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Im Intravillan der Gemeinde Novosedly (Bez. Břeclav) wurde im Frühling 2019 ein ungarischer Dukaten der Königin Marie von Anjou gefunden. Der behandelte Dukaten stellt einen ausnehmenden Beleg des ungarischen Münzwesens auf dem Gebiet Böhmens und Mährens dar. Die Münze, die dem Münzen des Kammergrafen Jan Saracén zugeschrieben wird, trägt zur Erkenntnis des Münzsystems der ungarischen Königin Marie von Anjou bei, das bloße 6 Jahre funktionierte. Die Messung der Metallqualität bestätigte eine hohe Goldreinheit, im Durchschnitt 99,8 %, was den Dukaten aus jener Zeit entspricht. Der Münzfund belegt wirtschaftliche Verhältnisse auf dem Territorium des mittelalterlichen Kolonisationsdorfes des 14. und 15. Jahrhunderts, dessen Besiedlung mehr aus schriftlichen als archäologischen Quellen bekannt ist. Dem Finder danken wir für das Leihen der Münze für Dokumentationszwecke. [ABSTRACT FROM AUTHOR]

Context. Surveying the spatial distribution of exoplanets in the Galaxy is important for improving our understanding of planet formation and evolution. Aims. We aim to determine the spatial gradients of exoplanet occurrence in the Solar neighbourhood and in the vicinity of open clusters. Methods. We combined Kepler and Gaia DR2 data for this purpose, splitting the volume sampled by the Kepler mission into certain spatial bins. We determined an uncorrected and bias-corrected exoplanet frequency and metallicity for each bin. Results. There is a clear drop in the uncorrected exoplanet frequency with distance for F-type stars (mainly for smaller planets), a decline with increasing distance along the Galactic longitude l = 90°, and a drop with height above the Galactic plane. We find that the metallicity behaviour cannot be the reason for the drop of the exoplanet frequency around F stars with increasing distance. This might have only contributed to the drop in uncorrected exoplanet frequency with the height above the Galactic plane. We argue that the above-mentioned gradients of uncorrected exoplanet frequency are a manifestation of a single bias of undetected smaller planets around fainter stars. When we correct for observational biases, most of these gradients in exoplanet frequency become statistically insignificant. Only a slight decline of the planet occurrence with distance for F stars remains significant at the 3σ level. Apart from that, the spatial distribution of exoplanets in the Kepler field of view is compatible with a homogeneous one. At the same time, we do not find a significant change in the exoplanet frequency with increasing distance from open clusters. In terms of byproducts, we identified six exoplanet host star candidates that are members of open clusters. Four of them are in the NGC 6811 (KIC 9655005, KIC 9533489, Kepler-66, Kepler-67) and two belong to NGC 6866 (KIC 8396288, KIC 8331612). Two out of the six had already been known to be cluster members. [ABSTRACT FROM AUTHOR]

This paper analyses the economic aspects of the mining industry in the Slovak Republic. This study aims to point out the changes in the sectoral structure with a focus on the mining industry and its role in the economy of Slovak Republic. The analysed period is based on the time series provided by the current statistics for the years 2004-2016 using the revised ESA 2010, which represents the most recent internationally comparable accounting framework of the EU. The paper presents two selected analytical approaches to the evaluation of the mining industry in the V4 countries. The shares of individual sectors on the Slovak economy are surveyed on GDP and employment within the analysed period. At the same time, structural changes in the Slovak economy are analysed using selected indicators - the Krugman index of specialisation and Balassa concentration index. These indices are examined on the gross value added basis at constant prices for specific sectors in V4 countries. The result of this study is the quantification of the interrelations between selected indicators characterising the mining industry and the identification of the economic position of the mining industry in the Slovak Republic. The benefit of the study also consists in the quantification of inter-sectoral relations in the Slovak economy. [ABSTRACT FROM AUTHOR]

We outline the impact of a small two-band UV-photometry satellite mission on the field of stellar physics, magnetospheres of stars, binaries, stellar clusters, interstellar matter, and exoplanets. On specific examples of different types of stars and stellar systems, we discuss particular requirements for such a satellite mission in terms of specific mission parameters such as bandpass, precision, cadence, and mission duration. We show that such a mission may provide crucial data not only for hot stars that emit most of their light in UV, but also for cool stars, where UV traces their activity. This is important, for instance, for exoplanetary studies, because the level of stellar activity influences habitability. While the main asset of the two-band UV mission rests in time-domain astronomy, an example of open clusters proves that such a mission would be important also for the study of stellar populations. Properties of the interstellar dust are best explored when combining optical and IR information with observations in UV. It is well known that dust absorbs UV radiation efficiently. Consequently, we outline how such a UV mission can be used to detect eclipses of sufficiently hot stars by various dusty objects and study disks, rings, clouds, disintegrating exoplanets or exoasteroids. Furthermore, UV radiation can be used to study the cooling of neutron stars providing information about the extreme states of matter in the interiors of neutron stars and used for mapping heated spots on their surfaces. [ABSTRACT FROM AUTHOR]

Background: Congestion is the main cause of morbidity in patients with heart failure. Treatment of fluid overload is often challenging in everyday clinical practice. Objective: The aim of this study was to determine the diuretic effect of acetazolamide in patients with exacerbations of chronic heart failure, in addition to their stable diuretic therapy. Methods: This was a single-center, unblinded study. Patients hospitalized with chronic heart failure exacerbations, with left ventricular ejection fraction (EF) < 50% and signs of volume overload, with a stable dose of diuretics anticipated by the attending physician over the next 4 days, were considered eligible for the study. On day 1, patients were randomized to receive acetazolamide orally, once daily (dose-adjusted to body weight) or no treatment (control group) as add-on diuretic therapy, on days 2 and 3. Diuresis, natriuresis, fluid balance, and symptoms were assessed daily, up to day 4. Results: Twenty patients (mean ± standard deviation age 72 ± 11.6 years; 85% men; mean EF 33.8 ± 11.4%; mean N-terminal pro-B-type natriuretic peptide 8064 ± 5593 pg/mL; mean intravenous furosemide dose 105 ± 55 mg) were enrolled. Diuresis, natriuresis, fluid balance, and symptoms were stable on days 1-4 in the control group. An increase in diuresis and natriuresis, and a greater change in fluid balance after administration of acetazolamide, were observed in patients randomized to acetazolamide. On day 4, there was a significant difference in fluid balance between the acetazolamide and control groups (−666 ± 1194 mL vs. +332 ± 705 mL; p = 0.035), and dyspnea was lower in patients receiving acetazolamide (visual scale, p < 0.001; 5-point Likert scale, 1.444 vs. 2.222; p = 0.04) Conclusions: In this pilot study, the addition of acetazolamide to the background diuretic regimen in patients with chronic heart failure exacerbations produced an additional diuretic effect and alleviation of dyspnea. [ABSTRACT FROM AUTHOR]

Studies on polymeric materials used in contactology for manufacturing of contact lenses are presented in the paper. Different types of brand new contact lenses were investigated: hydrogel, silicone-hydrogel and rigid gas permeable. Positron annihilation lifetime spectroscopy (PALS) was used to characterize geometrical sizes and fraction of the free volume holes in the investigated samples. Measurements reveal significant differences between the materials. Namely differences in size and fraction of free volume were observed. These changes are strongly correlated with oxygen permeability in contact lenses. Middle infrared (MIR) spectroscopy was carried out in order to investigate the internal structure of materials. Furthermore, UV–vis–NIR studies were performed in order to determine the transmittance properties of contact lenses. [ABSTRACT FROM AUTHOR]

Context. Apart from thousands of "regular" exoplanet candidates, Kepler satellite has discovered a small number of stars exhibiting peculiar eclipse-like events. They are most probably caused by disintegrating bodies transiting in front of the star. However, the nature of the bodies and obscuration events, such as those observed in KIC 8462852, remain mysterious. A swarm of comets or artificial alien mega-structures have been proposed as an explanation for the latter object. Aims. We explore the possibility that such eclipses are caused by the dust clouds associated with massive parent bodies orbiting the host star. Methods. We assumed a massive object and a simple model of the dust cloud surrounding the object. Then, we used the numerical integration to simulate the evolution of the cloud, its parent body, and resulting light-curves as they orbit and transit the star. Results. We found that it is possible to reproduce the basic features in the light-curve of KIC 8462852 with only four objects enshrouded in dust clouds. The fact that they are all on similar orbits and that such models require only a handful of free parameters provides additional support for this hypothesis. Conclusions. This model provides an alternative to the comet scenario. With such physical models at hand, at present, there is no need to invoke alien mega-structures for an explanation of these light-curves. [ABSTRACT FROM AUTHOR]

There has been growing observational evidence for the presence of condensates in the atmospheres and/or comet-like tails of extrasolar planets. As a result, systematic and homogeneous tables of dust properties are useful in order to facilitate further observational and theoretical studies. In this paper we present calculations and analysis of non-isotropic phase functions, asymmetry parameter (mean cosine of the scattering angle), absorption and scattering opacities, single scattering albedos, equilibrium temperatures, and radiative accelerations of dust grains relevant for extrasolar planets. Our assumptions include spherical grain shape, Deirmendjian particle size distribution, and Mie theory. We consider several species: corundum/alumina, perovskite, olivines with 0 and 50 per cent iron content, pyroxenes with 0, 20, and 60 per cent iron content, pure iron, carbon at two different temperatures, water ice, liquid water, and ammonia. The presented tables cover the wavelength range of 0.2-500 μm and modal particle radii from 0.01 to 100 μm. Equilibrium temperatures and radiative accelerations assume irradiation by a non-blackbody source of light with temperatures from 7000 to 700 K seen at solid angles from 2π to 10-6 sr. The tables are provided to the community together with a simple code which allows for an optional, finite, angular dimension of the source of light (star) in the phase function. [ABSTRACT FROM AUTHOR]

Of patients with acute myocardial infarction eligible for the International Study of Infarct Survival-4, randomized to captopril (n = 30) or placebo (n = 33), the captopril group had a significant decrease in blood adrenaline on day 3 compared with baseline values. Results suggest that suppression of sympathetic activity contributes to the beneficial effects of treatment with angiotensin-converting enzyme inhibitors in the early phase of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are no data on the association between in-hospital bleeding and mortality in patients with pulmonary embolism (PE). Objectives: To assess whether in-hospital major bleeding predicts in-hospital and 90-day mortality in patients with PE confirmed objectively using validated diagnostic criteria. Methods: ZATPOL is a prospective national registry of consecutive patients with suspected PE admitted to 86 cardiology departments across Poland from January 2007 to September 2008. We retrospectively studied the influence of in-hospital bleeding on outcomes. Results: Of 2015 patients enrolled, 1216 were locally diagnosed with PE. Validated diagnostic criteria according to the European Society of Cardiology guidelines were met in 1112 patients. In the latter group, major bleeding occurred in 3.6%, and 0.5% had fatal bleeding. Thrombolytic therapy was administered to 11% of patients. Vascular access site bleeding was the most common (40%). Except for hypotension or shock and cancer, major bleeding was the strongest independent predictor of both in-hospital (OR 3.47; P=0.003) and 90-day mortality (OR 2.75; P=0.009). Other factors independently associated with in-hospital mortality were: shock or hypotension (OR 7.45; P<0.001), cancer (OR 1.9; P=0.044), and presence of ≥1 concomitant disease (OR 2.59; P<0.001). Other predictors of 90-day mortality were: shock or hypotension (OR 5.23; P<0.001), cancer (OR 3.57; P<0.001), presence of ≥1 concomitant disease (OR 2.01; P=0.001) and age>71years (OR 1.5; P=0.063). Conclusion: In-hospital major bleeding is a newly described strong independent predictor of both in-hospital and 90-day mortality in patients with objectively confirmed PE. [Copyright &y& Elsevier]

]Context. An object with a very peculiar light curve was recently discovered using Kepler data. When this object was discovered, it was suggested that this object may be a transiting disintegrating extrasolar planet with a comet-like dusty tail. Aims. We aim to verify this model by modelling the light curve and put constraints on the geometry of the dust region and various dust properties. Methods. We modified the code SHELLSPEC, which is designed for modelling interacting binary stars to calculate the light curves of such planets. Mie absorption and scattering on spherical dust grains with realistic dust opacities, phase functions, and a finite radius of the source of the scattered light are taken into account Results. The light curve is reanalysed using long- and short-cadence Kepler observations from the first 14 quarters. The orbital period of the planet was improved. We prove that the peculiar light curve agrees with the idea of a planet with a comet-like tail. The light curve has a prominent pre-transit brightening and a less prominent post-transit brightening. Both are caused by the forward scattering and are a strong function of the particle size. This feature enabled us to estimate a typical particle size (radius) in the dust tail of about 0.1-1 micron. However, there is an indication that the particle size changes (decreases) along the tail. The dust density in the tail is a steep decreasing function of the distance from the planet, which indicates a significant tail destruction caused by the star-planet interaction. Several possible combinations of other dust properties are tabulated. We reveal interesting periodic long-term evolution of the tail on a time scale of about 1.3 years and also argue that the "planet" does not show a uniform behaviour, but may have at least two constituents. This exoplanet's tail evolution may find an analogy in the comet tail disconnection events caused by the magnetic/coronal activity of the Sun while the light curve with pre-transit brightening is analogous to the light curve of €Aur and AZ Cas with mid-eclipse brightening and forward scattering playing a significant role in such eclipsing systems. [ABSTRACT FROM AUTHOR]

