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ISCHAEMIC HEART DISEASE
Late presentation with acute MI: do nothing or do a primary angioplasty? ▸
No studies to date have specifically addressed whether primary PCI is the most beneficial strategy in the patient presenting more than 12 hours from the onset of an ST elevation myocardial infarction (STEMI). In the BRAVE-2 trial, 365 patients presenting between 12–48 hours after the start of symptoms were randomised to immediate invasive treatment (stenting with abciximab) or a conventional conservative treatment strategy. The primary end point of left ventricular infarct size (as measured by a single photon emission computed tomography (SPECT) study with technetium sestamibi) was found to be significantly smaller in patients assigned to the invasive group (median 8% v 13%). The mean difference in final left ventricular infarct size was −6.8% smaller in the invasive group. No significant differences between the two treatment groups were found on comparing the secondary end point, a composite of death, recurrent myocardial infarction (MI), or stroke at 30 days.
Routine invasive treatment for ACS is better than selective use of catheterisation ▸
A meta-analysis of seven trials examining a routine invasive versus a selective invasive strategy following non-STEMI (NSTEMI) looked at the rates of death or MI in the 9212 patients studied. Overall, death or MI was reduced from 14.4% of patients in the selective invasive group to 12.2% of patients in the routine invasive group. Higher risk patients with elevated cardiac biomarker values at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker values. However, during initial hospitalisation, a routine invasive strategy was associated with a significantly higher early mortality (1.1% v 1.8%), and the composite of death or MI. But after discharge, a routine invasive strategy led to fewer subsequent deaths and MIs (11.0% v 7.4%). At the end of follow up, a routine invasive strategy led to a 33% reduction in severe angina, and a 34% reduction in rehospitalisation.
Oxidised phospholipids may be a marker for coronary disease ▸
Concentrations of oxidised low …