Everolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease

Background-In patients with diabetes mellitus and multivessel disease, coronary artery bypass graft surgery and percutaneous coronary intervention are treatment options. However, there is paucity of data comparing coronary artery bypass graft surgery against newer generation stents. Methods and Results-Patients included in the New York State registries who had diabetes mellitus and underwent isolated coronary artery bypass graft surgery or percutaneous coronary intervention with everolimus eluting stent (EES) for multivessel disease were included. Propensity score matching was used to assemble a cohort with similar baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Short-term (within 30 days) and long-term outcomes were evaluated. Among 16 089 patients with diabetes mellitus and multivessel disease, 8096 patients with similar propensity scores were included. At short-term, EES was associated with a lower risk of death (hazard ratio [HR] =0.58; 95% confidence interval [CI], 0.34-0.98; P=0.04) and stroke (HR=0.14; 95% CI, 0.06-0.30; P0.0001) but higher risk of MI (HR=2.44; 95% CI, 1.13-5.31; P=0.02). At long-term, EES was associated with a similar risk of death (425 [10.50%] versus 414 [10.23%] events; HR=1.12; 95% CI, 0.96-1.30; P=0.16), a lower risk of stroke (118 [2.92%] versus 157 [3.88%] events; HR=0.76; 95% CI, 0.58-0.99; P=0.04) but a higher risk of MI (260 [6.42%] versus 166 [4.10%] events; HR=1.64; 95% CI, 1.32-2.04; P0.0001) and repeat revascularization (889 [21.96%] versus 421 [10.40%] events; HR=2.42; 95% CI, 2.12-2.76; P0.0001). The higher risk of MI was not seen in the subgroup of EES patients who underwent complete revascularization (HR=1.37; 95% CI, 0.76-2.47; P=0.30). Conclusions-In patients with diabetes mellitus and multivessel disease, EES was associated with lower upfront risk of death and stroke when compared with coronary artery bypass graft surgery. However, at long-term, EES was associated with similar risk of death, a higher risk of MI (in those with incomplete revascularization), and repeat revascularization but a lower risk of stroke. © 2015 American Heart Association, Inc

Thirty-Day Readmissions After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis in New York State

Background Several studies have compared short-term and medium-term mortality rates for patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR), but no studies have compared short-term readmission rates for the 2 procedures. Methods and Results New York\u27s Cardiac Surgery Reporting System was used to propensity match 617 TAVI and 1981 SAVR patients using numerous patient risk factors contained in the registry. The 389 propensity-matched pairs were then used to analyze differences in readmission rates between the 2 groups. TAVI and SAVR readmission rates were also compared for patients with a history of congestive heart failure and for patients aged 80. Also, reasons for readmission for TAVI and SAVR patients were examined and compared. Readmission rates were not statistically different for all propensity-matched TAVI and SAVR patients (respective rates, 18.8% and 19.3%; P=0.86). After further adjustment using a logistic regression model, there was still no significant difference (adjusted odds ratio, 0.97; 95% confidence interval [0.68-1.39]). For patients aged 80, the 30-day readmission rates were 19.9% and 22.0% (P=0.59), and when further adjusted using the logistic regression model, adjusted odds ratio=0.89 (0.55-1.45). For patients with a history of congestive heart failure, the respective rates were 22.8% and 20.4% (P=0.56), and with further adjustment, adjusted odds ratio became 1.15 (0.72-1.82). Conclusions There are no statistically significant differences between TAVI and SAVR patients in short-term readmission rates

2017 Versus 2012 Appropriate Use Criteria for Percutaneous Coronary Interventions: Impact on Appropriateness Ratings

© 2018 American College of Cardiology Foundation Objectives: The purpose of this study is to revisit cases rated as “inappropriate” in the 2012 appropriate use criteria (AUC) using the 2017 AUC. Background: AUC for coronary revascularization in patients with stable ischemic heart disease (SIHD) were released in January 2017. Earlier 2012 AUC identified a relatively high percentage of New York State patients for whom percutaneous coronary intervention (PCI) was rated as “inappropriate” versus optimal medical therapy alone. Methods: New York State\u27s PCI registry was used to rate inappropriateness of patients undergoing PCI in 2014 using the 2012 and 2017 AUC, and to examine patient characteristics for patients rated differently. Results: A total of 911 of 9,261 (9.8%) patients who underwent PCI in New York State in 2014 with SIHD without prior coronary artery bypass grafting were rated as “inappropriate” using the 2012 AUC, but only 171 (1.8%) patients were rated as “rarely appropriate” (“inappropriate” in 2012 AUC terminology) using the 2017 AUC. A total of 26% of all 8,407 patients undergoing PCI in New York State with 1- to 2-vessel SIHD were without high-risk findings on noninvasive testing and were either asymptomatic or without antianginal therapy. No current or past randomized controlled trials have focused on these patients. Conclusions: The percentage of 2014 New York State PCI patients with SIHD who are rated “rarely appropriate” has decreased substantially using 2017 AUC in comparison with the older 2012 AUC. However, for many low-risk patients undergoing the procedure, the relative benefits of optimal medical therapy with and without PCI are unknown. Randomized controlled trials are needed to study these groups

