10-year follow-up of a prospective randomized trial comparing bare-metal stenting with internal mammary artery grafting for proximal, isolated de novo left anterior coronary artery stenosis the SIMA (Stenting versus Internal Mammary Artery grafting) trial

OBJECTIVES: This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery. BACKGROUND: Although numerous trials have compared coronary angioplasty with bypass surgery, none assessed the clinical evaluation in the long term. METHODS: We evaluated the 10-year clinical outcome in the SIMA (Stent versus Internal Mammary Artery grafting) trial. Patients were randomly assigned to stent implantation versus CABG. RESULTS: Of 123 randomized patients, 59 underwent CABG and 62 received a stent (2 patients were excluded). Follow-up after 10 years was obtained for 98% of the randomized patients. Twenty-six patients (42%) in the percutaneous coronary intervention group and 10 patients (17%) in the CABG group reached an end point (p < 0.001). This difference was due to a higher need for additional revascularization. The incidences of death and myocardial infarction were identical at 10%. Progression of the disease requiring additional revascularization was rare (5%) and was similar for the 2 groups. Stent thrombosis occurred in 2 patients (3%). Angina functional class showed no significant differences between the 2 groups. CONCLUSIONS: Both stent implantation and CABG are safe and highly effective in relieving symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Stenting with bare-metal stents is associated with a higher need for repeat interventions. The long-term prognosis for these patients is excellent with either mode of revascularization.

Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease: the DELFT (Drug Eluting stent for LeFT main) Registry

OBJECTIVES: The purpose of this study was to investigate the long-term safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for unprotected left main coronary artery (ULMCA) disease. BACKGROUND: Long-term clinical outcomes after DES implantation for ULMCA disease have not yet been ascertained. METHODS: From April 2002 to April 2004, 358 consecutive patients who underwent PCI with DES implantation for de novo lesions on ULMCA were retrospectively selected and analyzed in 7 European and U.S. tertiary care centers. No patients were excluded from the analysis, and all patients had a minimum follow-up of 3 years. RESULTS: Technical success rate was 100%. Procedural success rate was 89.6%. After 3 years, major adverse cardiovascular events (MACE)-free survival in the whole population was 73.5%. According to the Academic Research Consortium definitions, cardiac death occurred in 9.2% of patients, and reinfarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) occurred in 8.6%, 5.8%, and 14.2% of patients, respectively. Definite stent thrombosis occurred in 2 patients (specifically at 0 and 439 days). In elective patients, the 3-year MACE-free survival was 74.2%, with mortality, reinfarction, TLR, and TVR rates of 6.2%, 8.3%, 6.6%, and 16%, respectively. In the emergent group the 3-year MACE-free survival was 68.2%, with mortality, reinfarction, TLR, and TVR rates of 21.4%, 10%, 2.8%, and 7.1%, respectively. CONCLUSIONS: Routine DES implantation in ULMCA disease seems encouraging, with favorable long-term clinical results.

Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study

OBJECTIVES: We sought to determine the risk of late stent thrombosis (ST) during long-term follow-up beyond 3 years, searched for predictors, and assessed the impact of ST on overall mortality. BACKGROUND: Late ST was reported to occur at an annual rate of 0.6% up to 3 years after drug-eluting stent (DES) implantation. METHODS: A total of 8,146 patients underwent percutaneous coronary intervention with a sirolimus-eluting stent (SES) (n=3,823) or paclitaxel-eluting stent (PES) (n=4,323) and were followed up to 4 years after stent implantation. Dual antiplatelet treatment was prescribed for 6 to 12 months. RESULTS: Definite ST occurred in 192 of 8,146 patients with an incidence density of 1.0/100 patient-years and a cumulative incidence of 3.3% at 4 years. The hazard of ST continued at a steady rate of 0.53% (95% confidence interval [CI]: 0.44 to 0.64) between 30 days and 4 years. Diabetes was an independent predictor of early ST (hazard ratio [HR]: 1.96; 95% CI: 1.18 to 3.28), and acute coronary syndrome (HR: 2.21; 95% CI: 1.39 to 3.51), younger age (HR: 0.97; 95% CI: 0.95 to 0.99), and use of PES (HR: 1.67; 95% CI: 1.08 to 2.56) were independent predictors of late ST. Rates of death and myocardial infarction at 4 years were 10.6% and 4.6%, respectively. CONCLUSIONS: Late ST occurs steadily at an annual rate of 0.4% to 0.6% for up to 4 years. Diabetes is an independent predictor of early ST, whereas acute coronary syndrome, younger age, and PES implantation are associated with late ST.

