Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

BACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral agent tranilast has been shown to decrease the frequency of angiographic restenosis after PCI. METHODS AND RESULTS: In this double-blind, randomized, placebo-controlled trial of tranilast (300 and 450 mg BID for 1 or 3 months), 11 484 patients were enrolled. Enrollment and drug were initiated within 4 hours after successful PCI of at least 1 vessel. The primary end point was the first occurrence of death, myocardial infarction, or ischemia-driven target vessel revascularization within 9 months and was 15.8% in the placebo group and 15.5% to 16.1% in the tranilast groups (P=0.77 to 0.81). Myocardial infarction was the only component of major adverse cardiovascular events to show some evidence of a reduction with tranilast (450 mg BID for 3 months): 1.1% versus 1.8% with placebo (P=0.061 for intent-to-treat population). The primary reason for not completing treatment was > or =1 hepatic laboratory test abnormality (11.4% versus 0.2% with placebo, P<0.01). In the angiographic substudy composed of 2018 patients, minimal lumen diameter (MLD) was measured by quantitative coronary angiography. At follow-up, MLD was 1.76+/-0.77 mm in the placebo group, which was not different from MLD in the tranilast groups (1.72 to 1.78+/-0.76 to 80 mm, P=0.49 to 0.89). In a subset of these patients (n=1107), intravascular ultrasound was performed at follow-up. Plaque volume was not different between the placebo and tranilast groups (39.3 versus 37.5 to 46.1 mm(3), respectively; P=0.16 to 0.72). CONCLUSIONS: Tranilast does not improve the quantitative measures of restenosis (angiographic and intravascular ultrasound) or its clinical sequelae

The "Ermonville" classification of observations at coronary angioscopy - evaluation of intra- and inter-observer agreement

A European coronary angioscopy working group has been established to create and evaluate a classification system for angioscopic observation. The 'Ermenonville' classification features items, graded in 3-5 categories, such as lumen diameter, shape of narrowing, colours of surface, atheroma, dissection, thrombus, etc. Inter- and intra-observer agreement on the interpretation of angioscopic images, using this classification system, was studied within the working group. Kappa values for chance-corrected intra-observer agreement o

The Residual Risk Reduction Initiative: A Call to Action to Reduce Residual Vascular Risk in Patients with Dyslipidemia

Despite achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure, and glycemia in accordance with current standards of care, patients with dyslipidemia remain at high residual risk of vascular events. Atherogenic dyslipidemia, characterized by elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease (CVD), type 2 diabetes mellitus, or metabolic syndrome and contributes,to both macrovascular and microvascular residual risk. However, atherogenic dyslipidemia is largely underdiagnosed and undertreated in clinical practice. The Residual Risk Reduction Initiative (R(3)i) was established to address this highly relevant clinical issue. The aims of this position paper are (1) to highlight evidence that atherogenic dyslipidemia is associated with residual macrovascular and microvascular risk in patients at high risk for CVD, despite current standards of care for dyslipidemia and diabetes; and (2) to recommend therapeutic intervention for reducing this residual vascular risk supported by evidence and, expert consensus. Lifestyle modification with nutrition and exercise is an important, effective, and underutilized first step in reducing residual vascular risk. Therapeutic intervention aimed at achievement of all lipid targets is also often required. Combination lipid-modifying therapy, with the addition of niacin, a fibrate, or omega-3 fatty acids to statin therapy, increases the probability of achieving all lipid goals. Outcomes studies are in progress to evaluate whether these combination treatment strategies translate to a clinical benefit greater than that achieved with statins alone. The R(3)i highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual risk of CVD events and microvascular complications among patients with dyslipidemia receiving therapy for high levels of LDL cholesterol and for diabetes in accordance with current standards of care. (c) 2008 Published by Elsevier Inc. (Am J Cardiol 2008;102[suppl]:1K-34K

