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Sleem A, Effron MB, Stebbins A, Wruck LM, Marquis-Gravel G, Muñoz D, Re RN, Gupta K, Pepine CJ, Jain SK, Girotra S, Whittle J, Benziger CP, Farrehi PM, Knowlton KU, Polonsky TS, Roe MT, Rothman RL, Harrington RA, Jones WS, Hernandez AF. Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial. JAMA Cardiol 2023; 8:1061-1069. [PMID: 37792369 PMCID: PMC10551818 DOI: 10.1001/jamacardio.2023.3364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/06/2023] [Indexed: 10/05/2023]
Abstract
Importance Clinicians recommend enteric-coated aspirin to decrease gastrointestinal bleeding in secondary prevention of coronary artery disease even though studies suggest platelet inhibition is decreased with enteric-coated vs uncoated aspirin formulations. Objective To assess whether receipt of enteric-coated vs uncoated aspirin is associated with effectiveness or safety outcomes. Design, Setting, and Participants This is a post hoc secondary analysis of ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness), a pragmatic study of 15 076 patients with atherosclerotic cardiovascular disease having data in the National Patient-Centered Clinical Research Network. Patients were enrolled from April 19, 2016, through June 30, 2020, and randomly assigned to receive high (325 mg) vs low (81 mg) doses of daily aspirin. The present analysis assessed the effectiveness and safety of enteric-coated vs uncoated aspirin among those participants who reported aspirin formulation at baseline. Data were analyzed from November 11, 2019, to July 3, 2023. Intervention ADAPTABLE participants were regrouped according to aspirin formulation self-reported at baseline, with a median (IQR) follow-up of 26.2 (19.8-35.4) months. Main Outcomes and Measures The primary effectiveness end point was the cumulative incidence of the composite of myocardial infarction, stroke, or death from any cause, and the primary safety end point was major bleeding events (hospitalization for a bleeding event with use of a blood product or intracranial hemorrhage). Cumulative incidence at median follow-up for primary effectiveness and primary safety end points was compared between participants taking enteric-coated or uncoated aspirin using unadjusted and multivariable Cox proportional hazards models. All analyses were conducted for the intention-to-treat population. Results Baseline aspirin formulation used in ADAPTABLE was self-reported for 10 678 participants (median [IQR] age, 68.0 [61.3-73.7] years; 7285 men [68.2%]), of whom 7366 (69.0%) took enteric-coated aspirin and 3312 (31.0%) took uncoated aspirin. No significant difference in effectiveness (adjusted hazard ratio [AHR], 0.94; 95% CI, 0.80-1.09; P = .40) or safety (AHR, 0.82; 95% CI, 0.49-1.37; P = .46) outcomes between the enteric-coated aspirin and uncoated aspirin cohorts was found. Within enteric-coated aspirin and uncoated aspirin, aspirin dose had no association with effectiveness (enteric-coated aspirin AHR, 1.13; 95% CI, 0.88-1.45 and uncoated aspirin AHR, 0.99; 95% CI, 0.83-1.18; interaction P = .41) or safety (enteric-coated aspirin AHR, 2.37; 95% CI, 1.02-5.50 and uncoated aspirin AHR, 0.89; 95% CI, 0.49-1.64; interaction P = .07). Conclusions and Relevance In this post hoc secondary analysis of the ADAPTABLE randomized clinical trial, enteric-coated aspirin was not associated with significantly higher risk of myocardial infarction, stroke, or death or with lower bleeding risk compared with uncoated aspirin, regardless of dose, although a reduction in bleeding with enteric-coated aspirin cannot be excluded. More research is needed to confirm whether enteric-coated aspirin formulations or newer formulations will improve outcomes in this population. Trial Registration ClinicalTrials.gov Identifier: NCT02697916.
