Gender differences in presentation, coronary intervention, and outcomes of 28,985 acute coronary syndrome patients in Victoria, Australia

BACKGROUND: Differences in demographics, presenting characteristics, and treatment of heart disease in women may contribute to adverse outcomes. The purpose of this paper was to describe gender differences in the epidemiology, treatment, and outcomes of all admissions for acute coronary syndrome (ACS) in Victoria that occurred between June 2007 and July 2009. METHODS: We undertook a retrospective cohort study of all patients admitted to Victorian hospitals with a first time diagnosis of ACS. Use of angiograms, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and adverse outcomes (death and/or unplanned readmission) were compared by gender and hierarchical logistic regression models were used to account for confounding variables. RESULTS: Of a total of 28,985 ACS patients, 10,455 (36%) were women. Compared with men, women were older (aged ≥75 years: 54% vs 31%; p < .001), more likely to present with multiple comorbidities (>1 comorbidity: 53% vs 46%; p < .001), and more likely to be diagnosed with non-ST-segment elevation ACS (86% vs 80%; p < .001). Women were less likely to receive coronary interventions (angiogram: adjusted odds ratio [aOR], 0.71; 95% CI, 0.66-0.75; PCI: aOR, 0.73; 95% CI, 0.66-0.80; CABG: aOR, 0.58; 95% CI, 0.53-0.64). Adverse outcomes were similar in women and men after accounting for confounding variables. CONCLUSIONS: Our results show that women in Victoria were less likely to receive coronary interventions after an admission for ACS. Clinicians should be wary of inherent gender bias in decisions to refer patients for angiography.

EBSD and AFM observations of the microstructural changes induced by low temperature plasma carburising on AISI 316

Low temperature plasma carburising (LTPC) has been increasingly accepted as a hardening process for austenitic stainless steels because it produces a good combination of tribological and corrosion properties. The hardening mechanism is based on the supersaturation of the austenitic structure with carbon, which greatly hardens the material, significantly expands the fcc unit cell, produces high levels of compressive residual stresses and, ultimately, leads to the occurrence of deformation bands and rotation of the crystal lattice. The microstructural changes introduced during plasma carburising have a significant impact on the mechanical, tribological and corrosion performance and, for this reason, the microstructure of expanded austenite or S-phase has been extensively studied. However, modern surface characterisation techniques could provide new insights into the formation mechanism of S-phase layers. In this work, backscattered electron diffraction and atomic force microscopy were used to characterise the surface layers of expanded austenite produced by LTPC in an active screen furnace. Based on the experimental results, the plastic deformation, its dependence on crystallographic orientation, the evolution of grain boundaries, and their effects on mechanical, tribological and corrosion properties are discussed. © 2011 Elsevier B.V. All rights reserved.

Corrosion behaviour of direct current and active screen plasma carburised AISI 316 stainless steel in boiling sulphuric acid solutions

Active screen plasma is a recently developed plasma surface alloying technique, which has shown potential for addressing some drawbacks associated with conventional direct current plasma processes. In this study, the corrosion performance of untreated, direct current and active screen plasma carburised AISI 316 was investigated by immersion in a boiling solution of sulphuric acid. The experimental results show that the corrosion behaviour of expanded austenite produced by low temperature plasma carburising is controlled by the type and density of surface defects; the corrosion properties of the active screen plasma carburised material are superior to that produced by direct current plasma because of the significantly reduced edge effect and surface defects; and the bias level used in the active screen carburising treatment has a profound effect on the corrosion performance of the material. Based on the experimental results, the corrosion mechanisms involved are discussed.