outcomes between men and women. However, women assigned to PCI demonstrated a greater benefit as compared to men, with a reduction in heart failure hospitalization and need for future revascularization. These exploratory observations require further prospective study.

133 Article Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age. 2016

Epps, Kelly C / Holper, Elizabeth M / Selzer, Faith / Vlachos, Helen A / Gualano, Sarah K / Abbott, J Dawn / Jacobs, Alice K / Marroquin, Oscar C / Naidu, Srihari S / Groeneveld, Peter W / Wilensky, Robert L. ·From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.) · Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.) · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.) · Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.) · Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.) · Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.) · Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.) · Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.) · and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.). ·Circ Cardiovasc Qual Outcomes · Pubmed #26908855.

ABSTRACT: BACKGROUND: Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population. METHODS AND RESULTS: Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events. Although procedural success rates were similar by sex, the cumulative rate of major adverse cardiovascular events at 1 year was higher in young women (27.8 versus 19.9%; P=0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P<0.001, adjusted hazard ratio 2.4, 95% confidence interval 1.5-4.0; PCI: 19.0% versus 13.0%, P=0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P=0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01-2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P=0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24-2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men. CONCLUSIONS: Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.

134 Article Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study. 2016

Hoffmann, Udo / Massaro, Joseph M / D'Agostino, Ralph B / Kathiresan, Sekar / Fox, Caroline S / O'Donnell, Christopher J. ·Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA uhoffmann@partners.org. · Department of Mathematics, Boston University, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA. · Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA Division of Intramural Research, NHLBI, Bethesda, MD. · Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA Division of Intramural Research, NHLBI, Bethesda, MD. ·J Am Heart Assoc · Pubmed #26903006.

ABSTRACT: BACKGROUND: We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality independent of Framingham risk factors in the community-based Framingham Heart Study. METHODS AND RESULTS: Coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C-statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all-cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all-cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78-0.82; net reclassification index 32%, 95% CI 11-53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5-10%) 10-year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%). CONCLUSIONS: CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community-dwelling persons and accurately reclassifies two-thirds of the intermediate-risk population.

135 Article Incidence and predictors of incomplete revascularization in a contemporary cohort. 2016

Waldo, Stephen W / Abtahian, Farhad / Kennedy, Kevin F / Scirica, Benjamin M / Mahmood, Sadiqa / Yeh, Robert W. ·aDepartment of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado bDepartment of Medicine, Rochester General Hospital, Rochester, New York cSaint Luke's Mid-America Heart Institute, Kansas City, Missouri dDepartment of Medicine, Cardiovascular Division, Brigham and Women's Hospital eDepartment of Quality, Safety, and Value, Partners Healthcare fDepartment of Medicine, Division of Cardiology, Beth Israel Deaconess, Boston, Massachusetts, USA. ·Coron Artery Dis · Pubmed #26882019.

ABSTRACT: OBJECTIVES: Complete coronary revascularization has been associated with improved mortality among patients undergoing surgical bypass grafting. A similar evaluation among patients undergoing percutaneous coronary intervention (PCI) for multivessel disease has produced largely concordant results, although complete percutaneous revascularization is often not achieved in this population. The present study sought to evaluate the clinical and anatomic limitations to complete revascularization among contemporary patients undergoing percutaneous revascularization for multivessel coronary artery disease. METHODS: All patients undergoing nonemergent PCI for unprotected left main or multivessel coronary artery disease were identified at two academic medical centers from 2009 to 2012. Complete revascularization was determined through a review of the electronic medical records and corresponding coronary angiograms. The underlying reasons that precluded complete revascularization were then derived from a review of the clinical and angiographic findings. RESULTS: Among 978 patients with multivessel coronary artery disease, 267 (27%) underwent complete percutaneous coronary revascularization. Factors that prevented complete revascularization included chronic total occlusions (54%), treatment limited to the culprit lesion (24%), or persistent disease in small nondominant vessels (24%). After multivariable adjustment, the presence of a chronic total occlusion was associated with significantly reduced odds of receiving complete revascularization (adjusted odds ratio: 0.18, 95% confidence interval: 0.12-0.27). CONCLUSION: Complete percutaneous revascularization is uncommon and is hindered by the presence of chronic total occlusions or isolated treatment of an angiographic culprit lesion. Evolving interventional techniques enabling treatment of chronic total occlusions may increase the prevalence of complete percutaneous revascularization in the future.

136 Article Association Between Interstitial Lung Abnormalities and All-Cause Mortality. 2016

Putman, Rachel K / Hatabu, Hiroto / Araki, Tetsuro / Gudmundsson, Gunnar / Gao, Wei / Nishino, Mizuki / Okajima, Yuka / Dupuis, Josée / Latourelle, Jeanne C / Cho, Michael H / El-Chemaly, Souheil / Coxson, Harvey O / Celli, Bartolome R / Fernandez, Isis E / Zazueta, Oscar E / Ross, James C / Harmouche, Rola / Estépar, Raúl San José / Diaz, Alejandro A / Sigurdsson, Sigurdur / Gudmundsson, Elías F / Eiríksdottír, Gudny / Aspelund, Thor / Budoff, Matthew J / Kinney, Gregory L / Hokanson, John E / Williams, Michelle C / Murchison, John T / MacNee, William / Hoffmann, Udo / O'Donnell, Christopher J / Launer, Lenore J / Harrris, Tamara B / Gudnason, Vilmundur / Silverman, Edwin K / O'Connor, George T / Washko, George R / Rosas, Ivan O / Hunninghake, Gary M / Anonymous3340858 / Anonymous3350858. ·Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Respiratory Medicine and Sleep, Landspital University Hospital, University of Iceland, Reykjavik, Iceland. · Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. · Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts6Department of Radiology, St. Luke's International Hospital, Tokyo, Japan. · Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts7National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts. · Pulmonary Center, Department of Medicine, Boston University, Boston, Massachusetts9Department of Neurology, Boston University, Boston, Massachusetts. · Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts10Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Radiology, University of British Columbia, Vancouver, BC, Canada. · Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts12Comprehensive Pneumology Center, Ludwig-Maximilians-University, University Hospital Grosshadern, Munich, Germany13Helmholtz Zentrum München. · Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts14Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts14Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts14Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Icelandic Heart Association, Kopavogur, Iceland. · Icelandic Heart Association, Kopavogur, Iceland16University of Iceland, Reykjavik, Iceland. · Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California. · Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado. · University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, Scotland. · Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland. · Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland. · Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts23Cardiovascular Epidemiology and Human Genomics Branch, NHLBI Division of Intramural Research, Bethesda, Maryland. · Intramural Research Program, National Institute of Aging, NIH, Bethesda, Maryland. · National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts8Pulmonary Center, Department of Medicine, Boston University, Boston, Massachusetts. · Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. ·JAMA · Pubmed #26881370.

