Short term outcomes in the elderly patients with non-ST-elevation acute coronary syndromes undergoing early percutaneous coronary intervention: a report from the ISACS-TC registry

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Morphology and composition of oxidized InAs nanowires studied by combined Raman spectroscopy and transmission electron microscopy

importance for semiconductor nanowires because of the high surface-to-volume ratio and only little is known about the consequences of oxidation for these systems. Here, we study the properties of indium arsenide nanowires which were locally oxidized using a focused laser beam. Polarization dependent micro-Raman measurements confirmed the presence of crystalline arsenic, and transmission electron microscopy diffraction showed the presence of indium oxide. The surface dependence of the oxidation was investigated in branched nanowires grown along the [0001] and [01 (1) over bar0] wurtzite crystal directions exhibiting different surface facets. The oxidation did not occur at the [ 011 (1) over bar 0] direction. The origin of this selectivity is discussed in terms transition state kinetics of the free surfaces of the different crystal families of the facets and numerical simulations of the laser induced heating

Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay

Background: We sought to investigate sex-related differences in access to care among patients with myocardial infarction (STEMI) in order to identify gender-related factors associated with outcomes. Methods: We studied 7457 patients enrolled in the ISACS-TC registry 2010-2014 (ClinicalTrials.gov NCT01218776). Outcome measures were: inhospital mortality, time delay to call emergency medical services (EMS), home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset. Constant variables included in logistic regression analyses were: age, risk factors, severity of clinical presentation, reperfusion therapies, and concurrent acute medications. Time to treatment from symptom onset was used as dummy variable. Results: Women were less likely than men to receive care within the benchmark time for reperfusion therapy (time to treatment from symptom onset 60 min in 70.3% of women vs 29.7% of men. There were no significant differences in door-to-needle (median; 28 min vs 26 min) and door-to-balloon (median: 45 min vs 45 min) times. Major (z >4)determinants of poorer rates of reperfusion therapies included time to treatment from symptom onset >12 hours (adjusted OR: 5.37, CI: 4.58 - 6.31) Killip class > 2 (OR: 1.53, CI: 1.27-1.86) and history of prior heart failure (OR: 2.77, CI, 1.99 to 3.87). After adjustment, women had greater inhospital mortality rates than men (OR: 1.34, CI: 1.01-1.77). Sex differences in in-hospital mortality rates were no longer observed in the cohort, when time to treatment from symptom onset <12 hours was included in the multivariable analysis (OR: 1.31, CI: 0.98 -1.74). Conclusion: Sex differences in outcomes persist among STEMI patients, as fewer women receive timely reperfusion therapy. Pre-hospital delays in women experiencing STEMI remain unacceptably long

Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay

Background: We sought to investigate sex-related differences in access to care among patients with myocardial infarction (STEMI) in order to identify gender-related factors associated with outcomes. Methods: We studied 7457 patients enrolled in the ISACS-TC registry 2010-2014 (ClinicalTrials.gov NCT01218776). Outcome measures were: inhospital mortality, time delay to call emergency medical services (EMS), home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset. Constant variables included in logistic regression analyses were: age, risk factors, severity of clinical presentation, reperfusion therapies, and concurrent acute medications. Time to treatment from symptom onset was used as dummy variable. Results: Women were less likely than men to receive care within the benchmark time for reperfusion therapy (time to treatment from symptom onset 60 min in 70.3% of women vs 29.7% of men. There were no significant differences in door-to-needle (median; 28 min vs 26 min) and door-to-balloon (median: 45 min vs 45 min) times. Major (z >4)determinants of poorer rates of reperfusion therapies included time to treatment from symptom onset >12 hours (adjusted OR: 5.37, CI: 4.58 - 6.31) Killip class > 2 (OR: 1.53, CI: 1.27-1.86) and history of prior heart failure (OR: 2.77, CI, 1.99 to 3.87). After adjustment, women had greater inhospital mortality rates than men (OR: 1.34, CI: 1.01-1.77). Sex differences in in-hospital mortality rates were no longer observed in the cohort, when time to treatment from symptom onset <12 hours was included in the multivariable analysis (OR: 1.31, CI: 0.98 -1.74). Conclusion: Sex differences in outcomes persist among STEMI patients, as fewer women receive timely reperfusion therapy. Pre-hospital delays in women experiencing STEMI remain unacceptably long

Fibrinolysis Versus Primary Pci In Stemi Patients Enrolled In The International Survey Of Acute Coronary Syndromes In Transitional Countries

