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maandag 24 september 2018

The Lancet: [Articles] Thin composite wire strut, durable polymer-coated (Resolute Onyx) versus ultrathin cobalt–ch...

[Articles] Thin composite wire strut, durable polymer-coated (Resolute Onyx) versus ultrathin cobalt–chromium strut, bioresorbable polymer-coated (Orsiro) drug-eluting stents in allcomers with coronary artery disease (BIONYX): an international, single-blind, randomised non-inferiority trial
The Resolute Onyx stent was non-inferior to Orsiro for a combined safety and efficacy endpoint at 1-year follow-up in allcomers. The low event rate in both groups suggests that both stents are safe, and the very low rate of stent thrombosis in the Resolute Onyx group warrants further clinical investigation.
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[Comment] Are all drug-eluting stents created equal?
Non-inferiority trials with combined clinical endpoints in allcomer populations were suggested as a compromise between premarket assessments and speed of innovation.1 However, it is important to remain aware of the limitations of the information provided by these trials. In The Lancet, Clemens von Birgelen and colleagues2 report their comparison of two highly regarded drug-eluting stents in clinical use (the Resolute Onyx and the Orsiro stents) in a population of 2488 allcomers. The primary endpoint was target vessel failure, a hierarchical combination of safety endpoints (cardiac death or target vessel myocardial infarction) with an efficacy endpoint (target vessel revascularisation) at 1 year.
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[Articles] A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): a randomised, non-inferiority trial
The Eluvia stent was non-inferior to the Zilver PTX stent in terms of primary patency and major adverse events at 12 months after treatment of patients for femoropopliteal peripheral artery disease.
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[Comment] Endovascular stenting in femoropopliteal arteries
Peripheral arterial disease (PAD) represents a major burden on public health worldwide. The number of affected patients has increased in both low-income and middle-income countries (by 28·7% for 2000–10) and high-income countries (by 13·1%).1 The strong association with ageing, tobacco smoking, and diabetes means that the prevalence of PAD will continue to increase in the coming years.1 Although undertreatment of patients with PAD is common in many countries, endovascular intervention has become the dominant modality for treatment of obstructive disease patterns, and various different devices have been investigated in clinical trials.
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[Comment] Just societies, health equity, and dignified lives: the PAHO Equity Commission
The USA is the richest country in the Americas and its residents enjoy good health: female life expectancy is 81 years and male is 76 years. Haiti is the poorest country in the Americas; its residents suffer poor health: female life expectancy is 66 years and male is 61 years. US gross national income (GNI) is about US$59 000 per person. In Haiti, it is just over $1800 per person, adjusting for purchasing power.1
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