Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.).

Abstract-Our aim was to determine the usefulness of circulating oxidized low density lipoprotein (LDL) in the identification of patients with coronary artery disease (CAD). A total of 304 subjects were studied: 178 patients with angiographically proven CAD and 126 age-matched subjects without clinical evidence of cardiovascular disease. The Global Risk Assessment Score (GRAS) was calculated on the basis of age, total and high density lipoprotein cholesterol, blood pressure, diabetes mellitus, and smoking. Levels of circulating oxidized LDL were measured in a monoclonal antibody 4E6 -based competition ELISA. Compared with control subjects, CAD patients had higher levels of circulating oxidized LDL (PϽ0.001) and a higher GRAS (PϽ0.001). The sensitivity for CAD was 76% for circulating oxidized LDL (55% for men and 81% for women) compared with 20% (24% for men and 12% for women) for GRAS, with a specificity of 90%. Logistic regression analysis revealed that the predictive value of oxidized LDL was additive to that of GRAS (PϽ0.001). Ninety-four percent of the subjects with high (exceeding the 90th percentile of distribution in control subjects) circulating oxidized LDL and high GRAS had CAD (94% of the men and 100% of the women Key Words: atherosclerosis Ⅲ coronary artery disease Ⅲ diagnosis Ⅲ lipoproteins M ajor independent risk factors for coronary artery disease (CAD) are advancing age, elevated blood pressure, elevated serum total and LDL cholesterol levels, low serum HDL cholesterol level, diabetes mellitus, and cigarette smoking. 1-3 The Framingham Heart Study 1 has elucidated the quantitative relationship between these risk factors and CAD. It has shown that the major risk factors are additive in predictive power. Accordingly, the total risk of a person can be estimated by a summing of the risk imparted by each of the major risk factors. Recently, the American Heart Association and the American College of Cardiology issued a scientific statement that assessed the Global Risk Assessment Scoring (GRAS) as a guide to primary prevention. 4 GRAS is based on age, total and HDL cholesterol levels, systolic blood pressure, diabetes mellitus, and smoking. Predisposing factors such as obesity, physical inactivity, and family history of premature CAD are not included in GRAS.Elevated levels of oxidized LDL have previously been detected in the plasma of CAD patients. 5-7 Therefore, we determined the predictive value of circulating oxidized LDL for CAD. Logistic regression analysis was used to determine whether the predictive value of circulating oxidized LDL was additive to that of GRAS. Finally, the correlation between circulating oxidized LDL and major cardiovascular risk factors in subjects without clinical evidence of CAD was studied. Methods Study DesignThe present study included 304 subjects (aged Ͼ45 years). Seventyeight patients with angiographically proven CAD have previously been described. 6 Blood samples from these patients were collected from 1993 to 1994 and were analyzed within 1 month after collection. Bl...

NCT01760083.

The study has no external funding; all costs are covered by ESHRE. There are no competing interests.

No abstract

The 13th ESHRE report on ART shows a continuing expansion of the number of treatment cycles in Europe, with more than half a million of cycles reported in 2009. The use of ICSI has reached a plateau. Pregnancy and delivery rates after IVF and ICSI remained relatively stable compared with 2008 and 2007. The number of multiple embryo transfers (3+ embryos) and the multiple delivery rate have shown a clear decline.

Background-Durability assessment of mitral valve repair for degenerative valve incompetence is actually limited to reoperation as the primary indicator, with valve-related risk factors for late death as a secondary indicator. We assessed serial echocardiographic follow-up of valve function as an indicator of the durability of mitral valve repair. Methods and Results-In

Background-Prosthesis-patient mismatch (P-PtM) after aortic valve replacement results in disturbed valve performance associated with increased pressure gradients. However, it is unknown whether this can be related to future structural valve deterioration (SVD) of the bioprosthesis. Methods and Results-In 564 patients (mean age, 74Ϯ5 years) receiving an aortic valve bioprosthesis, clinical follow-up (median, 6.1 years; maximum, 16.4 years) was analyzed including echocardiography. SVD was diagnosed in 40 patients (7%) as substantially increased stenosis (nϭ24) or regurgitation (nϭ16) of the operated valve over time. When patients with P-PtM (effective orifice area index Ͻ0.85 cm 2 /m 2 ; nϭ285) developed SVD, it was preferentially of the stenosis type, whereas when patients without P-PtM (nϭ279) developed SVD, the majority was of the incompetence type (PϽ0.05). Multivariable analysis including patient-and valve-related variables revealed that P-PtM and label size Յ21 were independent predictors of SVD (Pϭ0.04 and Pϭ0.02, respectively). A nonparametric Turnbull estimate analysis showed that SVD is virtually nonexistent for up to 9 years in patients without P-PtM. Thereafter, SVD starts to occur and is mainly of the incompetence-type SVD (79% of cases). In patients with P-PtM, SVD starts to occur after 2 to 3 years after implantation and is mainly of the stenosis-type SVD (81% of cases). Conclusions-These data suggest that stenosis-type SVD is an early, P-PtM-related, and thus preventable phenomenon.Incompetence-type SVD is a time-dependent, nonspecific wear damage to bioprosthetic valves, which is not related to P-PtM. (Circulation. 2010;121:2123-2129.)