急性冠状动脉综合征与稳定型心绞痛患者冠状动脉病变的血管内超声比较研究

目的　探讨急性冠状动脉综合征与稳定型心绞痛患者的冠状动脉 (冠脉 )病变血管内超声特征。方法　 5 2例急性冠脉综合征患者与 79例稳定型心绞痛患者进行冠脉造影及血管内超声检查 ,根据超声检查结果 ,冠脉病变分为钙化斑块、硬斑块及软斑块。钙化斑块为斑块的回声比血管壁外膜回声强并伴有声影 ,其范围大于 90° ;硬斑块为斑块的回声与血管壁外膜回声大致相同 ,但后方无声影 ;软斑块为斑块的回声比血管壁外膜回声弱。不稳定斑块为纤维帽较薄、有脂质池的斑块或并有斑块破裂。稳定型斑块为钙化斑块及硬斑块。结果　稳定型心绞痛的冠脉病变特点以稳定型斑块为主 ,急性冠脉综合征冠脉病变特点以不稳定型斑块为主。 61.5 %急性冠脉综合征及 3 8.0 %稳定型心绞痛患者为软斑块 ( P <0 .0 1) ,2 8.9%急性冠脉综合征及 6.3 %稳定型心绞痛患者有脂质池 (P <0 .0 1) ,并且急性冠脉综合征患者冠脉斑块多伴有斑块破裂。结论　急性冠脉综合征及稳定型心绞痛的冠脉病变各有自己的特征 ,血管内超声对其有一定的诊断价值。     

64排CT冠状动脉成像结合心肌肌钙蛋白测定在急性冠脉综合征的联合应用价值研究

目的：探讨64排多层螺旋CT（MSCT）冠状动脉成像和心肌肌钙蛋白（cTnI）在急性冠脉综合征的联合应用价值及相互关系。方法：稳定型心绞痛（SA）组为对照组,急性冠脉综合征（ACS）组分为不稳定型心绞痛（UA）组及急性心肌梗死（AMI）组,3组受试患者进行cTnI和64排MSCT冠状动脉成像检查,比较2组cTnI和64排MSCT冠状动脉成像结果。结果：ACS组cTnI均明显高于SA组,2组间cTnI水平差异有统计学意义（P〈0．01）。2组冠脉狭窄程度比较差异有统计学意义,即ACS组以轻、中度狭窄为主,sA组以重度狭窄为主。结论：64排MSCT冠状动脉成像联合cTnI检测,对判断冠状动脉狭窄程度、斑块稳定性及心肌受损程度具有较高的敏感性和准确性,对ACS的诊断治疗及预后评价有重要应用价值。     

CD40-1C/T基因多态性与急性冠脉综合征易感性的研究

目的 探讨CD40基因-1C/T单核苷酸多态性位点(SNP)与急性冠脉综合征(ACS)易感相关性及血小板表达CD40的关系.方法 研究对象来自江苏大学附属医院心内科2007年7月至2008年11月住院患者.ACS患者210例,SA患者189例,对照组163例.ACS的诊断:(1)心绞痛或胸闷或心电图改变;(2)肌钙蛋白I升高;(3)冠脉造影至少一支冠脉血管直径狭窄≥50%.稳定型心绞痛:心绞痛稳定发作3个月以上.所有入选者均行冠脉造影.排除患有感染、肿瘤及肝肾疾病.采用聚合酶链反应-限制性片段长度多态性(PCR-RELP)检测CD40基因多态性并测序鉴定,流式细胞术检测血小板表达CD40水平.等位基因频率及遗传平衡采用x~2检验.结果 ACS组CC基因型频率(31%)及C等位基因频率(57.9%)明显高于SA组(15.9%,43.1%)及对照组(16.0%,42.6%),在SA组与对照组差异无统计学意义(X~2=0.053,P=0.974;X~2=0.017,P=0.897).各组C等位基因携带者血小板表达CD40水平明显增高(P<0.0001).结论 CD40基因-1C/T SNP与ACS相关,C等位基因增加ACS患病风险.     

