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Foreword

The editorial board and staff are pleased to present the latest issue of US Cardiology Review. The reviews cover important topics in each of five sections of the journal and have been selected based on relevance to daily practice of the general cardiologist and advanced internist.

Percutaneous Coronary Intervention in Older People: Does Age Make a Difference?

There will be guidelines about the optimal management of most clinical situations. It makes decision making in medicine more universal, but often you have to think about all of the awkward situations that sit outside the guidelines. One neglected area of research involves the management of illness in older people. The older patient is often not included in trial protocols, and so a well of knowledge is absent for an ever-increasing number of patients.

ST-segment Elevation Myocardial Infarction: Challenges in Diagnosis

Heart disease remains the leading cause of death in the US, with ischemic heart disease comprising almost half of these deaths based on the most recent 2013 mortality data.1 While there have been reports of declining rates of acute myocardial infarction (AMI) from various registries and Medicare beneficiary reports, coronary heart disease remained the underlying cause of death in one out of seven deaths in the US.2–4 The acute coronary syndromes (ACS) are responsible for the largest share of mortality among the etiologies of coronary heart disease, wi

Expert Opinion on Fractional Flow Reserve-Guided Full Revascularisation of ST Segment Elevation Myocardial Infarction Patients

Today, the interest in optimal treatment of acute coronary syndrome (ACS) has never been greater. Several factors have contributed to this including an expanding patient population, the poorer prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease and the recent evidence from randomised trials suggesting that multivessel percutaneous coronary intervention (PCI) is not only safe but reduces major adverse cardiac events (MACEs).1–3

Myocardial Infarction With Non-obstructive Coronary Arteries – Diagnosis and Management

Early coronary angiography performed during acute MI (AMI) identifies an occluded vessel in most patients with ST elevation MI (STEMI)1 and less frequently in those with non-STEMI;2 however, ≥90 % of patients with AMI have evidence of obstructive coronary artery disease.3 For these patients with overt coronary artery disease (CAD), the benefits of reperfusion strategies and cardioprotective therapies are well established and appropriate considering the documented atherothrombotic process involved.

Contemporary Antiplatelet Strategies in the Treatment of STEMI using Primary Percutaneous Coronary Intervention

Antiplatelet Therapy
Current guidelines support the early administration of oral antiplatelet agents upstream of angiographic assessment and intervention.1 Aspirin is commonly given by the first medical contact and additional oral antiplatelet drugs are administered on arrival in hospital (see Figure 1).