The risk of stroke in patients hospitalized with an acute coronary syndrome (ACS) ranges from <1% to ≥2.5%. The aim of this study was to develop a simple predictive tool for bedside risk estimation of in-hospital ischemic stroke in patients with ACS to help guide clinicians in the acute management of these high-risk patients. Data were obtained from 63,118 patients enrolled from April 1999 to December 2007 in the Global Registry of Acute Coronary Events (GRACE), a multinational registry involving 126 hospitals in 14 countries. A regression model was developed to predict the occurrence of in-hospital ischemic stroke in patients hospitalized with an ACS. The main study outcome was the development of ischemic stroke during the index hospitalization for an ACS. Eight risk factors for stroke were identified: older age, atrial fibrillation on index electrocardiogram, positive initial cardiac biomarkers, presenting systolic blood pressure ≥160 mm Hg, ST-segment change on index electrocardiogram, no history of smoking, higher Killip class, and lower body weight (c-statistic 0.7). The addition of coronary artery bypass graft surgery and percutaneous coronary intervention into the model increased the prediction of stroke risk. In conclusion, the GRACE stroke risk score is a simple tool for predicting in-hospital ischemic stroke risk in patients admitted for the entire spectrum of ACS, which is widely applicable to patients in various hospital settings and will assist in the management of high-risk patients with ACS. [Copyright &y& Elsevier]

Context. The internal heat loss, or cooling, of a planet determines its structure and evolution. Aims. We study the effects of irradiation, metallicity of the atmosphere, heat redistribution, stratospheres, and the depth where the heat redistribution takes place on the atmospheric structure, the core entropy, and subsequently on the cooling of the interior of the planet. Methods. We address in a consistent fashion the coupling between the day and the night sides of a planet by means of model atmosphere calculations with heat redistribution. We assume that strong convection leads to the same entropy on the day and night sides and that gravity is the same on both hemispheres. Results. We argue that the core cooling rates from the two hemispheres of a strongly irradiated planet may not be the same and that the difference depends on several important parameters. If the day-night heat redistribution is very efficient or if it takes place at the large optical depth, then the day-side and the night-side cooling may be comparable. However, if the day-night heat transport is not efficient or if it takes place at a shallow optical depth then there can be a large difference between the day- and the night-side cooling and the night side will cool more efficiently. If stellar irradiation becomes stronger, e.g. owing to stellar evolution or migration, cooling from both the day and the night sides is reduced. Enhanced metallicity of the atmosphere would act as an added "blanket" and reduces both the day- and the night-side cooling. However, a stratosphere on the planetary day side can enhance day-side cooling since its opacity acts as a "sunshade" that screens the stellar irradiation. These effects may also influence the well-known gravity darkening and bolometric albedo effects in interacting binaries, especially for strongly irradiated cold components [ABSTRACT FROM AUTHOR]

Background: During clinical trials in emergency medicine, providing appropriate oral and written information to a patient is usually a challenge. There is little published information regarding patients' opinions and competence to provide informed consent, nor on physicians' attitudes towards the process. We have investigated the problem of obtaining consent from patients in emergency-setting clinical trials (such as acute coronary syndromes (ACS) and stroke) from a physicians' perspective. Methods: A standardised anonymous 14-item questionnaire was distributed to Polish cardiac and stroke centres. Results: Two hundred and fourteen informative investigator responses were received. Of these investigators, 73.8% had experience with ACS and 25.2% had experience with acute stroke trials (and 1% with both fields). The complete model of informed consent (embracing all aspects required by Good Clinical Practice (GCP) and law) was used in 53.3% of cases in emergency settings, whereas the legal option of proxy consent was not used at all. While less than 15% of respondents considered written information to have been fully read by patients, 80.4% thought that the amount of information being given to emergency patients is too lengthy. Although there is no legal obligation, more than half of the investigators sought parallel consent (assent) from patients' relatives. Most investigators confirmed that they would adopt the model proposed by the GCP guidelines: abbreviated verbal and written consent in emergency conditions with obligatory "all-embracing" deferred consent to continue the trial once the patient is able to provide it. However, this model would not follow current Polish and European legislation. Conclusion: An update of national and European regulations is required to enable implementation of the emergency trial consent model referred to in GCP guidelines. [ABSTRACT FROM AUTHOR]

The main goal of this paper is to continue a systematic abundance analysis of a sample of Am binaries in order to search for possible abundance anomalies driven by tidal interaction in these binary systems. New CCD observations in two spectral regions (6400–6500 and 6660–6760 Å) of HD 861, HD 18778, HD 20320, HD 29479, HD 96528 and HD 108651 were obtained. Synthetic spectrum analysis was carried out, and basic stellar properties, effective temperatures, gravities, projected rotational velocities, masses, ages and abundances of several elements were determined. We conclude that HD 861, 29479 and 108651 are typical Am stars, while HD 20320 and 96528 are mild Am stars. HD 18778 turned out not to be an Am star although its projected rotational velocity is very low (27 km s−1). On the contrary, HD 96528 has one of the highest projected rotational velocities (85 km s−1) among Am binaries with orbital periods in the range 20–200 d, and yet it exhibits Am anomalies. Pseudo-synchronization and abundance anomalies are discussed in the context of possible tidal effects. [ABSTRACT FROM AUTHOR]

It is suggested that if the tidally induced meridional circulation of Tassoul & Tassoul existed, it might successfully compete with diffusion processes and rotationally induced meridional circulation. This could affect the chemical composition of an Am binary component. The main goal of this paper is to start a systematic abundance analysis of a sample of Am binaries in order to search for possible observable abundance anomalies driven by tidal interaction in these binary systems. A synthetic spectrum analysis of CCD observations in two spectral regions (6400–6500 and 6660–6760 Å) of HD 33254, HD 178449 and HD 198391 was carried out. Basic stellar properties, atmospheric parameters and abundance patterns were derived. HD 33254 is the star with pronounced Am anomalies, while HD 198391 is found to be an extremely sharp-lined hot Am star. HD 178449 is a controversial and extremely highly rotating star. We have succeeded in detecting a very faint secondary spectrum. The most probable explanation is that we have discovered the new spectroscopic Ab component of this spectroscopic and visual multiple system. [ABSTRACT FROM AUTHOR]

