Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

Structure and Conformation of an Antidepressant Drug, Nitroxazepine Hydrochloride Monohydrate

CIsH20N3Oa+.C1-.H2 O, M r = 395, orthorhombic, Pn21a, a = 7.710 (4), b = 11.455 (3), c -- 21.199 (3)/k, Z = 4, V = 1872.4/k 3, D m = 1.38, D C = 1.403 g cm -3, F(000) = 832, g(Cu Kct) = 20.94 cm -l. Intensities for 1641 reflections were measured on a Nonius CAD-4 diffractometer; of these, 1470 were significant. The structure was solved by direct methods and refined to an R index of 0.045 using a blockdiagonal least-squares procedure. The angle between the least-squares planes through the benzene rings is 125.0 (5) ° and the side chain is folded similarly to one of the independent molecules of imipramine hydrochloride.

Structure and conformation of an anti-depressant drug, nitroxazepine hydrochloride monohydrate

CIsH20N3Oa+.C1-.H2 O, M r = 395, orthorhombic, Pn21a, a = 7.710 (4), b = 11.455 (3), c -- 21.199 (3)/k, Z = 4, V = 1872.4/k 3, D m = 1.38, D C = 1.403 g cm -3, F(000) = 832, g(Cu Kct) = 20.94 cm -l. Intensities for 1641 reflections were measured on a Nonius CAD-4 diffractometer; of these, 1470 were significant. The structure was solved by direct methods and refined to an R index of 0.045 using a blockdiagonal least-squares procedure. The angle between the least-squares planes through the benzene rings is 125.0 (5) ° and the side chain is folded similarly to one of the independent molecules of imipramine hydrochloride.

Raman spectrum of hydroxylamine hydrochloride (NH3OH.Cl)

The Raman spectrum of hydroxylamine hydrochloride (NH3OH.Cl) in the form of a single crystal has been photographed usingλ 2536·5 excitation. 32 Raman lines with frequency shifts 40, 57, 78, 88, 111, 125, 135, 156, 187, 217, 250, 330, 550, 575, 1004, 1168, 1204, 1470, 1496, 1565, 1590, 1979, 2636, 2710, 2750, 2789, 2926, 2970, 3000, 3050, 3141 and 3220 cm.−1 have been recorded. Of these, the first 8 low-frequency lines belong to the external oscillation, while the four lines at 187, 217, 250 and 330 cm.−1 should be attributed to the vibrations of the hydrogen bond valence vibrations. The remaining Raman lines have been assigned to the vibrations of the NH3OH ion. The O-H and N-H stretching vibrations are very much influenced by the presence of the hydrogen bonds in the crystal.

Raman spectra of addition compounds of glycine (diglycine hydrochloride, diglycine hydrobromide and diglycine nitrate)

Raman spectra of single crystals of diglycine hydrochloride, diglycine hydrobromide and diglycine nitrate have been recorded for the first time. λ 2536·5 resonance radiation of mercury has been used as exciter. The spectrum of diglycine hydrochloride exhibits 10 low frequency lines and 41 lines due to internal oscillations, while that of diglycine hydrobromide exhibits 11 lines and 41 lines respectively. In the case of diglycine nitrate 46 lines have been recorded, of which 10 belong to the lattice spectrum. These spectra are compared with the Raman spectra of triglycine sulphate and α-glycine and proper assignments have been given to the internal oscillations.

Vibrational analysis of boldine hydrochloride using QM/MM approach

A complete vibrational analysis was performed on the molecular structure of boldine hydrochloride using QM/MM method. The equilibrium geometry, harmonic vibrational frequencies and infrared intensities were calculated by QM/MM method with B3LYP/6-31G(d) and universal force field (UFF) combination using ONIOM code. We found the geometry obtained by the QM/MM method to be very accurate, and we can use this rapid method in place of time consuming ab initio methods for large molecules. A detailed interpretation of the infrared spectra of boldine hydrochloride is reported. The scaled theoretical wave numbers are in perfect agreement with the experimental values. The FT-IR spectra of boldine hydrochloride in the region 4000-500 cm(-1) were recorded in CsI (solid phase) and in chloroform with concentration 5 and 10 mg/ml.

Crystal and molecular structure of l-valyl-l-lysine hydrochloride

l-Valyl-l-lysine hydrochloride, C11N3O3H23 HCl, rystallizes in the monoclinic space group P2, with a = 5.438(5), b = 14.188(5), c = 9.521(5) Å, β= 95.38(2)° and Z = 2. The crystal structure, solved by direct methods, refined to R = 0.036, using full matrix least-squares method. The peptide exists in a zwitterionic form, with the N atom of the lysine side-chain protonated. The two γ-carbons of the valine side-chain have positional disorder, giving rise to two conformations, χ111= -67.3 and 65.9°, one of which (65.9°) is sterically less favourable and has been found to be less popular amongst residues branching at β-C. The lysine side-chain has the geometry of g− tgt, not seen in crystal structures of the dipeptides reported so far. Interestingly, χ32 (63.6°) of lysine side-chain has a gauche+ conformation unlike in most of the other tructures, where it is trans. The neighbouring peptide molecules are hydrogen bonded in a head-to-tail fashion, a rather uncommon interaction in lysine peptide structures. The structure shows considerable similarity with that of l-Lys-l-Val HO in conformational angles and H-bond interactions [4].

Reaction of spironaphthalenones with hydroxylamine hydrochloride: Part IV

Reaction of 1-methoxynaphthalene with 1-formylnaphthalene in presence of n-BuLi/TMEDA, followed by deoxygenation and demethylation gave the bisnaphthol 6. Oxidation of 6 with KOBr yielded the spironaphthalenones 4a-b and 5a-b. The spironaphthalenones 3a-c on reaction with NH2OH.HCl gave naphth[2,1-c]isoxazole derivatives 9a-c. While similar reaction of 4a-b gave the pyrrolotropones 11a-b, spironaphthalenones 5a-b afforded the naphth[1,2-c]isoxazole derivatives 12a-b.