Heartdrug : excellence in cardiovascular trials最新文献

{"title":"Rationale and Design of the OACIS-LIPID Study That Evaluates Early Use of Pravastatin in Acute Myocardial Infarction","authors":"Y. Sakata, Hiroshi Sato, Kunihiro Kinjo, K. Fujii, K. Kodama, J. Tanouchi, M. Mishima, H. Kusuoka, D. Nakatani, H. Mizuno, M. Shimizu, M. Hori","doi":"10.1159/000089599","DOIUrl":"https://doi.org/10.1159/000089599","url":null,"abstract":"We conduct a prospective randomized study, the OACIS-LIPID, to determine whether early use of pravastatin can prevent secondary cardiac events in patients with acute myocardial infarction (AMI) and hyperlipidemia (HL). Three hundred and fifty Japanese patients with AMI and mild to moderate HL are randomly assigned to receive or not to receive pravastatin in an open-labeled fashion. The primary dose of pravastatin is 10 mg per day, which is a standard dose for the Japanese population. Both groups receive dietary counseling. Over a 9-month follow-up period, the combination of the endpoints (death, nonfetal myocardial infarction, unstable angina, noncardiac rehospitalization, revascularization and nonfetal stroke) will be evaluated. The results of the OACIS-LIPID study will determine the utility of a practical dose of hydroxymethylglutaryl coenzyme A reductase as an early intervention in AMI.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"193 - 196"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitric Oxide Synthase Inhibitors in Refractory Cardiogenic Shock due to Myocardial Infarction after Percutaneous Coronary Intervention","authors":"E. Kaluski, O. Milo, N. Uriel, Z. Vered, G. Cotter","doi":"10.1159/000085890","DOIUrl":"https://doi.org/10.1159/000085890","url":null,"abstract":"ST-elevation myocardial infarction complicated by cardiogenic shock (CS), warrants optimal medical support and urgent revascularization usually by percutaneous coronary intervention (PCI). However, contemporary studies report that half of these post-PCI patients will succumb to intractable heart stunning, failure, and death. Most of those who survive, however, become asymptomatic or mildly symptomatic. We discuss current definitions of CS, and pump function, as well as the potential deleterious effects of nitric oxide on the stunned and failing heart. We review the studies employing nitric oxide synthase inhibitors for post-PCI cardiogenic shock, and point out future studies.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"161 - 167"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Dyslipidemia and Concomitant Risk Factors with In-Hospital Mortality in Acute Coronary Syndrome in Switzerland","authors":"D. Radovanović, P. Erne, J. Schilling, G. Noseda, F. Gutzwiller","doi":"10.1159/000085886","DOIUrl":"https://doi.org/10.1159/000085886","url":null,"abstract":"Background: Although dyslipidemia is one of the main risk factors for cardiovascular diseases, very few randomized trials have provided data on the association of dyslipidemia and in-hospital mortality in patients with acute coronary syndrome (ACS). Objective: The study assessed the association of dyslipidemia and concomitant risk factors, and early lipid-lowering therapy (LLD) on in-hospital mortality in patients admitted for ACS. Methods: Using AMIS Plus registry data, 13,482 patients admitted between January 1997 and October 2003 were analyzed, and logistic regression was used for predicting in-hospital mortality. Results: Baseline characteristics of patients with dyslipidemia (n = 6,079) significantly differed from those without, and in-hospital mortality was lower (5.5 vs. 9.4%; p < 0.001). Subgroup analyses of 9,383 patients with one or more of four preexisting main risk factors (hypertension, diabetes, coronary heart disease, CHD, or dyslipidemia) showed that whenever dyslipidemia was combined with another risk factor, the mortality rate clearly decreased. Patients with dyslipidemia were, in all subgroups, significantly younger (p < 0.001) and predominantly male, and they had more frequently primary percutaneous coronary intervention (PCI). However, this was only significant in patients with hypertension or hypertension and CHD. Independent in-hospital mortality predictors were age (odds ratio, OR: 1.08 per year, 95% confidence interval, CI, 1.07–1.09), diabetes (OR: 1.96, 95% CI: 1.56–2.46, p < 0.0001) and primary PCI (OR: 0.62, 95% CI: 0.44–0.86, p < 0.0001). In patients who received LLD, mortality was significantly lower regardless of the total cholesterol level measured within 24 h after symptom onset. Conclusion: Patients with dyslipidemia admitted for ACS had significantly lower in-hospital mortality than patients without dyslipidemia, mainly but not only due to the younger age of these patients. Early administration of LLD was associated with lower in-hospital mortality.