Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock

Aims Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment.Methods and results In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%).Conclusion In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.[GRAPHICS

Avaliação do uso de resíduo de serragem de pedra Cariri (RSPC) para produção de concretos convencionais

No estado do Ceará, na região do Cariri, um minério calcário laminado, comercialmente conhecido como pedra Cariri, é muito explorado. Os processos de exploração e beneficiamento desse minério são causas da geração de resíduos. Um dos tipos de resíduo gerado é o decorrente da serragem de pedra Cariri, denominado de resíduo de serragem de pedra Cariri (RSPC). Nesta pesquisa, avalia-se a viabilidade do uso de RSPC como substituição parcial do cimento na produção de concretos convencionais. Foram determinadas as características químicas e físicas do RSPC. A influência foi avaliada através das propriedades mecânicas (resistência à compressão axial e diametral) e parâmetros de durabilidade (absorção por imersão e por sucção capilar). Foram produzidos 9 traços, variando a relação a/c (0,45; 0,55; 0,65) e os teores de substituição (0%, 10% e 20%) do cimento. Os resultados demonstram que a utilização de RSPC no concreto proporcionou uma redução nas resistências à compressão e à tração por compressão diametral. Entretanto, em relação aos parâmetros de durabilidade, os concretos com RSPC apresentaram comportamento compatível com os concretos de referência. De um modo geral, do ponto de vista técnico, o RSPC não proporcionou resultados satisfatórios para aplicação em concreto

ORNITHOLOGICAL NOTES MADE IN THE STRAITS SETTLEMENTS AND IN THE WESTERN STATES OF THE MALAY PENINSULA: PART I

Volume: 9Start Page: 109End Page: 14

100.03 Routine Invasive Versus Conservative Management of Non-ST Elevation Acute Coronary Syndromes in Patients With Previous Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

Background A routine invasive strategy is recommended in the management of higher risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS). However, patients with previous coronary artery bypass graft surgery (CABG) were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. Methods A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Eligible studies were RCTs of routine invasive versus a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data was collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction and cardiac related hospitalization. Using a random-effects model, risk ratios with 95% confidence intervals were calculated. Results Summary data was obtained from eleven RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive). A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97-1.29), cardiac mortality (RR 1.05, 95% CI 0.70-1.58), myocardial infarction (RR 0.90, 95% CI 0.65-1.23) or cardiac related hospitalization (RR 1.05, 95% CI 0.78-1.40). Conclusions This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT