Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.

As compared with bare-metal stents, drug-eluting stents are associated with a similar long-term incidence of death or myocardial infarction and provide a clinically important decrease in the rate of restenosis among high-risk patients.

Background and Purpose-Carotid artery atherosclerosis has been shown to correlate with coronary artery disease (CAD).This study evaluates the capacity of duplex ultrasonography of the carotid arteries as a tool in the diagnosis of CAD in comparison with exercise stress test and variance ECG. Methods-Carotid ultrasonography, exercise stress test, and variance ECG were performed in 184 symptomatic patients evaluated with coronary angiography. The diagnostic capacity of the studied noninvasive methods was assessed by use of receiver operating characteristic (ROC) curves constructed by successive consideration of several cut points, such as (1) the presence of unilateral/bilateral plaques and (2) cross-sectional common carotid artery (CCA) intima-media (IM) area from 10 to 30 mm 2 for ultrasonography; (1) ST depression Ն0.1 mV and Ն0.2 mV with and (2) without chest pain for exercise test; and electrical variability index from 50 to 100 for variance ECG. Results-Coronary angiography revealed the presence of CAD (Ն50% luminal stenosis in 1 or more major epicardial arteries) in 147 patients (80%). Identification of carotid plaques on one or both sides and calculation of the left-sided (but not right-sided) CCA IM area provided a significant discrimination (PϽ.001 and PϽ.01, respectively) of patients with CAD. The discriminating capacity of the ultrasound procedures was equal to that of variance ECG and exercise test with ST depression criterion only but somewhat lower than that of exercise test with the combined chest pain and ST depression criterion (PϽ.05). However, at the chosen cut points, carotid plaque identification offered higher sensitivity than exercise test with either criterion (PϽ.01 and PϽ.001, respectively). Conclusions-Carotid ultrasonography is a useful diagnostic method that is comparable to exercise test and variance ECG for detection of CAD in a high-prevalence population. (Stroke. 1998;29:439-446.)

In alteplase treated AMI adjunctive dalteparin for 4-7 days seems to reduce the risk of early coronary artery occlusion and reinfarction. However, early after cessation of treatment there is a raised risk of events, which might eliminate any long-term gains.

This real-life registry study shows that restenosis was halved by DES in diabetic patients with stable or unstable coronary disease, with similar risk of death or MI up to 4 years compared with BMS.

There are gender and socio-economic inequalities in access to cardiac procedures in Sweden.

Summary:Rapid reperfusion of an infarct-related artery reduces the extent of myocardial damage and improves survival in acute myocardial infarction (AMI). Currently, anticoagulant treatment with unfractionated heparin (UFH) is used as adjuvant therapy to fibrinolytic treatment. The low-molecular-weight heparin (LMWH) dalteparin is at least as effective as UFH in unstable coronary artery disease. The ASSENT PLUS trial was carried out to evaluate whether dalteparin is as effective as UFH as an adjunct to recombinant tissue-plasminogen activator (rt-PA) and aspirin in obtaining patency and Thrombolysis in Myocardial Infarction (TIMI)-3 flow in patients with AMI. The primary assessment of this phase I1 trial was TIMI flow, determined by coronary angiography. Patients with ST-elevation MI were randomized to receive aspirin and either rt-PA and UFH for 48 h, or rt-PA and dalteparin for 4 to 7 days. Evaluation was by TIMI flow after 4 to 7 days and clinical events (death, reinfarction, or revascularization) up to 30 days. There was a clear trend toward greater TIMI 3 flow with dalteparin compared with UFH. There was significantly less TIMI 0-1 flow or thrombus in the dalteparin group. Bleeding rates were similar. The Occurrence of reinfarction was reduced during dalteparin treatment. These findings suggest that dalteparin could be substituted for UFH as an adjunct to rt-PA/ aspirin in the management of patients with M I .

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