Unlabelled: AIM AND PERSPECTIVE: To estimate the cost effectiveness of enoxaparin versus unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS) from a Polish hospital perspective. This was intended to facilitate the decisionmaking process in selecting the most cost-effective treatment for ACS.Method: A decision model was used to quantify costs and effectiveness of alternative treatments. Published results from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study were used to estimate the probability for clinical endpoints (death, myocardial infarction or recurrent angina) at 30 days. Probabilities of patients undergoing revascularisation procedures were obtained from the Global Registry of Acute Coronary Events (GRACE) which included data from 961 patients at six centres in Poland. The analysis assessed only direct medical costs, determined from actual resource consumption on a patient-specific basis (6-month observational study) and estimated using Polish data on unit costs. One- and two-way sensitivity analyses and threshold analysis were performed.Results: At 30 days, 19.8% of patients receiving enoxaparin compared with 23.3% of those receiving UFH reached a composite endpoint consisting of death, myocardial infarction and recurrent angina (p = 0.02). The average costs (in zloty ; 1 US dollar = 4 zloty [2000 values]) were 1,085 per patient receiving enoxaparin compared with 1,097 per patient receiving UFH. Therefore, for every 29 patients treated, not only would enoxaparin therapy avoid one event of the composite endpoint, it would also save 348 zloty. The threshold analysis suggests that enoxaparin would lose dominance when the cost of enoxaparin increased by 10%, the cost of monitoring UFH therapy decreased by 12%, the probability of reaching the composite endpoint in the enoxaparin arm increased to 0.22 or decreased to 0.21 in the UFH arm.Conclusion: According to our model enoxaparin was more effective at a lower cost than UFH, therefore this treatment was shown to be dominant for patients with ACS in Poland. [ABSTRACT FROM AUTHOR]

Studies radiative accelerations on Ne in the atmospheres of late B stars. Atmospheres; Galaxies; Microscopic diffusion.

Investigates the neon (Ne) abundances in normal late-B and mercury-manganese stars. Measurement of the equivalent widths of several Ne line; Detection of the weal Ne lines in the stars; Importance of the low Ne abundances on the intensity of the stellar winds.

Investigates the relation of the physical characteristics of Ap stars to binarity. Occurrence of the striking gap in the orbital period distribution of Ap binaries; Comparison between eccentricities of Ap star and B9-A2 normal binaries; Effects of binarity on magnetism.

We present a practical application of real time three-dimensional transesophageal echocardiography in a 67-year-old male patient with congenital heart disease. [ABSTRACT FROM AUTHOR]

It is unknown whether clinical benefit of proprotein convertase subtilisin/kexin type 9 inhibitors is associated with baseline or on-treatment triglyceride concentrations. This study sought to examine relations between triglyceride levels and the effect of alirocumab vs placebo on cardiovascular outcomes using prespecified and post hoc analyses of the ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial. Patients with recent acute coronary syndrome (ACS) (n = 18,924) and elevated atherogenic lipoproteins despite optimized statin therapy were randomized to alirocumab 75 to 150 mg or matching placebo every 2 weeks subcutaneously. Major adverse cardiovascular events (MACE) were examined in relation to continuous or dichotomous triglyceride concentrations. Median baseline triglyceride concentration was 129 mg/dL. In both treatment groups, a 10-mg/dL higher baseline concentration was associated with an adjusted MACE HR of 1.008 (95% CI: 1.003-1.013; P < 0.005). Baseline triglycerides ≥150 vs <150 mg/dL were associated with a HR of 1.184 (95% CI: 1.080-1.297; P < 0.005). Versus placebo, alirocumab reduced low-density lipoprotein cholesterol from baseline (average, 54.7%) and reduced MACE (HR: 0.85; 95% CI: 0.78-0.93). At month 4, triglyceride levels were reduced from baseline by median 17.7 mg/dL (P < 0.001) and 0.9 mg/dL (P = NS) with alirocumab and placebo, respectively. A 10-mg/dL decline from baseline in triglycerides was associated with lower subsequent risk of MACE with placebo (HR: 0.988; 95% CI: 0.982-0.995; P < 0.005) but not with alirocumab (HR: 0.999; 95% CI: 0.987-1.010; P = 0.82). Among patients with recent ACS on optimized statin therapy, baseline triglycerides was associated with cardiovascular risk. However, the reduction in triglycerides with alirocumab did not contribute to its clinical benefit. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402) [ABSTRACT FROM AUTHOR]

The optimal antithrombotic regimen for patients with atrial fibrillation (AF) who had an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is not known. The authors sought to determine which antithrombotic regimen best balances safety and efficacy. AUGUSTUS, a multicenter 2 × 2 factorial design randomized trial compared apixaban with vitamin K antagonist (VKA) and aspirin with placebo in patients with AF with recent ACS and/or PCI treated with a P2Y 12 inhibitor. We conducted a 4-way analysis comparing safety and efficacy outcomes in the 4 randomized groups. The primary outcome was a composite of all-cause death, major or clinically relevant nonmajor bleeding, or hospitalization for cardiovascular causes over 6-month follow-up. Secondary outcomes included individual components of the primary endpoint. A total of 4,614 patients were enrolled. All patients were treated with a P2Y 12 inhibitor. The primary endpoint occurred in 21.9% of patients randomized to apixaban plus placebo, 27.3% randomized to apixaban plus aspirin, 28.0% randomized to VKA plus placebo, and 33.3% randomized to VKA plus aspirin. Rates of major or clinically relevant nonmajor bleeding and hospitalization for cardiovascular causes were lower with apixaban and placebo compared with the other 3 antithrombotic strategies. There was no difference between the 4 randomized groups with respect to all-cause death. In patients with AF and a recent ACS and/or PCI, an antithrombotic regimen that included a P2Y 12 inhibitor and apixaban without aspirin resulted in a lower incidence of the composite of death, bleeding, or cardiovascular hospitalization than regimens including VKA, aspirin, or both. (An Open-label, 2 x 2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban vs. Vitamin K Antagonist and Aspirin vs. Aspirin Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention; NCT02415400) [ABSTRACT FROM AUTHOR]

Background Older people less frequently receive invasive coronary angiography (ICA) for NSTEMI than younger patients. We describe care, ICA data, and in-hospital and 30-day outcomes of NSTEMI by age in a contemporary and geographically diverse cohort. Methods Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by age (≥75 years, n = 761). Quality of care was evaluated based on 12 guideline-recommended care interventions, and data collected on ICA. Outcomes included in hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack, BARC Type ≥3 bleeding and death, as well as 30-day mortality. Results Patients aged ≥75 years, compared with younger patients, at presentation had a higher prevalence of comorbidities and oral anticoagulation prescription (22.4% vs 7.6%, p  < 0.001). Older patients less frequently received ICA than younger patients (78.6% vs 90.6%, p  < 0.001) with the recorded reason more often being advanced age, comorbidities or frailty. Of those who underwent ICA, older patients more frequently demonstrated 3-vessel, 4-vessel and/or left main stem coronary artery disease compared to younger patients (49.7% vs 34.1%, p  < 0.001) but less frequently received revascularisation (63.6% vs 76.9%, p  < 0.001). Older patients experienced higher rates of in-hospital acute heart failure (15.0% vs 8.4%, p  < 0.001) and bleeding (2.8% vs 1.3%, p  = 0.006), as well as in-hospital and 30-day mortality (3.4% vs 1.3%, p  < 0.001; 4.8% vs 1.7%, p  < 0.001; respectively), than younger patients. Conclusions Patients aged ≥75 years with NSTEMI, compared with younger patients, less frequently received ICA and guideline-recommended care, and had worse short-term outcomes. [ABSTRACT FROM AUTHOR]

