1) This study compared long-term outcomes of 626 STEMI patients treated with primary PCI who were randomized to drug-eluting stents (DES, n=313) or bare-metal stents (BMS, n=313).
2) At 3 years, the rate of major adverse cardiac events (MACE), including death, MI, and target lesion revascularization (TLR), was significantly lower in the DES group compared to the BMS group (10.5% vs 16.3%, p=0.024).
3) Rates of cardiac death (4.2% vs 6.1%), MI (6.1% vs 8.9%), and TLR (3
1) The RESOLUTE All Comers Trial compared the zotarolimus-eluting Resolute stent to the everolimus-eluting Xience V stent for percutaneous coronary intervention in a randomized trial of 2,292 patients.
2) At 12 months, the primary endpoint of target lesion failure occurred in 8.2% of patients receiving the Resolute stent and 8.3% of patients receiving the Xience V stent, demonstrating non-inferiority of the Resolute stent.
3) There were no significant differences between the stents in rates of cardiac death, target vessel myocardial infarction, or clinically-indicated target lesion revascularization that made up the primary endpoint.
The document discusses recent developments in left atrial appendage closure. Key points include:
- Long term results and meta-analyses from randomized trials of warfarin vs. Watchman leading to FDA approval.
- Differences between trial populations and real-world patients.
- Results from studies of patients who cannot take oral anticoagulants.
- Technical advances in devices.
- Role of CT imaging.
This document describes a study analyzing electrocardiographic criteria for diagnosing acute myocardial infarction in patients presenting with left bundle-branch block. The study used data from over 26,000 patients to develop and validate criteria. Three criteria were independently predictive: ST-segment elevation concordant with the QRS complex; ST-segment depression in leads V1-V3; and ST-segment elevation discordant from the QRS complex. Combining these into a scoring system allowed accurate diagnosis of infarction in this difficult patient group.
ESC 2012 research highlights: A slideshow presentationtheheart.org
The European Society of Cardiology (ESC) 2012 Congress took place in Munich, Germany from August 25 through August 29, 2012. Key trials presented at the sessions include: WOEST, ALTITUDE, FAME II, TRILOGY ACS, ACCESS EU,PURE, GARY. IABP SHOCK II, PARAMOUNT and DeFACTO
Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.
Impact of percutaneous coronary intervention on the levels of interleukin-6 and C-reactive protein in the coronary circulation of subjects with coronary artery disease
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
This document discusses different treatment options for in-stent restenosis, including drug-eluting balloons (DEBs). It summarizes the results of several clinical trials that compared DEBs to other treatments such as plain balloon angioplasty and drug-eluting stents. The trials showed that DEBs were non-inferior or superior to other options in reducing restenosis rates and target lesion revascularization at follow-up timepoints ranging from 6 months to 3 years, with comparable or lower risks of death and heart attack. DEBs therefore represent a promising treatment for in-stent restenosis that may avoid the need for additional stent layers.
1) The RESOLUTE All Comers Trial compared the zotarolimus-eluting Resolute stent to the everolimus-eluting Xience V stent for percutaneous coronary intervention in a randomized trial of 2,292 patients.
2) At 12 months, the primary endpoint of target lesion failure occurred in 8.2% of patients receiving the Resolute stent and 8.3% of patients receiving the Xience V stent, demonstrating non-inferiority of the Resolute stent.
3) There were no significant differences between the stents in rates of cardiac death, target vessel myocardial infarction, or clinically-indicated target lesion revascularization that made up the primary endpoint.
The document discusses recent developments in left atrial appendage closure. Key points include:
- Long term results and meta-analyses from randomized trials of warfarin vs. Watchman leading to FDA approval.
- Differences between trial populations and real-world patients.
- Results from studies of patients who cannot take oral anticoagulants.
- Technical advances in devices.
- Role of CT imaging.
This document describes a study analyzing electrocardiographic criteria for diagnosing acute myocardial infarction in patients presenting with left bundle-branch block. The study used data from over 26,000 patients to develop and validate criteria. Three criteria were independently predictive: ST-segment elevation concordant with the QRS complex; ST-segment depression in leads V1-V3; and ST-segment elevation discordant from the QRS complex. Combining these into a scoring system allowed accurate diagnosis of infarction in this difficult patient group.
ESC 2012 research highlights: A slideshow presentationtheheart.org
The European Society of Cardiology (ESC) 2012 Congress took place in Munich, Germany from August 25 through August 29, 2012. Key trials presented at the sessions include: WOEST, ALTITUDE, FAME II, TRILOGY ACS, ACCESS EU,PURE, GARY. IABP SHOCK II, PARAMOUNT and DeFACTO
Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.
Impact of percutaneous coronary intervention on the levels of interleukin-6 and C-reactive protein in the coronary circulation of subjects with coronary artery disease
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
This document discusses different treatment options for in-stent restenosis, including drug-eluting balloons (DEBs). It summarizes the results of several clinical trials that compared DEBs to other treatments such as plain balloon angioplasty and drug-eluting stents. The trials showed that DEBs were non-inferior or superior to other options in reducing restenosis rates and target lesion revascularization at follow-up timepoints ranging from 6 months to 3 years, with comparable or lower risks of death and heart attack. DEBs therefore represent a promising treatment for in-stent restenosis that may avoid the need for additional stent layers.
1) Complete revascularization (CR), defined as treating all significant coronary stenoses, is associated with lower mortality compared to incomplete revascularization (IR) based on observational studies and randomized trials. IR is more common after percutaneous coronary intervention (PCI) than coronary artery bypass grafting (CABG).
2) For stable coronary artery disease (SCAD), CR is recommended when feasible, while for acute coronary syndromes (ACS) and ST-segment elevation myocardial infarction (STEMI), treating the culprit lesion only is usually recommended initially, with staged revascularization of non-culprit lesions if needed.
3) Randomized trials of preventive PCI of non-culprit lesions in STEMI
The RESOLUTE International study evaluated the Resolute stent in a large "real-world" patient population across multiple centers internationally. It found that use of the Resolute stent was associated with a low rate of major cardiac events such as death, heart attack and stent thrombosis, consistent with results from the RESOLUTE All Comers trial. The study enrolled over 2,300 patients across various countries and baseline characteristics and outcomes were similar between monitored and unmonitored patients, supporting the generalizability of prior RESOLUTE trial results.
Eluting balloons, the mechanism of action, indications for use Ivan. G. HorvathChaichuk Sergiy
1) Eluting balloons deliver antiproliferative drugs locally via a balloon catheter to prevent restenosis without the need for a permanent stent.
