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INTRODUCTION AND OBJECTIVES: Transfemoral access is the most frequently used vascular approach in chronic total occlusion percutaneous coronary interventions (CTO-PCI). The aim of this study was to evaluate the safety and feasibility of a transradial access CTO-PCI program and its impact on angiographic and clinical results and length of hospital stay.; METHODS: Retrospective multicenter cohort study including 2550 consecutive CTO-PCI procedures included in a multicenter registry with accurate information on vascular access. A total of 896 procedures were performed as radial-only access while 1654 were performed through at least 1 femoral puncture. Clinical and angiographic data were collected.; RESULTS: The mean age was 66.3 ± 11.4 years. The mean Japan-chronic total occlusion score (2.7 ± 0.3) was similar in the 2 groups. Successful revascularization was achieved in 2009 (79.6%) cases, 78.2% and 82.1% in the femoral and radial access cohorts, respectively (P = .002). Periprocedural in-hospital complications were observed in 5.1% and 2.3% (P = .02), with fewer access site-dependant vascular complications in the transradial cohort (2.3% vs 0.2%; P = .009). The mean length of hospital stay was significantly shorter in the transradial access group (0.89 ± 1.4 vs 2.2 ± 3.2 days, P < .001).; CONCLUSION: A transradial program for CTO-PCI is safe and effective in most CTO lesions. The transradial strategy has fewer vascular complications and shorter length of hospital stay without compromising the success rate. Copyright © 2022. Published by Elsevier Espana, S.L.U.

BACKGROUND: The long-term safety and performance of magnesium-based bioresorbable scaffolds (MgBRS) in ST-segment-elevation myocardial infarction (STEMI) patients are uncertain. AIMS: The aim of this study was to report the 3-year clinical outcomes of the MAGSTEMI trial. METHODS: This investigator-driven, multicentre, randomised, single-blind, controlled trial randomised STEMI patients 1:1 to MgBRS or to permanent metallic sirolimus-eluting stents (SES) at 11 academic centres. The main secondary endpoints included device-oriented composite endpoints (DoCE) and patient-oriented composite endpoints (PoCE), their individual components, any bleeding, and device thrombosis rate. All endpoints were defined according to the Academic Research Consortium. Events were adjudicated by an independent committee. RESULTS: Three-year clinical follow-up was obtained in 142 (90.0%) patients. At 3-year follow-up, MgBRS were associated with a higher rate of DoCE than SES (13 [17.6%] vs 5 [6.6%], diff -11.0 [95% CI: -21.3 to -0.7]; p=0.038). This difference was driven by an increased incidence of DoCE within the first year of follow-up. In the landmark analysis, there was no difference between 1 and 3 years (0 [0.0%] vs 1 [1.4%]; p=1.000). The difference in the rate of DoCE was driven by a higher incidence of target lesion revascularisation (TLR) in the MgBRS group compared to SES (12 [16.2%] vs 4 [5.3%]; diff -10.9% [95% CI: -20.7 to -1.2]; p=0.030). The difference in TLR was observed during the first year, with no further differences observed between 1 and 3 years (0 [0.0%] vs 1 [1.4%]; p=1.000). CONCLUSIONS: At 3-year follow-up, MgBRS were associated with a higher rate of TLR, which was clustered within the first year, compared to SES.

Aim Use of a Bioresorbable Scaffolds (BRS) either in clinical practice or in the setting of an acute myocardial infarction (MI) is controversial. Despite an overall high rate of thrombosis, vascular healing response following BRS implantation tend to superiority as compared to metallic drug-eluting stent in ST-segment elevation myocardial infarction (STEMI) patients. We sought to compare the in-stent/scaffold vasomotion between metallic BRS and sirolimus eluting stent (SES) at 12-month angiographic follow-up in the setting of patients with STEMI treated by primary PCI. Study design This is an investigator-driven, prospective, multicenter, randomized, single blind, two-arm, controlled trial ( number: NCT03234348). This trial will randomize similar to 148 patients 1:1 to SES or BRS. Primary end-point is the in-stent/scaffold change in mean lumen diameter after nitroglycerin administration at 12-month angiographic follow-up. Besides, patient-oriented combined endpoint of all-cause death, any MI, and any revascularization, together with scaffold/stent thrombosis rate and device-oriented endpoint of cardiac death, target vessel (TV)-MI and TVR at 1 year will be also evaluated. Clinical follow-up will be scheduled yearly up to 5 years. Conclusion This trial will shed light on the vascular vasomotion following BRS implantation in the complex scenario of STEMI.

