Adjunctive Drug Therapy of Acute Myocardial Infarction — Evidence from Clinical Trials

Hennekens, C; Cm, Albert; Sl, Godfried; Jm, Gaziano; Je, Buring

doi:10.1056/nejm199611283352207

Cited by 228 publications

(78 citation statements)

References 62 publications

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“…The high-risk nature of patients with even moderate RI must be appreciated and appropriate therapies initiated. Moreover, although ␤-adrenergic blockers and ACE inhibitors improve survival in patients after AMI, 37 these agents are often underused in patients with RI compared with those with normal renal function. 4,38,39 All attempts must be made to prevent contrast nephropathy, including adequate hydration, 40 minimizing contrast use, 29 use of low-osmolar contrast, 41 and possibly administration of N-acetylcysteine.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…[1][2][3][4][5][6][7][8] Pooled data from 18 000 patients show that ␤-blockers reduce sudden cardiac death by 32% to 50%. 6 These trials examined the effects of ␤-blockers when initiated early after an index infarction, with follow-up ranging from 3 to 72 months.…”

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confidence: 99%

Effect of β-Blocking Therapy on Outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)

et al. 2002

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Background-␤-Blockers are known to reduce total mortality and sudden death in survivors of recent myocardial infarction. The effects of these agents in patients at high risk for sudden death with remote infarction are not clear. Methods and Results-We analyzed the effect of ␤-blockers on outcomes in 2096 patients with coronary artery disease, ejection fraction Յ40%, and spontaneous nonsustained ventricular tachycardia enrolled in the Multicenter UnSustained Tachycardia Trial (MUSTT). Forty-five percent of 702 patients with inducible sustained ventricular tachyarrhythmia and 35% of 1394 patients without inducible tachycardia were discharged from hospital receiving ␤-blockers. Patients treated with ␤-blockers were younger and had higher ejection fractions, higher rates of recent angina, and more recent infarction. ␤-Blockers were associated with decreased total mortality for the entire study population (5-year mortality 50% with ␤-blockers versus 66% without ␤-blockers; adjusted Pϭ0.0001). The mortality benefit associated with ␤-blockers was present in patients with and without inducible tachycardia, except those treated with implantable defibrillators. There was no significant effect of ␤-blocker therapy on the rate of arrhythmic death or cardiac arrest (adjusted Pϭ0.2344). Conclusions-␤-Blocking agents have beneficial effects on survival of patients having characteristics of those enrolled in the MUSTT trial. These effects do not appear to be due to a specific antiarrhythmic effect of ␤-blockers. The beneficial effects of ␤-blockers were demonstrable in all patients except those treated with implantable defibrillators. (Circulation.

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“…A HAS é uma doença frequente na população brasileira (2,3) , contudo, sua prevalência no país permanece desconhecida (4) . Estudos epidemiológicos apontam que níveis elevados de pressão arterial aumentam o risco de doença vascular encefálica, doenças arteriais coronarianas, insuficiência cardíaca congestiva e acidente vascular (5)(6)(7)(8)(9) . Além disso, a influência da HAS sobre o desenvolvimento das doenças cardiovasculares (DCV) exige o reconhecimento de sua real distribuição nos distintos estados brasileiros (10) .…”

Section: Introductionunclassified

Prevalência e perfil sociodemográfico de diabetes e hipertensão em indivíduos do sistema de informação da atenção básica

Pozzobon¹,

Hoerlle²,

Carreno³

2014

RBPS

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RESUMOObjetivos: Verificar a prevalência e o perfil sociodemográfico de indivíduos com diabetes mellitus (DM) e hipertensão arterial sistêmica (HAS), cadastrados no Sistema de Informação da Atenção Básica (SIAB) do município de Lajeado-RS, no ano de 2012. Métodos: O presente estudo, transversal, descritivo-exploratório, com abordagem quantitativa, utilizou dados secundários extraídos do SIAB de 757 indivíduos. Os dados foram processados e analisados com software SPPS versão 20.0. Resultados: Da amostra de 757 indivíduos, obteve-se uma média de idade de 40,87 ± 16,15 anos, sendo 50,2% (380) do sexo masculino e 49,8% (377) do sexo feminino. Da mesma forma, 97% (734) são alfabetizados. Encontrouse uma frequência de apenas 3,1% (1.131) de DM na população total e de 4,5% (34) na amostra selecionada, e obteve-se uma prevalência de HAS de 15% (5.849) e 17,3% (131), respectivamente. Houve correlação positiva -fraca, mas significativa -entre HAS, DM e idade (p=0,000). Conclusão: Os dados obtidos indicaram uma baixa prevalência de DM e HAS em indivíduos cadastrados no SIAB em um município do interior do Rio Grande do Sul.Descritores: Hipertensão; Diabetes Mellitus; Prevalência. ABSTRACT Objective: To determine the prevalence and sociodemographic profile of individuals with diabetes mellitus (DM) and systemic arterial hypertension (SAH), registered in the Primary

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Adjunctive Drug Therapy of Acute Myocardial Infarction — Evidence from Clinical Trials

Cited by 228 publications

References 62 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Effect of β-Blocking Therapy on Outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)

Prevalência e perfil sociodemográfico de diabetes e hipertensão em indivíduos do sistema de informação da atenção básica

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