***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Antiplatelet therapy with aspirin and antithrombotic therapy with heparin both prevent the complications of unstable angina ; however , no definitive data exist on the relative clinical efficacy of the two drugs . Methods and Results Aspirin ( 325 mg bid ) or heparin ( 5000-U intravenous bolus followed by a perfusion titrated to the APTT ) were compared in a double-blind r and omized trial of 484 patients in two cohorts enrolled sequentially . The study was initiated at admission to hospital at a mean of 8.3±7.8 hours after the last episode of pain . End points were assessed 5.7±3.3 days later , when the decision for long-term management was made . Myocardial infa rct ion occurred in 2 ( 0.8 % ) of the 240 patients r and omized to heparin  and in 9 ( 3.7 % ) of the 244 r and omized to aspirin ( P=.035 ) , an odds ratio of 0.22 and a risk difference of 2.9%o ( 95 % confidence limits , 0.3 % to 5.6 % ) with heparin . The only death result ed from a myocardial infa rct ion in an aspirin patient . Survival curves with Cox logistic regression analysis showed that the improvement in survival without myocardial infa rct ion  with heparin ( P=.035 ) was independent of other baseline characteristics . Conclusions This study documents that heparin prevents myocardial infa rct ion better than aspirin during the acute phase of unstable angina BACKGROUND The CAPTURE ( C7E3 fab AntiPlatelet Therapy in Unstable REfactory angina ) trial enrolled patients with refractory unstable angina and documented a therapeutic benefit for abciximab , a platelet glycoprotein IIb/IIIa receptor antagonist , that was particularly evident in patients with elevated troponin T ( TnT ) levels . In the current study , we related the angiographic data to the TnT status of the CAPTURE patients . METHODS AND RESULTS In 853 patients , angiographic data at baseline and 18 to 24 hours after treatment were available and assessed by an Angiographic Committee with respect to TIMI flow , lesion severity , and visibility of thrombus . TnT levels > 0.1 microg/L were found in 30.9 % of the patients . Before r and omization , thrombus was visible in 14.6 % of TnT-positive patients ( TnT levels > 0.1 microg/L ) and 4.2 % of TnT-negative patients ( P=0.004 ) . Complex lesion characteristics B2+/C ( 72.0 % versus 53.9 % ; P<0.001 ) and TIMI flow < 2 ( 15.6 % versus 5 . 1 % ; P<0.001 ) were more frequent in TnT-positive patients . Abciximab was effective with respect to reduction of visible thrombus , increase of TIMI flow , and reduction of cardiac events in TnT-positive patients only . Multivariate analysis identified TnT status , but not angiographic findings , as an independent predictor for both outcome and efficacy of treatment with abciximab . CONCLUSIONS Complex lesion characteristics and visible thrombus formation at baseline were significantly linked to TnT elevation . However , TnT status was a more powerful predictor of increased cardiac risk and efficacy of treatment with abciximab than either . Relative to the angiogram , TnT can thus be considered a more sensitive marker for the underlying pathology , identifying patients with unstable angina who will particularly benefit from antiplatelet treatment AIMS We compared invasive ( on-site coronary angioplasty or emergency air-ambulance transfer for bypass grafting surgery ) vs conservative ( persistent medical treatment ) strategies in the management of refractory unstable angina in geographically isolated hospitals without cardiac surgical facilities . METHODS AND RESULTS One hundred and forty eight r and omized patients with refractory unstable angina were compared on an intention-to-treat basis . Outcomes ( invasive vs conservative ) : ( a ) in hospital : stabilization ( 96 % vs 43 % , P=0.0001 ) , non-fatal myocardial infa rct ion ( 2.6 % vs 4.2 % , P = ns ) , death ( 1.3 % vs 8.3 % , P=0.046 ) , combined outcome ( 3.9 % vs 12.5 % , P=0.053 ) and hospitalization ( 11.4+/-6.3 vs 12.4+/-8.0 days , P = ns ) . ( b ) 30-days follow-up : non-fatal myocardial infa rct ion ( 2.6 % vs 4.2 % , P = ns ) , death ( 2.6 % vs 11.1 % , P=0.030 ) and combined outcome ( 5.3 % vs 15.3 % , P=0.031 ) . ( c ) 12 month follow-up : non-fatal myocardial infa rct ion ( 3 . 