Stent Thrombosis in Drug-Eluting or Bare-Metal Stents in Patients Receiving Dual Antiplatelet Therapy

OBJECTIVES This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS. BACKGROUND Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES. METHODS Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months. RESULTS Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001). CONCLUSIONS DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).

Benefits and Risks of Extended Duration Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction

BACKGROUND The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction (MI) compared with more stable presentations. OBJECTIVES This study sought to assess the benefits and risks of 30 versus 12 months of dual antiplatelet therapy among patients undergoing coronary stent implantation with and without MI. METHODS The Dual Antiplatelet Therapy Study, a randomized double-blind, placebo-controlled trial, compared 30 versus 12 months of dual antiplatelet therapy after coronary stenting. The effect of continued thienopyridine on ischemic and bleeding events among patients initially presenting with versus without MI was assessed. The coprimary endpoints were definite or probable stent thrombosis and major adverse cardiovascular and cerebrovascular events (MACCE). The primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries) moderate or severe bleeding. RESULTS Of 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presented with MI. Between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs. 1.9%, p < 0.001; no MI group, 0.4% vs. 1.1%, p < 0.001; interaction p = 0.69). The reduction in MACCE for continued thienopyridine was greater for patients with MI (3.9% vs. 6.8%; p < 0.001) compared with those with no MI (4.4% vs. 5.3%; p = 0.08; interaction p = 0.03). In both groups, continued thienopyridine reduced MI (2.2% vs. 5.2%, p < 0.001 for MI; 2.1% vs. 3.5%, p < 0.001 for no MI; interaction p = 0.15) but increased bleeding (1.9% vs. 0.8%, p = 0.005 for MI; 2.6% vs. 1.7%, p = 0.007 for no MI; interaction p = 0.21). CONCLUSIONS Compared with 12 months of therapy, 30 months of dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, and increased bleeding. (The Dual Antiplatelet Therapy Study [The DAPT Study]; NCT00977938).

Antiplatelet therapy duration following bare metal or drug-eluting coronary stents: the dual antiplatelet therapy randomized clinical trial

IMPORTANCE Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) treatment duration effect within the combined cohorts of randomized patients treated with DES or BMS as prespecified secondary analyses. DESIGN, SETTING, AND PARTICIPANTS International, multicenter, randomized, double-blinded, placebo-controlled trial comparing extended (30-months) thienopyridine vs placebo in patients taking aspirin who completed 12 months of DAPT without bleeding or ischemic events after receiving stents. The study was initiated in August 2009 with the last follow-up visit in May 2014. INTERVENTIONS Continued thienopyridine or placebo at months 12 through 30 after stent placement, in 11,648 randomized patients treated with aspirin, of whom 1687 received BMS and 9961 DES. MAIN OUTCOMES AND MEASURES Stent thrombosis, MACCE, and moderate or severe bleeding. RESULTS Among 1687 patients treated with BMS who were randomized to continued thienopyridine vs placebo, rates of stent thrombosis were 0.5% vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95% CI, 0.15-1.64; P = .24), rates of MACCE were 4.04% vs 4.69% (n = 33 vs 38; HR, 0.92; 95% CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding were 2.03% vs 0.90% (n = 16 vs 7; P = .07), respectively. Among all 11,648 randomized patients (both BMS and DES), stent thrombosis rates were 0.41% vs 1.32% (n = 23 vs 74; HR, 0.31; 95% CI, 0.19-0.50; P < .001), rates of MACCE were 4.29% vs 5.74% (n = 244 vs 323; HR, 0.73; 95% CI, 0.62-0.87; P < .001), and rates of moderate/severe bleeding were 2.45% vs 1.47% (n = 135 vs 80; P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing coronary stent placement with BMS and who tolerated 12 months of thienopyridine, continuing thienopyridine for an additional 18 months compared with placebo did not result in statistically significant differences in rates of stent thrombosis, MACCE, or moderate or severe bleeding. However, the BMS subset may have been underpowered to identify such differences, and further trials are suggested. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00977938.

