AimsTo compare primary percutaneous coronary intervention (pPCI) and fibrinolysis in very old patients with ST-segment elevation myocardial infarction (STEMI), in whom head-to-head comparisons between both strategies are scarce.Methods and resultsPatients ≥75 years old with STEMI <6 h were randomized to pPCI or fibrinolysis. The primary endpoint was a composite of all-cause mortality, re-infarction, or disabling stroke at 30 days. The trial was prematurely stopped due to slow recruitment after enroling 266 patients (134 allocated to pPCI and 132 to fibrinolysis). Both groups were well balanced in baseline characteristics. Mean age was 81 years. The primary endpoint was reached in 25 patients in the pPCI group (18.9%) and 34 (25.4%) in the fibrinolysis arm [odds ratio (OR), 0.69; 95% confidence interval (CI) 0.38–1.23; P = 0.21]. Similarly, non-significant reductions were found in death (13.6 vs. 17.2%, P = 0.43), re-infarction (5.3 vs. 8.2%, P = 0.35), or disabling stroke (0.8 vs. 3.0%, P = 0.18). Recurrent ischaemia was less common in pPCI-treated patients (0.8 vs. 9.7%, P< 0.001). No differences were found in major bleeds. A pooled analysis with the two previous reperfusion trials performed in older patients showed an advantage of pPCI over fibrinolysis in reducing death, re-infarction, or stroke at 30 days (OR, 0.64; 95% CI 0.45–0.91).ConclusionPrimary PCI seems to be the best reperfusion therapy for STEMI even for the oldest patients. Early contemporary fibrinolytic therapy may be a safe alternative to pPCI in the elderly when this is not available.Clinicaltrials.gov # NCT00257309.

The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.

Angiographic measurements are not reliable in the assessment of intermediate LMCA lesions. An MLA of 6 mm(2) or more is a safe value for deferring revascularization of the LMCA, given the application of the clinical and angiographic inclusion criteria used in this study.

Quantum chaos in many-body systems provides a bridge between statistical and quantum physics with strong predictive power. This framework is valuable for analyzing properties of complex quantum systems such as energy spectra and the dynamics of thermalization. While contemporary methods in quantum chaos often rely on random ensembles of quantum states and Hamiltonians, this is not reflective of most real-world systems. In this paper, we introduce a new perspective: across a wide range of examples, a single non-random quantum state is shown to encode universal and highly random quantum state ensembles. We characterize these ensembles using the notion of quantum state k-designs from quantum information theory and investigate their universality using a combination of analytic and numerical techniques. In particular, we establish that k-designs arise naturally from generic states as well as individual states associated with strongly interacting, timeindependent Hamiltonian dynamics. Our results offer a new approach for studying quantum chaos and provide a practical method for sampling approximately uniformly random states; the latter has wide-ranging applications in quantum information science from tomography to benchmarking.

The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails.