P W Armstrong

..We undertook a prespecified pooled analysis of data from the ASSENT-3 and ASSENT-3 PLUS trials...

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..We evaluated whether optimal pharmacologic therapy at the earliest point of care, emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI)...

..However, in patients without prompt reestablishment of brisk coronary flow and tissue perfusion, mortality remains high, providing an opportunity for novel treatments, including anti-inflammatory agents...

..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 trial is embedded in an academic research organization motif and promises to provide a significant contribution to the body of knowledge in acute heart failure and the care of patients so afflicted...

..To trace the evolution of coronary care and the management of acute coronary syndromes...

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..This issue has not been studied systematically among the spectrum of patients with acute coronary presentations, encompassing those with and without ST-segment elevation...

..The authors believe it is time to embrace an integrated dual reperfusion strategy to best serve all patients with STEMI...

..We undertook an angiographic, dose-finding study of staphylokinase (SAK42D variant) to evaluate its efficacy and safety in patients with acute ST-segment myocardial infarction...

..Traditional time-to-event analysis assigns equal weight to the first event in the composite end point. This is counterintuitive to many stakeholders...

..The program has recruited 19 trainees from a broad cross-section of disciplines, integrating 2 University of Alberta campuses. The preliminary experience has been both favourable and gratifying...

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..We assessed the incremental value of baseline Q waves over time from symptom onset as a marker of clinical outcome in ST-segment elevation myocardial infarction (STEMI)...

..Pilot studies with bolus pegulated staphylokinase (PEG-Sak) have revealed excellent Thrombolysis In Myocardial Infarction (TIMI) 3 60-minute flow...

..CONCLUSIONS: These data provide new evidence supporting the powerful prognostic value of the baseline electrocardiogram and, in particular, the magnitude and distribution of ST segment depression in predicting unfavorable events...

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..Time to treatment further differentiates between high- and low-risk patients and further highlights the importance of reducing time delay to initiation of fibrinolysis in acute myocardial infarction...

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..To examine whether ST segment depression influenced clinical decision making and whether there was international variation in the use of cardiac procedures across ST segment depression categories...

..To evaluate the anticoagulation effect of subcutaneous (SQ) and intravenous (IV) enoxaparin through systematic anti-Xa sampling during primary PCI for acute STEMI...

..Additional investigation into the causes, treatment, and policy implications of the age-sex interaction is warranted...

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..To determine whether multidisciplinary disease management programmes for patients with coronary heart disease improve processes of care and reduce morbidity and mortality...

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..The relative incidence of elevated cardiac troponins in this population and their relationship to clinical events remain unknown...

..Further research into the mechanisms of anemia in CHF and randomized controlled trials to test whether correction of anemia improves prognosis in CHF are needed...

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

..The future is likely to emphasize greater application of the already effective therapies at our disposal and the development of novel anti-platelet and anti-thrombin agents as well as those directed toward inflammation...

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..NT-proBNP at baseline, 24 h and 72 h after presentation with acute STEMI, is an independent predictor of a poor outcome and adds clinically useful prognostic information...

..We used population-level data to determine the rate at which such patients seek medical attention for these symptoms, whether sex differences are present, and if an association between prodromes and 1-year mortality exists...

..The absence of provincial or national guidelines may have influenced the uptake and application of this novel therapy...

..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...

..82 for the composite and day 7-30 models, respectively. CONCLUSIONS: Dynamic risk assessment is feasible and reliable. This approach can improve risk assessment and provide valuable guidance for management of patients with NSTE-ACS...

..Spontaneous reperfusion (SR) in ST elevation myocardial infarction (STEMI) improves clinical outcome, yet its incidence and impact among diabetic patients is unclear...

..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...

..Hence, in STEMI patients treated with primary percutaneous coronary intervention, we examined whether baseline atrial electrocardiographic changes or atrial infarction patterns predicted new AF or mortality...

..To examine the extent and impact on clinical outcomes of adherence to electrocardiogram (ECG) entry criteria in ST-elevation myocardial infarction patients in the assessment of pexelizumab in acute myocardial infarction (APEX-AMI) trial...

