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血管紧张素受体阻断剂对心肌梗死无不良作用:新的CHARM分析消除了疑虑

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世界核心医学期刊文摘（心脏病学分册） 2005年第12期1卷 11-12页

阿司匹林和溶栓疗法加用氯吡格雷治疗ST段抬高心肌梗死

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 19-20页

作者： Sabatine M.S. Cannon C.P. Gibson C.M. 任付先 Dr. TIMI Study Group Cardiovascular Division Brigham and Women's Hospital 75 Francis St. Boston MA 02115 United States

BACKGROUND: A substantial proportion of patients receiving fibrinolytic therapy for myocardial infarction with ST-segment elevation have inadequate reperfusion or reocclusion of the infarct-related artery, leading to an increased risk of complications and death. METHODS: We enrolled 3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation myocardial infarction and randomly assigned them to receive clopidogrel(300-mg loading dose, followed by 75 mg once daily) or placebo. Patients received a fibrinolytic agent, aspirin, and when appropriate, heparin(dispensed according to body weight) and were scheduled to undergo angiography 48 to 192 hours after the start of study medication. The primary efficacy end point was a composite of an occluded infarct-related artery(defined by a Thrombolysis in Myocardial Infarction flow grade of 0 or 1) on angiography or death or recurrent myocardial infarction before angiography. RESULTS: The rates of the primary efficacy end point were 21.7 percent in the placebo group and 15.0 percent in the clopidogrel group, representing an absolute reduction of 6.7 percentage points in the rate and a 36 percent reduction in the odds of the end point with clopidogrel therapy(95 percent confidence interval, 24 to 47 percent; P< 0.001). By 30 days, clopidogrel therapy reduced the odds of the composite end point of death from cardiovascular causes, recurrent myocardial infarction, or recurrent ischemia leading to the need for urgent revascularization by 20 percent(from 14.1 to 11.6 percent, P=0.03). The rates of major bleeding and intracranial hemorrhage were similar in the two groups. CONCLUSIONS: In patients 75 years of age or younger who have myocardial infarction with ST-segment elevation and who receive aspirin and a standard fibrinolytic regimen, the addition of clopidogrel improves the patency rate of the infarct-related artery and reduces ischemic complications.

关键词：溶栓疗法梗死相关动脉溶栓药物再通率血流分级负荷量联合终点急诊血运重建术血管造影术安慰剂

急性心肌梗死后应用雷米普利是否确实优于其他血管紧张素转换酶抑制剂?

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世界核心医学期刊文摘（心脏病学分册） 2006年第11期2卷 29-30页

作者： Gunraj N. Mamdani M. 高登峰

Whether angiotensin-converting enzyme(ACE) inhibitors are interchangeable and equally efficacious after acute myocardial infarction(AMI) is controversial. We assessed whether ramipril was superior to other ACE inhibitors after AMI as suggested by a previously published study. We performed a retrospective cohort study using linked administrative databases on >1.4 million elderly residents in the province of Ontario who were admitted to the hospital for AMI, survived ≥30 days after discharge, and were initiated on an ACE inhibitor after AMI and remained on the same ACE inhibitor from April 1, 1997 to March 31, 2000. We followed patients for 2 years and measured readmission for AMI or mortality, together or alone. Our cohort included 5,408 elderly patients. Compared with patients on enalapril, there was no significant difference for the combined end points of readmission for AMI or mortality across users of ramipril(adjusted hazard ratio 0.95, 95%confidence interval 0.79 to 1.15), lisinopril(adjusted hazard ratio 1.02, 95%confidence interval 0.84 to 1.25), or other ACE inhibitors(adjusted hazard ratio 1.08,95%confidence interval 0.88, 1.32). In conclusion, the findings of this study support a class effect among ACE inhibitors in treatment after AMI.

关键词：雷米普利急性心肌梗死赖诺普利联合终点回顾性队列研究连锁管理安大略省无显著性差异日至

抗生素治疗对冠心病患者预后的影响:对随机对照试验的荟萃分析

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世界核心医学期刊文摘（心脏病学分册） 2005年第11期1卷 26-27页

作者： Andraws R. Berger J. S. Brown D. L. 朱冰坡 Division of Cardiovascular Medicine State University of New York-Stony Brook School of Medicine Health Sciences Center T16-080 Stony Brook NY 11794 United States Dr.

