Issue Of European Heart Journal Research Articles

REVIEW OF RECOMMENDATIONS FOR THE MANAGEMENT OF THE ACUTE CORONARY SYNDROMES IN PATIENTS PRESENTING WITHOUT PERSISTENT ST-SEGMENT ELEVATION (ESC 2015). Part II

In the August issue of European Heart Journal the guidelines, devoted to a problem of the acute coronary syndromes in patients presenting without persistent ST-segment elevation, which are developed by leading experts of the European Society of Cardiology, were published. The aim of these recommendations is to provide clinicians with brief statement of the modern management that could be successfully applied in practice. In this overview we present basic statements of this document.

REVIEW OF RECOMMENDATIONS FOR THE MANAGEMENT OF THE ACUTE CORONARY SYNDROMES IN PATIENTS PRESENTING WITHOUT PERSISTENT ST-SEGMENT ELEVATION (ESC 2015). Part I

In the August issue of European Heart Journal the guidelines, devoted to a problem of the acute coronary syndromes in patients presenting without persistent ST-segment elevation, which are developed by leading experts of the European Society of Cardiology, were published. The aim of these recommendations is to provide clinicians with brief statement of the modern management that could be successfully applied in practice. In this overview we present basic statements of this document.

Non-steroidal anti-inflammatory drugs and incident atrial fibrillation

This editorial refers to ‘NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction – a nationwide study’, by A.-M. S. Olsen et al. , on pages 107–114 Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used drugs, but much attention has been focused on the relationship of these drugs to cardiovascular conditions.1 In this issue of European Heart Journal – Cardiovascular Pharmacotherapy , Olsen et al. 2 reported on an association, which has had perhaps less attention: the higher risk of developing atrial fibrillation (AF) in patients with prior myocardial infarction (MI) taking NSAIDs. The authors reported a crude event incidence of 2.2 [95% confidence interval (CI) 2.0–2.4] per 100 person-years in post-MI patients prescribed with NSAIDs, compared with patients never prescribed. The adjusted … [↵][1]*Corresponding author. Tel: +44 121 507 5080, Fax: +44 121 554 4083, Email: g.y.h.lip{at}bham.ac.uk [1]: #xref-corresp-1-1

Balancing the risks of stent thrombosis and major bleeding during primary percutaneous coronary intervention

This editorial refers to ‘Bivalirudin is superior to heparins alone with bailout GPIIb/IIIa Inhibitors in patients with ST-segment elevation myocardial infarction transported emergently for primary percutaneous coronary intervention: a pre-specified analysis from the EUROMAX trial’[†][1], by U. Zeymer et al ., on page 2460. Two feared peri-procedural complications of primary percutaneous coronary intervention (PCI) are stent thrombosis (ST) and major bleeding. Although rare, ST is associated with high rates of myocardial infarction and death.1 Potent antithrombotic therapy around the time of PCI markedly reduces the risk of ST, but increases bleeding hazard ( Figure 1 ). Historically, the anticoagulant of choice for PCI has been unfractionated heparin (UFH). Glycoprotein inhibitors (GPI) added to heparin significantly reduce peri-procedural ischaemic complications, but increase major bleeding and the need for transfusions. There has been a consistent association between major bleeding and increased mortality.2 In PCI for elective indications and across the spectrum of acute coronary syndrome (ACS), the direct thrombin inhibitor bivalirudin is non-inferior to heparin plus GPI with respect to overall ischaemic complications, but significantly decreases major bleeding. Figure 1 Balancing reductions in stent thrombosis with increases in major bleeding. PCI, percutaneous coronary intervention. In this issue of European Heart Journal , an important pre-specified analysis by Zeymer et al. uses the European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) study population to compare patients receiving bivalirudin with patients receiving heparins [UFH or low-molecular weight heparin (LMWH)] with routine GPI use (defined as initiation before or during coronary angiography) and patients receiving heparins with only bailout GPI use (defined as initiation after the start of PCI). This study expands on the original EUROMAX findings by reporting a significant difference in the composite primary endpoint of death or major bleeding that favours bivalirudin over heparins with routine GPI use and heparins with bailout GPI use (5.1 vs. … [1]: #fn-1

Interleukin-8: more on the mechanisms of progenitor cells mobilization in acute coronary syndromesThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

In the article published in the current issue of European Heart Journal, Schomig and collaborators identify new humoral factor associated with the release of progenitor cells in acute myocardial infarction (AMI). The article expands current knowledge with regard to mobilization of bone-marrow progenitors in AMI by showing that parallel to already described increase of vascular endothelial growth factor, there is a marked upregulation of interleukin-8 (IL-8) in patients with AMI treated with primary percutaneous coronary intervention (PCI). The increase of IL-8 levels shows the similar time-course as the mobilization of CD133+ cells, moreover plasma concentrations of IL-8 and were shown to be an independent predictor of circulating CD133+ cells number in multivariable regression model that included parameters known to influence the progenitor cell mobilization, such as cardiovascular risk factors, infarct size, and use of statins. Authors investigated the mobilization of three populations of circulating cells differentiated according to their immunophenotype and in vitro characteristics: endothelial progenitor cells (EPC), mature endothelial cells (EC), and less well-defined CD133+ CD34+ CD45− progenitor cells.1 EPC are capable of transforming into mature, functional EC and can be regarded as the pool of cells maintaining the integrity of vascular endothelium, as numerous studies confirmed their pivotal role in vasculogenesis and angiogenesis after ischaemic injury in the setting of AMI and peripheral artery disease.2 Shintani et al .3 were the first to describe and characterize the CD34+ mononuclear cells positive for lineage markers (KDR, VE-cadherin, CD31) as well as function (Dil-acLDL uptake) and morphology of EPC which were mobilized into peripheral blood in AMI. These findings were subsequently confirmed and expanded by Masa et al .,4 in AMI patients … *Corresponding author. Tel: +48 604188669; fax: +48 32 2523930. E-mail address : wojwoj{at}mp.pl