OX40 ligand levels and high-sensitivity C-reactive protein levels in blood from local coronary plaque and the femoral artery in patients with acute coronary syndrome or stable angina

OX40 ligand (OX40L) and high-sensitivity C-reactive protein (hs-CRP) play important roles in the pathogenesis of atherosclerosis. In this study, consecutive patients with acute coronary syndrome (ACS; n = 90) or stable angina (SA; n = 40) and healthy control subjects (n = 50) were evaluated to assess plasma OX40L and serum hs-CRP levels in local coronary plaque and the femoral artery. OX40L and hs-CRP levels in the femoral artery were significantly higher in patients with ACS compared with controls. OX40L and hsCRP levels in local coronary plaque (OX40L(c) and hs-CRP(c), respectively) were significantly higher in ACS than in SA patients. OX40L and hs-CRP levels were positively correlated with each other and were also correlated with fibrinogen levels. The number of complex lesions was correlated with OX40L(c) and hs-CRP(c) levels. It is concluded that the OX40L(c) level was highly sensitive for evaluating the inflammatory response in ACS and elevated levels of OX40L(c) may be a valuable predictive marker for increased risk of atherosclerotic progression in ACS patients.     

Novel predictors of acute coronary syndrome outcomes

Morbidity and mortality rates among patients with acute coronary syndrome (ACS) remain high, and it is difficult to determine which patients will progress satisfactorily and which patients will have poor outcomes. Research has indicated that the inflammatory process is involved in coronary disease. There is great interest within the research community in determining if inflammatory markers could be used to determine the severity of the disease process and therefore serve as a prognostic tool for clinicians. This article describes the inflammatory process in ACS and provides a review of the current diagnostic studies of endothelial inflammatory markers (EIMs) in heart disease. Although research results of EIMs have not all been significant in determining outcomes, there is some evidence that they may be more specific than other generalized inflammatory markers, such as C-reactive protein. Future research of EIMs in patients with ACS might provide evidence of easy-to-measure and economically feasible markers that are sound prognosticators.     

Minimally modified electronegative LDL and its autoantibodies in acute and chronic coronary syndromes

OBJECTIVES: To determine the minimally modified electronegative LDL (LDL-) and its autoantibodies in coronary syndromes. DESIGN AND METHODS: LDL(-) and its autoantibodies were determined by ELISA in patients with acute (ACS, unstable angina; AMI, acute myocardial infarction) and chronic coronary syndromes (stable angina, SA) and compared to subjects without coronary disease (controls). Results are expressed as median of LDL- (microg/mL) and anti-LDL(-) IgG (OD405 nm). RESULTS: The concentrations of LDL(-) were higher in patients with coronary disease (ACS: 40.7 microg/mL; SA: 35.0 microg/mL) as compared to controls (21.6 microg/mL). The highest LDL- concentrations were found in patients with AMI (41.8 microg/mL). Anti-LDL(-) IgG was elevated in ACS (1.143) in relation to CCS (0.527) and controls (0.467). A positive correlation was observed between anti-LDL- IgG and CRP levels (r = 0.34, p <0.01) in the studied groups. CONCLUSIONS: LDL(-) and anti-LDL(-) autoantibodies may be useful markers to follow patients with high risk for coronary events.     

缺血修饰白蛋白和C反应蛋白在急性冠脉综合征诊断中的作用

嗜酸粒细胞性胃肠炎 误诊 嗜酸粒细胞增高 嗜酸粒细胞增多 临床表现 腹部不适 病例分析 误漏诊 目的：探讨缺血修饰白蛋白（IMA）及C反应蛋白（CRP）检测对急性冠咏综合征（ACS）的早期诊断评价。方法：监测急诊稳定型心绞痛（SA）和ACS患者共113例，入院后即刻取血测定IMA及CRP，观察其变化同时选择76例门诊体检者作对照．经受试者工作特征曲线（ROC曲线）分析获得区分SA与ACS最适界值点（cutoff值）.结果：ACS组与对照组、SA组间IMA、CRP值差异均具有统计学意义。IMA ROC曲线下面积为0．948，在最适cutoff值为70．5U／ml．时敏感性和特异性分别为94.4％和82．6％．阳性预测值和阴性预测值分别95．5％和79.2％，CRPROC曲线下面积为0．746，在最适cutoff值为4．905mg／L时敏感性和特异性分别为55．6％和87．0％，阳性预测值和阴性预测值分别78．1％和18.4％.结论：IMA可对急性心肌缺血作出早期诊断．且明显提高对ACS早期诊断敏感性     