Context Although Chlamydia pneumoniae infection has been associated with the initiation and progression of atherosclerosis, results of clinical trials investigating antichlamydial antibiotics as adjuncts to standard therapy in patients with coronary artery disease(CAD) have been inconsistent. Objective To conduct a meta-analysis of clinical trials of antichlamydial antibiotic therapy in patients with CAD. Data Sources The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from 1966 to April 2005 for English-language trials of antibiotic therapy in patients with CAD. Bibliographies of retrieved articles were searched for further studies. Presentations at major scientific meetings(2003-2004) were also reviewed. Search terms included antibacterial agents, myocardial infarction, unstable angina, and coronary arteriosclerosis. Study Selection Eligible studies were prospective, randomized, placebo-controlled trials of antichlamydial antibiotic therapy in patients with CAD that reported all-cause mortality, myocardial infarction, or unstable angina. Of the 110 potentially relevant articles identified, 11 reports enrolling 19217 patients were included. Data Extraction Included studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points. End points of interest included all-cause mortality, myocardial infarction(MI), and a combined end point of Ml and unstable angina. Data Synthesis Event rates were combined using a random-effects model. Antibiotic therapy had no impact on all-cause mortality among treated vs untreated patients(4.7%vs 4.6%; odds ratio OR , 1.02; 95%confidence interval CI , 0.89-1.16; P=.83), on the rates of MI(5.0%vs 5.4%; OR, 0.92; 95%CI, 0.81-1.04; P=.19), or on the combined end point of MI and unstable angina(9.2%vs 9.6%; OR, 0.91; 95%CI, 0.76-1.07; P=.25). Conclusion Evidence available to date does not demonstrate an overall benefit of antibiotic therapy in reducing morta

关键词：随机对照试验荟萃分析不稳定型心绞痛联合终点心血管事件全因死亡临床试验肺炎衣原体感染 Cochrane 抗菌药

从ACTION研究的高血压亚组分析结果看长效钙通道阻断剂治疗冠心病的有效性和安全性

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世界核心医学期刊文摘（心脏病学分册） 2005年第5期1卷 8-9页

作者： Robert H.Fagard

氯吡格雷联合阿司匹林与单用阿司匹林预防动脉粥样硬化血栓性事件的比较

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 6-7页

作者： Bhatt D.L. Fox K.A.A. Hacke W. E.J. Topol 罗亮 Department of Genetics Case Western Reserve University BRB 724 10900 Euclid Ave. Cleveland OH 44106-4955 United States Dr.

BACKGROUND: Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events. METHODS: We randomly assigned 15,603 patients with either clinically evident cardiovascular disease or multiple risk factors to receive clopidogrel(75 mg per day) plus low-dose aspirin(75 to 162 mg per day) or placebo plus low-dose aspirin and followed them for a median of 28 months. The primary efficacy end point was a composite of myocardial infarction, stroke, or death from cardiovascular causes. RESULTS: The rate of the primary efficacy end point was 6.8 percent with clopidogrel plus aspirin and 7.3 percent with placebo plus aspirin(relative risk, 0.93; 95 percent confidence interval, 0.83 to 1.05; P=0.22). The respective rate of the principal secondary efficacy end point, which included hospitalizations for ischemic events, was 16.7 percent and 17.9 percent(relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.995; P=0.04), and the rate of severe bleeding was 1.7 percent and 1.3 percent(relative risk, 1.25; 95 percent confidence interval, 0.97 to 1.61 percent; P=0.09). The rate of the primary end point among patients with multiple risk factors was 6.6 percent with clopidogrel and 5.5 percent with placebo(relative risk, 1.2; 95 percent confidence interval, 0.91 to 1.59; P=0.20) and the rate of death from cardiovascular causes also was higher with clopidogrel(3.9 percent vs. 2.2 percent, P=0.01). In the subgroup with clinically evident atherothrombosis, the rate was 6.9 percent with clopidogrel and 7.9 percent with placebo(relative risk, 0.88; 95 percent confidence interval, 0.77 to 0.998; P=0.046). CONCLUSIONS: In this trial, there was a suggestion of benefit with clopidogrel treatment in patients with symptomatic atherothrombosis and a suggestion of harm in patients with multiple risk factors. Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone

关键词：血栓性疾病联合终点联合小剂量心血管疾病安慰剂死亡发生率亚组高危人群出血发生率随机分

依普利酮与安慰剂治疗合并左室功能不全和心衰的心肌梗死患者的成本-效益分析

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世界核心医学期刊文摘（心脏病学分册） 2005年第8期1卷 38-39页

作者： Weintraub W.S. Mahoney E.M. 苏畅 Department of Medicine Emory University 1256 Briarcliff Rd Atlanta GA 30306 United States

