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Primary Percutaneous Coronary Intervention The Deception of Delay ⁎ ⁎
Primary percutaneous coronary intervention (PCI) has become the predominant reperfusion strategy for ST-segment elevation myocardial infarction (STEMI) throughout western healthcare systems. Recent estimates in the United States suggest that primary PCI is used in 85% of all STEMI cases that undergo reperfusion, with thrombolytic agents used in only 9% and the combination of thrombolytic agents with PCI in 6% (1). This dramatic switch from thrombolytic therapy to primary PCI was the result of several studies conducted in the early 1990s that demonstrated the superiority of primary PCI at reducing stroke and reinfarction as...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - April 15, 2013 Category: Cardiology Source Type: research

Atrial Fibrillation and Thrombosis: The Missing Molecular Links ⁎ ⁎
Nonvalvular atrial fibrillation (AF) confers a 5-fold increased risk of stroke and systemic thromboembolism (TE), especially in the presence of stroke risk factors (1). AF is common, and the TE manifestations are evident in many diverse cardiovascular conditions. For example, transient new-onset AF in acute myocardial infarction is a risk factor for stroke (2). Also, patients with left ventricular systolic impairment with associated AF are at high risk of TE (3). Fortunately, the use of anticoagulation therapy reduces the risk of stroke and/or TE (by 64%) as well as all-cause mortality (by 26%), whereas aspirin results in ...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - February 18, 2013 Category: Cardiology Source Type: research

Reply
We thank Drs. Li and Zhao for their interest in our paper (1). They are correct that indirect comparisons cannot address all the heterogeneity between trials, as well as the underlying pathogenic mechanisms that they allude to. However, it is not very likely that there would be major differences in stroke subtypes among the 3 studies. Also, the inclusion and exclusion criteria are broadly the same in the 3 trials, except for the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial, wherein more patient...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 28, 2013 Category: Cardiology Source Type: research

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