Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.).

Abstract-Our aim was to determine the usefulness of circulating oxidized low density lipoprotein (LDL) in the identification of patients with coronary artery disease (CAD). A total of 304 subjects were studied: 178 patients with angiographically proven CAD and 126 age-matched subjects without clinical evidence of cardiovascular disease. The Global Risk Assessment Score (GRAS) was calculated on the basis of age, total and high density lipoprotein cholesterol, blood pressure, diabetes mellitus, and smoking. Levels of circulating oxidized LDL were measured in a monoclonal antibody 4E6 -based competition ELISA. Compared with control subjects, CAD patients had higher levels of circulating oxidized LDL (PϽ0.001) and a higher GRAS (PϽ0.001). The sensitivity for CAD was 76% for circulating oxidized LDL (55% for men and 81% for women) compared with 20% (24% for men and 12% for women) for GRAS, with a specificity of 90%. Logistic regression analysis revealed that the predictive value of oxidized LDL was additive to that of GRAS (PϽ0.001). Ninety-four percent of the subjects with high (exceeding the 90th percentile of distribution in control subjects) circulating oxidized LDL and high GRAS had CAD (94% of the men and 100% of the women Key Words: atherosclerosis Ⅲ coronary artery disease Ⅲ diagnosis Ⅲ lipoproteins M ajor independent risk factors for coronary artery disease (CAD) are advancing age, elevated blood pressure, elevated serum total and LDL cholesterol levels, low serum HDL cholesterol level, diabetes mellitus, and cigarette smoking. 1-3 The Framingham Heart Study 1 has elucidated the quantitative relationship between these risk factors and CAD. It has shown that the major risk factors are additive in predictive power. Accordingly, the total risk of a person can be estimated by a summing of the risk imparted by each of the major risk factors. Recently, the American Heart Association and the American College of Cardiology issued a scientific statement that assessed the Global Risk Assessment Scoring (GRAS) as a guide to primary prevention. 4 GRAS is based on age, total and HDL cholesterol levels, systolic blood pressure, diabetes mellitus, and smoking. Predisposing factors such as obesity, physical inactivity, and family history of premature CAD are not included in GRAS.Elevated levels of oxidized LDL have previously been detected in the plasma of CAD patients. 5-7 Therefore, we determined the predictive value of circulating oxidized LDL for CAD. Logistic regression analysis was used to determine whether the predictive value of circulating oxidized LDL was additive to that of GRAS. Finally, the correlation between circulating oxidized LDL and major cardiovascular risk factors in subjects without clinical evidence of CAD was studied. Methods Study DesignThe present study included 304 subjects (aged Ͼ45 years). Seventyeight patients with angiographically proven CAD have previously been described. 6 Blood samples from these patients were collected from 1993 to 1994 and were analyzed within 1 month after collection. Bl...

NCT01760083.

The study has no external funding; all costs are covered by ESHRE. There are no competing interests.