The TRA·CER trial compared vorapaxar, a novel platelet protease-activated receptor (PAR)-1 antagonist, with placebo in 12 944 patients with high-risk non-ST-segment elevation acute coronary syndromes ...(NSTE ACS). In this analysis, we explored the effect of vorapaxar on myocardial infarction (MI).
A blinded, independent central endpoint adjudication committee prospectively defined and classified MI according to the universal MI definition, including peak cardiac marker value (creatine kinase-MB CK-MB and/or troponin). Because the trial failed to meet its primary endpoint, these analyses are considered exploratory. During a median follow-up of 502 days, 1580 MIs occurred in 1319 patients. The majority (n = 1025, 64.9%) were type 1 (spontaneous) MI, followed by type 4a percutaneous coronary intervention (PCI)-related MI (n = 352; 22.3%). Compared with placebo, vorapaxar reduced the hazard of a first MI of any type by 12% hazard ratio (HR), 0.88; 95% confidence interval (CI), 0.79-0.98; P = 0.021 and the hazard of total number of MIs (first and subsequent) by 14% (HR, 0.86; 95% CI, 0.77-0.97; P = 0.014), an effect that was sustained over time. Vorapaxar reduced type 1 MI by 17% (HR, 0.83; 95% CI, 0.73-0.95; P = 0.007). Type 4a MIs were not significantly reduced by vorapaxar (HR, 0.90; 95% CI, 0.73-1.12; P = 0.35). Vorapaxar effect was consistent across MI sizes defined by peak cardiac marker elevations and across key clinical subgroups; however, in patients not treated with thienopyridine at baseline (HR, 0.65; 95% CI, 0.46-0.92) compared with patients who received thienopyridine (HR, 0.91; 95% CI, 0.81-1.02), there was a trend towards a higher effect (Pint = 0.077).
The PAR-1 antagonist vorapaxar was associated with a reduction of MI, including total number of infarctions. This reduction was sustained over time and was mostly evident in type 1 MI, the most common type of MI observed.
Abstract
A possibility of spontaneous magnetization in high density
symmetric quark matter is investigated using the NJL type effective model of
QCD by means of an effective potential with respect to ...an auxiliary field.
It is shown that the quark ferromagnetic condensate has non-vanishing
value at high baryon density due to the tensor-type four-point
interaction between quarks.
In N. Barberán, J. da Providência, Jr., Z. Phys. B 101 (1996) 3–12, a variational procedure appropriate for the description of the collective modes of valence electrons in a metal was proposed. This ...approximation, which is based on the quantum mechanical action principle and uses a Slater determinant as the wave function of the cloud of valence electrons, is here generalized. In the present note we use the semiclassical approximation, considering now that the generator of the fluctuations
S
ˆ
=
∑
i
N
S
(
r
i
,
−
i
ħ
∇
i
,
t
)
of the Slater determinant (
|
ϕ
〉
=
exp
(
i
S
ˆ
/
ħ
)
|
ϕ
0
〉
) is a polynomial of order five in the single particle momentum, introducing in this way six collective coordinates (each one as a coefficient of the corresponding power of the single particle momentum operator). As a result we obtain a branch with higher energy and two branches with lower energy, which are important for describing the experimental data obtained for large momentum transfer. Comparison with experimental data is presented for aluminum, beryllium and lithium.
On a reverse Heinz–Kato–Furuta inequality Bebiano, N.; Lemos, R.; da Providência, J.
Linear algebra and its applications,
10/2012, Volume:
437, Issue:
7
Journal Article
Peer reviewed
Open access
In the set up of Minkowski spaces, the Schwarz inequality holds with the reverse inequality sign. As a consequence, the same occurs with the triangle inequality. In this note, extensions of this ...indefinite version of the Schwarz inequality are presented. Namely, a reverse Heinz–Kato–Furuta inequality valid for timelike vectors is included and related inequalities that also hold with the reverse sign are investigated.
Introduction
Identifying drivers in persistent atrial fibrillation (AF) remains challenging. We sought to validate an automated system for detection of focal activation using basket and PentaRay ...catheters in AF.
Methods
Patients having ablation for atrial tachycardia (AT) and persistent AF were mapped. Thirty‐second unipolar basket and PentaRay recordings were analyzed using CARTOFINDER. Focal activation or “region of interest” (ROI) was defined as more than or equal to 2 consecutive focal activations with one electrode leading relative to its neighbors with QS morphology on the unipolar electrogram. ROI was validated in AT. AF patients were mapped to (1) look for evidence of focal activations on wavefront maps, (2) evaluate whether these were detected as ROI on basket recordings, and (3) whether these sites could be identified on sequential PentaRay recordings.
Results
ROIs were identified in five focal ATs but none of 16 reentrant ATs. Twenty‐eight AF patients had 35 focal drivers identified from basket wavefront maps with an ablation response in all (16 cycle length slowing and 19 AF termination). Thirty focal activations were detected on basket ROI maps (86%). Twenty‐three of 28 patients had sequential PentaRay mapping and 22 of 30 focal drivers in these patients (73%) were identified as ROI. These drivers had greater temporal stability (3.6 ± 0.6 vs 2.7 ± 0.6; P < 0.001), higher recurrence rate (12.4 ± 2.7 vs 7.2 ± 0.9;
P < 0.001), and more frequently were associated with AF termination (
P < 0.001) compared with those not identified as ROI.
Conclusions
Focal activations can be detected in AF using sequential recordings. The ablation response at focal sources suggests they may be viable therapeutic targets.
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