scholarly journals Evaluation of endothelial function, of elasticity of vessel wall and their influence on one-year prognosis of patients with myocardial infarction with obstructive and non-obstructive coronary arteries

2020 ◽  
Vol 28 (4) ◽  
pp. 488-496
Author(s):  
Olga Fomina ◽  
Sergey Stepanovich Yakushin
Keyword(s):  
Myocardial Infarction ◽  
Endothelial Function ◽  
Coronary Arteries ◽  
Vessel Wall ◽  
Augmentation Index ◽  
Study Groups ◽  
Morphological Alterations ◽  
Significant Difference ◽  
One Year ◽  
The One

Aim. To carry out comparative analysis of the state of the endothelial function (EF), elasticity of the vessel wall and their influence on one-year prognosis of patients with myocardial infarction (MI) with obstructive and non-obstructive coronary arteries (CA). Materials and Methods. In the first stage, 206 patients were selected diagnosed with MI, of them 103 patients with MI with non-obstructive CA (MINOCA) according to the results of coronaroangiography, and 103 patients with MI with obstructive CA (MIOCA). Using the method of random numbers, 59 patients were selected (34 patients of the first group and 25 of the second group), in whom EF and elastic properties of the arterial wall were evaluated. Patients of both groups were initially comparable in age, gender, clinical and anamneustic characteristics, and also in frequency of application of the main groups of medical drugs that influence prognosis. One-year prognosis of the two groups of patients was studied depending on the presence/absence of functional and morphological alterations of the vessel wall. Results. In evaluation of EF in patients MINOCA, the occlusion index by amplitude (OIA) below threshold values was recorded in 22 of 34 (64.7%) cases of MINOCA and in 22 of 25 (88.0%, р0.05) cases of MIOCA. Here, the average values of OIA were 1.7 (1.5; 2.3) and 1.4 (1.2; 1.8), respectively (р0.05). The values of phase shifts between the channels below the norm were equally frequent in two groups (88.2 and 88.0%, р0.05), and comparison of the average values of this parameter did not show any statistically significant difference. The calculated augmentation index normalized to the pulse rate 75 beats per minute (AIp75), in the study groups was 12.5 (9.9; 17.9) and 18.8 (12.9; 20.8), respectively (р0.05). Reduction of the elasticity of the vessel wall in the group with MINOCA was noted in 82.4% of patients, in the group MIOCA in 100% of cases (р0.05). No statistically significant differences were found in the frequency of cardiovascular events between the groups during a year (р0.05). Conclusion. Functional alterations of the vessel wall (endothelial dysfunction and reduction of elasticity of the vessel wall) in patients with MINOCA were recorded almost in 2/3 of cases, however, their incidence in MIOCA was still higher (88.0%). The one-year prognosis in the study groups MINOCA and MIOCA showed no differences.

scholarly journals Treatment of advanced-stage ovarian cancer including combination of intra-abdominal chemotherapy

2021 ◽  
Vol 20 (2) ◽  
pp. 28-35
Author(s):  
V. V. Saevets ◽  
A. V. Privalov ◽  
A. V. Vazhenin ◽  
Y. A. Semenov ◽  
A. V. Shmidt
Keyword(s):  
Ovarian Cancer ◽  
Survival Rate ◽  
Abdominal Cavity ◽  
Relative Survival ◽  
Study Groups ◽  
Stage Iiia ◽  
Results Of Treatment ◽  
Significant Difference ◽  
One Year ◽  
The One