急性冠状动脉综合征患者D-Ⅱ聚体、CD62p检测的临床意义

目的　探讨急性冠状动脉综合征 (ACS)患者血中D Ⅱ聚体、血小板膜糖蛋白CD6 2p阳性表达率测定的临床意义。方法　分别测定 2 1例稳定型心绞痛 (SA)患者、 2 2例不稳定型心绞痛 (UA)患者、14例急性心肌梗塞 (AMI)患者、 2 0例对照组患者的D Ⅱ聚体、CD6 2p、肌钙蛋白 (cTnI) ,分析不同组间各检出物的水平与ACS检出的敏感度。结果　指标的检测 :UA组和AMI组D Ⅱ聚体、CD6 2p的水平与SA组及对照组相比较差异有显著性 (P <0 0 1) ;UA组与AMI组相比 ,两者含量差异有显著性 (P <0 0 5 )。cTnI含量检测 :AMI组与其余 3组比较 ,差异有显著性 (P <0 0 1) ;而SA组与对照组比较 ,差异无显著性(P >0 0 5 )。D Ⅱ聚体、CD6 2p对ACS的检出均较cTnI为敏感。结论　D Ⅱ聚体、CD6 2p可作为冠状动脉内血栓形成的指标 ,并在一定程度上反映了UA的严重程度 ,它们在cTnI的基础上加强了临床对ACS的尽早确诊     

血尿酸在不同类型冠心病发生中的作用机制

目的 探讨血尿酸在不同类型冠心病发生中的作用机制.方法 88例住院患者分为对照组、稳定型心绞痛(SA)组和急性冠状动脉综合征(ACS)组,分别测定其血尿酸、血小板α-颗粒膜蛋白(GMP-140)、血管性假性血友病因子(vWF)、纤溶酶原激活物抑制物-1(PAI-1)、血栓素B_2(TXB_2)、C-反应蛋白(CRP).结果 (1)①UA、CRP:ACS组[(392.10±68.57)μmol/L、(42.2±39.4)mg/L]和SA组[(370.50±58.80)μmoL/L、(18.9±17.1)mg/L]均高于对照组[(286.00±65.31)μmol/L、(2.5±0.7)mg/L,P均＜0.05];UA在ACS组、SA组差异无统计学意义(P＞0.05),ACS组CRP高于SA组(P＜0.05);②vWF、TXB_2:ACS组[(1.65±0.48)%、(19.73±18.66)ng/L]和SA组[(1.35±0.49)%、(11.18±10.71)ng/L]均高于对照组[(1.07±0.26)%、(6.46±5.41)ng/L,P均＜0.05],ACS组高于SA组(P均＜0.05);③GMP-140、PAI-1:ACS组[(13.04±0.99)μg/,L、(65.65±14.76)μg/L]和SA组[(12.55±0.74)μg/L、(62.69±12.24)μg/L]均高于对照组[(12.32±0.29)μg/L、(50.78±13.88)μg/L,P均＜0.05],ACS组与SA组间差异无统计学意义(P均＞0.05).④ACS组血尿酸升高者与血尿酸正常者CRP[(71.3±18.9)、(20.70±17.9)mg/L]、vWF[(1.08±0.52)%、(0.84±0.54)%]、GMP-140[(13.57±1.11)、(13.23±1.07)μg/L]、TXB_2[(57.26±47.84)、(26.70±23.83)ng/L]、PAI-1[(72.12±9.23)、(61.30±12.07)μg/L]差异均有统计学意义(t值分别为7.394、0.008、0.227、7.605、0.421,P均＜0.05),SA组血尿酸升高者与血尿酸正常者CRP[(31.1±18.9)、(10.9±10.1)mg/L]、TXB_2[(21.54±3.90)、(5.02±4.93)ng/L]差异均有统计学意义(t值分别为0.494、8.669,P均＜0.05).(2)Logistic逐步回归分析:与急性冠状动脉综合征相关的因素有UA、CRP、PAI-1、PT、TG(OR值分别为1.046、7.615、1.301、0.300和2.243,P均＜0.05).结论 血尿酸升高是影响冠心病发生、发展的重要危险因素.血尿酸升高可能通过损害血管内皮功能、激活血小板、影响凝血和纤溶功能、引发炎症反应参与不同类型冠心病的发生与发展.     

