BACKGROUND AND OBJECTIVES: The median kidney transplant half-life is 10-15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980-2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies "retransplant" versus "remain waitlisted with maintenance dialysis" are reported for different waiting times after first graft loss. RESULTS: Second kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, -14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively. CONCLUSIONS: Second kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.

• MeSH
• Time Factors MeSH
• Kidney Failure, Chronic mortality   surgery   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Survival Rate MeSH
• Retreatment statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Waiting Lists * MeSH
• Kidney Transplantation statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. METHODS: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. RESULTS: A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. CONCLUSIONS: In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone. (Funded by St. Jude Medical and others; FAME 2 ClinicalTrials.gov number, NCT01132495 .).

• MeSH
• Angina Pectoris therapy   MeSH
• Antihypertensive Agents therapeutic use   MeSH
• Fractional Flow Reserve, Myocardial * MeSH
• Myocardial Infarction epidemiology   prevention & control   MeSH
• Platelet Aggregation Inhibitors therapeutic use   MeSH
• Kaplan-Meier Estimate MeSH
• Percutaneous Coronary Intervention * MeSH
• Coronary Disease drug therapy   mortality   therapy   MeSH
• Coronary Stenosis drug therapy   physiopathology   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Retreatment statistics & numerical data   MeSH
• Aged MeSH
• Drug-Eluting Stents MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

OBJECTIVE: To evaluate the long-term follow-up of the unrestricted use of a biodegradable polymer-coated drug-eluting stent in patients undergoing percutaneous coronary intervention (PCI). METHODS: The Nobori 2 study was a prospective, multicentre, observational registry evaluating the safety and the efficacy of the biodegradable polymer biolimus-eluting stent (BP-BES) among 3067 patients recruited at 125 international sites. The primary combined endpoint was a composite of cardiac death, myocardial infarction and target-lesion revascularisation (TLR). RESULTS: Five-year follow-up was available in 2738 (89.3%) patients. The combined endpoint occurred in 268 patients (10%, 95% CIs 8.9% to 11.3%) at 5 years, with 3.9% of events during the first year and 6.2% during years 1-5 of follow-up. Cumulative rates of TLR and definite/probable stent thrombosis were 5.3% (95% CI 4.5% to 6.3%) and 1.1% (95% CI 0.8% to 1.6%), respectively. Between 1 and 5 years, TLR and very late stent thrombosis rates were 3.5% (95% CI 2.8% to 4.4%) and 0.6% (95% CI 0.3% to 1.1%), respectively. Previous PCI (HR, 2.05, 95% CI 1.68 to 2.50), moderate-to-severe renal disease (HR, 1.89, 95% CI 1.30 to 2.74) and peripheral vascular disease (HR, 1.86, 95% CI 1.38 to 2.52) were the three most powerful independent predictors of the combined endpoint at 5 years. CONCLUSIONS: The final 5-year follow-up of the Nobori 2 registry demonstrates the safety and effectiveness of the BP-BES in an unselected, broadly inclusive cohort of PCI patients, highlighting the excellent performance of this coronary stent technology after polymer biodegradation. TRIAL REGISTRATION NUMBER: ISRCTN81649913; Results.

• MeSH
• Immunosuppressive Agents administration & dosage   MeSH
• Kaplan-Meier Estimate MeSH
• Percutaneous Coronary Intervention adverse effects   instrumentation   methods   MeSH
• Coronary Thrombosis epidemiology   etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Kidney Diseases epidemiology   etiology   MeSH
• Peripheral Vascular Diseases epidemiology   etiology   MeSH
• Retreatment statistics & numerical data   MeSH
• Polymers MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Registries MeSH
• Aged MeSH
• Sirolimus administration & dosage   analogs & derivatives   MeSH
• Drug-Eluting Stents * adverse effects   MeSH
• Absorbable Implants * adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

Chemoterapie v léčbě kastračně rezistentního karcinomu prostaty má své uplatnění v 1. a 2. linii léčby s přínosem v prodloužení přežití a zlepšení kvality života. Docetaxel je standardně používaným lékem v 1. linii léčby. Cabazitaxel je první cytostatikum, které prokázalo prodloužení přežití u nemocných léčených v 2. linii po předchozí léčbě docetaxelem. Vinorelbin představuje, zejména pro dobrou toleranci, variantu pro nemocné s kontraindikacemi k aplikaci taxanů.

