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While LM stenosis is a potentially attractive target for PCI because of its large diameter and proximal position in the coronary circulation, two important pathophysiological features may mitigate against the success of PCI: (i) up to 80% of LM disease involves the bifurcation known to be at particularly high risk of restenosis; and (ii) up to 80% of LM patients also have multivessel CAD where CABG, as already discussed, may already offer a survival advantage.

The most ‘definitive’ current account of treatment of LM disease by CABG or PCI is from the hypothesis-generating subgroup analysis of the SYNTAX trial. In 705 randomized LM patients, the 1-year rate of death (4.4% vs. 4.2%; P = 0.88), CVA (2.7% vs. 0.3%; P = 0.009), MI (4.1% vs. 4.3%; P = 0.97), repeat revascularization (6.7% vs. 12.0%; P = 0.02) and MACCE (13.6% vs. 15.8%; P = 0.44) only favoured CABG for repeat revascularization, but at a higher risk of CVA.

By SYNTAX score terciles, MACCE rates were 13.0% vs. 7.7% ( P = 0.19), 15.5% vs. 12.6% ( P = 0.54), and 12.9% vs. 25.3% ( p = 0.08) for CABG vs. PCI in the lower (0–22), intermediate (23–32), and high (≥33) terciles, respectively. Unpublished data at 2 years show respective mortalities of 7.9% and 2.7% ( P = 0.02) and repeat revascularization rates of 11.4% and 14.3% ( P = 0.44) in the two lower terciles, implying that PCI may be superior to CABG at 2 years. Of note, among the 1212 patients with LM stenosis included in the registry or in the RCTs, 65% had SYNTAX scores ≥33.

Support for the potential of PCI at least in lower risk LM lesions comes from several other sources. In a meta-analysis of 10 studies, including two RCTs and the large MAIN-COMPARE registry, of 3773 patients with LM stenosis, Naik et al. [ 56 ] reported that there was no difference between PCI and CABG in mortality or in the composite endpoint of death, MI, and CVA up to 3 years, but up to a four-fold increase in repeat revascularization with PCI. These results were confirmed at 5 years in the MAIN-COMPARE registry [ 57 ].

The two issues to be addressed are:

the appropriateness of revascularization ( Table 8

Table 8
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Indications for revascularization in stable angina or silent ischaemia

Table 8
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Download slide

Indications for revascularization in stable angina or silent ischaemia

the relative merits of CABG and PCI in differing patterns of CAD ( Table 9

Table 9
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Download slide

Indications for coronary artery bypass grafting vs. percutaneous coronary intervention in stable patients with lesions suitable for both procedures and low predicted surgical mortality

Table 9
View large Download slide

Indications for coronary artery bypass grafting vs. percutaneous coronary intervention in stable patients with lesions suitable for both procedures and low predicted surgical mortality

Current best evidence shows that revascularization can be readily justified:

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We are building a revolutionary privacy protocol. Our secret contracts enable truly decentralized applications. We make @CatalystCrypto. $ENG

Hello to the community! We have some awesome news to share today as the second quarter of 2018 finally comes to a close.

As we’ve stated from the earliest days of the Enigma project, our goal has always been to enable decentralized applications to scale and gain wide adoption. We believe our development of groundbreaking privacy technologies is the first major step towards building a platform that will support our vision of a more sustainable, decentralized future. As Enigma is one of the most ambitious projects in our space, we are always working hard to identify sale Guess Men’s Active Man Trainers Red the cheapest buy cheap online outlet best place 9GgsTfamV
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But in a space that’s often overcrowded with vision and undersaturated with substance, we have always been determined to build and deploy real solutions — not simply propose them. It is important for us to always keep building and always keep promises. That is why today we are very excited to announce the immediate launch of Enigma’s initial testnet.

This development has been a long time coming, ever since our CEO Guy Zyskind’s initial whitepapers were published back in 2015. Since then, our core principle — that — has been validated over and over again. Guy’s original whitepaper “ Decentralizing Privacy ” is now one of the most highly cited papers in the space with nearly 250 citations. We’ve never been more certain of the necessity of our project to the future of decentralization, and we’re glad to see more and more leaders and projects acknowledge the significance of privacy.

We acknowledge that development of these types of innovative technologies is non-linear and an ongoing, iterative process. We’re not simply forking an existing platform — we’re building something completely new and essential, something that will take (and has taken) many people and many days and nights to build. As we move along our ambitious roadmap, we anticipate meeting many challenges, some unforeseen. Enigma is committed to transparency and openness at every phase, and we will work actively with our developer community to tackle these problems and create better solutions. Privacy solutions are essential to securing all of our futures — and that is why we are determined to succeed.

If this sounds as exciting to you as it does to us, please read on for more details about the testnet and how you can begin building Reebok Pump Omni Lite sale affordable buy cheap low price fee shipping free shipping great deals 100% original sale online sale professional rUROlNheeh
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What’s in thebox?

The initial testnet release is a self-contained network which allows external developers to build their first secret contracts. This developer release provides a deployable Docker network that holds a simplified, containerized environment that also makes available multiple core components of the Enigma protocol. Developers are able to deploy secret contracts, and verify that these contracts are executed as intended.

Secret contracts operate by being executed in a retrofitted EVM running inside a Trusted Execution Environment (TEE), based on Intel’s SGX technology. This supports out-of-the-box interoperability with Solidity, as well as the Ethereum network.

Keep in mind, at this time you cannot:

What comesnext?

In the next Enigma release, we will have a couple of major changes. Some of these noteworthy changes are:

How can you getstarted?

To get started, you’ll need a host machine with Intel SGX enabled. Check for hardware that supports this and also a script that will check if yours is compatible. Then, great deals cheap online buy cheap best seller British Knights Demon Women’s Low Noir Black/Black popular clearance new clearance footaction PY5DnvkeSk
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If you note any errors in the documentation or have observations you believe are helpful to other developers, please make a post in the outlet store Locations sneakernews Guess Men’s Morales Sneaker Black cheap sale footlocker pictures Bywtrrn
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If you identify any protocol bugs or security issues, Enigma welcomes you to report these on our Github . All repositories are public.

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