American heart journal
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American heart journal · Jan 2003
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialDouble-blind comparison between zofenopril and lisinopril in patients with acute myocardial infarction: results of the Survival of Myocardial Infarction Long-term Evaluation-2 (SMILE-2) study.
Angiotensin-converting enzyme (ACE) inhibitors have been reported to be effective in placebo-controlled trials in various subsets of patients with acute myocardial infarction (MI). However, no direct comparisons have been performed between different ACE inhibitors in the same patient population. ⋯ The SMILE-2 study demonstrates that both zofenopril and lisinopril are safe and associated with a rather low rate of severe hypotension when given in accordance with a dose-titrated scheme to thrombolyzed patients with acute MI. These findings could have a positive clinical impact and increase the proportion of patients with acute MI who can be safely treated with ACE inhibitors.
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American heart journal · Nov 2002
Randomized Controlled Trial Multicenter Study Clinical TrialEsmolol in acute ischemic syndromes.
beta-Blockers have been shown to reduce both morbidity and mortality rates in patients with acute coronary syndromes. However, because of potential side effects, their use is limited in patients who might benefit the most from such therapy. It was thought that the use of an ultra-short-acting intravenous beta-blocker might produce similar results with fewer complications in those patients with relative contraindications to beta-blocker therapy. ⋯ The use of an ultra-short-acting beta-blocker such as esmolol might offer an alternative to patients with contraindications to standard beta-blocker therapy. Although this trial had limited power to detect safety and efficacy differences between the 2 therapies, it was observed that safety end points, which occurred during esmolol administration, resolved readily when the infusions were decreased or discontinued. Additional testing is needed to substantiate these findings.
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American heart journal · Oct 2002
Randomized Controlled Trial Multicenter Study Clinical TrialTezosentan in patients with acute heart failure and acute coronary syndromes: design of the Randomized Intravenous Tezosentan study (RITZ-4).
Endothelin-1 is the most potent known endogenous vasoconstrictor. It is released during ischemia, and elevated levels have been demonstrated in hypertension, myocardial infarction, and heart failure. Tezosentan is a dual endothelin receptor antagonist, and it has improved cardiac output and reduced pulmonary and systemic vascular resistance in experimental animal models and in initial human acute decompensated heart failure studies. ⋯ The RITZ-4 study evaluated an important population in which few data are available to guide medical management. RITZ-4 will provide valuable safety and efficacy data with the novel compound tezosentan in patients with acute heart failure and acute coronary syndrome.
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American heart journal · Aug 2002
Randomized Controlled Trial Comparative Study Clinical TrialRandomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis.
Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently, cilostazol has been used for antiplatelet therapy after coronary stent implantation. However, its evaluation has not been established yet. ⋯ Aspirin plus cilostazol therapy may be an effective regimen for prevention of not only stent thrombosis but also restenosis.
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American heart journal · Jul 2002
Randomized Controlled Trial Clinical TrialHeparin dosing and outcome in acute coronary syndromes: the GUSTO-IIb experience. Global Use of Strategies to Open Occluded Coronary Arteries.
This study analyzed relationships among heparin dosage, patient characteristics, and 30-day outcome because optimal unfractionated-heparin dosing in acute coronary syndromes remains uncertain. ⋯ There is a defined, dose-associated benefit of unfractionated heparin in acute coronary syndromes similar to that seen previously in thrombolytic-treated infarctions. Heparin therapy is complicated by its complex biologic interactions and relatively crude measures of its effect. Better measures of heparin effectiveness and strategies need to be developed with either better antithrombin agents or adjunctive therapies such as antiplatelet regimens to treat patients who require benefits beyond that supplied by unfractionated heparin.