Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes.

Background Conflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome. Methods We randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin. Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion. Primary outcomes for the comparison between bivalirudin and heparin were the occurrence of major adverse cardiovascular events (a composite of death, myocardial infarction, or stroke) and net adverse clinical events (a composite of major bleeding or a major adverse cardiovascular event). The primary outcome for the comparison of a post-PCI bivalirudin infusion with no post-PCI infusion was a composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events. Results The rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (10.3% and 10.9%, respectively; relative risk, 0.94; 95% confidence interval [CI], 0.81 to 1.09; P=0.44), nor was the rate of net adverse clinical events (11.2% and 12.4%, respectively; relative risk, 0.89; 95% CI, 0.78 to 1.03; P=0.12). Post-PCI bivalirudin infusion, as compared with no infusion, did not significantly decrease the rate of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (11.0% and 11.9%, respectively; relative risk, 0.91; 95% CI, 0.74 to 1.11; P=0.34). Conclusions In patients with an acute coronary syndrome, the rates of major adverse cardiovascular events and net adverse clinical events were not significantly lower with bivalirudin than with unfractionated heparin. The rate of the composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events was not significantly lower with a post-PCI bivalirudin infusion than with no post-PCI infusion. (Funded by the Medicines Company and Terumo Medical; MATRIX ClinicalTrials.gov number, NCT01433627 .).

Sutureless Aortic Valve Replacement International Registry (SU-AVR-IR): design and rationale from the International Valvular Surgery Study Group (IVSSG).

BACKGROUND Sutureless aortic valve replacement (SU-AVR) is an innovative approach which shortens cardiopulmonary bypass and cross-clamp durations and may facilitate minimally invasive approach. Evidence outlining its safety, efficacy, hemodynamic profile and potential complications is replete with small-volume observational studies and few comparative publications. METHODS Minimally invasive aortic valve surgery and high-volume SU-AVR replacement centers were contacted for recruitment into a global collaborative coalition dedicated to sutureless valve research. A Research Steering Committee was formulated to direct research and support the mission of providing registry evidence warranted for SU-AVR. RESULTS The International Valvular Surgery Study Group (IVSSG) was formed under the auspices of the Research Steering Committee, comprised of 36 expert valvular surgeons from 27 major centers across the globe. IVSSG Sutureless Projects currently proceeding include the Retrospective and Prospective Phases of the SU-AVR International Registry (SU-AVR-IR). CONCLUSIONS The global pooling of data by the IVSSG Sutureless Projects will provide required robust clinical evidence on the safety, efficacy and hemodynamic outcomes of SU-AVR.

Giovanni Bottesini, Brustbild

Signatur des Originals: S 36/F00185

Giovanni di Dio, Ganzfigurbildnis, mit Violoncello

Signatur des Originals: S 36/F00363

Giovanni Mario, Ganzfigurbildnis

Signatur des Originals: S 36/F01194

Giovanni Mario, Brustbild

Signatur des Originals: S 36/F01195

Giovanni Paisiello, Brustbild

Signatur des Originals: S 36/F01461

Giovanni Pierluigi da Palestrina, Brustbild

Signatur des Originals: S 36/F01462

Giovanni Battista Rubini, Hüftbild

Signatur des Originals: S 36/F01689

Francisco d'Andrade als Don Giovanni, Rollenbild, Brustbild, in: Mozart: Don Giovanni

Signatur des Originals: S 36/F02585

Francisco d'Andrade als Don Giovanni, Rollenbild, Kniestück, in: Mozart: Don Giovanni

Signatur des Originals: S 36/F02586

Francisco d'Andrade als Don Giovanni, Rollenbild, in: Mozart: Don Giovanni

Signatur des Originals: S 36/F02587

Francisco d'Andrade als Don Giovanni, Rollenbild, Ganzfigurbildnis, in: Mozart: Don Giovanni

Signatur des Originals: S 36/F02588

Francisco d'Andrade als Don Giovanni, Rollenbild, Kniestück, in: Mozart: Don Giovanni

Signatur des Originals: S 36/F02589