9 % vs 4.2 % , P = ns ) , death ( 3.9 % vs 12.5 % , P=0.053 ) , combined outcome ( 7.9 % vs 16.7 % , P = ns ) , re-admissions for unstable angina : ( 17.1 % vs 23.6 % , P = ns ) , late coronary angioplasty :  ( 15.8 % vs 11.1 % , P = ns ) and ( d ) late coronary bypass grafting :  ( 7.9 % vs 12.5 % , P = ns ) . CONCLUSION Invasive treatment of patients with refractory angina in remote areas without surgical back-up results in significant in-hospital stabilization and a reduction in major events in-hospital and at 30 days . Coronary angioplasty in st and -alone units and air-transfer of these patients seems safe Objective : To develop a scoring system for risk stratification and evaluation of the effect of an early invasive strategy for treatment of unstable coronary artery disease ( CAD ) . Design : Retrospective analysis of a r and omised study ( FRISC II ; fast revascularisation in instability in coronary disease ) . Setting : 58 Sc and inavian hospitals . Patients : 2457 patients with unstable CAD from the FRISC II study . Main outcome measures : One year rates of mortality and death/myocardial infa rct ion ( MI ) . Methods : Patients were r and omly assigned to an early invasive or a non-invasive strategy . From the non-invasive cohort independent variables of death or death/MI were identified . Results : Seven factors , age > 70 years , male sex , diabetes , previous MI , ST depression , and increased concentrations of troponins and markers of inflammation ( interleukin 6 or C reactive protein ) , were associated with an independent increased risk for death or death/MI . In patients with ⩾ 5 of these factors the invasive strategy reduced mortality from 15.4 % ( 20 of 130 ) to 5.2 % ( 7 of 134 ) ( risk ratio ( RR ) 0.34 , 95 % confidence interval ( CI ) 0.15 to 0.78 , p = 0.006 ) . Death/MI was also reduced in patients with 3–4 factors from 15.7 % ( 80 of 511 ) to 10.8 % ( 58 of 538 ) ( RR 0.69 , 95 % CI 0.50 to 0.94 , p = 0.02 ) . Neither death nor death/MI was reduced in patients with 0–2 risk factors . Conclusion : In unstable CAD , this scoring system based on factors independently associated with an adverse outcome can be used shortly after admission to the hospital for risk stratification and for selection of patients to an early invasive treatment strategy BACKGROUND There are limited data describing the presenting characteristics , management , and outcomes of diabetic and nondiabetic patients with an acute coronary syndrome ( ACS ) . OBJECTIVE To examine differences in these factors , patients with ST-segment elevation acute myocardial infa rct ion , non-ST-segment elevation acute myocardial infa rct ion , and unstable angina were enrolled in a large multinational coronary disease registry . METHODS The Global Registry of Acute Coronary Events is a prospect i ve observational study of patients hospitalized with an ACS at 94 hospitals in 14 countries . The study sample consisted of 5403 patients with ST-segment elevation acute myocardial infa rct ion , 4725 with non-ST-segment elevation acute myocardial infa rct ion , and 5988 with unstable angina . RESULTS Approximately 1 in 4 patients presented to participating hospitals with a history of diabetes . Patients with diabetes were older , more often women , with a greater prevalence of comorbidities , and they were less likely to be treated with effective cardiac therapies than nondiabetic patients . Patients with diabetes who developed an ACS were at increased risk for each hospital outcome examined including heart failure , renal failure , cardiogenic shock , and death . These differences