ABSTRACT: IMPORTANCE: Interstitial lung abnormalities have been associated with lower 6-minute walk distance, diffusion capacity for carbon monoxide, and total lung capacity. However, to our knowledge, an association with mortality has not been previously investigated. OBJECTIVE: To investigate whether interstitial lung abnormalities are associated with increased mortality. DESIGN, SETTING, AND POPULATION: Prospective cohort studies of 2633 participants from the FHS (Framingham Heart Study; computed tomographic [CT] scans obtained September 2008-March 2011), 5320 from the AGES-Reykjavik Study (Age Gene/Environment Susceptibility; recruited January 2002-February 2006), 2068 from the COPDGene Study (Chronic Obstructive Pulmonary Disease; recruited November 2007-April 2010), and 1670 from ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; between December 2005-December 2006). EXPOSURES: Interstitial lung abnormality status as determined by chest CT evaluation. MAIN OUTCOMES AND MEASURES: All-cause mortality over an approximate 3- to 9-year median follow-up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort. RESULTS: Interstitial lung abnormalities were present in 177 (7%) of the 2633 participants from FHS, 378 (7%) of 5320 from AGES-Reykjavik, 156 (8%) of 2068 from COPDGene, and in 157 (9%) of 1670 from ECLIPSE. Over median follow-up times of approximately 3 to 9 years, there were more deaths (and a greater absolute rate of mortality) among participants with interstitial lung abnormalities when compared with those who did not have interstitial lung abnormalities in the following cohorts: 7% vs 1% in FHS (6% difference [95% CI, 2% to 10%]), 56% vs 33% in AGES-Reykjavik (23% difference [95% CI, 18% to 28%]), and 11% vs 5% in ECLIPSE (6% difference [95% CI, 1% to 11%]). After adjustment for covariates, interstitial lung abnormalities were associated with a higher risk of death in the FHS (hazard ratio [HR], 2.7 [95% CI, 1.1 to 6.5]; P = .03), AGES-Reykjavik (HR, 1.3 [95% CI, 1.2 to 1.4]; P < .001), COPDGene (HR, 1.8 [95% CI, 1.1 to 2.8]; P = .01), and ECLIPSE (HR, 1.4 [95% CI, 1.1 to 2.0]; P = .02) cohorts. In the AGES-Reykjavik cohort, the higher rate of mortality could be explained by a higher rate of death due to respiratory disease, specifically pulmonary fibrosis. CONCLUSIONS AND RELEVANCE: In 4 separate research cohorts, interstitial lung abnormalities were associated with a greater risk of all-cause mortality. The clinical implications of this association require further investigation.

137 Article Triple vs Dual Antithrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease. 2016

Lopes, Renato D / Rao, Meena / Simon, DaJuanicia N / Thomas, Laine / Ansell, Jack / Fonarow, Gregg C / Gersh, Bernard J / Go, Alan S / Hylek, Elaine M / Kowey, Peter / Piccini, Jonathan P / Singer, Daniel E / Chang, Paul / Peterson, Eric D / Mahaffey, Kenneth W. ·Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: renato.lopes@duke.edu. · Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. · Hofstra North Shore/LIJ School of Medicine, New York, NY. · UCLA School of Medicine, Los Angeles, Calif. · Mayo Clinic College of Medicine, Rochester, Minn. · Kaiser Permanente, Oakland, Calif. · Boston University School of Medicine, Mass. · Lankenau Institute for Medical Research, Wynnewood, Pa. · Harvard Medical School and Massachusetts General Hospital, Boston. · Janssen Pharmaceuticals, Raritan, NJ. · Stanford University School of Medicine, Calif. ·Am J Med · Pubmed #26797080.

ABSTRACT: BACKGROUND: The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease. METHODS: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP]). RESULTS: The use of triple antithrombotic therapy, OAC plus AA, and DAP at baseline was 8.5% (n = 155), 80.4% (n = 1468), and 11.2% (n = 204), respectively. Among patients treated with OAC plus AA, aspirin was the most common antiplatelet agent used (90%), followed by clopidogrel (10%) and prasugrel (0.1%). The use of triple antithrombotic therapy was not affected by patient risk of either stroke or bleeding. Patients treated with triple antithrombotic therapy at baseline were hospitalized for all causes (including cardiovascular) more often than patients on OAC plus AA (adjusted hazard ratio 1.75; 95% confidence interval, 1.35-2.26; P <.0001) or DAP (hazard ratio 1.82; 95% confidence interval, 1.25-2.65; P = .0018). Rates of major bleeding or a combined cardiovascular outcome were not significantly different by treatment group. CONCLUSIONS: Choice of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease was not affected by patient stroke or bleeding risks. Triple antithrombotic therapy-treated patients were more likely to be hospitalized for all causes than those on OAC plus AA or on DAP.

138 Article Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents. 2016

Hermiller, James B / Krucoff, Mitchell W / Kereiakes, Dean J / Windecker, Stephan / Steg, P Gabriel / Yeh, Robert W / Cohen, David J / Cutlip, Donald E / Massaro, Joseph M / Hsieh, Wen-Hua / Mauri, Laura / Anonymous5180855. ·St. Vincent Heart Center, Indianapolis, Indiana. · Department of Medicine, Duke University Medical Center, Durham, North Carolina. · The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Université Paris-Diderot, INSERM U-1148, and Hôpital Bichat, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France; National Heart & Lung Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom. · The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts. · Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. · Harvard Medical School, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts; Department of Medicine, Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Harvard Clinical Research Institute, Boston, Massachusetts; School of Public Health, Boston University School of Medicine, Boston, Massachusetts. · Harvard Clinical Research Institute, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: lmauri1@partners.org. ·JACC Cardiovasc Interv · Pubmed #26793956.

