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Recent advances: Cardiology

Important advances are being made in acute ischaemic syndromes, chronic coronary artery disease, congestive heart failure, and sudden cardiac death. This review highlights some of the advances in cardiology and the resultant changes in clinical practice that are taking place.

For this review, I have used data from published literature and information on ongoing trials obtained from colleagues. Since doctors usually look to clinical trials to guide their practices, I discuss recent important clinical trials (for explanation of study acronyms see box on BMJ website at www.bmj.com). I also used data from, and systematic overviews of, randomised clinical trials where available.

Acute myocardial infarction and unstable angina are the main reasons for hospitalisation. Pathophysiologically, treatment focuses on the intracoronary thrombosis. Thrombolysis has been clearly shown to be efficacious and is widely used in acute myocardial infarction but is unproved in treating unstable angina. Adjunctive treatment with new antiplatelet and antithrombin agents are being investigated.

### Platelet glycoprotein IIb/IIIa inhibition

Interest in the role of platelets in forming the thrombus has led to identification of the platelet surface glycoprotein IIb/IIIa complex, which, when activated by exposure to ADP or thrombin, binds fibrinogen and links platelets into large aggregates.1 Inhibitors of this complex, a member of the integrin family of adhesion receptors mediating the final common pathway in platelet aggregation, have been evaluated in the acute ischaemic syndromes and after coronary angioplasty. One such inhibitor is a mouse monoclonal antibody, known as 7E3 or abciximab. When given to patients with evolving acute myocardial infarction or unstable angina who are undergoing coronary angioplasty, this agent has produced remarkable reductions in acute myocardial infarction and need for urgent revascularisation in the 30 days after the procedure and beyond (table 1).2-5

### Recent advances

Inhibitors of the platelet surface glycoprotein IIb/IIIa complex are promising treatments for acute ischaemic syndromes in …