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  1. Article ; Online: Non ST-elevation acute coronary syndrome.

    Sarkees, Michael L / Bavry, Anthony A

    BMJ clinical evidence

    2010  Volume 2010

    Abstract: Introduction: Non ST-elevation acute coronary syndrome (NSTE-ACS, here defined as unstable angina and non ST-elevation MI) is characterised by episodes of chest pain at rest or with minimal exertion, which increase in frequency or severity, often with ... ...

    Abstract Introduction: Non ST-elevation acute coronary syndrome (NSTE-ACS, here defined as unstable angina and non ST-elevation MI) is characterised by episodes of chest pain at rest or with minimal exertion, which increase in frequency or severity, often with dynamic ECG changes. Between 9% and 19% of people with NSTE-ACS die in the first 6 months after diagnosis, with about half of these deaths occurring within 4 weeks of diagnosis.
    Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antiplatelet; antithrombin; anti-ischaemic; lipid-lowering; and invasive treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
    Results: We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
    Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: aspirin, beta-blockers, calcium channel blockers, clopidogrel, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors (oral or intravenous), heparin (low molecular weight, unfractionated), fondaparinux, nitrates, routine early cardiac catheterisation and revascularisation, statins, and warfarin.
    MeSH term(s) Acute Coronary Syndrome/drug therapy ; Acute Disease ; Angina, Unstable/diagnosis ; Humans ; Myocardial Infarction/diagnosis ; Platelet Glycoprotein GPIIb-IIIa Complex/therapeutic use ; Treatment Outcome
    Chemical Substances Platelet Glycoprotein GPIIb-IIIa Complex
    Language English
    Publishing date 2010-11-15
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2393858-4
    ISSN 1752-8526 ; 1757-0816 ; 1475-9225
    ISSN (online) 1752-8526
    ISSN 1757-0816 ; 1475-9225
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Acute coronary syndrome (unstable angina and non-ST elevation MI).

    Sarkees, Michael L / Bavry, Anthony A

    BMJ clinical evidence

    2009  Volume 2009

    Abstract: Introduction: In people with acute coronary syndrome (ACS) the incidence of serious adverse outcomes (such as death, acute myocardial infarction [MI], or refractory angina requiring emergency revascularisation) is 5-10% within the first 7 days and about ...

    Abstract Introduction: In people with acute coronary syndrome (ACS) the incidence of serious adverse outcomes (such as death, acute myocardial infarction [MI], or refractory angina requiring emergency revascularisation) is 5-10% within the first 7 days and about 15% at 30 days. Between 5-14% of people with acute coronary syndrome die in the year after diagnosis, with about half of these deaths occurring within 4 weeks of diagnosis.
    Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antiplatelet; antithrombin; anti-ischaemic; lipid-lowering; and invasive treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
    Results: We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
    Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: aspirin, beta-blockers, calcium channel blockers, clopidogrel, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors (oral or intravenous), heparin (low molecular weight, unfractionated), nitrates, routine early cardiac catheterisation and revascularisation, statins, and warfarin.
    MeSH term(s) Acute Coronary Syndrome/chemically induced ; Acute Disease ; Administration, Oral ; Angina, Unstable/drug therapy ; Aspirin ; Calcium Channel Blockers/therapeutic use ; Humans ; Incidence ; Myocardial Infarction/diagnosis ; Platelet Glycoprotein GPIIb-IIIa Complex/therapeutic use
    Chemical Substances Calcium Channel Blockers ; Platelet Glycoprotein GPIIb-IIIa Complex ; Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2009-01-13
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2393858-4
    ISSN 1752-8526 ; 1757-0816 ; 1475-9225
    ISSN (online) 1752-8526
    ISSN 1757-0816 ; 1475-9225
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Bare metal stent thrombosis 13 years after implantation.

    Sarkees, Michael L / Bavry, Anthony A / Galla, John M / Bhatt, Deepak L

    Cardiovascular revascularization medicine : including molecular interventions

    2009  Volume 10, Issue 1, Page(s) 58–59

    Abstract: There has been a great deal of recent controversy regarding the risk of very late stent thrombosis with drug eluting stents, especially in the context of antiplatelet therapy cessation. We report a case of very late stent thrombosis of a bare metal stent ...