Key PointsQuestionWhat are the benefits and risks of continuing aspirin in addition to P2Y12 receptor inhibition with ticagrelor among patients with acute coronary syndrome between 1 month and 12 months after percutaneous coronary intervention? FindingsIn this nonprespecified, post hoc analysis of the GLOBAL LEADERS randomized clinical trial, beyond 1 month after percutaneous coronary intervention in acute coronary syndrome, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. MeaningThe findings of this hypothesis-generating analysis pave the way for further trials evaluating aspirin-free antiplatelet strategies after percutaneous coronary intervention. ImportanceThe role of aspirin as part of antiplatelet regimens in acute coronary syndromes (ACS) needs to be clarified in the context of newer potent P2Y12 antagonists. ObjectiveTo evaluate the benefit and risks of aspirin in addition to ticagrelor among patients with ACS beyond 1 month after percutaneous coronary intervention (PCI). Design, Setting, and ParticipantsThis is a nonprespecified, post hoc analysis of GLOBAL LEADERS, a randomized, open-label superiority trial comparing 2 antiplatelet treatment strategies after PCI. The trial included 130 secondary/tertiary care hospitals in different countries, with 15991 unselected patients with stable coronary artery disease or ACS undergoing PCI. Patients had outpatient visits at 1, 3, 6, 12, 18, and 24 months after index procedure. InterventionsThe experimental group received aspirin plus ticagrelor for 1 month followed by 23-month ticagrelor monotherapy; the reference group received aspirin plus either clopidogrel (stable coronary artery disease) or ticagrelor (ACS) for 12 months, followed by 12-month aspirin monotherapy. In this analysis, we examined the clinical outcomes occurring between 31 days and 365 days after randomization, specifically in patients with ACS who, within this time frame, were assigned to receive either ticagrelor alone or ticagrelor and aspirin. Main Outcomes and MeasuresThe primary outcome was the composite of all-cause death or new Q-wave myocardial infarction. ResultsOf 15968 participants, there were 7487 patients with ACS enrolled; 3750 patients were assigned to the experimental group and 3737 patients to the reference group. Between 31 and 365 days after randomization, the primary outcome occurred in 55 patients (1.5%) in the experimental group and in 75 patients (2.0%) in the reference group (hazard ratio [HR], 0.73; 95% CI, 0.51-1.03; P=.07); investigator-reported Bleeding Academic Research Consortium-defined bleeding type 3 or 5 occurred in 28 patients (0.8%) in the experimental group and in 54 patients (1.5%) in the reference arm (HR, 0.52; 95% CI, 0.33-0.81; P=.004). Conclusions and RelevanceBetween 1 month and 12 months after PCI in ACS, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. These findings should be interpreted as exploratory and hypothesis generating; however, they pave the way for further trials evaluating aspirin-free antiplatelet strategies after PCI. Trial RegistrationClinicalTrials.gov identifier: NCT01813435. This secondary analysis of the GLOBAL LEADERS randomized clinical trial evaluates the benefit and risks of aspirin in addition to ticagrelor among patients with acute coronary syndrome beyond 1 month after percutaneous coronary intervention.

The objective of this work is to analyze the local hemodynamic changes caused in a coronary bifurcation by three different stenting techniques: simple stenting of the main vessel, simple stenting of the main vessel with kissing balloon in the side branch and culotte. To carry out this study an idealized geometry of a coronary bifurcation is used, and two bifurcation angles, 45° and 90°, are chosen as representative of the wide variety of real configurations. Both numerical simulations and experimental measurements are performed. First, steady simulations are carried out with the commercial code ANSYS Fluent, then, experimental measurements with PIV (Particle Image Velocimetry), obtained in the laboratory, are used to validate the numerical simulations. The steady computational simulations show a good overall agreement with the experimental data. Second, pulsatile flow is considered to take into account the transient effects. The time averaged wall shear stress, oscillatory shear index (OSI) and pressure drop obtained numerically are used to compare the behavior of the stenting techniques. As conclusions obtained, simple stenting technique shows the worst results in terms of pressure drop, and kissing the best ones. This criterion could be applied for DES (Drug Eluting Stents) where the restenosis is not as critical as the reestablishment of the blood flow. But considering the regions of low wall shear stress (0.1), the culotte procedure shows the worst performance and the simple stent, the best. This could be applied to BMS (Bare Metal Stents).

