Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (Platelet Glycoprotein IIb/IIIa in unstable angina: receptor suppression using integreling therapy)

BACKGROUND: The 6-month clinical outcome of patients with multivessel disease enrolled in PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) is described. Patients with complete angiography data were included; multivessel disease was stratified according to the treatment strategy applied early during hospitalization, i.e. medical treatment, percutaneous coronary intervention (PCI) (balloon), PCI (stent), or coronary artery bypass grafting (CABG). METHODS: Patients were divided into three groups according to the treatment strategy applied during the first 30 days of enrolment. Patients who did not undergo a percutaneous or surgical coronary intervention were classified as medically treated. Patients who underwent a PCI (prior to a possible CABG) were separated from those who underwent a CABG (prior to a possible PCI). The PCI group was further subdivided: patients receiving >/=1 coronary stents were separated from those in whom no stents were used. RESULTS: The mortality rate at 30 days was 6.7, 3.9, 2.4 and 4.8% for the medical treatment, PCI (balloon), PCI (stent) and CABG groups, respectively (p value = 0.002). Differences as observed at 30 days were still present at 6-month follow-up with 11.1, 5.8, 5.5 and 6.5% mortality event rates for the aforementioned groups (p value = 0.002). The 30-day myocardial infarction (MI) rate according to the opinion of the Clinical Events Committee was lower among medically than non-medically treated patients, with the highest event rate observed in the CABG group (27.7%). Approximately half of the MIs in the PCI and CABG subgroups occurred within 48 h after the procedure. CONCLUSIONS: The observed differences in clinical outcomes are explained by an imbalance in baseline characteristics and comorbid conditions between the analyzed groups of patients

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Ecotypic differentiation in thermal traits in the tropical to warm-temperate green macrophyte Valonia utricularis

Differentiation of thermal traits (i.e. growth, survival and reproduction) was studied in the green macrophyte Valonia utricularis (Roth) C. Agardh, which has a world-wide tropical to warm-temperate distribution. Ecotypic differentiation between northeast Atlantic/Mediterranean and Indo-west Pacific isolates occurred with respect to all investigated temperature characteristics. The Atlantic/Mediterranean group is more eurythermal and cold-tolerant compared to the Indo-west Pacific group, which is stenothermal and cold-sensitive. Isolates of Atlantic/Mediterranean origin show clearly higher growth rates at low temperatures (lower temperature limit: 5-8 vs. 18-20degreesC) and a much better tolerance to low temperatures than the Indo-west Pacific isolates (0-5 vs. 16degreesC). Large shifts towards low temperatures are accompanied by parallel but smaller shifts at high temperatures. Differences in upper survival temperatures amounted on average to 4degreesC (32-33degreesC vs. 34-37degreesC) and growth ceased in the Atlantic isolates at 30degreesC, whereas the Indo-west Pacific isolates still reached significant growth at 33degreesC. Additionally, temperature requirements for reproduction were shifted towards lower temperatures in the Atlantic/Mediterranean isolates [18-20 and 25degreesC vs. 28-30(33)degreesC]. The, cold-adapted Atlantic/Mediterranean ecotype retained a strong tropical imprint with high temperature tolerance and high growth rates at temperatures > 25degreesC. The northern distribution limit in the northeastern Atlantic Ocean at 39degreesN (at the 13degreesC February and 17degreesC August isotherms) is probably set by a growth and/or reproduction boundary. The northern distribution limit in the Pacific Ocean at 26degreesN (at the 21degreesC February and 29degreesC August isotherms) is probably set by low lethal winter temperatures. The different latitudes of these boundaries must be attributed to the occurrence of more cold-adapted populations in the northeastern Atlantic Ocean compared to the northwestern Pacific Ocean. The development of cold-adaptation in the northeastern Atlantic Ocean and its absence in the northwestern Pacific Ocean has been related to different impacts of Pleistocene glaciations

Ecotypic differentiation in thermal traits in the tropical to warm-temperate green macrophyte Valonia utricularis

