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  1. Iqbal Malik, Editor

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Ischaemic heart disease

Inflammation marks the risk ▸

CD40 ligand is released from activated lymphocytes and platelets, and is proinflammatory. The concentrations of soluble CD40 ligand were raised (above 5.0 μg/l) in 221 of 626 patients with acute coronary syndromes (40.6%). Raised soluble CD40 ligand values identified those with acute coronary syndromes who were at high risk for death or non-fatal myocardial infarction (MI) (hazard ratio v with those with low levels, 6.65, 95% confidence interval (CI) 3.18 to 13.89; p < 0.001) independent of troponin concentrations. Elevation of soluble CD40 ligand identifies a subgroup of patients at high risk who are likely to benefit from antiplatelet treatment with abciximab (adjusted hazard ratio as compared with those receiving placebo, 0.37, 95% CI 0.20 to 0.68; p = 0.001). Whether this adds to assessment using C reactive protein, a better validated risk marker, was not tested.

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Informed consent for acute MI trials is nearly impossible ▸

Patients being asked to take part in a trial with approved protocol were assessed to see what information they were able to take in during the stress of an acute MI. The patient information sheet needed education to age 18 for comprehension, although only 75 of 345 patients (22%) had been educated beyond secondary school. Only 63 of 346 (18%) read the patient information sheet before giving or refusing consent to participate. Patients who gave consent were more likely to report good or partial comprehension of the information provided than were those who refused consent. In an assessment of competence to make a decision, 75 of 145 (52%) were ranked at the lowest grade and …

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