Left ventricular outflow tract obstruction provoked during dobutamine stress echocardiography predicts future chest pain, syncope, and near syncope

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• 作者：Buddhadeb Dawn ; Vidhu S. Paliwal ; Syed T. Raza ; Kourosh Mastali ; Rita A. Longaker ; Marcus F. Stoddard
• 关键词：Body mass index ; Enhanced external counterpulsation therapy ; Myocardial infarction
• 刊名：American Heart Journal
• 出版年：2005
• 出版时间：May 2005
• 年：2005
• 卷：149
• 期：5
• 页码：908-916
• 全文大小：479 K

文摘

We have previously reported significant benefits of using enoxaparin, compared to tinzaparin, in the 7- and 30-day incidence of the composite triple end point of death, myocardial infarction (MI), or recurrent angina in patients with non–ST-segment elevation acute coronary syndromes (NSTACS). In the present study, we aimed to determine whether the observed benefits of enoxaparin were maintained beyond the early phase and report the results of the 6-m follow-up of patients in the EVET study.

Methods

We recruited 438 patients with NSTACS. All patients received oral aspirin and were randomized to also receive enoxaparin, 100 IU/kg subcutaneously twice daily (equivalent to 1 mg/kg twice daily; n = 220), or tinzaparin, 175 IU/kg subcutaneously once daily (n = 218), for up to 7 days.

Results

At 6 m, the incidence of the composite triple end point of death, MI, or recurrent angina was lower among patients receiving enoxaparin compared to those receiving tinzaparin (25.5 % vs 44.0 % , P < .001). A lower incidence of the secondary composite end point of death or MI was also found in the enoxaparin group compared to tinzaparin group (2.7 % vs 6.9 % , P = .046). The need for revascularization procedures was also lower in the enoxaparin group compared to tinzaparin group (23.2 % vs 37.2 % , P = .002).

Conclusions

In patients with NSTACS, enoxaparin significantly reduced the rates of recurrent ischemic events and therapeutic procedures in the short term, with sustained benefit at 6 m compared to tinzaparin.