Differentiation of thermal traits (i.e. growth, survival and reproduction) was studied in the green macrophyte Valonia utricularis (Roth) C. Agardh, which has a world-wide tropical to warm-temperate distribution. Ecotypic differentiation between northeast Atlantic/Mediterranean and Indo-west Pacific isolates occurred with respect to all investigated temperature characteristics. The Atlantic/Mediterranean group is more eurythermal and cold-tolerant compared to the Indo-west Pacific group, which is stenothermal and cold-sensitive. Isolates of Atlantic/Mediterranean origin show clearly higher growth rates at low temperatures (lower temperature limit: 5-8 vs. 18-20degreesC) and a much better tolerance to low temperatures than the Indo-west Pacific isolates (0-5 vs. 16degreesC). Large shifts towards low temperatures are accompanied by parallel but smaller shifts at high temperatures. Differences in upper survival temperatures amounted on average to 4degreesC (32-33degreesC vs. 34-37degreesC) and growth ceased in the Atlantic isolates at 30degreesC, whereas the Indo-west Pacific isolates still reached significant growth at 33degreesC. Additionally, temperature requirements for reproduction were shifted towards lower temperatures in the Atlantic/Mediterranean isolates [18-20 and 25degreesC vs. 28-30(33)degreesC]. The, cold-adapted Atlantic/Mediterranean ecotype retained a strong tropical imprint with high temperature tolerance and high growth rates at temperatures &gt; 25degreesC. The northern distribution limit in the northeastern Atlantic Ocean at 39degreesN (at the 13degreesC February and 17degreesC August isotherms) is probably set by a growth and/or reproduction boundary. The northern distribution limit in the Pacific Ocean at 26degreesN (at the 21degreesC February and 29degreesC August isotherms) is probably set by low lethal winter temperatures. The different latitudes of these boundaries must be attributed to the occurrence of more cold-adapted populations in the northeastern Atlantic Ocean compared to the northwestern Pacific Ocean. The development of cold-adaptation in the northeastern Atlantic Ocean and its absence in the northwestern Pacific Ocean has been related to different impacts of Pleistocene glaciations.</p

Chilling-induced photoinhibition in nine isolates of Valonia utricularis (Chlorophyta) from different climate regions

Chilling induced inhibition of photosynthesis was studied in nine isolates of the marine tropical to warm-temperate green macrophyte Valonia utricularis (Roth) C. Agardh. According to their temperature requirements for growth and survival, the isolates belong to a cold-tolerant Atlantic/Mediterranean group and a cold-sensitive Indo-west Pacific group. After 5 hours exposure to 5 degreesC under moderate light, all isolates experienced similar substantial photoinhibition, which approached steady state levels after a decline in Fv/Fm to about 40 % of the initial values. After return to optimal temperature and dim light conditions, Fv/Fm values increased with biphasic kinetics. A fast phase with half-life times of less than 30 minutes (dynamic photoinhibition) was followed by a slow phase lasting a few hours, indicating repair of photodamaged PSII reaction centres (chronic photoinhibition). In the Atlantic/Mediterranean isolates the fast phase accounted for more than 80 % of the recovery response, showing that these isolates were able to cope with the applied low temperature stress by down-regulating their PSII reaction centres. In contrast, the two isolates from the Seychelles were predominantly photodamaged. In a second experiment, three isolates (Corsica, Seychelles, Japan) were exposed to a similar relative amount of cold stress (0, 10, 15degreesC, respectively). The Japanese isolate and the isolate from the Seychelles showed significantly less inhibition compared to 5 degreesC exposure, but no significant difference was found in the Corsican isolate. However, the degree of low temperature stress had no significant influence on the relative contributions of dynamic and chronic photoinhibition. Only two of the seven investigated isolates had a lower final inhibition level when grown at sub-optimal temperatures than at optimal temperatures. However, all sub-optimally grown Atlantic/Mediterranean isolates exhibited faster recovery kinetics from chilling-induced photoinhibition than optimally grown plants. This is related to a faster recovery from chronic photoinhibition than to a higher relative contribution of dynamic photoinhibition. A specific role of the photoprotective pigments of the xanthophyll cycle, leading to an acclimation response in the Atlantic/Mediterranean isolates may be involved. We conclude that ecotypic differentiation in V utricularis is mirrored in different degrees of susceptibility to low temperature stress

Jazz combo concert

No program receivedDigital audio of these performances is not yet available. You may submit a request for these recordings to be digitized and made available at this site within 10 work days at http://lib.asu.edu/music/services/perfdigitizeform?identifier=1986/10-29A&title=Jazz+combo+concer