1-Year COMBO stent outcomes stratified by the PARIS bleeding prediction score: From the MASCOT registry

Background: The COMBO stent is a biodegradable-polymer sirolimus-eluting stent with endothelial progenitor cell capture technology for faster endothelialization. Objective: We analyzed COMBO stent outcomes in relation to bleeding risk using the PARIS bleeding score. Methods: MASCOT was an international registry of all-comers undergoing attempted COMBO stent implantation. We stratified patients as low bleeding-risk (LBR) for PARIS score 3 based on baseline age, body mass index, anemia, current smoking, chronic kidney disease and need for triple therapy. Primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, myocardial infarction (MI) not clearly attributed to a non-target vessel or clinically-driven target lesion revascularization (TLR). Bleeding was adjudicated using the Bleeding Academic Research Consortium (BARC) definition. Dual antiplatelet therapy (DAPT) cessation was independently adjudicated. Results: The study included 56% (n = 1270) LBR and 44% (n = 1009) IHBR patients. Incidence of 1-year TLF was higher in IHBR patients (4.1% vs. 2.6%, p = 0.047) driven by cardiac death (1.7% vs. 0.7%, p = 0.029) with similar rates of MI (1.8% vs. 1.1%, p = 0.17), TLR (1.5% vs. 1.6%, p = 0.89) and definite/ probable stent thrombosis (1.2% vs. 0.6%, p = 0.16). Incidence of 1-year major BARC 3 or 5 bleeding was significantly higher in IHBR patients (2.3% vs. 0.9%, p = 0.0094), as was the incidence of DAPT cessation (29.3% vs. 22.8%, p < 0.01), driven by physician-guided discontinuation. Conclusions: Patients with intermediate-to-high PARIS bleeding risk in the MASCOT registry experienced greater incidence of 1-year TLF, major bleeding and DAPT cessation than LBR patients, without significant differences in stent thrombosis

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

AIMS: The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin-kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (>/=1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. METHODS AND RESULTS: Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77-0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77-0.99; P = 0.032) and Type 2 (0.77, 0.61-0.97; P = 0.025), but not Type 4 MI. CONCLUSION: After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types

Prevention of microbial hazard on fresh‐cut lettuce through adoption of food safety and hygienic practices by lettuce farmers

Lettuce is consumed raw in salads and is susceptible to microbial contamination through environment, agricultural practices, and its morphology, thus, a potential vehicle for food‐borne illness. This study investigated the effect of adoption of food safety and hygienic practices by lettuce farmers on the microbial safety of field sourced lettuce in Lagos State, Nigeria. Ten structured questionnaires were administered randomly to 10 lettuce farmers to assess food safety and hygienic practices (FSH). Two farmers who practice FSH and two farmers who do not practice NFSH were finally used for this study. Samples of ready‐to‐harvest lettuce, manure applied, and irrigation water were obtained for a period of five months (August – December 2013) and analyzed for total plate count (TPC), total coliform count (TCC), Escherichia coli, Listeria spp., Salmonella spp., and Shigella spp. counts. Result of microbial analyses of lettuce samples was compared with international microbiological specification for ready‐to‐eat foods. Results showed that the range of TPC on lettuce was 6.00 to 8.11 LogCFU/g from FSH farms and TPC of lettuce samples from NFSH farms ranged from 6.66 to 13.64 LogCFU/g. 1.49 to 4.85LogCFU/g were TCC ranges from lettuce samples obtained from FSH farms while NFSH farms had TCC ranging between 3.95 and 10.86 LogCFU/g, respectively. The range of isolated pathogen count on lettuce from FSH and NFSH farms exceeded the international safety standard; there was a significant difference in the microbial count of lettuce from FSH farms and NFSH farms. This study concludes that the lettuce samples obtained did not pass the international microbial safety standards. FSH compliance is a major determinant of the microbial safety of lettuce. Hence, the institution of FSH on farm to improve microbial safety of lettuce produced for public consumption is emphasized