Pharmacological adjuvant therapies in primary coronary interventions: bivalirudin.

The direct thrombin inhibitor bivalirudin has gained popularity in cardiovascular medicine over the past decade because, in comparison with unfractionated heparin, it guarantees a predictable dose-related degree of anticoagulation with a low immunogenic profile and, possibly, with reduced rates of major bleeding complications. In the past bivalirudin has been frequently employed in the management of patients with heparin-induced thrombocytopenia. The REPLACE-2, ACUITY and ISAR-REACT4 studies demonstrated bivalirudin non-inferiority in comparison with unfractionated heparin in terms of ischemic end-points with a reduction of the bleeding rate also in patients acute coronary syndrome without ST elevation.

[Death after ST-elevation myocardial infarction in patients treated with fibrinolytic therapy, angioplasty, or conventional therapy. A post-mortem study to verify cardiac rupture as a cause of death].

Background: Experimental clinical observations suggest that fibrinolysis (FL) in acute myocardial infarction, even though reducing global mortality, is associated with an increasing incidence of death in the first 24-48 h. The responsible mechanism is not yet known, although available evidence supports heart rupture as the possible cause.

Methods: We studied 154 patients at autopsy who died of cardiac causes from January 1, 1994 to December 31, 2005 among a cohort of 2260 patients who were admitted for ST-elevation myocardial infarction.

N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes.

Background: The prognostic value of natriuretic peptide elevations in patients with acute coronary syndromes (ACS) is still incompletely defined. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission in patients with ACS and ECG evidence of myocardial ischemia.

Methods And Results: The NT-proBNP was measured at a median time of 3 hours after symptom onset in 1756 patients.