ABSTRACT: OBJECTIVES: The purpose of this study was to characterize outcomes for everolimus-eluting stent (EES)-treated subjects according to treatment with continued thienopyridine plus aspirin versus aspirin alone 12 to 30 months after stenting. BACKGROUND: In the DAPT (Dual Antiplatelet Therapy) study, continued thienopyridine plus aspirin beyond 1 year after coronary stenting reduced ischemic events. Given low rates of stent thrombosis and myocardial infarction (MI) for current drug-eluting stents, we examined outcomes among EES-treated subjects in the DAPT study. METHODS: The DAPT study enrolled 25,682 subjects (11,308 EES-treated) after coronary stenting. Following 12 months of treatment with thienopyridine and aspirin, eligible subjects continued treatment with aspirin and 9,961 (4,703 with EES) were randomized to 18 months of continued thienopyridine or placebo. Stent type was not randomized, and the EES subset analysis was post hoc. RESULTS: Among EES-treated patients, continued thienopyridine reduced stent thrombosis (0.3% vs. 0.7%, hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.15 to 0.97; p = 0.04) and MI (2.1% vs. 3.2%, HR: 0.63, 95% CI: 0.44 to 0.91; p = 0.01) versus placebo but did not reduce a composite of death, MI, and stroke (4.3% vs. 4.5%, HR: 0.89, 95% CI: 0.67 to 1.18; p = 0.42), and increased moderate/severe bleeding (2.5% vs. 1.3%, HR: 1.79, 95% CI: 1.15 to 2.80; p = 0.01), and death (2.2% vs. 1.1%, HR: 1.80, 95% CI: 1.11 to 2.92; p = 0.02). Death due to cancer and not related to bleeding was increased (0.64% vs. 0.17%; p = 0.01). CONCLUSIONS: In EES-treated subjects, significant reductions in stent thrombosis and MI and an increase in bleeding were observed with continued thienopyridine beyond 1 year compared with aspirin alone. (The Dual Antiplatelet Therapy Study [DAPT Study]); NCT00977938).

139 Article Endothelial Cell Bioenergetics and Mitochondrial DNA Damage Differ in Humans Having African or West Eurasian Maternal Ancestry. 2016

Krzywanski, David M / Moellering, Douglas R / Westbrook, David G / Dunham-Snary, Kimberly J / Brown, Jamelle / Bray, Alexander W / Feeley, Kyle P / Sammy, Melissa J / Smith, Matthew R / Schurr, Theodore G / Vita, Joseph A / Ambalavanan, Namasivayam / Calhoun, David / Dell'Italia, Louis / Ballinger, Scott W. ·From the Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport (D.M.K.) · Department of Nutrition Sciences (D.R.M.), Center for Free Radical Biology and Medicine (D.R.M., D.G.W., K.J.D.-S., J.B., A.W.B., K.P.F., M.J.S., M.R.S., L.D., S.W.B.), Division of Molecular and Cellular Pathology, Department of Pathology (D.G.W., J.B., A.W.B., K.P.F., M.J.S., M.R.S., S.W.B.), Department of Pediatrics (N.A.), Department of Medicine (D.C., L.D.), University of Alabama at Birmingham · Department of Medicine, Queen's University, Kingston, Ontario, Canada (K.J.D.-S.) · Department of Anthropology, University of Pennsylvania, Philadelphia (T.G.S.) · and Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, MA (J.A.V.). ·Circ Cardiovasc Genet · Pubmed #26787433.

ABSTRACT: BACKGROUND: We hypothesized that endothelial cells having distinct mitochondrial genetic backgrounds would show variation in mitochondrial function and oxidative stress markers concordant with known differential cardiovascular disease susceptibilities. To test this hypothesis, mitochondrial bioenergetics were determined in endothelial cells from healthy individuals with African versus European maternal ancestries. METHODS AND RESULTS: Bioenergetics and mitochondrial DNA (mtDNA) damage were assessed in single-donor human umbilical vein endothelial cells belonging to mtDNA haplogroups H and L, representing West Eurasian and African maternal ancestries, respectively. Human umbilical vein endothelial cells from haplogroup L used less oxygen for ATP production and had increased levels of mtDNA damage compared with those in haplogroup H. Differences in bioenergetic capacity were also observed in that human umbilical vein endothelial cells belonging to haplogroup L had decreased maximal bioenergetic capacities compared with haplogroup H. Analysis of peripheral blood mononuclear cells from age-matched healthy controls with West Eurasian or African maternal ancestries showed that haplogroups sharing an A to G mtDNA mutation at nucleotide pair 10398 had increased mtDNA damage compared with those lacking this mutation. Further study of angiographically proven patients with coronary artery disease and age-matched healthy controls revealed that mtDNA damage was associated with vascular function and remodeling and that age of disease onset was later in individuals from haplogroups lacking the A to G mutation at nucleotide pair 10398. CONCLUSIONS: Differences in mitochondrial bioenergetics and mtDNA damage associated with maternal ancestry may contribute to endothelial dysfunction and vascular disease.

140 Article Patients with Diabetes and Significant Epicardial Coronary Artery Disease Have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest. 2016

Rasalingam, Ravi / Holland, Mark R / Cooper, Daniel H / Novak, Eric / Rich, Michael W / Miller, James G / Pérez, Julio E. ·Cardiovascular Division, Boston Veterans Affairs Medical Center, West Roxbury, Massachusetts. · Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana. · Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. · Department of Physics, Washington University in St. Louis, St. Louis, Missouri. ·Echocardiography · Pubmed #26593856.

ABSTRACT: OBJECTIVE: The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction. DESIGN: A prospective observational study. SETTING: Diagnosis of epicardial CAD in patients with diabetes. PATIENTS AND METHODS: Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. MAIN OUTCOME MEASURES: Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography. RESULTS: Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001). CONCLUSIONS: Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest.