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Affiliation(s)
- Amber Sleem
- Department of Medicine, Ochsner Medical Center, New Orleans, Louisiana
| | - Mark B. Effron
- John Ochsner Heart and Vascular Institute, University of Queensland-Ochsner Clinical School, New Orleans, Louisiana
| | - Amanda Stebbins
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Lisa M. Wruck
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Guillaume Marquis-Gravel
- Montreal Heart Institute, Montreal, Canada
- Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Daniel Muñoz
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard N. Re
- Research Division, Ochsner Medical Center, New Orleans, Louisiana
| | - Kamal Gupta
- University of Kansas Medical Center, Kansas City
| | - Carl J. Pepine
- Department of Medicine, University of Florida, Gainesville
| | - Sandeep K. Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Saket Girotra
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey Whittle
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | | | | | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah
| | - Tamar S. Polonsky
- University of Chicago Medicine, Department of Medicine, Chicago, Illinois
| | - Matthew T. Roe
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Robert A. Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Medicine, Duke University Health System, Durham, North Carolina
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Duran A, Tutor A, Shariati F, Sleem A, Wever-Pinzon J, Desai S, Eiswirth C, Ventura HO, Krim SR. Preimplant hyponatremia does not predict adverse outcomes in patient with left ventricular assist devices. Curr Probl Cardiol 2022:101239. [PMID: 35513184 DOI: 10.1016/j.cpcardiol.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hyponatremia is a well-established marker of adverse outcomes in chronic heart failure (HF) but not well studied in patients with left ventricular assist device (LVAD). METHODS This is a retrospective study, single center study of HM3 [Abbott, USA] LVAD implants. We divided our population based on their sodium prior to LVAD implantation - hyponatremia if <135 mEq/L and normal sodium if 135 - 145 mEq/L. We compared postoperative and long-term outcomes. RESULTS A total of 195 patients were included, preimplant hyponatremia was present in 40% with a sodium of 132.1±2.1 vs. 137.8±1.9 mEq/L in the normal sodium group. No differences were observed in the postoperative or long-term outcomes. CONCLUSION Preimplant hyponatremia was not associated with mortality or HF admissions, likely due to adequate left ventricular unloading and resolution of the mechanisms that lead to hyponatremia. These results suggest that optimization of mild hyponatremia may not be critical and should not delay LVAD placement.
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Affiliation(s)
- Antonio Duran
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
| | - Austin Tutor
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Farnoosh Shariati
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Amber Sleem
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - James Wever-Pinzon
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Sapna Desai
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Clement Eiswirth
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Hector O Ventura
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Selim R Krim
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Okor I, Bob-Manuel T, Price J, Sleem A, Amoran O, Kelly J, Ekerete MF, Bamgbose MO, Bolaji OA, Krim SR. COVID-19 Myocarditis: An Emerging Clinical Conundrum. Curr Probl Cardiol 2022; 47:101268. [PMID: 35644500 PMCID: PMC9135640 DOI: 10.1016/j.cpcardiol.2022.101268] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) has been a significant cause of global mortality and morbidity since it was first reported in December 2019 in Wuhan, China. COVID19 like previous coronaviruses primarily affects the lungs causing pneumonia, interstitial pneumonitis, and severe acute respiratory distress syndrome (ARDS). However, there is increasing evidence linking COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. Given the novelty of this virus, there is paucity of data on some cardiovascular complications of COVID-19, specifically myocarditis. Myocarditis is an inflammatory disease of the heart muscle with a heterogenous clinical presentation and progression. It is mostly caused by viral infections and is the result of interaction of the virus and the host's immune system. There have been several case reports linking COVID-19 with myocarditis, however the true mechanism of cardiac injury remains under investigation. In this paper we review the clinical presentation, proposed pathophysiology, differential diagnoses and management of myocarditis in COVID-19 patients.
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Affiliation(s)
- Ivana Okor
- John Ochsner Heart and Vascular Center, New Orleans, LA, USA
| | | | - Justin Price
- John Ochsner Heart and Vascular Center, New Orleans, LA, USA
| | - Amber Sleem
- John Ochsner Heart and Vascular Center, New Orleans, LA, USA
| | - Olayiwola Amoran
- Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Jayna Kelly
- John Ochsner Heart and Vascular Center, New Orleans, LA, USA
| | | | | | - Olayiwola A Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Centre, Lake Arbor, MD, USA
| | - Selim R Krim
- John Ochsner Heart and Vascular Center, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.
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Joury A, Bob-Manuel T, Sanchez A, Srinithya F, Sleem A, Nasir A, Noor A, Penfold D, Bober R, Morin DP, Krim SR. Leadless and Wireless Cardiac Devices: The Next Frontier in Remote Patient Monitoring. Curr Probl Cardiol 2021; 46:100800. [PMID: 33545511 DOI: 10.1016/j.cpcardiol.2021.100800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/31/2022]
Abstract
In the last decade, advances in wireless and sensor technologies, and the implementation of telemedicine, have led to innovative digital health care for cardiac patients. Continuous monitoring of patients' biomedical signals, and acute changes in these signals, may result in timely, accurate diagnoses and implementation of early interventions. In this review, we discuss commonly used wireless and leadless cardiac devices including pulmonary artery pressure sensors, implantable loop recorders, leadless pacemakers and subcutaneous implantable cardioverter-defibrillators. We discuss the concept and function of each device, indications, methods of delivery, potential complications, consideration for implantation, and cost-effectiveness.
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Affiliation(s)
- Abdulaziz Joury
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | | | - Alexandra Sanchez
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Fnu Srinithya
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Amber Sleem
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Ayman Nasir
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Abdullah Noor
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Dana Penfold
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Robert Bober
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
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