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"131 - 139"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Intravenous β-Blocker Administration in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Intervention","authors":"A. Halkin, G. Stone","doi":"10.1159/000085891","DOIUrl":"https://doi.org/10.1159/000085891","url":null,"abstract":"The clinical effects of intravenous β-adrenoreceptor- blocking agents (β-blockers) administered during evolving acute myocardial infarction (AMI) have varied among published studies, depending on whether or not reperfusion therapy was employed. Primary percutaneous coronary intervention (PCI) is accepted as the superior form of reperfusion therapy for AMI if it can be performed by an experienced team in a timely fashion. Intravenous β-blockers are not routinely used in this setting and their role as adjunctive medical therapy to catheter-based reperfusion requires definition. Emerging data strongly indicate that in the absence of cardiogenic shock or specific contra-indications, pre-procedural intravenous β-blockade improves survival and recovery of left ventricular function after primary PCI, and that these effects are modulated by oral β-blocker use at the time of AMI onset. In the absence of contra-indications, the available evidence supports the routine administration of intravenous β-blockers to patients with ST-segment elevation AMI managed by catheter-based reperfusion therapy, especially in patients in whom oral β-blockers were not used before admission. While no data are available on the effects of intravenous β-blocker therapy with catheter-based intervention for acute coronary syndromes other than ST-segment elevation AMI, it is reasonable to apply the aforementioned recommendations regarding primary PCI to these patients as well.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"168 - 174"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboembolic Prophylaxis with Fondaparinux in Major Orthopaedic Surgery: Outcomes and Costs","authors":"T. Szucs, Walter Kaiser, F. Mahler, F. Gutzwiller","doi":"10.1159/000085885","DOIUrl":"https://doi.org/10.1159/000085885","url":null,"abstract":"Objective: To compare economic impacts of anti-thromboembolism prophylaxis with two medications – new pentasaccharide fondaparinux versus low molecular weight heparin (LMWH) – in major orthopaedic surgery, such as hip and knee replacement and hip fracture repair, in Switzerland. In order to meet this objective, three parameters were determined for an observation period of 5 years. (1) Outcomes: Frequency of deep vein thrombosis (DVT), pulmonary embolism (PE) and their complications. (2) Cost burden of disease: Determination of the costs of DVT, PE and complications not prevented despite prophylaxis. (3) Total costs of prophylaxis: Costs were calculated from the perspective of the health insurance scheme. Methods: In order to determine outcomes and cost burden of disease, a model was applied which generates the post-surgery course of thromboembolic events (TE) and their complications for individual cohorts of patients undergoing hip and knee replacement surgery and hip fracture repair. These findings were allocated to the Swiss standard diagnostic and therapeutic measures (resource consumption), which enabled subsequent calculation of the costs of TE, including complications not prevented in spite of prophylaxis (cost burden of disease) based on standard Swiss tariffs. Additionally, total costs of prophylaxis, including costs of medications and monitoring, were determined. Results: In Switzerland, the following outcomes (expressed as percentage of the number of patients undergoing surgery) can be expected for TE prophylaxis with LMWH and with fondaparinux: DVT 3.4 vs. 2.3%, PE 1.4 vs. 0.7%, recurrent DVT 0.2 vs. 0.1%, post-thrombotic syndrome 4.8 vs. 3.5%. The costs of non-prevented TE and their complications add up to CHF 437 vs. CHF 306 per patient undergoing major orthopaedic surgery; the total cost burden for Switzerland amounts to CHF 13.4 million vs. CHF 9.4 million (30% less). Thus, despite higher medication costs, the use of fondaparinux instead of LMWH saves a total of CHF 105 per operated patient from the perspective of the health insurer. Conclusion: Fondaparinux is superior to LMWH in regards to both clinical efficacy and financial costs. This statement is confirmed by sensitivity analysis with different parameters over a broad range.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"121 - 130"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085885","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmogenic Right Ventricular Cardiomyopathy: A Presentation of Thirty Consecutive Patients","authors":"H. B. Nielsen, C. Thomsen, Xu Chen, C. B. Andersen, G. G. Toft, L. Søndergaard, S. Haunsø, J. Svendsen","doi":"10.1159/000085888","DOIUrl":"https://doi.org/10.1159/000085888","url":null,"abstract":"Background: There is a limited number of studies of consecutive patients suspected of having arrhythmogenic right ventricular cardiomyopathy (ARVC) as established by the Task Force report [Br Heart J 1994;71:215–218]. Objective: The aim of this study was to describe a population of ARVC patients who were referred to a university hospital for thorough clinical evaluation of right ventricle arrhythmia using both noninvasive and invasive procedures. Methods: In a prospective design 48 patients suspected of having ARVC underwent cardiac magnetic resonance imaging (MRi), contrast ventriculography, an electrophysiological test and endomyocardial biopsies from the lower septum. Results: A diagnosis of ARVC was established in 30 patients (age 40 ± 2 years, mean ± SEM) and in one third of the patients, intense running, cycling or rowing provoked palpitations and syncope. Arrhythmias were frequent premature contractions of RV origin and/or ventricular tachycardia with a left bundle branch configuration. In 14 ARVC patients the ECG trace showed right bundle branch block or inverted T waves in right precordial leads. Contrast ventriculography demonstrated RV dilatation in 11 ARVC patients and in 18 patients the septal biopsies showed fatty tissue myocardial infiltration. In 25 patients cardiac MRi showed islands of high signal intensity indicative of RV fatty infiltration. Conclusions: ARVC is a heterogeneous syndrome and an abnormal right ventricle and arrhythmias of right ventricle origin must lead to a clinical evaluation. Cardiac MRi appears to be an important diagnostic tool in patients suspected of ARVC and should be used to guide invasive procedures.