Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction.

Major bleeding has been associated with an increased risk of ischemic events and death in patients with acute coronary syndromes. We examined the relationship between bleeding and outcome in 1,389 consecutive patients with ST-elevation myocardial infarction (STEMI) presenting to a tertiary center between May 1, 2003 and July 10, 2007. We recorded bleeding, length of stay and death during the first 30 days after hospitalization.

Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials.

Background: Small randomized trials have demonstrated that radial access reduces access site complications compared to a femoral approach. The objective of this meta-analysis was to determine if radial access reduces major bleeding and as a result can reduce death and ischemic events compared to femoral access.

Methods: MEDLINE, EMBASE, and CENTRAL were searched from 1980 to April 2008.

Computed tomographic coronary angiographic assessment of high-risk coronary anatomy in patients with suspected coronary artery disease and intermediate pretest probability.

Background: It is unclear if computed tomographic coronary angiography (CTA), an evolving technique for the evaluation of coronary artery disease (CAD), can identify patients with high-risk coronary anatomy.

Methods: Among patients referred for invasive angiography at Hamilton Health Sciences (Hamilton, Ontario, Canada), those with an intermediate pretest probability (25%-60% likelihood of a significant stenosis) were prospectively identified using a multivariate risk score and were studied on a 64-detector Toshiba Aquilion scanner (Toshiba Medical Systems, Tokyo, Japan) before invasive angiography. Patients with high-risk anatomy (left main, 3-vessel CAD, or 2-vessel CAD involving the proximal left anterior descending artery) or at least 1 significant stenosis were identified on CTA and invasive angiography, and the results of these modalities were compared on a per patient basis.