Babylon - Bagdad

Robert W. Horn

Babylon - Bagdad

Robert W. Horn

Zur Siedlungsfrage in der Türkei [Rezension]

Robert W. Horn

Na 1 Nachlass Max Horkheimer, 687 - "Experimental Movie Project", "The Police and Minority Groups" u.a. (p. IX 150.1-17 - IX 152.1-2)

"Experimental Movie Project" (1945-46):; 1. "Below the Surface", Drehbuch des Testfilms, a) als Typoskript vervielfältigt, 46 Blatt, b) als Typoskript vervielfältigt, 26 Blatt, c) als Typoskript vervielfältigt, 26 Blatt, d) als Typoskript vervielfältigt, 26 Blatt "Experimental Movie Project" (1945-46): Memoranden zum Test; 2. 'Notes' 25.4.1946, Typoskript, 1 Blatt; 3. "Memorandum on Experimental Movie Project", 19.4.1946. Typoskript, 3 Blatt; 4. "Memorandum re: 'Below the Surface" (Juli 1945). Typoskript, 2 Blatt; 5. Dore Schary und Allen Rivkin: 'Memorandum, Subject: New Suggested Treatment for 'Below the Surface'", 13.7.1945. Typoskript, 2 Blatt; 6. Hans Richter: "Report about the film script 'Below the surface'", 7. u. 8.7.1945, a) Typoskript, 1 Blatt, b) Typoskript, 1 Blatt; 7. Hans Richter: Bestätigung der Vereinbarung mit dem American Jewish Committee, 3.7.1945. Typoskript, 1 Blatt; 8. "Notes and Suggestions re Experimental Motion Picture", Juni 1945. Typoskript, 2 Blatt; 9. Siegfried Kracauer; "Suggestions for the Dialogue" (4.4.1945). Typoskript, 3 Blatt; 10. "Motion Picture", März 1945. Typoskript, 5 Blatt; 11. "Project on a Test film", a) Typoskript, 4 Blatt, b) Typoskript, 5 Blatt; 12. "Memorandum re: 'Below the Surface'", a) Typoskript, 3 Blatt, b) Typoskript mit eigenhändigen Korrekturen von Theodor W. Adorno, 3 Blatt; "Experimental Movie Project" (1945-46): Korrespondenz zum Test-Film-Projekt:; 13. Friedrich Pollock: 1 Brief an Max Horkheimer, Santa Monica, California, 12.10.1945; 14. Theodor W. Adorno: 2 Briefe an Max Horkheimer, Los Angeles und Santa Monica, California, 1945; 15. Joseph M. Proskauer: 1 Brief von Max Horkheimer, o.O., 29.6.1945, 1 Brief mit Unterschrift an Max Horkheimer, o.O., o.D., 3 Blatt; 16. Alexander Hackenschmied, 1 Brief mit Unterschrift an Max Horkheimer, New York, 19.6.1945, 1 Blatt; 17. Gilbert Gabriel: 1 Brief von John Slawson, o.O., 22.3.1945, 2 Blatt; "The Police and Minority Groups" (1946):; 1. "The Police and Minority Groups". Typoskript, 2 Blatt; 2. Robert W. Kenny: "Police and Minority Groups - an Experiment". Als Typoskript vervielfältigt, 17 Blatt; 3. Davis McEntire, Robert B. Powers: "Police Training Bulletin. A Guide to Race Relations for Police Officers", State of California, 1946, 38 Seiten; Max Horkheimer: "Memorandum on a Study of Race Hatred in Post-War Germany" (1946):; 1. Memorandum, a) Typoskript, 8 Blatt, b) Typoskript mit eigenhändigen und handschriftlichen Korrekturen, 6 Blatt, c) Typoskript, 5 Blatt, d) Teilstück, Typoskript mit eigenhändigen Korrekturen, 1 Blatt e) Typoskript mit eigenhändigen Korrekturen, 5 Blatt, f) Teilstück, Typoskript mit handschriftlichen Korrekturen, 2 Blatt, g) Typoskript mit eigenhändigen Korrekturen, 7 Blatt, h) Teilstück, Typoskript mit eigenhändigen Korrekturen und Ergänzungen, 1 Blatt, i) Typoskript, 2 Blatt; 2. Theodor W. Adorno: "Ad Memorandum Neumann", Manuskript, 3 Blatt;

All Adults Once Were Children

Issue Editor, Robert Block's, point of view and summary of the articles in New Morbidities 2.0