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Background/Introduction The optimal duration of DAPT after coronary stent implantation remains a matter of debate and a novel antiplatelet regimen without an increased risk of bleeding while maintaining an anti-ischemic efficacy is of paramount importance in patients at higher risk of ischemia. Purpose The aim of the present sub-study of the Global Leaders trial is to evaluate the efficacy and safety of the experimental antiplatelet strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with multivessel percutaneous coronary intervention (PCI). Methods The Global Leaders trial enrolled 15,991 patients treated by default with a biolimus A-9 eluting stent. The present sub-study of the trial sought to evaluate the impact of the long-term ticagrelor monotherapy on the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code) at two years. In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years. Results A total of 15,845 patients was included in this analysis, of whom 3,576 patients received multivessel PCI. At two years, the experimental strategy significantly reduced a risk of the primary endpoint (the composite of all-cause death and new Q-wave myocardial infarction [MI]) (3.05% vs. 4.85%, HR: 0.62, 95% CI: 0.44–0.88, p=0.006, Pinteraction=0.031) in patients with multivessel PCI. Similarly, the experimental treatment had a significant risk reduction in the patient-oriented composite endpoint (POCE), defined as the composite of all-cause death, any stroke, any MI, and any revascularization (13.37% vs. 16.74%, HR: 0.78, 95% CI: 0.66–0.93, p=0.005, Pinteraction=0.020) and the net adverse clinical events (NACE), defined as the composite of POCE and Bleeding Academic Research Consortium [BARC] defined bleeding type 3 or 5 (14.65% vs. 18.38%, HR: 0.78, 95% CI: 0.66–0.92, p=0.003, Pinteraction=0.014) at two years. There was no significant difference in BARC type 3 or 5 bleeding (2.44% vs. 2.65%, HR: 0.92, 95% CI: 0.61–1.39, p=0.685, Pinteraction=0.754) at two years between the two regimens. KM in patients with multivessel PCI Conclusion The present study has demonstrated the experimental antiplatelet strategy, when compared with the reference regimen, could potentially have a favourable balance between ischemic efficacy and bleeding safety in patients who underwent multivessel PCI. Acknowledgement/Funding The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R
Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the SYNTAX pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the SYNTAX score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score.
No abstract is provided for this article.
Binding of [3H]Ro5-4864, a ligand selective for peripheral-type benzodiazepine receptors, to human and guinea pig lung membranes was characterized and the binding sites localized in lung sections by light microscopic autoradiography. Inhibition of [3H]Ro5-4864 binding by unlabeled Ro5-4864, PK11195, midazolam, diazepam, clonazepam and flumazenil indicated that [3H]Ro5-4864 bound to specific receptors and binding was reversible. Scatchard analysis indicated a single class of binding site, with a dissociation constant (Kd) of 12.8 +/- 2.1 nM with maximum binding capacity of 2.6 +/- 0.6 pmol/mg of protein for human lung and Kd of 8.4 +/- 1.5 nM and maximum binding capacity of 3.5 +/- 0.3 pmol/mg of protein for guinea pig lung. Autoradiograms showed specific labeling over discrete structures in both human and guinea pig lung. Labeling was particularly dense over submucosal glands in intrapulmonary bronchi of human. Airways were also labeled, with epithelium having a higher grain density than smooth muscle. Labeling over smooth muscle was denser in small compared to large airways. Vascular smooth muscle was not labeled in either human and guinea pig. The alveolar walls were uniformly labeled in both species. The functional significance of pulmonary peripheral-type benzodiazepine receptors remains to be determined.
Abstract This paper reports on recent developments in high‐strength and stainless steel tubular members and connections. It includes carbon steel tubes with a yield stress up to 1350 MPa and stainless steel tubes. The paper describes high‐strength tubes in terms of residual stresses, material properties at elevated temperatures, member behaviour, welded connections under static loading, fatigue strength of welded connections, fabricated sections utilizing high‐strength steel tubes and stainless steel tubular members and connections.
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Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.
Stainless steel is gaining wider usage in a range of engineering applications due to its favourable mechanical properties and corrosion resistance, with ferritic grades expected to become more prevalent in construction due to their lower and more stable cost compared with traditional austenitic and duplex grades. Circular hollow sections (CHS) are a popular structural cross-section due to their visual appeal and structural attributes. A series of ferritic stainless steel CHS beam-column tests have been undertaken, addressing a lack of existing experimental data for this cross-section type and metallic material. In total, 26 beam-column tests, including two section sizes (a non-slender class 3 and slender class 4 cross-section), two member slenderness values and a wide range of loading eccentricities have been undertaken to investigate the interaction between local and global buckling. The experimental results have also been used to assess current design guidance along with previous stainless steel CHS continuous strength method proposals. The outcome is a new comprehensive dataset, along with initial design recommendations for CHS ferritic stainless steel beam-columns.
