553 research outputs found
Angiotensin-converting enzyme inhibition with perindopril in patients with prior myocardial infarction and/or revascularization: A subgroup analysis of the EUROPA trial
No full textBackground.— The European trial on Reduction Of cardiac events with perindopril in patients
with stable coronary Artery disease (EUROPA) demonstrated the benefits of perindopril with
respect to secondary prevention of cardiovascular risk in patients with stable coronary artery
disease.
Aims.— To describe the clinical effects of perindopril in a subpopulation of patients from
EUROPA with a history of myocardial infarction and/or revascularization.
Patients and methods.— Of the 12,218 patients in the EUROPA study, 10,962 had a history of
myocardial infarction and/or revascularization. In this EUROPA subpopulation, 7910 patients had
a history of myocardial infarction and 6709 had a history of revascularization. Patients were randomized to treatment with perindopril 8 mg/day or placebo. The primary endpoint was a
composite of cardiovascular mortality, myocardial infarction and resuscitated cardiac arrest.
Results.— After a mean follow-up of 4.2 years, treatment with perindopril 8 mg/day was associated
with a 22.4% reduction in the primary endpoint compared with placebo (p < 0.001) in
patients with a history of myocardial infarction. Patients with a history of myocardial revascularization
showed a 17.3% reduction in the primary endpoint with perindopril versus placebo
(p < 0.05). In the combined population of patients with a history of myocardial infarction and/or
revascularization, treatment with perindopril produced a 22.4% reduction in the primary endpoint
compared with placebo (p < 0.001).
Conclusions.— This study confirms the benefits of a high dose of angiotensin-converting enzyme
inhibitor for the secondary prevention of cardiovascular risk among patients with a history of
myocardial infarction and/or revascularization.
© 2008 Elsevier Masson SAS. All rights reserved
ACE inhibition and endothelial function in t he Europa Trial: The main findings from the PERFECT Study.
No full textEffects of perindopril on long-term clinical outcome of patients with coronary artery disease and left ventricular function
No full textResults in patients with preserved LV function are consistent with those of the whole EUROPA study population and perindopril 8mg is beneficial in all patients with stable CAD
Perindopril and beta-blocker for the prevention of cardiac events and mortality in stable coronary artery disease patients: A EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) subanalysis
No full textBackground beta-Blockers relieve angina/ischemia in stable coronary artery disease (CAD), and angiotensin-converting enzyme inhibitors prevent CAD outcomes. In EUROPA, the angiotensin-converting enzyme inhibitor perindopril reduced cardiovascular outcomes in low-risk stable CAD patients over 4.2 years. This post hoc analysis examined whether the addition of perindopril to beta-blocker in EUROPA had additional benefits on outcomes compared with standard therapy including beta-blocker. Methods EUROPA was a multicenter, double-blind, placebo-controlled, randomized trial in patients with documented stable CAD. Randomized EUROPA patients who received beta-blocker at baseline were identified, and the effect on cardiovascular outcomes of adding perindopril or placebo was analyzed. Endpoints were the same as those in EUROPA. Results At baseline, 62% (n = 7534 [3789 on perindopril and 3745 on placebo]) received beta-blocker. Treatment with perindopril/beta-blocker reduced the relative risk of the primary end point (cardiovascular death, nonfatal myocardial infarction, and resuscitated cardiac arrest) by 24% compared with placebo/beta-blocker (HR, 0.76; 95% CI, 0.64-0.91; P = .002). Addition of perindopril also reduced fatal or nonfatal myocardial infarction by 28% (HR, 0.72; 95% CI, 0.59-0.88; P = .001) and hospitalization for heart failure by 45% (HR, 0.55; 95% CI, 0.33-0.93; P = .025). Serious adverse drug reactions were rare in both groups, and cardiovascular death and hospitalizations occurred less often with perindopril/beta-blocker. Conclusions The addition of perindopril to beta-blocker in stable CAD patients was safe and resulted in reductions in cardiovascular outcomes and mortality compared with standard therapy including beta-blocker
ACE inhibition with perindopril and endothelial function. Results of a substudy of the EUROPA study: PERTINENT
No full textACE inhibition with perindopril and endothelial function. Results of a substudy of the EUROPA study: PERTINEN
Hydrodynamic analysis of the Johor river estuary
