A 51-year-old man with type 2 diabetes, previous coronary bypass surgery in 2009, and multiple percutaneous coronary interventions afterwards was admitted to the emergency department with unstable angina for 4 days. The patient had been exercising vigorously in recent weeks to lose weight. His blood pressure at admission was repeatedly high with a mean of 185/105 mmHg. Laboratory analysis showed a high sensitive troponin of 10 ng/L on admission (reference value < 5 ng/L) and 11 ng/L after 1 h. Electrocardiogram revealed new anterior and lateral ischaemic changes (Supplementary material online, Figures S1 and S2). The patient was hospitalized and fondaparinux was started awaiting invasive coronary angiography (ICA). He was already on aspirin and ticagrelor at admission.
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