Aims: Patients with stable coronary artery disease(CAD) are at increased risk. Estimation of individual risk is difficult. We developed a cardiovascular risk model based on the EUROPA study population and investigated...Aims: Patients with stable coronary artery disease(CAD) are at increased risk. Estimation of individual risk is difficult. We developed a cardiovascular risk model based on the EUROPA study population and investigated whether benefit of long-term administration of the angiotensin-con- verting enzyme(ACE)-inhibitor perindopril was modified by risk level. Methods and results: A total of 12218 patients with stable CAD were treated with 8 mg perindopril or placebo. Baseline patient characteristics were assessed for association with 1091 cardiovascular deaths or non-fatal myocardial infarction(MI). Risk factors were age over 65 years, male gender [hazard ratio(HR) 1.2], previous MI(HR 1.5), previous stroke and/or peripheral vascular disease(HR 1.7), diabetes, smoking, angina(all HR 1.5), and high serum cholesterol and systolic blood pressure. Treatment benefit by perindopril was consistent among high, intermediate, and low risk patients(HRs 0.88, 0.68, and 0.83, respectively). Risk reduction was thus not modified by absolute risk level. Conclusion: Risk factors such as age, male gender, smoking, total cholesterol, and blood pressure continue to play an important role once clinical sequellae of coronary heart disease have developed. Patients at moderate-to-high risk because of uncontrolled risk factors and those with other indications for ACE-inhibitors have the most to gain from ACE-inhibition.展开更多
The purpose of this randomized study was to investigate the performance of single-and dual-chamber tachyarrhythmia detection algorithms. A proposed benefit of dual-chamber implantable cardioverter-defibrillators(ICDs)...The purpose of this randomized study was to investigate the performance of single-and dual-chamber tachyarrhythmia detection algorithms. A proposed benefit of dual-chamber implantable cardioverter-defibrillators(ICDs)is improved specificity of tachyarrhythmia detection. All ICD candidates received a dual-chamber ICD and were randomized to programmed single-or dual-chamber detection. Of 60 patients(47 male, age 58±14 years, left ventricular ejection fraction 30%), 29 had single-chamber and 31 had dual-chamber settings. The detection results were corrected for multiple episodes within a patient with the generalized estimating equations method. A total of 653 spontaneous arrhythmia episodes(39 patients)were classified by the investigators; 391 episodes were ventricular tachyarrhythmia(32 patients). All episodes of ventricular tachyarrhythmias were appropriately detected in both settings. In 25 patients, 262 episodes of atrial tachyarrhythmias were recorded. Detection was inappropriate for 109 atrial tachyarrhythmia episodes(42%, 18 patients). Rejection of atrial tachyarrhythmias was not significantly different between both groups(p=0.55). Episodes of atrial flutter/tachycardia were significantly more misclassified(p=0.001). Overall, no significant difference in tachyarrhythmia detection(atrial and ventricular)between both settings was demonstrated(p=0.77). The applied detection criteria in dual-chamber devices do not offer benefits in the rejection of atrial tachyarrhythmias. Discrimination of atrial tachyarrhythmias with a stable atrioventricular relationship remains a challenge.展开更多
文摘Aims: Patients with stable coronary artery disease(CAD) are at increased risk. Estimation of individual risk is difficult. We developed a cardiovascular risk model based on the EUROPA study population and investigated whether benefit of long-term administration of the angiotensin-con- verting enzyme(ACE)-inhibitor perindopril was modified by risk level. Methods and results: A total of 12218 patients with stable CAD were treated with 8 mg perindopril or placebo. Baseline patient characteristics were assessed for association with 1091 cardiovascular deaths or non-fatal myocardial infarction(MI). Risk factors were age over 65 years, male gender [hazard ratio(HR) 1.2], previous MI(HR 1.5), previous stroke and/or peripheral vascular disease(HR 1.7), diabetes, smoking, angina(all HR 1.5), and high serum cholesterol and systolic blood pressure. Treatment benefit by perindopril was consistent among high, intermediate, and low risk patients(HRs 0.88, 0.68, and 0.83, respectively). Risk reduction was thus not modified by absolute risk level. Conclusion: Risk factors such as age, male gender, smoking, total cholesterol, and blood pressure continue to play an important role once clinical sequellae of coronary heart disease have developed. Patients at moderate-to-high risk because of uncontrolled risk factors and those with other indications for ACE-inhibitors have the most to gain from ACE-inhibition.
文摘The purpose of this randomized study was to investigate the performance of single-and dual-chamber tachyarrhythmia detection algorithms. A proposed benefit of dual-chamber implantable cardioverter-defibrillators(ICDs)is improved specificity of tachyarrhythmia detection. All ICD candidates received a dual-chamber ICD and were randomized to programmed single-or dual-chamber detection. Of 60 patients(47 male, age 58±14 years, left ventricular ejection fraction 30%), 29 had single-chamber and 31 had dual-chamber settings. The detection results were corrected for multiple episodes within a patient with the generalized estimating equations method. A total of 653 spontaneous arrhythmia episodes(39 patients)were classified by the investigators; 391 episodes were ventricular tachyarrhythmia(32 patients). All episodes of ventricular tachyarrhythmias were appropriately detected in both settings. In 25 patients, 262 episodes of atrial tachyarrhythmias were recorded. Detection was inappropriate for 109 atrial tachyarrhythmia episodes(42%, 18 patients). Rejection of atrial tachyarrhythmias was not significantly different between both groups(p=0.55). Episodes of atrial flutter/tachycardia were significantly more misclassified(p=0.001). Overall, no significant difference in tachyarrhythmia detection(atrial and ventricular)between both settings was demonstrated(p=0.77). The applied detection criteria in dual-chamber devices do not offer benefits in the rejection of atrial tachyarrhythmias. Discrimination of atrial tachyarrhythmias with a stable atrioventricular relationship remains a challenge.