Percutaneous coronary intervention for stable coronary artery disease

Patients with significant coronary artery stenoses are at increased risk of future cardiac events. However, in the absence of acute coronary syndrome or recent myocardial infarction and residual ischemia, elective percutaneous coronary intervention has not been shown to improve prognosis. Possible explanations for this might be the limited follow-up time adopted by most randomized trials comparing percutaneous coronary intervention with medical therapy, limited number of patients with proven ischemia enrolled in these trials, and adoption of complex, elaborate techniques that have not proved their usefulness. Published evidence identifies certain indications for percutaneous coronary intervention in patients with stable coronary lesions: demonstration of significant inducible ischemia, particularly in the context of a recent myocardial infarction; detection of unequivocally reduced fractional flow reserve; and specific angiographic features of coronary stenoses. Operators should take into account long-term consequences of adopted techniques rather than immediate angiographic results. We review existing evidence and provide our recommendations in this setting.

Survival and cardiac remodeling benefits in patients undergoing late percutaneous coronary intervention of the infarct-related artery: evidence from a meta-analysis of randomized controlled trials

Our purpose was to perform a systematic review and meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) with medical therapy in patients randomized >12 h after acute myocardial infarction (AMI).

Stent thrombosis is associated with an impaired response to antiplatelet therapy

OBJECTIVES: We sought to evaluate the response to antiplatelet therapy in patients with stent thrombosis (ST). BACKGROUND: Stent thrombosis is associated with considerable morbidity and mortality. An impaired response to antiplatelet therapy might be related to an increased risk for ST. METHODS: Eighty-two patients were included in the present study: 23 patients with previous ST, 50 matched controls (coronary stenting without ST), and 9 healthy volunteers. Platelet aggregation (PA) was studied (optical aggregometry) under monotherapy with acetylsalicylic acid (ASA) 100 mg daily for one month, followed by dual therapy with ASA 100 mg and clopidogrel 75 mg daily (loading dose 300 mg) for another month. RESULTS: Maximal (5 and 20 micromol) adenosine diphosphate-induced PA was significantly higher in patients with ST compared with controls (5 micromol, p < 0.005; 20 micromol, p < 0.05) and volunteers (5 micromol, p < 0.005; 20 micromol, p < 0.05). Resistance to ASA (>20% aggregation with 0.5 mg/ml arachidonic acid) was more prevalent in patients with ST (48%) compared with control patients (32%, p = ns) and volunteers (0%, p = 0.01). Clopidogrel significantly reduced PA in all three groups, but intergroup differences persisted. Clopidogrel resistance (<10% relative change) was similar in patients with ST, control patients, and volunteers (4%, 6%, and 11%, respectively, all p = NS). However, combined ASA and clopidogrel resistance was more prevalent in patients with ST (52%) compared with controls (38%, p = NS) and volunteers (11%, p < 0.05). CONCLUSIONS: Patients with previous ST show an impaired response to antiplatelet therapy with ASA compared with controls and volunteers. Additional treatment with clopidogrel is not able to overcome these differences in PA. Acetylsalicylic acid but not clopidogrel resistance appears to be associated with ST.

