The flexible, electropositive cavity of linear 1,4-diaryl-1,2,3-triazole oligomers provides a suitable host for complexation of various anions. The binding affinities for various combinations of oligomer and anion were determined by (1)H NMR titrations. Effective ionic radius is found to be a primary determinant of the relative binding interactions of various guests, with small but measurable deviations in the case of nonspherical anions. Solvent effects are significant, and the strength of the binding interaction is found to depend directly on the donor ability of the solvent. A picture emerges in which anion binding can be effectively interpreted in terms of a competition between two solvation spheres: one provided by the solvent and a second dominated by a folded cavity lined with electropositive 1,2,3-triazole CH protons. Implications for rigid macrocycles and other multivalent hosts are discussed.
Introduction:
Non-ST-elevation myocardial infarction (NSTEMI) patients have more comorbidities and extensive CAD than STEMI patients. However, there is a need for comparative data on the long-term prognosis and resource utilization of stable patients after these MI subtypes.
Methods:
TIGRIS enrolled 9027 stable patients 1-3 years post-MI (369 centers, 25 countries) with ≥1 risk factor (age ≥65 years, diabetes, 2nd prior MI, multivessel CAD, CKD). The incidence of cardiovascular (CV) events and deaths, and self-reported EQ-D5 score were recorded over 2 years. Multivariable Poisson regression models were used to compare STEMI and NSTEMI patients for relative risks, adjusting for prognostically relevant patient factors.
Results:
MI subtype was known in 8494 patients (STEMI: 56%; NSTEMI: 44%). At enrollment, NSTEMI patients were more likely to be older, have diabetes, hypertension, hyperlipidemia, and prior CAD compared with STEMI patients. NSTEMI patients had significantly poorer self-rated health and a lower use of dual antiplatelet therapy at discharge and 1-3 years later. NSTEMI patients had a higher incidence of the composite of MI, stroke and CV death over 2 years (5.6% vs 4.0%, p<0.001) and higher all-cause mortality (4.1% vs 2.6%, p<0.001) vs STEMI patients (Figure). These excess risks for the composite outcome attenuated after adjusting for baseline characteristics (adj RR 1.18, 95% CI 0.96-1.45, p=0.11), but remained significant for all-cause mortality (adj RR 1.31, 95% CI 1.02-1.68, p=0.03). Resource utilization over 2 years was higher in NSTEMI patients, although the mean number of cardiologist visits were higher for STEMI patients (4.2 vs 2.8, p<0.001).
Conclusions:
NSTEMI patients had a less favorable risk profile and experienced more adverse CV events during long-term follow-up than STEMI patients, but had less intense cardiology follow-up. Continued efforts are needed to optimize secondary prevention and care of stable patients after NSTEMI.
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