Biomarker concentrations and their changes during acute coronary syndrome (ACS) provide clinically useful information on pathophysiological processes, e.g. myocardial necrosis, hemodynamic stress and inflammation. However, current evidence on temporal biomarker patterns early during ACS is limited, and studies investigating multiple biomarkers are lacking. We measured concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), NT-terminal pro-B-type natriuretic peptide, C-reactive protein, and growth-differentiation factor-15 (GDF-15) in plasma samples obtained at randomization in ACS patients from the PLATelet inhibition and patient Outcomes (PLATO) trial. Linear regressions with interaction analyses were used to investigate the associations of biomarker concentrations with the time from symptom onset and to model temporal biomarker concentration patterns. The study population consisted of 16,944 patients (median age 62 years; 71.3 % males) with 6,853 (40.3 %) having ST-elevation myocardial infarction (STEMI) and 10,141 (59.7 %) having non-ST-elevation ACS (NSTE-ACS). Concentrations of all biomarkers were associated with time from symptom onset (pinteraction<0.001), apart for GDF-15 (pinteraction=0.092). Concentration increases were more pronounced in STEMI compared to NSTE-ACS. Temporal biomarker patterns for hs-cTnT and hs-cTnI were different depending on sex whereas biomarker patterns for the other biomarkers were similar in cohorts defined by age and sex. Temporal concentration patterns differ for various biomarkers early during ACS, reflecting the variability in the activation and duration of different pathophysiological processes, and the amount of injured myocardium. Our data emphasize that the time elapsed from symptom onset should be considered for the interpretation of biomarker results in ACS. [ABSTRACT FROM AUTHOR]

This document is a correction notice for a paper titled "Combined use of stress echocardiography and cardiopulmonary exercise testing to assess exercise intolerance in patients treated for acute myocardial infarction." The correction states that the Data Availability statement in the paper is incorrect and provides the correct link to access the raw dataset. Additionally, there is an error in Table 1, where the data for "Hemoglobin at discharge, g/dL" is incorrectly formatted and should have appeared in one row. The table provides demographic and clinical characteristics of patients with acute myocardial infarction based on their percentage of predicted oxygen uptake. [Extracted from the article]

This article discusses the use of ultrasonography in determining the appropriate access site for percutaneous coronary intervention (PCI). While radial access (RA) has been recommended as the preferred access site, the novel technique of distal radial access (DRA) has gained popularity due to improved patient and operator comfort. The article presents a case study of a patient who underwent PCI via the right transradial approach but experienced complications due to the misplacement of the sheath in the narrow palmar superficial branch of the radial artery. The authors argue that preprocedural ultrasonography can help prevent such complications and advocate for its use in selecting between radial and distal radial approaches. [Extracted from the article]

We present results from long-term spectroscopic monitoring of 21 T-Tauri stars located in the Taurus–Auriga star-forming region (SFR). We combine medium and high-dispersion Echelle spectroscopy obtained at the Stará Lesná, Skalnaté Pleso (both in Slovakia), and Tautenburg (Germany) observatories with low-resolution flux-calibrated spectra from Asiago (Italy) observatory all taken between 2015 and 2018. We extend the coverage by additional medium-resolution spectra from Stará Lesná obtained in 2022. In the previous paper, we measured photometric periods of these targets in a range of 0.7–3.1 d, which could be due to the rotation of a spotted surface or binarity. Here, we use the broadening-function technique to determine the radial and projected rotational velocities to reveal any close binary companion. Our analysis concludes that no such companion is present with an orbital period equal to the photometric period. We focus our analysis primarily on determining atmospheric parameters such as surface gravity log  g , effective temperature T eff, and metallicity [Fe/H]. Additionally, we measure the equivalent width of H α, Li i , and interstellar Na i lines. We also investigate the effect of possible reddening on individual targets and construct the HR diagram of our sample. Using pre-main-sequence evolutionary models, we determine the age of our targets. This analysis hints at ages younger than 50 Myr with mean age 5 ± 3 Myr, masses between 0.75 and 2.10 M⊙, and minimum radii in the range 0.60–3.17 R⊙. Altogether, the results are consistent with expected young stars with larger radii than those of main-sequence stars. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a clinical syndrome with high morbidity and mortality, and its prevalence is rapidly increasing. Galectin-3 (Gal-3) is an important factor in the pathophysiology of HF, mainly due to its role in cardiac fibrosis, inflammation, and ventricular remodeling. Fibrosis is a hallmark of cardiac remodeling, HF, and atrial fibrillation development. This review aims to explore the involvement of Gal-3 in HF and its role in the pathogenesis and clinical diagnostic and prognostic significance. We report data on Gal-3 structure and molecular mechanisms of biological function crucial for HF development. Over the last decade, numerous studies have shown an association between echocardiographic and CMR biomarkers in HF and Gal-3 serum concentration. We discuss facts and concerns about Gal-3's utility in acute and chronic HF with preserved and reduced ejection fraction for diagnosis, prognosis, and risk stratification. Finally, we present attempts to use Gal-3 as a therapeutic target in HF. [ABSTRACT FROM AUTHOR]

The object of this paper is the issue of career counseling for secondary school students using the "Model career counseling" (hereinafter MCC). The aim of this paper is to demonstrate the contribution of the MCC for students while deciding about the choice of their further education and career choices with the implementation of abilities, interests and personal abilities of the student. The method is an analysis of personality preconditions, general, specific abilities and interests of students by using standardized tests and non-standardized author's questionnaires. Consequently, comparison is realized of the collected data about students with graduate profiles in the study program. Based on the observed results, the focus of their further study is recommended to the students. [ABSTRACT FROM AUTHOR]

Key Points: Question: How do heart failure etiology, treatment, and outcomes differ between groups of countries at different levels of economic development? Findings: Ischemic heart disease and hypertension were the most common causes of heart failure. Half of patients with reduced ejection fraction received combined guideline-directed medications, with the lowest use in lower–middle-income and low-income countries. Mortality rates were more than 2-fold higher in lower–middle-income and low-income countries compared with high-income countries. In low-income countries, deaths were more frequent than hospitalizations, and the short-term risk of death associated with a hospitalization was 3- to 5-fold higher in lower–middle-income and low-income countries compared with high-income countries. Meaning: These data may be useful for planning approaches to improve heart failure management globally. Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P <.001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally. This study uses data from the Global Congestive Heart Failure Registry, sorted by country and by country income level, to evaluate trends in heart failure etiologies, management, and outcomes. [ABSTRACT FROM AUTHOR]

An abstract of the study "Impact of Heart Failure in Patients With Acute Coronary Syndromes Without ST Segment Elevation," by S. Stec and colleagues is presented.

