ABSTRACT
The aim of the present study was to identify the genetic defect responsible for familial coronary artery disease/myocardial infarction (CAD/MI), which exhibited an autosomal dominant pattern of inheritance, in an extended Chinese Han pedigree containing 34 members. Using exome and Sanger sequencing, a novel 6base pair (bp) 'CAGCCG' deletion in exon 11 of the myocyte enhancer factor 2A (MEF2A) gene was identified, which cosegregated with CAD/MI cases in this family. This 6bp deletion was not detected in 311 sporadic cases of premature CAD/MI or in 323 unrelated healthy controls. Determination of a genetic risk profile has a key role in understanding the pathogenesis of CAD and MI. Among the reported riskconferring genes and their variants, mutations in MEF2A have been reported to segregate with CAD/MI in Caucasian families. Causative missense mutations have also been detected in sporadic CAD/MI cases. However, this suggested genetic linkage is controversial, since it could not be confirmed by ensuing studies. The discovery of a novel MEF2A mutation in a Chinese family with premature CAD/MI suggests that MEF2A may have a significant role in the pathogenesis of premature CAD/MI. To better understand this association, further in vitro and in vivo studies are required.
Subject(s)
Coronary Artery Disease/diagnosis , Coronary Artery Disease/genetics , MEF2 Transcription Factors/genetics , Sequence Deletion , Adolescent , Adult , Aged , Aged, 80 and over , Alleles , Asian People , Biomarkers , Child , China , Chromosome Mapping , Coronary Angiography , Exome , Female , High-Throughput Nucleotide Sequencing , Humans , Male , Middle Aged , Pedigree , Young AdultSubject(s)
Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/drug therapy , Dabigatran/administration & dosage , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Warfarin/administration & dosage , Aged , Anticoagulants/administration & dosage , Antithrombins/administration & dosage , Atrial Fibrillation/epidemiology , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Thrombosis/epidemiology , Treatment Outcome , UltrasonographyABSTRACT
PURPOSE: This study aimed to assess pulmonary vein isolation (PVI) efficacy on atrial fibrillation (AF) recurrence and to determine a predictive dispersion of atrial refractoriness (dERP) value for performing PVI in paroxysmal supraventricular tachycardia (PSVT) patients. METHODS: Of 67 PSVT patients with past AF episodes who underwent accessory pathway (AP) or slow pathway of atrioventricular node ablation, 63 (4 lost to follow-up or death) were assigned into two groups (A and B; 29 and 34 patients, respectively) based on whether they underwent or not subsequent PVI, and all were followed-up up to 3 years. Atrial effective refractory period (AERP) and dERP were measured during the ablation procedure. RESULTS: In receiver operating characteristic (ROC) curve analysis, dERP = 74.5 ms effectively predicted AF recurrence in PSVT patients (p = 0.003). Difference in AF recurrence rate between groups did not reach statistical significance (17.2%, 5/29 vs. 29.4%, 10/34, p = 0.203). AF recurrence rate was lower in patients with dERP >74.5 ms who underwent AP or slow-pathway ablation with vs. without PVI (18.2%, 2/11 vs. 77.8%, 7/9, p = 0.012). CONCLUSIONS: PVI addition after successful AP or slow pathway of atrioventricular node ablation significantly reduced AF recurrence in PSVT patients with high atrial vulnerability (dERP >74.5 ms).
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Pulmonary Veins/surgery , Tachycardia, Supraventricular/surgery , Adult , Atrial Fibrillation/diagnosis , Catheter Ablation/adverse effects , Cohort Studies , Electrocardiography/methods , Female , Follow-Up Studies , Humans , Logistic Models , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Recurrence , Risk Assessment , Tachycardia, Supraventricular/diagnosis , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: An increasing number of patients with an indication for long-term oral anticoagulation (OAC) have undergone percutaneous coronary intervention with stent implantation (PCI-s). However, the optimal antithrombotic treatment for these patients is currently unknown. The purpose of this study was to characterize the benefits and risks of triple antithrombotic therapy (combined aspirin, clopidogrel, and OAC) after stent implantation in patients under long-term OAC treatment compared with dual antiplatelet therapy (combined aspirin and clopidogrel). METHODS: The study consisted of clinical controlled trials with ≥ 3 months of follow-up that compared triple antithrombotic therapy with dual antiplatelet therapy after stent implantation in patients undergoing long-term OAC treatment. RESULTS: Nine clinical trials included 1,996 participants. The meta-analysis was feasible because the grouping criterion was similar. The meta-analysis of the prevention of a major adverse cardiovascular event shows triple antithrombotic therapy to be more efficacious than dual antiplatelet therapy (OR, 0.60; 95% CI, 0.42-0.86; P = .005). There was a significant reduction in all-cause mortality with triple antithrombotic therapy compared with dual antiplatelet therapy. The meta-analysis of major bleeding in the first 6 months during follow-up shows significantly more events with triple antithrombotic therapy (OR, 2.12; 95% CI, 1.05-4.29; P = .04). CONCLUSIONS: Based on our analysis, triple antithrombotic therapy is substantially more efficacious in reducing the occurrence of cardiovascular events and mortality in PCI-s patients with an indication for long-term OAC, compared with dual antiplatelet therapy. Although triple therapy predisposes patients to an increased risk of bleeding, especially major bleeding, it is the better choice for patients with a low bleeding risk.
