Comparative Effectiveness and Safety of New-Generation Versus Early-Generation Drug-Eluting Stents According to Complexity of Coronary Artery Disease: A Patient-Level Pooled Analysis of 6,081 Patients.

OBJECTIVES The purpose of this study was to compare the 2-year safety and effectiveness of new- versus early-generation drug-eluting stents (DES) according to the severity of coronary artery disease (CAD) as assessed by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score. BACKGROUND New-generation DES are considered the standard-of-care in patients with CAD undergoing percutaneous coronary intervention. However, there are few data investigating the effects of new- over early-generation DES according to the anatomic complexity of CAD. METHODS Patient-level data from 4 contemporary, all-comers trials were pooled. The primary device-oriented clinical endpoint was the composite of cardiac death, myocardial infarction, or ischemia-driven target-lesion revascularization (TLR). The principal effectiveness and safety endpoints were TLR and definite stent thrombosis (ST), respectively. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 2 years for overall comparisons, as well as stratified for patients with lower (SYNTAX score ≤11) and higher complexity (SYNTAX score >11). RESULTS A total of 6,081 patients were included in the study. New-generation DES (n = 4,554) compared with early-generation DES (n = 1,527) reduced the primary endpoint (HR: 0.75 [95% CI: 0.63 to 0.89]; p = 0.001) without interaction (p = 0.219) between patients with lower (HR: 0.86 [95% CI: 0.64 to 1.16]; p = 0.322) versus higher CAD complexity (HR: 0.68 [95% CI: 0.54 to 0.85]; p = 0.001). In patients with SYNTAX score >11, new-generation DES significantly reduced TLR (HR: 0.36 [95% CI: 0.26 to 0.51]; p < 0.001) and definite ST (HR: 0.28 [95% CI: 0.15 to 0.55]; p < 0.001) to a greater extent than in the low-complexity group (TLR pint = 0.059; ST pint = 0.013). New-generation DES decreased the risk of cardiac mortality in patients with SYNTAX score >11 (HR: 0.45 [95% CI: 0.27 to 0.76]; p = 0.003) but not in patients with SYNTAX score ≤11 (pint = 0.042). CONCLUSIONS New-generation DES improve clinical outcomes compared with early-generation DES, with a greater safety and effectiveness in patients with SYNTAX score >11.

Ms. lat. qu. 97 Bd. 4 - Memorie originali risguardanti le belle arti, Nr. 179 - 195

Vorbesitzer: Michelangelo Gualandi;

Aus Urväter-Tagen : biblische Legenden und Märchen

Frieda Weissmann

Ms. lat. oct. 216 - Collegium Pandectarum

Vorbesitzer: Henricus Dominicus de Heyden;

Satisfaction with medical care among Mexican-Americans (Hispanic HANES, 1982--1984)

This research focussed on the extent to which the characteristics of a sample of 8,554 Mexican-Americans affected their satisfaction with medical care by: (1) describing satisfaction with medical care among the population, (2) examining the relationships between satisfaction with health services and personal characteristics of the population, and (3) comparing the results of the research with the results of studies of personal health services in other times, places, and populations.^ The distribution of sex among this population was close to even with men representing 50.4%, however respondents over age 50 years represent 11.3% of the sample. The highest grade attended was found in the Elementary (37.9%), and 70% responded they have a good health. Ninety-three percent of the sample were attended to within thirty minutes they arrived at their clinic/health center. Eighty-two percent of the sample were "Very Satisfied" with the care they received during their last visit.^ Ten hypotheses were tested in this research. Females tend to be more satisfied than males; age was found to correlate with satisfaction with respondents over 40 years reporting more satisfaction levels; there was no correlation between education and satisfaction with the educated expressing more skepticism about medical care; respondents covered by Medicare or Medicaid were more satisfied; perceived health status rating was highly correlated with satisfaction; respondents who spent less than 30 minutes traveling to the clinic/health center were more satisfied while 82% of respondents who had less than 30 minutes waiting time expressed more satisfaction.^ As remarked by Hulka and Aday that responses to client satisfaction questionnaire often provided socially acceptable answers, the results found in this sample was therefore not surprising. The author recommends that instruments for the collection of information on client satisfaction should be studied and modified where applicable to reduce what John Ware termed Acquiescent Response Set (ARS)--a tendency to agree with statement of opinion regardless of content. ^

Physical oceanography from the TRACTOR project

Primary Objectives - Describe and quantify the present strength and variability of the circulation and oceanic processes of the Nordic Seas regions using primarily observations of the long term spread of a tracer purposefully released into the Greenland Sea Gyre in 1996. - Improve our understanding of ocean processes critical to the thermaholine circulation in the Nordic Seas regions so as to be able to predict how this region may respond to climate change. - Assess the role of mixing and ageing of water masses on the carbon transport and the role of the thermohaline circulation in carbon storage using water transports and mixing coefficients derived from the tracer distribution. Specific Objectives Perform annual hydrographic, chemical and SF6 tracer surveys into the Nordic regions in order to: - Measure lateral and diapycnal mixing rates in the Greenland Sea Gyre and in the surrounding regions. - Document the depth and rates of convective mixing in the Greenland Sea using the SF6 and the water masses characteristics. - Measure the transit time and transport of water from the Greenland Sea to surrounding seas and outflows. Document processes of water mass transformation and entrainment occurring to water emanating from the central Greenland Sea. - Measure diapycnal mixing rates in the bottom and margins of the Greenland Sea basin using the SF6 signal observed there. Quantify the potential role of bottom boundary-layer mixing in the ventilation of the Greenland Sea Deep Water in absence of deep convection. Monitor the variability of the entrainment of water from the Greenland Sea using time series auto-sampler moorings at strategic positions i.e., sill of the Denmark Strait, Labrador Sea, Jan Mayen fracture zone and Fram Strait. Relate the observed variability of the tracer signal in the outflows to convection events in the Greenland Sea and local wind stress events. Obtain a better description of deepwater overflow and entrainment processes in the Denmark Strait and Faeroe Bank Channel overflows and use these to improve modelling of deepwater overflows. Monitor the tracer invasion into the North Atlantic using opportunistic SF6 measurements from other cruises: we anticipate that a number of oceanographic cruises will take place in the north-east Atlantic and the Labrador Sea. It should be possible to get samples from some cruises for SF6 measurements. Use process models to describe the spread of the tracer to achieve better parameterisation for three-dimensional models. One reason that these are so resistant to prediction is that our best ocean models are as yet some distance from being good enough, to predict climate and climate change.