Cholesterol crystals at the culprit lesion in patients with acute coronary syndrome are associated with worse cardiovascular outcomes at two years follow up - results from the translational OPTICO-ACS study program.

BACKGROUND: Cholesterol crystals (CCs) represent a feature of advanced atherosclerotic plaque and may be assessed by optical coherence tomography (OCT). Their impact on cardiovascular outcomes in patients presenting with acute coronary syndromes (ACS) is yet unknown. METHODS: The culprit lesion (CL) of 346 ACS-patients undergoing preintervention OCT imaging were screened for the presence of CCs and divided into two groups accordingly. The primary end-point was the rate of major adverse cardiac events plus (MACE+) consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to unstable or progressive angina at two years. RESULTS: Among 346 patients, 57.2% presented with CCs at the CL. Patients with CCs exhibited a higher prevalence of ruptured fibrous caps (RFC-ACS) (79.8% vs. 56.8%; p < 0.001) and other high-risk features such as thin cap fibroatheroma (80.8% vs. 64.9%; p = 0.001), presence of macrophages (99.0% vs. 85.1%; p < 0.001) as well as a greater maximum lipid arc (294.0° vs. 259.3°; p < 0.001) at the CL as compared to patients without CCs. MACE+ at two years follow-up occurred more often in CC-patients (29.2% vs. 16.1%; p = 0.006) as compared to patients without CCs at the culprit site. Multivariable cox regression analysis identified CCs as independent predictor of MACE+ (HR 1.705; 1.025-2.838 CI, p = 0.040). CONCLUSIONS: CCs were associated with conventional high-risk plaque features and associated with increased MACE+-rates at two years follow up. The identification of CCs might be useful as prognostic marker in patients with ACS and assist "precision prevention" in the future.

Contribution to the taxonomy of the Southeast Asian Mesochorinae (Hymenoptera, Ichneumonidae).

In this taxonomical study, one new genus and 41 new species of the subfamily Mesochorinae (Hymenoptera, Ichneumonidae) are described from Southeast Asia, namely from Indonesia, Malaysia, Thailand and Vietnam. The new genus is Orientochorus n. gen., the new species are Orientochorus tonkinensis n. sp., Astiphromma bicoloratus n. sp., Mesochorus achterbergi n. sp., Mesochorus anamnesis n. sp., Mesochorus brevipunctatus n. sp., Mesochorus cariniscuta n. sp., Mesochorus controversus n. sp., Mesochorus diversidens n. sp., Mesochorus flavator n. sp., Mesochorus flavopronotalis n. sp., Mesochorus fuscomaculatus n. sp., Mesochorus halmaherae n. sp., Mesochorus harlequinus n. sp., Mesochorus kinabaluensis n. sp., Mesochorus lamdongensis n. sp., Mesochorus longimurus n. sp., Mesochorus longistylus n. sp., Mesochorus longivalvator n. sp., Mesochorus malaysiacus n. sp., Mesochorus malucutus n. sp., Mesochorus nigripleuris n. sp., Mesochorus nigrofemur n. sp., Mesochorus nigromaculatus n. sp., Mesochorus paratenebris n. sp., Mesochorus pictiloides n. sp., Mesochorus pterostigmator n. sp., Mesochoprus rufator n. sp., Mesochorus sabahensis n. sp., Mesochorus sapaensis n. sp., Mesochorus semifuscus n. sp., Mesochorus semipunctatus n. sp., Mesochorus siamensis n. sp., Mesochorus stigmaticolor n. sp., Mesochorus striatofacies n. sp., Mesochorus sulaensis n. sp., Mesochorus sumaterae n. sp., Mesochorus templator n. sp., Mesochorus tenebris n. sp., Mesochorus tonkinensis n. sp., Mesochorus train n. sp., and Mesochorus vietnamensis n. sp. All species are illustrated and described in detail. In addition, a key for the females of the known Mesochorus species of Southeast Asia is presented.

Contribution to the knowledge of the Ichneumoninae (Hymenoptera, Ichneumonidae) from Maritime Southeast Asia.