Chemotherapy in the treatment of castration-resistant prostate cancer is used in the first- and second-line therapy with a benefit of prolonged survival and improved quality of life. Docetaxel is a drug standardly used in the first-line therapy. Cabazitaxel is the first cytostatic drug to have been shown to extend survival in patients treated in the second line after previous treatment with docetaxel. Vinorelbine, particularly due to its good tolerance, represents an option for patients with contraindications to taxane administration.

• Keywords
• cabazitaxel,
• MeSH
• Antineoplastic Agents, Phytogenic administration & dosage   therapeutic use   MeSH
• Antineoplastic Agents administration & dosage   therapeutic use   MeSH
• Docetaxel MeSH
• Drug Therapy methods   trends   MeSH
• Carcinoma drug therapy   MeSH
• Clinical Trials as Topic statistics & numerical data   MeSH
• Humans MeSH
• Prostatic Neoplasms, Castration-Resistant * drug therapy   MeSH
• Retreatment methods   statistics & numerical data   trends   MeSH
• Palliative Care methods   MeSH
• Prognosis MeSH
• Taxoids administration & dosage   therapeutic use   MeSH
• Vinblastine analogs & derivatives   MeSH
• Vinorelbine MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Review MeSH

Úvod: Součástí terapeutického postupu u diferencovaného karcinomu šítné žlázy (DTC) je po chirurgické léčbě tyreoeliminace zbytků štítné žlázy radiojódem (RJ). Cíl: Hodnocení úspěšnosti tyreoeliminace radiojódem (TERJ) u nemocných operovaných na ORL klinice ve Fakultní nemocnici Ostrava (FNO) v letech 2007–2012. Materiál: 131 nemocných s DTC po téměř totální tyreoidektomii (nTTE), z toho 109 pacientů s papilárním (83 %) a 22 s folikulárním karcinomem (17 %). Zastoupení podle velikosti primárního tumoru: T1 72 pacientů, T2 21 pacientů, T3 5 pacientů, u 33 pacientů.nebyla velikost tumoru zjištěna (Tx). Metodika: Hospitalizace na KNM za 5–6 týdnů po nTTE v hypotyreóze, provedení scintigrafie oblasti krku s vizuálním hodnocením zbytků tyreoidální tkáně, podání tyreoablační dávky 3,7 GBq 131I, rehospitalizace za 6 měsíců v myxedému, celotělová scintigrafie po diagnostické dávce 110–185 MBq 131I. Kritériem úspěšné TERJ je negativní nález v oblasti krku při scintigrafii. Sledovali jsme také efektivitu TERJ v závislosti na vstupní hladině tyreoglobulinu (Tg). Výsledky: Při kontrolní celotělové scintigrafii nebyla patrná na krku žádná tyreoidální tkáň u 105 ze 131 nemocných (80 %). Ve 26 případech (20 %) TERJ nebyla úspěšná a byla nutná další terapie RJ. Pravděpodobnost úspěšné TERJ pro hladinu Tg <1 µg/l byla 8:1, pro Tg mezi 1–10 µg/l 4,25:1 a pro Tg >10 µg/l 0,75:1. Závěr: Úspěšnost TERJ v 80 % případů je srovnatelná s literárními údaji a svědčí pro uspokojivou radikalitu operací prováděných na ORL klinice FNO. Vstupní hladina tyreoglobulinu je důležitý faktor predikce úspěšnosti radioablace zbytků štítné žlázy a při jeho vyšších hladinách (obvykle nad 10 µg/l) preferujeme při kontrolní hospitalizaci přímé podání léčebné dávky 131I.

