Comparison of prasugrel and clopidogrel-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis of the Acute Myocardial Infarction in Switzerland (AMIS)-Plus Registry

OBJECTIVE The purpose of this study was to investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry. BACKGROUND Prasugrel was found to be superior to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about its efficacy in everyday practice. METHODS All ACS patients enrolled in the Acute Myocardial Infarction in Switzerland (AMIS)-Plus registry undergoing PCI and being treated with a thienopyridine P2Y12 inhibitor between January 2010-December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge. RESULTS Out of 7621 patients, 2891 received prasugrel (38%) and 4730 received clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. After propensity score matching (2301 patients per group), the primary endpoint was significantly lower in prasugrel-treated patients (3.0% vs 4.3%; p=0.022) while bleeding events were more frequent (4.1% vs 3.0%; p=0.048). In-hospital mortality was significantly reduced (1.8% vs 3.1%; p=0.004), but no significant differences were observed in rates of recurrent infarction (0.8% vs 0.7%; p=1.00) or stroke (0.5% vs 0.6%; p=0.85). In a predefined subset of matched patients with one-year follow-up (n=1226), mortality between discharge and one year was not significantly reduced in prasugrel-treated patients (1.3% vs 1.9%, p=0.38). CONCLUSIONS In everyday practice in Switzerland, prasugrel is predominantly used in younger patients with STEMI undergoing primary PCI. A propensity score-matched analysis suggests a mortality benefit from prasugrel compared with clopidogrel in these patients.

ZPO StPO plus Verweise: Schweizerisches Prozessrecht inklusive SchKG und Verwaltungsverfahrensrecht des Bundes. 3. Auflage

Diese Textausgabe enthält mit der ZPO und der StPO zwei unentbehrliche Gesetze für Zivil- und Strafprozesse. Dank dem Einbezug des Verwaltungsverfahrensrechts des Bundes (insbesondere des VwVG) und des Zwangsvollstreckungsrechts (SchKG, GebV SchKG, KOV, VZG) sowie weiterer verfahrensrechtlich relevanter Erlasse deckt das Werk alle Bereiche des schweizerischen Prozessrechts ab. Alle in diesem handlichen Band aufgenommenen 23 Erlasse sind auf dem aktuellsten Stand der Gesetzgebung (Stichtag 1. Januar 2016). Diese für Studium und Beruf bestens geeignete Textausgabe ist mit vielen Querverweisen sowie Hinweisen auf die neuste Rechtsprechung des Bundesgerichts versehen, was eine rasche und umfassende Erschliessung der komplexen Materie ermöglicht. Die neuen Regelungen der ZPO im Zusammenhang mit dem revidierten Kindesunterhalt sind bereits in kursiver Form bgedruckt.

Bevacizumab continuation versus no continuation after first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a randomized phase III non-inferiority trial (SAKK 41/06)

BACKGROUND Chemotherapy plus bevacizumab is a standard option for first-line treatment in metastatic colorectal cancer (mCRC) patients. We assessed whether no continuation is non-inferior to continuation of bevacizumab after completing first-line chemotherapy. PATIENTS AND METHODS In an open-label, phase III multicentre trial, patients with mCRC without disease progression after 4-6 months of standard first-line chemotherapy plus bevacizumab were randomly assigned to continuing bevacizumab at a standard dose or no treatment. CT scans were done every 6 weeks until disease progression. The primary end point was time to progression (TTP). A non-inferiority limit for hazard ratio (HR) of 0.727 was chosen to detect a difference in TTP of 6 weeks or less, with a one-sided significance level of 10% and a statistical power of 85%. RESULTS The intention-to-treat population comprised 262 patients: median follow-up was 36.7 months. The median TTP was 4.1 [95% confidence interval (CI) 3.1-5.4] months for bevacizumab continuation versus 2.9 (95% CI 2.8-3.8) months for no continuation; HR 0.74 (95% CI 0.58-0.96). Non-inferiority could not be demonstrated. The median overall survival was 25.4 months for bevacizumab continuation versus 23.8 months (HR 0.83; 95% CI 0.63-1.1; P = 0.2) for no continuation. Severe adverse events were uncommon in the bevacizumab continuation arm. Costs for bevacizumab continuation were estimated to be ∼30,000 USD per patient. CONCLUSIONS Non-inferiority could not be demonstrated for treatment holidays versus continuing bevacizumab monotheray, after 4-6 months of standard first-line chemotherapy plus bevacizumab. Based on no impact on overall survival and increased treatment costs, bevacizumab as a single agent is of no meaningful therapeutic value. More efficient treatment approaches are needed to maintain control of stabilized disease following induction therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, number NCT00544700.

Le partage politique de l'Afrique d'après les transactions internationales les plus récentes : (1885 à 1888)

par Émile Banning

David et Salomon, rois d'Israël : d'après le texte de la Sainte-Écriture, la tradition et les commentateurs israélites les plus accrédités

par Gédéon Netter

La vie de Mr. Descartes : contenant l'histoire de sa philosophie & de ses autres ouvrages ; et aussi ce qui luy est arrivé de plus remarquable pendant le cours de sa vie ; réduite en abregé

Baillet

Ms. lat. qu. 105 Bd. 1 - Les vies des plus sçavans et des plus renommés architectes, peintres, sculpteurs, graveurs et orfevres, de l'antiquité recueillies

Vorbesitzer: Julius H. Jeidels; Bibliothek für Kunst und Technik Frankfurt am Main