[Correspondence] Subclinical leaflet thrombosis
Tarun Chakravarty and colleagues (June 17, 2017, p 2383)1 reported that anticoagulation was superior to dual antiplatelet therapy in the prevention of subclinical valve thrombosis. This highly relevant analysis added much-needed evidence regarding optimal antithrombotic medication in patients with transcatheter aortic valve replacement. In these patients, ischaemic events are rare and bleeding events are frequent. Unfortunately, bleeding was not investigated and interindividual pharmacodynamic response to antiplatelet medication varies substantially. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Kerstin Piayda, Tobias Zeus, Horst Sievert, Malte Kelm, Amin Polzin Tags: Correspondence Source Type: research
[Correspondence] Bioresorbable polymer drug-eluting stents – Authors' reply
We thank Rahman Shah and Mohammed Alkhalil for their interest and thoughtful comments regarding the results of the BIOFLOW V trial1 and appreciate the opportunity to respond with further perspective. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: David E Kandzari, Laura Mauri, Jacques J Koolen, Gheorghe Doros, Ron Waksman Tags: Correspondence Source Type: research
[Correspondence] Bioresorbable polymer drug-eluting stents
In the BIOFLOW V randomised trial,1 ultrathin bioresorbable polymer sirolimus-eluting stents (Orsiro; BIOTRONIK, Buelach, Switzerland) were found to be superior to durable polymer everolimus-eluting stents (Xience; Abbott Vascular, Santa Clara, CA, USA) in combined composite endpoints of cardiovascular death, target vessel-related myocardial infarction, or ischaemia-driven target lesion revascularisation at 12 months (95% CI −6·84 to −0·29, p=0·0399). The Kaplan-Meier plot for the primary composite endpoints revealed that most events occurred 1–2 days after patients were randomly assigned; however, the curves run ...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Mohammad Alkhalil Tags: Correspondence Source Type: research
[Correspondence] Bioresorbable polymer drug-eluting stents
I read with great interest the results of the BIOFLOW V trial (Oct 21, 2017, p 1843).1 David Kandzari and colleagues should be congratulated on such an important study. The authors concluded that an ultrathin bioresorbable polymer drug-eluting stent (BRP-DES) outperformed a durable polymer-eluting stent (DP-DES) because the proportion of patients who had target-vessel myocardial infarctions at 12 months was lower in the BRP-DES group than in the DP-DES group. However, the proportion of patients who had myocardial infarction at 12 months was substantially higher in the DP-DES group than in previous trials comparing a BRP-DE...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Rahman Shah Tags: Correspondence Source Type: research
[Correspondence] Clinical benefits of evolocumab appear less than hoped – Authors' reply
Our analysis1 of the association between LDL-cholesterol concentrations at 4 weeks and cardiovascular outcomes reported in FOURIER2 complemented the primary data from the randomised comparison between evolocumab and placebo. Unlike previous epidemiological studies and the selected studies cited by Simon B Dimmitt and colleagues, we analysed the association between the reduction of LDL-cholesterol concentrations to unprecedented low levels and clinical outcomes, adjusting for differences in baseline characteristics. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Robert P Giugliano, Anthony C Keech, Peter S Sever, Terje R Pedersen, Marc S Sabatine Tags: Correspondence Source Type: research
[Correspondence] Clinical benefits of evolocumab appear less than hoped
The strong correlation between on-treatment LDL cholesterol and cardiovascular events observed in the prespecified secondary analysis of the FOURIER trial published in The Lancet (Oct 28, 2017, p 1962)1 is no different from that reported on treatment in several previous clinical trials of statins and on no treatment in epidemiological studies. The on treatment correlation conflates the epidemiology with pharmacological lowering of LDL2 by evolocumab and the co-prescribed statin. In FOURIER,3 the addition of evolocumab to statin therapy lowered LDL by 59%, but the risk of myocardial infarction was only reduced by 27% compar...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Simon B Dimmitt, Hans G Stampfer, Jennifer H Martin, John B Warren Tags: Correspondence Source Type: research
[Correspondence] Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis
Immune checkpoint inhibitors have greatly improved clinical outcomes in multiple cancer types and are increasingly being used in earlier disease settings and in combination with other therapies.1 However, high-grade immune-related adverse events can occur. Fulminant cases of immune checkpoint inhibitor-related myocarditis have been reported,2 –4 but the characteristics, timing, and outcomes of this new clinical entity are unknown. We used VigiBase,5 WHO's database of individual case safety reports, to identify 101 cases of severe myocarditis following treatment with immune checkpoint inhibitors, and observed early onset ...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Javid J Moslehi, Joe-Elie Salem, Jeffrey A Sosman, B énédicte Lebrun-Vignes, Douglas B Johnson Tags: Correspondence Source Type: research
[Obituary] Francis Fontan
Cardiac surgeon who devised the Fontan procedure. He was born in Nay, France, on July 3, 1929, and died at home in Bordeaux, France, on Jan 14, 2017, aged 88 years. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research
[Perspectives] BioArt: materials and molecules
Anna Dumitriu: BioArt and Bacteria at the University of Oxford's Museum of the History of Science is the first time, according to Silke Ackermann, the Museum Director, that the special exhibition space has been wholly given over to artworks, without directly referencing objects from the museum. Dumitriu's work, the exhibition declares, “combines traditional artistic media with contemporary science to produce artwork that is not only about bacteria but actually fused with them”. The show follows on from Back from the Dead, a 2017 special exhibition at the museum that examined the nature of antibiotics from the 1940s to ...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Kelley Swain Tags: Perspectives Source Type: research
[Perspectives] The promissory nature of artificial hearts
“The Artificial Heart is Here” announced LIFE magazine in September, 1981. An image of the Utah total artificial heart (TAH), also known as the Jarvik-7 heart, dominated the issue cover against a vivid red background. The inside story, bolstered with large, colourful photographs, predicted a bre akthrough decade for this technology. Such anticipation was not entirely off-base, given the promissory nature of the technology as a curative fix for end-stage heart failure that aligned with the view of the body as an entity of replacement parts and the confidence of artificial heart researchers i n these devices. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Shelley McKellar Tags: Perspectives Source Type: research
[Perspectives] Resistance to injustice
Some of the most compelling films at this year's Human Rights Watch Film Festival in London, UK, show women battling the established political, social, or moral order. “We have not just women directors this year, we have a group of films that show central female characters very strongly pushing back against society in one way or another”, said John Biaggi, the festival's creative director. Half of the 14 award-winning international documentary and feature film s in the festival, which Biaggi and his team selected from more than 500 entries, are directed by women. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Mark Tran Tags: Perspectives Source Type: research
[Perspectives] Peter Sands: charting a new course for The Global Fund
Peter Sands had a stormy start before taking up his new position as Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria on March 5, 2018. He was plunged into controversy last month after the decision by The Global Fund's senior management team to partner with Heineken, among other multinationals, and the implications for global health. The organisation, which invests and raises almost US$4 billion each year, is the world's largest public –private partnership set up to finance programmes to treat and prevent these three diseases and strengthen national health systems in the long term. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Pamela Das Tags: Perspectives Source Type: research
[World Report] Rheumatic heart disease in the Pacific island nations
A pending motion from WHO might seek to eradicate rheumatic heart disease, which is still prevalent in Pacific island nations where progress is lagging. Chris McCall reports. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Chris McCall Tags: World Report Source Type: research
[World Report] Canada's federal budget under review
Canada champions science, women, and Indigenous health, while sidestepping pharmacare. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Paul Webster Tags: World Report Source Type: research
[World Report] Access to family planning in Senegal
In a jail in Senegal, a woman is imprisoned, convicted with infanticide. Access to family planning could help to prevent this societal woe. Amy Yee reports from Dakar. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Amy Yee Tags: World Report Source Type: research