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"146 - 152"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65290006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Writing the Original Medical Research Paper","authors":"T. Schmidt, Jan Bech, K. Kjeldsen","doi":"10.1159/000085889","DOIUrl":"https://doi.org/10.1159/000085889","url":null,"abstract":"An original article is generally considered a cornerstone of modern research. It is a detailed written presentation of novel and original data that undergo peer review. The current paper describes in detail how to draw up an original article effectively, using strategies such as modern information technology and a rational sequence of writing title page, materials and methods, figures and tables, legends, results, introduction, discussion, acknowledgements, abstract (summary), key words and reference list. As a preliminary step, important basic facts on medical writing are described, in particular the distinction between generating/collecting data and actually putting fingers to the keyboard. The Vancouver requirements and important aspects of authorship are discussed; how to choose a journal is also outlined. Finally we describe the repeated process of writing, reviewing and revising your manuscript together with your mentor or co-workers to obtain the highest level of quality before submission.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"153 - 160"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Effects of a Single High Dose of Simvastatin on C-Reactive Protein in Patients with Unstable Angina","authors":"Jian‐Jun Li, Chun-Hong Fang, Ming-zhe Chen, Xin Chen","doi":"10.1159/000085887","DOIUrl":"https://doi.org/10.1159/000085887","url":null,"abstract":"Background: Elevated levels of C-reactive protein (CRP) became widely accepted as a risk factor for a higher incidence of coronary events, and rapid lowering of CRP following the administration of drugs may result in early beneficial effects on the coronary endothelium in patients with coronary heart disease, and reduce angina and coronary events after revascularization. Limited information has been available, however, on the potential effect of a single, high dose of simvastatin on CRP in patients with unstable angina (UA) within 48 h. Hypothesis: The present study was performed to investigate whether a rapid CRP reduction can be achieved by a single, high-dose simvastatin therapy in patients with UA given immediately on admission. Patients and Methods: Forty-two patients with chest pain at rest were randomly assigned to a single placebo dose or 80 mg of simvastatin given at the time of admission in addition to standard therapy. Blood samples were also drawn on admission and 48 h following admission for serum CRP evaluation. Results: The results showed that a single, high dose of 80 mg simvastatin induced significant reductions in median serum CRP levels and in mean CRP levels 48 h following the administration of simvastatin (25.4 and 32.7%, respectively; p < 0.001). Conclusions: Our data suggest that a single, high dose of simvastatin, given during admission, is an effective therapy for controlling inflammatory responses in patients with UA, and its beneficial effect on the vascular endothelium might be reflected by the immediate reduction in CRP levels in this high-risk subgroup, thus improving their prognosis.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"140 - 145"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000085887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65289905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congress Calendar","authors":"","doi":"10.1159/000086478","DOIUrl":"https://doi.org/10.1159/000086478","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"175 - 176"},"PeriodicalIF":0.0,"publicationDate":"2005-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000086478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65295038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACE Inhibitors for Older Patients with Heart Failure: A Review of Evidence, Practice Patterns and Challenges","authors":"Pamela N. Peterson, F. Masoudi","doi":"10.1159/000083665","DOIUrl":"https://doi.org/10.1159/000083665","url":null,"abstract":"Heart failure is predominantly a condition of the elderly and is associated with substantial mortality, morbidity and functional limitation. In clinical trials of patients with left ventricular systolic dysfunction (LVSD), angiotensin-converting enzyme (ACE) inhibitors reduce the burden of heart failure. Clinical trials, however, have largely excluded older persons. This paper reviews the evidence for efficacy and effectiveness of ACE inhibitors, current patterns of use of these important agents and the challenges of prescribing ACE inhibitors for older patients with heart failure. The existing literature indicates that (1) despite a relative paucity of data from randomized controlled trials, observational studies suggest that the elderly with LVSD are as likely to benefit from ACE inhibitors as younger patients; (2) ACE inhibitors are underused in older persons despite guideline recommendations, and (3) the older population presents specific challenges in applying the clinical evidence supporting ACE inhibitors, including polypharmacy, cognitive impairment and other common comorbid conditions. Nevertheless, the judicious use of ACE inhibitors in eligible older patients will likely improve health outcomes.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"89 - 99"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}