Of 749 women with baseline data on TE, 41 (5.5%) had a TE at the time of PPCM diagnosis ( I Figure i 1A), 1.1% had a stroke, 1.7% an arterial TE and 4.2% a venous TE. The most common causes of death were HF and stroke (each accounting for 40% of deaths) in women with TE compared with HF in women without TE (41% due to HF, 33% sudden). Peripartum cardiomyopathy (PPCM) is a form of heart failure (HF) that develops towards the end of pregnancy or within the first months after delivery.[1] Rates of thromboembolism in PPCM are reportedly higher than in many other cardiomyopathies.[2] In the United States, thromboembolism was the most common serious complication in PPCM, occurring in 6.6% of affected women.[3] In the multinational European Society of Cardiology (ESC) EURObservational Research Programme (EORP) PPCM registry, 5% of patients had a thromboembolic event (TE) during the index hospitalization.[4] The peripartum period is a hypercoagulative phase, an evolutionary remnant to minimize postpartum haemorrhage.[5] The combination of left ventricular (LV) dilatation, endothelial injury, immobility, and postpartum hypercoagulable state, may explain the high prevalence of TE in women with PPCM. [Extracted from the article]

Background: Oral activated factor XI (FXIa) inhibitors may modulate coagulation to prevent thromboembolic events without substantially increasing bleeding. We explored the pharmacodynamics, safety, and efficacy of the oral FXIa inhibitor asundexian for secondary prevention after acute myocardial infarction (MI).Methods: We randomized 1601 patients with recent acute MI to oral asundexian 10, 20, or 50 mg or placebo once daily for 6 to 12 months in a double-blind, placebo-controlled, phase 2, dose-ranging trial. Patients were randomized within 5 days of their qualifying MI and received dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor. The effect of asundexian on FXIa inhibition was assessed at 4 weeks. The prespecified main safety outcome was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding comparing all pooled asundexian doses with placebo. The prespecified efficacy outcome was a composite of cardiovascular death, MI, stroke, or stent thrombosis comparing pooled asundexian 20 and 50 mg doses with placebo.Results: The median age was 68 years, 23% of participants were women, 51% had ST-segment-elevation MI, 80% were treated with aspirin plus ticagrelor or prasugrel, and 99% underwent percutaneous coronary intervention before randomization. Asundexian caused dose-related inhibition of FXIa activity, with 50 mg resulting in >90% inhibition. Over a median follow-up of 368 days, the main safety outcome occurred in 30 (7.6%), 32 (8.1%), 42 (10.5%), and 36 (9.0%) patients receiving asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian versus placebo: hazard ratio, 0.98 [90% CI, 0.71-1.35]). The efficacy outcome occurred in 27 (6.8%), 24 (6.0%), 22 (5.5%), and 22 (5.5%) patients assigned asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian 20 and 50 mg versus placebo: hazard ratio, 1.05 [90% CI, 0.69-1.61]).Conclusions: In patients with recent acute MI, 3 doses of asundexian, when added to aspirin plus a P2Y12 inhibitor, resulted in dose-dependent, near-complete inhibition of FXIa activity without a significant increase in bleeding and a low rate of ischemic events. These data support the investigation of asundexian at a dose of 50 mg daily in an adequately powered clinical trial of patients who experienced acute MI.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT04304534; URL: https://www.clinicaltrialsregister.eu/ctr-search/search; Unique identifier: 2019-003244-79. [ABSTRACT FROM AUTHOR]

Background: Using data from the ODYSSEY OUTCOMES trial (NCT01663402), we sought to identify factors associated with the development of incident atrial fibrillation in patients with recent acute coronary syndrome without prior atrial fibrillation and to determine whether alirocumab treatment influenced risk of incident atrial fibrillation.Methods: ODYSSEY OUTCOMES compared alirocumab treatment with placebo in 18,924 patients with recent acute coronary syndrome and dyslipidemia despite high-intensity or maximum-tolerated statin therapy. The primary outcome of major adverse cardiovascular events (MACE) comprised death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischemic stroke, or unstable angina requiring hospitalization. Patients were classified as having previous atrial fibrillation (present prior to or at randomization) or no previous atrial fibrillation. A multivariable model was used to determine factors associated with incident atrial fibrillation.Results: Among 18,262 participants without prior atrial fibrillation at baseline, 499 (2.7%) had incident atrial fibrillation during follow-up. Older age, history of heart failure or myocardial infarction, and higher body mass index were significantly associated with incident atrial fibrillation. Treatment with alirocumab or placebo did not influence the cumulative incidence of atrial fibrillation (hazard ratio 0.91; 95% confidence interval, 0.77-1.09). Patients with vs without a history of atrial fibrillation had a higher incidence of MACE (8.8 vs 3.7 events per 100 patient-years), without significant interaction between atrial fibrillation and randomized treatment on risk of MACE (Pinteraction = .78).Conclusions: While alirocumab did not modify risk of incident atrial fibrillation after acute coronary syndrome, it did reduce the risk of MACE, regardless of prior atrial fibrillation history. History of atrial fibrillation is an independent predictor of recurrent cardiovascular events after acute coronary syndrome. [ABSTRACT FROM AUTHOR]

A unique short-period ( P = 0.65356(1) d) Mercury-size Kepler exoplanet candidate KIC012557548b has been discovered recently by Rappaport et al. (2012). This object is a transiting disintegrating exoplanet with a circum-planetary material-comet-like tail. Close-in exoplanets, like KIC012557548b, are subjected to the greatest planet-star interactions. This interaction may have various forms. In certain cases it may cause formation of the comet-like tail. Strong interaction with the host star, and/or presence of an additional planet may lead to variations in the orbital period of the planet. Our main aim is to search for comet-like tails similar to KIC012557548b and for long-term orbital period variations. We are curious about frequency of comet-like tail formation among short-period Kepler exoplanet candidates. We concentrate on a sample of 20 close-in candidates with a period similar to KIC012557548b from the Kepler mission. We first improved the preliminary orbital periods and obtained the transit light curves. Subsequently we searched for the signatures of a circum-planetary material in these light curves. For this purpose the final transit light curve of each planet was fitted with a theoretical light curve, and the residuals were examined for abnormalities. We then searched for possible long-term changes of the orbital periods using the method of phase dispersion minimization. In 8 cases out of 20 we found some interesting peculiarities, but none of the exoplanet candidates showed signs of a comet-like tail. It seems that the frequency of comet-like tail formation among short-period Kepler exoplanet candidates is very low. We searched for comet-like tails based on the period criterion. Based on our results we can conclude that the short-period criterion is not enough to cause comet-like tail formation. This result is in agreement with the theory of the thermal wind and planet evaporation (Perez-Becker & Chiang 2013). We also found 3 cases of candidates which showed some changes of the orbital period. Based on our results we can see that orbital period changes are not caused by comet-like tail disintegration processes, but rather by possible massive outer companions. (© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [ABSTRACT FROM AUTHOR]

Tissue Doppler echocardiography is a novel technique that can be used to diagnose right ventricular (RV) systolic dysfunction. Until recently, there have been no data on the influence of tissue Doppler-derived RV systolic dysfunction on exercise capacity after inferior (posterior) myocardial infarction (MI). We studied 90 consecutive patients (76% men, mean age 61 ± 10 years) with first inferior ST-segment elevation MI and left ventricular ejection fraction ≥45%. RV systolic dysfunction was defined as RV systolic myocardial velocity <11.5 cm/s at the basal segment of the RV free wall assessed by pulse tissue Doppler. Patients were categorized as with or without RV systolic dysfunction (RV systolic myocardial velocity 9.34 ± 1.36 and 13.74 ± 1.58 cm/s, respectively). A cardiopulmonary exercise test was performed before or soon after discharge (day 14 ± 10). Patients with RV systolic dysfunction had lower oxygen consumption assessed as percent predicted oxygen uptake in liters per minute and milliliters per kilogram per minute at their anaerobic threshold (61 ± 11% vs 69 ± 17%, p = 0.007; 53 ± 12% vs 61 ± 19%, p = 0.012, respectively) and at peak exercise (71 ± 12% vs 83 ± 16%, p = 0.0001; 62 ± 14% vs 74 ± 21%, p = 0.002, respectively). Multivariate regression analysis revealed that the following independent factors negatively influenced exercise capacity: RV systolic dysfunction, female gender, age, lower body mass index, current smoking, and maximal troponin I concentration. In conclusion, we found decreased exercise capacity in patients with systolic RV dysfunction assessed by pulse tissue Doppler in patients with inferior (posterior) wall acute MI despite preserved left ventricular function. [ABSTRACT FROM AUTHOR]

ABSTRACT We continue here the systematic abundance analysis of a sample of Am binaries in order to search for possible abundance anomalies driven by tidal interaction in these binary systems. New CCD observations of HD 116657, HD 138213, HD 155375, HD 159560, HD 196544 and HD 204188 were obtained in two spectral regions (6400-6500 and 6660-6760 Å). A synthetic spectrum analysis was carried out and the basic stellar properties, effective temperatures, gravities, projected rotational velocities, masses, ages and abundances of several elements were determined. We conclude that all six stars are Am stars. These stars were put into the context of other Am binaries with 10 < Porb < 200 d, and their abundance anomalies discussed in the context of possible tidal effects. There is a clear anticorrelation of the Am peculiarities with v sin i. However, there seems also to be a correlation with the eccentricity and perhaps with the orbital period. The dependence on temperature, age, mass and microturbulence was studied as well. The projected rotational velocities obtained by us were compared with those of and . [ABSTRACT FROM AUTHOR]

Background: Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel. Methods: In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation. Results: At 12 months, the primary end point — a composite of death from vascular causes, myocardial infarction, or stroke — had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types. Conclusions: In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non–procedure-related bleeding. (ClinicalTrials.gov number, NCT00391872.) N Engl J Med 2009;361:1045-57. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the relationship between ischemia detected on continuous electrocardiographic (cECG) recording and cardiovascular outcomes after acute coronary syndrome (ACS). Background: The small size of prior studies evaluating cECG prevented full evaluation of the risk associated with ischemia across subpopulations and compared with other methods of risk stratification. Ranolazine, a new antianginal agent, reduces ischemic symptoms in patients with chronic angina and after ACS but the anti-ischemic effect, as detected by cECG, is not known. Methods: In all, 6,560 patients hospitalized with non–ST-segment elevation ACS were randomly assigned to ranolazine or placebo in the MERLIN–TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction 36) trial. The cECG was performed for 7 days after randomization. Outcomes were followed for a median of 348 days. Clinical events that occurred during cECG recording were excluded from analysis. Results: A total of 6,355 (97%) patients had cECG recordings evaluable for ischemia analysis. Patients with ≥1 episode of ischemia on cECG (n = 1,271, 20%) were at increased risk of cardiovascular death (7.7% vs. 2.7%, p < 0.001), MI (9.4% vs. 5.0%, p < 0.001), and recurrent ischemia (17.5% vs. 12.3%, p < 0.001). The relationship with cardiovascular death was independent of baseline characteristics or elevated biomarkers (adjusted hazard ratio: 2.46, p < 0.001). Ischemia on cECG was associated with significantly worse outcomes in several subgroups. Ranolazine did not reduce the rate of ischemia detected on cECG (19.9% vs. 21.0%, hazard ratio: 0.93, p = 0.21). Conclusions: In more than 6,300 patients with ACS, ischemia detected on cECG occurred frequently and was strongly and independently associated with poor cardiovascular outcomes, including cardiovascular death. Continuous ECG monitoring to detect ischemia after ACS may help to identify patients at increased risk. (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes [MERLIN]; NCT00099788) [Copyright &y& Elsevier]