血清同型半胱氨酸与冠状动脉病变的相关性研究

目的探讨血清同型半胱氨酸（HCY）水平与急性冠状动脉（下称冠脉）综合征患者冠脉病变支数及冠脉狭窄程度（以Gensini冠脉病变积分为评价标准）的相关性。方法以酶联免疫吸附试验（ELISA）法检测急性冠脉综合征患者（ACS组,n=51）、稳定型心绞痛患者（SA组,n=20）、非冠心病患者（NCHD组,n=23）的血清HCY水平,并分析其与冠心痛严重程度的关系。结果ACS组患者血清HCY水平高于NCHD组和SA组患者,差异均有统计学意义（均P〈0．01）;SA组患者血清HCY水平高于NCHD组,差异有统计学意义（P〈0．05）;ACS组患者外周血清HcY水平与冠脉病变支数呈正相关,差异有统计学意义（r=0．497,P〈0．01）,且与Gensini积分呈正相关,差异有统计学意义（r=0．446,P〈O．01）。结论ACS组患者血清HCY水平明显高于SA组和NCHD组患者,表明该指标可能与冠脉易损斑块的病理生理相关;ACS患者血清HCY水平与冠脉病变支数及Gensini积分呈正相关,进一步提示血清HCY水平的升高可能与急性冠脉综合征的发生发展相关。     

The clinical implications of increased OX40 ligand expression in patients with acute coronary syndrome

BACKGROUND: Increasing evidence show that OX40 ligand (OX40L), also known as tumor necrosis factor superfamily member 4 (TNFSF4), plays an important role in the pathogenesis of atherosclerosis. We investigated whether expression levels of soluble OX40L in serum and of membrane OX40L on platelets were related to serum concentrations of matrix metalloproteinases (MMPs) and stability of coronary atherosclerotic plaque in patients with acute coronary syndrome (ACS). METHODS: We included healthy controls (n=30), patients with stable angina (SA) (n=40) and patients with ACS, including unstable angina (UA) (n=70) and acute myocardial infarction (AMI) (n=40). The expression of OX40L on platelets (pOX40L) was analyzed with flow cytometry whereas serum concentrations of soluble OX40L (sOX40L), MMP-9 and MMP-3 were determined with ELISA. All coronary stenoses with >/=30% diameter reduction were assessed by angiographic coronary stenosis morphology. RESULTS: The expression of OX40L on platelets were significantly higher in patients with ACS (61.5+/-11.5) compared with healthy controls (28.9+/-7.4) or with the group of patients with SA (31.2+/-8.1) (mean fluorescence intensity+/-SD) (p<0.001). Similarly, we observed higher sOX40L concentrations in patients with ACS (34.6+/-9.3) compared with controls (10.2+/-4.7) or patients with SA (11.4+/-5.8) (ng/ml+/-SD) (p<0.001). Serum MMP-3 and MMP-9 levels in patients were two times greater than those in the control group. A positive correlation was observed between OX40L expression on platelets and MMP-9 and MMP-3 serum concentrations. OX40L expression on platelets were furthermore correlated with soluble OX40L in serum and with complex coronary stenoses (r1=0.61, r2=0.57, p<0.001). CONCLUSION: Patients with ACS show increased OX40L system (pOX40L and sOX40L) expression which may create a proinflammatory milieu for aggravating the development of atherosclerosis, and may be a valuable marker for predicting the severity of ACS.     

Increased coronary sinus blood temperature: correlation with systemic inflammation

BACKGROUND: Recent studies have shown that patients with single vessel coronary artery disease (CAD) suffering from acute coronary syndromes (ACS) have increased coronary sinus (CS) blood temperature compared with the right atrium (RA). The aim of this study was to investigate whether there is a correlation between systemic inflammatory indexes and CS temperature and whether there is a difference in CS temperature between patients with single vs. multivessel disease. MATERIALS AND METHODS We included consecutive patients scheduled for coronary angiography for recent-onset chest pain evaluation. We measured C-reactive protein (CRP) levels in the study population. Coronary sinus and RA blood temperature measurements were performed by a 7F thermography catheter. DeltaTau was calculated by subtracting the RA from the CS blood temperature. RESULTS: The study population comprised 53 patients with ACS, 25 patients with stable angina (SA) and 22 subjects without CAD (control group). DeltaTau was greater in patients with ACS and with SA compared with the control group (0.22 +/- 0.10 degrees C, 0.18 +/- 0.04 degrees C vs. 0.14 +/- 0.07 degrees C, P < 0.01 for both comparisons). The ACS group had greater DeltaTau compared with the SA group, although the difference did not reach statistical significance (P = 0.09). Eighteen (39.1%) out of 46 patients with multivessel disease had three-vessel disease and 28 (60.8%) had two-vessel disease. DeltaTau between patients with multivessel and single vessel disease was similar (0.22 +/- 0.01 degrees C, 0.19 +/- 0.01 degrees C, P = 0.17). The levels of CRP were well correlated with DeltaTau (R = 0.35b, P < 0.01). CONCLUSIONS: Systemic inflammation is well correlated with CS temperature; thus, an inflammatory process could be the underlying mechanism for increased heat production from the myocardium.     