    Abstract There has been a great deal of recent controversy regarding the risk of very late stent thrombosis with drug eluting stents, especially in the context of antiplatelet therapy cessation. We report a case of very late stent thrombosis of a bare metal stent initially implanted for treatment of a myocardial infarction. The patient presented thirteen years later with a recurrent myocardial infarction three days after discontinuing aspirin. Angiography demonstrated thrombotic occlusion and severe underlying restenosis of the stent. To our knowledge, this is the latest bare metal stent thrombosis described in the world medical literature.
    MeSH term(s) Aged ; Angioplasty, Balloon, Coronary/adverse effects ; Angioplasty, Balloon, Coronary/instrumentation ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Restenosis/diagnostic imaging ; Coronary Restenosis/etiology ; Coronary Restenosis/therapy ; Coronary Stenosis/complications ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/therapy ; Humans ; Male ; Metals ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/etiology ; Myocardial Infarction/therapy ; Platelet Aggregation Inhibitors/therapeutic use ; Prosthesis Design ; Recurrence ; Stents ; Thrombectomy ; Thrombosis/diagnostic imaging ; Thrombosis/etiology ; Thrombosis/therapy ; Time Factors ; Treatment Outcome
    Chemical Substances Metals ; Platelet Aggregation Inhibitors
    Language English
    Publishing date 2009-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2212113-4
    ISSN 1878-0938 ; 1553-8389
    ISSN (online) 1878-0938
    ISSN 1553-8389
    DOI 10.1016/j.carrev.2008.04.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Comprehensive meta-analysis on drug-eluting stents versus bare-metal stents during extended follow-up.

    Roukoz, Henri / Bavry, Anthony A / Sarkees, Michael L / Mood, Girish R / Kumbhani, Dharam J / Rabbat, Mark G / Bhatt, Deepak L

    The American journal of medicine

    2009  Volume 122, Issue 6, Page(s) 581.e1–10

    Abstract: Background: Several observational reports have documented both increased and decreased cardiac mortality or Q-wave myocardial infarction with drug-eluting stents compared with bare-metal stents.: Methods: We sought to evaluate the safety and efficacy ...

    Abstract Background: Several observational reports have documented both increased and decreased cardiac mortality or Q-wave myocardial infarction with drug-eluting stents compared with bare-metal stents.
    Methods: We sought to evaluate the safety and efficacy of drug-eluting stents compared with bare-metal stents early after intervention (<1 year) and late (>1 year) among a broad population of patients, using a meta-analysis of randomized clinical trials.
    Results: We identified 28 trials with a total of 10,727 patients and a mean follow-up of 29.6 months. For early outcomes (<1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 2.1% versus 2.4% (risk ratio [RR] 0.91, [95% confidence interval (CI), 0.70-1.18]; P=.47), non-Q-wave myocardial infarction was 3.3% versus 4.4% (RR 0.78 [95% CI, 0.61-1.00]; P=.055), target lesion revascularization was 5.8% versus 18.4% (RR 0.28 [95% CI, 0.21-0.38]; P <.001), and stent thrombosis was 1.1% versus 1.3% (RR 0.87 [95% CI, 0.60-1.26]; P=.47). For late outcomes (>1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 5.9% versus 5.7% (RR 1.03 [95% CI, 0.83-1.28]; P=.79), target lesion revascularization was 4.0% versus 3.3% (RR 1.22 [95% CI, 0.92-1.60]; P=.16), non-Q-wave myocardial infarction was 1.6% versus 1.2% (RR 1.36 [95% CI, 0.74-2.53]; P=.32) and stent thrombosis was 0.7% versus 0.1% (RR 4.57 [95% CI, 1.54-13.57]; P=.006).
    Conclusions: There was no excess mortality with drug-eluting stents. Within 1 year, drug-eluting stents appear to be safe and efficacious with possibly decreased non-Q-wave myocardial infarction compared with bare-metal stents. After 1 year, drug-eluting stents still have similar mortality, despite increased stent thrombosis. The reduction in target lesion revascularization with drug-eluting stents mainly happens within 1 year, but is sustained thereafter.
    MeSH term(s) Confidence Intervals ; Coronary Restenosis/etiology ; Coronary Restenosis/mortality ; Drug-Eluting Stents/adverse effects ; Follow-Up Studies ; Humans ; Minnesota/epidemiology ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Odds Ratio ; Randomized Controlled Trials as Topic ; Research Design ; Risk Factors ; Stents/adverse effects ; Survival Rate ; Time Factors
    Language English
    Publishing date 2009-06
    Publishing country United States
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2008.12.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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