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BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:105
  1. Christopher Martyn, associate editor (

    Angioplasty is beneficial if thrombolysis fails

    What is the best treatment for patients with acute myocardial infarction when thrombolysis fails? It's an important question because intravenous thrombolysis restores good blood flow in the infarct related artery in only about 60% of cases. Some doctors, especially in hospitals without interventional facilities, treat such patients conservatively. Another option is to try a second dose of a thrombolytic agent. Small trials have suggested that percutaneous coronary intervention is justified, but current guidelines recommend it only for high risk patients.

    Credit: N ENGL J MED

    The results of a multicentre trial in Britain now indicate that angioplasty is probably best for everyone. In the trial 427 patients in whom thrombolytic treatment had failed (judged by lack of ST segment resolution) were randomly assigned to repeated thrombolysis, conservative therapy, or emergency percutaneous coronary intervention. The primary end point was a composite of death, reinfarction, stroke, or severe heart failure within six months. Event-free survival was significantly better among patients assigned to rescue angioplasty, even though a substantial proportion of the patients treated in this way had to be transferred from hospitals without interventional facilities. In comparison with the group receiving repeated thrombolysis, their treatment was delayed by a median time of 84 minutes. There were no differences in rates of major bleeding complications between groups, although minor bleeding episodes, mostly at the access site, occurred in more than 20% of those treated percutaneously.

    Dietary antioxidants may help prevent age related macular degeneration

    Age related macular degeneration is the commonest cause of irreversible blindness in elderly people. We know little about its causation, but—because the retina may be particularly susceptible to oxidative stress owing to its high concentrations of oxygen, polyunsaturated fatty acids, and photosensitisers—it's thought that levels of antioxidant vitamins may be important. A randomised controlled trial found that high doses of βcarotene, vitamins C and E and zinc tended …

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