Residual risk reduction initiative: Výzva ke sníž ení reziduálního vaskulárního rizika u pacientů s dyslipidemií

Navzdory současným standardům léčby zaměřené na dosažení cílových hodnot LDL cholesterolu, krevního tlaku a glykemie mají pacienti s dyslipidemií vysoké reziduální riziko vzniku vaskulárních příhod. Aterogenní dyslipidemie, zejména vyšší hodnota triglyceridů a nízká koncentrace HDL cholesterolu, se často vyskytuje spolu s vyšší koncentrací apolipoproteinu B a non‑HDL cholesterolu u pacientů s diagnostikovanými kardiovaskulárními onemocněními, diabetes mellitus 2. typu, obezitou nebo metabolickým syndromem a je spojena s reziduálním makrovaskulárním a mikrovaskulárním rizikem. Residual Risk Reduction Initiative (R3i) byla založena proto, aby se touto důležitou problematikou zabývala. Cílem tohoto souhrnného přehledu je vyzdvihnout skutečnost, že se aterogenní dyslipidemie podílí na reziduálním makrovaskulárním riziku a mikrovaskulárních komplikacích, a doporučit léčebnou intervenci vedoucí ke snížení tohoto rizika, podpořenou důkazy a odborným konsensem. Důležitým prvním krokem je úprava životního stylu. Často je mimo to nutná také farmakoterapie. Přidání niacinu, fibrátu nebo ω‑3 mastných kyselin k terapii statiny zlepšuje všechny lipidové rizikové faktory. Klinické studie hodnotí, zda mají tyto strategie lepší klinický přínos než léčba statiny. Závěrem lze říci, že iniciativa R3i zdůrazňuje potřebu ovlivnit vysokou míru reziduálního vaskulárního rizika u pacientů s dyslipidemií, kteří jsou léčeni prostřednictvím úpravy životního stylu anebo farmakoterapií v souladu se současnými standardy léčby

Discovery of a giant H i tail in the galaxy group HCG 44

International audienceWe report the discovery of a giant H i tail in the intragroup medium of HCG 44 as part of the ATLAS3D survey. The tail is ˜ 300 kpc long in projection and contains ˜ 5 × 108 M&sun; of H i. We detect no diffuse stellar light at the location of the tail down to ˜ 28.5 mag arcsec- 2 in g band. We speculate that the tail might have formed as gas was stripped from the outer regions of NGC 3187 (a member of HCG 44) by the group tidal field. In this case, a simple model indicates that about 1/3 of the galaxy's H i was stripped during a time interval of < 1 Gyr. Alternatively, the tail may be the remnant of an interaction between HCG 44 and NGC 3162, a spiral galaxy now ˜ 650 kpc away from the group. Regardless of the precise formation mechanism, the detected H i tail shows for the first time direct evidence of gas stripping in HCG 44. It also highlights that deep H i observations over a large field are needed to gather a complete census of this kind of events in the local Universe

Discovery of a giant HI tail in the galaxy group HCG 44

We report the discovery of a giant HI tail in the intragroup medium of HCG 44 as part of the ATLAS3D survey. The tail is ˜ 300 kpc long in projection and contains ˜ 5 × 108 M⊙ of HI. We detect no diffuse stellar light at the location of the tail down to ˜ 28.5 mag arcsec- 2 in g band. We speculate that the tail might have formed as gas was stripped from the outer regions of NGC 3187 (a member of HCG 44) by the group tidal field. In this case, a simple model indicates that about 1/3 of the galaxy's HI was stripped during a time interval of &lt;1 Gyr. Alternatively, the tail may be the remnant of an interaction between HCG 44 and NGC 3162, a spiral galaxy now ˜ 650 kpc away from the group. Regardless of the precise formation mechanism, the detected HI tail shows for the first time direct evidence of gas stripping in HCG 44. It also highlights that deep HI observations over a large field are needed to gather a complete census of this kind of events in the local Universe