Context: Ranolazine is a novel antianginal agent that reduces ischemia in patients with chronic angina but has not been studied in patients with acute coronary syndromes (ACS).Objective: To determine the efficacy and safety of ranolazine during long-term treatment of patients with non-ST-elevation ACS.Design, Setting, and Patients: A randomized, double-blind, placebo-controlled, multinational clinical trial of 6560 patients within 48 hours of ischemic symptoms who were treated with ranolazine (initiated intravenously and followed by oral ranolazine extended-release 1000 mg twice daily, n = 3279) or matching placebo (n = 3281), and followed up for a median of 348 days in the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes (MERLIN)-TIMI 36 trial between October 8, 2004, and February 14, 2007.Main Outcome Measures: The primary efficacy end point was a composite of cardiovascular death, myocardial infarction (MI), or recurrent ischemia through the end of study. The major safety end points were death from any cause and symptomatic documented arrhythmia.Results: The primary end point occurred in 696 patients (21.8%) in the ranolazine group and 753 patients (23.5%) in the placebo group (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.83-1.02; P = .11). The major secondary end point (cardiovascular death, MI, or severe recurrent ischemia) occurred in 602 patients (18.7%) in the ranolazine group and 625 (19.2%) in the placebo group (HR, 0.96; 95% CI, 0.86-1.08; P = .50). Cardiovascular death or MI occurred in 338 patients (10.4%) allocated to ranolazine and 343 patients (10.5%) allocated to placebo (HR, 0.99; 95% CI, 0.85-1.15; P = .87). Recurrent ischemia was reduced in the ranolazine group (430 [13.9%]) compared with the placebo group (494 [16.1%]; HR, 0.87; 95% CI, 0.76-0.99; P = .03). QTc prolongation requiring a reduction in the dose of intravenous drug occurred in 31 patients (0.9%) receiving ranolazine compared with 10 patients (0.3%) receiving placebo. Symptomatic documented arrhythmias did not differ between the ranolazine (99 [3.0%]) and placebo (102 [3.1%]) groups (P = .84). No difference in total mortality was observed with ranolazine compared with placebo (172 vs 175; HR, 0.99; 95% CI, 0.80-1.22; P = .91).Conclusions: The addition of ranolazine to standard treatment for ACS was not effective in reducing major cardiovascular events. Ranolazine did not adversely affect the risk of all-cause death or symptomatic documented arrhythmia. Our findings provide support for the safety and efficacy of ranolazine as antianginal therapy.Trial Registration: clinicaltrials.gov Identifier: NCT00099788. [ABSTRACT FROM AUTHOR]

Objective: To determine whether revascularisation is more likely to be performed in higher-risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies. Methods: GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24,189 patients enrolled at 73 hospitals with on-site angiographic facilities. Results: Overall, 32.5% of patients with a non-ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in-hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low-risk to 3.3% in medium-risk and 13.0% in high-risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low- (40% non-STEMI, 60% STEMI) than medium- (35%, 54%) or high-risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non-ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2-33.7%, n = 7210 observations), medium (35.7-51.4%, n = 7913 observations) or high rates (52.6-77.0%, n = 8942 observations) of intervention. Conclusions: A risk-averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient's risk status. Systematic and accurate risk stratification may allow higher-risk patients to be selected for revascularisation procedures, in contrast to current international practice. [ABSTRACT FROM AUTHOR]

Background: Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown.Methods: We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated.Findings: Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women.Interpretation: Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction. [ABSTRACT FROM AUTHOR]

Objective: To determine whether creatinine clearance at the time of hospital admission is an independent predictor of hospital mortality and adverse outcomes in patients with acute coronary syndromes (ACS).Design: A prospective multicentre observational study, GRACE (global registry of acute coronary events), of patients with the full spectrum of ACS.Setting: Ninety four hospitals of varying size and capability in 14 countries across four continents.Patients: 11 774 patients hospitalised with ACS, including ST and non-ST segment elevation acute myocardial infarction and unstable angina.Main Outcome Measures: Demographic and clinical characteristics, medication use, and in-hospital outcomes were compared for patients with creatinine clearance rates of > 60 ml/min (normal and minimally impaired renal function), 30-60 ml/min (moderate renal dysfunction), and < 30 ml/min (severe renal dysfunction).Results: Patients with moderate or severe renal dysfunction were older, were more likely to be women, and presented to participating hospitals with more comorbidities than those with normal or minimally impaired renal function. In comparison with patients with normal or minimally impaired renal function, patients with moderate renal dysfunction were twice as likely to die (odds ratio 2.09, 95% confidence interval 1.55 to 2.81) and those with severe renal dysfunction almost four times more likely to die (odds ratio 3.71, 95% confidence interval 2.57 to 5.37) after adjustment for other potentially confounding variables. The risk of major bleeding episodes increased as renal function worsened.Conclusion: In patients with ACS, creatinine clearance is an important independent predictor of hospital death and major bleeding. These data reinforce the importance of increased surveillance efforts and use of targeted intervention strategies in patients with acute coronary disease complicated by renal dysfunction. [ABSTRACT FROM AUTHOR]

Our primary study aim was to examine extent of, and factors associated with, delay in seeking medical care in a large multinational registry of patients with acute myocardial infarction (AMI) and unstable angina pectoris. A secondary goal was to examine the relation between duration of prehospital delay and receipt and timing of coronary reperfusion strategies. Investigators from 14 countries are participating in the Global Registry of Acute Coronary Events (GRACE) project. The study sample consisted of 3,693 patients with ST-segment elevation AMI, 2,935 with non-ST-segment elevation AMI, and 3,954 patients with unstable angina hospitalized between 1999 and 2001. The average and median delay times were longest in patients with non-ST-segment elevation AMI (6.1 and 3.0 hours, respectively) followed by patients with unstable angina (5.6 and 3.0 hours) and those with ST-segment elevation AMI (4.7 and 2.3 hours). Approximately 41% of patients with ST-segment elevation AMI presented to the 94 study hospitals within 2 hours of the onset of acute coronary symptoms; this compared with approximately one third of patients with non-ST-segment elevation AMI and unstable angina. Several demographic and clinical characteristics were associated with prehospital delay. In patients with ST-segment elevation AMI, duration of prehospital delay was inversely related to the receipt of thrombolytic therapy, but was inconsistently related to the use of percutaneous coronary interventions. The results of this study demonstrate that a large proportion of patients continue to exhibit prolonged delay in seeking medical care after the onset of acute coronary symptoms and remain in need of targeted educational efforts to reduce extent of delay. [ABSTRACT FROM AUTHOR]

Recently, associations between the biomarker galectin-3 and numerous pathological processes involved in heart failure (HF) and right ventricular (RV) function have been observed. We aimed to assess the long-term prognostic ability of galectin-3 and RV function parameters for all-cause mortality in HF patients treated with cardiac resynchronization therapy (CRT). We prospectively studied 63 symptomatic HF patients with a left ventricular (LV) ejection fraction (EF) ≤ 35%. The median serum galectin-3 concentration was 13.4 ng/mL (IQR 11.05, 17.15). A detailed assessment of LV and RV geometry and function was performed with echocardiography. CRT defibrillator implantation was achieved in all patients without major complications. The follow-up lasted 5 years. In the multivariable Cox regression model, independent predictors for all-cause mortality were log baseline galectin-3 and baseline RV function expressed as tricuspid annular plane systolic excursion with HR 2.96 (p = 0.037) and HR 0.88 (p = 0.023), respectively. Analysis of subgroups defined by galectin-3 concentration and CRT response showed that patients with high baseline galectin-3 concentrations and a lack of response to CRT had a significantly lower probability of survival. In our patient cohort, the baseline galectin-3 concentration and RV function were independent predictors of long-term all-cause mortality in HFrEF patients following CRT implantation. [ABSTRACT FROM AUTHOR]