Introduction. Ovarian cancer is the leading cause of death from gynecological malignancies: the one-year relative survival rate with stages 3 and 4 of the disease is 20%. The results of treatment remain unsatisfactory, which dictates the need to find new methods of treatment. The aim of the study was to evaluate the effectiveness of the use of HIIH (hyperthermic intraperitoneal intraoperative chemoperfusion, HIPEC) in patients with the diagnosis of: ovarian cancer IIIA-From the stage of the disease.Materials and methods. 117 cases of stage IIIA-C ovarian cancer treated at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine from January 2014 to March 2021 were retrospectively studied. All patients underwent 3 cycles of neoadjuvant chemotherapy (NAPHT) according to the paclitaxel+carboplatin (PCb) scheme, followed by surgical treatment to the extent of maximum cytoreductive surgery. Two study groups were formed: 1 — cases with GIIH (N=57), 2-without GIIH (N=60). On the 14-16 day after the operation, all patients underwent 3 cycles of adjuvant chemotherapy according to the PCb scheme.Results. A significant increase in overall survival was found in the first group of patients with HIPEC. This technique allows to increase the survival rate of patients for 14 months at stage IIIA-B (p<0.05). At stage IIIC, there was no statistically significant difference in the survival rate of patients. There was a tendency to increase the survival rate by 5 months (p>0.05), which is associated with the pronounced prevalence of the tumor process and the technical impossibility of removing the tumor. Discussion. The concentration of drugs in the abdominal cavity and in the blood plasma significantly differs due to the functioning of the peritoneal-plasma barrier, which leads to a lower toxicity in comparison with systemic chemotherapy, and therefore allows you to give a large dose of the drug with fewer adverse events, and the fact of hyperthermia (42°C) has a positive effect on the effectiveness of intraperitoneal chemotherapy. To date, this method has not been included in the clinical recommendations on the territory of the Russian Federation, but data from foreign literature, including randomized trials, have shown the high effectiveness of this method.Conclusion. The results obtained in the course of our study demonstrate the effectiveness of this technique, in the form of an increase in overall and relapse-free survival with acceptable toxicity.

scholarly journals One-Year Clinical Evaluation of the Bonding Effectiveness of a One-Step, Self-Etch Adhesive in Noncarious Cervical Lesion Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Babacar Faye ◽  
Mouhamed Sarr ◽  
Khaly Bane ◽  
Adjaratou Wakha Aidara ◽  
Seydina Ousmane Niang ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Retention Rate ◽  
Recall Rate ◽  
Acid Etching ◽  
Significant Difference ◽  
Usphs Criteria ◽  
One Step ◽  
One Year ◽  
The One ◽  
Self Etch

This study evaluated the one-year clinical performance of a one-step, self-etch adhesive (Optibond All-in-One, Kerr, CA, USA) combined with a composite (Herculite XRV Ultra, Kerr Hawe, CA, USA) to restore NCCLs with or without prior acid etching. Restorations performed by the same practitioner were evaluated at baseline and after 3, 6, and 12 months using modified USPHS criteria. At 6 months, the recall rate was 100%. The retention rate was 84.2% for restorations with prior acid etching, but statistically significant differences were observed between baseline and 6 months. Without acid etching, the retention rate was 77%, and no statistically significant difference was noted between 3 and 6 months. Marginal integrity (93.7% with and 87.7% without acid etching) and discoloration (95.3% with and 92.9% without acid etching) were scored as Alpha or Bravo, with better results after acid etching. After one year, the recall rate was 58.06%. Loss of pulp vitality, postoperative sensitivity, or secondary caries were not observed. After one year retention rate was of 90.6% and 76.9% with and without acid conditioning. Optibond All-in-One performs at a satisfactory clinical performance level for restoration of NCCLs after 12 months especially after acid etching.

scholarly journals The One-Year In Vivo Comparison of Lithium Disilicate and Zirconium Dioxide Inlays

Materials ◽  
2021 ◽  
Vol 14 (11) ◽  
pp. 3102
Author(s):  
Rini Behera ◽  
Lora Mishra ◽  
Darshan Devang Divakar ◽  
Abdulaziz A. Al-Kheraif ◽  
Naomi Ranjan Singh ◽  
...  
Keyword(s):  
Zirconium Dioxide ◽  
Clinical Performance ◽  
Lithium Disilicate ◽  
Study Groups ◽  
Resin Cement ◽  
Internal Surfaces ◽  
Colour Match ◽  
One Year ◽  
The One

