Ultrathin-Strut versus Thin-Strut Drug-Eluting Stents for Multi- and Single-Stent Lesions: A Lesion-Level Subgroup Analysis of Two Randomized Trials.

BACKGROUND Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than one stent is unknown. METHODS In a post-hoc lesion-level analysis of two randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) versus thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multi stent lesions (MSL) versus single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months. RESULTS Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At two years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95%CI, 0.77-1.64; p=0.53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95%CI, 0.62-1.18; p = 0.35) in the SSL-group (p for interaction = 0.241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs. 5.2%; SHR, 0.67; 95%CI 0.46-0.97; p=0.036), no significant difference was observed in MSL (7.1% vs. 5.4%; SHR, 1.31; 95%CI 0.85-2.03; p=0.216) with significant interaction between groups (p for interaction=0.014). CONCLUSIONS Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES versus thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multi-stent lesions. CONDENSED ABSTRACT Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than one stent is unknown. In a post-hoc analysis of two randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) versus thin-strut durable polymer Everolimus-eluting stents (DP-EES), 5328 lesions in 3397 patients were stratified into multi-stent lesions (MSL) versus single-stent lesions (SSL). At 2 years, rates of target lesion failure were comparable between BP-SES and DP-EES in both MSL and SSL. In the SSL group, lesion-related myocardial infarction or revascularization were significantly lower in BP-SES as compared to DP-EES; in contrast, no significant difference between stents was observed in the MSL group (p for interaction = 0.014)

Antithrombotic management and outcomes of patients with atrial fibrillation treated with NOACs early at the time of market introduction:Main results from the PREFER in AF Prolongation Registry

International audienceAbstract The management of patients with atrial fibrillation (AF) has rapidly changed with increasing use of non-vitamin K antagonist oral anticoagulants (NOACs) and changes in the use of rhythm control therapy. The prevention of thromboembolic events European Registry in Atrial Fibrillation Prolongation Registry (PREFER Prolongation) enrolled consecutive patients with AF on NOACs between 2014 and 2016 in a multicentre, prospective, observational study with one-year follow-up, focusing on the time of introduction of NOACs. Overall, 3783 patients were enrolled, with follow-up information available in 3223 (85%). Mean age was 72.2 ± 9.4 years, 40% were women, mean CHA 2 DS 2 VASc score was 3.4 ± 1.6, and 2587 (88.6%) had a CHA 2 DS 2 VASc score ≥ 2. Rivaroxaban was used in half of patients, and dabigatran and apixaban were used in about a quarter of patients each; edoxaban was not available for use in Europe at the time. Major cardiovascular event rate was low: serious events occurred in 74 patients (84 events, 2%), including 24 strokes (1%), 62 major bleeds (2%), of which 30 were life-threatening (1%) and 3 intracranial (0.1%), and 28 acute coronary syndromes (1%). Mortality was 2%. Antiarrhythmic drugs were used in about 50% of patients, catheter ablation in 5%. Adverse events were low in this contemporary European cohort of unselected AF patients treated with NOACs already at the time of their first introduction, despite high thromboembolic risk

Rationale and design of the MULTISTARS AMI Trial: a randomized comparison of immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease

Background: About half of patients with acute ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). Recent evidence supports complete revascularization in these patients. However, optimal timing of non-culprit lesion revascularization in STEMI patients is unknown because dedicated randomized trials on this topic are lacking. Study design: The MULTISTARS AMI trial is a prospective, international, multicenter, randomized, two-arm, open-label study planning to enroll at least 840 patients. It is designed to investigate whether immediate complete revascularization is non-inferior to staged (within 19-45 days) complete revascularization in patients in stable hemodynamic conditions presenting with STEMI and MVD and undergoing primary percutaneous coronary intervention (PCI). After successful primary PCI of the culprit artery, patients are randomized in a 1:1 ratio to immediate or staged complete revascularization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year. Conclusions: The MULTISTARS AMI trial tests the hypothesis that immediate complete revascularization is non-inferior to staged complete revascularization in stable patients with STEMI and MVD

