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The prevalence of coronary artery disease, and its manifestation as acute coronary syndromes (ACS), has reached a pandemic level as a consequence of modernization of the developing world. Drs. Ruff and Braunwald discuss the evolving demographics of ACS, including the impact of the introduction of troponin testing and the change in the definition of myocardial infarction. They also highlight the importance of modifiable risk factors and adherence to guideline-recommended therapy.
Thoracic aortic dissection (TAD) is the progressive separation of the layers of the thoracic aortic wall; this condition is strongly related to excessive dilatation of the aorta and is associated with very high mortality. The authors of this article present an in-depth review of the incidence, demographic distribution, and factors associated with TAD and related thoracic aortic syndromes, as well as a discussion of the challenges involved in assessing the epidemiology of these conditions.
Although a diminished pharmacodynamic effect of clopidogrel has been demonstrated in patients treated with proton-pump inhibitors (PPIs), whether its clinical efficacy is reduced remains highly controversial. The FDA and European Medicines Agency recommend that PPIs and clopidogrel should not routinely be coadministered, and the 2010 expert consensus guidelines support this recommendation.
The population of aged patients treated with percutaneous coronary intervention (PCI) is growing in contemporary practice. The elderly might derive greater benefits from PCI than younger patients, but also have specific age-related characteristics that can increase interventional risks. The authors of this Review discuss the benefits and challenges of PCI in the elderly and make recommendations to optimize patient care.
Worsening renal function is common among patients hospitalized with acute heart failure and is associated with poor outcomes. Although preliminary studies suggested that adenosine receptor antagonists could preserve renal function and improve diuretic responsiveness, the A1-receptor antagonist rolofylline did not provide benefit in patients with acute heart failure in PROTECT.