2) Early studies showed eluting balloons significantly reduced late lumen loss and restenosis compared to uncoated balloons in treating small vessel disease and in-stent restenosis.
3) Subsequent randomized trials found eluting balloons were non-inferior and in some cases superior to drug-eluting stents in preventing restenosis, with fewer risks of stent thrombosis and need for long-term dual antiplatelet therapy.
Биодеградирующие стенты расширение показаний, отдаленные результаты применен...Chaichuk Sergiy
This document summarizes clinical trial results for bioresorbable vascular scaffolds (BVS). It describes several Abbott-sponsored clinical trials of the Absorb BVS including Cohort A (30 patients, 5 years), Cohort B (101 patients, 4 years), EXTEND (814 patients, 3 years), and provides 3-year outcomes from the EXTEND trial. The results demonstrate low rates of major adverse cardiac events including scaffold thrombosis and no evidence of late scaffold recoil or deterioration over time. Imaging data from Cohort B at 5 years showed complete resorption of the scaffold.
The ZEST trial was a randomized controlled trial that compared the efficacy and safety of the zotarolimus-eluting stent (ZES) to the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in patients requiring percutaneous coronary intervention. Over 2,600 patients undergoing stent placement for coronary artery disease across 19 centers in Korea were randomized to receive one of the three drug-eluting stents. The primary endpoint was the composite of death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Secondary outcomes included safety endpoints like stent thrombosis. Baseline patient characteristics were similar between groups. Results showed the ZES group had a
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Seguimiento de pacientes con FA y SCA tras intervención coronaria percutánea. Evidencia con ACOD
Dr. Marcelo Sanmartín Fernández, Hospital Universitario Ramón y Cajal (Madrid)
1) The study evaluated the authors' learning curve for septal myectomy to treat hypertrophic obstructive cardiomyopathy (HOCM) in 19 Egyptian patients between 2000-2010.
2) Immediate postoperative peak gradients dropped significantly from a mean of 105+30 mmHg to 11.5+6.1 mmHg in all patients, and MR was reduced.
3) At follow-up of 34.4 months on average, most patients were free of symptoms. Two patients died, one from renal failure and one during dialysis. Egyptian HOCM patients tended to be younger with higher gradients than large international series.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
This randomized controlled trial compared the effects of aspirin plus clopidogrel (AC group) versus aspirin alone (A group) on saphenous vein graft patency at 3 months after coronary artery bypass grafting (CABG) surgery in 249 patients. Multislice computed tomography angiography at 3 months showed higher saphenous vein graft patency in the AC group compared to the A group (91.6% vs 85.7%, p=0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency. The study suggests dual antiplatelet therapy may be more effective than aspirin alone for improving early saphenous vein graft patency following CABG surgery.
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
A randomised comparison of reservoir-based polymer-free amphilimus-eluting stents versus everolimus-eluting stents in patients with diabetes mellitus: the RESERVOIR clinical trial
Trial to assess chelation therapy (tact) slidesMarilyn Mann
The Trial to Assess Chelation Therapy (TACT) was a randomized controlled trial that compared chelation therapy (disodium EDTA injections) to placebo injections in 1708 patients with prior heart attacks. The primary goal was to see if chelation therapy reduced cardiovascular events like death, heart attack, stroke, and hospitalization. The trial found that chelation therapy reduced the primary composite endpoint compared to placebo with a hazard ratio of 0.82 and p-value of 0.035. A pre-specified subgroup analysis found the benefit was greater in patients with diabetes, with a hazard ratio of 0.61 and p-value of 0.002 for chelation therapy versus placebo in reducing cardiovascular events. The trial provides evidence that che
Local drug delivery with balloons eluting a liquid paclitaxel formulation. Yo...Chaichuk Sergiy
Local drug delivery with balloons eluting a liquid paclitaxel formulation
Paclitaxel is a lipophilic drug that is active at low concentrations and remains in cells after short exposure by binding to microtubules. Animal and cellular studies show paclitaxel inhibits smooth muscle cell proliferation after brief exposure. A catheter using porous balloons delivered paclitaxel locally in rabbit arteries, preventing neointimal thickening. Further animal studies using drug-coated and eluting balloons found local paclitaxel reduced restenosis. Initial human trials showed local paclitaxel delivery with eluting balloons was feasible and safe for treating in-stent restenosis, with low
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors like inflammation. It also explores using thermography to non-invasively identify vulnerable plaques by detecting heat from macrophages in inflamed plaques. Studies in animal models and humans found significant temperature differences in atherosclerotic arteries compared to healthy ones, and higher temperatures correlated with risk factors for heart attacks. Thermography may allow early detection of vulnerable plaques before they cause symptoms.
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors like inflammation. It also explores using thermography to identify vulnerable plaques by detecting heat from inflammatory macrophages. Studies in animal models and humans found temperature differences in atherosclerotic arteries compared to healthy ones, with statins reducing heat. This non-invasive method may allow screening for vulnerable plaques and patients at risk of heart attacks.
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...MedicineAndFamily
- Endeavor IV was a randomized trial comparing the zotarolimus-eluting Endeavor stent to the paclitaxel-eluting Taxus stent.
- The primary endpoint was target vessel failure at 9 months, with a pre-specified non-inferiority margin of 3.8%.
- 1,548 patients at 80 sites in the US were randomized 1:1 to receive either the Endeavor or Taxus stent. Follow-up was planned through 5 years.
This randomized controlled trial compared vertebroplasty to conservative treatment for acute osteoporotic vertebral compression fractures. 202 patients with persistent pain were randomly assigned to vertebroplasty (101 patients) or conservative treatment (101 patients). Vertebroplasty provided significantly greater pain relief than conservative treatment at both 1 month and 1 year, with differences in mean pain scores of 2.6 and 2.0 respectively. No serious complications were reported. Vertebroplasty was found to be an effective and safe treatment for acute osteoporotic vertebral compression fractures with persistent pain.
Rupture Risk Based On Anatomical And Morphological Factorsguest629cef
This document summarizes literature on the risk factors for rupture of unruptured intracranial aneurysms. Several studies have found that larger aneurysm size and posterior circulation location are associated with higher rupture risk. However, the data is inconsistent. The aspect ratio of aneurysms, which compares the width to neck size, also differs on average between ruptured and unruptured aneurysms, with higher ratios indicating higher risk. Due to variations in study populations and methods, a definitive meta-analysis is not possible, but these anatomical features provide some guidance on rupture risk assessment.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Qwest reported third quarter 2004 results with improved revenue trends driven by wireline and wireless segments. Revenue increased slightly compared to last quarter but decreased year-over-year. Cost reduction initiatives expanded margins while cash from operations exceeded capital expenditures. Key growth areas like DSL subscribers and long-distance lines increased significantly.