remained after adjustment for potentially confounding prognostic factors . CONCLUSIONS A considerable proportion of patients with an ACS has diabetes and is at increased risk for adverse outcomes compared with patients without diabetes . There are certain proven therapeutic strategies that remain underused in the diabetic population . A more widespread awareness of this increased risk and a more diligent use of proven cardiac treatment approaches are indicated for patients with diabetes who develop an ACS BACKGROUND Few studies have investigated the effects of an early revascularization in relation to renal function in patients with unstable coronary artery disease ( CAD ) . METHODS Patients ( n = 2457 ) with unstable CAD r and omized to a noninvasive or invasive treatment strategy in the Fast Revascularisation during InStability in Coronary artery disease ( FRISC-II ) trial were stratified according to tertiles of creatinine clearance ( CrCl < 69 mL/min , CrCl 69 - 90 mL/min , CrCl > 90 mL/min ) and followed for 2 years regarding death and /or myocardial infa rct ion ( MI ) . RESULTS In the noninvasive cohort , the rate of death or MI at 2 years was 22.4 % at CrCl < 69 mL/min , 14.6 % at CrCl 60 - 90 mL/min , and 11.6 % at CrCl > 90 mL/min . In the invasive cohort , the rate of death or MI was reduced to 14.6 % ( P = .003 ) at CrCl < 69 mL/min and to 9.9 % ( P = .048 ) at CrCl 69 to 90 mL/min , but no significant reduction ( 11.2 % ) at CrCl > 90 mL/min . In a logistic regression analysis adjusting for other important covariables , CrCl < 69 mL/min remained independently associated with the risk of the combined end point in the noninvasively treated group ( odds ratio , 1.96 ; 95 % confidence interval , 1.12 - 3.42 ) but not in the invasively treated group ( odds ratio , 1.09 ; 95 % confidence interval , 0.56 - 2.14 ) . When the interaction term for treatment strategy and CrCl group was included in the analysis , the interaction between treatment strategy and CrCl < 90 mL/min was independently associated with the risk of future MI ( P = .006 ) . CONCLUSION In unstable CAD , an early invasive treatment strategy reduces the long-term risk of future death and MI in patients with mildly to moderately reduced CrCl OBJECTIVES This study was design ed to evaluate B-type natriuretic peptide ( BNP ) for risk assessment and clinical decision making over a range of cut points , alone and with cardiac troponin I ( cTnI ) , in patients with non-ST-elevation acute coronary syndromes ( ACS ) . BACKGROUND B-type natriuretic peptide holds promise for risk stratification . Additional evidence regarding optimal decision limits , use in combination with troponin , and use in targeting therapy is needed before acceptance into clinical use for ACS . METHODS We evaluated BNP at baseline in 1,676 patients with non-ST-elevation ACS r and omized to early invasive versus conservative management . RESULTS Patients with elevated BNP ( > 80 pg/ml ; n = 320 ) were at higher risk of death at seven days ( 2.5 % vs. 0.7 % , p = 0.006 ) and six months ( 8.4 % vs. 1.8 % , p < 0.0001 ) . The association between BNP and mortality at six months ( adjusted odds ratio [ OR ] 3.3 ; 95 % confidence interval [ CI ] 1.7 to 6.3 ) was independent of important clinical predictors , including cTnI and congestive heart failure ( CHF ) . Patients with elevated BNP had a fivefold higher risk of developing new CHF by 30 days ( 5.9 % vs. 1.0 % , p < 0.0001 ) . B-type natriuretic peptide added prognostic information to cTnI , discriminating patients at higher mortality risk among those with negative ( OR 6.9 ; 95 % CI 1.9 to 25.8 ) and positive ( OR 4.1 ; 95 
    Output:
    
The composite end-point of death or non-fatal myocardial infa rct ion was significantly decreased by an invasive strategy at several time points after initial hospitalization .
AUTHORS ' CONCLUSIONS An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI