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Browsing by Issue Date, starting with "2023-04-26"

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  • Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
    Publication . Steg, P. Gabriel; Szarek, Michael; Valgimigli, Marco; Islam, Shahidul; Zeiher, Andreas M.; Bhatt, Deepak L.; Bittner, Vera A.; Chiang, Chern-En; Diaz, Rafael; Goodman, Shaun G.; Gotcheva, Nina; Harrington, Robert A.; Jukema, J. Wouter; Kim, Hyo-Soo; Kim, Sang-Hyun; Morais, João; Pordy, Robert; Scemama, Michel; White, Harvey D.; Schwartz, Gregory G.; Steg, Ph. Gabriel
    Background Many patients require revascularization after index acute coronary syndrome (ACS). Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In ODYSSEY OUTCOMES, alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a) levels. We explored whether risk of revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo. Methods In ODYSSEY OUTCOMES alirocumab was compared with placebo in 18,924 patients with ACS and elevated atherogenic lipoprotein levels despite optimized statin treatment. In this post hoc analysis, treatment effects are summarized using competing risks proportional hazard models. Results A total of 1559 (8.2%) patients had coronary, 204 (1.1%) had limb, and 40 (0.2%) had carotid revascularization. Alirocumab reduced coronary revascularization (2.8 vs 3.2 events per 100 patient-years; hazard ratio [HR], 0.88 [95% confidence interval (CI), 0.80-0.97]; P = 0.01) and any revascularization (3.2 vs 3.7 events per 100 patient-years; HR, 0.85 [95% CI, 0.78-0.94]; P = 0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm and inversely related to treatment HRs (all P for trend < 0.01). Alirocumab produced the greatest reduction of coronary revascularization in patients with baseline lipoprotein(a) in the top quartile (≥ 59.6 mg/dL; HR, 0.69 [95% CI, 0.57-0.84]), but no apparent reduction in the bottom quartile (HR, 1.00 [95% CI, 0.82-1.22]). Findings were similar for the effect of alirocumab on any revascularization. Conclusions Alirocumab reduced revascularization rates after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.
    2023-04-26Journal article Open access Show more
  • Path Generation and Execution for Automatic Shotcrete in Railway Tunnels
    Publication . Moniz, Gonçalo; Costelha, Hugo
    The shotcrete process has been extensively used for many years in different civil and mining operations. Nevertheless, it is still either applied by an operator which controls the shotcrete nozzle manually or through a remote control. In either case, the operation is entirely controlled by the operator. Automating the shotcrete process involves developments in different parts of the process, such as the tunnel scanning for 3D model generation and the shotcrete path automatic generation and execution. This paper describes the work developed for this last part, namely the automatic generation and execution of a shotcrete path, given the mesh of a tunnel and a set of input parameters, for application in railway tunnels. The developed path also considers specificities of the concrete projection process, such as the uncontrolled flow variation due to the pumping systems, generating a trajectory that aims at minimizing this effect. Results are shown using a realistic simulator and an uneven railway tunnel, using an industrial robot mounted on a railway wagon.
    2023-04-26Journal article Restricted access Show more