In this study, new distributional records are given for 98 species and subspecies of Darwin wasps of the subfamily Ichneumoninae (Hymenoptera, Ichneumonidae) from Maritime Southeast Asia, namely from Indonesia and Malaysia: Sabah. Four genera, 31 species and three subspecies are described as new. The new genera are: Atanyjoppoides n. gen., Moluccarches n. gen., Orientodromus n. gen. and Platylaboides n. gen. The new species are: Achaius sabahensis n. sp., Allonotus rufiventris n. sp., Amblyjoppa nigra n. sp., Amblyjoppa striata n. sp., Atanyjoppoides mandibulator n. sp., Benyllus mesonotator n. sp., Benyllus rufostriatus n. sp., Benyllus sundaensis n. sp., Celebarches albifrons n. sp., Celebarches nigritor n. sp., Celebarches sabahensis n. sp., Celebarches tricolor n. sp., Coelichneumon (Exephanides) nigropropodealis n. sp., Compsophorus (Xenojoppa) quadrimaculatus n. sp., Deniya scutellaris n. sp., Eccoptosage nigrifemur n. sp., Eccoptosage sabahensis n. sp., Heresiarches simile n. sp., Lareiga nigrita n. sp., Lissosculpta albifrons n. sp., Lissosculpta malucuensis n. sp., Lissosculpta seramensis n. sp., Losgna baliensis n. sp., Losgna rufobasalis n. sp., Moluccarches albimaculatus n. sp., Orientodromus thyridialis n. sp., Platylaboides javanicus n. sp., Pseudoplatylabus rufoniger n. sp., Setanta albimaculata n. sp., Stirexephanes albicoxis n. sp., and Stirexephanes rufopetiolaris n. sp. The new subspecies are: Allonotus rufus sumatrensis n. ssp., Amblyjoppa rufobalteata sumatera n. ssp., and Anisobas vietnamensis sabahensis n. ssp. Vulgichneumon stegemanni (Heinrich, 1934) is transferred to the genus Virgichneumon Heinrich, 1977, n. stat.. For the following species the hitherto unknown are described: Barichneumonites properans (Tosquinet, 1903), Celebarches unicus Heinrich, 1934, Celebichneumon egregius Heinrich, 1934, Coelichneumon (Coelichneumon) lineiscutis Heinrich, 1966, Eccoptosage quadridentata (Cameron, 1905), Menkokia major (Heinrich, 1934), Nesostenodontus formosanus Cushman, 1937, Stenichneumonopsis albifasciatus Heinrich, 1934, Stirexephanes impictus Heinrich, 1934, Ulesta plagiata Heinrich, 1934, and Virgichneumon stegemanni (Heinrich, 1934). All new species are described in detail and illustrated. For the known species of Celebarches Heinrich, a determination key is provided.

Gender-Specific Performance of One- Compared to Two-Catheter Concepts in Transradial Coronary Angiography - Insights From the Randomized UDDC-Radial-Trial.

OBJECTIVES: The present sub-analysis from the randomized UDDC-Radial-Trial sought to compare one-catheter concepts (OCC) with two-catheter concepts (TCC) in different patient subgroups, particularly in those depending on gender and age. BACKGROUND: There is an ongoing debate regarding potential performance differences of OCC compared to TCC for transradial coronary angiography in specific patient subgroups. METHODS: The randomized UDDC-Radial-Trial enrolled a total of 300 patients planed for coronary angiography in a 2:1 ratio to either OCC by Tiger II (n = 100) and BLK (n = 100) or TCC by Judkins (n = 100) catheters. Predefined patient subgroups stratified for age, gender and patient constitution were analyzed with regard to the primary outcome measure of time required for a complete coronary angiography. RESULTS: In male patients time for coronary angiography was significantly shorter in the TCC group compared to the OCC group (510 ± 37 s vs. 615 ± 35 s; p = 0.046). No difference between the catheter concepts was observed in the subset of female patients (525 ± 34 s vs. 583 ± 54 s; p = 0.43). TCC was associated with shorter coronary angiography time in patients aged <71 years compared to OCC (462 ± 23 s vs. 570 ± 38 s; p = 0.018). In patients ≥72 years of age no difference was detected (573 ± 41 s vs. 636 ± 45 s; p = 0.31). Other subgroups showed no relevant differences in angiography time among OCC and TCC. CONCLUSIONS: The present subgroup analysis from the UDDC-radial trial demonstrates the use of OCC in transradial diagnostic angiography to be inferior compared to TCC in terms of angiography time in younger and male patients.

