News from the American Heart Association's 2011 Scientific Sessions in Orlando
Stenting After Stroke or TIA—Does Timing Affect the Outcome?
Researchers found no significant difference in the outcome for patients who received carotid artery stenting more than 30 days post–transient ischemic attack (TIA) or stroke versus those who received carotid artery stenting 30 days or sooner postevent.
Surgical literature recommends that the removal of plaque from the carotid artery take place within 14 days of a TIA or stroke for the best outcomes. However, little is known about the optimal timing of carotid artery stenting for these patients.
Nicholas J. Ruggiero II, MD, Director of Structural Heart Disease and Non-Coronary Interventions at the Jefferson Heart Institute and Assistant Professor of Medicine, Jefferson Medical College of Thomas Jefferson University in Philadelphia, led a multisite team of researchers who attempted to uncover the optimal timing for carotid artery stenting after TIA or stroke.
“We hope for the results of this study to serve as a guide for the appropriate timing and use for carotid artery stenting,” said Dr. Ruggiero.
The team retrospectively evaluated 899 symptomatic patients in the NCDR CARE Registry who underwent carotid artery stenting from January 2005 to February 2011. They compared such baseline characteristics as procedural, in-hospital, and 30-day events (including TIA, stroke, heart attack, or neurologic death).
Of the 899 patients, 614 received carotid artery stenting at 30 days or sooner postevent and 285 at more than 30 days. The demographics of each patient population were evenly matched, except for a higher prevalence of smoking, abnormal lipid levels, chronic obstructive pulmonary disease, and use of clopidogrel in the group that received carotid artery stenting after 30 days, and a higher occurrence of hemodialysis in the 30 days or fewer group.
“This study suggests that the optimal timing of carotid artery stenting in symptomatic patients can be individualized and performed safely, but further studies are necessary to substantiate this,” said Dr. Ruggiero.
Severe Sepsis, New-Onset Atrial Fibrillation Associated With Increased Risk of In-Hospital Stroke, Death
A study has found an increased risk of stroke and mortality among patients diagnosed with severe sepsis and new-onset atrial fibrillation during hospitalization.
Allan J. Walkey, MD, Assistant Professor of Medicine at the Boston University School of Medicine and a pulmonologist at Boston Medical Center, is the lead author of the study, which will be published in JAMA.
Although severe sepsis and atrial fibrillation are common illnesses and chronic atrial fibrillation is a known risk factor for stroke and death, very little is known about new-onset atrial fibrillation during severe sepsis.
“The purpose of our retrospective study was to examine if a new-onset atrial fibrillation diagnosis in patients with severe sepsis was associated with an increased risk of stroke and mortality in a hospital setting,” said Dr. Walkey.
The researchers examined data, provided by the Agency for Healthcare Research and Quality, from more than three million hospitalized patients. Looking at the risks of stroke and mortality, the study authors found that patients with new-onset atrial fibrillation during severe sepsis had three times the risk of having a stroke and a 7% increased risk of death during hospitalization. Almost 3% of patients with new-onset atrial fibrillation during severe sepsis had a stroke during hospitalization, compared with less than 1% of those not diagnosed with the condition during severe sepsis.
The data also showed that 56% of patients with severe sepsis and new-onset atrial fibrillation died, whereas 39% of patients with severe sepsis who did not develop new-onset atrial fibrillation did not die. In addition, 6% of patients with severe sepsis developed new-onset atrial fibrillation, compared with less than 1% of patients who did not have severe sepsis and were hospitalized for another reason. Furthermore, among all patients with or without severe sepsis, 14% of all new-onset atrial fibrillation cases occurred in patients with severe sepsis.
“It is projected that one million Americans will have severe sepsis this year, and based on our data, approximately 60,000 people will develop new-onset atrial fibrillation,” said Dr. Walkey. “There are currently no guidelines on how best to care for these specific patients, but this study is a call to action that this under-recognized potential complication of severe sepsis requires further investigation on how to treat these critically ill patients.”
Professional Dental Cleanings May Reduce Risk of Heart Attack and Stroke
Professional tooth scaling was associated with fewer heart attacks and strokes, according to investigators.
Among more than 100,000 people, those who had their teeth scraped and cleaned (tooth scaling) by a dentist or dental hygienist had a 24% lower risk of heart attack and 13% lower risk of stroke, compared with those who had never had a dental cleaning. The participants were followed for an average of seven years.