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Aims Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (≤72h) and subacute (≤30 days) stent thrombosis has not been investigated.Methods Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention.Results Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1·3% in group I vs 0·3% in group II, P=0·001; subacute stent occlusion: 2·4% in group I vs 0·7% in group II, P=0·001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22·9% vs 16·3%,P =0·001).Conclusions Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated. [ABSTRACT FROM PUBLISHER]

Milrinone exerts positive inotropic and dose-dependent vasodilatory effects that promote haemodynamic improvement after intravenous administration to patients with heart failure. Bolus doses of 12·5–75 μg kg−1 markedly increase cardiac output and cause a substantial reduction in cardiac filling pressure and in systemic vascular and pulmonary vascular resistance. There is no evidence of tolerance to these effects which are maintained during continuous infusion for up to 48 h. In contrast, there are minimal effects on heart rate or systemic blood pressure, except at very high doses. At lower filling pressures, milrinone increases cardiac output more markedly than equally hypotensive doses of pure vasodilators. This response is accompanied by an increased left ventricular dP/dtmax and a shift in the left ventricular performance is associated with a lower myocardial energy requirement. Despite a fall in mean arterial pressure and transcoronary driving pressure, coronary venous flow is increased and there is a reduction in the arterio-coronary venous oxygen difference. This reflects a global improvement in left ventricular diastolic function, characterized by accelerated early relaxation and greater chamber distensibility. Improved performance of the right ventricle is due primarily to reduced right ventricular afterload as milrinone produces minimal inotropic effects on the right ventricle. [ABSTRACT FROM PUBLISHER]

To verify favourable long-term effects, 14 patients with chronic congestive heart failure, NYHA class II-IV, who had been treated with oral amrinone for 8–15 months with apparent clinical benefit, had the drug with drawn according to a 12 week placebo controlled double-blind crossover protocol. Evaluation was performed noninvasively by means of exercise stress test, echocardiogram, radionuclide angiography and systolic time intervals. None of these variables were significantly changed after discontinuation of amrinone, regardless of whether placebo was introduced during the first (group B, N = 7) or the second 6 week period (group A, N = 5), nor when the medication was finally openly withheld for another 6 weeks. In 2 further group A patients, premature termination of the trial was due to deterioration of symptoms on blinded amrinone. Hence, no sustained drug related effects could be proven by controlled withdrawal of long-term amrinone in this trial. [ABSTRACT FROM PUBLISHER]