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New England Journal of Medicine

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https://www.readbyqxmd.com/read/28328283/the-mirage-of-reform-republicans-struggle-to-dismantle-obamacare
#1
Jonathan Oberlander
No abstract text is available yet for this article.
March 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28320259/levosimendan-for-hemodynamic-support-after-cardiac-surgery
#2
Giovanni Landoni, Vladimir V Lomivorotov, Gabriele Alvaro, Rosetta Lobreglio, Antonio Pisano, Fabio Guarracino, Maria G Calabrò, Evgeny V Grigoryev, Valery V Likhvantsev, Marcello F Salgado-Filho, Alessandro Bianchi, Vadim V Pasyuga, Massimo Baiocchi, Federico Pappalardo, Fabrizio Monaco, Vladimir A Boboshko, Marat N Abubakirov, Bruno Amantea, Rosalba Lembo, Luca Brazzi, Luigi Verniero, Pietro Bertini, Anna M Scandroglio, Tiziana Bove, Alessandro Belletti, Maria G Michienzi, Dmitriy L Shukevich, Tatiana S Zabelina, Rinaldo Bellomo, Alberto Zangrillo
Background Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving patients in whom perioperative hemodynamic support was indicated after cardiac surgery, according to prespecified criteria. Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#3
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317415/uninterrupted-dabigatran-versus-warfarin-for-ablation-in-atrial-fibrillation
#4
Hugh Calkins, Stephan Willems, Edward P Gerstenfeld, Atul Verma, Richard Schilling, Stefan H Hohnloser, Ken Okumura, Harvey Serota, Matias Nordaby, Kelly Guiver, Branislav Biss, Marc A Brouwer, Massimo Grimaldi
Background Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation. Methods In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2...
March 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28316276/levosimendan-in-patients-with-left-ventricular-dysfunction-undergoing-cardiac-surgery
#5
Rajendra H Mehta, Jeffrey D Leimberger, Sean van Diepen, James Meza, Alice Wang, Rachael Jankowich, Robert W Harrison, Douglas Hay, Stephen Fremes, Andra Duncan, Edward G Soltesz, John Luber, Soon Park, Michael Argenziano, Edward Murphy, Randy Marcel, Dimitri Kalavrouziotis, Dave Nagpal, John Bozinovski, Wolfgang Toller, Matthias Heringlake, Shaun G Goodman, Jerrold H Levy, Robert A Harrington, Kevin J Anstrom, John H Alexander
Background Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. Methods In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0...
March 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317460/complete-revascularization-in-st-elevation-myocardial-infarction
#6
Lars Køber
No abstract text is available yet for this article.
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317458/use-of-the-instantaneous-wave-free-ratio-or-fractional-flow-reserve-in-pci
#7
Justin E Davies, Sayan Sen, Hakim-Moulay Dehbi, Rasha Al-Lamee, Ricardo Petraco, Sukhjinder S Nijjer, Ravinay Bhindi, Sam J Lehman, Darren Walters, James Sapontis, Luc Janssens, Christiaan J Vrints, Ahmed Khashaba, Mika Laine, Eric Van Belle, Florian Krackhardt, Waldemar Bojara, Olaf Going, Tobias Härle, Ciro Indolfi, Giampaolo Niccoli, Flavo Ribichini, Nobuhiro Tanaka, Hiroyoshi Yokoi, Hiroaki Takashima, Yuetsu Kikuta, Andrejs Erglis, Hugo Vinhas, Pedro Canas Silva, Sérgio B Baptista, Ali Alghamdi, Farrel Hellig, Bon-Kwon Koo, Chang-Wook Nam, Eun-Seok Shin, Joon-Hyung Doh, Salvatore Brugaletta, Eduardo Alegria-Barrero, Martijin Meuwissen, Jan J Piek, Niels van Royen, Murat Sezer, Carlo Di Mario, Robert T Gerber, Iqbal S Malik, Andrew S P Sharp, Suneel Talwar, Kare Tang, Habib Samady, John Altman, Arnold H Seto, Jasvindar Singh, Allen Jeremias, Hitoshi Matsuo, Rajesh K Kharbanda, Manesh R Patel, Patrick Serruys, Javier Escaned