141 Article Blood Transfusion and 30-Day Mortality in Patients With Coronary Artery Disease and Anemia Following Noncardiac Surgery. 2016

Hollis, Robert H / Singletary, Brandon A / McMurtrie, James T / Graham, Laura A / Richman, Joshua S / Holcomb, Carla N / Itani, Kamal M / Maddox, Thomas M / Hawn, Mary T. ·Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama. · Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts. · VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver. ·JAMA Surg · Pubmed #26444569.

ABSTRACT: IMPORTANCE: Although liberal blood transfusion thresholds have not been beneficial following noncardiac surgery, it is unclear whether higher thresholds are appropriate for patients who develop postoperative myocardial infarction (MI). OBJECTIVE: To evaluate the association between postoperative blood transfusion and mortality in patients with coronary artery disease and postoperative MI following noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study involving Veterans Affairs facilities from January 1, 2000, to December 31, 2012. A total of 7361 patients with coronary artery disease who underwent inpatient noncardiac surgery and had a nadir postoperative hematocrit between 20% and 30%. Patients with significant bleeding, including any preoperative blood transfusion or transfusion of greater than 4 units during the intraoperative or postoperative setting, were excluded. Mortality rates were compared using both logistic regression and propensity score matching. Patients were stratified by postoperative nadir hematocrit and the presence of postoperative MI. EXPOSURE: Initial postoperative blood transfusion. MAIN OUTCOMES AND MEASURES: The 30-day postoperative mortality rate. RESULTS: Of the 7361 patients, 2027 patients (27.5%) received at least 1 postoperative blood transfusion. Postoperative mortality occurred in 267 (3.6%), and MI occurred in 271 (3.7%). Among the 5334 patients without postoperative blood transfusion, lower nadir hematocrit was associated with an increased risk for mortality (hematocrit of 20% to <24%: 7.3%; 24% to <27%: 3.7%; and 27% to 30%: 1.6%; P < .01). In patients with postoperative MI, blood transfusion was associated with lower mortality, for those with hematocrit of 20% to 24% (odds ratio, 0.28; 95% CI, 0.13-0.64). In patients without postoperative MI, transfusion was associated with significantly higher mortality for those with hematocrit of 27% to 30% (odds ratio, 3.21; 95% CI, 1.85-5.60). CONCLUSIONS AND RELEVANCE: These findings support a restrictive postoperative transfusion strategy in patients with stable coronary artery disease following noncardiac surgery. However, interventional studies are needed to evaluate the use of a more liberal transfusion strategy in patients who develop postoperative MI.

142 Article Association of Fruit and Vegetable Consumption During Early Adulthood With the Prevalence of Coronary Artery Calcium After 20 Years of Follow-Up: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. 2015

Miedema, Michael D / Petrone, Andrew / Shikany, James M / Greenland, Philip / Lewis, Cora E / Pletcher, Mark J / Gaziano, J Michael / Djousse, Luc. ·From the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.) · Brigham and Women's Hospital, Division of Aging, and Boston Veterans Affairs Healthcare System, Harvard Medical School, MA (A.P., J.M.G., L.D.) · Division of Preventive Medicine, University of Alabama at Birmingham (J.M.S.) · Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (P.G.) · and Department of Epidemiology and Biostatistics, University of California - San Francisco (C.E.L., M.J.P.). ·Circulation · Pubmed #26503880.

ABSTRACT: BACKGROUND: The relationship between intake of fruits and vegetables (F/V) during young adulthood and coronary atherosclerosis later in life is unclear. METHODS AND RESULTS: We studied participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of young, healthy black and white individuals at baseline (1985-1986). Intake of F/V at baseline was assessed using a semiquantitative interview administered diet history, and coronary artery calcium was measured at year 20 (2005-2006) using computed tomography. We used logistic regression to adjust for relevant variables and estimate the adjusted odds ratios and 95% confidence intervals across energy-adjusted, sex-specific tertiles of total servings of F/V per day. Among our sample (n=2506), the mean (SD) age at baseline was 25.3 (3.5) years, and 62.7% were female. After adjustment for demographics and lifestyle variables, higher intake of F/V was associated with a lower prevalence of coronary artery calcium: odds ratio (95% confidence interval) =1.00 (reference), 0.78 (0.59-1.02), and 0.74 (0.56-0.99), from the lowest to the highest tertile of F/V, P value for trend <0.001. There was attenuation of the association between F/V and coronary artery calcium after adjustment for other dietary variables, but the trend remained significant: odds ratio (95% confidence interval): 1.00 (reference), 0.84 (0.63-1.11), and 0.92 (0.67-1.26), P value for trend <0.002]. CONCLUSIONS: In this longitudinal cohort study, higher intake of F/V during young adulthood was associated with lower odds of prevalent coronary artery calcium after 20 years of follow-up. Our results reinforce the importance of establishing a high intake of F/V as part of a healthy dietary pattern early in life.

143 Article Stent Thrombosis in Drug-Eluting or Bare-Metal Stents in Patients Receiving Dual Antiplatelet Therapy. 2015

Kereiakes, Dean J / Yeh, Robert W / Massaro, Joseph M / Driscoll-Shempp, Priscilla / Cutlip, Donald E / Steg, P Gabriel / Gershlick, Anthony H / Darius, Harald / Meredith, Ian T / Ormiston, John / Tanguay, Jean-François / Windecker, Stephan / Garratt, Kirk N / Kandzari, David E / Lee, David P / Simon, Daniel I / Iancu, Adrian Corneliu / Trebacz, Jaroslaw / Mauri, Laura / Anonymous5020846. ·Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio. · Harvard Clinical Research Institute, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts. · Harvard Clinical Research Institute, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts. · Harvard Clinical Research Institute, Boston, Massachusetts. · Harvard Clinical Research Institute, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Department of Medicine, Cardiology Division, Boston, Massachusetts. · Université Paris-Diderot, Paris, France, INSERM U-1148, Paris, France; Hôpital Bichat, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, United Kingdom. · Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom. · Vivantes Neukoelln Medical Center, Department of Cardiology, Angiology, Nephrology and Intensive Care Medicine, Berlin, Germany. · Monash Heart, Monash Health, Monash University, Victoria, Australia. · Mercy Hospital, Auckland, New Zealand. · Montreal Heart Institute, Department of Medicine/Division of Interventional Cardiology, Université de Montréal, Department of Medicine, Montreal, Canada. · Bern University Hospital, Department of Cardiology, Bern, Switzerland. · Center for Heart and Vascular Health, Christiana Care, Wilmington, Delaware. · Piedmont Heart Institute, Atlanta, Georgia. · Stanford University, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California. · University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio. · Heart Institute, University of Medicine Iuliu Hatieganu, Cluj Napoca, Romania. · Jan Pawel II Hospital Krakow, Krakow, Poland. · Harvard Clinical Research Institute, Boston, Massachusetts; Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, Massachusetts. Electronic address: lmauri1@partners.org. ·JACC Cardiovasc Interv · Pubmed #26493248.

