The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).

for the Veterans Affairs Randomized On/Off Bypass Follow-up Study (ROOBY-FS) Group Complete revascularization (CR) at the time of coronary artery bypass graft (CABG) surgery improves long-term cardiac outcomes. No studies have previously reported angiographically confirmed CR rates post-CABG. This study's aim was to assess the impact upon long-term outcomes of CR versus incomplete revascularization (IR), confirmed by coronary angiography 1 year after CABG. Randomized On/Off Bypass Study patients who returned for protocol-specified 1-year post-CABG coronary angiograms were included. Patients with a widely patent graft supplying the major diseased artery within each diseased coronary territory were considered to have CR. Outcomes were all-cause mortality and major adverse cardiovascular events (MACE; all-cause mortality, nonfatal myocardial infarction, repeat revascularization) over the 4 years after angiography. Of the 1,276 patients, 756 (59%) had CR and 520 (41%) had IR. MACE was 13% CR versus 26% IR, p <0.001. This difference was driven by fewer repeat revascularizations (5% CR vs 18% IR; p <0.001). There were no differences in mortality (7.1% CR vs 8.1% IR, p = 0.13) or myocardial infarction (4% in both). Adjusted multivariable models confirmed CR was associated with reduced MACE (odds ratio 0.44, 95% confidence interval 0.33 to 0.58, p <0.01), but had no impact on mortality. In conclusion, CR confirmed by post-CABG angiography was associated with improved MACE but not mortality. Repeat revascularization of patients with IR, driven by knowledge of the research angiography results, may have ameliorated potential mortality differences. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.

Coarctation of the aorta is a diaphragmlike ridge narrowing the lumen of the proximal descending aorta. Although surgical repair has proven to be a successful treatment of coarctation of the aorta, immediate and delayed postoperative complications are not rare. Of particular interest is the occurrence of aneurysms after Dacron patch aortoplasty--often decades after surgery. Delayed complication rates of up to 50% have been reported. We describe the clinical-radiologic presentations of 3 late complications of Dacron patch angioplasty: aortobronchopleural fistula, leaking pseudoaneurysm, and giant descending aortic aneurysm--all successfully treated with bypass grafts. Because of the high incidence of delayed complications, lifelong surveillance is necessary. The chest x-ray may be the first clue to a delayed complication. Knowledge of radiologic findings is helpful in the detection of complications-before they become symptomatic. Transesophageal echocardiography, computed tomography angiography, or magnetic resonance imaging with multiplanar reconstruction is diagnostic.

Background: Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft surgery (CABG); however, it’s impact on long-term mortality is unknown. This study’s objective was to determine if baseline HRQoL status predicts five-year post-CABG mortality. Methods: This pre-specified, Randomized On/Off Bypass Follow-up Study (ROOBY-FS) sub-analysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans Rand Short Form 36 (VR-36), between five-year post-CABG survivors and non-survivors. Standardized sub-scores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey sub-components independently predicted five-year mortality (p < 0.05). Results: Of the 2,203 ROOBY-FS enrollees, 2,104 (95.5%) completed baseline surveys. Significant differences between five-years post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-white race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 Physical Component Summary score (PCS) [p = 0.01], VR-36 Mental Component Summary score (MCS) (p < 0.001) and SAQ Physical Limitation score (SAQ-PL) (p = 0.003) were all associated with five-year all-cause mortality. Conclusions: Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision making and enhancing pre-CABG informed consent.