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Sophia’s readers will know that results of percutaneous coronary intervention are generally superior to thrombolysis in ST elevation myocardial infarction. They will also be aware of the ongoing debate as to whether or not to delay treatment in order to deliver percutaneous coronary intervention. An observational study using data from GRACE (global registry of acute cardiac events) of 3959 patients with ST elevation myocardial infarction suggests that delay to intervention was relatively less deleterious with percutaneous coronary intervention. For every 10 minute delay, mortality increased by 0.30% for thrombolysis (30–60 minutes) compared with 0.18% for percutaneous coronary intervention (90–150 minutes) (Heart 2007;93:1552–5).


A German study of patients admitted with strokes, found that patients without a discernable cause (such as large-artery atherosclerosis, haemorrhage, cardio-embolism or small-vessel occlusion) had a significantly higher incidence of patent foramen ovale on transoesophageal echocardiogram. Paroxysmal embolism has been suggested as a cause of stroke in young patients and in this study it was implicated in older patients also. Among those aged …

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    BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine