Daniel E. Hilleman

Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging

Pharmacologic stress with dipyridamole has provided useful diagnostic, as well as prognostic, information in patients undergoing thallium-201 myocardial perfusion imaging. With its ultrashort half-life and a potent and consistent vasodilator effect, adenosine may be the coronary vasodilator of choice with myocardial perfusion imaging. Fifty-one healthy subjects and 93 patients with suspected coronary artery disease constituted the study group. In this multicenter study the comparative safety and diagnostic efficacy of single-photon emission computed tomography (SPECT) thallium imaging during adenosine-induced coronary hyperemia was compared with exercise treadmill stress. There was a mean increase in heart rate of 37% and a mean decrease in diastolic blood pressure of 5% during the adenosine infusion of 140 micrograms/kg per min for 6 min. Adenosine infusion was well tolerated in 95% of the subjects. Side effects requiring intervention occurred in seven subjects (5%). None of the subjects experienced a life-threatening complication. The sensitivity, specificity and predictive accuracy for detection of coronary artery disease with use of quantitative analysis was 83%, 87% and 84% for adenosine SPECT and 82%, 80% and 81% for exercise SPECT studies, respectively. Most false negative results with adenosine, as well as exercise SPECT studies, occurred in patients with single-vessel disease. The first-order concordance (no defect vs. defect) and second-order concordance (no defect vs. irreversible vs. reversible defect) was 89% and 78% between the two studies, respectively. Thus, the results of adenosine SPECT imaging are highly concordant with exercise SPECT thallium imaging. Adenosine SPECT thallium imaging provides a safe and highly accurate imaging mode for the detection of coronary artery disease.

Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography

BACKGROUND Contrast-induced nephropathy (CIN) after coronary angiography is associated with increased morbidity and mortality rates. Preliminary studies with N-acetylcysteine (NAC) have found conflicting results in the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC in the prevention of CIN in patients undergoing coronary angiography. METHODS This study was prospective, randomized, double-blind, and placebo-controlled. Patients referred for elective coronary angiography with a baseline creatinine clearance level <50 mL/min and serum creatinine >1.2 mg/dL were randomly assigned to 1500 mg NAC or placebo, starting the evening before angiography and given every 12 hours for 4 doses. The primary study end point was the development of CIN, which was defined as an increase of >0.5 mg/dL or an increase of > or =25% in serum creatinine over baseline within 48 hours of angiography. Secondary end points included changes in serum creatinine and blood urea nitrogen, requirement of dialysis, side effects of study medication, hospital length of stay, and hospital charges. RESULTS CIN occurred in 8.2% (4/49) of patients taking NAC and 6.4% (3/47) of patients taking placebo. Changes in BUN and serum creatinine from baseline were not significantly different in the two treatment groups. Baseline BUN and volume of contrast were the only independent predictors of CIN. More patients with diabetes had development of CIN (5/43; 12%) compared with nondiabetic patients (2/52; 4%), but the difference was not significant (P =.15). The incidence of CIN in diabetic patients was not different in the two treatment groups. No patient with development of CIN required dialysis. Side effects (mostly gastrointestinal) occurred in 16% of patients taking NAC and in none of the patients taking placebo. Length of stay and hospital charges were not different between the treatment groups. CONCLUSIONS In patients with reduced renal function undergoing elective coronary angiography, NAC does not reduce the risk of CIN.

Impact of Pharmacy Counseling on Compliance and Effectiveness of Combination Lipid-Lowering Therapy in Patients Undergoing Coronary Artery Revascularization: A Randomized, Controlled Trial

This randomized, controlled trial evaluated the impact of personalized follow‐up on compliance rates in high‐risk patients receiving combination lipid‐lowering therapy over 2 years. A random sample of 30 patients 7–30 days after cardiac surgery had baseline fasting low‐density lipoprotein levels higher than 130 mg/dl. All patients received lovastatin 20 mg/day and colestipol 5 g twice/day. Weekly telephone contact was made with each patient for 12 weeks. Short‐ and long‐term compliance was assessed by pill and packet counts and refill records. Compliance and lipid profile results were significantly better in the intervention group (p<0.05) up to 2 years after the start of therapy than in the control group for all parameters except high‐density lipoprotein. However this effect was not apparent during the first 12 weeks of therapy. Short‐term telephone follow‐up favorably affected compliance and lipid profile results up to 2 years after start of therapy.

Conversion of Recent-Onset Atrial Fibrillation with Intravenous Amiodarone: A Meta-Analysis of Randomized Controlled Trials

Study Objective. To evaluate efficacy and safety of intravenous amiodarone for conversion of recent‐onset atrial fibrillation.

Economic burden of chronic obstructive pulmonary disease. Impact of new treatment options.

The incidence, morbidity and mortality of chronic obstructive pulmonary disease (COPD) is rising throughout the world. The total economic cost of COPD in the US in 1993 was estimated to be over

Optimal management of amiodarone therapy: Efficacy and side effects

US15.5 billion, with

Clinical and economic evaluation of the Trellis-8 infusion catheter for deep vein thrombosis

US6.1 billion for hospitalisation,

Safety of Esmolol in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy Who Had Relative Contraindications to Beta-Blocker Therapy

US4.4 billion for physician and other fees,

New Recommendations from the 1999 American College of Cardiology/American Heart Association Acute Myocardial Infarction Guidelines

US2.5 billion for drugs,

Efficacy and tolerance of high-dose intravenous amiodarone for recurrent, refractory ventricular tachycardia

US1.5 billion for nursing home care and