Silicon detectors for the sLHC

In current particle physics experiments, silicon strip detectors are widely used as part of the inner tracking layers. A foreseeable large-scale application for such detectors consists of the luminosity upgrade of the Large Hadron Collider (LHC), the super-LHC or sLHC, where silicon detectors with extreme radiation hardness are required. The mission statement of the CERN RD50 Collaboration is the development of radiation-hard semiconductor devices for very high luminosity colliders. As a consequence, the aim of the RandD programme presented in this article is to develop silicon particle detectors able to operate at sLHC conditions. Research has progressed in different areas, such as defect characterisation, defect engineering and full detector systems. Recent results from these areas will be presented. This includes in particular an improved understanding of the macroscopic changes of the effective doping concentration based on identification of the individual microscopic defects, results from irradiation with a mix of different particle types as expected for the sLHC, and the observation of charge multiplication effects in heavily irradiated detectors at very high bias voltages. © 2011 Elsevier B.V

Silicon detectors for the sLHC

In current particle physics experiments, silicon strip detectors are widely used as part of the inner tracking layers. A foreseeable large-scale application for such detectors consists of the luminosity upgrade of the Large Hadron Collider (LHC), the super-LHC or sLHC, where silicon detectors with extreme radiation hardness are required. The mission statement of the CERN RD50 Collaboration is the development of radiation-hard semiconductor devices for very high luminosity colliders. As a consequence, the aim of the R&D programme presented in this article is to develop silicon particle detectors able to operate at sLHC conditions. Research has progressed in different areas, such as defect characterisation, defect engineering and full detector systems. Recent results from these areas will be presented. This includes in particular an improved understanding of the macroscopic changes of the effective doping concentration based on identification of the individual microscopic defects, results from irradiation with a mix of different particle types as expected for the sLHC, and the observation of charge multiplication effects in heavily irradiated detectors at very high bias voltages. (C) 2011 Elsevier B.V. All rights reserved

Silicon detectors for the sLHC

In current particle physics experiments, silicon strip detectors are widely used as part of the inner tracking layers. A foreseeable large-scale application for such detectors consists of the luminosity upgrade of the Large Hadron Collider (LHC), the super-LHC or sLHC, where silicon detectors with extreme radiation hardness are required. The mission statement of the CERN RD50 Collaboration is the development of radiation-hard semiconductor devices for very high luminosity colliders. As a consequence, the aim of the R&D programme presented in this article is to develop silicon particle detectors able to operate at sLHC conditions. Research has progressed in different areas, such as defect characterisation, defect engineering and full detector systems. Recent results from these areas will be presented. This includes in particular an improved understanding of the macroscopic changes of the effective doping concentration based on identification of the individual microscopic defects, results from irradiation with a mix of different particle types as expected for the sLHC, and the observation of charge multiplication effects in heavily irradiated detectors at very high bias voltages. (C) 2011 Elsevier B.V. All rights reserved

Silicon detectors for the sLHC

In current particle physics experiments, silicon strip detectors are widely used as part of the inner tracking layers. A foreseeable large-scale application for such detectors consists of the luminosity upgrade of the Large Hadron Collider (LHC), the super-LHC or sLHC, where silicon detectors with extreme radiation hardness are required. The mission statement of the CERN RD50 Collaboration is the development of radiation-hard semiconductor devices for very high luminosity colliders. As a consequence, the aim of the R&D programme presented in this article is to develop silicon particle detectors able to operate at sLHC conditions. Research has progressed in different areas, such as defect characterisation, defect engineering and full detector systems. Recent results from these areas will be presented. This includes in particular an improved understanding of the macroscopic changes of the effective doping concentration based on identification of the individual microscopic defects, results from irradiation with a mix of different particle types as expected for the sLHC, and the observation of charge multiplication effects in heavily irradiated detectors at very high bias voltages