Review of Syzeuctus Frster, 1869 (Hymenoptera: Ichneumonidae: Banchinae) in Iran, with description of a new species.

A new ichneumonid species, Syzeuctus flavocephalus Zardouei Riedel sp. nov. (Hymenoptera: Ichneumonidae: Banchinae) from the Eastern high mountains of Iran (Sistan-o Baluchestan province) is described and illustrated. Together with this new species, nine previously recorded species from Iran are reviewed, and a comprehensive key of the Iranian species of Syzeuctus is provided.

A checklist of the subfamily Mesochorinae (Hymenoptera, Ichneumonidae) from the Ukrainian Carpathians.

The distributional data on the Ukrainian Carpathian mesochorines are summarized. The list contains 64 species belonging to three genera. The genus Astiphromma Frster, 1869 numbering 14 species, of which A. albitarse (Brischke, 1880) and A. flagellator Riedel, 2015, are the first records for Ukraine. All three European species of the genus Cidaphus Frster, 1869 are distributed in the studied region and are the first records from the country. The genus Mesochorus Gravenhorst, 1829 is the most species-rich genus of the subfamily with 46 species found in the Ukrainian Carpathians, containing newly described M. (Mesochorus) genator sp. n. and 41 species recorded from the Ukrainian fauna for the first time. Taxonomic remarks and illustrations for most of the species are provided.

Coexistence of calcified- and lipid-containing plaque components and their association with incidental rupture points in acute coronary syndrome-causing culprit lesions: results from the prospective OPTICO-ACS study.

AIMS: Rupture of the fibrous cap (RFC) represents the main pathophysiological mechanism causing acute coronary syndromes (ACS). Destabilization due to plaque biomechanics is considered to be importantly involved, exact mechanisms triggering plaque ruptures are, however, unknown. This study aims at characterizing the relation between plaque components and rupture points at ACS-causing culprit lesions in a large cohort of ACS-patients assessed by high-resolution intracoronary imaging. METHODS AND RESULTS: Within the prospective, multicentric OPTICO-ACS study program, the ACS-causing culprit plaques of 282 consecutive patients were investigated following a standardized optical coherence tomography (OCT) imaging protocol. Each pullback was assessed on a frame-by-frame basis for the presence of lipid components (LC), calcium components (CC), and coexistence of both LC and CC (LCC) by two independent OCT-core labs. Of the 282 ACS-patients, 204 patients (72.3%) presented with ACS caused by culprit lesions with rupture of the fibrous cap (RFC-ACS) and 27.7% patients had ACS caused by culprit lesions with intact fibrous cap (IFC-ACS). When comparing RFC-ACS to IFC-ACS, a preferential occurrence of all three plaque components (LC, CC, and LCC) in RFC-ACS became apparent (P < 0.001). Within ruptured culprit lesions, the zone straight at the rupture point [extended rupture zone (RZ)] was characterized by similar (24.7% vs. 24.0%; P = ns) calcium content when compared with the proximal and distal border of the culprit lesion [border zone (BZ)]. The RZ displayed a significantly higher amount of both, LC (100% vs. 69.8%; P < 0.001) and LCC (22.7% vs. 6.8%; P < 0.001), when compared with the BZ. The relative component increase towards the RZ was particularly evident for LCC (+233.8%), while LC showed only a modest increase (+43.3%). CONCLUSIONS: Calcified- and lipid-containing components characterize ruptured fibrous cap ACS-causing culprit lesions. Their coexistence is accelerated directly at the ruptured point, suggesting a pathophysiological contribution in the development of RFC-ACS.

