Background: To assess safety of early discharge following primary percutaneous coronary intervention (PPCI) for STelevation myocardial infarction (STEMI). Methods and results: Retrospective analysis of prospectively collected data of 2448 STEMI patients treated with PPCI surviving to hospital discharge. Post-discharge all-cause mortality was reported at 1, 7, and 30 days and long-term follow up. A total of 1542 patients (63.0%) were discharged within 2 days of admission (early discharge group) and 906 patients (37.0%) after 2 days (late discharge group). In both groups, no deaths were recorded 1 day post discharge. The early and late discharge group mortality figures for 7 days were 0 and 4 patients (0.04%) and between 7 and 30 days were 11 (0.7%) and 11 patients (1.2%), respectively. During a mean follow up of 584 days, 178 patients (7.3%) died: 67 in the early discharge group (4.3%) and 111 in the late discharge group (12.3%). Conclusions: This exploratory, observational study demonstrates that discharging low-risk STEMI patients within 2 days following PPCI is safe. For providers of health care, early discharge can help to allay the cost of providing a 24-hour PPCI service and adds to the recognized benefits arising from PPCI.

Patients with diabetes mellitus presenting with acute coronary syndrome have a higher risk of cardiovascular complications and recurrent ischemic events when compared to nondiabetic counterparts. Different mechanisms including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrinolysis have been implicated for this increased atherothrombotic risk. Platelets play an important role in atherogenesis and its thrombotic complications in diabetic patients with acute coronary syndrome. Hence, potent platelet inhibition is of paramount importance in order to optimise outcomes of diabetic patients with acute coronary syndrome. The aim of this paper is to provide an overview of the increased thrombotic burden in diabetes and acute coronary syndrome, the underlying pathophysiology focussing on endothelial and platelet abnormalities, currently available antiplatelet therapies, their benefits and limitations in diabetic patients, and to describe potential future therapeutic strategies to overcome these limitations.

SUMMARYBackground: The prognostic value of admission heart rate (HR) on long-term mortality in ST-elevation myocardial infarction (STEMI) remains uncertain in the modern era of primary percutaneous coronary intervention (PPCI). This study aimed to assess the predictive value of admission HR on long-term mortality following PPCI and the influence of betablockers on postdischarge survival. Methods: Retrospective analysis of prospectively collected data on 2310 PPCI-treated STEMI patients at a regional tertiary center between March 2008 and June 2010. Results: Patients were classified according to admission HR into either low ( 70 beat per minute [bpm], n = 1015) or high HR group (>70 bpm, n = 1295). At a median follow-up of 559 days, all-cause mortality was 7.0% in the low HR group compared to 12.7% in the high-HR group. In the Cox proportional hazard model, adjusted for several confounders, the hazard ratio (95% confidence interval) for all-cause mortality in the high HR group was 1.59 (1.15-2.20; P = 0.005). Every 10-bpm increase in admission HR was associated with 17% increase in all-cause mortality. Beta-blockers on discharge was associated with a reduction in postdischarge mortality only in the high HR group (adjusted hazard ratio, 0.49 [0.31-0.77; P = 0.002]), but not in the low HR group (adjusted hazard ratio, 0.74 [0.37-1.49; P = 0.33]). Conclusions: Elevated admission heart rate in PPCI-treated STEMI patients is associated with long-term all-cause mortality. Beta blocker therapy improved postdischarge survival in patients with elevated admission heart rate.

Here we explore the disk-jet connection in the broad-line radio quasar 4C+74.26, utilizing the results of the multiwavelength monitoring of the source. The target is unique in that its radiative output at radio wavelengths is dominated by a moderately-beamed nuclear jet, at optical frequencies by the accretion disk, and in the hard X-ray range by the disk corona. Our analysis reveals a correlation (local and global significance of 96% and 98%, respectively) between the optical and radio bands, with the disk lagging behind the jet by 250 ± 42 days. We discuss the possible explanation for this, speculating that the observed disk and the jet flux changes are generated by magnetic fluctuations originating within the innermost parts of a truncated disk, and that the lag is related to a delayed radiative response of the disk when compared with the propagation timescale of magnetic perturbations along relativistic outflow. This scenario is supported by the re-analysis of the NuSTAR data, modelled in terms of a relativistic reflection from the disk illuminated by the coronal emission, which returns the inner disk radius R in /R ISCO = 35 +40 −16 . We discuss the global energetics in the system, arguing that while the accretion proceeds at the Eddington rate, with the accretion-related bolometric luminosity L bol ∼ 9 × 10 46 erg s −1 ∼ 0.2L Edd , the jet total kinetic energy L j ∼ 4 × 10 44 erg s −1 , inferred from the dynamical modelling of the giant radio lobes in the source, constitutes only a small fraction of the available accretion power.

