Comparison of Everolimus-Eluting and Sirolimus-Eluting Coronary Stents: 1-Year Outcomes from the Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET)

BACKGROUND: Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes. However, only 1 trial was powered for a clinical end point, and no trial was powered for evaluating target-lesion revascularization. METHODS AND RESULTS: Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. The trial was powered for evaluating noninferiority of EES relative to SES in terms of target-lesion revascularization. From February and July 2010, 3197 patients were randomly assigned to receive either EES (1597 patients) or SES (1600 patients). At 1 year, the primary efficacy end point of target-lesion revascularization occurred in 65 patients (4.3%) in the EES group and in 76 patients (5.0%) in the SES group, demonstrating noninferiority of EES to SES (P(noninferiority)<0.0001, and P(superiority)=0.34). Cumulative incidence of definite stent thrombosis was low and similar between the 2 groups (0.32% versus 0.38%, P=0.77). An angiographic substudy enrolling 571 patients (EES, 285 patients and SES, 286 patients) demonstrated noninferiority of EES relative to SES regarding the primary angiographic end point of in-segment late loss (0.06±0.37 mm versus 0.02±0.46 mm, P(noninferiority)<0.0001, and P(superiority)=0.24) at 278±63 days after index stent implantation. CONCLUSIONS: One-year clinical and angiographic outcome after EES implantation was noninferior to and not different from that after SES implantation in a stable coronary artery disease population with relatively less complex coronary anatomy. One-year clinical outcome after both EES and SES use was excellent with a low rate of target-lesion revascularization and a very low rate of stent thrombosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035450.     

Afterloading increases the left ventricular end-systolic force-length relation slope in dogs.

We evaluated the effects of pressure loading produced by gradual aortic occlusion on left ventricular (LV) myocardial contractility by assessing changes in the slope of the LV end-systolic force-diameter (Fes-Des) relation. Eleven adult mongrel dogs were prepared with ultrasonic crystals for measuring LV diameter and a micromanometer for measuring LV pressure. Preload was decreased by vena caval occlusion (VCO), and afterload was increased by aortic occlusion (AOO). The slopes (Ec) and extrapolated diameter intercepts (Do) of the LV Fes-Des relation were determined for each dog from the end-systolic data obtained during VCO and AOO. During VCO and also AOO, the heart rate showed little change (134 +/- 18 vs. 134 +/- 16 bpm in VCO, 135 +/- 16 vs. 132 +/- 17 bpm in AOO). The values of Ec and Do during VCO were 62.8 +/- 15.6 g/cm and 1.20 +/- 0.36 cm, respectively, while during AOO the respective values were 122.6 +/- 18.6 g/cm and 1.66 +/- 0.38 cm. Ec and Do were both significantly increased during AOO in comparison with VCO (p less than 0.001). These results suggest that gradual aortic occlusion increases LV myocardial contractility in anesthetized, open-chest dogs under autonomic blockade. This phenomenon might be related to length-dependent calcium activation.     

Ruptured gastric artery aneurysm: An uncommon manifestation of microscopic polyangiitis

Gastric artery aneurysm is a rare and lethal condition, and is caused by inflammatory or degenerative vasculopathies. We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associated with microscopic polyangiitis. Absence of vasculitic changes in the aneurysm resected and negative results of autoantibodies interfered with our diagnostic process. We should have adopted an interventional radiology and initiated steroid therapy promptly to rescue the patient.     

Immunological function and nutritional status in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Infection is a major complication associated with increased morbidity and mortality in patients with hepatocellular carcinoma. We compared the immunological function and nutritional status in 16 patients with hepatocellular carcinoma (13 patients had liver cirrhosis) with those of 21 normal healthy subjects. METHODOLOGY: The immunological function was assessed by chemotaxis and superoxide anion production by neutrophils, phagocytosis and killing activities of neutrophils and monocytes, absolute and relative number of peripheral blood lymphocytes, the percentage of peripheral lymphocyte subsets and serum concentrations of immunoglobulins. RESULTS: Although the phagocytic and bactericidal activities of monocytes and superoxide production of neutrophils were not different between the groups, the phagocytic and bactericidal activities of neutrophils and the percentage of natural killer cells were significantly reduced in patients with hepatocellular carcinoma. In the latter group, the prognostic nutrition index was significantly high compared with normal subjects, indicating a poor nutritional status. The phagocytic and bactericidal activities of neutrophils were low in patients with a poor nutritional status compared to those with a good nutritional status. CONCLUSIONS: Our results suggest that impaired immunological competence and undernourishment may be one of the mechanisms causing increased susceptibility of patients with hepatocellular carcinoma to infection.     

Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva

Introduction

Although focal atrial tachycardia (AT) is known to sometimes be ablated from the noncoronary aortic cusp (NCC), the electro-anatomic characteristics of NCC-AT are not well known.

Methods

We compared the clinical, 12-lead electrocardiogram (ECG), and transthoracic echocardiogram characteristics of 6 women (median age, 66.5 years) with NCC-AT and 12 age-matched women (median age, 64.0 years) with atrioventricular nodal reentrant tachycardia (AVNRT) as the control group.