Contribution to the Ophioninae (Hymenoptera: Ichneumonidae) of Iran with the description of 16 new species and an illustrated key to the Eremotylus of the Western Palaearctic.

In this study, material of Iranian Ophioninae was examined. In total, 63 species are recognized as occurring in Iran. Sixteen species are described as new to science: Enicospilus amerii Johansson sp. nov., E. apocalypticus Johansson sp. nov., E. haladai Johansson sp. nov., Enicospilus peri sp. nov., Ophion al Johansson sp. nov., Ophion angustigena Johansson sp. nov., Ophion breviflagellator Johansson sp. nov., Ophion golestanicus Johansson sp. nov., Ophion klimenkoi Johansson sp. nov., Ophion persicus Johansson sp. nov., Ophion schmidti Johansson sp. nov., Ophion sinuosus Johansson sp. nov., Ophion sistanicus Johansson sp. nov., Ophion transcarinatus Johansson sp. nov., Ophion vasi Johansson sp. nov. and Ophion xrafstra Johansson sp. nov. Sixteen species: Enicospilus combustus (Gravenhorst, 1829); E. intermedius (Johansson, 2018); E. undulatus (Gravenhorst, 1829); Ophion angularis Johansson Cederberg, 2019; Ophion bipictor Aubert, 1980; Ophion crassicornis Brock, 1982; Ophion confusus Johansson, 2019; Ophion ellenae Johansson, 2019; Ophion eremita Kokujev, 1906; Ophion kallanderi Johansson, 2019; Ophion rostralis Meyer, 1935; Ophion rufoniger Kohl, 1905; Ophion semipullatus Kokujev, 1909; Ophion tenuicornis Johansson, 2019; Hellwigiella dichromoptera (Costa, 1886) and Eremotylus curvinervis (Kriechbaumer, 1878) are new records for the fauna of Iran. Enicospilus flavocephalus (Kirby, 1900), Enicospilus monostigma (Vollenhoven, 1879) and Eremotylus sibiricus Szpligeti, 1905 are excluded from the Iranian checklist due to previous misidentifications. Enicospilus tarsalis Hedwig, 1957 syn. nov. is excluded from synonymy with E. ahngeri and instead introduced as a junior synonym of E. cruciator Viktorov, 1957. Enicospilus affinis Hedwig, 1957 stat. rev. is excluded from synonymy with E. ocellatus Shestakov, 1926 and reinstated as a valid species. Enicospilus splendidus Rousse, Soliman Gadallah, 2017 syn. nov. is a junior synonym of Enicospilus stenopsis Kohl, 1905. Enicospilus grandiflavus Townes Townes, 1973 (= E. grandis Morley) syn. nov. is synonymized with Enicospilus unicallosus (Vollenhoven, 1878). Enicospilus contributus Shestakov, 1926 is confirmed as a junior synonym of E. merdarius (Gravenhorst, 1829). Ophion fossulatus Hedwig, 1957 stat. rev. is excluded from synonymy with Ophion mocsaryi Brauns, 1899 and reinstated as a valid species close to Ophion parvulus Kriechbaumer. Ophion mocsaryi var. decedens Hedwig, 1961 syn. nov. is a synonym of Ophion bipictor Aubert, 1980. Ophion obscuratus var. heratensis Hedwig, 1961 syn. nov. is treated as a synonym of Ophion turcomanicus Szpligeti, 1905. Ophion pravinervis Kokujev, 1906, previously only known from the lost type collected in Georgia, is redescribed. Despite the relatively high number of new species here presented, the Iranian fauna most likely still harbours additional species awaiting discovery.

First record of the subfamily Oxytorinae (Insecta, Hymenoptera, Ichneumonidae) from the Oriental Region, with descriptions of two new species from Vietnam.

BACKGROUND: The Oxytorinae is a small subfamily of the family Ichneumonidae (Insecta, Hymenoptera) with the single genus Oxytorus Förster and 23 described species. Species were previously known to occur in the Palaearctic, Nearctic and Neotropical Regions. NEW INFORMATION: The ichneumonid subfamily Oxytorinae is recorded for the first time from the Oriental Region. Two species, one from northern and one from central Vietnam, are described as new: Oxytoruscarinatus Riedel, sp. n. and O.rufopropodealis Riedel, sp. n.

