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Gibson CM, Pinto DS, Chi G, Arbetter D, Yee M, Mehran R, Bode C, Halperin J, Verheugt FWA, Wildgoose P, Burton P, van Eickels M, Korjian S, Daaboul Y, Jain P, Lip GYH, Cohen M, Peterson ED, Fox KAA. Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy. Circulation 2016; 135:323-333. [PMID: 27881555 PMCID: PMC5266420 DOI: 10.1161/circulationaha.116.025783] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. Methods: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. Results: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66–0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62–0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. Conclusions: Among patients with atrial fibrillation undergoing intracoronary stenting, administration of either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy or 2.5 mg rivaroxaban twice daily plus DAPT was associated with a reduced risk of all-cause mortality or recurrent hospitalization for adverse events compared with standard-of-care VKA plus DAPT. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830543.
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Affiliation(s)
- C Michael Gibson
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.).
| | - Duane S Pinto
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Gerald Chi
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Douglas Arbetter
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Megan Yee
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Roxana Mehran
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Christoph Bode
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Jonathan Halperin
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Freek W A Verheugt
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Peter Wildgoose
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Paul Burton
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Martin van Eickels
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Serge Korjian
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Yazan Daaboul
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Purva Jain
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Gregory Y H Lip
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Marc Cohen
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Eric D Peterson
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Keith A A Fox
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
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