JACC: Cardiovascular Interventions, Volume 12, pp 709-717; doi:10.1016/j.jcin.2019.01.230
Abstract: The aims of this study were to describe variability in intensive care unit (ICU) utilization for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI), evaluate the proportion of these patients who developed in-hospital complications requiring ICU care, and assess whether ICU use patterns and complication rates vary across categories of first medical contact to device times. In the era of rapid primary percutaneous coronary intervention, ICUs may be overutilized as patients presenting with STEMI are less likely to develop complications requiring ICU care. Using data from the Chest Pain-MI Registry linked to Medicare claims, the authors examined patterns of ICU utilization among hemodynamically stable patients with STEMI ≥65 years of age treated with uncomplicated primary percutaneous coronary intervention, stratified by timing of reperfusion: early (first medical contact–to–device time ≤60 min), intermediate (61 to 90 min), or late (>90 min). Of 19,507 patients with STEMI treated at 707 hospitals, 82.3% were treated in ICUs, with a median ICU stay of 1 day (interquartile range [IQR]: 1 to 2 days). The median FMC-to-device time was 79 min (IQR: 63 to 99 min); 22.0% of patients had early, 44.8% intermediate, and 33.2% late reperfusion. ICU utilization rates did not differ between patients with early, intermediate, and late reperfusion times (82%, 83%, and 82%; p for trend = 0.44). Overall, 3,159 patients (16.2%) developed complications requiring ICU care while hospitalized: 3.7% died, 3.7% had cardiac arrest, 8.7% shock, 0.9% stroke, 4.1% high-grade atrioventricular block requiring treatment, and 5.7% respiratory failure. Patients with longer FMC-to-device times were more likely to develop at least 1 of these complications (early 13.4%, intermediate 15.7%, and late 18.7%; p for trend 80% of stable patients with STEMI are treated in the ICU after primary percutaneous coronary intervention, the risk for developing a complication requiring ICU care is 16%. Implementing a risk-based triage strategy, inclusive of factors such as degree of reperfusion delay, could optimize ICU utilization for patients with STEMI.
JACC: Cardiovascular Interventions, Volume 12, pp 718-720; doi:10.1016/j.jcin.2019.02.028
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JACC: Cardiovascular Interventions, Volume 12, pp 731-733; doi:10.1016/j.jcin.2019.02.040
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JACC: Cardiovascular Interventions, Volume 12, pp 798-799; doi:10.1016/j.jcin.2019.02.021
Published: 22 April 2019
JACC: Cardiovascular Interventions, Volume 12, pp 801-802; doi:10.1016/j.jcin.2019.01.242
JACC: Cardiovascular Interventions, Volume 12, pp 752-763; doi:10.1016/j.jcin.2019.01.233
Abstract: This study sought to examine whether the prognosis of patients with severe aortic stenosis (AS) having high versus low transvalvular mean pressure gradients (MPGs) is intrinsically different after transcatheter aortic valve replacement (TAVR), even after strict matching of baseline parameters. Patients with low MPG are characterized by higher cardiovascular risk and more comorbidities than other AS patients are. In this retrospective, single-center study involving 2,282 patients, 3 groups were derived according to the following criteria: 1) high-gradient AS (HG-AS) (MPG ≥40 mm Hg); 2) low-flow, low-gradient AS (LFLG-AS) (MPG <40 mm Hg, ejection fraction [EF] ≤40%, stroke volume index ≤35 ml/m2); 3) paradoxical LFLG-AS (pLFLG-AS) (similar to LFLG-AS but with EF ≥50%). Propensity score matching that included EF was used to compare 1-year survival. A total of 136 patients with HG-AS or LFLG-AS were identified. Kaplan-Meier survival curves were significantly different (p = 0.039), with death occurring in 11 versus 21 patients (hazard ratio: 2.12; 95% confidence interval: 1.02 to 4.39; p = 0.044), respectively. A total of 226 patients with HG-AS or pLFLG-AS were identified and here the curves were identical (p = 0.468), with death occurring in 18 versus 21 patients (hazard ratio: 1.26; 95% confidence interval: 0.67 to 2.38; p = 0.469). This is the first study comparing survival after TAVR of patients with high versus low MPG in matched study populations. Mortality in patients with LFLG-AS was twice that of HG-AS patients. However, it appears that patients with pLFLG-AS might benefit from TAVR to the same extent as patients with HG-AS. There must be still unmasked factors that influence mortality of patients with LFLG-AS.
Published: 22 April 2019
Zeitschrift für Kristallographie - New Crystal Structures; doi:10.1515/ncrs-2019-0001
Abstract: C14H24Cl2ZnN4, orthorhombic, Pbca (no. 61), a = 13.3238(11) Å, b = 15.9366(13) Å, c = 18.0943(16) Å, V = 3842.1(6) Å3, Z = 8, Rgt(F) = 0.0393, wRref(F2) = 0.1053, T = 298(2) K.
Abstract: The ability of chiral media to differentiate circularly polarized light is conventionally characterized by circular dichroism (CD) which is based on the difference in the absorption of the incident light for different polarizations. Thus, CD probes the bulk properties of chiral media. Here, we introduce a new approach termed as circular phase-dichroism that is based on the surface properties and is defined as the difference of the reflection phase for different circularly polarized incident lights in characterizing chiral media. As a demonstration, we measure the reflection phase from planar chiral sawtooth metasurface for circularly polarized light in the visible range using a simple Fabry Perot interference technique. The measured circular phase-dichroism is also crosschecked by conventional CD measurement of the transmitted light and by full-wave simulations. Our results demonstrate the potential applications of circular phase-dichroism in sensing and metasurface characterizations.
Published: 22 April 2019
Zeitschrift für Kristallographie - New Crystal Structures; doi:10.1515/ncrs-2019-0006
Abstract: C66H54Br4N8NiO18, triclinic, P1̄ (no. 2), a = 8.821(2) Å, b = 14.6587(14) Å, c = 14.8211(14) Å, α = 119.608(1)°, β = 95.365(1)°, γ = 99.249(1)°, V = 1610.8(5) Å3, Z = 1, Rgt(F) = 0.0345, wRref(F2) = 0.0815, T = 296(2) K.