Checklist of the Ichneumonidae of Germany (Insecta, Hymenoptera).

BACKGROUND: A revised checklist of the Ichneumonidae of Germany is provided. The list represents an updated version of an earlier checklist published in 2001. The present list includes several records of species that are new for the German fauna and species that were discovered since the last checklist was published. The present checklist was compiled as part of the DNA barcoding projects at the Zoologische Staatssammlung München. NEW INFORMATION: The checklist includes 3,644 species of Ichneumonidae from Germany, with 48 species recorded for the first time. Compared to the checklist published 20 years ago, the number of ichneumonid species recorded from Germany has increased by 312 species.

The genus Coelichneumon Thomson in Japan (Hymenoptera, Ichneumonidae, Ichneumoninae).

In this taxonomic study, 29 species of the genus Coelichneumon Thomson, 1893 found in Japan are described in detail. For some species, other East Palaearctic material is also mentioned.                Five of the species are new to science: Coelichneumon caerulogaster nov. sp. (from Hokkaido and Honshu), C. carinator nov. sp. (from Honshu; also Russia and Korea), C. cyanator nov. sp. (from Honshu), C. terebrator nov. sp. (from Honshu) and C. uchidai nov. sp. (from Honshu). Four species are newly reported from Japan: C. clypeatus (Uchida, 1955), C. decemguttatus Uchida, 1932, C. maritimensis Heinrich, 1980 and C. nobilis (Wesmael, 1857). C. femoralis Uchida, 1927 is newly recorded from Far East Russia and C. rufibasalis (Uchida, 1927) from China and Mongolia.                C. birmanicus Heinrich, 1966 is newly synonymized under Ichneumon bivittatus Matsumura, 1912. C. coxalis Uchida, 1926 is newly synonymized under Ichneumon sinister Wesmael, 1848, and Ichneumon flavitarsis Smith, 1874 is newly synonymized under Ichneumon deliratorius Linnaeus, 1758. The female of C. rufibasalis (Uchida, 1927) and the male of C. maritimensis Heinrich, 1980 are described for the first time. For C. flavitarsis sensu Lee et al. non Smith, a new name, C. flavitarsator, is established and a lectotype designated.                The genus Aglaojoppa Cameron, 1901 is newly synonymized under Coelichneumon. Hence, A. centummaculata (Christ, 1791) is transferred to Coelichneumon (rev. stat.). The specific names of A. rufofemoratus Cameron, 1903 and A. victoriae Heinrich, 1968 are preoccupied in Coelichneumon and two replacement names are proposed, Coelichneumon cameroni nom. nov. for the former and C. paravictoriae nom. nov. for the latter species.

Impact of real-time angiographic co-registered optical coherence tomography on percutaneous coronary intervention: the OPTICO-integration II trial.

AIMS: Longitudinal geographic mismatch (LGM) as well as edge dissections are associated with an increased risk of adverse events after percutaneous coronary intervention (PCI). Recently, a novel system of real-time optical coherence tomography (OCT) with angiographic co-registration (ACR) became available and allows matched integration of cross-sectional OCT images to angiography. The OPTICO-integration II trial sought to assess the impact of ACR for PCI planning on the risk of LGM and edge dissections. METHODS: A total of 84 patients were prospectively randomized to ACR-guided PCI, OCT-guided PCI (without co-registration), and angiography-guided PCI. Primary endpoint was a composite of major edge dissection and/or LGM as assessed by post-PCI OCT. RESULTS: The primary endpoint was significantly reduced in ACR-guided PCI (4.2%) as compared to OCT-guided PCI (19.1%; p = 0.03) and angiography-guided PCI (25.5%; p < 0.01). Rates of LGM were 4.2%, 17.0%, and 22.9% in the ACR-guided PCI, in the OCT-guided PCI, and the angiography-guided PCI groups, respectively (ACR vs. OCT p = 0.04; ACR vs. angiography p = 0.04). The number of major edge dissections was low and without significant differences among the study groups (0% vs. 2.1% vs. 4.3%). CONCLUSION: This study for the first time demonstrates superiority of ACR-guided PCI over OCT- and angiography-guided PCI in reducing the composite endpoint of major edge dissection and LGM, which was meanly driven by a reduction of LGM.

Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study.

AIMS: Acute coronary syndromes with intact fibrous cap (IFC-ACS), i.e. caused by coronary plaque erosion, account for approximately one-third of ACS. However, the underlying pathophysiological mechanisms as compared with ACS caused by plaque rupture (RFC-ACS) remain largely undefined. The prospective translational OPTICO-ACS study programme investigates for the first time the microenvironment of ACS-causing culprit lesions (CL) with intact fibrous cap by molecular high-resolution intracoronary imaging and simultaneous local immunological phenotyping. METHODS AND RESULTS: The CL of 170 consecutive ACS patients were investigated by optical coherence tomography (OCT) and simultaneous immunophenotyping by flow cytometric analysis as well as by effector molecule concentration measurements across the culprit lesion gradient (ratio local/systemic levels). Within the study cohort, IFC caused 24.6% of ACS while RFC-ACS caused 75.4% as determined and validated by two independent OCT core laboratories. The IFC-CL were characterized by lower lipid content, less calcification, a thicker overlying fibrous cap, and largely localized near a coronary bifurcation as compared with RFC-CL. The microenvironment of IFC-ACS lesions demonstrated selective enrichment in both CD4+ and CD8+ T-lymphocytes (+8.1% and +11.2%, respectively, both P < 0.05) as compared with RFC-ACS lesions. T-cell-associated extracellular circulating microvesicles (MV) were more pronounced in IFC-ACS lesions and a significantly higher amount of CD8+ T-lymphocytes was detectable in thrombi aspirated from IFC-culprit sites. Furthermore, IFC-ACS lesions showed increased levels of the T-cell effector molecules granzyme A (+22.4%), perforin (+58.8%), and granulysin (+75.4%) as compared with RFC plaques (P < 0.005). Endothelial cells subjected to culture in disturbed laminar flow conditions, i.e. to simulate coronary flow near a bifurcation, demonstrated an enhanced adhesion of CD8+T cells. Finally, both CD8+T cells and their cytotoxic effector molecules caused endothelial cell death, a key potential pathophysiological mechanism in IFC-ACS. CONCLUSIONS: The OPTICO-ACS study emphasizes a novel mechanism in the pathogenesis of IFC-ACS, favouring participation of the adaptive immune system, particularly CD4+ and CD8+ T-cells and their effector molecules. The different immune signatures identified in this study advance the understanding of coronary plaque progression and may provide a basis for future development of personalized therapeutic approaches to ACS with IFC. TRIAL REGISTRATION: The study was registered at clinicalTrials.gov (NCT03129503).

A pilot study of the Carpathian ichneumonine parasitoids (Hymenopera, Ichneumonidae: Ichneumoninae) reveals eighty-eight new records for Ukraine.

Data on the subfamily Ichneumoninae Latreille, 1802 (Hymenopera: Ichneumonidae) from the Ukrainian Carpathians is summarized, with 196 species from eight tribes, of which 88 species are recorded from Ukraine for the first time. The new Ukrainian records belong to four tribes, Heresiarchini Ashmead, 1900, Ichneumonini Latreille, 1802, Phaeogenini Förster, 1869, and Platylabini Berthoumieu, 1904. Phaeogenini is the most poorly studied with 75% of species recorded for the country for the first time. High-altitude zone distribution is discussed: oak forest zone is the most species-rich (125 species), while the subalpine zone is the most poorly studied (57% of species found only in this zone are new records for Ukraine). The flying adults of Ichneumoninae were found from April until October, with a maximum number of species and genera collected in July, and with most specimens collected in May. Stenobarichneumon ridibitor Aubert, 1994 is transferred to the genus Baranisobas Heinrich, 1972 (comb. nov.).

