Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis

PURPOSE: Conduct a meta-analysis to study the prognostic influence of a previous coronary artery bypass grafting (CABG) in patients admitted for an acute coronary syndrome (ACS). METHODS: A systematic review of the literature was performed using electronic reference databases through January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar and references cited in other studies). Studies in which ACS outcomes with a previous history of CABG were compared with ACS outcomes with no history of previous CABG were considered for inclusion. The main endpoints of interest were mortality and non-fatal acute myocardial infarction. Data was aggregated at three follow-up times using random-effects meta-analysis models. RESULTS: Twenty-four studies were included which provided 387,181 patients for analysis. Previous CABG ACS patients were older, more diabetic and had a more frequent history of a previous myocardial infarction. Pooled in-hospital mortality was higher for the previous CABG ACS patients (OR 1.22 [1.04-1.44], p<0.01, I(2) 88%). The pooled adjusted OR showed no significant differences for the two groups (adjusted OR 1.13 [0.93-1.37], p=0.22, I(2) 92%). Previous CABG ACS patient had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02, I(2) 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01, I(2) 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01, I(2) 0%) long-term mortality. Both the in-hospital and the long-term re-infarction rates were higher for the previous CABG ACS patients. CONCLUSIONS: According to our data, ACS patients with previous CABG history had a higher risk for short- and long-term adverse events

A Parametric Finite-Element Model for Evaluating Segmented Mirrors with Discrete, Edgewise Connectivity

Since future astrophysics missions require space telescopes with apertures of at least 10 meters, there is a need for on-orbit assembly methods that decouple the size of the primary mirror from the choice of launch vehicle. One option is to connect the segments edgewise using mechanisms analogous to damped springs. To evaluate the feasibility of this approach, a parametric ANSYS model that calculates the mode shapes, natural frequencies, and disturbance response of such a mirror, as well as of the equivalent monolithic mirror, has been developed. This model constructs a mirror using rings of hexagonal segments that are either connected continuously along the edges (to form a monolith) or at discrete locations corresponding to the mechanism locations (to form a segmented mirror). As an example, this paper presents the case of a mirror whose segments are connected edgewise by mechanisms analogous to a set of four collocated single-degree-of-freedom damped springs. The results of a set of parameter studies suggest that such mechanisms can be used to create a 15-m segmented mirror that behaves similarly to a monolith, although fully predicting the segmented mirror performance would require incorporating measured mechanism properties into the model. Keywords: segmented mirror, edgewise connectivity, space telescop

A Flux-Pinning Mechanism for Segment Assembly and Alignment

Currently, the most compelling astrophysics questions include how planets and the first stars formed and whether there are protostellar disks that contain large organic molecules. Although answering these questions requires space telescopes with apertures of at least 10 meters, such large primaries are challenging to construct by scaling up previous designs; the limited capacity of a launch vehicle bounds the maximum diameter of a monolithic primary, and beyond a certain size, deployable telescopes cannot fit in current launch vehicle fairings. One potential solution is connecting the primary mirror segments edgewise using flux-pinning mechanisms, which are analogous to non-contacting damped springs. In the baseline design, a flux-pinning mechanism consists of a magnet and a superconductor separated by a predetermined gap, with the damping adjusted by placing aluminum near the interface. Since flux pinning is possible only when the superconductor is cooled below a critical temperature, flux-pinning mechanisms are uniquely suited for cryogenic space telescopes. By placing these mechanisms along the edges of the mirror segments, a primary can be built up over time. Since flux pinning requires no mechanical deployments, the assembly process could be robotic or use some other non-contacting scheme. Advantages of this approach include scalability and passive stability

Referral for coronary artery revascularization procedures after diagnostic coronary angiography: Evidence for gender bias?