Tony Ross, president of United Way of Pennsylvania, gave this presentation as part of the PA Budget Town Hall Meeting held in Scranton, PA on March 9, 2012.
1) Complete revascularization (CR), defined as treating all significant coronary stenoses, is associated with lower mortality compared to incomplete revascularization (IR) based on observational studies and randomized trials. IR is more common after percutaneous coronary intervention (PCI) than coronary artery bypass grafting (CABG).
2) For stable coronary artery disease (SCAD), CR is recommended when feasible, while for acute coronary syndromes (ACS) and ST-segment elevation myocardial infarction (STEMI), treating the culprit lesion only is usually recommended initially, with staged revascularization of non-culprit lesions if needed.
3) Randomized trials of preventive PCI of non-culprit lesions in STEMI
The RESOLUTE International study evaluated the Resolute stent in a large "real-world" patient population across multiple centers internationally. It found that use of the Resolute stent was associated with a low rate of major cardiac events such as death, heart attack and stent thrombosis, consistent with results from the RESOLUTE All Comers trial. The study enrolled over 2,300 patients across various countries and baseline characteristics and outcomes were similar between monitored and unmonitored patients, supporting the generalizability of prior RESOLUTE trial results.
Eluting balloons, the mechanism of action, indications for use Ivan. G. HorvathChaichuk Sergiy
1) Eluting balloons deliver antiproliferative drugs locally via a balloon catheter to prevent restenosis without the need for a permanent stent.
2) Early studies showed eluting balloons significantly reduced late lumen loss and restenosis compared to uncoated balloons in treating small vessel disease and in-stent restenosis.
3) Subsequent randomized trials found eluting balloons were non-inferior and in some cases superior to drug-eluting stents in preventing restenosis, with fewer risks of stent thrombosis and need for long-term dual antiplatelet therapy.
Биодеградирующие стенты расширение показаний, отдаленные результаты применен...Chaichuk Sergiy
This document summarizes clinical trial results for bioresorbable vascular scaffolds (BVS). It describes several Abbott-sponsored clinical trials of the Absorb BVS including Cohort A (30 patients, 5 years), Cohort B (101 patients, 4 years), EXTEND (814 patients, 3 years), and provides 3-year outcomes from the EXTEND trial. The results demonstrate low rates of major adverse cardiac events including scaffold thrombosis and no evidence of late scaffold recoil or deterioration over time. Imaging data from Cohort B at 5 years showed complete resorption of the scaffold.
The ZEST trial was a randomized controlled trial that compared the efficacy and safety of the zotarolimus-eluting stent (ZES) to the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in patients requiring percutaneous coronary intervention. Over 2,600 patients undergoing stent placement for coronary artery disease across 19 centers in Korea were randomized to receive one of the three drug-eluting stents. The primary endpoint was the composite of death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Secondary outcomes included safety endpoints like stent thrombosis. Baseline patient characteristics were similar between groups. Results showed the ZES group had a
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Seguimiento de pacientes con FA y SCA tras intervención coronaria percutánea. Evidencia con ACOD
Dr. Marcelo Sanmartín Fernández, Hospital Universitario Ramón y Cajal (Madrid)
1) The study evaluated the authors' learning curve for septal myectomy to treat hypertrophic obstructive cardiomyopathy (HOCM) in 19 Egyptian patients between 2000-2010.
2) Immediate postoperative peak gradients dropped significantly from a mean of 105+30 mmHg to 11.5+6.1 mmHg in all patients, and MR was reduced.
3) At follow-up of 34.4 months on average, most patients were free of symptoms. Two patients died, one from renal failure and one during dialysis. Egyptian HOCM patients tended to be younger with higher gradients than large international series.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
This randomized controlled trial compared the effects of aspirin plus clopidogrel (AC group) versus aspirin alone (A group) on saphenous vein graft patency at 3 months after coronary artery bypass grafting (CABG) surgery in 249 patients. Multislice computed tomography angiography at 3 months showed higher saphenous vein graft patency in the AC group compared to the A group (91.6% vs 85.7%, p=0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency. The study suggests dual antiplatelet therapy may be more effective than aspirin alone for improving early saphenous vein graft patency following CABG surgery.
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
A randomised comparison of reservoir-based polymer-free amphilimus-eluting stents versus everolimus-eluting stents in patients with diabetes mellitus: the RESERVOIR clinical trial
Trial to assess chelation therapy (tact) slidesMarilyn Mann
The Trial to Assess Chelation Therapy (TACT) was a randomized controlled trial that compared chelation therapy (disodium EDTA injections) to placebo injections in 1708 patients with prior heart attacks. The primary goal was to see if chelation therapy reduced cardiovascular events like death, heart attack, stroke, and hospitalization. The trial found that chelation therapy reduced the primary composite endpoint compared to placebo with a hazard ratio of 0.82 and p-value of 0.035. A pre-specified subgroup analysis found the benefit was greater in patients with diabetes, with a hazard ratio of 0.61 and p-value of 0.002 for chelation therapy versus placebo in reducing cardiovascular events. The trial provides evidence that che
Local drug delivery with balloons eluting a liquid paclitaxel formulation. Yo...Chaichuk Sergiy
Local drug delivery with balloons eluting a liquid paclitaxel formulation
Paclitaxel is a lipophilic drug that is active at low concentrations and remains in cells after short exposure by binding to microtubules. Animal and cellular studies show paclitaxel inhibits smooth muscle cell proliferation after brief exposure. A catheter using porous balloons delivered paclitaxel locally in rabbit arteries, preventing neointimal thickening. Further animal studies using drug-coated and eluting balloons found local paclitaxel reduced restenosis. Initial human trials showed local paclitaxel delivery with eluting balloons was feasible and safe for treating in-stent restenosis, with low
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors like inflammation. It also explores using thermography to non-invasively identify vulnerable plaques by detecting heat from macrophages in inflamed plaques. Studies in animal models and humans found significant temperature differences in atherosclerotic arteries compared to healthy ones, and higher temperatures correlated with risk factors for heart attacks. Thermography may allow early detection of vulnerable plaques before they cause symptoms.
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors like inflammation. It also explores using thermography to identify vulnerable plaques by detecting heat from inflammatory macrophages. Studies in animal models and humans found temperature differences in atherosclerotic arteries compared to healthy ones, with statins reducing heat. This non-invasive method may allow screening for vulnerable plaques and patients at risk of heart attacks.
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...MedicineAndFamily
- Endeavor IV was a randomized trial comparing the zotarolimus-eluting Endeavor stent to the paclitaxel-eluting Taxus stent.
- The primary endpoint was target vessel failure at 9 months, with a pre-specified non-inferiority margin of 3.8%.
- 1,548 patients at 80 sites in the US were randomized 1:1 to receive either the Endeavor or Taxus stent. Follow-up was planned through 5 years.
This randomized controlled trial compared vertebroplasty to conservative treatment for acute osteoporotic vertebral compression fractures. 202 patients with persistent pain were randomly assigned to vertebroplasty (101 patients) or conservative treatment (101 patients). Vertebroplasty provided significantly greater pain relief than conservative treatment at both 1 month and 1 year, with differences in mean pain scores of 2.6 and 2.0 respectively. No serious complications were reported. Vertebroplasty was found to be an effective and safe treatment for acute osteoporotic vertebral compression fractures with persistent pain.
Rupture Risk Based On Anatomical And Morphological Factorsguest629cef
This document summarizes literature on the risk factors for rupture of unruptured intracranial aneurysms. Several studies have found that larger aneurysm size and posterior circulation location are associated with higher rupture risk. However, the data is inconsistent. The aspect ratio of aneurysms, which compares the width to neck size, also differs on average between ruptured and unruptured aneurysms, with higher ratios indicating higher risk. Due to variations in study populations and methods, a definitive meta-analysis is not possible, but these anatomical features provide some guidance on rupture risk assessment.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Qwest reported third quarter 2004 results with improved revenue trends driven by wireline and wireless segments. Revenue increased slightly compared to last quarter but decreased year-over-year. Cost reduction initiatives expanded margins while cash from operations exceeded capital expenditures. Key growth areas like DSL subscribers and long-distance lines increased significantly.
Tony Ross, president of United Way of Pennsylvania, gave this presentation as part of the PA Budget Town Hall Meeting held in Scranton, PA on March 9, 2012.
2009: Særmagasin: Kina - det nye nærmarked. Opgøret med VestenAnders Rostgaard
Kinas transformation fra underudviklet land mod verdensmagt går stærkt – og stærkere end de fleste tror. Danske virksomheder som Vestas, Grundfos og Danfoss kæmper for at følge med i det høje tempo. Tag i syv kapitler med på besøg hos danske firmaer i Kina, der i øjeblikket tager del i “Kinas renæssance.”
This document summarizes a research paper that examines how different types of network structures within communities influence different economic development strategies. The document defines two main economic development strategies - industrial recruitment and self-development. It then defines four types of network structures: complete, factional, coalitional, and bridging. The document hypothesizes that more cohesive network structures like complete and coalitional are better for self-development strategies, while looser bridging structures are better for industrial recruitment by facilitating access to external resources. Factional structures are unlikely to aid either strategy due to lack of information sharing between factions.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
9th Inter-Parliamentary Meeting on Renewable Energy and Energy EfficiencyAlliance To Save Energy
The document summarizes a presentation by Kateri Callahan, President of the Alliance to Save Energy, on energy efficiency policy under the Obama Administration. Key points include:
- The Obama Administration has been a "game changer" for energy efficiency policy, allocating $65 billion for efficiency in the stimulus package and establishing new efficiency standards and programs.
- Major legislation like the stimulus package and proposed climate bills allocate significant funding for energy efficiency initiatives and are expected to create hundreds of thousands of new green jobs.
- International agreements on issues like clean energy research and codes and standards harmonization are helping set a framework for global cooperation on efficiency.
- Looking ahead, continued federal support for efficiency combined with
El documento presenta una propuesta de "insourcing", donde una compañía especializada en efectividad de fuerza de ventas comparte los riesgos de explotación con la compañía propietaria de los productos farmacéuticos. El insourcing permitiría a ambas compañías sumar recursos para ser más eficientes, optimizando la inversión y evitando inmovilizados financieros. El beneficio obtenido por las ventas incrementales se repartiría entre ambas compañías. El insourcing es una tendencia moderna que se está imponiendo
The European Environment Agency (EEA) provides information to support environmental policy in Europe. It works through a network of organizations called Eionet that includes National Focal Points and European Topic Centres. One topic centre focuses on noise and advises the EEA and EU organizations on noise-related issues. This includes implementing the Environmental Noise Directive, developing common noise assessment methods, and publishing reports on recommended noise guidelines and health impacts of road traffic noise in Europe. The EEA also collaborates with the EPA Network, an informal group of environmental agencies, to share experiences and work towards harmonization of noise monitoring, reduction measures, and limit values across Europe.
Bharti is in talks to sell its 25% stake in its mutual fund joint venture with AXA to Bank of India. Tata Indicom launched the Blackberry Bold 9650, the first CDMA-GSM smartphone for CDMA users, offering global roaming and free data packs for two months. Apple sold more iPhones than Blackberry maker RIM in Q3, with Apple shipping 14.1 million iPhones and RIM shipping 12.4 million Blackberries. RIM has temporarily agreed to allow lawful interception of its messenger services by Indian security agencies, affecting over 1 million Blackberry subscribers in India.
Solution57 ApS is an embedded software solutions company, specializing in multimedia technologies on Android and other embedded Linux platforms and optimizing communication between devices to reduce bandwidth and improve responsiveness. Founded by a small group of senior SW specialists with 60+ years of experience in embedded development and consumer electronics.
Responsible investment & governance annual report 2011Nordea Bank
This document discusses Nordea's commitment to responsible investing and governance. It highlights achievements in 2011, such as engaging with companies that violated human rights and exerting influence on how companies manage environmental, social and governance risks. It also summarizes Nordea's responsible investing framework, products that integrate ESG factors, and efforts to build knowledge through research and team awards. Key company examples that demonstrate good ESG performance are provided.
Nets realized strong financial results in 2015 through revenue growth and cost reductions. Net revenue increased 6% to DKK 6,836 million due to 6% organic growth. Expenses decreased due to improved operations. EBITDA before special items improved 35% to DKK 2,250 million and the margin increased to 33%. Adjusted EBIT increased 45% to DKK 1,979 million. Nets continued investing in operations and solutions while realizing growth and efficiencies.
The governor's proposed 2011-2012 budget cuts state funding significantly due to more than $3 billion in lost federal stimulus funds. It reduces funding for education by 11%, higher education by 52%, and economic development by 31%. Specific education cuts include a $1.1 billion reduction to basic education and elimination of the accountability block grant. Health and human services also face cuts, though some programs serving vulnerable groups see small funding increases. The budget aims to balance without raising taxes or fees by reducing many areas of state spending.
1) The CREST trial compared outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treatment of carotid artery stenosis and found they had similar rates of the primary composite outcome of periprocedural stroke, heart attack, or death as well as subsequent ipsilateral strokes.
2) Periprocedural strokes were lower in the CEA group while periprocedural heart attacks were lower in the CAS group.
3) Younger patients had slightly better outcomes with CAS while CEA remained effective, with low risks of recurrent strokes after either procedure indicating durability, especially when combined with medical therapy.
Jan-Malte Sinning: The role of pMCS – Which patients benefit from hemodynamic...Euro CTO Club
14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
Main Session - Breakfast Symposium by Abiomed
The role of pMCS – Which patients benefit from hemodynamic support
Jan-Malte Sinning, Köln, Germany
Room:
Guteberg Hall (Auditorium) - Saturday 7:30
Chair:
Carlo di Mario, Florence, Italy
1) The document discusses carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treating carotid artery disease. It reviews data from clinical trials comparing the two procedures.
2) Operator experience is an important factor for CAS outcomes, with over 100 cases associated with lower risk. New technologies like mesh-covered stents may further reduce risks of CAS.
3) Future studies like CREST-2 aim to provide more data on CAS and CEA in asymptomatic patients to help guide treatment decisions. Both procedures can effectively treat carotid artery disease when performed by experienced operators.
This network meta-analysis compared clinical outcomes of 5 coronary bifurcation PCI techniques based on 21 randomized trials including 5,711 patients. The techniques were provisional stenting, T/TAP stenting, crush, culotte, and double-kissing crush (DK-crush). When all techniques were considered, DK-crush was associated with fewer major adverse cardiovascular events (MACE), driven by lower rates of repeat revascularization, with no differences among techniques for death, myocardial infarction, or stent thrombosis. In non-left main bifurcations specifically, DK-crush reduced MACE compared to provisional stenting. No differences in MACE were found among provisional stenting, culotte,
1) Primary percutaneous coronary interventions (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease can be performed via culprit-only PCI, multivessel (MV) PCI during the same procedure, or staged PCI.
2) Studies have found that MV PCI during STEMI is associated with higher mortality and stent thrombosis compared to culprit-only or staged PCI.
3) The HORIZONS-AMI trial of patients with STEMI and multivessel disease found higher mortality with single/one-time MV PCI compared to staged PCI.
Blister aneurysms- Evolution of Endovascular management Dr Vipul Gupta
This document discusses blister aneurysms, which are rare lesions characterized by a hemispherical shape and fragile walls located in non-branching sites of arteries like the internal carotid artery. It notes that blister aneurysms are very small and atypical in location, making them difficult to treat surgically or with endovascular coiling. The document presents the author's experience using flow diverters like the Enterprise stent to treat 17 patients with blister aneurysms, finding a high rate of complete occlusion and no rebleeding or need for retreatment compared to other methods. It emphasizes the importance of detecting and recognizing small blister/dissecting aneurysms and having a careful antiplatelet protocol when using flow diverters in their
This document summarizes research on foveal sparing in patients with Stargardt disease. It finds that 13 of 149 Stargardt patients showed foveal sparing. Most had late onset of symptoms after age 50 and initial vision loss. Genetic analysis found various mutations in the ABCA4 gene in these patients. Imaging like autofluorescence and OCT scans revealed atrophy surrounding the spared fovea. Possible causes of foveal sparing discussed are milder mutations, influence of modifier genes, anatomical differences in the fovea, and roles of Muller cells and photoreceptor distribution. The findings provide insight into pathogenic pathways in foveal sparing Stargardt disease.
The RESOLUTE International study evaluated the Resolute stent in a large "real-world" patient population across multiple international centers. Over 2,300 patients were enrolled with nearly complete 12-month follow-up. The primary endpoint of cardiac death and target vessel myocardial infarction at 12 months occurred in 4.1% of patients. Rates of stent thrombosis, target lesion revascularization, and other secondary endpoints were also low out to 12 months, and event rates were similar between monitored and unmonitored patients. Outcomes were also consistent across various high-risk subgroups. Results from RESOLUTE International are generally comparable to those seen in the RESOLUTE All Comers trial.
Rol actual del cardiodesfibrilador implantable subcutáneo en la prevención de...Sergio Pinski
This document summarizes the role of subcutaneous implantable cardioverter defibrillators (S-ICD) in preventing sudden cardiac death. It discusses:
- How S-ICDs detect and treat ventricular fibrillation and tachycardia without leads in the heart.
- Studies showing S-ICDs effectively detect and terminate arrhythmias while having a lower risk of complications than transvenous ICDs.
- S-ICDs should be considered for any patient with an ICD indication who does not require cardiac pacing. Ongoing randomized trials will further establish the role of S-ICDs.
Impact of contralateral carotid or vertebral artery occlusion in patients und...uvcd
1) The study analyzed the risk of early neurologic complications in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) based on the presence of contralateral carotid occlusion (CCO) or vertebral artery occlusion (VAO).
2) CCAS was associated with significantly higher rates of early neurologic complications (8.1% vs 2.6%) and stroke (6.8% vs 1.3%) compared to CEA.
3) For CEA patients, CCO and a history of stroke were independent risk factors for early neurologic complications, but CCO was not a risk factor for stroke.
AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh 020359
Ultrasound shows promise as a diagnostic tool for giant cell arteritis (GCA) that could reduce the need for temporal artery biopsies. A large study found ultrasound had higher sensitivity (54%) than biopsy (39%) for GCA diagnosis, though lower specificity. Using ultrasound first and only doing biopsies for high-risk cases could avoid 87-98% of biopsies while maintaining high sensitivity for GCA detection. Follow-up ultrasounds may help monitor disease activity and detect relapses in GCA patients treated with steroids.
This document discusses indications and techniques for carotid artery stenting (CAS). It notes that symptomatic stenosis over 70% on non-invasive imaging or over 50% on catheter angiography are indications for revascularization. Asymptomatic stenosis over 70% may also be treated if life expectancy is over 5 years and stenosis is over 80%. The technique involves pre- and post-dilation of stents with the use of protection devices to prevent embolic strokes. Results depend on the operator's experience and complications include strokes, hypotension, and restenosis. Larger trials found CAS and CEA to have similar outcomes, with CAS preferred for younger patients, though CEA is preferred in certain high risk cases.
This document summarizes a study evaluating the use of MRI and MRS in characterizing intracranial ring-enhancing lesions. 50 patients with ring-enhancing lesions detected on CT or MRI were evaluated using conventional MRI sequences, diffusion-weighted imaging, and MRS. The most common lesions observed were tuberculomas (44%), followed by primary brain tumors (22%) and neurocysticercosis (12%). MRS found choline peaks in most lesions (56%), with lipid peaks also common. MRI and MRS patterns helped differentiate between benign and malignant lesions, with MRS providing additional metabolic information to aid characterization though not enabling diagnosis on its own.
The document discusses the lack of consensus around treating asymptomatic carotid artery disease. While surgery reduces the risk of stroke, the absolute benefit is small given the already low risk with medical management alone. More recent data favors a purely medical approach for most asymptomatic patients. The evidence for invasive treatments like carotid endarterectomy (CEA) or stenting is considered weak, with no clear benefits shown for subgroups like women, those over 75, or different degrees of stenosis. Treating asymptomatic disease at a population level may lead to many unnecessary interventions that provide little benefit given evolving medical therapies.
WASHINGTON, D.C.—Use of certain doses of atopaxar in acute coronary syndrome patients can reduce rates of bleeding, cardiovascular events and better achieve platelet inhibition, according to the results of the LANCELOT-ACS trial presented Sept. 23 as a late-breaking clinical trial during the 2010 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting.
www.cardiovascularbusiness.com/topics/coronary-intervention-surgery/tct-lancelot-acs-says-certain-doses-atopaxar-can-reduce-bleeding-cv-events
A 42-year-old male patient was admitted with repeated dizziness and right-sided weakness for over 3 months. Imaging showed a linear filling defect in the proximal left internal carotid artery, revealing over 90% stenosis and delayed blood flow. The patient underwent carotid endarterectomy and was discharged on medical therapy. Three months later, the patient experienced recurrent symptoms. Carotid web was considered a potential cause given the patient's age and lack of atherosclerosis history. Intervention may be a safe and effective option for symptomatic carotid web in addition to medical management, with recurrent risk up to 26.8% with medical management alone.
Prasugrel Compared to Clopidogrel in Patients with Acute Coronary Syndromes Undergoing PCI with Stenting: the TRITON - TIMI 38 Stent Analysis trial found that intensive antiplatelet therapy with prasugrel compared to clopidogrel resulted in a 52% reduction in stent thrombosis across various patient groups and stent types. Prasugrel provided significant reductions in ischemic events but increased major bleeding compared to clopidogrel. The net clinical benefit of prasugrel supported its efficacy in reducing stent thrombosis and ischemic events.
Ischaemic cardiomyopathy revascularisation how when and whycardiositeindia
This document discusses ischemic cardiomyopathy and revascularization. It begins with an overview of ischemic cardiomyopathy and discusses factors that contribute to left ventricular remodeling and heart failure progression. It then reviews data from studies such as the Duke CVD Data Bank and STITCH trial on the outcomes of coronary artery bypass grafting versus medical therapy for patients with ischemic cardiomyopathy. The document discusses the role of myocardial viability and hibernation in identifying patients most likely to benefit from revascularization. It reviews various modalities for assessing myocardial viability and hibernation such as cardiac MRI, PET, and echocardiography. Overall, the document provides an overview of ischemic cardiomyopathy and the evidence regarding revascularization outcomes based on viability assessment.
This document provides a summary of 6 late-breaking sessions to attend at the Heart Rhythm Society Scientific Sessions in Boston from May 13-16, 2015. The sessions include: (1) a study on the impact of remote monitoring on clinical events and healthcare utilization; (2) a randomized global trial comparing uninterrupted rivaroxaban to vitamin K antagonists in patients undergoing catheter ablation; and (3) a study comparing cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. The other sessions include: (4) first-in-human experience with a miniaturized transcatheter pacing system; (5) results from the Canadian Registry of Card
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into information and driving transformation. Speakers include doctors, public health experts, and data analysts.
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into actionable information. The sessions will take place between April 13-16, 2015 and include speakers such as doctors, healthcare executives, and data analysts.
This document summarizes 7 innovative technologies that will be on display at ACC.15:
1) Medtronic's CoreValve transcatheter aortic valve replacement system provides a minimally invasive alternative to open heart surgery for replacing diseased heart valves.
2) St. Jude Medical's CardioMEMS heart failure monitoring system allows clinicians to monitor pulmonary pressures and manage treatment in patients with heart failure.
3) Toshiba's dose-tracking system measures radiation skin dose during interventional procedures to help clinicians monitor patient radiation exposure.
4) Merge Cardio provides a centralized web-based system for physicians to manage multiple aspects of patients' integrated cardiovascular records.
The document summarizes several imaging sessions at the upcoming American College of Cardiology's Annual Scientific Session & Expo on March 14-16 in San Diego. Key sessions include:
1) Results from the PROMISE trial comparing diagnostic testing for chest pain will be presented on Saturday, and costs will be discussed on Sunday.
2) A joint multimodality imaging symposium with several societies will discuss imaging high risk patients, techniques for difficult diagnoses, and radiation safety.
3) An international perspective on cardiac imaging will be provided including a discussion of using CT on Egyptian mummies to study heart disease over millennia.
If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.
The 2014 RSNA conference in Chicago saw over 56,000 attendees, up 5% from the previous year, with more than 2,000 additional professional registrations. Although exhibitor attendance dipped slightly by 2%, the conference floor was packed with 636 exhibits occupying over 426,000 square feet. The conference featured special exhibits celebrating RSNA's 100th anniversary and highlighting the organization's contributions to advances in medical imaging over the past century.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document summarizes a study examining the length of stay and economic implications of treating pulmonary embolism with rivaroxaban versus low molecular weight heparin-vitamin K antagonist (LMWH-VKA) in an emergency room setting. The study found that among patients in North America from the EINSTEIN PE trial, the median length of stay was 1 day shorter for those treated with rivaroxaban (3 days) compared to LMWH-VKA (4 days). This 1 day reduction in length of stay was associated with an estimated $2040 savings per patient for the rivaroxaban cohort based on average hospital costs. The study concluded that rivaroxaban was associated with a consistent
Shorr and bria innovation at the point-of-care rethinking the doctor-patient...Trimed Media Group
The document discusses innovations in doctor-patient interactions through technology. It proposes two solutions: 1) Creating a "story" of the patient's medical history and presenting issues for doctors to review before visits to improve care. This would be generated through automated document assembly. 2) Developing an "ad hoc" user interface optimized for point-of-care use, allowing doctors to take notes digitally in various formats like ink, checkboxes and dictation to focus on patient interaction instead of formal documentation. The goal is to enhance both the patient and provider experience through disruptive technology.
Kuperman Health Information Exchange & Care CoordinationTrimed Media Group
1) Care coordination requires improved information sharing both within care teams and across settings using health information exchange (HIE). However, current electronic health records (EHRs) were not designed for care coordination and do not adequately support sharing data and coordinating care.
2) NewYork-Presbyterian Hospital is working to enhance care coordination for patients with diabetes and depression by improving EHR tools, care team workflows, and data sharing across settings using its regional HIE. Key features include standardized screening and monitoring, patient and provider education, population health analytics, and secure messaging.
3) The success of care coordination interventions is being evaluated based on clinical outcomes like HbA1c and depression measures, as well as process measures
This document discusses the need for innovation in healthcare, particularly for the elderly population and their caregivers. It introduces the InfoSAGE project, which aims to create a "living laboratory" to study how technology can improve communication, coordination and collaboration between elderly patients and their families. InfoSAGE will connect various sources of health information and services through identity and content coordination to address the challenges of aging and caregiving. The goal is to develop tools that help address problems around care coordination, respecting patient preferences and reducing caregiver burnout, as electronic health records currently do not adequately meet the needs of elderly patients and their families.
[Hongsermeier] clinical decision support services amdis finalTrimed Media Group
1) Clinical Decision Support Services (CDSS) allow externalization of clinical knowledge and decision support logic from electronic health records (EHRs) to specialized CDSS providers.
2) The Clinical Decision Support Consortium (CDSC) is working on standards for knowledge management, specification, and sharing of CDS content and services.
3) Opportunities exist for EHR vendors to leverage external CDSS as curating all needed clinical knowledge internally is challenging, and most EHR CDS cannot support advanced inferencing required for personalized medicine. Challenges include ensuring appropriate implementation and use of external CDSS within EHR workflows.
This document discusses delivering clinical knowledge and guidance directly into healthcare workflows through clinical decision support (CDS). CDS aims to provide clinicians and patients with intelligently filtered, situation-specific information to enhance patient care. The goal is to repurpose existing clinical content from various sources and deliver the most precise and useful information for each workflow and information need. Physician information needs were analyzed from query data to develop an ontology of needs. Content is curated, indexed as discrete facts, and tailored for specific situations by matching it to patient data, workflows, and information needs. Knowledge delivery aims to integrate actionable tools and options directly into clinical systems like EHRs.
The document summarizes a presentation on providing collaborative and coordinated care for patients with complex illnesses. Some key points:
- To achieve the goals of improved health outcomes, quality of care, and reduced costs ("Triple Aim"), the healthcare system needs to focus on caring for patients with complex chronic conditions who account for a large portion of costs.
- Successful models involve interdisciplinary, team-based care coordinated across care settings. CareMore, a Medicare Advantage plan, achieves better outcomes and lower costs through intensive management of frail patients using nurse practitioners, protocols, home monitoring, and an electronic health record.
- Clinical IT can support collaborative care by enabling documentation, care planning, decision support, and information
This document discusses challenges with using electronic health records (EHRs) to support clinical knowledge management (KM) and continuous learning. It outlines several investments made by Lahey Health to address these challenges, including using an external collaboration platform to manage clinical decision support (CDS) content outside of the EHR. The document argues that EHRs are not designed for collaboration or learning, and that clinical KM 3.0 approaches are needed to help health systems and users continuously self-improve.
The document is from the Intelligent Health Lab and discusses several topics:
1. The Lab's director and its affiliation with Harvard.
2. The potential for an "App Store for Health" where innovators can create and distribute apps across EMR systems, similar to app stores for smartphones.
3. The vision of a "Learning Health System" where evidence is continuously generated from patient data to improve outcomes over time.
Kibbe expect direct health information exchange in the context of state 2 mea...Trimed Media Group
This document provides an introduction to Direct exchange for those engaged in Stage 2 Meaningful Use programs. It discusses how Direct exchange relates to Stage 2 MU objectives and the role of DirectTrust in supporting Direct exchange adoption. Direct exchange allows EHR users using different vendors to securely send and receive messages and attachments. It is one way providers can meet Stage 2 MU requirements for transmitting care summaries during transitions of care and allowing patients to view, download and transmit health information. The document describes how Direct exchange works, involving Health Information Service Providers, Certificate Authorities, Registration Authorities, and X.509 certificates to enable secure exchange between organizations and individuals.
Crotty engaging patients in new ways from open notes to social mediaTrimed Media Group
The document discusses new ways to engage patients through open notes and social media. It describes initial findings from the OpenNotes project that showed patients found value in reading clinical notes. It also outlines how patients use social media to find health information and connect with others. The document argues that healthcare providers can leverage these technologies and concepts to reduce information asymmetry, educate patients, and learn from them to provide more engaging and effective care.
Crotty engaging patients in new ways from open notes to social media
Dedication clemmensen
1. DEDICATION
Long-term outcome after drug-eluting versus
bare-metal stent implantation in patients with
ST-elevation myocardial infarction
3 year follow-up of the randomised DEDICATION trial
Peter Clemmensen, Henning Kelbæk, Anne Kaltoft, Steffen Helqvist,
Jens Flensted Lassen, Lene Kløvgaard, Christian J Terkelsen, Hans
Henrik Tilsted, Thomas Engstrøm, Lars R Krusell, Evald H.
Christiansen, Kari Saunamäki, Erik Jørgensen, Hans E. Bøtker, Jan
Ravkilde, Klaus F Kofoed, Lars Køber, Leif Thuesen
Copenhagen University Hospital
Rigshospitalet
Aarhus University Hospital
Skejby
Denmark
2. DEDICATION
Disclosures
The study has received unrestricted grants from the
Johnson & Johnson, Medtronic, Abbott, and Boston
Scientific companies
The presenter has previously or currently been involved in
research contracts, consulting or received research and
educational grants from:
Abbott, AstraZeneca, Aventis, Bayer, Bristol Myers Squibb,
Eli-Lilly, Merck, Myogen, Medtronic, Mitsubishi Pharma,
Nycomed, Organon, Pfizer, Pharmacia, Sanofi-Synthelabo,
Searle, The Medicines Company.
