Monitoring of these markers could help to determine implementation of protective interventions during CABG with CPB to prevent myocardial deterioration and to predict the risk and prognosis.

No abstract

Objective: To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non-ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti-thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone. Design: Observational study. Setting: A large university hospital. Patients: 224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002. Main outcome measures: Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge. Results: Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p,0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were ,1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS). Conclusions: Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups.A cute coronary syndromes comprise non-ST segment elevation acute coronary syndrome (NSTEACS) and ST segment elevation myocardial infarction (STEMI), and share in most cases, a common pathological process of atherosclerotic plaque rupture and erosion. NSTEACS can be further subdivided into unstable angina and non-ST segment elevation myocardial infarction, the latter being accompanied by a detectable rise in cardiac enzymes as a result of myocardial necrosis.1 Over the past few years, a number of national and international guidelines have highlighted an evidence based approach in managing patients with NSTEACS [2][3][4][5] and STEMI. Both NSTEACS and STEMI patients should be considered for aspirin, b blocker, and statin therapy. In addition, clopidogrel when added to aspirin has been shown to be effective in the short term management of NSTEACS, especially where an initial non-interventional management was favoured. 4 In the CURE study, 8 the addition of clopidogrel to the standard antiplatelet treatment of aspirin in NSTEACS has been shown to reduce combined cardiovascular mortality, non-fatal myocardial infarction, and stroke from 11.4% to 9.3% (absolute risk reduction 2.1%, relative risk reduction 20%). Although this risk reduction was evident in both low and high risk subgroups, 9 there was a 37% excess in major bleeding among patients who received combined clopidogrel and aspirin therapy. The median study treatment duration was nine months, and the l...