Association of left ventricular end-diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes.

OBJECTIVES: This study sought to investigate the relation between left ventricular end-diastolic pressure (LVEDP) and outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). BACKGROUND: Risk stratification in ACS patients is important. Data on the role of LVEDP in the prognostication of ACS patients are scarce. METHODS: A total of 1,410 patients undergoing PCI for ACS and with available data on LVEDP were divided according to LVEDP tertiles (lowest tertile: ≤13 mmHg, intermediate tertile: 14-20 mmHg, and highest tertile: >20 mmHg). The primary endpoint was all-cause mortality at a median follow-up of 246 [28-848] days. RESULTS: Median LVEDP was 16 (11-22) mmHg. All-cause mortality was 2.8%, 4.5%, and 15.0% in the lowest, the intermediate, and the highest LVEDP tertile groups (p < .001), respectively. Belonging to the highest LVEDP tertile was associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] = 2.66, 95% confidence interval [CI] [1.30, 5.47], p = .008). By receiver operating characteristic curve analysis, the optimal cut-off value for predicting all-cause mortality was 20 mmHg (sensitivity 68.3%, specificity 72.5%). There was no differential effect of LVEDP on mortality in patients with and without LV dysfunction (interaction p = .23) or ST-elevation myocardial infarction as index ACS event (interaction p = .86). CONCLUSIONS: In patients undergoing PCI for ACS, LVEDP was independently related with mortality. Hence, LVEDP should be incorporated into early risk stratification and clinical decision making of ACS patients.

Completing Linnaeus's inventory of the Swedish insect fauna: Only 5,000 species left?

Despite more than 250 years of taxonomic research, we still have only a vague idea about the true size and composition of the faunas and floras of the planet. Many biodiversity inventories provide limited insight because they focus on a small taxonomic subsample or a tiny geographic area. Here, we report on the size and composition of the Swedish insect fauna, thought to represent roughly half of the diversity of multicellular life in one of the largest European countries. Our results are based on more than a decade of data from the Swedish Taxonomy Initiative and its massive inventory of the country's insect fauna, the Swedish Malaise Trap Project The fauna is considered one of the best known in the world, but the initiative has nevertheless revealed a surprising amount of hidden diversity: more than 3,000 new species (301 new to science) have been documented so far. Here, we use three independent methods to analyze the true size and composition of the fauna at the family or subfamily level: (1) assessments by experts who have been working on the most poorly known groups in the fauna; (2) estimates based on the proportion of new species discovered in the Malaise trap inventory; and (3) extrapolations based on species abundance and incidence data from the inventory. For the last method, we develop a new estimator, the combined non-parametric estimator, which we show is less sensitive to poor coverage of the species pool than other popular estimators. The three methods converge on similar estimates of the size and composition of the fauna, suggesting that it comprises around 33,000 species. Of those, 8,600 (26%) were unknown at the start of the inventory and 5,000 (15%) still await discovery. We analyze the taxonomic and ecological composition of the estimated fauna, and show that most of the new species belong to Hymenoptera and Diptera groups that are decomposers or parasitoids. Thus, current knowledge of the Swedish insect fauna is strongly biased taxonomically and ecologically, and we show that similar but even stronger biases have distorted our understanding of the fauna in the past. We analyze latitudinal gradients in the size and composition of known European insect faunas and show that several of the patterns contradict the Swedish data, presumably due to similar knowledge biases. Addressing these biases is critical in understanding insect biomes and the ecosystem services they provide. Our results emphasize the need to broaden the taxonomic scope of current insect monitoring efforts, a task that is all the more urgent as recent studies indicate a possible worldwide decline in insect faunas.

Performance of One- Compared With Two-Catheter Concepts in Transradial Coronary Angiography (from the Randomized Use of Different Diagnostic Catheters-Radial-Trial).

