One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry

BACKGROUND:Diabetes mellitus has worse outcome after percutaneous coronary intervention.AIM:We assessed stent thrombosis (ST), major adverse cardiac events (MACE), and major bleeding rates at 1 year after implantation of sirolimus-eluting stents (SES) in patients with diabetes mellitus in a large multicenter registry.METHODS:From May 2006 to April 2008, 15,147 unselected consecutive patients were enrolled at 320 centers in 56 countries in a prospective, observational registry after implantation of ≥ 1 SES. Source data were verified in 20% randomly chosen patients at > 100 sites. Adverse events were adjudicated by an independent Clinical Event Committee.RESULTS:Complete follow-up at 1 year was obtained in 13,693 (92%) patients, 4,577 (30%) of whom were diabetics. Within diabetics, 1,238 (9%) were insulin-treated diabetics (ITD). Diabetics were older (64 vs. 62 years, P < 0.001), with higher incidence of major coronary risk factors, co-morbidities, and triple-vessel coronary artery disease. Coronary lesions had smaller reference vessel diameter (2.88 ± 0.46 vs. 2.93 ± 0.45 mm, P < 0.001) and were more often heavily calcified (26.1% vs. 22.6%, P < 0.001). At 1 year, diabetics had higher MACE rate (6.8% vs. 3.9%, P < 0.001) driven by ITD (10.6% vs. 5.5%, P < 0.001). Finally, diabetics had significant increase in ST (1.7% vs. 0.7%, P < 0.001), principally owing to ITD (3.4% vs. 1.1%, P < 0.001). There was an overall low risk of major bleeding during follow-up, without significant difference among subgroups.CONCLUSIONS:In the e-SELECT registry, diabetics represented 30% of patients undergoing SES implantation and had significantly more co-morbidities and complex coronary lesions. Although 1-year follow-up documented good overall outcome in diabetics, higher ST and MACE rates were observed, mainly driven by ITD.

Outcomes in patients undergoing multivessel percutaneouscoronary intervention using sirolimus-eluting stents: a reportfrom the e-SELECT registry

Aims: Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedurehas potential economic and social advantages. However comprehensive outcome data of real world practicein a large population is limited. We aimed to compare short- and long-term outcomes between patients with multivesselcoronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry.Methods and results: The e-SELECT registry combines data collected at 320 medical centres in 56 countrieswhere patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardialinfarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or targetlesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A totalof 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand twohundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vesselPCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higherprevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI groupwhile pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within thefirst 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of theinfarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year werehigher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005)...

Stent thrombosis and bleeding complications after implantation of sirolimus-eluting coronary stentsin an unselected worldwide population a report from the e-SELECT (Multi-Center Post-Market Surveillance) registry

Objectives The aim of this study was to ascertain the 1-year incidence of stent thrombosis (ST) and major bleeding (MB) ina large, unselected population treated with sirolimus-eluting stents (SES).Background Stent thrombosis and MB are major potential complications of drug-eluting stent implantation. Their relativeincidence and predisposing factors among large populations treated worldwide are unclear.Methods The SES were implanted in 15,147 patients who were entered in a multinational registry. We analyzed the incidenceof: 1) definite and probable ST as defined by the Academic Research Consortium; and 2) MB, with theSTEEPLE (Safety and efficacy of Enoxaparin in PCI) definition, together with their relation to dual antiplatelettherapy (DAPT) and to 1-year clinical outcomes.Results The mean age of the sample was 62 11 years, 30.4% were diabetic, 10% had a Charlson comorbidity index 3, and 44% presented with acute coronary syndrome or myocardial infarction. At 1 year, the reported compliancewith DAPT as recommended by the European Society of Cardiology guidelines was 86.3%. Adverse eventrates were: ST 1.0%, MB 1.0%, mortality 1.7%, myocardial infarction 1.9%, and target lesion revascularization2.3%. Multivariate analysis identified 9 correlates of ST and 4 correlates of MB. Advanced age and a high Charlsonindex were associated with an increased risk of both ST and MB. After ST, the 7-day and 1-year all-causemortality was 30% and 35%, respectively, versus 1.5% and 10% after MB. Only 2 of 13,749 patients (0.015%)experienced both MB and ST during the entire 1-year follow-up period.Conclusions In this worldwide population treated with 1 SES, the reported compliance with DAPT was good, and the incidenceof ST and MB was low. Stent thrombosis and MB very rarely occurred in the same patient.

