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https://doi.org/10.1136/heart.86.6.609

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    iqbal malik

    Editor, JournalScan

    ISCHAEMIC HEART DISEASE

    Clopidogrel for all acute coronary syndromes? JournalScan mentioned the CURE trial when it was presented at the American College of Cardiology meeting earlier this year (

    (2001) Heart 86:15–15.

    ). The full paper is now published. Clopidogrel in addition to aspirin reduces the risk of death/myocardial infarction (MI) and stroke by 20% if given to all patients with non-ST elevation acute coronary syndromes. At present, clopidogrel is only used after stent implantation in the UK. The CURE study showed similar benefits in low, medium, and higher risk patients (such as those with ST depression, positive troponins, or haemodynamic instability). Initiating treatment in all patients with acute coronary syndromes awaiting transfer for in-patient angiography is probably merited. The CURE investigators suggest that this group has a 28% reduction in death/MI at nine months follow up, having had six days pretreatment with the drug.

     1 CURE Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST segment elevation. The clopidogrel in unstable angina to prevent recurrent events trial investigators.

    (2001) N Engl J Med 345:494–502.

    .

      2 Mehta SR, Yusuf S, Peters RJG, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H-J, Zhao F, Chrolavicius S, Copland I, Fox KAA, for the Clopidogrel in Angina to Prevent Recurrent Events Trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.

    (2001) Lancet 358:527–33.

    .

    In-hospital arrest has a survival rate of 23% to discharge: A study of in-hospital resuscitation events suggests that 104 (23%) of 445 patients who received full advanced cardiac life support survived to hospital discharge. Survival was highest for patients with primary cardiac disease (30%), followed by those with infectious diseases (15%), with only 8% of patients with …

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    Footnotes

    • Journals scanned—American Journal of Medicine; American Journal of Physiology: Heart and Circulatory Physiology; Annals of Emergency Medicine; Annals of Thoracic Surgery; Archives of Internal Medicine; BMJ; Chest; European Journal of Cardiothoracic Surgery; Lancet; JAMA; Journal of Clinical Investigation; Journal of Diabetes and its Complications; Journal of Immunology; Journal of Thoracic and Cardiovascular Surgery; Nature Medicine; New England Journal of Medicine; Pharmacoeconomics; Thorax. Reviewers—C Baker, E Barnes, V Bhatia, R Desilva, M Earley, K Fox, D Gorog, G Jenkins, R Kaprilian, A Kapur, M Khan, P Lambiese, V Markides, M Poullis, P Ramrakha, J Strange, B Wasan, H Walker.