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Advances in the Diagnosis of Coronary Atherosclerosis by Suna F. Kiraç

By Suna F. Kiraç

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It is recommended (ESC and ACC class I recommendation) that patients who presented with non STEACS should be treated with an invasive strategy of coronary angiography. This is especially for patients with evidence of ischaemia on ECG or biomarkers, the two most 38 Advances in the Diagnosis of Coronary Atherosclerosis powerful predictors of adverse events, as a prelude to definitive treatment for unstable coronary culprit lesions. Several meta-analyses including a Cochrane review (Hoenig et al, 2006; Fox et al, 2010; Mehta et al, 2005) of randomized controlled trials have concluded a routine invasive strategy improved ischaemic endpoints - reducing recurrent ischaemia, rehospitalisation and revascularization; and a more recent meta-analysis of three RCTs (FRISC-II, ICTUS, RITA-3) in 2010 (Fox et al, 2010) showed the benefit of a routine invasive strategy in cardiovascular death or non fatal MI was maintained at five years.

Conclusions Recent emerging evidence has suggested the definite involvement of TRAIL in cardiovascular diseases. Taken together, these results have shown that lower serum TRAIL levels appear to be associated with worse prognosis in patients with CAD and HF. One of most important question is why TRAIL levels are lower in such conditions. It is necessary to investigate how TRAIL is produced and cleared in humans in future studies. In addition, to confirm the direct effects of TRAIL on cardiovascular diseases, administration of recombinant TRAIL may be a powerful approach.

2010). Metalloproteinase 2 cleaves in vitro recombinant TRAIL: potential implications for the decreased serum levels of TRAIL after acute myocardial infarction. Atherosclerosis, Vol. 211, No. 1, (March 2010) pp. 333-336, ISSN 1879-1484 Ter Avest, E, et al. (2007). What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction? Clin Sci (Lond), Vol. 112, No. 10, (April 2007) pp. 507-516, ISSN 1470-8736 Testa, U. (2010). TRAIL/TRAIL-R in hematologic malignancies.

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