Na 1 Nachlass Max Horkheimer, 8 - Korrespondenzen u.a. mit den City Club of New York (p. I 4, 298-419)

1 Brief von Max Horkheimer an das Californian Hotel Fresno, 20.07.1947; 1 Brief von Franz Calvelli-Adorno an Max Horkheimer, 1948; 1 Brief von der Cambridge Univerity Press London an Max Horkheimer, 09.06.1940; 1 Brief vonMax Horkheimer an C.E. De Camp, 09.12.1940; 1 Brief von Max Horkheimer an Hadley Cantril, 09.01.1939; 5 Briefe zwischen William Charles Carlé und Max Horkheimer, 1939-1944; 1 Brief von Rose Carter an Max Horkheimer, 20.04.1940; 3 Briefe zwischen der Central Westchester Human Society, White Plains, NY und Max Horkheimer, 1939; 1 Brief von Frank F. Charles an Max Horkheimer, 16.03.1939; 7 Briefe zwischen der Charity Organisation Society London und Max Horkheimer, 1936-1938; 1 Brief von Christa Christian an Max Horkheimer, 12.11.1937; 4 Briefe zwischen Ada Citroen-Kater und Max Horkheimer, 1940; 7 Briefe zwsichen Fenny van Leer und Max Horkheimer, 1940; 3 Briefe zwischen Leo Löwenthal an Frieda Fromm-Reichmann, 1940, 13.11.1940; 1 Brief von Leo Löwenthal an David Reissner, 05.09.1940; 21 Briefe zwischen dem City Club of New York und Max Horkheimer, 1938-1940; 1 Brief von Max Horkheimer an das City College of New York, 20.11.1940; 1 Brief von Max Horkheimer an Charles Upson Clark, 04.06.1938; 2 Briefe zwischen Morris R. Cohen und Max Horkheimer, 16.02.1939, 24.03.1941; 7 Briefe zwischen Alfred E. Cohn und Max Horkheimer, 1939-1941; 1 Brief und 1 Entwurf von Max Horkheimer an Else Cohnstaedt, März 1941; 1 Brief von dem College of the Pacific California an Max Horkheimer, 01.03.1949; 10 Briefe zwischen Gerhard Colm und Max Horkheimer, 1935-1939; 1 Brief von Gerhard Colm an Georg Rusche, 19.09.1938;

Na 1 Nachlass Max Horkheimer, 67 - Korrespondenzen u.a. mit der Columbia University New York (p. II 5, 1-219)

17 Briefe und Beilage zwischen Joseph Christ und Max Horkheimer, 1942-1943; 13 Briefe zwischen Elliot E. Cohen und Max Horkheimer, 1946-1947; 7 Briefe zwischen Stewart G. Cole und Max Horkheimer, 1944-1945 sowie 1 Sonderdruck; 1 Memorandum von Theodor W. Adorno an F. Pollock, 1948; 5 Briefe zwischen dem Collegium [Studentischer Club an der Universität Frankfurt am Main] und Max Horkheimer, 1949; 17 Briefe und Beilage zwischen dem College of Jewish Studies, 1948-1949, 1951 sowie Drucksachen und 9 Papers zum Antisemitismus; 18 Briefe und Beilagen zwischen der Columbia University New York und Max Horkheimer, 1942-1947;

Jewish life in oriental countries : a list of books and manuscripts exhibited at the New York public library March 30th to December 31st, 1926

Prepared and arranged by Joshua Bloch

Lin KERNS, The secret of secrets (Secreta secretorum). A modern translation, with introduction, of “The governance of princes", with a foreword by Elizabeth Matthew, Lewiston (New York), The Edwin Mellen Press, 2008, ISBN 978-0-7734-5118-6, 168 pp.

Fil: Cuccia, Emiliano Javier.

Eric D. Perl, Theophany. The Neoplatonic Philosophy of Dionysius the Areopagite, State University of New York Press (SUNY series in ancient Greek philosophy), 2007. 163 p., ISBN-13: 978-0-7914-7111-1

Fil: Caram, Gabriela de los Ángeles.