Primary angioplasty has been shown to be more effective than fibrinolysis in terms of mortality and adverse outcomes. More recent data, however, suggests that timely reperfusion with fibrinolysis is comparable to primary angioplasty. The current study gathered data from the International Survey of Acute Coronary Syndromes in Transitional Countries registry. Among 7406 ST-elevation myocardial infarction patients presenting within 12 hours from symptom onset, 6315 underwent primary percutaneous coronary intervention and 1091 were treated with fibrinolysis. The primary outcome was 30-day mortality, while the secondary outcome was a composite of 30-day incidence of death, severe left ventricular dysfunction, stroke or reinfarction. Patients who underwent primary angioplasty tended to have a greater cardiovascular risk profile and were slightly older. On the other hand, patients treated with fibrinolysis received less anti-platelet medications yet were more often prescribed beta blockers in the acute phase. Among those who received fibrinolysis, 43% underwent coronary angiography while 32.3% were treated with a subsequent angioplasty. Total ischemic time was lower in patients undergoing fibrinolysis (185 minutes) than in those treated with primary angioplasty (258 minutes). Rates of primary and secondary combined endpoints were higher in patients receiving fibrinolysis compared to those receiving primary angioplasty (7.8% vs. 4.1%; p<0.0001; OR 1.97, 95% CI, 1.38-2.81; and 14.8% vs. 10.1%, p<0.0001; OR 1.43, 95% CI, 1.12-1.81). When considering only patients receiving reperfusion within 3 hours, regardless of reperfusion strategy, differences in mortality (6.3% vs. 4%, p=0.094, for fibrinolysis or primary angioplasty, respectively; OR 0.87, 95% CI, 0.35-2.16) and in the combined secondary endpoint were no longer observed (12.9% vs 10.8%, p=0.33; OR 0.98, 95% CI, 0.58-1.64), and female sex was no longer a significant predictor of adverse outcomes. When performed 3 hours from symptom onset, fibrinolysis is safe and feasible, in terms of mortality and adverse outcomes, compared to primary angioplasty

Microvascular angina as a cause of ischemia: An update

Since initial reports over four decades ago, the diagnosis and the management of \u201cmicrovascular angina\u201d continue to be a troublesome dilemma for physicians. Microvascular angina is suspected in those patients presenting with angina or angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease. Many of these patients often complain of chest pain and disability for years, and the morbidity is considerable. Earlier reports have questioned the presence of ischemia in such patients. Recent investigations have sought to demonstrate an association of chest pain with the occurrence of adverse events including cardiac death and nonfatal myocardial infarction. The role of coronary microvascular function remains controversial with regards to pathophysiology, diagnosis and management

Coronary heart disease incidence and competing risks. an important issue

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Effects of Statin Treatment on Patients with Angina and Normal or Nearly Normal Angiograms

This article offers an updated and comprehensive overview of major findings on the effects of statin treatment in patients with chronic angina but without any epicardial coronary artery with obstructive lesion

Prognostic implications of peripheral artery disease in coronary artery disease

Prevalence of peripheral arterial disease in patients with coronary artery disease is considerably higher than in the general population. A graded increase in the risk of major cardiovascular events in a variety of clinical settings is associated with the number of arterial beds affected by peripheral arterial disease. This is not surprising, considering that both coronary artery disease and peripheral arterial disease are linked to a higher prevalence of cardiovascular risk factors and a greater incidence of atherosclerotic burden. Aggressive lipid lowering therapy is associated with less coronary and peripheral arterial disease progression and greater regression. On the contrary, blood pressure therapy should be carefully managed, considering the association of both high and low values of pressure with adverse outcomes

Does the Evidence Support a Radial Approach in Non-ST Elevation Acute Coronary Syndromes?

Introduction: Trans-radial access (TRA) for PCI has been consistently shown to reduce mortality and bleeding complications compared with trans-femoral access (TFA) in pts with STEMI. On the contrary the efficacy and the safety of TRA in NSTE-ACS is still matter of debate Hypothesis: The purpose of this study was to determine the potential clinical benefits of TRA in the NSTE-ACS patient population Methods: We compared outcomes of TRA versus TFA in a real world population of patients with NSTE-ACS drawn from the ISACS-TC registry (NCT01218776) The primary outcome was the incidence of all cause death and stroke at 30 days. The secondary outcome was the combined endpoint of periprocedural major complications (MI type 4, abrupt closure, loss of side branches, distal embolization and postPCI TIMI flow 642). The incidence of nonCABG related major bleeding (TIMI definition) was also noted Results: Of 3127 NSTE ACS patients undergoing PCI 2047 (65.5%) underwent TRA, which was more likely to be employed among male sex and patients with lower-risk characteristics: patients were younger with a lower burden of risk factors. Patients undergoing TRA had significantly more periprocedural complications than those who received TFA (24.4% vs 8.6% p&lt;0.001). The combined endpoint was driven mainly by the rate of noreflow phenomenon (24.4% vs 9.7%). After adjustment for baseline variables, the risk of periprocedural complications was attenuated but still remained significant between the radial and femoral groups (OR 3.63 CI: 2.52-5.22). There were significant differences in center experience: 1651 of the 2047 TRA procedures were performed by centers with high volume characteristics. There was heterogeneity in treatment effect in patients receiving TRA in centers with high versus medium/low volume characteristics. The risk of periprocedural complications was no longer significant after adjustment for center characteristics (OR 0.94 CI 0.52-1.68). The rate of the primary outcome was 1.6% in the TRA group compared with 2.2% in the TFA (adjusted OR 0.65 CI 0.33-1.29). The rate of nonCABG-related major bleeding at 30 days was 1.5% in the TRA group compared with 0.5% in the TFA group. Yet this rate was substantially lower in centers with high volume characteristics. (Adjusted for age and sex OR 0.25 CI 0.03-2.06). Conclusions: No significant differences in the combined outcome of 30 day mortality and ischemic stroke were seen between TRA and TFA approach in patients with NSTE-ACS undergoing PCI. TRA may be preferred in these patients only in centers with considerable experience