Worldwide, more than 2 million patients will be treated with a percutaneous coronary intervention (PCI) this year, with approximately half of these performed in the United States.1 For almost three fourths of these patients, the diagnosis necessitating the procedure will be an acute coronary syndrome (ACS)—either unstable angina or a myocardial infarction (MI).2
Inhibitors of platelet function are a critical component of peri-PCI pharmacological therapy. Aspirin, although initially viewed as a weak agent with minimal potential to prevent acute thrombotic events, has been shown in a placebo-controlled trial to decrease the incidence of Q-wave MIs by 75% compared with heparin alone during coronary angioplasty.3 However, with aspirin alone, thrombotic complications following PCI remained unacceptably high. To address this, the platelet glycoprotein (Gp) IIb/IIIa antagonists were developed as a means to effectively prevent platelet aggregation and its associated complications. Abciximab, eptifibatide, and tirofiban were studied in several placebo-controlled trials involving nearly 17 000 patients undergoing nonemergent PCI. In the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT)4 and Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT)5 trials, randomization of stented patients to receive either abciximab or eptifibatide was found to decrease rates of 30-day death, MI, or urgent target vessel revascularization by 52% and 35%, respectively, compared with placebo. Importantly, this relative risk reduction was similar for patients diagnosed with stable angina or an ACS.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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