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October 2, 2003 Vol. 349 No. 14
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The sirolimus-eluting stent has shown promise in the prevention of restenosis after balloon dilation of simple coronary lesions. This clinical trial compared the sirolimus-eluting stent with a standard stent in patients with complex coronary lesions. The sirolimus-eluting stent proved to be superior in the prevention of restenosis and neointimal hyperplasia.
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Preexisting renal failure confers a risk of radiocontrast-agent–induced nephropathy after percutaneous coronary interventions. This study compared preemptive hemofiltration administered in an intensive care unit (ICU) with isotonic intravenous hydration given in a step-down unit for the prevention of contrast-agent–induced nephropathy in high-risk patients. A decrease in renal function occurred less frequently with hemofiltration (in 5 percent vs. 50 percent of patients; P<0.001). In-hospital and cumulative one-year mortality was lower in the hemofiltration group.
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This controlled trial involving 39,836 children evaluated the efficacy of a 9-valent pneumococcal conjugate vaccine in South Africa. Vaccination decreased the frequency of invasive pneumococcal disease among both HIV-negative and HIV-positive children and reduced the number of first episodes of radiologically confirmed pneumonia.
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This study of the entire Medicare fee-for-service population documented substantial racial and geographic variation in the use of knee arthroplasty in the United States. Geographic variation explained part of the racial variation in national arthroplasty rates. However, geographic variation did not explain the significantly lower arthroplasty rates among black men than among non-Hispanic white men in nearly all geographic regions.
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