There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI).
The authors aimed to evaluate the efficacy and safety of ...an aspirin-free strategy in patients undergoing complex PCI.
We conducted the prespecified subgroup analysis based on complex PCI in the STOPDAPT-3 (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3), which randomly compared low-dose prasugrel (3.75 mg/d) monotherapy to dual antiplatelet therapy (DAPT) with low-dose prasugrel and aspirin in patients with acute coronary syndrome or high bleeding risk. Complex PCI was defined as any of the following 6 criteria: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or a target of chronic total occlusion. The coprimary endpoints were major bleeding events (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) at 1 month.
Of the 5,966 study patients, there were 1,230 patients (20.6%) with complex PCI. Regardless of complex PCI, the effects of no aspirin relative to DAPT were not significant for the coprimary bleeding (complex PCI: 5.30% vs 3.70%; HR: 1.44; 95% CI: 0.84-2.47; P = 0.18 and noncomplex PCI: 4.26% vs 4.97%; HR: 0.85; 95% CI: 0.65-1.11; P = 0.24; P for interaction = 0.08) and cardiovascular (complex PCI: 5.78% vs 5.93%; HR: 0.98; 95% CI: 0.62-1.55; P = 0.92 and noncomplex PCI: 3.70% vs 3.10%; HR: 1.20; 95% CI: 0.88-1.63; P = 0.25; P for interaction = 0.48) endpoints without significant interactions.
The effects of the aspirin-free strategy relative to standard DAPT for the cardiovascular and major bleeding events were not different regardless of complex PCI. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 STOPDAPT-3; NCT04609111)
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High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes are critical in determining bleeding and cardiovascular event risk after percutaneous coronary intervention (PCI).
In 4476 ACS ...patients enrolled in the STOPDAPT-3, where the no-aspirin and dual antiplatelet therapy (DAPT) strategies after PCI were randomly compared, the pre-specified subgroup analyses were conducted based on HBR/non-HBR and ST-segment elevation myocardial infarction (STEMI)/non-ST-segment elevation ACS (NSTE-ACS). The co-primary bleeding endpoint was BARC type 3 or 5, and the co-primary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke at 1 month.
Irrespective of the subgroups, the effect of no-aspirin compared with DAPT was not significant for the bleeding endpoint (HBR N = 1803: 7.27% and 7.91%, HR 0.91, 95%CI 0.65-1.28; non-HBR N = 2673: 3.40% and 3.65%, HR 0.93, 95%CI 0.62-1.39; Pinteraction = 0.94; STEMI N = 2553: 6.58% and 6.56%, HR 1.00, 95% CI 0.74-1.35; NSTE-ACS N = 1923: 2.94% and 3.64%, HR 0.80, 95%CI 0.49-1.32; Pinteraction = 0.45), and for the cardiovascular endpoint (HBR: 7.87% and 5.75%, HR 1.39, 95%CI 0.97-1.99; non-HBR: 2.56% and 2.67%, HR 0.96, 95%CI 0.60-1.53; Pinteraction = 0.22; STEMI: 6.07% and 5.46%, HR 1.11, 95%CI 0.81-1.54; NSTE-ACS: 3.03% and 1.71%, HR 1.78, 95%CI 0.97-3.27; Pinteraction = 0.18).
In patients with ACS undergoing PCI, the no-aspirin strategy compared to the DAPT strategy failed to reduce major bleeding events irrespective of HBR and ACS subtypes. The numerical excess risk of the no-aspirin strategy relative to the DAPT strategy for cardiovascular events was observed in patients with HBR and in patients with NSTE-ACS.
The survival of pancreatic cancer patients with portal vein resection is extremely poor due to the high incidence of liver metastasis. The occurrence of liver metastasis is decreased by locoregional ...arterial infusion after pancreatic surgery. Chemosensitivity tests can provide the basis for individualized chemotherapy in each patient and predict the clinical response. Therefore, the current study was designed to clarify whether locoregional chemotherapy based on the results of chemosensitivity tests has the clinical effects of preventing liver metastasis and improving survival for patients with portal vein resection.
The resected specimens from 40 of 47 patients with resection of pancreatic cancer were assessed for chemosensitivity to various anticancer drugs. Fourteen patients underwent portal vein resection due to direct invasion, and nine of these patients received intra-arterial adjuvant chemotherapy on the basis of the results of MTT assay to prevent liver metastasis. The remaining five patients received no chemotherapy.
None of the patients who received intra-arterial chemotherapy had liver metastasis, and this group of patients had improved survival. The mean survival of patients with intra-arterial chemotherapy was significantly longer than that of patients without chemotherapy (25.6 months with chemotherapy versus 9.4 months without chemotherapy).
A pilot study of postoperative intra-arterial chemotherapy showed the reduction of liver metastasis and improvement of survival among pancreatic cancer patients with portal vein resection.
Purpose: Our aim was to study whether transcranial direct current stimulation (tDCS) over premotor cortex (PM) can modify the excitability of the ipsilateral primary motor (M1) and somatosensory (S1) ...cortices via cortico-cortical connectivity. Methods: Ten subjects received, anodal, cathodal and sham tDCS (1mA) over left PM for 15min. PM was determined to be 2cm anterior and 3cm medial to the hotspot of right first dorsal interosseus muscle. Motor evoked potentials (MEPs) were recorded from right first dorsal interosseus (FDI) muscle with transcranial magnetic stimulation over left M1. Somatosensory evoked potentials (SEPs) to right median nerve stimulation were also recorded from left C3'. Both MEPs and SEPs were recorded before, immediately after and 15min after tDCS. Results: The amplitudes of MEPs after anodal tDCS were shown to decrease while those of SEPs tended to increase. In contrast, the effects of cathodal tDCS were opposite to those of anodal tDCS. Statistical analysis (ANOVA) revealed that a significant interaction among INTERVENTION (anodal, cathodal) times TIME (before, after, after15 min) on both MEPs (p Lt 0.01) and SEPs (p Lt 0.05). Discussion: We infer that decreased MEP amplitudes resulted from inhibitory input to M1 from PM with anodal tDCS over PM, whereas the opposite effect was mediated from PM to M1 with cathodal tDCS. It is likely that changes in S1 excitability reflect the alternation of input-output modulation between M1 and S1. Conclusion: tDCS is useful for modulating the excitability of PM with which plastic functions of M1 and S1 can be assessed.
Adenosquamous carcinoma of the pancreas is a rare tumor with an extremely poor survival rate. No obvious evidence that multidisciplinary treatments improves the prognosis and survival has been ...reported.
A 63-yr-old female with adenosquamous carcinoma of the pancreas underwent extended radical surgery, intraoperative radiation therapy, postoperative intraarterial chemotherapy, and external beam radiation therapy. The patient is alive at 40 mo after surgery with no recurrence.
Multidisciplinary treatments including aggressive surgery, intraoperative radiation therapy, and locoregional chemotherapy might improve the survival of patients with adenosquamous carcinoma of the pancreas to inhibit liver metastasis and local recurrence.
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