Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

SummaryBackgroundThe transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials.AimsTo compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach.MethodsA prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed.ResultsPatients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28–0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31–0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13–0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58–0.68) and major bleeding (RR: 0.43, 95%CI: 0.32–0.59).ConclusionThe transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

SummaryBackgroundThe transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials.AimsTo compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach.MethodsA prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed.ResultsPatients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28–0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31–0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13–0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58–0.68) and major bleeding (RR: 0.43, 95%CI: 0.32–0.59).ConclusionThe transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres

Coronary-Pulmonary Fistulas Involving All Three Major Coronary Arteries Co-Existing With Myocardial Infarction

We report the case of a man who presented with acute anterior myocardial infarction and in whom the coronary angiogram showed tight stenosis of the left anterior descending coronary artery and the right coronary artery associated with substantial coronary-pulmonary fistulas involving all three major coronary arteries. We discuss the possible links between coronary artery fistulas and myocardial infarction

Determination of the top-quark pole mass and strong coupling constant from the ttbar production cross section in pp collisions at sqrt(s) = 7 TeV

The inclusive cross section for top-quark pair production measured by the CMS experiment in proton-proton collisions at a center-of-mass energy of 7 TeV is compared to the QCD prediction at next-to-next-to-leading order with various parton distribution functions to determine the top-quark pole mass, $m_t^{pole}$, or the strong coupling constant, $\alpha_S$. With the parton distribution function set NNPDF2.3, a pole mass of 176.7$^{+3.0}_{-2.8}$ GeV is obtained when constraining $\alpha_S$ at the scale of the Z boson mass, $m_Z$, to the current world average. Alternatively, by constraining $m_t^{pole}$ to the latest average from direct mass measurements, a value of $\alpha_S(m_Z)$ = 0.1151$^{+0.0028}_{-0.0027}$ is extracted. This is the first determination of $\alpha_S$ using events from top-quark production

Non-local rheology in dense granular flows -- Revisiting the concept of fluidity

Granular materials belong to the class of amorphous athermal systems, like foams, emulsion or suspension they can resist shear like a solid, but flow like a liquid under a sufficiently large applied shear stress. They exhibit a dynamical phase transition between static and flowing states, as for phase transitions of thermodynamic systems, this rigidity transition exhibits a diverging length scales quantifying the degree of cooperatively. Several experiments have shown that the rheology of granular materials and emulsion is non-local, namely that the stress at a given location does not depend only on the shear rate at this location but also on the degree of mobility in the surrounding region. Several constitutive relations have recently been proposed and tested successfully against numerical and experimental results. Here we use discrete elements simulation of 2D shear flows to shed light on the dynamical mechanism underlying non-locality in dense granular flows

Transverse momentum spectra of b jets in pPb collisions at sqrt(s[NN]) = 5.02 TeV

We present a measurement of b jet transverse momentum (pt) spectra in proton-lead (pPb) collisions using a dataset corresponding to about 35 inverse nanobarns collected with the CMS detector at the LHC. Jets from b quark fragmentation are found by exploiting the long lifetime of hadrons containing a b quark through tagging methods using distributions of the secondary vertex mass and displacement. Extracted cross sections for b jets are scaled by the effective number of nucleon-nucleon collisions and are compared to a reference obtained from PYTHIA simulations of pp collisions. The PYTHIA-based estimate of the nuclear modification factor is found to be 1.22 +/- 0.15 (stat + syst pPb) +/- 0.27 (syst PYTHIA) averaged over all jets with pt between 55 and 400 GeV/c and with abs(eta[lab]) < 2. We also compare this result to predictions from models using perturbative calculations in quantum chromodynamics

Searches for electroweak production of charginos, neutralinos, and sleptons decaying to leptons and W, Z, and Higgs bosons in pp collisions at 8 TeV

Searches for the direct electroweak production of supersymmetric charginos, neutralinos, and sleptons in a variety of signatures with leptons and W, Z, and Higgs bosons are presented. Results are based on a sample of proton-proton collision data collected at center-of-mass energy sqrt(s) = 8 TeV with the CMS detector in 2012, corresponding to an integrated luminosity of 19.5 inverse femtobarns. The observed event rates are in agreement with expectations from the standard model. These results probe charginos and neutralinos with masses up to 720 GeV, and sleptons up to 260 GeV, depending on the model details

Search for quark contact interactions and extra spatial dimensions using dijet angular distributions in proton-proton collisions at sqrt(s) = 8 TeV

A search is presented for quark contact interactions and extra spatial dimensions in proton-proton collisions at sqrt(s) = 8 TeV using dijet angular distributions. The search is based on a data set corresponding to an integrated luminosity of 19.7 inverse femtobarns collected by the CMS detector at the CERN LHC. Dijet angular distributions are found to be in agreement with the perturbative QCD predictions that include electroweak corrections. Limits on the contact interaction scale from a variety of models at next-to-leading order in QCD corrections are obtained. A benchmark model in which only left-handed quarks participate is excluded up to a scale of 9.0 (11.7) TeV for destructive (constructive) interference at 95% confidence level. Lower limits between 5.9 and 8.4 TeV on the scale of virtual graviton exchange are extracted for the Arkani-Hamed--Dimopoulos--Dvali model of extra spatial dimensions

Probing color coherence effects in pp collisions at sqrt(s) = 7 TeV

A study of color coherence effects in pp collisions at a center-of-mass energy of 7 TeV is presented. The data used in the analysis were collected in 2010 with the CMS detector at the LHC and correspond to an integrated luminosity of 36 inverse picobarns. Events are selected that contain at least three jets and where the two jets with the largest transverse momentum exhibit a back-to-back topology. The measured angular correlation between the second- and third-leading jet is shown to be sensitive to color coherence effects, and is compared to the predictions of Monte Carlo models with various implementations of color coherence. None of the models describe the data satisfactorily