Serum TSH levels, particularly in the SCH range, are associated with higher thrombus burden despite optimal recommended secondary prevention therapy after NSTE-ACS. This may explain the higher CV risk seen in SCH patients. Future trials to assess the effect of individualized antithrombotic as well as thyroid hormone replacement therapy to reduce atherothrombotic risk in this population are needed.

Here we present an analysis of the X-ray morphology and flux variability of the particularly bright and extended western hotspot in the nearest powerful (FR II-type) radio galaxy, Pictor A, based on data obtained with the Chandra X-ray Observatory. The hotspot marks the position where the relativistic jet, which originates in the active nucleus of the system, interacts with the intergalactic medium, at hundreds-of-kiloparsec distances from the host galaxy, forming a termination shock that converts jet bulk kinetic energy to internal energy of the plasma. The hotspot is bright in X-rays due to the synchrotron emission of electrons accelerated to ultrarelativistic energies at the shock front. In our analysis, we make use of several Chandra observations targeting the hotspot over the last decades with various exposures and off-axis angles. For each pointing, we study in detail the point-spread function, which allows us to perform the image deconvolution, and to resolve the hotspot structure. In particular, the brightest segment of the X-ray hotspot is observed to be extended in the direction perpendicular to the jet, forming a thin, ∼3 kpc long, feature that we identify with the front of the reverse shock. The position of this feature agrees well with the position of the optical intensity peak of the hotspot, but is clearly offset from the position of the radio intensity peak, located ∼1 kpc further downstream. In addition, we measure the net count rate on the deconvolved images, finding a gradual flux decrease by about 30% over the 15 yr timescale of the monitoring.

ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Gyntnema sylvesrre: (T. Sirukurincha) is used in indigeneous medicine for control of glycosuria. In this work the hypoglycaemic effect of G. sjlvesrrr was studied in 16 normal subjects and in 43 mild diabetics. Normal subjects anci diabetics were between 43 and 68 years of age. All the subjects were administered with G . Sylvestre leaf powder (10 g/day) for 7 days. Oral glucose tolerance test was performcd on all subjects before the administration of G. sylvesrre leaf powder. Normal subjecrs had the zero and 2 hour blood glucose levels of 80.8 ( 11.9) mg dl-' and 72.6 (? 14.4) mg dl~'respectively, while 43 mild diabetics had 152.7 (+ 28.5) mg dl-' and 240.0 ( k 22.5) mg dl-'. From 7th day, 36 mild diabetics were treated with tolbutamide for one week as prescribed by their doctors, while the remaining 7 diabetics continued the intake of G . Sylvestreleaf powder for another two weeks. Fasting blood glucose levels of normals, 36 diabetics on G.Sylvesrre and on tolbutamide, and 7 diabetics who continued with G. sylvestre leaf powder, were measured on zero, and 7th days; on zero, 7th and 14th days and on zero, 11th and 21st days respectively. Fasting blood glucose levels on the 7th da for normals K and mild diabetics w'ere 71.6 ( 2 12.9) mg dl" and 136.3 (k 20.3) mg dl7 respectively. The mean fasting blood glucose levels of both normals and diabetics had significantly decreased 7 days after the administration of G . Sylvesrrr leaf powder. Fasting blood ' ' glucose levels of the 36 diabetics on tolbutamide for 7 days (on 14th day of commencement of the experiment) was 131.1 (2 15.1) mg dl-'. Mean fasting blood glucose levels of 36 diabetics on 7th day (136.3 k 20.3 mg dl-') and 14th day (131.1 + 15.1 mg dl-') showed no significant difference. Fasting bldod glucose levels of 7 diabetics who took G. Sylvesrre leaf powder for 3 weeks showed improved glucose tolerance on the 21st day, (101.2 + 31.9 rng dl-'). This indicates that G. Sylvesrre leaf powder has probably had a hypoglycaemic effect comparable to tolbutamide. Serum triacylglycerol, free fatty acids and cholesterol levels of the normals were unaffected by the intake of G.sylvestre leaf powder for one week, whereas that of diabetics had significantly decreased.Serum ascorbic acid and iron levels of normals and diabetics were elevated significantly due to the intake of G. sylvestre leaf powder. Intake of G. Sylvesrre had not affected the excretion of creatine in normals whereas in diabetics it had decreased the excretion of creatine. S G O T and SGPT levels of normals and diabetics, before and after the administration of G. sylvestre, were not significantly different.