The Use of Different Diagnostic Catheters-Radial-Trial sought to compare the safety and efficacy of one-catheter concepts (OCC) using Tiger II or BLK catheters with two-catheter concepts (TCC) using standard Judkins catheters for transradial coronary angiography. A total of 300 patients planed for coronary angiography were enrolled into this single-center, single-blinded trial. Patients were randomized in a 2:1 ratio to either OCC by Tiger II (n = 100) and BLK (n = 100) or TCC by Judkins (n = 100) catheters. Primary end point was time required to perform a complete coronary angiography. Coronary angiography duration was 603 ± 29 seconds and 552 ± 26 sec in the OCC and the TCC groups (p = 0.052). Fluoroscopy time was longer in the OCC (408 ± 28 sec) as compared with the TCC group (258 ± 28 sec, p = 0.009) and the amount of contrast volume used significantly higher (98 ± 5 ml vs 67 ± 4 ml, p < 0.001). Crossover rates were increased in the OCC as compared with the TCC group (37% vs 4%, p < 0.001). These effects were observed irrespective of OCC catheter type. In conclusion, this study demonstrates that OCC do not reduce angiography time, but are associated with an increased amount of contrast volume and longer fluoroscopy time as compared with TCC.

Impact of acute kidney injury in elderly (≥80 years) patients undergoing percutaneous coronary intervention.

OBJECTIVES: This study sought to investigate the prevalence and impact of acute kidney injury (AKI) in elderly patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: AKI may complicate PCI and has been associated with worse outcomes. Data on AKI following PCI in elderly patients are scarce. METHODS: A total of 458 elderly (≥80 years) patients undergoing PCI at Charité-University Medicine Berlin between January 2009 and December 2014 were stratified according to the presence/absence of AKI. The primary endpoint was all-cause mortality. The secondary endpoint was rate of major adverse cardiovascular events (MACE), a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure. Median follow-up was 280 (interquartile range 22-1190) days. RESULTS: Of the 458 patients, 125 (27.3%) developed AKI following PCI. Age >90 years, congestive heart failure, and C-reactive protein at presentation emerged as independent predictors of AKI. All-cause mortality was 20.0% and 8.4% in patients with and without AKI (P = 0.001), and corresponding rates of MACE were 39.2% and 26.4% (P = 0.01), respectively. The occurrence of AKI was associated with an increased risk of all-cause mortality (adjusted HR 2.41, 95%CI 1.12-5.17, P = 0.02) and MACE (adjusted HR 1.75, 95%CI 1.15-2.67, P = 0.01). CONCLUSIONS: AKI occurs in a third of elderly (≥80 years) patients undergoing PCI and is associated with increased mortality. These findings underline the unmet clinical need to identify novel strategies for the prevention of AKI in this high-risk patient subset.

Real-time optical coherence tomography coregistration with angiography in percutaneous coronary intervention-impact on physician decision-making: The OPTICO-integration study.

AIMS: Intracoronary optical coherence tomography (OCT) imaging allows for high-resolution characterization of coronary lesions. Difficulties in matching cross-sectional OCT-images with angiographic lesion localization may limit optimal clinical utilization. We sought to prospectively assess the impact of a novel system of real-time OCT coregistration with angiography (ACR) on physician decision-making during percutaneous coronary interventions (PCI). METHODS AND RESULTS: Strategy for PCI (stent - length, - diameter, - strategy, landing zone) and PCI-optimization (stent-malappostion, -underexpansion, edge-dissections, geographical mismatch) was prospectively assessed in 50 patients with 58 coronary lesions after (I) angiography, (II) OCT imaging, and (III) ACR. Preprocedural OCT imaging altered stent-length (58.9%), diameter (33.9%), and PCI-strategy (12.5%) in 40 (71.4%) lesions. The use of ACR resulted in additional changes in PCI strategy in 40.7% of mostly complex lesions in comparison to OCT imaging alone and involved mainly device landing zone (24.1%) and stent length (22.2%). Postprocedural OCT imaging revealed the need for PCI optimization in 52.2% of the lesions, whereas post-procedural ACR had no further impact. CONCLUSIONS: Real-time OCT ACR had significant impact on PCI strategy, favoring mainly complete lesion coverage especially in complex lesions.