Background- In the Eplerenone Post- Acute Myocardial Infarction Heart Failure Efficacy and Survival Study(EPHESUS), aldosterone blockade with eplerenone decreased mortality in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. The present study was performed to evaluate the cost- effectiveness of eplerenone compared with placebo in these patients. Methods and Results- A total of 6632 patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction were randomized to eplerenone or placebo and followed up for a mean of 16 months. The coprimary end points were all- cause mortality and the composite of cardiovascular mortality/cardiovascular hospitalization. The evaluation of resource use included hospitalizations, outpatient services, and medications. Eplerenone was priced at the average wholesale price, ＄ 3.60 per day. Survival beyond the trial period was estimated from data from the Framingham Heart Study, the Saskatchewan Health database, and the Worcester Heart Attack Registry. The incremental cost- effectiveness of eplerenone in cost per life- year and quality- adjusted life- year gained compared with placebo was estimated. The number of life- years gained with eplerenone was 0.1014 based on Framingham(95% CI, 0.0306 to 0.1740), 0.0636 with Saskatchewan(95% CI, 0.0229 to 0.1038), and 0.1337 with Worcester(95% CI, 0.0438 to 0.2252) data. Cost was ＄ 1391 higher over the trial period in the eplerenone arm(95% CI, 656 to 2165) because of drug cost. The incremental cost- effectiveness ratio was ＄ 13 718 per life- year gained with Framingham(96.7% under ＄ 50 000 per life- year gained), ＄ 21 876 with Saskatchewan, and ＄ 10 402 with Worcester. Conclusions- Eplerenone compared with placebo in the treatment of heart failure after acute myocardial infarction is effective in reducing mortality and is cost- effective in increasing years of life by commonly used criteria.

关键词：左室功能不全普利成本-效益分析安慰剂心血管病死亡率左心室收缩功能全因死亡住院率联合终点心脏病发作

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维生素预防卒中干预试验的疗效分析

世界核心医学期刊文摘（神经病学分册） 2006年第3期2卷 52-53页

作者： Spence J.D. Chambless L.E. Stampfer M.J. 郭中孟 Stroke Prevention and Atherosclerosis Research Centre 1400 Western Rd London Ont. N6G 2V2 Canada

Background and Purpose -The Vitamin Intervention for Stroke Prevention trial (VISP) intention-to-treat analysis did not show efficacy of combined vitamin therapy for recurrent vascular events in patients with nondisabling stroke. Reasons for lack of efficacy may have included folate fortification of grain products, inclusion of the recommended daily intake for B12 in the lowdose arm, treatment with parenteral B12 in patients with low B12 levels in both study arms, a dose of B12 too low for patients with malabsorption, supplementation with nonstudy vitamins, and failure of patients with significant renal impairment to respond to vitamin therapy. We conducted an efficacy analysis limited to patients most likely to benefit from the treatment, based on hypotheses arising from evidence developed since VISP was initiated. The criteria for this subgroup were defined before any data analysis. Methods -For this analysis, we excluded patients with low and very high B12 levels at baseline ( 637 pmol/L, representing the 25th and 95th percentiles), to exclude those likely to have B12 malabsorption or to be taking B12 supplements outside the study and patients with significant renal impairment (glomerular filtration rate < 46.18; the 10th percentile). Results -This subgroup represents 2155 patients (37%female), with a mean age of 66±10.7 years. For the combined end point of ischemic stroke, coro nary disease, or death, there was a 21%reduction in the risk of events in the h igh-dose group compared with the low-dose group (unadjusted P=0.049; adjusted for age, sex, blood pressure, smoking, and B12 level P=0.056). In Kaplan-Meier survival analysis comparing 4 groups, patients with a baseline B12 level at the median or higher randomized to high-dose vitamin had the best overall outcome, and those with B12 less than the median assigned to low-dose vitamin had the wo rst (P=0.02 for combined stroke, death, and coronary events; P=0.03 for stroke a nd coronary events). Concl

关键词：干预试验联合终点吸收不良高半胱氨酸血症百分位数亚组肾功能损害缺血性卒中处方量生存分

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2010年急性冠脉综合征抗栓治疗进展

中国医学前沿杂志（电子版） 2011年第1期3卷 31-34页

作者：李为民韩薇哈尔滨医科大学附属第一医院心内科哈尔滨150001

抗栓治疗能显著降低急性冠脉综合征(acute coronary syndrome,ACS)的发病率和死亡率,在ACS治疗中起着至关重要的作用。抗栓治疗包括抗血小板和抗凝两部分。在过去的20年中,阿司匹林和氯吡格雷的双联抗血小板治疗能显著降低ACS和经皮冠... 详细信息

抗栓治疗能显著降低急性冠脉综合征(acute coronary syndrome,ACS)的发病率和死亡率,在ACS治疗中起着至关重要的作用。抗栓治疗包括抗血小板和抗凝两部分。在过去的20年中,阿司匹林和氯吡格雷的双联抗血小板治疗能显著降低ACS和经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)相关的冠脉内血栓和再梗死风险,是目前ACS和PCI围术期的标准抗血小板方案。

关键词：抗栓治疗急性冠脉综合征比伐卢定介入治疗普通肝素负荷剂量双联联合终点心血管事件血小板活性