American heart journal
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American heart journal · Jul 2006
The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative.
Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied. ⋯ Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes.
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American heart journal · Jun 2006
Randomized Controlled Trial Multicenter StudyEvaluation of a novel anti-ischemic agent in acute coronary syndromes: design and rationale for the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-elevation acute coronary syndromes (MERLIN)-TIMI 36 trial.
Despite advances in antithrombotic therapies and invasive technology, the risk of recurrent ischemic complications in patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs) remains substantial. Ranolazine is a novel agent that inhibits the late sodium current thereby reducing cellular sodium and calcium overload and has been shown to reduce ischemia in patients with chronic stable angina. ⋯ MERLIN-TIMI 36 will evaluate the role of ranolazine in the acute and chronic management of patients presenting with NSTE-ACS.
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American heart journal · Jun 2006
ReviewRole of fibrinolytic therapy in the current era of ST-segment elevation myocardial infarction management.
In patients presenting with ST-elevation myocardial infarction, early, effective reperfusion of the culprit artery is needed to salvage myocardium, maintain left ventricular function, and reduce mortality. According to American College of Cardiology/American Heart Association guidelines for the treatment of these patients, the time from medical contact (i.e., firm ST-elevation myocardial infarction diagnosis) to initiation of fibrinolytic therapy (door-to-needle time) should be 30 minutes, and the time from medical contact to percutaneous coronary intervention (PCI) (door-to-balloon time) should be 90 minutes. Because many patients present to hospitals that are not equipped to administer PCI, door-to-balloon time often falls far short of the ideal. When PCI is not readily available, efficient prehospital treatment with t-PA-based fibrinolytic agent formulations that can be delivered in a bolus and do not require weight-based adjustment may reduce mortality rates and result in outcomes similar to PCI when administered promptly.
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American heart journal · Jun 2006
The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase.
Changes in the treatment of coronary artery disease both surgically and percutaneously have rendered the major randomized trials historical. Furthermore, the restrictive criteria of previous trials excluded most patients treated in daily practice. Although coronary surgery is still considered the current, evidence-based, gold-standard treatment of left main (LM) and 3-vessel coronary disease, the added benefit of drug-eluting stents has further expanded the use of percutaneous coronary intervention (PCI) beyond less complex populations in daily practice. ⋯ By replacing most traditional inclusion and exclusion criteria with the real-world decision between the cardiothoracic surgeon and the interventionalist, this study will define the roles of CABG and PCI using drug-eluting stents in the contemporary management of LM and 3VD. Results of the run-in phase were used by the steering committee to determine eligibility and to project enrollment for each site.