The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear. In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation. A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P = 0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09). The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.).

We present results of meson and baryon spectroscopy using the Chirally Improved Dirac operator on lattices of size ${16}^3\times 32$ with two mass-degenerate light sea quarks. Three ensembles with pion masses of 322(5), 470(4), and 525(7) MeV and lattice spacings close to 0.15 fm are investigated. Results for ground and excited states for several channels are given, including spin two mesons and hadrons with strange valence quarks. The analysis of the states is done with the variational method, including two kinds of Gaussian sources and derivative sources. We obtain several ground states fairly precisely and find radial excitations in various channels. Excited baryon results seem to suffer from finite size effects, in particular, at small pion masses. We discuss the possible appearance of scattering states, considering masses and eigenvectors. Partially quenched results in the scalar channel suggest the presence of a 2-particle state, however, in most channels we cannot identify them. Where available, we compare our results to results of quenched simulations using the same action. DOI: http://dx.doi.org/10.1103/PhysRevD.82.034505 © 2010 The American Physical Society

For almost 30 years, urgent revascularization termed primary percutaneous coronary intervention has been a cornerstone of modern care for acute myocardial infarction (AMI). It lowers mortality and improved cardiovascular outcome compared to conservative therapy including thrombolysis. Reperfusion injury, which occurs after successful re-opening of the formerly occluded coronary artery, had been exploited as a potential therapeutic target. When revascularization became faster and primary percutaneous coronary intervention was successfully performed within 60-90 minutes of symptom onset, the interest in a potential additive effect of targeting reperfusion injury vanished. More recently, several meta-analyses indicated that limiting reperfusion injury prevents microvascular obstruction and reduces final infarct size, thereby lowering the probability of heart failure events and improving quality of life in AMI survivors. Here, we describe the current strategies to limit reperfusion injury and to improve post-AMI outcomes such as systemic or intracoronary hypothermia, left-ventricular unloading, intracoronary infusion of super-saturated oxygen, intermittent coronary sinus occlusion, and C-reactive protein apheresis.

BACKGROUND: In DanGer Shock (the Danish–German Cardiogenic Shock trial), use of a microaxial flow pump (mAFP) in patients with ST-segment–elevation myocardial infarction–related cardiogenic shock led to lower all-cause mortality but higher rates of renal replacement therapy (RRT). In this prespecified analysis, rates and predictors of acute kidney injury (AKI) and RRT were assessed. METHODS: In this international, randomized, open-label, multicenter trial, 355 adult patients with ST-segment–elevation myocardial infarction–related cardiogenic shock were randomized to mAFP (n=179) or standard care alone (n=176). AKI was defined according to RIFLE criteria (Risk, Injury, Failure, Loss, and End-stage kidney disease) and assessed using logistic regression models. Use of RRT was assessed accounting for the competing risk of death using Fine-Gray subdistribution hazard models. RESULTS: AKI (RIFLE ≥1) was recorded in 110 patients (61%) in the mAFP group and 79 patients (45%) in the control group ( P <0.01); RRT was used in 75 (42%) and 47 (27%) patients, respectively ( P <0.01). About two-thirds of the RRTs were initiated within the first 24 hours from admission (n=48 [64%] in the mAFP group and n=31 [66%] in the control group). Occurrence of AKI and RRT were associated with higher 180-day mortality in both study arms. At 180 days, all patients alive were free of RRT. mAFP use was associated with higher rates of RRT, even when accounting for competing risk of death (subdistribution hazard, 1.67 [1.18–2.35]). This association was largely consistent among prespecified subgroups. Allocation to mAFP was associated with lower 180-day mortality irrespective of AKI or RRT ( P _interaction =0.84). Relevant predictors of AKI in both groups comprised reduced left ventricular ejection fraction, baseline kidney function, shock severity, bleeding events, and positive fluid balance. Predictors of AKI specific to mAFP were suction events, higher pump speed, and longer duration of support. CONCLUSIONS: Shock severity, allocation to mAFP, and device-related complications were associated with an increased risk of AKI. AKI was generally associated with higher mortality, but the allocation to mAFP consistently led to lower mortality rates at 180 days irrespective of the occurrence of AKI with or without RRT initiation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01633502.

Functional perfusion imaging with a separate labeling coil located above the common carotid artery was demonstrated in human volunteers at 3 T. A helmet resonator and a spin‐echo echo‐planar imaging (EPI) sequence were used for imaging, and a circular surface coil of 6 cm i.d. was employed for labeling. The subjects performed a finger‐tapping task. Signal differences between the condition of finger tapping and the resting state were between −0.5% and −1.1 % among the subjects. The imaging protocol included a long post‐label delay (PLD) to reduce transit time effects. Labeling was applied for all repetitions of the functional run to reduce the sampling interval. Magn Reson Med 49:791–795, 2003.