Kardiol Pol
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The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal. ⋯ Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor.
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Primary percutaneous coronary intervention (PPCI) is regarded as the treatment of choice for ST elevation myocardial infarction (STEMI) patients. It has been emphasised that only experienced centres with round-the-clock cathlab facilities should perform PPCI. Some investigators have doubted whether PPCI performed during 'off-hours' is as effective and safe as that performed during regular hours. Papers supporting both possibilities have been published. ⋯ The PPCI performed in high-volume, experienced invasive cardiology centres in Europe during off-hours is associated with a comparable outcome and safety profile as PPCI performed during regular working hours.
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The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE). ⋯ ECG parameters are useful in predicting myocardial injury and assessing prognosis in patients with APE.
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Recurrent myocardial ischaemia and restenosis are more common in diabetic patients treated with primary percutaneous coronary intervention (PCI) due to an acute coronary syndrome (ACS) compared to patients without diabetes. Diabetes is also associated with increased residual platelet activity during dual antiplatelet treatment. In recent reports, platelet reactivity has been linked to outcomes after ACS. Appropriate platelet inhibition might lead to improved outcomes in this patient population. To this end, newest methods to evaluate platelet function may prove helpful. ⋯ Increased platelet reactivity evaluated by TRAP-induced aggregation is related to a higher rate of restenosis and recurrent ACS during a 6-month follow-up of diabetic STEMI patients treated with PCI.