The objective of the present study was to evaluate the one-year clinical performance of lithium disilicate (LD) and zirconium dioxide (ZrO2) class II inlay restorations. Thirty healthy individuals who met the inclusion criteria were enrolled for the study. The patients were randomly divided into two study groups (n = 15): LD (IPS e.max press) and ZrO2 (Dentcare Zirconia). In the ZrO2 group, the internal surfaces of the inlays were sandblasted and silanized with Monobond N (Ivoclar, Leichsteistein, Germany). In the LD group, the internal surfaces of the inlays were etched with 5% hydrofluoric acid. The ceramic inlays were cemented with self-cure resin cement (Multilink N). Clinical examinations were performed using modified United State Public Health Codes and Criteria (USPHS) after 2 weeks, 4 weeks, 6 months and 1 year. The one-year survival rate was evaluated. In total, one failure was observed in the ZrO2 group. The survival probability after 1 year for the ZrO2 inlays was 93%, and for the LD inlays was 100%, which was statistically insignificant. The differences between both groups for most USPHS criteria (except for colour match) were statistically insignificant. Within the imitations of the present study, the lithium disilicate- and zirconia dioxide-based inlays exhibited comparable clinical performances. However, the colour and translucency match was superior for the lithium disilicate restorations.

PROGRESSIVE ATHEROSCLEROTIC CORONARY ARTERIES IN PATIENTS WITH SEVERAL ISCHEMIC EVENTS IN ANAMNESIS

2021 ◽  
pp. 113-119
Author(s):  
Parkhomenko O.M. ◽  
Lozhkina N.G.
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Clinical Signs ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Syntax Score ◽  
One Year ◽  
The Moment ◽  
Microsoft Office ◽  
Ischemic Events

Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes; study and understanding of this process is necessary to identify the appropriate risk groups. Purpose of the study to study the dynamics of atherosclerotic lesions of the coronary arteries in patients with several ischemic events in history. Patient Characterization and Research Methods. The present subanalysis included 51 patients with recurrent nonfatal myocardial infarction (MI) out of the initially included 100 patients with index MI. All 100 patients had a history of two or more ischemic coronary or cerebral events, which corresponds to the clinical signs of progressive atherosclerosis. The dynamics of the degree of coronary stenosis from the moment of index MI to repeated MI was assessed according to the data of selective coronary angiography. The statistical program Microsoft Office Excel 2019 was used. Results. All patients with recurrent myocardial infarction (51 people) had signs of progression of coronary artery stenosis: "mild" progression - 82.3%, "moderate" and "severe" - 15.6% and 2.1%, respectively. SYNTAX Score> 22.5 points was a predictor of one-year adverse outcomes: OR 6.349, CI (2.548-15.823). The results obtained make it possible to distinguish a group of patients with accelerated atherosclerosis syndrome in order to stratify the risk and optimally manage this complex category of patients.

scholarly journals An evaluation of the nature and level of musculoskeletal imaging training in physiotherapy educational programme in Nigeria

2020 ◽  
Author(s):  
Ogochukwu Kelechi Onyeso ◽  
Joseph O Umunnah ◽  
Charles Ikechukwu Ezema ◽  
Joseph A Balogun ◽  
Chigozie Uchenwoke ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Economic Cost ◽  
Educational Programme ◽  
Medical Rehabilitation ◽  
Musculoskeletal Imaging ◽  
Significant Difference ◽  
Level Of Training ◽  
One Year ◽  
The One ◽  
Training Programmes

Abstract Background: Previous studies have shown that deficiency in training may lead to inappropriate utilisation of diagnostic imaging among healthcare professionals, thus, raising concerns about patient safety and economic cost. This study aimed to evaluate the nature and level of musculoskeletal imaging (MI) training received by physiotherapists who graduated from Nigerian universities and completed the one-year mandatory internship. Methods: An online version of the Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), which was previously validated, was administered to all eligible physiotherapists identified through the database of the Medical Rehabilitation Therapist Board’s (MRTBN). Data were obtained on demographics, nature, and level of training on various MI modalities using the PMIPQ. Descriptive statistics, Friedman’s ANOVA, and Kruskal-Wallis tests were used for the data analysis at P ≤ 0.05. Results: The results showed that only 10.0% of the respondents had a standalone undergraduate course in MI, 92.8% did not have any MI clinical posting exposure during the internship, and 67.3% had never attended any MI workshop. There was a significant difference in the level of training received across various MI modalities [χ2 (15) = 1285.899; P = 0.001]. However, there was no significant difference in the level of MI training across the institutions (P = 0.36). The study participants with Doctor of Physiotherapy (DPT) education were better trained in MI than their counterparts with a bachelor’s degree (P = 0.047). Conclusions: The self-reported level of MI training among the respondents was deficient, but the knowledge of X-ray was significantly higher than other MI modalities. Based on the overall findings in this study, we recommend that diagnostic imaging contents be introduced early in the current and future physiotherapy training programmes.

