Safety and efficacy of drug-eluting stents in women: a patient-level pooled analysis of randomised trials

BACKGROUND The safety and efficacy of drug-eluting stents (DES) in the treatment of coronary artery disease have been assessed in several randomised trials. However, none of these trials were powered to assess the safety and efficacy of DES in women because only a small proportion of recruited participants were women. We therefore investigated the safety and efficacy of DES in female patients during long-term follow-up. METHODS We pooled patient-level data for female participants from 26 randomised trials of DES and analysed outcomes according to stent type (bare-metal stents, early-generation DES, and newer-generation DES). The primary safety endpoint was a composite of death or myocardial infarction. The secondary safety endpoint was definite or probable stent thrombosis. The primary efficacy endpoint was target-lesion revascularisation. Analysis was by intention to treat. FINDINGS Of 43,904 patients recruited in 26 trials of DES, 11,557 (26·3%) were women (mean age 67·1 years [SD 10·6]). 1108 (9·6%) women received bare-metal stents, 4171 (36·1%) early-generation DES, and 6278 (54·3%) newer-generation DES. At 3 years, estimated cumulative incidence of the composite of death or myocardial infarction occurred in 132 (12·8%) women in the bare-metal stent group, 421 (10·9%) in the early-generation DES group, and 496 (9·2%) in the newer-generation DES group (p=0·001). Definite or probable stent thrombosis occurred in 13 (1·3%), 79 (2·1%), and 66 (1·1%) women in the bare-metal stent, early-generation DES, and newer-generation DES groups, respectively (p=0·01). The use of DES was associated with a significant reduction in the 3 year rates of target-lesion revascularisation (197 [18·6%] women in the bare-metal stent group, 294 [7·8%] in the early-generation DES group, and 330 [6·3%] in the newer-generation DES group, p<0·0001). Results did not change after adjustment for baseline characteristics in the multivariable analysis. INTERPRETATION The use of DES in women is more effective and safe than is use of bare-metal stents during long-term follow-up. Newer-generation DES are associated with an improved safety profile compared with early-generation DES, and should therefore be thought of as the standard of care for percutaneous coronary revascularisation in women. FUNDING Women in Innovation Initiative of the Society of Cardiovascular Angiography and Interventions.

Inland Wetland Definitions

This work is the result of a year-long study of the definitions of inland wetlands in which definitions from geology, hydrogeology, hydrology, pedology, biology, systems ecology, sociology, economics, political sciences, public health and law were considered. Of these, geology, hydrogeology, hydrology, biology, systems ecology and economics are discussed in detail in this report and used in writing a final theoretical (ideal) definition of inland wetlands for the glaciated northeastern United States. A proposed legal definition for Connecticut is also offered with descriptions and explanations of terms.

Transition Zones of Forested Inland Wetlands in Northeastern Connecticut

Inland wetlands are valuable natural resources intimately associated with the hydrologic cycle. This study was designed to (1) investigate vegetation distribution and selected physical and chemical properties of wetland and bordering upland soils and the interface between the two, and (2) provide the ground truth necessary for the identification and delineation of deciduous wetland forests using false-color infrared (FCIR) imagery.

Products of chlorophyll diagenesis from DSDP Leg 57 Holes

Tetrapyrrole pigments isolated from sediments retrieved during Leg 57 include pheophytin-a, a myriad of chlorins, free-base deoxophylloerythroetioporphyrin (DPEP), as well as copper and nickel porphyrins. Their richness, both qualitatively and quantitatively, in chlorin tetrapyrroles affords a relatively complete study on the early diagenesis of chlorophyll. Our studies, coupled with those in the preceding chapter by Louda et al., point out the influence of pre- and postdepositional environments upon the mode of chlorophyll diagenesis. Formation of tetrapyrroles, collectively called "petroporphyrins," is seen to occur in only a limited set of environmental conditions (see Baker and Palmer, 1978). The more generalized route of chlorophyll diagenesis, at least in the ocean, results in removal of tetrapyrrole pigment, from the fossil record. Late diagenetic products, metalloporphyrins, are found to represent an extremely minor component of the tetrapyrrole assemblage in sediments studied from the Japan Trench. The products of chlorophyll diagenesis isolated from Japan Trench sediments allow expansion of previous diagenetic schemes (Baker and Palmer, 1978; Triebs, 1936) and indicate directions for future studies.

Pliocene foraminifera and SST changes in ODP Site 184-1125

Planktonic foraminiferal census counts were converted to sea surface temperature (SST) estimates using the modern analogue technique (MAT) for the middle-late Pliocene (4.0-2.37 Ma) in ODP Site 1125, north side of Chatham Rise, SW Pacific Ocean. MAT SST(warm) records range between 8°C and 20.5°C, and MAT SST(cold) records parallel that pattern but with a temperature range of 5-15°C. The modern position of Site 1125 is just north of the Subtropical Front and has an annual temperature range of ~14-18°C. Pliocene warmest temperatures are 1-2° warmer than modern summers, whereas cold season SST records are up to 6-10°C cooler than modern winters. Overall average temperatures at the site are 2-3°C cooler than modern temperatures during a time of sustained global warmth. Three major cold excursions centred on 3.35, 3.0, and 2.8 Ma showed warm season temperatures over 5°C colder than the last glacial maximum, experiencing temperatures typical of modern subantarctic waters. Two minor cold excursions at 2.7 Ma and 2.4 Ma experienced temperatures cooler than modern winters but not as cold as last glacial conditions. Cold season SSTs show a shift to warmer climate upward through the study interval, whereas warm season estimates remain essentially unchanged. We interpret the strong regional cooling of subtropical Southwest Pacific water through the middle-late Pliocene as having been caused by increased upwelling. It is also possible that the subtropical frontal zone moved north over the site in the Pliocene, however, this is considered the least likely interpretation. Our record of cool conditions in the Southwest Pacific corroborate evidence of cooler than modern conditions in other regions of the western Pacific through the mid-Pliocene despite overall global warming.