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BACKGROUND: Co-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined. METHODS: The Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study. CONCLUSIONS: This clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT04347330).
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Background: The clinical manifestations of pulmonary embolism are varied, and atypical pulmonary embolism can easily be missed in some patients, resulting in serious clinical consequences and injuries. Case Description: This report describes a rare case of acute pulmonary embolism with loss of consciousness as the first manifestation. A 50-year-old male was admitted with loss of consciousness and difficulty breathing. Acute coronary syndromes and neurological disorders such as seizures were excluded by clinical history and electrocardiogram dynamic changes. Multiple clues such as coagulation function and myocardial enzymes are highly suggestive of pulmonary embolism, after the completion of computed tomography pulmonary angiogram (CTPA) diagnosis, the severity of the acute pulmonary embolism was evaluated, after which the patient was given low-molecular-weight heparin sequentially overlapping with oral warfarin as the anticoagulation treatment. Following this, the life signs of the patient were stable, and there were no special complaints; thus, this patient was discharged smoothly. As of this writing, the patient is still being followed up clinically with no recurrent embolism or deterioration occurred. Conclusions: This case is of guiding significance for the early detection and rapid diagnosis and treatment of such patients with pulmonary embolism. It is necessary to acquire the vital signs, including those related to heart rate, electrocardiography, respiration, and blood oxygen saturation in the first clinical contact for patients with syncope as soon as possible. Patients with problems related to the above-mentioned basic vital signs should be highly suspected of cardiopulmonary diseases, and CTPA should be performed as soon as possible after the evaluation of the clinical possibility of pulmonary embolism and D-dimer screening. Moreover, the critical degree of pulmonary embolism should be evaluated, and then reperfusion or anticoagulation treatment should be performed appropriately. This should be followed by etiology screening. To avoid recurrence or aggravation of pulmonary embolism, the cause of the disease should be determined and treated.