ABSTRACT: OBJECTIVES: This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS. BACKGROUND: Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES. METHODS: Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months. RESULTS: Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001). CONCLUSIONS: DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).

144 Article High-risk percutaneous coronary intervention is associated with reverse left ventricular remodeling and improved outcomes in patients with coronary artery disease and reduced ejection fraction. 2015

Daubert, Melissa A / Massaro, Joseph / Liao, Lawrence / Pershad, Ashish / Mulukutla, Suresh / Magnus Ohman, Erik / Popma, Jeffrey / O'Neill, William W / Douglas, Pamela S. ·Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: melissa.daubert@duke.edu. · Harvard Clinical Research Institute, Boston, MA; Boston University, Boston, MA. · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. · Banner Good Samaritan Hospital, Phoenix, AZ. · University of Pittsburgh Medical Center, Pittsburgh, PA. · Harvard Clinical Research Institute, Boston, MA; Beth Israel Deaconess Hospital, Boston, MA. · Henry Ford Hospital, Detroit, MI. ·Am Heart J · Pubmed #26385039.

ABSTRACT: BACKGROUND: Therapies that reverse pathologic left ventricular (LV) remodeling are often associated with improved outcomes. The incidence and impact of reverse LV remodeling after high-risk percutaneous coronary intervention (PCI) are unknown. METHODS: The PROTECT II study was a multicenter trial in patients with complex, multivessel coronary artery disease and reduced ejection fraction (EF) that revealed an increase in visual EF after high-risk PCI. Among patients with quantitative echocardiography (LV volumes and biplane EF), we assessed the extent and predictors of reverse LV remodeling, defined as improved systolic function with an absolute increase in EF ≥5% and correlated these findings with clinical events. RESULTS: Quantitative echocardiography was performed in 184 patients at baseline and longest follow-up. Mean EF at baseline was 27.1%. Ninety-three patients (51%) demonstrated reverse LV remodeling with an absolute increase in EF of 13.2% (P < .001). End-systolic volume decreased from 137.7 to 106.6 mL (P = .002). No significant change in EF or end-systolic volume was seen among non-remodelers. Reverse LV remodeling occurred more frequently in patients with more extensive revascularization (odds ratio, 7.52; 95% CI [1.31-43.25]) and was associated with significantly fewer major adverse events (composite of death/myocardial infarction/stroke/transient ischemic attack): 9.7% versus 24.2% (P = .009). There was also a greater reduction in New York Heart Association class III/IV heart failure among reverse LV remodelers (66.7% to 24.0%) than non-remodelers (56.3% to 34.4%), P = .045. CONCLUSIONS: Reverse LV remodeling can occur after high-risk PCI in patients with complex coronary artery disease and reduced EF and is associated with improved clinical outcomes.

145 Article A comprehensive 1,000 Genomes-based genome-wide association meta-analysis of coronary artery disease. 2015

Nikpay, Majid / Goel, Anuj / Won, Hong-Hee / Hall, Leanne M / Willenborg, Christina / Kanoni, Stavroula / Saleheen, Danish / Kyriakou, Theodosios / Nelson, Christopher P / Hopewell, Jemma C / Webb, Thomas R / Zeng, Lingyao / Dehghan, Abbas / Alver, Maris / Armasu, Sebastian M / Auro, Kirsi / Bjonnes, Andrew / Chasman, Daniel I / Chen, Shufeng / Ford, Ian / Franceschini, Nora / Gieger, Christian / Grace, Christopher / Gustafsson, Stefan / Huang, Jie / Hwang, Shih-Jen / Kim, Yun Kyoung / Kleber, Marcus E / Lau, King Wai / Lu, Xiangfeng / Lu, Yingchang / Lyytikäinen, Leo-Pekka / Mihailov, Evelin / Morrison, Alanna C / Pervjakova, Natalia / Qu, Liming / Rose, Lynda M / Salfati, Elias / Saxena, Richa / Scholz, Markus / Smith, Albert V / Tikkanen, Emmi / Uitterlinden, Andre / Yang, Xueli / Zhang, Weihua / Zhao, Wei / de Andrade, Mariza / de Vries, Paul S / van Zuydam, Natalie R / Anand, Sonia S / Bertram, Lars / Beutner, Frank / Dedoussis, George / Frossard, Philippe / Gauguier, Dominique / Goodall, Alison H / Gottesman, Omri / Haber, Marc / Han, Bok-Ghee / Huang, Jianfeng / Jalilzadeh, Shapour / Kessler, Thorsten / König, Inke R / Lannfelt, Lars / Lieb, Wolfgang / Lind, Lars / Lindgren, Cecilia M / Lokki, Marja-Liisa / Magnusson, Patrik K / Mallick, Nadeem H / Mehra, Narinder / Meitinger, Thomas / Memon, Fazal-Ur-Rehman / Morris, Andrew P / Nieminen, Markku S / Pedersen, Nancy L / Peters, Annette / Rallidis, Loukianos S / Rasheed, Asif / Samuel, Maria / Shah, Svati H / Sinisalo, Juha / Stirrups, Kathleen E / Trompet, Stella / Wang, Laiyuan / Zaman, Khan S / Ardissino, Diego / Boerwinkle, Eric / Borecki, Ingrid B / Bottinger, Erwin P / Buring, Julie E / Chambers, John C / Collins, Rory / Cupples, L Adrienne / Danesh, John / Demuth, Ilja / Elosua, Roberto / Epstein, Stephen E / Esko, Tõnu / Feitosa, Mary F / Franco, Oscar H / Franzosi, Maria Grazia / Granger, Christopher B / Gu, Dongfeng / Gudnason, Vilmundur / Hall, Alistair S / Hamsten, Anders / Harris, Tamara B / Hazen, Stanley L / Hengstenberg, Christian / Hofman, Albert / Ingelsson, Erik / Iribarren, Carlos / Jukema, J Wouter / Karhunen, Pekka J / Kim, Bong-Jo / Kooner, Jaspal S / Kullo, Iftikhar J / Lehtimäki, Terho / Loos, Ruth J F / Melander, Olle / Metspalu, Andres / März, Winfried / Palmer, Colin N / Perola, Markus / Quertermous, Thomas / Rader, Daniel J / Ridker, Paul M / Ripatti, Samuli / Roberts, Robert / Salomaa, Veikko / Sanghera, Dharambir K / Schwartz, Stephen M / Seedorf, Udo / Stewart, Alexandre F / Stott, David J / Thiery, Joachim / Zalloua, Pierre A / O'Donnell, Christopher J / Reilly, Muredach P / Assimes, Themistocles L / Thompson, John R / Erdmann, Jeanette / Clarke, Robert / Watkins, Hugh / Kathiresan, Sekar / McPherson, Ruth / Deloukas, Panos / Schunkert, Heribert / Samani, Nilesh J / Farrall, Martin. ·Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Canada. · Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. · Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. · Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA. · Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA. · Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. · Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. · Institut für Integrative und Experimentelle Genomik, Universität zu Lübeck, Lübeck, Germany. · DZHK (German Research Center for Cardiovascular Research) partner site Hamburg-Lübeck-Kiel, Lübeck, Germany. · William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Center for Non-Communicable Diseases, Karachi, Pakistan. · NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK. · CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK. · Deutsches Herzzentrum München, Technische Universität München, München, Germany. · DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany. · Department of Epidemiology, Erasmus University Medical center, Rotterdam, The Netherlands. · Estonian Genome Center, University of Tartu, Tartu, Estonia. · Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia. · Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA. · Department of Health, National Institute for Health and Welfare, Helsinki, Finland. · Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland. · Diabetes & Obesity Research Program, University of Helsinki, Helsinki, Finland. · Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Harvard Medical School, Boston, Massachusetts, USA. · State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. · Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK. · Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. · Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. · Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. · Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. · Science for Life Laboratory, Uppsala University, Uppsala, Sweden. · Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK. · National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA. · Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA. · Center for Genome Science, Korea National Institute of Health, Chungcheongbuk-do, Korea. · Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany. · The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA. · The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York, USA. · Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland. · Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland. · Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA. · Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany. · LIFE Research Center of Civilization Diseases, Leipzig, Germany. · Icelandic Heart Association, Kopavogur, Iceland. · Faculty of Medicine, University of Iceland, Reykjavik, Iceland. · Department of Public Health, University of Helsinki, Helsinki, Finland. · Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland. · Department of Epidemiology and Biostatistics, Imperial College London, London, UK. · Department of Cardiology, Ealing Hospital NHS Trust, Middlesex, UK. · Medical Research Institute, University of Dundee, Dundee, UK. · Population Health Research Institute, Hamilton Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Platform for Genome Analytics, Institutes of Neurogenetics & Integrative and Experimental Genomics, University of Lübeck, Lübeck, Germany. · Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology, and Medicine, London, UK. · Heart Center Leipzig, Cardiology, University of Leipzig, Leipzig, Germany. · Department of Dietetics-Nutrition, Harokopio University, Athens, Greece. · INSERM, UMRS1138, Centre de Recherche des Cordeliers, Paris, France. · Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK. · Lebanese American University, School of Medicine, Beirut, Lebanon. · Hypertension Division, Fuwai Hospital, National Center For Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. · Klinikum rechts der Isar, München, Germany. · Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany. · Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden. · Institut für Epidemiologie, Christian-Albrechts Universität zu Kiel, Kiel, Germany. · Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden. · Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland. · Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. · Punjab Institute of Cardiology, Lahore, Pakistan. · All India Institute of Medical Sciences, New Delhi, India. · Institut für Humangenetik, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. · Institute of Human Genetics, Technische Universität München, München, Germany. · Red Crescent Institute of Cardiology, Hyderabad, Pakistan. · Department of Biostatistics, University of Liverpool, Liverpool, UK. · Department of Medicine, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland. · Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece. · Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. · Department of Haematology, University of Cambridge, Cambridge, UK. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands. · National Human Genome Center at Beijing, Beijing, China. · National Institue of Cardiovascular Diseases, Karachi, Pakistan. · Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. · Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy. · Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA. · Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA. · Imperial College Healthcare NHS Trust, London, UK. · Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. · The Berlin Aging Study II; Research Group on Geriatrics; Charité - Universitätsmedizin Berlin, Berlin, Germany. · Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Grupo de Epidemiología y Genética Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain. · MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA. · Division of Endocrinology and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. · Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA. · Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. · Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK. · Cardiovascular Genetics and Genomics Group, Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. · Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA. · Cleveland Clinic, Cleveland, Ohio, USA. · Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. · Kaiser Permanente Division of Research, Oakland, California, USA. · Durrer Center for Cardiogenetic Research, Amsterdam, The Netherlands. · Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of Forensic Medicine, University of Tampere School of Medicine, Tampere, Finland. · Cardiovascular Science, National Heart and Lung Institute, Imperial College London, London, UK. · Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. · The Mindich Child Health and Development Institute, The Icahn School of Medicine at Mount Sinai, New York, New York, USA. · Department of Clinical Sciences, Hypertension and Cardiovascular Disease, Lund University, University Hospital Malmö, Malmö, Sweden. · Synlab Academy, Synlab Services GmbH, Mannheim, Germany. · Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. · Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA. · Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · University of Ottawa Heart Institute, Ottawa, Canada. · Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. · Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. · Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. · Oklahoma Center for Neuroscience, Oklahoma City, Oklahoma, USA. · Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. · Department of Epidemiology, University of Washington, Seattle, Washington, USA. · Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Institute of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK. · Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Medical Faculty, Leipzig, Germany. · Harvard School of Public Health, Boston, Massachusetts, USA. · National Heart, Lung and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA. · Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Health Sciences, University of Leicester, Leicester, UK. · Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia. ·Nat Genet · Pubmed #26343387.