Background Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. Methods We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317438/instantaneous-wave-free-ratio-versus-fractional-flow-reserve-to-guide-pci
#8
Matthias Götberg, Evald H Christiansen, Ingibjörg J Gudmundsdottir, Lennart Sandhall, Mikael Danielewicz, Lars Jakobsen, Sven-Erik Olsson, Patrik Öhagen, Hans Olsson, Elmir Omerovic, Fredrik Calais, Pontus Lindroos, Michael Maeng, Tim Tödt, Dimitrios Venetsanos, Stefan K James, Amra Kåregren, Margareta Nilsson, Jörg Carlsson, Dario Hauer, Jens Jensen, Ann-Charlotte Karlsson, Georgios Panayi, David Erlinge, Ole Fröbert
Background The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. Methods We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317428/fractional-flow-reserve-guided-multivessel-angioplasty-in-myocardial-infarction
#9
Pieter C Smits, Mohamed Abdel-Wahab, Franz-Josef Neumann, Bianca M Boxma-de Klerk, Ketil Lunde, Carl E Schotborgh, Zsolt Piroth, David Horak, Adrian Wlodarczak, Paul J Ong, Rainer Hambrecht, Oskar Angerås, Gert Richardt, Elmir Omerovic
Background In patients with ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to restore blood flow in an infarct-related coronary artery improves outcomes. The use of PCI in non-infarct-related coronary arteries remains controversial. Methods We randomly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery in a 1:2 ratio to undergo complete revascularization of non-infarct-related coronary arteries guided by fractional flow reserve (FFR) (295 patients) or to undergo no revascularization of non-infarct-related coronary arteries (590 patients)...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317425/assessment-of-stable-coronary-lesions
#10
Deepak L Bhatt
No abstract text is available yet for this article.
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28316279/rivaroxaban-or-aspirin-for-extended-treatment-of-venous-thromboembolism
#11
Jeffrey I Weitz, Anthonie W A Lensing, Martin H Prins, Rupert Bauersachs, Jan Beyer-Westendorf, Henri Bounameaux, Timothy A Brighton, Alexander T Cohen, Bruce L Davidson, Hervé Decousus, Maria C S Freitas, Gerlind Holberg, Ajay K Kakkar, Lloyd Haskell, Bonno van Bellen, Akos F Pap, Scott D Berkowitz, Peter Verhamme, Philip S Wells, Paolo Prandoni
Background Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. Methods In this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous thromboembolism to receive either once-daily rivaroxaban (at doses of 20 mg or 10 mg) or 100 mg of aspirin. All the study patients had completed 6 to 12 months of anticoagulation therapy and were in equipoise regarding the need for continued anticoagulation...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28316277/reduced-intensity-rivaroxaban-for-the-prevention-of-recurrent-venous-thromboembolism
#12
Mark A Crowther, Adam Cuker
No abstract text is available yet for this article.
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28306389/inclisiran-in-patients-at-high-cardiovascular-risk-with-elevated-ldl-cholesterol
#13
Kausik K Ray, Ulf Landmesser, Lawrence A Leiter, David Kallend, Robert Dufour, Mahir Karakas, Tim Hall, Roland P T Troquay, Traci Turner, Frank L J Visseren, Peter Wijngaard, R Scott Wright, John J P Kastelein
Background In a previous study, a single injection of inclisiran, a chemically synthesized small interfering RNA designed to target PCSK9 messenger RNA, was found to produce sustained reductions in low-density lipoprotein (LDL) cholesterol levels over the course of 84 days in healthy volunteers. Methods We conducted a phase 2, multicenter, double-blind, placebo-controlled, multiple-ascending-dose trial of inclisiran administered as a subcutaneous injection in patients at high risk for cardiovascular disease who had elevated LDL cholesterol levels...
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304242/cardiovascular-efficacy-and-safety-of-bococizumab-in-high-risk-patients
#14
Paul M Ridker, James Revkin, Pierre Amarenco, Robert Brunell, Madelyn Curto, Fernando Civeira, Marcus Flather, Robert J Glynn, Jean Gregoire, J Wouter Jukema, Yuri Karpov, John J P Kastelein, Wolfgang Koenig, Alberto Lorenzatti, Pravin Manga, Urszula Masiukiewicz, Michael Miller, Arend Mosterd, Jan Murin, Jose C Nicolau, Steven Nissen, Piotr Ponikowski, Raul D Santos, Pamela F Schwartz, Handrean Soran, Harvey White, R Scott Wright, Michal Vrablik, Carla Yunis, Charles L Shear, Jean-Claude Tardif
Background Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and reduces levels of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the efficacy of bococizumab in patients at high cardiovascular risk. Methods In two parallel, multinational trials with different entry criteria for LDL cholesterol levels, we randomly assigned the 27,438 patients in the combined trials to receive bococizumab (at a dose of 150 mg) subcutaneously every 2 weeks or placebo...
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304233/pcsk9-inhibition-to-reduce-cardiovascular-events
#15
Robin P F Dullaart
No abstract text is available yet for this article.
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304229/antidrug-antibodies-in-patients-treated-with-alirocumab
#16
Eli M Roth, Anne C Goldberg, Alberico L Catapano, Albert Torri, George D Yancopoulos, Neil Stahl, Aurélie Brunet, Guillaume Lecorps, Helen M Colhoun
No abstract text is available yet for this article.
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304227/lipid-reduction-variability-and-antidrug-antibody-formation-with-bococizumab
#17
Paul M Ridker, Jean-Claude Tardif, Pierre Amarenco, William Duggan, Robert J Glynn, J Wouter Jukema, John J P Kastelein, Albert M Kim, Wolfgang Koenig, Steven Nissen, James Revkin, Lynda M Rose, Raul D Santos, Pamela F Schwartz, Charles L Shear, Carla Yunis
Background Bococizumab, a humanized monoclonal antibody targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), reduces levels of low-density lipoprotein (LDL) cholesterol. However, the variability and durability of this effect are uncertain. Methods We conducted six parallel, multinational lipid-lowering trials enrolling 4300 patients with hyperlipidemia who were randomly assigned to receive 150 mg of bococizumab or placebo subcutaneously every 2 weeks and who were followed for up to 12 months; 96% were receiving statin therapy at the time of enrollment...
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304224/evolocumab-and-clinical-outcomes-in-patients-with-cardiovascular-disease
#18
Marc S Sabatine, Robert P Giugliano, Anthony C Keech, Narimon Honarpour, Stephen D Wiviott, Sabina A Murphy, Julia F Kuder, Huei Wang, Thomas Liu, Scott M Wasserman, Peter S Sever, Terje R Pedersen
Background Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. Methods We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy...
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28304219/surgical-or-transcatheter-aortic-valve-replacement-in-intermediate-risk-patients
#19
Michael J Reardon, Nicolas M Van Mieghem, Jeffrey J Popma, Neal S Kleiman, Lars Søndergaard, Mubashir Mumtaz, David H Adams, G Michael Deeb, Brijeshwar Maini, Hemal Gada, Stanley Chetcuti, Thomas Gleason, John Heiser, Rüdiger Lange, William Merhi, Jae K Oh, Peter S Olsen, Nicolo Piazza, Mathew Williams, Stephan Windecker, Steven J Yakubov, Eberhard Grube, Raj Makkar, Joon S Lee, John Conte, Eric Vang, Hang Nguyen, Yanping Chang, Andrew S Mugglin, Patrick W J C Serruys, Arie P Kappetein
Background Although transcatheter aortic-valve replacement (TAVR) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk, less is known about comparative outcomes among patients with aortic stenosis who are at intermediate surgical risk. Methods We evaluated the clinical outcomes in intermediate-risk patients with severe, symptomatic aortic stenosis in a randomized trial comparing TAVR (performed with the use of a self-expanding prosthesis) with surgical aortic-valve replacement...
March 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28301297/out-of-sight-out-of-mind-behavioral-and-developmental-care-for-rural-children
#20
Kelly J Kelleher, William Gardner
The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and..
March 16, 2017: New England Journal of Medicine
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