259Higher risk of myocardial infarction in the first year following 5-fluorouracil treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J W D Shanmuganathan ◽  
K H K Kragholm ◽  
B T Tayal ◽  
L P Poulsen ◽  
T C E G El-Galaly ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Calcium Blockers ◽  
All Cause Mortality ◽  
One Year ◽  
The One ◽  
Population Controls ◽  
Age And Sex

Abstract Abstract Background 5-fluorouracil (5-FU) is the third most commonly used chemotherapeutic agent in the treatment of solid malignancies across the world. The most common manifestation of cardiotoxicity associated with 5-FU is chest pain, presenting as atypical chest pain, angina on exertion or rest and acute coronary syndromes including myocardial infarction and in worse case even death. Nevertheless, a widespread appreciation of 5-FU related cardiotoxicity including myocardial infarction is poorly understood. Purpose This study aims to examine risk of myocardial infarction in patients treated with 5-FU compared to age- and sex-matched population controls. Methods and results Methods: Individuals treated with 5-FU between 2004 and 2014 in the Danish National Patient Register were identified and risk set matching was used to find background population controls matched on age and sex in a 1:5 ratio. Furthermore, two years follow-up time were added with total 13 years. Neither 5-FU patients nor controls had prior ischemic disease. Aalen-Johansen and Kaplan-Meier estimates were used to report the cumulative incidence of myocardial infarction and all-cause mortality, respectively. A multivariable Shared Frailty Cox regression analysis (adjusted for patient age, sex, hypertension, hypercholesterolemia, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, heart failure and atrial fibrillation as well as selected anti-anginal medications including nitrates, beta- and calcium-blockers) was used to determine the association between 5-FU treatment and the one-year risk of myocardial infarction. Results A total of 9,012 5-FU patients and 45,060 controls formed the study population. Differences in comorbid conditions (diabetes, chronic obstructive pulmonary disease, chronic kidney disease, heart failure and atrial fibrillation) and selected anti-anginal medications (nitrates, beta- and calcium-blockers) were non-significant (all P>0.05). The one-year cumulative incidence of myocardial infarction is significantly higher for 5-FU patients at 0.8% versus 0.6% among population controls (Figure 1A), with a competing risk of death of 25.1% versus 1.2%. The risk diminishes beyond one year and becomes lower for 5-FU patients with time (Figure 1A), along with an increasing all-cause mortality (Figure 1B). The unadjusted and adjusted hazard ratio for the one-year risk of myocardial infarction were 1.38 [95% CI 1.07–1.78] and 1.54 [95% CI 1.19–1.99]. Conclusions Although the one-year risk of myocardial infarction is higher among 5-FU patients compared with population controls, the absolute risk is small and becomes insignificant beyond one year of follow-up.

scholarly journals 2505. Incidence of Transmitted Drug Resistance and Its Clinical Implications Between 1999 and 2018 in a Regional HIV Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S868-S869
Author(s):  
Raynell Lang ◽  
Hartmut B Krentz ◽  
Quang Vu ◽  
M John Gill
Keyword(s):  
Study Groups ◽  
Resistance Testing ◽  
Transmitted Drug Resistance ◽  
Pill Burden ◽  
Art Initiation ◽  
Drug Tolerability ◽  
Significant Difference ◽  
One Year ◽  
And Control ◽  
Effective Drugs