Results

There was no difference in the prevalence of hypertension between the two groups (67 vs. 33 %, respectively, P?=?0.3213). The resting ECG of the NCC-AT group vs. that of the AVNRT group showed a significantly longer PQ interval (170.0 (interquartile range (IQR), 157.5–180.0 ms) vs. 140.0 ms (IQR, 122.5–147.5 ms), P?=?0.0010) and leftward shifting of the QRS axis (4° (IQR, ?26.0° to 24.0°) vs. 57° (IQR, 43.0–70.2°), P?=?0.0087). The upper interventricular septum (IVS) thickness was significantly greater (15.6 (IQR, 11.9–18.7 ms) vs. 11.7 mm (IQR, 10.2–12.9 ms), P?=?0.0393), and the angle formed by the aortic roof and IVS (AS angle) was significantly steeper (103.0° (IQR, 94.2–119.2°) vs. 122.5° (IQR, 108.5–128.5°), P?=?0.0343) in the NCC-AT group than in the AVNRT group.

Conclusions

Our data suggest that NCC-AT is characterized by a longer atrioventricular (AV) conduction time, steeper AS angle, and thicker IVS than are seen with AVNRT. These electrocardiographic and echocardiographic characteristics from the IVS to the peri-AV nodal regions may have some effect on the development of NCC-AT.     

D-pro(2)-endomorphin-1 and D-pro(2)-endomorphin-2, respectively,attenuate the antinociception induced by endomorphin-1 and endomorphin-2 given intrathecally in the mouse

First, the antinociception with the tail-flick test of D-Pro(2)-endomorphin-1 and D-Pro(2)-endomorphin-2 given i.t. was compared with that produced by endomorphin-1 and -2 in male CD-1 mice. High doses of D-Pro(2)-endomorphin-1 (0.2-0.4 pmol) and D-Pro(2)-endomorphin-2 (300-800 pmol) given i.t. produced antinociception with low intrinsic activity [about 25% maximum possible effect (MPE)] compared with that of endomorphin-1 (16.4 nmol) and endomorphin-2 (35 nmol) (>90% MPE). Second, coadministration of a low dose of D-Pro(2)-endomorphin-1 (0.1 pmol), which given alone did not affect the tail-flick latencies, markedly attenuated the antinociception induced by endomorphin-1 (16.4 nmol) but not by endomorphin-2 (35 nmol). Similarly, coadministration of a low dose of D-Pro(2)-endomorphin-2 (200 pmol), which given alone did not affect the tail-flick latencies, significantly attenuated the antinociception induced by endomorphin-2 (35 nmol) and, to a much lesser extent, endomorphin-1 (16.4 nmol). It is concluded that D-Pro(2)-endomorphin-1 and D-Pro(2)-endomorphin-2 at high doses were partial opioid receptor agonists to produce antinociception, and at low doses were opioid receptor antagonists to block selectively the antinociception induced by endomorphin-1 and endomorphin-2, respectively. Furthermore, our results are consistent with the view that the antinociception induced by endomorphin-1 and endomorphin-2 is mediated by the stimulation of different subtypes of mu-opioid receptors.     

Bird fancier's lung complicated by pulmonary nocardiosis

We report the case of an 84-year-old male who was admitted to the hospital withpersistent cough and dyspnea. An initial chest X-ray revealed pulmonary infiltrates.Nocardia asteroides was detected in sputum, and the patient wastreated with antibiotics. However, his symptoms did not completely resolve. He wasadmitted multiple times, and his symptoms relapsed after every discharge. He wasfinally suspected of having hypersensitivity pneumonitis and was diagnosed with birdfancier''s lung. Pulmonary nocardiosis is likely to develop in patients with chronicpulmonary disorders, such as COPD, as well as in immunosuppressed hosts. To ourknowledge, this is the first report of a case of bird fancier''s lung complicated bypulmonary nocardiosis.     

Clinical and angiographic outcomes of axial stent deformations in unrestricted real world patient population

Background

Prior reports have suggested that the design of the Promus Element stent is prone to longitudinal stent deformation (LSD). However, little is known about the clinical and angiographic outcomes of Promus Element stent axial deformations when implanted in unrestricted coronary lesions.

Method and Results

Two independent reviewers retrospectively evaluated the procedure steps of 961 Promus Element stent (833 de novo lesions in 494 consecutive patients) implanted in unrestricted coronary lesions, between February 2012 and March 2013, and compared the prevalence, predictors, and the mid‐term clinical and angiographic outcomes between lesions with and without stent deformation. Fifteen stents (1.56%) with LSD were observed (95% confidence interval [CI]: 0.78–2.34%). The proximal edge of the stent was deformed in 13 stents (86.6%). Ostial stenting (Adjusted Odds ratio [OR]: 9; 95%CI: 2.27–33.3; P = 0.002), and bifurcation lesions (Adjusted OR: 3; 95%CI: 1.03–8.8; P = 0.04) were independently associated with the occurrence of stent deformation. LSD led to unplanned stenting in (53%, 8 of 15) of the deformed stents, which consumed larger contrast volume and longer fluoroscopy time. At 8‐month follow‐up, there was no significant difference in binary restenosis rate and target lesions revascularization between both groups (P = 0.98, and P = 0.56, respectively), while death occurred in six patients of the non‐LSD group (1.36%, 6 of 440) and none in the LSD group. All patients of the LSD group had no major adverse clinical events at 8‐month follow‐up.

Conclusions

Axial stent deformation in Promus Element platform is an infrequent event, occurs following manipulation of the interventional tools. Other than unplanned stenting, the LSD was not associated with any adverse clinical events at 8‐month follow‐up.