DESSOLVE III trial shows no clear advantage of bioresorbable polymer stents


Dr K K Aggarwal    13 January 2018

DESSOLVE III trial shows no clear advantage of bioresorbable polymer stents

DESSOLVE III trial shows no clear advantage of bioresorbable polymer stents. The trial randomly assigned nearly 1400 patients to a sirolimus-eluting bioresorbable polymer stent or an everolimus-eluting durable polymer stent. After 12 months, there was no difference in the rate of the composite end point, which included cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularization (Lancet. 2017). Based on this and other randomized trials showing no clear advantage of bioresorbable polymer stent materials, yet higher cost and less long-term experience compared with durable polymer stents, no one should implant bioresorbable polymer drug-eluting stents outside of clinical trials or registries. Idarucizumab is a monoclonal antibody fragment against dabigatran that can reverse the anticoagulant effect within minutes. A preliminary report suggested good efficacy in patients with dabigatran-associated bleeding or those undergoing emergency surgery. In a new report of over 500 patients treated with idarucizumab, most had cessation of bleeding or underwent surgery without abnormal bleeding (N Engl J Med. 2017; 377:431). The Global Burden of Disease study estimated that there were 33.4 million cases of rheumatic heart disease worldwide in 2015 (N Engl J Med. 2017; 377:713). Vitamin D supplementation (4000 IU daily for three years) compared with placebo did not reduce overall mortality in patients with advanced heart failure and baseline vitamin D levels <30 ng/dL (75 nmol/L) (Eur Heart J. 2017; 38:2279). Biotin, which is contained in varying amounts in many vitamins and dietary supplements, may impact the results of high-sensitivity troponin assays. While the reported troponin values are often decreased, elevations have also been reported (Clin Chem Lab Med. 2017; 55:e226). In the large ROOBY trial, the rate of death at five years was significantly higher with off-pump, compared with on-pump, CABG (15.2% vs 11.9%) (N Engl J Med. 2017; 377:623). Several trials have shown reduced arrhythmia-related mortality among patients with nonischemic cardiomyopathy who receive an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death, but no individual trial has shown a benefit in total mortality. Four meta-analyses that included patients receiving a primary prevention ICD from the same six trials (CAT, AMIOVIRT, DEFINITE, SCD-HeFT, COMPANION, and DANISH), demonstrate a significant benefit for all-cause mortality compared with medical therapy alone (19 to 24 percent hazard reduction) (Ann Intern Med. 2017;167:103). Biomarkers are going to be of increasing importance in the management of patients with Crohn’s disease. First is C-reactive protein and the second is fecal calprotectin. A new study by the Medical Research Council Laboratory of Molecular Biology at Cambridge University, has found that when the body processes alcohol it produces a chemical called acetaldehyde, which is harmful to DNA. Acetaldehyde snaps the DNA of stem cells, permanently altering the genetic code and triggering cancer. Acetaldehyde snaps the DNA of stem cells, permanently altering the genetic code and triggering cancer. The study also found that some people carry genetic mutations in two genes - aldh2 and Fancd2 - which make them even more susceptible to the effects of alcohol, making drinking far more dangerous. Ultrasound features that are specific for a cyst include a well-defined thin wall and increased through-transmission. Lesions which show these features need no further evaluation. The size of the liver mass is an important consideration in guiding the evaluation. Lesions smaller than approximately 1.0 cm are commonly benign incidental findings on imaging studies, and in most cases represent small cysts, hemangiomas, or biliary hamartomas (Radiology. 1999;210:71). The Supreme Court in October 2017 stayed National Consumer Disputes Redressal Commissions order bringing free medical services provided by government hospitals within the ambit of Consumer Protection Act to make doctors and hospital liable to pay compensation for any kind of negligence. August 2017: NCDRC says Delhi commission can admit cases against hospital located in Gurugram: The National Consumer Disputes Redressal Commission (NCDRC) has dismissed a plea by Medanta The Medicity Hospital, which claimed that the State Commission in Delhi has no jurisdiction over it as the hospital is located in Gurugram. The hospital contended that the complaint could be filed in Delhi only if the ‘hospital itself or its branch office was situated at Delhi’. The hospital further claimed that the patient had been treated by the same doctor, but in a different hospital and that it had no bearing on the treatment done at Medicity Hospital. Referring to the Consumer Protection Act, 1986, the NCDRC stated that the State commission’s jurisdictional limits included areas where the party ‘carries on business or has a branch office or personally works for gain’. “The words ‘carries on business’ do imply that the complaint could be instituted at a place from where the business of the opposite party is being handled, controlled or supervised,”. The NCDRC observed that as the hospital had its corporate or registered office in Delhi, it did give the State commission jurisdiction over it. The hospital is ‘carrying on its business’ from Delhi and the consumer complaint could be filed in Delhi as well.

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