International journal of cardiology
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes.
Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. ⋯ In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events. A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 microg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T < or =0.01 microg/l in only half of the patients. Troponin T >0.1 microg/l vs. < or =0.1 microg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 microg/l) the 30 day event rate was high regardless of the rapid troponin I result.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Safety and efficacy of valsartan versus enalapril in heart failure patients.
Although a cornerstone in the treatment of heart failure, angiotensin-converting enzyme inhibitors are under-used, partly due to side effects. If proven at least similarly efficacious to angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers may replace them due to their superior tolerability. We aimed to compare the efficacy and safety of valsartan and enalapril in heart failure patients stabilised on an angiotensin-converting enzyme inhibitor. ⋯ Left ventricular size (P<0.001) and function (P=0.048) improved significantly only in the valsartan group. Fewer patients experienced adverse events in the valsartan group (50%) than in the enalapril group (63%), although statistically non-significant. Valsartan is similarly efficacious and safe to enalapril in patients with stable, mild/moderate heart failure, previously stabilised on an angiotensin-converting enzyme inhibitor and directly switched to study medication.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
First dose hypotension after angiotensin converting enzyme inhibitor captopril and angiotensin II blocker losartan in patients with acute myocardial infarction.
First dose hypotension after the administration of an angiotensin-converting enzyme inhibitor in patients with acute myocardial infarction is one of the most important adverse events of this type of treatment. There is no information about first dose hypotension after angiotensin type 1-receptor blocker in this type of patient. ⋯ Low dose of losartan is safe for initiating therapy in patients with acute myocardial infarction within 24 h of hospital admission.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Safety of oral propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm: a prospective parallel placebo-controlled multicentre study.
Oral propafenone is effective in restoring sinus rhythm however the proarrhythmic effects are still unknown. The Safety Antiarrhythmic Therapy Evaluation (SATE) trial was a prospective randomized placebo-controlled multicentre study which evaluated the safety of acute oral loading dose of propafenone in patients with recent onset atrial fibrillation. Secondary end-points were to evaluate the effect of digitalis added to propafenone in ventricular rate control and the efficacy of propafenone alone or added to digitalis compared with efficacy of digitalis plus quinidine. ⋯ Propafenone in a single oral loading dose is safe and promptly effective in patients with recent onset atrial fibrillation.
-
Multicenter Study Comparative Study
Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group.
To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. ⋯ According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.