3. DEDICATION
Background
Implantation of drug eluting stents (DES) has proven to
be both safe and efficient in most patients with coronary
artery disease. However, long-term data are scarce with
regard to their use in STEMI patients treated with PCI
4. DEDICATION
Drug-Eluting vs Bare-Metal Stent
Implantation during Primary PCI
Previous published studies with ≥ 150 patients
Invasive RS,% MACE,% Primary
Study n FU DES/BMS DES/BMS endpoint p
STRATEGY 175 133 8/28 18/32 MACCE 0.001
TYPHOON 712 170 7/20 7/14 TVF 0.004
PASSION 619 - - 9/13 MACE 0.09
SESAMI 320 166 9/21 7/17 RS 0.03
5. DEDICATION
Purpose
The purpose of this study was to evaluate the clinical
results 3 years after implantation of DES vs BMS in
STEMI patients treated with primary PCI
6. DEDICATION
Flow chart
STEMI n=626
Randomization
+ Distal Protection - Distal Protection
Bare Metal Stent Drug Eluting Stent Bare Metal Stent Drug Eluting Stent
Post Procedure Angiography - QCA
1 month MACE
8 months Angiography - QCA / MACE
15 months MACE
3 years MACE
7. DEDICATION
Flow chart
STEMI n=626
Randomization
+ Distal Protection - Distal Protection
Bare Metal Stent Drug Eluting Stent Bare Metal Stent Drug Eluting Stent
Post Procedure Angiography - QCA
1 month MACE
8 months Angiography - QCA / MACE
15 months MACE
3 years MACE
8. DEDICATION
Endpoints
• MACE (cardiac death, re-infarction, TLR) at 3 years
• Cardiac death at 3 years
• Total mortality
• MI
• TLR
• TVR
• Stroke
9. DEDICATION
Major inclusion criteria
• Patients who presented with the symptoms and
signs of a first time large STEMI
• Chest pain ≤ 12 hours duration
• ST-elevation > 4 mm in contiguous leads
• High grade stenosis/occlusion of a native coronary artery
that could be crossed with a guidewire
10. DEDICATION
Major exclusion criteria
• History of a previous myocardial infarction
• Left main stem stenosis
• Gastrointestinal bleeding within 1 month
• Expected survival < 1 year
• Linguistic difficulties needing an interpretor
11. DEDICATION
Study Flow
Screened patients
1687
Included patients Excluded patients
626 1061
24 deaths - 216 Clinically or psychologically
instability / unconsciousness
- 162 ST-elevation < 4 mm
83 lost to re-angiography - 141 Participation in another study
- 140 Vessel unsuitable for filterwire
- 78 Onset symptoms >12 hours
543 patients for re-angiography - 72 Linguistic problems
- 68 Screening log not filled in
602 patients for 8-month FU - 58 Previous infarction
- 43 Severe other disease
- 35 Refused to participate
29 deaths - 26 Significant left main stenosis
- 22 Other
573 patients for 3-year FU
22. DEDICATION
Subgroup analysis
Group n Rate of MACE (%)
DES BMS Odds Ratio (95% CI)
All 626 11.5 18.2
Age < 63 315 9.4 19.4
Age ≥ 63 311 13.7 17.1
Male 458 11.8 16.1
Female 168 10.6 24.1
DM 65 13.8 22.2
no DM 561 11.3 17.7
Ref D > 3.1 mm 317 9.6 15.6
Ref D ≤ 3.1 mm 299 12.0 20.8
Visible thrombus 458 11.6 15.9
No visible thrombus 168 11.1 24.1
Stent length > 18 mm 309 12.9 17.8
Stent length ≤ 18 mm 310 9.5 17.9
LAD 258 14.8 20.6
CX / RCA 368 9.4 16.4
0 0.5 1.0 0.5 2.0
DES better BMS better
23. DEDICATION
Subgroup analysis
Group n Rate of MACE (%)
DES BMS Odds Ratio (95% CI)
All 626 11.5 18.2
Age < 63 315 9.4 19.4
Age ≥ 63 311 13.7 17.1
Male 458 11.8 16.1
Female 168 10.6 24.1
DM 65 13.8 22.2
no DM 561 11.3 17.7
Ref D > 3.1 mm 317 9.6 15.6
Ref D ≤ 3.1 mm 299 12.0 20.8
Visible thrombus 458 11.6 15.9
No visible thrombus 168 11.1 24.1
Stent length > 18 mm 309 12.9 17.8
Stent length ≤ 18 mm 310 9.5 17.9
LAD 258 14.8 20.6
CX / RCA 368 9.4 16.4
0 0.5 1.0 0.5 2.0
DES better BMS better
24. DEDICATION
Subgroup analysis
Group n Rate of MACE (%)
DES BMS Odds Ratio (95% CI)
All 626 11.5 18.2
Age < 63 315 9.4 19.4
Age ≥ 63 311 13.7 17.1
Male 458 11.8 16.1
Female 168 10.6 24.1
DM 65 13.8 22.2
no DM 561 11.3 17.7
Ref D > 3.1 mm 317 9.6 15.6
Ref D ≤ 3.1 mm 299 12.0 20.8
Visible thrombus 458 11.6 15.9
No visible thrombus 168 11.1 24.1
Stent length > 18 mm 309 12.9 17.8
Stent length ≤ 18 mm 310 9.5 17.9
LAD 258 14.8 20.6
CX / RCA 368 9.4 16.4
0 0.5 1.0 0.5 2.0
DES better BMS better
25. DEDICATION
Subgroup analysis
Group n Rate of MACE (%)
DES BMS Odds Ratio (95% CI)
All 626 11.5 18.2
Age < 63 315 9.4 19.4
Age ≥ 63 311 13.7 17.1
Male 458 11.8 16.1
Female 168 10.6 24.1
DM 65 13.8 22.2
no DM 561 11.3 17.7
Ref D > 3.1 mm 317 9.6 15.6
Ref D ≤ 3.1 mm 299 12.0 20.8
Visible thrombus 458 11.6 15.9
No visible thrombus 168 11.1 24.1
Stent length > 18 mm 309 12.9 17.8
Stent length ≤ 18 mm 310 9.5 17.9
LAD 258 14.8 20.6
CX / RCA 368 9.4 16.4
0 0.5 1.0 0.5 2.0
DES better BMS better
26. DEDICATION
Conclusions
In the DEDICATION trial implantation of DES
(compared with BMS) in STEMI patients
• reduced the rate of MACE and the need for repeat
revascularization
• was not associated with an increased rate of myocardial
infarction or stent thrombosis
• was associated with an increased risk of cardiac death