***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives Acute chest pain ( ACP ) is a leading cause of hospital emergency unit consultation . As there are various underlying conditions , ranging from musculoskeletal disorders to acute coronary syndrome ( ACS ) , thorough clinical diagnostics are warranted . The aim of this prospect i ve study was to assess whether  reproducible chest wall tenderness ( CWT ) on palpation in patients with ACP can help to rule out ACS . Methods In this prospect i ve , double-blinded diagnostic study , all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present .  Reproducible CWT on palpation  was the initial step and was recorded before further examinations were initiated . The final diagnosis was adjudicated by a study -independent physician . Results 121 patients ( 60.3 % male , median age 47 years , IQR 34–66.5 years ) were included . The prevalence of ACS was 11.6 % .  Non-reproducible CWT had a high sensitivity of 92.9 % ( 95 % CI 66.1 % to 98.8 % ) for ACS and the presence of reproducible CWT ruled out ACS ( p=0.003 ) with a high negative predictive value ( 98.1 % , 95 % CI 89.9 % to 99.7 % ) . Conversely non-reproducible CWT ruled in ACS with low specificity ( 48.6 % , 95 % CI 38.8 % to 58.5 % ) and low positive predictive value ( 19.1 % , 95 % CI 10.6 % to 30.5 % ) . Conclusions This prospect i ve diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process . However , ACS and other diagnoses should be considered in patients with a negative CWT test . Trial registration number Clinical Trial.gov : NCT01724996 Background GlycA , a novel protein glycan biomarker of N‐acetyl side chains of acute‐phase proteins , was recently associated with incident cardiovascular disease ( CVD ) in healthy women . Whether GlycA predicts CVD events in the setting of statin therapy in men and women without CVD but with evidence of chronic inflammation is unknown . Methods and Results In the Justfication for the Use of Statins in Prevention : an Intervention Trial Evaluating Rosuvastatin ( JUPITER ) trial ( NCT00239681 ) , participants with low‐density lipoprotein cholesterol < 130 mg/dL and high‐sensitivity C‐reactive protein ( hsCRP ) ≥2 mg/L were r and omized to rosuvastatin 20 mg/day or placebo . GlycA was quantified by nuclear magnetic resonance spectroscopy in 12 527 before r and omization and 10 039 participants at 1 year . A total of 310 first primary CVD events occurred during maximum follow‐up of 5.0 years ( median , 1.9 ) . GlycA changed minimally after 1 year on study treatment : 6.8 % and 4.7 % decrease in the rosuvastatin and placebo groups , respectively . Overall , baseline GlycA levels were associated with increased risk of CVD : multivariable‐adjusted hazard ratio ( HR ) per SD increment , 1.20 ( 95 % CI , 1.08–1.34 ; P=0.0006 ) . After additionally adjusting for hsCRP , this was slightly attenuated ( HR , 1.18 ; 95 % CI , 1.04–1.35 ; P=0.01 ) . On‐treatment GlycA levels were also associated with CVD ; corresponding multivariable‐adjusted HRs per SD before and after additionally adjusting for hsCRP : 1.27 ( 95 % CI , 1.13–1.42 ; P<0.0001 ) and 1.24 ( 95 % CI , 1.07–1.44 ; P=0.004 ) , respectively . Tests for heterogeneity by treatment arm were not significant ( P for interaction , > 0.20 ) . Conclusion In the JUPITER trial , increased levels of GlycA were associated with an increased risk of CVD events independent of traditional risk factors and hsCRP . Clinical Trials Registration URL : http://www . clinical trials.gov . Unique identifier : NCT00239681 BACKGROUND Atorvastatin , rosuvastatin and pitavastatin are available for intensive , aggressive low-density lipoprotein cholesterol (LDL-C)-lowering therapy in clinical practice . The objective of the R and omized Head-to-Head Comparison of Pitavastatin , Atorvastatin , and Rosuvastatin for Safety and Efficacy ( Quantity and Quality of LDL ) ( PATROL ) Trial was to compare the safety and efficacy of atorvastatin , rosuvastatin and pitavastatin head to head in patients with hypercholesterolemia . This is the first prospect i ve r and omized multi-center trial to compare these strong statins ( UMIN Registration No : 000000586 ) . METHODS AND RESULTS Patients with risk factors for coronary artery disease and elevated LDL-C levels were r and omized to receive atorvastatin ( 10mg/day ) , rosuvastatin ( 2.5mg/day ) , or pitavastatin ( 2mg/day ) for 16 weeks . Safety was assessed in terms of adverse event rates , including abnormal clinical laboratory variables related to liver and kidney function and skeletal muscle . Efficacy was assessed by the changes in the levels and patterns of lipoproteins .  