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All you need to read in the other general journals

BMJ 2009; 338 doi: (Published 29 June 2009) Cite this as: BMJ 2009;338:b2590

People given thrombolysis for heart attack should undergo PCI soon afterwards

Many patients with myocardial infarction are given fibrinolytic agents because percutaneous coronary intervention is unavailable at their local hospital. Should they be transferred for early angioplasty after thrombolysis?

In the latest and most definitive trial, people who were routinely transferred and treated within six hours of thrombolysis did significantly better than controls who were transferred for percutaneous coronary intervention only if thrombolysis failed or their chest pain recurred. The authors used an end point of death, reinfarction, recurrent ischaemia, heart failure, or cardiogenic shock within 30 days. There were 59 events among the 536 patients transferred and treated within 6 hours (11%), compared with 90 events among 522 controls (17.2%; relative risk 0.64, 95% confidence interval 0.47 to 0.87).

Four smaller trials have already reported in favour of early percutaneous coronary intervention following thrombolysis, says an editorial (pp 2779-81). Taken together the evidence looks conclusive. People who miss out on angioplasty and a stent immediately after a heart attack should be given thrombolysis and the best medical care, then transferred quickly and efficiently. In this trial, patients in the intervention group had percutaneous coronary intervention and stent placement (usually a bare metal stent) a median of three hours after thrombolysis. Two thirds of controls also needed mechanical reperfusion, but underwent the procedure a median of 22 hours after admission. The strategy of rapid transfer following thrombolysis was associated with no more major bleeding than the control strategy.

Researchers find more cerebellar lesions in women reporting migraine with aura

Researchers have found an association between migraine with aura and brain lesions that look like infarcts in an established Icelandic cohort. The 4689 men and women answered questions about headache around 1978, when they were middle aged, then underwent magnetic resonance imaging of the brain between 2002 and 2006.

Overall, 39.3% of the men and 24.6% of the women had evidence of …

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