S G Goodman

..To describe the rationale and design of the Prospective Reinfarction Outcomes in the Thrombolytic Era Cardizem CD Trial (PROTECT)...

..Despite clear guideline recommendations, there is a growing body of evidence that there is suboptimal use of lipid-lowering treatment in Canadians...

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..The impact and prognostic value of the redefinition of myocardial infarction (MI) with more sensitive markers have not been evaluated prospectively in a large, less selected population with acute coronary syndrome (ACS)...

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..Expanded GRACE aims to test the feasibility of a simplified data collection tool and provision of quarterly feedback to index individual hospital management practices to an international reference cohort...

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..Data on non-Q myocardial infarctions (MI) are derived primarily from prethrombolytic era studies. Previous trials demonstrated different development rates and none reported on clinical outcomes...

..A key issue of uncertainty is the safety and efficacy of combination glycoprotein IIb/IIIa inhibitor and low-molecular-weight heparin therapy...

..The goal of this study was to determine whether enoxaparin was more effective than heparin in reducing recurrent ischemic episodes...

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..Although studies in the 1990s suggested that highrisk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada...

..The extent of scintigraphic reversibility was directly correlated with clinical events. Therefore scintigraphic imaging remains clinically relevant for risk stratification in the current low-risk population after MI...

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..Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS)...

..dual antiplatelet therapy plus warfarin leads to an excess of adverse outcomes...

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..We examined the use of in-hospital cardiac catheterization and medications in relation to risk across the broad spectrum of non-ST elevation ACSs...

..We compared the initial treatment and clinical outcomes of patients presenting with evolving MI (EMI) with those presenting with MI...

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..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)...

..7% vs 35.9%, p = 0.03). In conclusion, enoxaparin significantly decreased the composite of silent AMI or clinical AMI and death at 1 year (9.3% vs 21%, p = 0.0001)...

..The long duration between administration of the last bedtime dose of antihypertensive medication and the physiologic early morning surge in BP makes it difficult to achieve satisfactory BP control...

..Our objective was to evaluate the relationship between risk stratification and therapeutic decision making in patients with non-ST-segment elevation acute coronary syndromes...

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..We sought to determine the relationship between bleeding and myocardial ischemia detected by concurrent continuous electrocardiogram (ECG) monitoring and their independent long-term prognostic significance...

..We compared prasugrel with clopidogrel among subjects with DM in TRITON-TIMI 38...

..Smoking remains a major public health issue. We investigated the incidence of smoking and outcomes in high-risk patients with acute coronary syndromes. Differences in treatment effect of antithrombin therapies were also investigated...

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..Patients in ASSENT-4 PCI undergoing tenecteplase-facilitated percutaneous coronary intervention (PCI) had more adverse events than those undergoing primary PCI. We analysed this to gain further insights...

..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...

..The role of routine early PCI after fibrinolysis, using stents and contemporary pharmacotherapy, has not been studied in a large adequately powered randomized trial...

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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...

..Because these data are not generalizable to all patients with acute myocardial infarction, we sought to better understand the scope of this problem in a "real-world" setting...

..Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI)...

..Practice guidelines support an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes, particularly in those at higher risk...

..Urgent PCI after thrombolysis may optimize reperfusion and prevent reinfarction and recurrent ischemia...

..It is hoped that the SYNERGY Library will serve as a model for future substudy design to maximize academic insight within the framework of a large-scale, multicenter trial...

..CONCLUSION: In a systematic overview of approximately 22 000 patients across the spectrum of ACS, enoxaparin is more effective than unfractionated heparin in preventing the combined end point of death or MI...

..The reasons for noncompliance are complex, and may be elucidated by future studies of medical and social determinants...

..002). CONCLUSIONS: Prompt fibrinolytic treatment improved the likelihood of aborted MI. The subgroup with complete 60-min ST-segment resolution had the best clinical outcomes...

..Moreover, there was a significant opportunity to enhance the discharge and long-term use of evidence-based secondary prevention therapies...

..Ongoing studies will clarify the role of low-molecular-weight heparins as adjunctive therapy for fibrinolysis...

..Accurate estimation of risk for untoward outcomes after patients have been hospitalized for an acute coronary syndrome (ACS) may help clinicians guide the type and intensity of therapy...

..To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE)...

..The objective of this report was to describe patterns of use of antithrombotic and antiplatelet therapies in patients with the spectrum of ACS through the use of data from the Global Registry of Acute Coronary Events (GRACE)...

..We compared ST resolution in each of the three treatment regimens in order to evaluate the speed, extent and stability of ST segment resolution and its relationship to the primary composite endpoint(s) of the trial...

..The gap between evidence and practice is well recognized but the factors influencing this disjunction, and the extent to which such factors are modifiable, remain uncertain...

..However, no data are available about the safety and efficacy in patients who are obese and patients with severe renal impairment...

..CONCLUSION: Women with early reinfarction following fibrinolysis for AMI had more frequent early death and were managed less aggressively. These findings suggest the need for increased awareness and timely intervention in these patients...

..Our findings underscore the potential importance of risk model validation in the general ACS population rather than a clinical trial population to establish its generalizability before integration into clinical practice...

..The benefit of catheterization in both syndromes may depend on patient risk for adverse clinical outcomes...

..Continued efforts to promote adherence to existing proven therapies and to develop novel treatment strategies targeting diabetes-specific cardiovascular pathophysiology are imperative to improve their adverse prognosis...

..Furthermore, registry data show that one-half of these patients are not even achieving the current LDL-C target of 2.5 mmol/L. Causes of the care gap are discussed and possible remedies to achieve the new lower targets are suggested...

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..In conclusion, in patients with NSTE-ACS, heart failure on admission is associated with increased short- and long-term rates of death and MI...

..Our findings emphasize the ongoing need to better define and promote optimal therapeutic regimens for elderly patients with ACS...

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..8-4.3). In addition, our review discusses electrocardiographic markers of poor outcome that were not independent risk factors on multivariate analysis, conflicting findings, and knowledge gaps that can help plan future research efforts...

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..92, 2.07-7.41) and death or MI (2.51, 1.41-4.48). CONCLUSIONS: In patients with NSTE-ACS, major bleeding is associated with increased short- and long-term rates of death and MI, and is predicted by simple clinical characteristics...

..The percentages of patients undergoing invasive and revascularization procedures were consistently higher in the U.S. cohorts of study subjects when compared to non-U.S. cohorts of study subjects...

..A risk-determined algorithm is presented, which applies observations made at the time of presentation to decide the optimal management for the individual patient...