The American journal of cardiology
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Randomized Controlled Trial Clinical Trial
Influence of early prehospital thrombolysis on mortality and event-free survival (the Myocardial Infarction Triage and Intervention [MITI] Randomized Trial). MITI Project Investigators.
The Myocardial Infarction Triage and Intervention Trial of prehospital versus hospital administration of thrombolytic therapy markedly reduced hospital treatment times, but the 2 groups had similar outcomes. However, patients treated < 70 minutes from symptom onset had better short-term outcomes. The purpose of this study was to determine the long-term influence of very early thrombolytic treatment for acute myocardial infarction. ⋯ In patients treated < 70 minutes from symptom onset, 2-year survival was 98%, and it was 88% for those treated later (p = 0.12). Two-year event-free survival was 65% for patients treated early and 59% for patients treated later (p = 0.80). In this trial, poorer long-term survival was associated with advanced age, history of congestive heart failure, and coronary artery bypass surgery performed before the index hospitalization, but not with time to treatment.
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Hypertrophic cardiomyopathy (HC) is characterized by impaired diastolic function, and left ventricular (LV) outflow tract obstruction in about one-fourth of patients. Verapamil improves diastolic properties, but may have dangerous adverse effects. This study investigates the effects of diltiazem on hemodynamics and LV function in 16 patients with HC who were studied with cardiac catheterization and simultaneous radionuclide angiography. ⋯ LV outflow tract gradient does not increase despite systemic vasodilation. In some patients, however, a marked increase in obstruction and a potentially harmful elevation in pulmonary artery wedge pressure do occur. Passive diastolic function is not affected.
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Clinical evaluation of the antiplatelet glycoprotein (GP) IIb/IIIa receptor antagonists has now extended over nearly a decade. The largest experience to date with this new class of agents has been in the prevention and management of complications of percutaneous coronary intervention. Four trials involving 3 different agents in the setting of coronary intervention are discussed: the Evaluation of c7E3 in Preventing Ischemic Complications (EPIC) and the Evaluation of PTCA to Improve Long-term Outcome by c7E3 GPIIB/IIIA Receptor Blockade (EPILOG) trials of the antibody fragment abciximab (ReoPro); the Integrilin to Minimize Platelet Aggregation and Prevent Coronary Thrombosis II (IMPACT II) trial evaluating the peptide Intergrilin; and the Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis (RESTORE) trial studying the nonpeptide mimetic tirofiban (Aggrastat). ⋯ Bleeding risks can be minimized by minor changes in standard patient care algorithms. Dosing strategies and treatment duration still need to be refined, especially for the competitive antagonists. The role of these agents as adjuncts in stenting and rotational atherectomy and as adjunctive therapy in other disease settings requires further study.
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Dobutamine stress ventriculography is a safe test that appears to separate groups of patients with and without significant coronary artery stenoses. In this study, all 7 patients with significant coronary artery stenoses who reached a heart rate > or = 110 beats/min had a positive stress test, whereas 9 of 10 control patients had a negative stress test.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia.
Efficacy of procainamide and lidocaine in terminating spontaneous monomorphic ventricular tachycardia (VT) was assessed in a randomized parallel study. Patients with acute myocardial infarction and those with poor hemodynamic tolerance of VT were excluded. Procainamide 10 mg/kg was given intravenously with an injection speed of 100 mg/min, and lidocaine was administered at an intravenous dose of 1.5 mg/kg in 2 minutes. ⋯ The protocol was stopped in 4 cases because of adverse effects. A comparison of the QRS width and QT interval before and at the end of the injection revealed significant lengthening of these values after procainamide but no change after lidocaine. In conclusion, procainamide is superior to lidocaine in terminating spontaneously occurring monomorphic VT.