Search

The total synthesis of the novel class antianginal drug ranolazine in its racemic (I) and enantiopure forms is described. [ABSTRACT FROM AUTHOR]

The article presents comments from readers on various topics including the story of a genie and a type 2 diabetes patient, review on the efficacy of flavonoid containing compound on venous leg ulcer healing in adults, and the establishment of an adult-like intestinal microbiota among U.S. children.

A letter to the editor is presented regarding nicorandil, a drug treatment for stable angina but may present unexplained oro-ulceration, and the risk factor of calcium antagonists which leads to reflux cough due to the fading of the lower oesophageal sphincter and reduced oesophageal clearance.

Images of stent thrombosis in the mid-left anterior descending artery (LAD) detected by optical coherence tomography (OCT) are presented.

The article provides an answer to a question of what stands novel in the recently released unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI) guidelines, meant for management of patients with unstable angina/non-ST-elevation myocardial infarction.

The article reports on a 2012 decision which the European Medicines Agency made to restrict the use of trimetazidine containing medicines in the treatment of patients with angina pectoris.

Abstract: Background: There are 10 million patients with angina in the United States (500,000 new diagnoses annually). Although clinical efficacy of angina treatments is understood, total costs of care and clinical outcomes for patients with chronic angina in different treatment protocols are unknown. Objective: Our objective was to estimate total costs of care and revascularization rates for patients with poorly controlled angina who added either (1) long-acting nitrates, (2) beta blockers or calcium channel blockers, or (3) ranolazine to their therapy. Study design: We performed retrospective claims analysis using an index event involving change of therapy in which a new antiangina drug was added. Methods: Using a large commercial insurance claims database, 4545 patients with angina with an index event (ie, change of antiangina therapy) and 6 months of continuous enrollment pre- and postindex event were identified. Using total cost of care and revascularization rates, we first compared preindex disease burden, medical care use, and total cost of care and components of total cost. We then compared unadjusted use and cost of care across treatment groups. Finally, we estimated regression models to predict postindex event total costs of care and revascularization rates. Results: During the preindex period, the 3 comparison groups had similar health measures, medical care use, and total costs of care. During the postindex period, ranolazine users had lower revascularization rates (9.9%) than comparison patient groups (15.4%–20.4%, both Ps < 0.001). Ranolazine users had lower total costs of care ($13,961) than the nitrate group ($18,166, 30.0% higher; P < 0.001) and the beta blockers/calcium channel blockers group ($17,612, 26.6% higher; P = 0.002). Conclusions: Adding ranolazine to the treatment regimen of patients with poorly controlled angina was associated with lower rates of revascularization and lower total costs of care than for comparable patients, differences both statistically and clinically relevant. [Copyright &y& Elsevier]

A letter to the editor is presented which is concerned with an evaluation of enoxaparin treatment at a Chinese tertiary referral teaching hospital.

The article presents a meta-analysis which shows that percutaneous coronary intervention (PCI) does not provide benefits to adults having stable coronary artery disease.

An abstract of the article "Obstructive Sleep Apnea Syndrome is Associated With Increased Risk of Low-Antiplatelet Response of Clopidogrel in Patients With Unstable Angina" by Wang Qian and colleagues is presented.

A letter to the editor is presented in response to the article "Myocardial Infarction After Aspirin Treatment," by D. J. Fox and his colleagues in the January 2005 issue.

Presents an abstract of the study `Lack of Pharmacologic Tolerance and Rebound Angina Pectoris During Twice-Daily Therapy With Isosorbide-5-Mononitrate,' by Udho Thadani et al.

Background: Activation of platelets is central to the pathophysiology of unstable angina. We studied whether inhibition of the final common pathway for platelet aggregation with tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor antagonist, would improve clinical outcome in this condition. Methods: In a double-blind study, we randomly assigned 3232 patients who were already receiving aspirin to additional treatment with intravenous tirofiban or heparin for 48 hours. The primary end point was a composite of death, myocardial infarction, or refractory ischemia at 48 hours. Results: The incidence of the composite end point was 32 percent lower at 48 hours in the group that received tirofiban (3.8 percent, vs. 5.6 percent with heparin; risk ratio, 0.67; 95 percent confidence interval, 0.48 to 0.92; P=0.01). Percutaneous revascularization was performed in 1.9 percent of the patients during the first 48 hours. At 30 days, the frequency of the composite end point (with the addition of readmission for unstable angina) was similar in the two groups (15.9 percent in the tirofiban group vs. 17.1 percent in the heparin group, P=0.34). There was a trend toward a reduction in the rate of death or myocardial infarction with tirofiban (a rate of 5.8 percent, as compared with 7.1 percent in the heparin group; risk ratio, 0.80; 95 percent confidence interval, 0.61 to 1.05; P=0.11), and mortality was 2.3 percent, as compared with 3.6 percent in the heparin group (P=0.02). Major bleeding occurred in 0.4 percent of the patients in both groups. Reversible thrombocytopenia occurred more frequently with tirofiban than with heparin (1.1 percent vs. 0.4 percent, P=0.04). Conclusions: Tirofiban was generally well tolerated and, as compared with heparin, reduced ischemic events during the 48-hour infusion period, during which revascularization procedures were not performed. The incidence of refractory ischemia and myocardial infarction was not reduced at 30 days, but mortality was lower among the patients given tirofiban. Platelet inhibition with aspirin plus tirofiban may have a role in the management of unstable angina. (N Engl J Med 1998;338:1498-505.) [ABSTRACT FROM AUTHOR]