Pravastatin in acute ischaemic syndromes: results of a randomised placebo-controlled trial.

Therapy with individual 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown conclusively to diminish coronary event rates and mortality in both primary and secondary prevention. To date, scant attention has been paid to whether initiation of such regimens in the hospital phase of acute coronary syndromes might confer cardioprotective benefits. The purpose of this study was to determine the safety and tolerability of early initiation of statin therapy in patients with acute coronary syndromes. In this randomised, double-blind, three-month, pilot study, 100 patients with acute myocardial infarction or unstable angina and low-density lipoprotein cholesterol > 3.5 mmol/l were randomly assigned to pravastatin 40 mg daily or placebo initiated within 48 hours of hospital admission. Pravastatin proved safe and well tolerated in these patients, who were well matched at baseline. No statistically significant differences in death, MI and drug-related adverse events were observed in the pravastatin group compared with control subjects. This pilot study shows that therapy with pravastatin early after an acute coronary event is safe and well tolerated. Larger, long-term studies are needed to confirm these findings.

P wave recognition and atrial stimulation with fractally iridium coated VDD single pass leads.

UNLABELLED: The bottleneck of VDD systems is the reliable detection of the small atrial signals by a floating atrial electrode. Fractally iridium coated electrodes offer excellent sensing and pacing performance. In this study, the performance of such a floating atrial lead in P wave sensing and synchronous ventricular stimulation was examined. Atrial pacing was also used as a test of atrial wall contact. PATIENTS AND METHODS: A fractally iridium coated VDD lead was implanted in 18 patients. In 15 patients it was interfaced with a VDD pacemaker and in 3 patients with a DDD system depending on the P wave amplitude measured acutely (> or = 2 mV). Simultaneous recordings of the surface ECG and pacemaker telemetry were used to analyze P wave amplitudes and AV synchrony in different body positions, and during normal and deep breathing. Additionally, exercise tests based on daily life activities and 24-hour ECG monitoring were performed to test the pacemaker function. RESULTS: During implantation P wave amplitudes were 1.86 mV +/- 1.08 mV (range 0.5-4.9 mV) and during follow-up (6.6 +/- 5.6 weeks) 0.18-3.8 mV. Holter recordings revealed reliable P wave sensing at a sensitivity setting of 0.5 mV (95.5%). P wave sensing was further improved by a higher atrial sensitivity. AV synchronous pacing > or = 99.9% was achieved in all patients. In 7 patients the atrial electrode could be positioned close to the atrial wall enabling atrial stimulation thresholds at an average of 4.3 volts. CONCLUSION: This fractally iridium coated VVD lead allowed consistent and reliable P wave sensing at an atrial sensitivity as low as 0.5 mV in selected patients.

Evaluation of lay skills in cardiopulmonary resuscitation.

The theoretical knowledge and practical performance of 166 lay people attending a short cardiopulmonary resuscitation course were evaluated according to the American Heart Association standards. Before tt course no participant was able to perform even a bad attempt at cardiopulmonary resuscitation. Theoretical knowledge was good at the end of the course and at the refresher course six months later. At the end of the initial course 65% (57/88) of the participants examined could adequately compress and ventilate the manikin. After six months 44% (30/68) could perform resuscitation adequately. Women were as proficient as men, and elderly people in general were as proficient as the younger ones. The skill of carotid artery palpation was surprisingly well retained after six months. Data on pulmonary ventilation and cardiac massage were recorded simultaneously on a recording resuscitation manikin. When these objective data were compared with the American Heart Association standards only a few participants were able to perform correct cardiopulmonary resuscitation. The number of compressions and ventilations per minute were often insufficient. A large discrepancy between self, subjective, and objective assessment of cardiopulmonary resuscitation knowledge and performance was found. The importance of a rapid diagnosis, an immediate call for help, an adequate rate of cardiac massage, and a reduction in the time needed for ventilation should be emphasised at these courses. Refresher courses should be provided at least twice a year.