A new study published in the New England Journal of Medicine sheds some much-needed light on the precise role of subclinical atrial fibrillation (AF) in the prognosis and development of ischemic stroke. ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial) followed 2580 patients with a newly implanted pacemaker or ICD…

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Every so often, one of my patients with no history of stroke or transient ischemic attack asks my opinion on what to do about a carotid ultrasound — not ordered by me — showing high-grade stenosis. I am a general internist, and I don’t obtain these studies in patients without a history of cerebrovascular symptoms. Guidelines…

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In recent years stenting for intracranial arterial stenosis has become widespread. Now, however, a trial testing the procedure has been terminated early, raising serious questions about both the safety and efficacy of the technique. In the SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial, which has now been published…

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After presentations at the ACC and American Association for Thoracic Surgery 2011 meetings, the PARTNER A results are finally published. PARTNER A compared  transaortic valve replacement (TAVR, also known as TAVI) with surgical aortic valve replacement (AVR) in patients with aortic stenosis who were eligible for AVR but considered to be at high surgical risk . At…

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Following its initial presentation at the ACC meeting in March, the results of PARTNER A have now been published online in the New England Journal of Medicine, in conjunction with a presentation at the Transcatheter Valve Therapies meeting in Vancouver. As reported previously, 699 high-risk older patients with severe aortic stenosis were randomized to either transcatheter aortic…

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In the past year transcatheter aortic valve implantation (TAVI) has emerged as a possible new treatment for patients with aortic valve disease who are not surgical candidates (the PARTNER B study) and for some patients as a viable alternative to surgery (the PARTNER A study). TAVI was found to be noninferior to surgery in the…

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The difference in stroke mortality among countries in Europe and Central Asia is large and, somewhat surprisingly, is growing larger, according to a new analysis of data from the World Health Organization. In a paper published online in the European Heart Journal, Josep Redon and colleagues examine recent 15-year trends from 39 countries. They report…

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Another good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading. The article, titled…

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Despite the increasing complexity of cases, the risk of stroke after CABG may be declining, according to a new study published in JAMA. Khaldoun Tarakji and colleagues prospectively studied more than 45,000 patients who underwent CABG at the Cleveland Clinic from 1982 through 2009. The overall stroke rate was 1.6%. The stroke rate was highest…

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Chronic lower respiratory disease (CLRD) has replaced stroke as the third leading cause of death in the United States, according to preliminary 2008 statistics published by the CDC’s National Center for Health Statistics. In 2008, there were 133,750 deaths from stroke compared to 141,075 deaths from CLRD. Although the stroke rate has been declining for…

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