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• Keywords
• tyreoablace radiojódem, diferencovaný karcinom štítné žlázy, thyreoablace,
• MeSH
• Radiotherapy Dosage MeSH
• Whole Body Imaging * MeSH
• Carcinoma, Papillary, Follicular surgery   radiotherapy   MeSH
• Combined Modality Therapy MeSH
• Humans MeSH
• Thyroid Neoplasms * surgery   radiotherapy   MeSH
• Retreatment statistics & numerical data   MeSH
• Carcinoma, Papillary surgery   radiotherapy   MeSH
• Prospective Studies MeSH
• Iodine Radioisotopes * administration & dosage   therapeutic use   MeSH
• Neoplasm, Residual * radiotherapy   MeSH
• Thyroglobulin * blood   MeSH
• Tomography, Emission-Computed MeSH
• Thyroidectomy MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

Budd-Chiari syndrom (BCS) má mnohdy akutní až fulminantní průběh vedoucí k ischemii až nekróze jaterního parenchymu v důsledku venostázy. Obnova drenáže jaterních sinusoid je v takové situaci klíčová. Při chronickém průběhu dominuje spíše riziko komplikací portální hypertenze. TIPS jako portosystémová spojka zajistí jak venózní drenáž, tak korekci portální hypertenze. Soubor a metodika: TIPS je u nás dostupný již 21 let. S jeho pomocí jsme ošetřili též 52 nemocných s BCS na podkladě trombózy jaterních žil. Medián věku je 37 let (13–82 let), 10 % souboru tvoří děti, 16 nemocných (31 %) jsou muži, 31 % byl urgentní zákrok. Myeloproliferativní syndrom byl příčinou u 60 %, jiný známý prokoagulační stav byl identifikován u 15 % a u necelé čtvrtiny se příčinu nepodařilo objasnit. Prvních pět let se používaly nepotažené stenty, od roku 1997 se začaly uplatňovat různé ePTFE potažené stenty a od roku 2001 jsou standardem dedikované ePTFE potažené stenty. Výsledky: Zaznamenali jsme třináct úmrtí: tři fulminantní jaterní selhání, jednu extenzivní tumorózní trombózu, tři časné septické komplikace, dvě jaterní selhání při pozdější akutní okluzi zkratu, dvě v důsledku hematoonkologického onemocnění, jedno úrazem a jedno z neznámé příčiny. Dva nemocní podstoupili transplantaci jater. U 39 nemocných zkrat zůstává při antikoagulační terapii a občasných revizích funkční, jaterní funkce stabilizované a komplikace portální hypertenze se neobjevují. Nezaznamenali jsme klinicky významnou jaterní encefalopatii po TIPS. Použití potažených stentů výrazně snížilo především výskyt časných okluzí zkratu. Při zobrazovacích vyšetřeních lze často pozorovat nodulární přestavbu. Závěr: TIPS považujeme za velmi výhodnou terapeutickou volbu u BCS na podkladě trombózy jaterních žil. Za předpokladu důsledné následné péče TIPS obvykle zajistí potřebnou perfuzi jaterní tkáně a zabrání komplikacím portální hypertenze, čímž velkou většinu nemocných ušetří transplantace jater.

Budd-Chiari syndrome (BCS) often has an acute or fulminant course leading to ischaemia and necrosis of the liver parenchyma as consequence of venostasis. Restitution of blood drainage is then a key measure. In the chronic course, symptoms of portal hypertension are dominant. TIPS as a portosystemic shunt ensures both venous drainage as well as corrected portal hypertension. Patients and methods: TIPS has already been available for 21 years in the Czech Republic. Using this method we also treated 52 patients with BCS from thrombosis of hepatic veins. The median age was 37 years (13 to 82 years), 10% were children, 16 patients (31%) were men, 31% procedures were urgent. Myeloproliferative syndrome was the cause in 60%, another thrombophilic disorder was detected in 15%, and in 25% of them the cause was not elucidated. In the first five years, uncovered stents were used, but since 1997 different types of ePTFE covered stents have been available and since 2001 dedicated ePTFE covered stents became the standard. Results: 13 patients died: three of fulminant liver failure, one of extensive tumorous thrombosis, three of early septic complications, two of liver failure due to later acute shunt occlusion, two of progressions of haemato-oncological disease, one tragically, and one of unknown cause. Two patients later underwent OLTx. In 39 patients the shunt remains patent on anticoagulant therapy and occasional reinterventions, liver functions are stable and no portal hypertension complications occur. We have not noticed significant hepatic encephalopathy. The use of ePTFE covered stents reduced a number of mainly early occlusions. In imaging we often find nodular hyperplasia. Conclusion: We consider TIPS an advantageous therapeutic approach in BCS due to thrombosis of the hepatic veins. If the follow-up treatment is rigorous, the TIPS usually ensures sufficient perfusion of the liver and prevents portal hypertension complications, saving most patients from liver transplantation. Key words: Budd-Chiari syndrome – portal hypertension – transjugular intrahepatic – portosystemic shunt The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 12. 3. 2014 Accepted: 7. 4. 2014

• MeSH
• Coated Materials, Biocompatible MeSH
• Budd-Chiari Syndrome * diagnosis   etiology   surgery   MeSH
• Child MeSH
• Adult MeSH
• Kaplan-Meier Estimate MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Myeloproliferative Disorders MeSH
• Retreatment statistics & numerical data   MeSH
• Polytetrafluoroethylene MeSH
• Postoperative Complications MeSH
• Hypertension, Portal * complications   prevention & control   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Statistics as Topic MeSH
• Stents MeSH
• Portasystemic Shunt, Transjugular Intrahepatic * methods   mortality   instrumentation   MeSH
• Thrombophilia MeSH
• Treatment Outcome MeSH
• Venous Thrombosis MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

This study investigated long-term outcome of catheter ablation of right anteroseptal atrio-ventricular (AV) accessory pathways (AP) located close to the His bundle. Methods Between April 2003 and June 2011, 26 patients (6 females, age 35±13 years) underwent catheter ablation of right anteroseptal AP. These APs represented 10% of all 248 APs ablated within the given reference period. Elimination of AP conduction in both directions and preservation of normal AV conduction were the ablation procedure endpoints. Results First ablation was effective in 18 (69%) patients. After repeat ablation, AP was permanently eliminated in 22 (85%) patients (one, two, and three ablation procedures in 16, 5, and 1 patient, respectively). Ablation failed in 4 patients (1 procedure in 3 patients, 2 procedures in 1 patient). During 56±27 (4–102) month follow-up period since the last ablation, no late AP conduction recovery was found, and no late advanced AV block occurred. Post-ablation AV node Wenckebach point was present at the pacing rate of 176±26 (130–230) beats per minute. Of the two engaged operators, more experienced operator successfully accomplished first, second, and third ablation procedure in 14/16 (88%), 5/5 (100%), and 1/1 (100%) patients, respectively, the latter operator attained successful ablation in 4/10 (40%) and 1/2 (50%) patients at the first and second ablation procedures, respectively. Conclusion Ablation of right anteroseptal AP close to the His bundle is feasible and safe. Late advanced AV block was not observed. Individual operator's experience influenced ablation efficacy.

• Keywords
• přídatná dráha,
• MeSH
• Adult MeSH
• Bundle of His physiopathology   MeSH
• Catheter Ablation methods   utilization   MeSH
• Middle Aged MeSH
• Humans MeSH
• Retreatment methods   statistics & numerical data   MeSH
• Heart Conduction System pathology   MeSH
• Arrhythmias, Cardiac therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH

Despite new medical products introduced in multiple myeloma therapy, autologous stem cell transplant (ASCT) remains a standard procedure in younger patients with symptomatic disease. We analyzed a group of 190 patients who underwent ASCT at our clinic for multiple myeloma as primary therapy in years 1995–2008. The total number of transplants performed in this group was 291. 110 patients underwent one ASCT, 59 patients had double transplant, out of which 51 patients underwent tandem transplant, 21 patients underwent triple ASCT, out of which 15 patients were transplanted front-line throughout a clinical trial and 6 patients underwent follow-up transplants due to disease progression. The assessment of the best therapeutic effect of ASCT showed the total rates of patients with complete remission – 22%, very good partial remission (VGPR) – 8%, partial remission – 63%, stabilized disease – 6% and progression – 1%. The transplant related mortality (TRM) was 4.1%. With the median follow-up of surviving patients 2.6 years, the median progression-free survival (PFS) and overall survival (OS) were 21 and 54 months, respectively; the likelihood of a 7-year overall survival was 28%. Comparing tandem versus single transplants, there was a significant increase in the median PFS (25.8 versus 20.8 months, respectively); however, there was no difference in overall survivals. The IVE mobilization regimen was found to be more efficacious for PBPC collection than high-dosed cyclophosphamide.

• MeSH
• Survival Analysis MeSH
• Antineoplastic Agents administration & dosage   adverse effects   therapeutic use   MeSH
• Transplantation, Autologous methods   utilization   MeSH
• Cyclophosphamide administration & dosage   adverse effects   therapeutic use   MeSH
• Financing, Organized MeSH
• Humans MeSH
• Multiple Myeloma drug therapy   blood   therapy   MeSH
• Recovery of Function immunology   drug effects   MeSH
• Retreatment methods   statistics & numerical data   utilization   MeSH
• Disease Progression MeSH
• Antineoplastic Combined Chemotherapy Protocols administration & dosage   adverse effects   therapeutic use   MeSH
• Retrospective Studies MeSH
• Statistics as Topic MeSH
• Thalidomide administration & dosage   adverse effects   therapeutic use   MeSH
• Hematopoietic Stem Cell Transplantation methods   trends   utilization   MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Humans MeSH

Cílem této práce bylo shrnout možné příčiny selhání primární endodontické terapie, posoudit důvody pro opakované endodontické léčení a vyhodnotit jeho úspěšnost. Sledovaný soubor tvořilo 41 zubů u pacientů, kteří byli v roce 2007 doporučeni na konzervační oddělelení Kliniky zubního lékařství LF UP v Olomouci k provedení reendodoncie. Dosažené výsledky jsme srovnávali s podobnou studií provedenou na témže pracovišti v roce 1997. Ve srovnání souborů z let 2007 a 1977 můžeme konstatovat, že hlavním důvodem potřeby opakovaného léčení je nedokonalé zaplnění kořenových kanálků v celé jeho délce a nenalezení některého z kořenových kanálků.

The aim of this work was to sum possible reasons of primary endodontic therapy, to judge causes of frequent endodontic treatment and evaluate its success. The collection consisted of 41 teeth from patients, who were recommended to our clinic to perform the reendodontic therapy in 2007. Final findings were compared to similar study, which was performed on the same workplace in 1997. This comparison formed the result – the main reason of repeated treatment is incomplete filling of root canals and impossibility to find one of the root canals.

• MeSH
• Endodontics methods   MeSH
• Humans MeSH
• Dental Pulp Diseases therapy   MeSH
• Retreatment statistics & numerical data   utilization   MeSH
• Root Canal Therapy methods   MeSH
• Check Tag
• Humans MeSH

Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS: We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. RESULTS: Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003). CONCLUSIONS: CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (ClinicalTrials.gov number, NCT00114972.) 2009 Massachusetts Medical Society

• MeSH
• Angioplasty, Balloon, Coronary adverse effects   MeSH
• Stroke mortality   MeSH
• Financing, Organized MeSH
• Myocardial Infarction mortality   MeSH
• Kaplan-Meier Estimate MeSH
• Cardiovascular Diseases epidemiology   MeSH
• Coronary Artery Bypass adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Coronary Artery Disease MeSH
• Retreatment statistics & numerical data   MeSH
• Prospective Studies MeSH
• Randomized Controlled Trials as Topic MeSH
• Aged MeSH
• Drug-Eluting Stents MeSH
• Severity of Illness Index MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Multicenter Study MeSH
• Comparative Study MeSH