Generation and analysis of expressed sequence tags from Botrytis cinerea

Botrytis cinerea is a filamentous plant pathogen of a wide range of plant species, and its infection may cause enormous damage both during plant growth and in the post-harvest phase. We have constructed a cDNA library from an isolate of B. cinerea and have sequenced 11,482 expressed sequence tags that were assembled into 1,003 contigs sequences and 3,032 singletons. Approximately 81% of the unigenes showed significant similarity to genes coding for proteins with known functions: more than 50% of the sequences code for genes involved in cellular metabolism, 12% for transport of metabolites, and approximately 10% for cellular organization. Other functional categories include responses to biotic and abiotic stimuli, cell communication, cell homeostasis, and cell development. We carried out pair-wise comparisons with fungal databases to determine the B. cinerea unisequence set with relevant similarity to genes in other fungal pathogenic counterparts. Among the 4,035 non-redundant B. cinerea unigenes, 1,338 (23%) have significant homology with Fusarium verticillioides unigenes. Similar values were obtained for Saccharomyces cerevisiae and Aspergillus nidulans (22% and 24%, respectively). The lower percentages of homology were with Magnaporthe grisae and Neurospora crassa (13% and 19%, respectively). Several genes involved in putative and known fungal virulence and general pathogenicity were identified. The results provide important information for future research on this fungal pathogen.

A Lux-like Quorum Sensing System in the Extreme Acidophile Acidithiobacillus ferrooxidans

The genome of the acidophilic, proteobacterium Acidithiobacillus ferrooxidans, contains linked but divergently oriented genes, termed afeI and afeR, whose predicted protein products are significantly similar to the LuxI and LuxR families of proteins. A possible promoter and Lux box are predicted upstream of afeI. A cloned copy of afeI, expressed in E. coli, encodes an enzyme that catalyzes the production of a diffusible compound identified by gas chromatography and mass spectrometry as an unsubstituted N-acyl homoserine lactone (AHL) of chain length C14. This AHL can be detected by a reporter strain of Sinorhizobium meliloti Rm41 suggesting that it is biologically active. The reporter strain also responds to extracts of the supernatant of A. ferrooxidans grown to early stationary phase in sulfur medium indicating that a diffusible AHL is produced by this microorganism. Semi-quantitative RT-PCR experiments indicate that afeI and afeR are expressed maximally in early stationary phase and are more expressed when A. ferrooxidans is grown in sulfur- rather than iron-containing medium. Given the predicted amino acid sequence and functional properties of AfeI and AfeR it is proposed that A. ferrooxidans has a quorum sensing system similar to the LuxI-LuxR paradigm.

Metodologías alternas en el control y prevención de la malaria (Estudio realizado en el caserio "Las Majadas", Distrito Sucre, Estado-Bolívar, 1986) / Methods in the prevention and control of the malarie (Study made in the caserio \"Las Majadas\", Disctrit Sucre, Bolivar-State, 1986)

Un grupo de investigadores de la Universidad de Carabobo y Maravén, llevaron a cabo un experimento involucrando a los 350 pobladores del caserio Las Majadas en el control y prevención de la malaria mediante la educación sanitaria, organización comunal y uso del mosquitero impregnado con Permetrina. En mayo de 1986 con la ayuda de la comunidad, se impregnaron 33 de los 55 mosquiteros existentes. Seis meses más tarde, en octubre, el equipo volvio a la comunidad y entrevistaron a 21 de las 33 personas que habían contraido la malaria en al intervalo enero-octubre, 1986. Se encontro que hubo un brote serio en el mes de junio que solo produjo 22 casos. Catorce de las victimas dormian en sitios sin ninguna protección contra el mosquito..