急性冠脉综合征患者血浆胱抑素C和超敏C反应蛋白检测的临床意义

目的 探讨检测急性冠脉综合征(ACS)患者血浆胱抑素C(CysC)和超敏C反应蛋白(hs-CRP)水平的临床意义.方法 选择108例ACS患者[急性心肌梗死(AMI)52例(AMI组),不稳定性心绞痛(UA)56例(UA组)]和54例稳定性心绞痛(SA)患者(SA组)及52例健康体检者(对照组),用乳胶增强免疫透射比浊法检测血浆CysC和hs-CRP,同时检测血清肌酐、血尿素氮等.结果 AMI组、UA组、SA组血浆CysC水平均高于对照组,肾小球滤过率(GFR)均低于对照组,AMI组、UA组血浆CysC 、hs-CRP水平均高于SA组和对照组,多支病变组血浆CysC、hs-CRP水平明显高于单支病变组(P<0.01),CysC与hs-CRP呈直线正相关(r=0.77,P<0.01).结论 血浆CysC水平能早期反映ACS患者肾功能改变,与血浆hs-CRP水平一样是反映ACS炎症程度的重要指标.     

Tackling the thrombotic burden in patients with acute coronary syndrome and diabetes mellitus

Patients with diabetes mellitus (DM) and coronary artery disease, particularly those presenting with acute coronary syndromes (ACS), have a higher risk of developing ischemic complications than their nondiabetic counterparts. Although ACS patients with DM benefit more than normoglycemic ACS patients from early coronary angiography and revascularization, they remain at a higher risk of complications following percutaneous coronary intervention and bypass surgery. The DM-associated prothrombotic state has been implicated in the pathogenesis of these complications and growing data supports the notion that potent platelet inhibition is of paramount importance in order to optimize outcomes of DM patients presenting with ACS. This article focuses on the evidence supporting the concept that augmented platelet reactivity and impaired responsiveness to oral antiplatelet agents are influential drivers of the increased propensity of DM patients with ACS to develop thrombotic complications. In particular, strategies to enhance platelet P2Y(12) receptor inhibition, a key factor to improve outcomes in this patient population, are reviewed.     

PCI术前测定血小板表面P-选择素的意义

目的探讨经皮冠状动脉介入(PCI)术前血小板表面P-选择素表达情况及与血小板聚集功能的关系。方法选择拟行PCI的冠心病患者51例,其中ST段抬高急性冠状动脉综合征(STE ACS)9例、非ST段抬高急性冠脉综合征(NSTE ACS)36例、稳定型心绞痛(SA)6例,另设对照组14名。分别采用全血法流式细胞术和光学法血小板聚集仪对各组血小板表面P-选择素和血小板聚集功能进行测定。结果各组间血小板表面P-选择素比较差异有统计学意义(F=16.915,P=0.001),其中STE ACS组明显高于其他组(P<0.05);NSTE ACS组、SA组与对照组比较差异无统计学意义(P>0.05)。血小板表面P-选择素与二磷酸腺苷、花生四烯酸诱导的血小板聚集功能无关(r分别为-0.038、0.165,P>0.05)。结论血小板表面P-选择素高表达与STE ACS相关,血小板P-选择素测定可结合血小板聚集法评价抗血小板治疗后残余血小板活性。     

Tackling the thrombotic burden in patients with acute coronary syndrome and diabetes mellitus

Patients with diabetes mellitus (DM) and coronary artery disease, particularly those presenting with acute coronary syndromes (ACS), have a higher risk of developing ischemic complications than their nondiabetic counterparts. Although ACS patients with DM benefit more than normoglycemic ACS patients from early coronary angiography and revascularization, they remain at a higher risk of complications following percutaneous coronary intervention and bypass surgery. The DM-associated prothrombotic state has been implicated in the pathogenesis of these complications and growing data supports the notion that potent platelet inhibition is of paramount importance in order to optimize outcomes of DM patients presenting with ACS. This article focuses on the evidence supporting the concept that augmented platelet reactivity and impaired responsiveness to oral antiplatelet agents are influential drivers of the increased propensity of DM patients with ACS to develop thrombotic complications. In particular, strategies to enhance platelet P2Y₁₂ receptor inhibition, a key factor to improve outcomes in this patient population, are reviewed.     

