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Review
. 2002 Jan 8;166(1):51-9.

New advances in the management of acute coronary syndromes: 3. The role of catheter-based procedures

Christopher E Buller  1 , Ronald G Carere
Affiliations
Review

New advances in the management of acute coronary syndromes: 3. The role of catheter-based procedures

Christopher E Buller et al. CMAJ. .
No abstract available

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Figures

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Fig. 1: Case 1. Initial electrocardiogram (ECG), showing ST-segment elevation in leads V1– V4, indicative of evolving anterior myocardial infarction. ST-segment depression is evident in leads II, III and aVF.
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Fig. 10: Case 2. A: Coronary angiography 24 hours after admission, showing high-grade stenosis in middle of right coronary artery with associated haziness consistent with intraluminal thrombus (arrow). B: Vessel is widely patent with improved distal blood flow following PTCA with stenting.
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Fig. 2: Case 2. Initial ECG, showing symmetrical T-wave inversion in leads II, III and aVF.
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Fig. 3: Stents such as this one (the ACS MULTILINK DUET balloon-expandable coronary stent) are commonly used during percutaneous transluminal coronary angioplasty (PTCA) in Canada. The stent is laser-cut from tubular stainless steel in a design providing radial strength and longitudinal flexibility. Stent diameter is determined by the balloon diameter used for deployment. Photo by: Courtesy: Guidant Corporation, Santa Clara, Calif.
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Fig. 4: One-year results from the EPISTENT study, demonstrating the synergy of stenting with intense platelet inhibition using abciximab. Rates of myocardial infarction and death were lower with stenting plus abciximab than with either stenting plus placebo or abciximab plus PTCA without stenting. Photo by: Courtesy: Eric Topol
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Fig. 5: Mortality at the end of the study period in 10 trials comparing direct PTCA with thrombolytic therapy. The rates for each study are grouped by thrombolytic regimen. Odds ratios with 95% confidence intervals (CIs) are plotted on the right. [Reprinted, with permission, from Weaver WD et al. © 1997, American Medical Association.
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Fig. 6: Kaplan–Meier survival at 1-year follow-up in the SHOCK study. Early revascularization resulted in a 39% relative reduction in mortality. [Reprinted, with permission, from Hochman et al. © 2001, American Medical Association.
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Fig. 7: Kaplan–Meier survival at 1-year follow-up in the FRISC II trial. Routine invasive management (coronary angiography and revascularization) resulted in lower rates of death than did routine conservative management. [Reprinted, with permission, from Wallentin L et al. © 2000 The Lancet Ltd.
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Fig. 8: Incidence of primary end point (composite of death, myocardial infarction or readmission to hospital with acute coronary syndrome) among patients enrolled in the TACTICS TIMI-18 trial. Invasive management reduced the incidence by 22% at 6 months (conservative management 19.4% v. invasive management 15.9%, odds ratio 0.78, 95% confidence interval 0.62–0.97). [Reprinted, with permission, from Cannon et al. Copyright © 2001, Massachusetts Medical Society. All rights reserved.
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Fig. 9: Case 1. A: Emergent coronary angiography, showing complete occlusion of left anterior descending coronary artery (arrow). B: Normal blood flow is re-established following direct PTCA with stenting.
See this image and copyright information in PMC

References

    1. Rankin JM, Spinelli JJ, Carere RG, Ricci DR, Penn IM, Hilton JD, et al. Improved clinical outcome after widespread use of coronary-artery stenting in Canada. N Engl J Med 1999;341:1957-65. - PubMed
    1. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665-71. - PubMed
    1. Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994;331:489-95. - PubMed
    1. Weaver WD, Reisman MA, Griffin JJ, Buller CE, Leimgruber PP, Henry T, et al. Optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial (OPUS-1): a randomised trial. Lancet 2000; 355:2199-203. - PubMed
    1. Buller CE, Dzavik V, Carere RG, Mancini GB, Barbeau G, Lazzam C, et al. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA). Circulation 1999;100:236-42. - PubMed

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