Summary Background Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, ...which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. Methods We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate stent implantation or deferred stent implantation 48 h after the index procedure if a stabilised flow could be obtained in the infarct-related artery. The primary endpoint was a composite of all-cause mortality, hospital admission for heart failure, recurrent infarction, and any unplanned revascularisation of the target vessel within 2 years' follow-up. Patients, investigators, and treating clinicians were not masked to treatment allocation. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov , number NCT01435408. Findings Between March 1, 2011, and Feb 28, 2014, we randomly assigned 1215 patients to receive either standard PCI (n=612) or deferred stent implantation (n=603). Median follow-up time was 42 months (IQR 33–49). Events comprising the primary endpoint occurred in 109 (18%) patients who had standard PCI and in 105 (17%) patients who had deferred stent implantation (hazard ratio 0·99, 95% CI 0·76–1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent implantation group, with no significant differences between groups. Interpretation In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing randomised trials might shed further light on the concept of deferred stenting in this patient population. Funding Danish Agency for Science, Technology and Innovation, and Danish Council for Strategic Research.
A large landslide occurred November 21, 2000 at Paatuut, facing the Vaigat Strait onthe west coast of Greenland. 90 million m super(3) (260 million tons) of mainly basalticmaterial slid very rapidly ...(average velocity 140 km/h) down from 1,000-1,400 maltitude. Approximately 30 million m super(3) (87 million tons) entered the sea, creatinga tsunami with an run-up height of 50 m close to the landslide and 28 m at Qullissat,an abandoned mining town opposite Paatuut across the 20 km wide Vaigat strait. Theevent was recorded seismically, allowing the duration of the slide to be estimated tocirca 80 s and also allowing an estimate of the surface-wave magnitude of the slideof 2.3. Terrain models based on stereographic photographs before and after the slidemade it possible to determine the amount of material removed, and the manner ofre-deposition. Simple calculations of the tsunami travel times are in good correspondencewith the reports from the closest populated village, Saqqaq, 40 km from Paatuut, whererefracted energy from the tsunami destroyed a number of boats. Landslides are notuncommon in the area, due to the geology with dense basaltic rocks overlying poorlyconsolidated sedimentary rocks, but the size of the Paatuut slide is unusual. Based onthe observations it is likely at least 500 years since an event with a tsunami of similarproportions occurred. The triggering of the Paatuut slide is interpreted to be caused byweather conditions in the days prior to the slide, where re-freezing melt water inpre-existing cracks could have caused failure of the steep mountain side.