Awareness, treatment and control of hypertension in Austria

Hintergrund Arterielle Hypertonie ist der bedeutendste singuläre Risikofaktor für die Gesamtsterblichkeit weltweit, wobei weniger als die Hälfte aller diagnostizierten und behandelten Patienten das Blutdruckziel erreichen. Da in Österreich keine rezenten Daten verfügbar sind, war es Ziel der Studie die Blutdruckkontrolle in vorwiegend therapietreuen Patienten zu untersuchen. Methoden und Ergebnisse In einer Querschnittsstudie wurden 4.303 von Hypertonie betroffene Patienten eingeschlossen, welche ihre antihypertensive Medikation aus einer von 158 teilnehmenden Apotheken bezogen. Die Patientenrekrutierung erfolgte innerhalb eines konsekutiven 10- tägigen Zeitraumes im Oktober 2015. Im Durchschnitt betrug der systolische/diastolische Blutdruck 14420/8412 mmHg unter Therapie mit 2.21.1 verschiedenen antihypertensiven Substanzen. Fünfundvierzig Prozent wurden mit einem modernen Kombinationspräparat behandelt. Die Awareness für die Erkrankung lag bei 93%, und 90% der Teilnehmer konstatierten die blutdrucksenkende Medikation am Studientag eingenommen zu haben. In Summe erreichten 41% normotensive Blutdruckwerte unter 140/90 mmHg. Niedrigeres Alter (OR 0.90, 95% CI 0.85, 0.96 pro Dekade Anstieg), Einnahme der blutdrucksenkenden Therapie am Studientag (OR 2.15, 95% CI 1.67, 2.76), ein akademischer Studienabschluss (OR 1.58, 95% CI 1.19, 2.08), weibliches Geschlecht (OR 1.23, 95% CI 1.07, 1.41) und eine Gestaltung der antihypertensiven Therapie durch einen Facharzt vs. einem Hausarzt (OR 1.20, 95% CI 1.04, 1.39) waren mit dem Erreichen des Blutdruckziels assoziiert. Zusammenfassung In einer Kohorte von überwiegend therapietreuen Patienten welche aufgrund einer arteriellen Hypertonie in Behandlung standen, erreichten nur 41% das Blutdruckziel. Aufgrund der niedrigen Anzahl an verschriebenen Antihypertensiva muss die Trägheit des Arztes zur Therapieintensivierung als ursächlicher Faktor in Betracht gezogen werden.Background Arterial hypertension (HTN) is the single largest contributor to mortality world-wide, however, adequate blood pressure (BP) control is achieved in less than half of diagnosed and treated patients. Since recent data are lacking in Austria, we sought to assess BP control in predominantly adherent patients who were medically treated for HTN. Methods and Results In a cross-sectional study, 4.303 patients suffering from HTN and who visited one of 158 participating pharmacies in order to obtain their antihypertensive medication were enrolled. Recruitment was performed within a period of 10 consecutive days in October 2015. Average systolic and diastolic BP was 14420/8412 mmHg under treatment with 2.21.1 different antihypertensive substances. Forty-five percent received a modern single-pill combination drug. Awareness for the disease was found in 93%, and 90% claimed to be compliant to medication intake on the day of study participation. In total, 41% achieved the BP target of 140/90 mmHg. Lower age (OR 0.90, 95% CI 0.85, 0.96 per decade increase), self-reported medication compliance at study participation (OR 2.15, 95% CI 1.67, 2.76), an academic degree (OR 1.58, 95% CI 1.19, 2.08), female gender (OR 1.23, 95% CI 1.07, 1.41) and treatment by a specialist vs. a family doctor (OR 1.20, 95% CI 1.04, 1.39) were major predictors of BP control. Conclusion In a cohort of predominantly adherent patients treated for HTN, only 41% achieved the BP target. Given the low number of antihypertensive drugs prescribed, physician s inertia might be at least partly accountable for these results.submitted by Dr. med univ. Miklos RohlaZusammenfassung in deutscher SpracheAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedizinische Universität Wien, Dissertation, 2017OeB

Pharmacist interventions to improve blood pressure control in primary care: a cluster randomised trial.

BACKGROUND High blood pressure (BP) is the single largest contributor to mortality world-wide. AIM To investigate the effectiveness of a pharmacists-led intervention to improve BP control using automated office blood pressure (AOBP). METHOD In this prospective parallel group, unblinded, cluster-randomised trial, 54 pharmacies enrolled pre-treated patients with uncontrolled AOBP above 135/85 mmHg. In the interventional group, pharmacists referred patients to the treating physician for therapy intensification in a structured fashion. In the control group, AOBP was recorded until the end of the trial. The primary endpoint was the proportion of patients achieving BP control at the threshold of 135/85 mmHg after 10 weeks. Key secondary endpoints were systolic AOBP reductions after 10 and 20 weeks. RESULTS A total of 497 patients were included between 2017 and 2019. In the interventional and control group, 61.5% and 19.8% of patients underwent a therapy modification within 20 weeks. The primary endpoint was achieved in 38.8% in the interventional group and 31.2% in the control group (mean difference 7.6%, 95% CI -8.1; 23.3, p = 0.336). Mean systolic AOBP reductions were greater in the interventional vs. control group at 10 and 20 weeks (14.3 ± 7.4 vs. 6.9 ± 7.0 mmHg, mean difference 7.3 mmHg, 95% CI 3.2;11.5, p < 0.001, and 15.5 ± 9.0 vs. 9.8 ± 7.5 mmHg, mean difference 5.8 mmHg, 95% CI 0.8;10.7, p = 0.023). Atrial fibrillation was newly detected in 7.8% of patients. CONCLUSION Through a pragmatic pharmacist-led disease management program, BP control was improved over time, without significant differences between groups. Greater systolic AOBP reductions were observed in the interventional vs. control group. (Pharmacists Intervention to Improve Hypertension Management in Primary Care:APOTHECARE; ClinicalTrials.gov registration NCT03274531)