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Comparison of Ticlopidine and Aspirine in Unstable Angina
Z.Sadowski, D.Luczak,A Matar,A.Dyduszynski, L.Giec, A.Kalicinski, T.Kraska, E.Nartowicz, T.Petelenz, W.Piwowarska, G.Swiatecka, J.Wodniecki, K.Wrabec. Multicenter Trial coordinated by the National Institute of Cardiology, Warsaw, Poland.
Randomized, double blind study in 320 patients (pts) with unstable angina (UA) type "angina crescendo" (204) or rest angina (116) was performed. All pts were treated with i.v. NTG and heparin during 48 hour and randomly assigned to one of 4 groups by 2 times 2 design: 1.Ticlopidine (T) and Metoprolol (M) 2.Ticlopidine and Gallopamil (G) 3.Aspirin (ASA) and Metoprolol 4.Aspirin and Gallopamil Medical tretment was continued during 3 month follow-up. PTCA (12.5%) or CABG (24.4%) was performed in the acute period or follow-up if medical treatment failed. In the group treated medically therapy was effective clinically in 74.7% (no rest angina). Rest angina did not reccur in G group in 78.0% and in M group in 71.1% (NS). During 3 months rest angina recurrence was observed more often in ASA than T group (38.5% and 22.5% respectively, p<0.05). Myocardial infarction (MI) was diagnosed during follow-up only in the group treated with ASA (7.4%), there was no MI in T group (p<0.05). Mortality rate in the group treated medically was low 2.0% (3 pts in ASA and 1 in T group died). Pts treated with M presented more often sinus bradycardia, heart failure, lower BP and HR compared with G (p<0.05). Drugs were discontinued due to side effects in 3.8%. Coronary angiography performed in 200 pts (62.5%) revealed significant coronary disease in the majority of patients, frequently multivessel disease (54.0%).
Conclusions: 1. Medical treatment of UA was effective during 3 month follow-up with no rest angina recurrence in 74.7%. Mortality rate and number of MI were low after 3 months: 2.0% and 7.5% respectively. 2. Rest angina was less often observed during 3 month follow-up in patients treated with T than ASA (22.5% vs 38.5%). MI was recognized in 7.4% in ASA group, there was no MI in T group.
Zygmunt P. Sadowski, MD [MEDLINE LOOKUP] John H. Alexander, MD [MEDLINE LOOKUP] Bogdan Skrabucha, MD [MEDLINE LOOKUP] Andrzej Dyduszynski, MD [MEDLINE LOOKUP] Jerzy Kuch, MD [MEDLINE LOOKUP] Edmund Nartowicz, MD [MEDLINE LOOKUP] Grazyna Swiatecka, MD [MEDLINE LOOKUP] David F. Kong, MD [MEDLINE LOOKUP] Christopher B. Granger, MD, FACC [MEDLINE LOOKUP]Warsaw, Poland, and Durham, NC
Background More than 20 randomized trials and 4 meta-analyses have been conducted on the use of prophylactic lidocaine in acute myocardial infarction (MI). The results suggest that lidocaine reduces ventricular fibrillation (VF) but increases mortality rates in acute MI.Methods and Results Patients with ST-elevation MI who were examined <6 hours after symptom onset (n = 903) were randomly assigned to either lidocaine or no lidocaine and to either streptokinase and heparin or heparin alone. Lidocaine was given as 4 boluses of 50 mg each every 2 minutes, then an infusion of 3 mg/min for 12 hours, then 2 mg/min for 36 hours. We compared the incidence of in-hospital death and ventricular arrhythmias. We then performed a meta-analysis of prophylactic lidocaine in acute MI that included these and prior trial results. The rates of VF and death with and without lidocaine were calculated for each trial, then odds ratios (OR) with confidence intervals (CI) were calculated for the risk of these events overall with and without lidocaine. Patients given lidocaine in the randomized study had significantly less VF (2.0% vs 5.7% without lidocaine, P = .004) and a trend toward increased mortality rates (9.7% vs 7.0%, P = .145). Meta-analysis revealed nonsignificant trends toward reduced VF (OR 0.71, 95% CI 0.47 to 1.09) and increased mortality rates (OR 1.12, 95% CI 0.91 to 1.36) with lidocaine.Conclusions Lidocaine reduces VF but may adversely affect mortality rates. The routine use of prophylactic lidocaine in acute MI is not recommended. (Am Heart J 1999;137:792-8.)
Copyright © 1999 by Mosby, Inc.
DISCORDANCE BETWEEN CLINICAL AND HOLTER MONITORING CRITERIA OF TREATMENT EFFICACY IN PATIENTS WITH UNSTABLE ANGINA
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W Pracowni Holtera Instytutu Kardiologii w Warszawie, ul. Spartańska 1 wykonujemy rocznie ponad 2500 badań u chorych z chorobą wieńcową i zawałem serca w celu oceny zaburzeń rytmu serca i niedokrwienia. W naszym zespole pracuje 4 lekarzy: 1. dr Dariusz Łuczak 2. dr Sławomir Jasek 3. dr Azzam Matar 4. dr Bogdan Skrabucha Odwiedź nasze inne strony - Publikacje Dodatkowo w Pracowni były i są koordynowane wieloosrodkowe i międzynarodowe badania: - PARAGON a i b - EMIP - FRAX.I.S - SYMPHONY - OPUS - ERAFT - GUSTO i inne Zapraszamy do kontaktu z nami w celu wymiany doświadczeń. tel. +48 (22) - 844 99 97
W Pracowni Holtera Instytutu Kardiologii w Warszawie, ul. Spartańska 1 wykonujemy rocznie ponad 2500 badań u chorych z chorobą wieńcową i zawałem serca w celu oceny zaburzeń rytmu serca i niedokrwienia. W naszym zespole pracuje 4 lekarzy:
1. dr Dariusz Łuczak 2. dr Sławomir Jasek 3. dr Azzam Matar 4. dr Bogdan Skrabucha
Odwiedź nasze inne strony - Publikacje
last updated 18.02.2000