ABSTRACT: Existing knowledge of genetic variants affecting risk of coronary artery disease (CAD) is largely based on genome-wide association study (GWAS) analysis of common SNPs. Leveraging phased haplotypes from the 1000 Genomes Project, we report a GWAS meta-analysis of ∼185,000 CAD cases and controls, interrogating 6.7 million common (minor allele frequency (MAF) > 0.05) and 2.7 million low-frequency (0.005 < MAF < 0.05) variants. In addition to confirming most known CAD-associated loci, we identified ten new loci (eight additive and two recessive) that contain candidate causal genes newly implicating biological processes in vessel walls. We observed intralocus allelic heterogeneity but little evidence of low-frequency variants with larger effects and no evidence of synthetic association. Our analysis provides a comprehensive survey of the fine genetic architecture of CAD, showing that genetic susceptibility to this common disease is largely determined by common SNPs of small effect size.

146 Article Long-Term Outcomes in Patients With Diabetes Mellitus Related to Prolonging Clopidogrel More Than 12 Months After Coronary Stenting. 2015

Thukkani, Arun K / Agrawal, Kush / Prince, Lillian / Smoot, Kyle J / Dufour, Alyssa B / Cho, Kelly / Gagnon, David R / Sokolovskaya, Galina / Ly, Samantha / Temiyasathit, Sara / Faxon, David P / Gaziano, J Michael / Kinlay, Scott. ·Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Cardiovascular Division, Boston Medical Center, Boston, Massachusetts. · MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. · MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: scott.kinlay@va.gov. ·J Am Coll Cardiol · Pubmed #26337986.

ABSTRACT: BACKGROUND: Recent large clinical trials show lower rates of late cardiovascular events by extending clopidogrel >12 months after percutaneous coronary revascularization (PCI). However, concerns of increased bleeding have elicited support for limiting prolonged treatment to high-risk patients. OBJECTIVES: The aim of this analysis was to determine the effect of prolonging clopidogrel therapy >12 months versus ≤12 months after PCI on very late outcomes in patients with diabetes mellitus (DM). METHODS: Using the Veterans Health Administration, 28,849 patients undergoing PCI between 2002 and 2006 were categorized into 3 groups: 1) 16,332 without DM; 2) 9,905 with DM treated with oral medications or diet; and 3) 2,612 with DM treated with insulin. Clinical outcomes, stratified by stent type, ≤4 years after PCI were determined from the Veterans Health Administration and Medicare databases and risk was assessed by multivariable and propensity score analyses using a landmark analysis starting 1 year after the index PCI. The primary endpoint of the study was the risk of all-cause death or myocardial infarction (MI). RESULTS: In patients with DM treated with insulin who received drug-eluting stents (DES), prolonged clopidogrel treatment was associated with a decreased risk of death (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.42 to 0.82) and death or MI (HR: 0.67; 95% CI: 0.49 to 0.92). Similarly, in patients with noninsulin-treated DM receiving DES, prolonged clopidogrel treatment was associated with less death (HR: 0.61; 95% CI: 0.48 to 0.77) and death or MI (HR: 0.61; 95% CI: 0.5 to 0.75). Prolonged clopidogrel treatment was not associated with a lower risk in patients without DM or in any group receiving bare-metal stents. CONCLUSIONS: Extending the duration of clopidogrel treatment >12 months may decrease very late death or MI only in patients with DM receiving first-generation DES. Future studies should address this question in patients receiving second-generation DES.

147 Article Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter? 2015

Hannan, Edward L / Zhong, Ye / Wu, Chuntao / Jacobs, Alice K / Stamato, Nicholas J / Sharma, Samin / Gold, Jeffrey P / Wechsler, Andrew S. ·School of Public Health, University at Albany, State University of New York, Albany, New York. Electronic address: edward.hannan@health.ny.gov. · School of Public Health, University at Albany, State University of New York, Albany, New York. · Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania. · Department of Cardiology, Boston Medical Center, Boston, Massachusetts. · Department of Cardiology, United Health Services, Binghamton, New York. · Department of Cardiology, Mt. Sinai Medical Center, New York, New York. · University of Nebraska Medical Center, Omaha, Nebraska. · Department of Cardiothoracic Surgery, Drexel University, Philadelphia, Pennsylvania. ·Ann Thorac Surg · Pubmed #26294345.

ABSTRACT: BACKGROUND: Several randomized controlled trials and observational studies have compared outcomes for coronary artery bypass graft (CABG) surgery and drug-eluting stents (DES), but these studies have not thoroughly investigated the relative difference in outcomes by sex. We aimed to compare 3-year outcomes (mortality, mortality/myocardial infarction/stroke, and repeat revascularization) for CABG surgery and percutaneous coronary interventions with DES by sex. METHODS: A total of 4,532 women (2,266 pairs of CABG and DES patients) and 11,768 men (5,884 pairs) were propensity matched separately using multiple patient risk factors and were compared with respect to 3-year outcomes. RESULTS: Both women and men receiving DES had significantly higher mortality rates (adjusted hazard ratio, 1.28; 95% confidence interval, 1.06 to 1.54 and adjusted hazard ratio, 1.22; 95% confidence interval, 1.06 to 1.41, respectively) and myocardial infarction/mortality/stroke rates (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19 to 1.64 and adjusted hazard ratio, 1.36; 95% confidence interval, 1.20 to 1.54, respectively) with DES. The advantage for CABG surgery was also present for several preselected patient subgroups. Men had consistently lower adverse outcome rates than women for both procedures. For example, the mortality rates for CABG and DES for men were 8.0% and 9.1%, compared with respective rates of 11.8% and 13.7% for women. CONCLUSIONS: For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.

148 Article Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease. 2015

Siddiqi, Omar K / Smoot, Kyle J / Dufour, Alyssa B / Cho, Kelly / Young, Melissa / Gagnon, David R / Ly, Samantha / Temiyasathit, Sara / Faxon, David P / Gaziano, J Michael / Kinlay, Scott. ·Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA Cardiovascular Division, Boston Medical Center, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Boston University School of Public Health, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. ·Heart · Pubmed #26209334.

