Background. Direct-acting antivirals (DAAs) are highly effective treatments against hepatitis C virus (HCV), with sustained virologic response (SVR) rates of 93–100% against all genotypes. In most patients, viral load (VL) becomes undetectable four weeks into treatment, but rarely a low positive VL may be observed at the end of treatment (EOT). This study was conducted to determine the effect of low positive EOT VLs with DAA therapies on SVR at 12 and 24 weeks. Methods. A retrospective chart review was conducted from January 2014 to December 2018 on 1256 HCV patients of all genotypes (1–6) who had received DAA therapy at two large hepatology referral centers. Baseline demographic data, along with VL at week four, EOT, and SVR12/24 time points were collected for patients that had positive EOT VL. Treatment outcome for any patient with positive EOT VL was noted. Results. Eight out of 1256 patients treated with varying DAA therapies were observed to have low positive EOT VLs ranging from <15 to 235 IU/mL. One patient had a negative EOT VL, but 23 IU/mL at week four after EOT. All eight patients who had low positive EOT VLs and one patient who had a low positive VL at four weeks after EOT achieved SVR at weeks 12 and 24. One of the eight patients had cirrhosis. The majority of patients were genotype 1a. Conclusion. In the DAA treatment era, low levels of detectable HCV RNA at EOT does not predict treatment failure.

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Background: Little evidence exists to guide risk stratification and management of patients with prior coronary artery stenting who require noncardiac surgery. While clinical models for perioperative risk stratification have been established, few studies have examined angiographic contributors to perioperative risk. Methods: We examined 405 patients with prior coronary artery stenting who underwent non-cardiac surgery between 8/23/2001 and 12/27/2009 at a tertiary care institution for whom detailed information on coronary anatomy and perioperative treatment could be obtained. Coronary angiograms were independently reviewed, and patients were followed for a median of 3.1 years after surgery. Results: In our study population, 52% had prior MI, 18% had prior stroke/TIA, and 26% had prior heart failure. The median time from PCI to surgery was 325 days (interquartile range [IQR] 81 to 808). Among these patients, 35% were stented electively, 14% were stented in the STEMI setting, and 51% were stented in the NSTE ACS setting. Lesions treated included 18 previously stented lesions, 83 bifurcation lesions, 117 highly calcified lesions, and 53 lesions with visible thrombus. A total of 188 patients (46%) were treated with Ն1 stent, with a median stent diameter of 3mm (IQR 2.5-3) and a median stent length of 18 mm (IQR 13 to 23). A total of 243 patients (60%) were stented with Ն1 drug eluting stent (DES). At the time of surgery, 125/220 (57%) patients still on clopidogrel stopped clopidogrel at a median of 8 days (IQR 5-11) prior to surgery. Among 116 DES patients undergoing surgery within a year of stent implantation, 37 (32%) stopped clopidogrel prior to surgery, and 12 (10%) were bridged with a parenteral antithrombotic agent. Perioperative MI occurred in 19 patients (4.7%). Perioperative bleeding defined as a preoperative to nadir hematocrit difference Ն10% occurred in 114 patients (28%) and transfusions were given in 65 patients (16%). The 3-year mortality risk was 17%. Conclusions: Patients with coronary disease undergoing noncardiac surgery remain a high risk population for whom evidence-based strategies are greatly needed to improve perioperative outcomes.Background: To evaluate the clinical safety and effectiveness of the DESolve™ Myolimus-Eluting Bioresorbable Coronary Scaffold (BCSS)in patients with single de novo native coronary artery lesions through clinical endpoints and multiple imaging modalities. The DESolve BCSS is a novel drug eluting device that combines a PLLA-based scaffold coated with a bioresorbable polylactide-based polymer and the drug Myolimus. Myolimus, a macrocyclic lactone mTOR inhibitor has demonstrated potent anti-proliferative properties in two First-in-Man (FIM) trials using Elixir's metallic Myolimus-eluting coronary stents. Drug dose is 3 mcg per mm of scaffold length; the same dose used in the FIM studies. Methods: Sixteen patients with single, de novo coronary artery lesions were enrolled in this prospective, multi-center, single-arm FIM study. One patient did not receive a study stent a...