Infarction double

Janssens SDC, Bogaert J, Theunissen K, et al. Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction double-blind, randomised controlled trial. Lancet 2006 367 1 13-121. 

Edavarone acute infarction study group. Effect of a novel free radical scavenger, edaravone (mci-186), on acute brain infarction. Randomized, placebo-controlled, double-blind study at multicenters. Cerebrovasc Dis 2003 15 222-229. 

CAPRIE was a 19,185-patient, 304-center, international, randomized, double-blind, parallel-group trial comparing Plavix (75mg daily) with aspirin (325mg daily). The outcome was to compare the first occurrence of new ischemic stroke, new myocardial infarction, or other vascular death. The following are tabulated results ... 

The effects of coenzyme Q10 on coronary artery disease and chronic stable angina are modest but appear promising. A theoretical basis for such benefit could be metabolic protection of the ischemic myocardium. Double-blind, placebo-controlled trials have demonstrated that coenzyme Q10 supplementation improved a number of clinical measures in patients with a history of acute myocardial infarction (AMI). Improvements have been observed in lipoprotein a, high-density lipoprotein cholesterol, exercise tolerance, and time to development of ischemic changes on the electrocardiogram during stress tests. In addition, very small reductions in cardiac deaths and rate of reinfarction in patients with previous AMI have been reported (absolute risk reduction 1.5%). 

Premature ventricular contractions (PVCs) are commonly recorded in patients convalescing from myocardial infarction. Since such arrhythmias have been associated with an increased risk of sudden cardiac death, it had been the empiric practice of many physicians to treat PVCs, even if asymp-tomatic, in such patients. In CAST (Cardiac Arrhythmia Suppression Trial [CAST], Echt et al, 1991), an attempt was made to document the efficacy of such therapy in a controlled clinical trial. The effects of several antiarrhythmic drugs on arrhythmia frequency were first evaluated in an open-label fashion. Then, patients in whom antiarrhythmic therapy suppressed PVCs were randomly assigned, in a double-blind fashion, to continue that therapy or its corresponding placebo. 

Because it is necessary for the stroke patient to receive prompt treatment before brain cell death occurs, any useful drug must be effective even when there is considerable time lapse (often several hours) between the occurrence of the stroke and the onset of treatment. The term "therapeutic window" refers to the critical time of intervention between the onset of the ischaemia and occurrence of brain infarction. Some of the drugs that have been developed and shown to be effective in the treatment of various animal models of stroke are listed in Table 14.5. It should be emphasized that none of these drugs is currently marketed for the treatment of stroke. All have been developed on animal models and recent positron emission tomography and magnetic resonance imaging studies have shown that the therapeutic window may be much more variable and prolonged in man than in such models. Only extensive double-blind clinical trials (estimated... 

Janssens S, Intracoronary autologous bone-marrow cell transfer after myocardial infarction a double-blind, randomized, and placebo-controlled clinical trial. American College of Cardiology Scientific Sessions, 2005. 

Sildenafil was the first oral treatment for ED and is the most extensively evaluated (35). Overall success rates in patients with cardiovascular disease of 80% or greater have been recorded with no evidence of tolerance, Patients with diabetes with or without additional risk factors, with their more complex, and extensive pathophysiology, have an average success rate of 60%. In randomized trials to date, open-label or outpatient monitoring studies the use of sildenafil is not associated with any excess risk of myocardial infarction, stroke, or mortality (38-40), In patients with stable angina pectoris there is no evidence of an ischemic effect due to coronary steal, and in one large, double-blind, placebo-controlled, exercise study sildenafil 100 mg increased exercise time and diminished ischemia (41), A study of the hemodynamic effects in men with severe CAD identified no adverse cardiovascular effects and a potentially beneficial effect on coronary blood flow reserve (42), Studies in patients with and without diabetes have demonstrated improved endothelial function acutely and after long-term oral dose administration, which may have implications beyond... 

Stroke is a very uncommon event in childbearing women, occurring in approximately 11 per 100,000 women over a 1-year period of time. Therefore, even a doubling of this risk with oral contraceptive pills would have minimal effect on attributable risk. The estimated risk of myocardial infarction associated with oral contraceptive pill use in nonsmokers is 3 per million women over 1 year. The estimated risk of venous thromboembolism attributable to oral contraceptive pills is less than 3 per 10,000 women per year. However, the risk may be increased in women who smoke or have other predisposing factors to thrombosis or thromboembolism. In fact, it should be emphasized that the risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who are heavy smokers (e.g., more than 15 cigarettes per day). Additionally, the literature suggests that there may be an increased risk of breast cancer associated with long-term oral contraceptive pill use in women under the age of 35. However, because the incidence of breast cancer is so relatively low in this population, the attributable risk of breast cancer from birth control pill use is small. 

Pectoris Aspirin Trial (SAPAT) Group. Double-blind trial of aspirin in juimary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992 340 1421-1425. 

Ceremuzynski L, Kleczar E, Krzeminska-Pakula M, Kuch J, Nartowicz E, Smielak-Korombel J, Dyduszynski A, Maciejewicz J, Zaleska T, Lazarczyk-Kedzia E, et al. Effect of amiodarone on mortality after myocardial infarction a double-bhnd, placebo-controlled, pilot study. J Am Coll Cardiol 1992 20(5) 1056-62. 

Hjalmarson A, Elmfeldt D, Herlitz J, Holmberg S, Malek I, Nyberg G, Ryden L, Swedberg K, Vedin A, Waagstein F, Waldenstrom A, Waldenstrom J, Wedel H, Wilhelmsen L, Wilhelmsson C. Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 1981 2(8251) 823-7. 

Gotoh F, Tohgi H, Hirai S, Terashi A, Fukuuchi Y, Otomo E, Shinohara Y, Itoh E, Matsuda T, Sawada T, Yamaguchi T, Nishimaru K, Ohashi Y. Cilostazol stroke prevention study a placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis 2000 9 147-57. 

In the corresponding myocardial infarction study, 1510 patients with severe left ventricular dysfunction after myocardial infarction were recruited in 37 Danish coronary-care units 749 were randomized double-blind to dofetihde and 761 to placebo (52). There were no significant differences between dofetihde and placebo in all-cause mortahty or total dysrhythmic deaths. Dofetilide was significantly better than placebo at restoring sinus rhythm in patients with atrial fibrillation or flutter. 

In the INSIGHT (Intervention as a Goal in Hypertension Treatment) study, a prospective, multicenter, double-blind study in 6321 hypertensive patients aged 55-80 years, long-acting nifedipine 30 mg was compared with co-amilozide (hydrochlorothiazide 25 mg plus amUoride 2.5 mg) (3). There were no differences between the two treatments in the primary end-points of cardiovascular death, myocardial infarction, heart failure, or stroke during follow-up for 4 years. 

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