ABSTRACT: OBJECTIVES: Patients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS). METHODS: We studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12  months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI. RESULTS: Of 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1-4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1-4 years after PCI. CONCLUSIONS: In patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.

149 Article Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. 2015

Pursnani, Amit / Massaro, Joseph M / D'Agostino, Ralph B / O'Donnell, Christopher J / Hoffmann, Udo. ·Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston2Cardiology Division, NorthShore University Health System, Evanston, Illinois. · Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts4The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts. · The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts5Department of Mathematics, Boston University, Boston, Massachusetts. · The Framingham Heart Study of the National Heart, Lung and Blood Institute and Boston University, Framingham, Massachusetts6Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland7Cardiology Division, Department of Me. · Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston7Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. ·JAMA · Pubmed #26172893.

ABSTRACT: IMPORTANCE: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for cholesterol management defined new eligibility criteria for statin therapy. However, it is unclear whether this approach improves identification of adults at higher risk of cardiovascular events. OBJECTIVE: To determine whether the ACC/AHA guidelines improve identification of individuals who develop incident cardiovascular disease (CVD) and/or have coronary artery calcification (CAC) compared with the National Cholesterol Education Program's 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal community-based cohort study, with participants for this investigation drawn from the offspring and third-generation cohorts of the Framingham Heart Study. Participants underwent multidetector computed tomography for CAC between 2002 and 2005 and were followed up for a median of 9.4 years for incident CVD. EXPOSURES: Statin eligibility was determined based on Framingham risk factors and low-density lipoprotein thresholds for ATP III, whereas the pooled cohort calculator was used for ACC/AHA. MAIN OUTCOMES AND MEASURES: The primary outcome was incident CVD (myocardial infarction, death due to coronary heart disease [CHD], or ischemic stroke). Secondary outcomes were CHD and CAC (as measured by the Agatston score). RESULTS: Among 2435 statin-naive participants (mean age, 51.3 [SD, 8.6] years; 56% female), 39% (941/2435) were statin eligible by ACC/AHA compared with 14% (348/2435) by ATP III (P < .001). There were 74 incident CVD events (40 nonfatal myocardial infarctions, 31 nonfatal ischemic strokes, and 3 fatal CHD events). Participants who were statin eligible by ACC/AHA had increased hazard ratios for incident CVD compared with those eligible by ATP III: 6.8 (95% CI, 3.8-11.9) vs 3.1 (95% CI, 1.9-5.0), respectively (P<.001). Similar results were seen for CVD in participants with intermediate Framingham Risk Scores and for CHD. Participants who were newly statin eligible (n = 593 [24%]) had an incident CVD rate of 5.7%, yielding a number needed to treat of 39 to 58. Participants with CAC were more likely to be statin eligible by ACC/AHA than by ATP III: CAC score >0 (n = 1015): 63% vs 23%; CAC score >100 (n = 376): 80% vs 32%; and CAC score >300 (n = 186): 85% vs 34% (all P < .001). A CAC score of 0 identified a low-risk group among ACC/AHA statin-eligible participants (306/941 [33%]) with a CVD rate of 1.6%. CONCLUSIONS AND RELEVANCE: In this community-based primary prevention cohort, the ACC/AHA guidelines for determining statin eligibility, compared with the ATP III, were associated with greater accuracy and efficiency in identifying increased risk of incident CVD and subclinical coronary artery disease, particularly in intermediate-risk participants.

150 Article Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial. 2015

Chen, C-Y Oliver / Holbrook, Monika / Duess, Mai-Ann / Dohadwala, Mustali M / Hamburg, Naomi M / Asztalos, Bela F / Milbury, Paul E / Blumberg, Jeffrey B / Vita, Joseph A. ·Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. oliver.chen@tufts.edu. · Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA, 02111, USA. oliver.chen@tufts.edu. · Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA. moholbro@bu.edu. · Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA. mduess@bu.edu. · Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA. mustali.dohadwala@gmail.com. · Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA. nhamburg@bu.edu. · Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. bela.asztalos@tufts.edu. · Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. pual.milbury@tufts.edu. · Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. jeffrey.blumberg@tufts.edu. · Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA. ·Nutr J · Pubmed #26080804.

ABSTRACT: OBJECTIVE: Almonds reduce cardiovascular disease risk via cholesterol reduction, anti-inflammation, glucoregulation, and antioxidation. The objective of this randomized, controlled, cross-over trial was to determine whether the addition of 85 g almonds daily to a National Cholesterol Education Program (NCEP) Step 1 diet (ALM) for 6 weeks would improve vascular function and inflammation in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: A randomized, controlled, crossover trial was conducted in Boston, MA to test whether as compared to a control NCEP Step 1 diet absent nuts (CON), incorporation of almonds (85 g/day) into the CON diet (ALM) would improve vascular function and inflammation. The study duration was 22 weeks including a 6-weeks run-in period, two 6-weeks intervention phases, and a 4-weeks washout period between the intervention phases. A total of 45 CAD patients (27 F/18 M, 45-77 y, BMI = 20-41 kg/m(2)) completed the study. Drug therapies used by patients were stable throughout the duration of the trial. RESULTS: The addition of almonds to the CON diet increased plasma α-tocopherol status by a mean of 5.8%, reflecting patient compliance (P ≤0.05). However, the ALM diet did not alter vascular function assessed by measures of flow-mediated dilation, peripheral arterial tonometry, and pulse wave velocity. Further, the ALM diet did not significantly modify the serum lipid profile, blood pressure, C-reactive protein, tumor necrosis factor-α or E-selectin. The ALM diet tended to decrease vascular cell adhesion molecule-1 by 5.3% (P = 0.064) and increase urinary nitric oxide by 17.5% (P = 0.112). The ALM intervention improved the overall quality of the diet by increasing calcium, magnesium, choline, and fiber intakes above the Estimated Average Requirement (EAR) or Recommended Dietary Allowance (RDA). CONCLUSIONS: Thus, the addition of almonds to a NECP Step 1 diet did not significantly impact vascular function, lipid profile or systematic inflammation in CAD patients receiving good medical care and polypharmacy therapies but did improve diet quality without any untoward effect. TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.Gov with the identifier: NCT00782015.

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