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BACKGROUND Management of acute coronary syndromes (ACS) should be guided by an estimate of patient risk. OBJECTIVE To develop a simple model to assess the risk for in-hospital mortality for the entire spectrum of ACS treated in general clinical practice. METHODS A multivariable logistic regression model was developed using 11 389 patients (including 509(More)
BACKGROUND Patients with a myocardial infarction with ST-segment elevation who present to hospitals that do not have the capability of performing percutaneous coronary intervention (PCI) often cannot undergo timely primary PCI and therefore receive fibrinolysis. The role and optimal timing of routine PCI after fibrinolysis have not been established. (More)
BACKGROUND Patients enrolled in randomized clinical trials (RCTs) may not reflect those seen in real-life practice. Our goal was to compare patients eligible for enrollment but not enrolled in contemporary RCTs of reperfusion therapy with patients who would have been ineligible and also with patients with acute myocardial infarction (AMI) participating in(More)
BACKGROUND Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y(12). This agent might have a role in the treatment of patients who require rapid, predictable, and profound but reversible platelet inhibition. METHODS We performed a large-scale international trial comparing(More)
AIMS The extent to which hospital and geographic characteristics influence the time course of uptake of evidence from key clinical trials and practice guidelines is unknown. 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. METHODS(More)
BACKGROUND Analyses from randomized controlled trials suggest that bleeding in patients with acute myocardial infarction is associated with poor outcomes. 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. METHODS AND RESULTS We(More)
AIM Many patients who are eligible for acute reperfusion therapy receive it after substantial delays or not at all. We wanted to determine whether over the years more patients are receiving reperfusion therapy. METHODS AND RESULTS This analysis is based on 10 954 patients with ST elevation or left bundle-branch block presenting within 12 h of symptom(More)
AIMS To determine whether the low-molecular weight heparin enoxaparin remains favourable when compared with unfractionated heparin (UFH) among patients with acute coronary syndromes (ACS) when incorporating efficacy and safety of these adjunctive therapies using a net clinical endpoint. METHODS AND RESULTS We performed a meta-analysis of randomized trials(More)
CONTEXT The SYNERGY trial comparing enoxaparin and unfractionated heparin in high-risk patients with acute coronary syndromes (ACS) showed that enoxaparin was not inferior to unfractionated heparin in reducing death or nonfatal myocardial infarction (MI) at 30 days. OBJECTIVE To evaluate continued risk in this patient cohort through 6-month and 1-year(More)
OBJECTIVE To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infarction to facilitate triage and management of patients with acute coronary syndrome. DESIGN Prospective multinational observational study in which we used multivariable regression to develop a final predictive model, with(More)