These findings demonstrate a dose dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools are not used. While study of a larger cohort is needed to confirm these findings, the results suggest ocular radio-protection should be utilized.
Aims:The optimal duration of DAPT in ACS patients treated with DES is still unclear. Therefore, the aim of the current study was to investigate a short versus a standard 12-month DAPT regimen in ACS patients undergoing new-generation DES implantation.Methods and results: REDUCE was a prospective, open-label, multicentre, investigator-initiated study that randomised 1,496 ACS patients after treatment with the COMBO stent to either three (n=751) or 12 months (n=745) of DAPT. The primary study endpoint was a composite of all-cause mortality, myocardial infarction, stent thrombosis, stroke, target vessel revascularisation and bleeding at 12 months. No difference was observed in the demographic and clinical characteristics between the two groups, except for gender (p=0.01). At one-year follow-up, non-inferiority of three-versus 12-month DAPT in the primary endpoint was met (8.2% vs 8.4%, p non-inferiority <0.001). The similar outcome between the two groups was confirmed at two-year follow-up (11.6% vs 12.1%, p=0.76), with no significant difference in overall mortality (3.1% vs 2.2%, p=0.27), cardiac mortality (1.8% vs 1.1%, p=0.28), stent thrombosis (1.6% vs 0.8%, p=0.16) and major bleeding (3.3% vs 4.0%, p=0.46).
Conclusions:The results show that, among ACS patients treated with the COMBO stent, three months is non-inferior to 12 months of DAPT. However, given the numerically higher rates of mortality and ST in the three-month DAPT group, one-year DAPT should still be recommended in ACS until more information becomes available. A three-month DAPT strategy should be considered only if clinically mandated.
Background: Guideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors/angiotensin-receptor blockers (ARBs) and beta-blockers are similar for men and women with heart failure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesized that there may be sex differences in the optimal dose of ACE-inhibitors/ARBs and beta-blockers in patients with HFrEF. Methods: We performed a post-hoc-analysis of BIOSTAT-CHF, a prospective study of HF patients in whom initiation and up-titration of ACE-inhibitors/ARBs and beta-blockers was encouraged by protocol. Findings were validated in an independent cohort (ASIAN-HF) of 3,539 men and 961 women with HFrEF. Findings: Among 1,308 men and 402 women with HFrEF from BIOSTAT-CHF, women were older (74 vs. 70 years, p<0•001), and had lower body weight (72 vs. 85 kg, p<0•001) and height (162 vs. 174 cm, p<0•001) than men, although body mass index did not differ significantly. A similar % of men and women reached guideline-recommended target doses of ACE-inhibitors/ARBs (25 vs. 23%; p=0•61) and beta-blockers (14 vs. 13%; p=0•54). In men, the lowest hazards of death and/or HFhospitalization occurred at 100% of the recommended dose of ACE-inhibitors/ARBs and betablockers, but women showed a ~30% lower risk at only 50% of the recommended doses, with no further decrease in risk at higher dose levels. These sex differences were still present after adjusting for clinical covariates including age and body surface area. In the ASIAN-HF registry, similar patterns were observed for both ACE-inhibitors/ARBs and beta-blockers, with women having a ~30% lower risk at 50% of the recommended doses, with no further benefit at higher dose levels. Interpretation: This study suggests that women with HFrEF may need lower doses of ACEinhibitors/ARBs and beta-blockers as compared with men, and brings into question what true 'optimal medical therapy' is for women versus men.
These first prospective multinational data from Asia show that HFpEF affects relatively young patients with a high burden of co-morbidities. Regional differences in types of co-morbidities, cardiac remodelling and outcomes of HFpEF across Asia have important implications for public health measures and global HFpEF trial design.
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