..Accordingly, we evaluated plasma samples acquired at presentation in 178 patients with ACS for a possible association between Cpn IgA titer and biochemical evidence of myocardial injury...

..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...

..Thus, the development and validation of a risk stratification scheme to identify those patients most likely to benefit from ICDs for primary prophylaxis should be a research priority...

..g. the identification of high-risk patients for possible co-interventions. CONCLUSION: Dynamic modelling for STEMI patients enhances the risk assessment and stratification and should provide valuable ongoing guidance for their management...

..The relative contributions of patient, hospital, and country level factors on clinical outcomes, however, remain unclear, and thus, was the objective of this study...

..Methods to improve timely and appropriate access to specialists and to improve collaborative care structures are needed...

..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...

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..Thus, although the complication rate was higher, the benefits of spironolactone seen in RALES extended to participants not in a trial who were treated with similar doses and followed closely in a clinic specializing in heart failure...

..We review past research in prehospital therapy for STEMI and practical impediments to implementation to establish a framework for interpretation of future developments...

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..1% vs 3.6%; P = .001). CONCLUSION: These findings support the etiological role of acute atrial ischemia in the development of early atrial arrhythmias and AV block complicating AMI...

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..In our cohort of elderly patients with multiple comorbidities, beta-blockers were well tolerated...

..24, HR for death/CHF/shock 2.93, 95% CI 1.84 to 4.67). In conclusion, infarct size as estimated by QRS scoring at hospital discharge is an independent and prognostically relevant metric in patients with STEMI undergoing primary PCI...

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..We sought to compare outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with or without previous coronary artery bypass grafts (CABG)...

..To assess the effects of socioeconomic status on mortality in patients with acute myocardial infarction...

..The purpose of this study was to develop 30-day and 1-year risk stratification models for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients that incorporate quantitative ST-segment depression and novel biomarkers...

..4%, adjusted P=0.02). We sought to determine whether Canadian-US differences in practice patterns in GUSTO-I had an impact on 5-year mortality...

..We examined discharge rates, and whether outcomes, including mortality, differed based on admission status in AHF...

..Despite its widespread use, limited data on the validity of the Canadian Cardiovascular Society angina (CCSA) classification relative to other measures of functional status have been reported...

..We aimed to identify the extent to which countries have taken advantage of the opportunity for early discharge...

..The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI)...

..This likely reflects the variability in NT-proBNP at presentation and the ability to integrate subsequent important physiologic sequelae of STEMI such as reperfusion and infarct size...

..We aimed to examine the individual and contextual factors perceived by patients and their informal caregivers' to influence their willingness and capacity to undertake effective HF self-care...

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..Guidelines recommend that patients with heart failure receive beta-blockers in doses used in the trials that have proven their efficacy. Although the adverse effects of beta-blockade are dose-related, it is unclear whether the benefits are...

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..We sought to examine sex-related differences at an earlier point in care--presentation to the emergency department...

..To examine the association of left ventricular hypertrophy (LVH) on admission electrocardiography with adverse outcomes in acute coronary syndrome (ACS) patients...

..To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT)...

..To examine the relative contribution of system and patient level factors to the variation in international revascularization rates, and their impact on mortality outcomes...

..Accordingly, the relationship among sex, anemia and outcomes in CHF was analyzed...

..The prevalence, prognostic import, and impact of renal insufficiency on the benefits of ACE inhibitors and beta-blockers in community-dwelling patients with heart failure are uncertain...

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..Data on mortality are inconclusive. Further studies are needed to establish the incremental benefits of the different elements of these programs...

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..Ca2+-independent NOS activity was undetectable in any cardiac tissue. The specific upregulation of eNOS in the left atria suggests that NO production may be enhanced to counterbalance hypertrophy that develops during pacing-induced CHF...

..These data lay the foundation for further investigation of factor Xa inhibitors in the treatment of patients with coronary atherothrombosis...

..CONCLUSION: Peak aPTT levels <50 s and >70 s are associated with worse clinical outcomes in the modern era of fibrinolytic therapy; these relationships are different in patients receiving standard reteplase vs. combination therapy...

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