Efficacy and safety of intravascular lithotripsy versus rotational atherectomy in balloon-crossable heavily calcified coronary lesions

BackgroundSevere coronary artery calcification is associated with poor procedural and clinical outcomes in patients undergoing percutaneous coronary intervention. Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are techniques used to optimize lesion preparation and facilitate stent implantation in this anatomical scenario. However, their comparative efficacy and safety remain unknown.MethodsWe retrospectively analyzed 101 patients who underwent PCI utilizing RA or IVL for lesion preparation in heavily calcified balloon-crossable coronary stenosis. The primary endpoint was procedural success. In addition, the occurrence of major adverse cardiovascular events (MACE, defined as the composite of all-cause mortality, target lesion revascularization(TLR), stroke and stent thrombosis (ST)) at 6-months was analyzed.ResultsHigh rates of procedural success were achieved in both RA and IVL (82 % vs. 92 %; p = 0.25), with a low in hospital complication rate (8 % vs. 4 %; p = 0.678). No significant differences were found in overall MACE at 6-months (12 % vs 6 %; P = 0.487), death (8 % vs. 2 %; p = 0.362), TLR (2 % vs. 2 %; p = 1.000), stroke (2 % vs. 2 %; P = 1.000) or ST (2 % vs. 0 %; P = 1.000). Moreover, IVL is associated with a significantly shorter fluoroscopy time (32 [22–45] vs 26 [16–37]; P = 0.041).ConclusionsBoth IVL and RA are safe and effective methods for treatment of heavily calcified coronary lesions with similar outcomes at short term follow up.Cardiolog

Trends in quality of care and dying perceived by family caregivers of nursing home residents with dementia 2005-2019

Background: Dementia palliative care is increasingly subject of research and practice improvement initiatives. Aim: To assess any changes over time in the evaluation of quality of care and quality of dying with dementia by family caregivers. Design: Combined analysis of eight studies with bereaved family caregivers' evaluations 2005-2019. Setting/participants: Family caregivers of nursing home residents with dementia in the Netherlands (n = 1189) completed the End-of-Life in Dementia Satisfaction With Care (EOLD-SWC; quality of care) and Comfort Assessment in Dying (EOLD-CAD, four subscales; quality of dying) instruments. Changes in scores over time were analysed using mixed models with random effects for season and facility and adjustment for demographics, prospective design and urbanised region. Results: The mean total EOLD-SWC score was 33.40 (SD 5.08) and increased by 0.148 points per year (95% CI, 0.052-0.244; adjusted 0.170 points 95% CI, 0.055-0.258). The mean total EOLD-CAD score was 30.80 (SD 5.76) and, unadjusted, there was a trend of decreasing quality of dying over time of -0.175 points (95% CI, -0.291 to -0.058) per year increment. With adjustment, the trend was not significant (-0.070 EOLD-CAD total score points, 95% CI, -0.205 to 0.065) and only the EOLD-CAD subscale 'Well being' decreased. Conclusion: We identified divergent trends over 14 years of increased quality of care, while quality of dying did not increase and well-being in dying decreased. Further research is needed on what well-being in dying means to family. Quality improvement requires continued efforts to treat symptoms in dying with dementia.Development and application of statistical models for medical scientific researc

Possibilities and limitations of interfaces for combined SFC-MS

In theory, coupling SFC to MS should be much easier than the combination of HPLC and MA. In this instalment od Coupling Matters, the guest columnists address specific problems often encountered when combining SFC with MS

Possibilities and limitations of interfaces for combined SFC-MS

In theory, coupling SFC to MS should be much easier than the combination of HPLC and MA. In this instalment od Coupling Matters, the guest columnists address specific problems often encountered when combining SFC with MS