Three hundred and two patients ( from 51 centers ) were enrolled , and these 3 strong statins equally reduced LDL-C and LDL particles , as well as fast-migrating LDL ( modified LDL ) by 40 - 45 % . Newly developed pitavastatin was non-inferior to the other 2 statins in lowering LDL-C. There were no differences in the rate of adverse drug reactions among the 3 groups , but HbA(1c ) was increased while uric acid was decreased in the atorvastatin and rosuvastatin groups . CONCLUSIONS The safety and efficacy of these 3 strong statins are equal . It is suggested that the use of these 3 statins be completely dependent on physician discretion based on patient background OBJECTIVES The purpose of this study was to determine the efficacy and safety of radial versus femoral access in women undergoing coronary angiography/intervention . BACKGROUND The risk of bleeding and vascular access site complications are higher in women than in men . METHODS In a pre-specified RIVAL ( RadIal Vs femorAL access for coronary intervention ) subgroup analysis , we compared outcomes in women ( n=1,861 ) and men ( n=5,160 ) r and omized to radial versus femoral access . RESULTS Overall , women were at higher risk of major vascular complications compared with men ( 4.7 % vs. 1.7 % ; p<0.0001 ) . Major vascular complications were significantly reduced with radial access in women ( 3.1 % vs. 6.1 % ; hazard ratio [ HR ] : 0.5 ; 95 % confidence interval [ CI ] : 0.32 to 0.78 ; p=0.002 ) and in men ( 0.7 % vs. 2.8 % ; HR : 0.27 ; 95 % CI : 0.17 to 0.45 ; p<0.0001 ; interaction p=0.092 ) . Crossover rates were higher with radial compared with femoral access in women ( 11.1 % vs. 1.9 % ; HR : 5.88 ; p<0.0001 ) and men ( 6.3 % vs. 1.9 % ; HR : 3.32 ; p<0.0001 ; interaction p=0.054 ) .  Percutaneous coronary intervention ( PCI ) success rates were similar irrespective of access site ( women : HR : 1.05 ; p=0.471 ; men : HR : 1.00 ; p=0.888 ; interaction p=0.674 ) , with no differences in PCI complications . In multivariable analyses , female sex was an independent predictor of major vascular complications ( HR : 2.39 ; 95 % CI : 1.76 to 3.25 ; p<0.0001 ) . There were consistent findings for women and men , with no difference for the primary composite endpoint of death , myocardial infa rct ion , stroke , and non-coronary artery bypass grafting bleeding ( women : 3.9 % vs. 5.0 % ; HR : 0.77 ; 95 % CI : 0.50 to 1.19 ; men : 3.54 % vs. 3.5 % ; HR : 1.00 ; 95 % CI : 0.75 to -1.34 ; interaction p=0.325 ) . CONCLUSIONS Women undergoing coronary angiography and PCI  have a higher risk of vascular access site complications compared with men , and radial access is an effective method to reduce these complications BACKGROUND Statin therapy reduces low-density lipoprotein ( LDL ) cholesterol levels and the risk of cardiovascular events , but whether the addition of ezetimibe , a nonstatin drug that reduces intestinal cholesterol absorption , can reduce the rate of cardiovascular events further is not known . METHODS We conducted a double-blind , r and omized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter ( 1.3 to 2.6 mmol per liter ) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter ( 1.3 to 3.2 mmol per liter ) if they were not receiving lipid-lowering therapy .  The combination of simvastatin ( 40 mg ) and ezetimibe ( 10 mg ) ( simvastatin-ezetimibe ) was compared with simvastatin ( 40 mg ) and placebo ( simvastatin monotherapy ) . The primary end point was a composite of cardiovascular death , nonfatal myocardial infa rct ion , unstable angina requiring rehospitalization , coronary revascularization ( ≥30 days after r and omization ) , or nonfatal stroke . The median follow-up was 6 years . RESULTS The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter ( 1.4 mmol per liter ) in the simvastatin-ezetimibe group , as compared with 69.5 mg per deciliter ( 1.8 mmol per liter ) in the simvastatin-monotherapy group ( P<0.001 ) . The Kaplan-Meier event rate for the primary end point at 7 years was 32.7 % in the simvastatin-ezetimibe group , as compared with 34.7 % in the simvastatin-monotherapy group ( absolute risk difference , 2.0 percentage points ; hazard ratio , 0.936 ; 95 % confidence interval , 0.89 to 0.99 ; P=0.016 ) . Rates of prespecified muscle , gallbladder , and hepatic adverse effects and cancer were similar in the two groups . CONCLUSIONS When added to statin therapy , ezetimibe result ed in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes . Moreover , lowering LDL cholesterol to levels below previous targets provided additional benefit . ( Funded by Merck ; IMPROVE-IT Clinical Trials.gov number , NCT00202878 . ) Objectives We prospect ively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy ( CIN ) in patients with chronic kidney disease ( CKD ) undergoing percutaneous coronary intervention ( PCI ) . Methods We enrolled 1078 consecutive patients with CKD undergoing elective PCI . Patients in Group 1 ( n = 273 ) received rosuvastatin ( 10 mg ) , and those in group 2 ( n = 805 ) received atorvastatin ( 20 mg ) . The primary end-point was the development of CIN , defined as an absolute increase in serum creatinine ≥0.5 mg/dL , or an increase ≥25 % from baseline within 48–72 h after contrast medium exposure . Results CIN was observed in 58 ( 5.4 % ) patients . The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin ( 5.9 % vs. 5.2 % , p = 0.684 ) . The same results were also observed when using other definitions of CIN . Clinical and procedural characteristics did not show significant differences between the two groups ( p>0.05 ) . Additionally , there were no significant inter-group differences with respect to in-hospital mortality rates ( 0.4 % vs. 1.5 % , p = 0.141 ) , or other in-hospital complications . Multivariate logistic regression analysis revealed that rosuv 
    Output:
    
Our systematic review and meta- analysis showed that , compared with the conventional dose , the loading dose of rosuvastatin was more beneficial to patients with ACS in China and is suitable for clinical application .