***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 CONTEXT International guidelines recommend an early invasive strategy for patients with high-risk acute coronary syndromes without ST-segment elevation , but the optimal timing of intervention is uncertain . OBJECTIVE To determine whether immediate intervention on admission can result in a reduction of myocardial infa rct ion compared with a delayed intervention . DESIGN , SETTING , AND PATIENTS The Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes R and omized for an Immediate or Delayed Intervention ( ABOARD ) study , a r and omized clinical trial that assigned , from August 2006 through September 2008 at 13 centers in France , 352 patients with acute coronary syndromes without ST-segment elevation and a Thrombolysis in Myocardial Infa rct ion ( TIMI ) score of 3 or more to receive intervention either immediately or on the next working day ( between 8 and 60 hours after enrollment ) . MAIN OUTCOME MEASURES The primary end point was the peak troponin value during hospitalization ; the key secondary end point was the composite of death , myocardial infa rct ion , or urgent revascularization at 1-month follow-up . RESULTS Time from r and omization to sheath insertion was 70 minutes with immediate intervention vs 21 hours with delayed intervention . The primary end point did not differ between the 2 strategies ( median [ interquartile range ] troponin I value , 2.1 [ 0.3 - 7.1 ] ng/mL vs 1.7 [ 0.3 - 7.2 ] ng/mL in the immediate and delayed intervention groups , respectively ; P = .70 ) . The key secondary end point was observed in 13.7 % ( 95 % confidence interval , 8.6%-18.8 % ) of the group assigned to receive immediate intervention and 10.2 % ( 95 % confidence interval , 5.7%-14.6 % ) of the group assigned to receive delayed intervention ( P = .31 ) . The other end points , as well as major bleeding , did not differ between the 2 strategies . CONCLUSION In patients with acute coronary syndromes without ST-segment elevation , a strategy of immediate intervention compared with a strategy of intervention deferred to the next working day ( mean , 21 hours ) did not result in a difference in myocardial infa rct ion as defined by peak troponin level . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00442949 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 
    Output:
    
In the all- study analysis , the evidence failed to show appreciable benefit with routine invasive strategies for unstable angina and non-ST elevation MI compared to conservative strategies in all-cause mortality and death or non-fatal MI at six to 12 months .
However , routine invasive strategies were associated with a relatively high risk ( almost double the risk ) of procedure-related MI , and increased risk of bleeding complications .
This systematic analysis of published RCTs supports the conclusion that , in patients with UA/NSTEMI , a selectively invasive ( conservative ) strategy based on clinical risk for recurrent events is the preferred management strategy