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In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, researchers examined the risk of ischemic events in patients with stable coronaryartery disease. years, with 57.1% occurring within 30 days after CABG. Original article: Redfors B et al.
The optimal treatment of chronic coronary syndromes (CCS) represents to date a matter of debate as revascularisation has not shown a real advantage over optimal medical therapy (OMT) alone on long-term overall survival, and has recently been reaffirmed in the latest guidelines as a useful strategy only in case of an ineffective response to OMT.
Angiography done after initial stabilization showed severe stenosis of distal left main coronaryartery. In addition, there were multiple lesions in all three vessels, making a standard indication for an urgent coronaryarterybypassgrafting. This patient had reported with recent onset angina.
Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. Again, cath lab was not activated. What does this troponin level mean? Int J Cardiol.
Watch what happends as the heart recovers from its episode of ischemia. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute? Hard to tell. How can we know? By the evolution of the ECG! The T-waves deflate, demonstrating that the first one was indeed hyperacute. Smith: not sure why that is.
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