The association between 1-year mortality and infarct location was evaluated in 544 patients with acute non-Q wave myocardial infarction. Infarcts were anterior (alone or including other locations) in ...51.1% (n = 278) of cases, localizable but not anterior 29.6% (n = 161) of the time, and nonlocalizable in 19.3% (n = 105) of patients. One-year actuarial mortality (73 deaths) was 16.9% in the anterior group, 13.3% in the nonanterior group, and 6.8% in nonlocalizable patients (p = 0.037). Anterior and localizable nonanterior mortality were similar (p = 0.367). However, there were differences when mixed location infarcts were excluded. Mortality in the inferior infarction only group (2.8%, n = 36) was less than in the lateral infarction only group (16.8%, n = 79, p = 0.041) and almost significantly less than in the anterior only group (15.1%, n = 62, p = 0.064). The positive prognosis in the inferior infarction only group may be associated with the low rate of ST depression among these patients compared with those with other infarct locations (p less than 0.0001). Mortality among localizable infarcts (15.5%) was greater than among those that were nonlocalizable (6.8%, p = 0.021). Despite the low overall risk of the nonlocalizable infarcts, 41.9% (n = 44) of these patients developed at least one important risk factor while in hospital.
Abstract
The Foundation Supernova Survey aims to provide a large, high-fidelity, homogeneous, and precisely calibrated low-redshift Type Ia supernova (SN Ia) sample for cosmology. The calibration of ...the current low-redshift SN sample is the largest component of systematic uncertainties for SN cosmology, and new data are necessary to make progress. We present the motivation, survey design, observation strategy, implementation, and first results for the Foundation Supernova Survey. We are using the Pan-STARRS telescope to obtain photometry for up to 800 SNe Ia at z ≲ 0.1. This strategy has several unique advantages: (1) the Pan-STARRS system is a superbly calibrated telescopic system, (2) Pan-STARRS has observed 3/4 of the sky in grizyP1 making future template observations unnecessary, (3) we have a well-tested data-reduction pipeline, and (4) we have observed ∼3000 high-redshift SNe Ia on this system. Here, we present our initial sample of 225 SN Ia grizP1 light curves, of which 180 pass all criteria for inclusion in a cosmological sample. The Foundation Supernova Survey already contains more cosmologically useful SNe Ia than all other published low-redshift SN Ia samples combined. We expect that the systematic uncertainties for the Foundation Supernova Sample will be two to three times smaller than other low-redshift samples. We find that our cosmologically useful sample has an intrinsic scatter of 0.111 mag, smaller than other low-redshift samples. We perform detailed simulations showing that simply replacing the current low-redshift SN Ia sample with an equally sized Foundation sample will improve the precision on the dark energy equation-of-state parameter by 35 per cent, and the dark energy figure of merit by 72 per cent.
Left ventricular (LV) hypertrophy is known to be an independent risk factor for cardiac death, but its significance in non-Q-wave acute myocardial infarction (AMI) has not been assessed previously. ...In a randomized diltiazem-placebo-controlled therapeutic trial of non-Q-wave AMI confirmed by creatine kinase-MB (CK-MB), 126 of 544 patients (23%) exhibited LV hypertrophy using standard voltage criteria. Compared to patients without LV hypertrophy, patients with LV hypertrophy were significantly older (65 vs 60 years, p less than 0.0001) and had smaller peak adjusted CK levels (490 +/- 376 vs 666 +/- 726 IU/liter, p less than 0.001) than patients without LV hypertrophy. Patients with and without LV hypertrophy did not differ significantly in acute mortality during hospitalization, progression to Q waves, reinfarction by CK-MB criteria or angina associated with transient electrocardiographic changes. Compared with patients without LV hypertrophy, those patients with non-Q-wave AMI and LV hypertrophy had a 2-fold higher incidence of reinfarction (24 vs 12%, p less than 0.005) and death (19 vs 9%, p = 0.044) during the first year of follow-up. Multivariate regression analysis revealed that the relative risk of death and reinfarction during the initial year after AMI was increased by a factor of 1.7 and 2.1 among patients with LV hypertrophy, respectively. It was therefore concluded that, although patients with LV hypertrophy and non-Q-wave AMI have smaller enzymatic infarcts and the same short-term prognosis as do patients without LV hypertrophy, their reinfarction and mortality rates are significantly increased during the first year of follow-up.
Abstract
Identification and management of patients at high bleeding risk undergoing percutaneous
coronary intervention are of major importance, but a lack of standardization in defining
this ...population limits trial design, data interpretation, and clinical decision-making.
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among
leading research organizations, regulatory authorities, and physician-scientists from the
United States, Asia, and Europe focusing on percutaneous coronary intervention–related
bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April
2018 and in Paris, France, in October 2018. These meetings were organized by the
Cardiovascular European Research Center on behalf of the ARC-HBR group and included
representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals
and Medical Devices Agency, as well as observers from the pharmaceutical and medical
device industries. A consensus definition of patients at high bleeding risk was developed
that was based on review of the available evidence. The definition is intended to provide
consistency in defining this population for clinical trials and to complement clinical
decision-making and regulatory review. The proposed ARC-HBR consensus document represents
the first pragmatic approach to a consistent definition of high bleeding risk in clinical
trials evaluating the safety and effectiveness of devices and drug regimens for patients
undergoing percutaneous coronary intervention.
Host-mediated lung inflammation is present
, and drives mortality
, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may ...identify mechanistic targets for therapeutic development
. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10
) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10
) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 × 10
) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10
) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice.
Aim: We aim at measuring the chemical gradients of the elements Mg, Al, Si, and Fe along the Galactic radius to provide new constraints on the chemical evolution models of the Galaxy and Galaxy ...models such as the Besancon model. Methods: We analysed three different samples selected from three independent datasets: a sample of 19,962 dwarf stars selected from the RAVE database, a sample of 10,616 dwarf stars selected from the Geneva-Copenhagen Survey (GCS) dataset, and a mock sample (equivalent to the RAVE sample) created by using the GALAXIA code, which is based on the Besancon model. We measured the chemical gradients as functions of the guiding radius (Rg) at different distances from the Galactic plane reached by the stars along their orbit (Zmax). Results: The chemical gradients of the RAVE and GCS samples are negative and show consistent trends, although they are not equal: at Zmax<0.4 kpc and 4.5<Rg(kpc)<9.5, the iron gradient for the RAVE sample is dFe/H/dRg=-0.065 dex kpc^{-1}, whereas for the GCS sample it is dFe/H/dRg=-0.043 dex kpc^{-1} with internal errors +-0.002 and +-0.004 dex kpc^{-1}, respectively. The gradients of the RAVE and GCS samples become flatter at larger Zmax. Conversely, the mock sample has a positive iron gradient of dFe/H/dRg=+0.053+-0.003 dex kpc^{-1} at Zmax<0.4 kpc and remains positive at any Zmax. These positive and unrealistic values originate from the lack of correlation between metallicity and tangential velocity in the Besancon model. The discrepancies between the observational samples and the mock sample can be reduced by i) decreasing the density, ii) decreasing the vertical velocity, and iii) increasing the metallicity of the thick disc in the Besancon model.
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