Explore the vast range of titles available.

To the Editor: Bangalore et al. (April 23 issue) 1 report the results of ISCHEMIA-CKD (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches–Chronic Kidney Disease), a large, randomized trial that compared an invasive strategy with a conservative strategy in patients with severe renal dysfunction and evidence of stable coronary disease. 2 The trial population was highly selected — approximately two patients enrolled per site per year — and included lower-risk patients; approximately half the patients had no angina, and one quarter had no clinically significant coronary disease. In the invasive-strategy group, only 70% and 40% of the patients underwent . . .

To the Editor: In the VALIDATE-SWEDEHEART trial, Erlinge et al. (Sept. 21 issue) 1 compared bivalirudin with heparin monotherapy in patients with acute myocardial infarction who were undergoing percutaneous coronary intervention (PCI). Treatment included the use of one of the new P2Y 12 inhibitors (ticagrelor, cangrelor, or prasugrel), which was given at least 60 minutes before PCI. Patients who received or were planned to receive glycoprotein IIb/IIIa inhibitors were excluded from enrollment, and the low rates of ischemic events and stent thrombosis are probably attributable to the early administration of the new P2Y 12 inhibitors. In the current era, in which immediate reperfusion . . .

To the Editor: A typical feature of recent trials on thrombus aspiration is the binary approach, with either thrombectomy or standard percutaneous coronary intervention (PCI) considered to be applicable to every patient. In an ideal trial, PCI alone would be compared with thrombectomy performed at the discretion of an experienced operator. The success of thrombus aspiration (an interventional action) is largely dependent on the skill of the individual operator, 1 and data on the effectiveness of the procedure (e.g., histologic analysis of retrieved material) should ideally be reported. In the Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in . . .

Assesses the pattern of cases of multiple-victim, multiple-offender child sexual abuse, occurring in a pre-school or similar setting, without physical evidence of abuse, from developed, English-speaking countries over the last 40 years. Describes where the cases occurred, the trial verdict, and any changes to that verdict from subsequent appeals. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

The ideal stent must fulfil a broad range of technical requirements. Stents must be securely crimped onto the delivery balloon and, in this form, must have a low profile and be sufficiently flexible to facilitate deliverability to the lesion site without distortion or displacement. Following expansion, stents must exert sufficient radial force on the vessel wall to overcome lesion resistance and elastic recoil. To achieve an optimal lumen diameter, the lesion must be uniformly and adequately scaffolded, with minimal tissue prolapse between struts but without compromising side-branch access. Furthermore, the deployed stent must conform to the vessel curvature to minimise vessel distortion, particularly at the stent edges. Radio-opacity is also important to guide safe positioning, adequate deployment and postdilataion and to permit assessment of optimal stent expansion. Equally though, the stent lumen must also be sufficiently visible to allow radiographic assessment of flow dynamics and restenosis. Efforts to optimise one characteristic of stent design may have detrimental effects on another. Thus, currently available stents all reflect a compromise between competing desirable features and have subtle differences in their performance characteristics. Striving to achieve stents with optimal deliverability, conformability and radial strength led to a reduction in longitudinal strength. The importance of this parameter was highlighted by complications occurring in the real-world setting where percutaneous coronary intervention is often undertaken in challenging anatomy. This review focuses on aspects of stent design relevant to longitudinal strength.

ObjectiveTakotsubo syndrome (TS) mimics acute coronary syndrome (ACS) but has a distinct pathophysiology. While in-hospital adverse outcomes appear similar to those presenting with an ACS, data on longer term postdischarge risk are conflicting. This study sought to assess the long-term prognosis of patients discharged alive after TS.MethodsThe clinical profile and in-hospital and long-term outcomes were prospectively assessed in consecutive patients with TS. Survival in patients with TS was compared with two representative age-matched and gender-matched comparison cohorts: a hospitalised ACS cohort and a community cohort without known cardiovascular disease (CVD).ResultsTwo hundred and-twenty-five patients with TS (216 women, mean age 63.7±11.8 years) were included. In-hospital mortality was 1.8% and 1.9% for patients with TS and ACS, respectively. Of the 219 patients with TS with postdischarge follow-up, at a mean follow-up of 4.8±3.2 years, there were 19 (8.3%) deaths, 18 of which were from non-cardiac causes. When compared with the cohort without prior CVD, postdischarge patients with TS were at increased mortality risk (HR 2.00, 95% CI 1.26 to 3.17, p=0.003), but mortality in postdischarge patients with ACS was over threefold higher (HR 3.43, 95% CI 2.97 to 3.96, p<0.0001).ConclusionsIn-hospital mortality for patients diagnosed with TS and ACS was similar. However, while postdischarge survivors of TS had a long-term survival which was poorer than for a community-based cohort without known CVD, their survival was better than for postdischarge survivors of an ACS event. Late deaths in patients with TS were almost all from non-cardiac causes.

Serial angiographic studies show that lumen loss might occur between 6 months and 2 years after stent placement; in 83 patients who received an evirolimus-eluting stent, mean in-stent late loss was 0·17 mm (SD 0·32) at 6 months and 0·33 mm (0·37) at 2 years.8 While this process might be due partly to proliferation of smooth-muscle cells, optical coherence tomography and autopsy studies have shown that lipid-laden plaque indicative of neoatherosclerosis is more likely to be present and to develop earlier in patients who have received drug-eluting stents than in those who have received bare-metal stents.9 Studies extending beyond 12 months are needed to assess stents with biodegradable polymers.

[...] patients receiving C°Cr-EES had lower 1-year rates of defi nite stent thrombosis than did those treated with other drug-eluting stents.

Presents the case of a patient in whom valve-in-valve (ViV) trans-catheter aortic valve implantation (TAVI) resulted in failure of clinical improvement and a high residual transvalvular gradient requiring redo surgical aortic valve replacement (SAVR). Discusses options for prevention of this complication. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Evaluates the safety and feasibility of helicopter transfer of Whangarei patients to Auckland City Hospital for primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.