H White

..This study was designed to determine the impact of bivalirudin on 1-year outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)...

..To discern if the prognostic meaning of QRS prolongation differs according to the location of ST elevation acute myocardial infarction..

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..We did a randomised, open-label trial to compare the thrombin-specific anticoagulant, bivalirudin, with heparin in patients undergoing fibrinolysis with streptokinase for acute myocardial infarction...

..To determine the effects of age on outcomes in patients with STEMI treated with a strategy of enoxaparin (ENOX) vs. unfractionated heparin (UFH)...

..The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial...

..Target INRs are frequently not achieved, and the risk of death, bleeding, myocardial infarction (MI), and stroke or systemic embolism event (SEE) may be related to INR control...

..The SYNERGY trial compared these agents in high-risk patients undergoing early invasive treatment. Enoxaparin was noninferior to UFH for the 30-day primary end point of death/myocardial infarction (MI), but modestly increased bleeding...

..Those with heart failure or impaired left ventricular left ventricular function after acute myocardial infarction have high complication and mortality rates. Little is known about outcomes with contemporary therapies in these patients...

..We need to have a better process whereby New Zealanders can rapidly access new treatments...

..The aim of this study was to compare outcomes in patients receiving consistent unfractionated heparin (UFH)/enoxaparin (ENOX) therapy and in those switched at randomization to bivalirudin monotherapy...

..Bivalirudin is an attractive antithrombotic choice in patients undergoing primary PCI...

..Two phase 3 trials are evaluating the efficacy and safety of vorapaxar in patients presenting with non-ST-segment elevation acute coronary syndromes and in patients with documented atherothrombotic disease...

..Direct inhibition of this proinflammatory enzyme with darapladib may benefit CV patients when given as an adjunct to standard of care, including lipid-lowering and antiplatelet therapies...

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..Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease...

..Hematomas > or =5 cm at the femoral puncture site are considered major bleeding events in some trials and minor in others. Limited information is available on the incidence and clinical relevance of hematomas > or =5 cm in PCI patients...

..In this review, the importance of the association of bleeding with mortality and strategies to reduce bleeding with percutaneous coronary intervention are discussed...

..Bivalirudin has also recently been investigated in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty and stenting. More than 27,000 patients were randomized in these trials...

..5 or 0.75 mg/kg, n = 2,298) or activated clotting time-adjusted unfractionated heparin (UFH, n = 1,230), stratified according to planned glycoprotein IIb/IIIa inhibitor use...

..Newer assays with higher precision for detection of troponin levels are about to enter clinical practice. The present review discusses the implications of the new assays for patients...

..To compare the management of acute coronary syndrome (ACS) patients presenting to interventional versus non-interventional New Zealand hospitals, with emphasis, on access delays for invasive assessment and revascularisation treatments...

..Therefore, a more aggressive approach to reperfusion might be warranted in these patients...

..Trials are required to determine the best treatment for high-risk and low-risk patients with LBBB...

..We also assessed flow with angiography at 3 months using a modified Thombolysis in Myocardial Infarction (TIMI) grade in the grafted coronary arteries...

..Bivalirudin is suitable for use as an alternative to heparin in the majority of patients undergoing PCI and in patients receiving streptokinase for acute MI...

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..This evidence-based treatment should be widely implemented to ensure that patients with heart failure receive appropriate medical therapy...

..1; interquartile range -0.2, 0.9 mg/L), intercellular adhesion molecule 1 (+17+/-75 ng/mL), or CD40 ligand (+0.4+/-2.1 ng/mL). Most of the individual variation in inflammatory marker levels was unrelated to changes in smoking habit...

..A higher neutrophil count is not associated with worse epicardial blood flow at 90 minutes after streptokinase, and a higher non-neutrophil count predicts a greater likelihood of achieving TIMI-3 flow...

..To compare patient management in 2007 with the 1st NZ Cardiac Society ACS Audit from 2002...

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..Enoxaparin is an appropriate choice for adjunctive therapy with fibrinolysis in patients with STEMI...

..Adjunctive therapies have been disappointing. To further improve outcomes, earlier pre-emptive and preventive strategies to ensure early revascularization should be pursued...

..The major benefit of direct thrombin inhibitors appears to be in patients undergoing PCI, particularly after STEMI...

..Although inherited thrombophilias are more common in patients with venous thromboembolism, their influence on the development of myocardial infarction (MI) requires clarification...

..This study assessed whether depressive symptoms were associated with adverse outcomes in people with a history of an acute coronary syndrome, and evaluated possible explanations for such an association...

..Effects of eplerenone on LV diastolic function and progression of valve stenosis were also evaluated...

..We aimed to assess whether patients with acute myocardial infarction could understand written and verbal information and whether they were competent to give autonomous informed consent to participate in a clinical trial...

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..This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS...

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..This study describes differences in cardiovascular risk factors and cardiovascular mortality in Australians and New Zealanders with stable coronary artery disease stratified by socioeconomic status...

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..Two large phase III clinical trials that are currently in progress will determine whether darapladib will reduce the risk of myocardial infarction, stroke, and cardiovascular death by stabilizing atherosclerotic plaques...

..These electrocardiographic features should be considered in risk stratification to identify high-risk patients...

..This Seminar discusses the underlying pathophysiology, evolving perspectives on diagnosis, risk stratification, and the invasive and pharmacological management of myocardial infarction...

..27 +/- 0.80 mm, P =.03; after high fat 1.24 +/- 0.74 mm, P =.04). CONCLUSIONS: Increased myocardial ischemia after food is caused by mechanisms other than endothelial dysfunction and by meal components other than cooked fat...

..In patients with chronic aortic regurgitation, measurement of natriuretic peptide levels may provide information on left ventricular function in addition to echocardiography...

..CONCLUSIONS: Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis...

..If results are positive, the clinical practice determinants required for the effective application of this strategy to the wider clinical community will need careful consideration...

..At one year, freedom from cardiac death or non-fatal myocardial infarction was 98% [95%CI 95,100]. CONCLUSIONS: The chest pain pathway facilitated patient triage and patients had high event-free survival...

..002), treadmill exercise duration (p = 0.004), biplane left ventricular sphericity index (p = 0.032), age (p = 0.043), and end-systolic volume index (p = 0.047), but not TIMI flow grade...

..Five days into the first course, after initially experiencing diarrhea, nausea, vomiting and a transient episode of retrosternal chest pain radiating to the left scapula, she presented to the emergency department with cardiogenic shock...

..C-reactive protein decreased from before to 6 months after aortic valve replacement for aortic stenosis. These observations suggest that aortic stenosis is an inflammatory disease...

..To describe the perceptions of the New Zealand public as to the role of the doctor in 2010...

..However, the relative prognostic importance of these measures over other baseline variables is less known...

..We examined characteristics, cardiovascular outcomes, and the influence of risk factors on outcomes in young survivors of AMI...

..Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), these patients still suffer substantial morbidity and mortality...

..To determine the relationship between anticoagulation levels during percutaneous coronary intervention, and ischaemic events and bleeding...

..We studied the incidence, timing, and outcomes of such arrhythmias in the international Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries (GUSTO)-III trial...

..These findings support the rationale and promise for combining GP IIb/IIIa blockers and LMWH for future management of acute coronary syndrome...

..To measure the cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with established ischaemic heart disease and average baseline cholesterol levels...

..Rates of nonfatal ischemic complications were significantly diminished...

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..CONCLUSIONS: Statin pretreatment in patients with acute coronary syndromes is associated with improved clinical outcome. However, discontinuation of statins after onset of symptoms completely abrogates this beneficial effect...

..Replacing UFH with enoxaparin when tirofiban is administered to patients may offer further therapeutic benefit, but could also increase bleeding...

..We sought to delineate predictors of AVB and determine long-term mortality of patients developing AVB in the setting of ST-segment elevation MI (STEMI) treated with thrombolytic therapy...

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..We evaluated the relationship between time from hospital admission to coronary angiography and outcomes in high-risk patients with non-ST-segment-elevation acute coronary syndrome who underwent angiography within 48 hours of admission...

..We investigated the relationships between statin use and sex-specific stroke incidence, severity, and mortality...

..Unfractionated heparin is often used as adjunctive therapy with fibrinolysis in patients with ST-elevation myocardial infarction. We compared a low-molecular-weight heparin, enoxaparin, with unfractionated heparin for this purpose...

..Accordingly, the current study examines the relationship of African American race to patient-related clinical factors, angiographic findings, and clinical events...

..12), which was independent of the treatment assignment. CONCLUSIONS: Even mild renal disease, as assessed by the estimated GFR, should be considered a major risk factor for cardiovascular complications after a myocardial infarction...

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..CONCLUSIONS: In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, stroke occurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk...

..Pilot trials suggest that the thrombin-specific anticoagulant bivalirudin may improve clinical outcomes in ACS...

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..2 and 6.5%, respectively (P<0.001). CONCLUSION: Patients with stroke after MI have a dismal prognosis. The presence of HF on admission for an acute MI increases in-hospital stroke risk. HF treatments may modify the risk of stroke...

..All MI types were associated with worse short- and long-term outcomes. Characterization of the type of MI provides an opportunity for more informed interpretation of clinical trial results and improved planning for future trials...

..In this review we evaluate the evidence for statin use in this important and increasingly large group of patients...

..The observed risk was apparent even after excluding patients who had undergone revascularization...

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..Reasons include limited trial data to guide the care of older adults and uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age or complex health status...

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..The aim of this study was to assess anticoagulation with the direct thrombin inhibitor bivalirudin during percutaneous coronary intervention in individuals with moderate and high-risk acute coronary syndromes...

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..We examined the clinical, angiographic, and procedural characteristics determining survival after percutaneous coronary intervention (PCI) for cardiogenic shock...

..Our objective was to analyze the impact of arterial access site, sheath size, timing of sheath removal, and use of access site closure devices on high-risk patients with acute coronary syndromes (ACS)...