冠心病患者外周血中CD19^＋细胞表达水平的意义

目的观察冠心病患者外周血中CD19^＋的表达水平,并探讨CD19^＋与炎症反应和脂质过氧化反应的关系。方法按美国心脏病学会/美国心脏学会冠心病处理指南的诊断标准并经冠状动脉造影检查确诊的冠心病患者60例,分为稳定型心绞痛（SA）组20例,急性冠状动脉综合征（ACS）组40例;并选择冠状动脉造影正常的20例非冠心病患者作为对照组。应用流式细胞术检测所有研究对象外周血中淋巴细胞表面CD19^＋的表达水平,比较各组CD19^＋的表达情况。同时检测C反应蛋白（CRP）和低密度脂蛋白胆固醇（LDL-C）浓度。并对CD19^＋细胞的表达率与CRP滴度和LDL-C进行Pearson直线相关分析。结果 ACS组患者B淋巴细胞CD19^＋表达率明显高于对照组（10.16±3.63）%vs（4.25±0.96）%（P〈0.01）,亦明显高于SA组（10.16±3.63）%vs（5.39±1.36）%（P〈0.01）;SA组CD19^＋细胞表达率和对照组患者CD19^＋细胞表达率相近（5.39±1.36）%vs（4.25±0.96）%（P〉0.05）。所研究对象外周血中CD19^＋细胞的表达水平与CRP滴度（r=0.661,P〈0.01）和LDL-C（r=0.351,P〈0.01）呈正相关。结论随着冠心病病情加重,冠心病患者外周血中B淋巴细胞CD19^＋的表达水平升高,CD19^＋的表达水平可反映冠心病危险分层,CD19^＋与炎症反应和脂质过氧化反应有关系。     

缺血修饰清蛋白检测在急性冠状动脉综合征中的临床应用

目的 探讨急性冠状动脉综合征（ACS）患者血清缺血修饰清蛋白（IMA）及心肌损伤标志物的变化和临床应用价值.方法 对确诊的126例ACS患者和48例健康对照组进行IMA、肌钙蛋白I（cTnI）、肌红蛋白（Mb）、肌酸激酶同工酶（CK-MB）、C反应蛋白（CRP）、心电图（ECG）、冠脉造影（CAC）检测,并进行统计分析.结果除SA组以外,其余ACS患者的IMA与健康对照组比较,差异均有统计学意义（P〈0.01）.ECG与IMA、cTnI、Mb、CK-MB、CRP诊断SA、UA、AMI的敏感性比较：IMA〉Mb〉cTnI〉ECG〉CRP〉CK-MB,IMA在各组中敏感性均最高,在AMI组可达97.62%.ECG与IMA、cTnI、Mb、CK-MB、CRP诊断SA、UA、AMI的特异性比较：IMA〉cTnI〉Mb〉ECG〉CRP〉CK-MB,AMI组IMA特异性最高可达100.0%.结论 IMA与其他检测指标相比,能及时提示急性心肌缺血的发生,具有出现时间早、敏感性高、阴性预测值高等优点,是一种较理想的早期诊断心肌缺血的指标.     

Impact of gender in patients with acute coronary syndrome

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms ‘gender’, ‘short- and long-term outcomes’ and ‘acute coronary syndrome’ and ‘myocardial infarction’. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males. Observational studies showed that guideline-recommended management strategies are used significantly less frequently in females than males. The undertreatment and worse outcome of female patients with ACS are probably multifactorial and have been reported in different ethnicities and cultures. However, there are conflicting data regarding to the impact of gender on early versus long-term outcomes, the benefit of early intervention in low- and high-risk females and the influence of unmeasured selection biases in the use of therapies in the observational data. These gender discrepancy trends warrant close follow-up, as this might reflect changes in primary and secondary prevention in the community. Furthermore, gender discrepancy gives an indication of healthcare quality and whether care is given in an unbiased manner. All high-risk females, and males with ACS, should receive optimal medical management, coronary angiography and revascularization whenever indicated.     

New-onset atrial fibrillation and acute coronary syndrome

Despite advances in the diagnosis and management of acute coronary syndrome (ACS), atrial fibrillation (AF) remains a commonly encountered complication leading to adverse short- and long-term outcomes across the whole spectrum of ACS. At present, the underlying mechanisms of AF in myocardial ischemia remain incompletely understood. This article evaluates the incidence and trends of new-onset AF in ACS, its impact on ACS management and the associated prognostic significance in patients with acute ischemic heart disease. The safety and use of oral anticoagulation treatment in ACS patients on multiple antiplatelet agents are also explored. Further experimental and clinical studies are needed to improve current understanding and management of new-onset AF in ACS patients.