AbstractObjectives. We sought to determine whether there is a gender bias in the selection of patients for coronary revascularization once the severity of the underlying coronary artery disease has been established with angiography.Background. It has been suggested that women with coronary artery disease are less likely to be referred for coronary angiography and coronary artery bypass surgery than men. Whether such a referral bias for revascularization procedures, including coronary angioplasty, is present once angiography has been performed is not clear.Methods. We retrospectively analyzed 22,795 patients with suspected coronary artery disease who underwent coronary angiography between 1981 and 1991 and compared the numbers of women and men who underwent either coronary artery bypass surgery or coronary angioplasty within 30 days of coronary angiography.Results. Angiography revealed significant (one-vessel or more) disease in 15,455 patients (52% of women, 76% of men). Despite worse symptoms, women had less extensive coronary disease than men as judged by the number of vessels diseased. Women were also more likely to have other co-morbid diseases. An equal proportion of women (54%) and men underwent revascularization procedures. After adjustment for baseline differences and age, differences in the two individual revascularization strategies were very small: More women tended to have coronary angioplasty ([absolute difference ± 1 SD] + 3.3 ± 0.7%, p < 0.0001), but fewer had coronary artery bypass surgery than men (−2.5 ± 0.8%, p = 0.003). When the two revascularization strategies were considered together, there was no significant gender difference in overall adjusted use of revascularization (+0.8 ± 0.9%, p = 0.41).Conclusions. Once diagnostic coronary angiography had been performed, no major differences in the overall utilization of revascularization procedures were noted for women compared with men

Meta-analysis of the influence of chronic kidney disease on the risk of thromboembolism among patients with nonvalvular atrial fibrillation

Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism in patients with nonvalvular AF and the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis method. Data sources included MEDLINE, EMBASE, and Cochrane (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the presence of CKD resulted in an increased risk of thromboembolism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.20 to 1.76, p = 0.0001), particularly in case of end-stage CKD (HR 1.83, 95% CI 1.56 to 2.14, p <0.00001). Warfarin decreased the incidence of thromboembolic events in patients with non-end-stage CKD (HR 0.39, 95% CI 0.18 to 0.86, p <0.00001). Recent data on novel oral anticoagulants suggested a higher efficacy of these agents compared with warfarin (HR 0.80, 95% CI 0.66 to 0.96, p = 0.02) and aspirin (HR 0.32, 95% CI 0.19 to 0.55, p <0.0001) in treating non-end-stage CKD. In conclusion, the presence of CKD in patients with AF is associated with an almost 50% increased thromboembolic risk, which can be effectively decreased with appropriate antithrombotic therapy. Further prospective studies are needed to better evaluate the interest of anticoagulation in patients with severe CKD

Electrodynamics of Media

Contains reports on four research project.Joint Services Electronics Program (Contract DAAB07-71-C-0300)U. S. Army - Research Office - Durham (Contract DAHCO4-72-C-0044

Outcome of Patients With Hypertrophic Cardiomyopathy and a Normal Electrocardiogram

ObjectivesThis study sought to clarify the frequency, clinical phenotype, and prognosis of those patients with hypertrophic cardiomyopathy (HCM) who present with a normal electrocardiogram (ECG).BackgroundHypertrophic cardiomyopathy is the most common cause of sudden death in young people. Screening advocates have recommended a 12-lead ECG for the early detection of HCM in athletes, yet the clinical outcomes of those presenting with a normal ECG remains to be fully delineated.MethodsBaseline characteristic and echocardiographic data were collected on all patients with HCM who initially presented to our institution with a diagnostic echocardiogram but a normal ECG. Follow-up was obtained and compared with the prognosis of HCM patients who presented with abnormal ECGs.ResultsWe compared 135 HCM patients with a normal ECG with 2,350 HCM patients with an abnormal ECG. The latter group was more likely to have worse symptoms, have higher gradients, and a greater degree of septal wall thickness than the patients with a normal ECG. Severe obstructive symptoms requiring surgical myectomy and implantation of an implantable cardioverter-defibrillator were more common in patients with abnormal ECGs. Cardiac survival was significantly better in the group with a normal ECG at presentation—none of these patients had a cardiac death at follow-up.ConclusionsAlmost 6% of patients presenting with demonstrable echocardiographic evidence of HCM had a normal ECG at the time of diagnosis. This subset of patients with normal ECG-HCM appears to exhibit a less severe phenotype with better cardiovascular outcomes