Background Stroke after acute coronary syndrome(ACS)can be devastating.It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage(ICH)are associated with different choices of P2Y12 inhibitors(po...Background Stroke after acute coronary syndrome(ACS)can be devastating.It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage(ICH)are associated with different choices of P2Y12 inhibitors(potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel).Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians,data on Chinese patients are sparse.Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017.The primary efficacy endpoint was ischaemic stroke.The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality,non-fatal myocardial infarction and ischaemic stroke.The primary safety endpoint was ICH.The secondary safety endpoint was a composite of major bleeding events.Results After adjustment of baseline characteristics by 1:1 propensity score matching,a total of 6220 patients(3110 on each group)were analysed.Compared with clopidogrel,potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke(HR 0.57;95%CI 0.37 to 0.87;p=0.008)and a lower risk of thrombotic events(HR 0.77;95%CI 0.66 to 0.90;p=0.001).Potent P2Y12 inhibitor was associated with similar risk of ICH(HR 0.65;95%CI 0.34 to 1.25,p=0.20)and major bleeding(HR 0.83;95%CI 0.68 to 1.01,p=0.069).Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events,compared with clopidogrel.The risks of ICH and major bleeding were similar.展开更多
Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacema...Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in 1958.In addition to various hardware design to enhance device longevity,software-based solutions to minimize pacing energy and yet with good safety margin have also been developed.Together with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic,several manufacturers have introduced different automatic threshold management algorithm.This article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.展开更多
文摘Background Stroke after acute coronary syndrome(ACS)can be devastating.It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage(ICH)are associated with different choices of P2Y12 inhibitors(potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel).Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians,data on Chinese patients are sparse.Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017.The primary efficacy endpoint was ischaemic stroke.The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality,non-fatal myocardial infarction and ischaemic stroke.The primary safety endpoint was ICH.The secondary safety endpoint was a composite of major bleeding events.Results After adjustment of baseline characteristics by 1:1 propensity score matching,a total of 6220 patients(3110 on each group)were analysed.Compared with clopidogrel,potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke(HR 0.57;95%CI 0.37 to 0.87;p=0.008)and a lower risk of thrombotic events(HR 0.77;95%CI 0.66 to 0.90;p=0.001).Potent P2Y12 inhibitor was associated with similar risk of ICH(HR 0.65;95%CI 0.34 to 1.25,p=0.20)and major bleeding(HR 0.83;95%CI 0.68 to 1.01,p=0.069).Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events,compared with clopidogrel.The risks of ICH and major bleeding were similar.
文摘Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in 1958.In addition to various hardware design to enhance device longevity,software-based solutions to minimize pacing energy and yet with good safety margin have also been developed.Together with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic,several manufacturers have introduced different automatic threshold management algorithm.This article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.