Explosive phenomena on concrete structures have catastrophic effects in many instances despite its reduced occurrence. The civil buildings are usually not designed to withstand this type of dynamic load, so a methodology to analyze the structural response on blast loads is recommended. This paper studies the behavior of reinforced concrete frame structures against these actions by lagrangian finite elements method with explicit time integration. Finite element models of segregated concrete and rebar are used to make possible the study of structure parts as columns and slabs, but is not possible to use these detailed models in complete structures because of excessive computational costs. Shell and beam elements models properly calibrated are needed to obtain a similar response. Conclusions and practical recommendations are provided for the use and calibration of models and realistic simulations. El fenómeno de explosión sobre estructuras de hormigón tiene efectos en muchos casos catastróficos a pesar de su reducida frecuencia. Las edificaciones civiles no suelen estar diseñadas para resistir este tipo de solicitación dinámica, por lo que conviene disponer de una metodología que permita analizar los efectos de las explosiones sobre las mismas. Este trabajo estudia el comportamiento de las estructuras reticuladas de hormigón armado frente a estas acciones, mediante métodos numéricos de elementos finitos lagrangianos con integración explícita en el tiempo. Se analizan de forma realista partes de la estructura como columnas y forjados usando modelos con hormigón y armaduras de forma segregada, pero las limitaciones computacionales los hacen inviables para estructuras completas. Se proponen modelos de elementos lámina y viga debidamente calibrados para obtener una respuesta similar. Se obtienen conclusiones para el uso y calibración de modelos y simulaciones realistas de edificios completos para estudios de seguridad.

Item does not contain fulltext BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. METHODS: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P=0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P

The threat of impact or explosive loads is regrettably a scenario to be taken into account in the design of lifeline or critical civilian buildings. These are often made of concrete and not specifically designed for military threats. Numerical simulation of such cases may be undertaken with the aid of state of the art explicit dynamic codes, however several difficult challenges are inherent to such models: the material modeling for the concrete anisotropic failure, consideration of reinforcement bars and important structural details, adequate modeling of pressure waves from explosions in complex geometries, and efficient solution to models of complete buildings which can realistically assess failure modes. In this work we employ LS-Dyna for calculation, with Lagrangian finite elements and explicit time integration. Reinforced concrete may be represented in a fairly accurate fashion with recent models such as CSCM model [1] and segregated rebars constrained within the continuum mesh. However, such models cannot be realistically employed for complete models of large buildings, due to limitations of time and computer resources. The use of structural beam and shell elements for this purpose would be the obvious solution, with much lower computational cost. However, this modeling requires careful calibration in order to reproduce adequately the highly nonlinear response of structural concrete members, including bending with and without compression, cracking or plastic crushing, plastic deformation of reinforcement, erosion of vanished elements etc. The main objective of this work is to provide a strategy for modeling such scenarios based on structural elements, using available material models for structural elements [2] and techniques to include the reinforcement in a realistic way. These models are calibrated against fully three-dimensional models and shown to be accurate enough. At the same time they provide the basis for realistic simulation of impact and explosion on full-scale buildings

Thoracic endografting is a very attractive therapeutic approach for thoracic aorta pathologies. Still some technological limitations need to be solved. Relay represents a new endograft specifically designed for thoracic aorta. The two-year clinical outcomes are presented.RESTORE is a multicenter, European, prospective and monitored clinical registry. Patients with thoracic pathologies (acute or elective) suitable to be treated with Relay stent-graft were consecutively enrolled. Preoperative demographic data, procedure details, in hospital assessment and two year-follow-up outcomes were registered and analyzed.A cohort of 150 patients (125 males and 25 females) was included. Aneurysm was the most common pathology treated (64.7%) followed by dissections (19.3%). Overall technical success rate was 97.33%. Paraplegia rate was 3.3%, recovered paraparesis in 3.3% of the cases and stroke rate was only 0.6%. Successful reinterventions were necessary in 8.7% of the cases; one trans-thoracic intervention due to a retrograde type A dissection. The 30-day mortality rate was 10%. Four non-related mortality were recorded during surveillance. Reintervention rate during two year-follow-up was 8.9% due to two stent graft migrations, three proximal type I endoleak, four type III endoleak and five distal type I endoleaks. No open conversion was needed during follow-up. No wire form ruptures were observed during the follow-up period.Relay provides a safe and accurate thoracic stent grafting for different aortic pathologies with acceptable mortality and morbidity. Associated stroke rate was clearly inferior to the expected.