The American journal of cardiology
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The fundamental aim of the International Studies of Infarct Survival (ISIS) collaborative group is to assess reliably the balance of any benefits and risks for widely practicable treatments that might produce moderate but worthwhile mortality reductions in patients with suspected acute myocardial infarction. Substantial numbers of lives might be saved by such treatments, but benefits of the size that can realistically be expected may be reliably detected only by randomized trials involving some tens of thousands of patients. In order to recruit such numbers, ISIS involves almost no extra work for collaborators: hence, busy general hospitals--where the majority of acute myocardial infarction patients are actually treated--can take part easily. ⋯ Apart from giving the trial treatments, all other aspects of individual patient management are left entirely to the responsible physician to decide. For example, previous trials in suspected acute myocardial infarction have shown that, for many categories of patients, antiplatelet and fibrinolytic therapy can save lives. Hence, most collaborating doctors will wish to give antiplatelet therapy routinely and to start fibrinolytic therapy in many of their patients before randomizing them in ISIS-4.(ABSTRACT TRUNCATED AT 400 WORDS)
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Certain clinical and morphologic findings are described in 67 patients (aged 23 to 76 years [mean 52]; 55 women [82%]) who had mitral valve replacement for mitral stenosis (with or without associated regurgitation), and simultaneous tricuspid valve replacement for pure tricuspid regurgitation (58 patients) or tricuspid stenosis (all with associated regurgitation; 9 patients). Of the 58 patients with pure tricuspid regurgitation, 21 had anatomically normal and 37 had anatomically abnormal (diffusely fibrotic leaflets) tricuspid valves. ⋯ All 9 patients with stenotic tricuspid valves had anatomically abnormal tricuspid valves. The latter group had a lower average right ventricular systolic pressure (tricuspid valve closing pressure) than those with pure tricuspid regurgitation, and none had severe pulmonary arterial hypertension (present in 20 [30%] of the 58 patients with pure tricuspid regurgitation).