Abstract Background Baseline genotype antiretroviral resistance testing (GART) were introduced to allow better selection of antiretroviral therapy (ART), minimizing the use of less effective drugs and risk for ongoing transmission of drug-resistant virus. However, the value of baseline GART has recently been questioned due to declining incidence of TDR in the setting of improved drug tolerability profiles and effectiveness. We aimed to evaluate the long-term clinical and economic impact of TDR using a well characterized, geographically defined cohort between 1999–2018. Methods In the Southern Alberta Cohort (SAC) database we identified all (ART naïve) HIV patients, ≥16 years of age, with a baseline GART. They were classified by presence or absence of TDR. Clinical and sociodemographic data were obtained from database and chart review. All statistical analysis was performed with Stata. Results During the study 745 GART tests were done on ART naïve patients. Baseline ART resistance was documented in 78 /745 patients. TDR was to the NNRTI class in 59 (75.6%), to NRTI in 12 (15.4%) and to the PI class in 7 (8.9%) patients. Two patients had two class resistance and none had INSTI resistance. There was a significant difference in cost per year of therapy comparing the TDR and control ($17,152/year vs. $15,362/year, P ≤ 0.001). Patients with TDR had greater pill burden with 20% being on BID/TID ART regimens compared with the controls of 13% (P = 0.003). No differences in incident ART adverse events (12.8% TDR vs. 13.3% no TDR), drug interactions (1.6% vs. 1.0%) or reasons to stop or change ARVs were seen between study groups. The duration of ART on any given drug class was similar between the two populations (P = 0.6694) as was status of viral suppression at one year 73% vs. 65%. Conclusion Presence of TDR at baseline had little immediate impact on ART initiation or tolerance, but by limiting choices negatively impacted pill burden and dosing as well as drug costs. Disclosures All authors: No reported disclosures.

P2754Streptococcal infective endocarditis: distribution of species and their prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
C Hassager ◽  
M Arpi ◽  
L Oestergaard ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Device ◽  
Species Level ◽  
University Hospital ◽  
Heart Valve Disease ◽  
Significant Difference ◽  
Streptococcal Species ◽  
Species Groups ◽  
One Year ◽  
The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

scholarly journals The One Year Incidence of Postoperative Myocardial Infarction in an Orthopedic Population

2007 ◽  
Vol 4 (1) ◽  
pp. 76-80 ◽  
Author(s):  
M. K. Urban ◽  
K. Jules-Elysee ◽  
C. Loughlin ◽  
W. Kelsey ◽  
E. Flynn
Keyword(s):  
Myocardial Infarction ◽  
Postoperative Myocardial Infarction ◽  
One Year ◽  
The One

scholarly journals Impact of the Residual SYNTAX Score on Outcomes of Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease

2016 ◽  
Vol 10 ◽  
pp. CMC.S35730 ◽  
Author(s):  
Mohamed Loutfi ◽  
Sherif Ayad ◽  
Mohamed Sobhy
Keyword(s):  
Myocardial Infarction ◽  
Multivessel Disease ◽  
Index Admission ◽  
Clinical Indication ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Term Survival ◽  
Significant Difference ◽  
One Year ◽  
Residual Syntax Score

Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. Aim The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and multivessel disease (MVD) to quantify the extent and complexity of residual coronary stenoses and their impact on adverse ischemic outcomes. Methods Between October 1, 2012, and November 30, 2013, we enrolled 120 consecutive STEMI patients with angiographic patterns of multivessel coronary artery disease (CAD) who had a clinical indication to undergo PCI. The patients were subdivided into those who underwent culprit-only PCI (60 patients) and those who underwent staged-multivessel PCI during the index admission or who were staged within 30 days of the index admission (60 patients). Both the groups were well matched with regard to clinical statuses and lesion characteristics. Clinical outcomes at one year were collected, and the baseline SYNTAX score and rSS were calculated. Results The mean total stent length (31.07 ± 12.7 mm vs. 76.3 ± 14.1 mm) and the number of stents implanted per patient (1.34 ± 0.6 vs. 2.47 ± 0.72) were higher in the staged-PCI group. The rSS was higher in the culprit-only PCI group (9.7 ± 5.7 vs. 1.3 ± 1.99). The angiographic and clinical results after a mean follow-up of 343 ± 75 days demonstrated no significant difference in the occurrence of in-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCE) between both the groups (6.7% vs. 5%, P = 1.000). However, patients treated with staged PCI with an rSS ≤8 had significant reductions in one-year MACCE (10.7% vs. 30.5%, P = 0.020*), death/Myocardial infarction (MI)/Cerebrovascular accident (CVA) (5% vs. 13.8%, P = 0.016*), and repeat revascularization (4.8% vs. 25%, P = 0.001*). We found that culprit-only, higher GRACE risk scores at discharge and an rSS >8 were independent predictors of MACCE at one year. Conclusions Staged PCI that achieves reasonable complete revascularization (rSS ≤8) improves mid-term survival and reduces the incidence of repeat PCI in patients with STEMI and MVD. Nonetheless, large-scale randomized trials are required to establish the optimal revascularization strategy for these high-risk patients.

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