No full textSingapore’s coastal waters are characterised by relatively complex tidal behaviour due to it’s location between two large oceans with different tidal regimes. This complex tidal behaviour results in poor understanding of the hydrodynamics and sediment dynamics. The hydrodynamics of the Johor River estuary, including part of the Singapore Strait and the Johor Strait, are investigated with a computational model in order to enhance the understanding of the sediment dynamics. The computational model used for this study is the Singapore Regional Model Refined and Aligned (SRMRA), which was developed applying the Delft3D modelling system. The domain of this validated model covers part of the Andaman Sea, South China Sea and Java Sea. An intra-tidal analysis over a period of 25 hours reveals that the tide propagates throughout the entire study domain up to the northernmost part of the Johor River. During the ebb phase in the estuary, the flow in the Singapore Strait is in the eastern direction. In contrast to many other shallow estuaries, the water levels are observed to be ebb dominant the further upstream. The transport patterns in the Johor River estuary on a larger timescale are described by means of the residual flow. The depth averaged residual flow is stronger and more multi-directional near the mouth of the Johor River estuary than in the upstream part. An ebb dominant and flood dominant channel can be observed. The residual flow in the surface layer is directed in the ebb direction and the residual flow in the third layer from the bed is directed in the flood direction. Moreover, the residual flow in the surface layer is stronger than the residual flow in the lower layer. The model predicts roughly a larger bed shear stress in the southern part of the Johor River estuary than in the northern part. In the area around Pulau Tekong the bed shear stress consequently was found to exceed most of the time 0.1 N/m2, which is considered a reasonable value for the critical bed shear stress for erosion of fine sediments. In the northernmost part of the Johor River the predicted bed shear stress is small enough for a sediment trap to be developed. Analysis of the particle paths shows that during the period of flood tide, flow from the Johor Strait may travel into the Johor River. Once a particle flows out of the estuary into the Singapore Strait during ebb, it is not likely to flow back into the estuary during flooding.These findings contribute to a larger understanding of the hydrodynamics and sediment dynamics of the Johor River estuary.Singapore-Delft Water AllianceHydraulic EngineeringCivil Engineering and Geoscience
Edge scour around an offshore wind turbine
No full textWind energy has experienced an enormous growth in the last years and is becoming more and more popular as an alternative for conventional power. Large growth numbers are also expected for the coming years, for onshore as well as for offshore wind energy. Currently, a wind power capacity of almost 4 GW is installed offshore in the European Union, meeting 0.4% of the European electricity need at this moment. More than 137 GW of offshore wind energy is being planned, consented or under construction in the European waters. This total of offshore wind power capacity could provide approximately 14% of the European demand for electricity. With an expected offshore installation of 1 MW per year, 9.9 million tonnes of CO2 emissions can be avoided annually [EWEA (2011b)]. The first offshore wind park in The Netherlands is Offshore Wind park Egmond aan Zee (OWEZ). The 36 wind turbines in this wind park have a capacity of 3 MW, together producing sufficient renewable energy for more than 100,000 households, approximately the size of the city of Eindhoven [NOORDZEEWIND (2011)]. In order to reach the mentioned numbers for the offshore wind energy, some engineering challenges need to be overcome. One of these challenges in offshore wind park construction is the bed protection around the turbine foundations. Surveys of the bed levels around the wind turbine foundations in OWEZ have shown that just beyond the scour protection edge scour develops. This can cause damage to the electricity cables buried in the bed. A damaged electricity cable results in down time of the wind turbine and the wind turbines connected to it further in the string. The required burial depth of the cables is therefore governed by the location and depth of the edge scour hole. Edge scour is not very well understood and therefore difficult to quantify. Improved insight in the development of edge scour is valuable for science and industry. The present exploratory study revealed that more research is needed to compute edge scour development correctly with the software package Delft3D-Flow. However, even if the model results in Delft3D-Flow would be perfect, considerable or even unacceptable computational times need to be overcome. Therefore, a less time consuming method to calculate the edge scour depth would be very valuable. In order to develop such a method for calculating edge scour depth, the following objectives have been studied: 1. Gain insight in the hydrodynamic and morphodynamic processes around the foundation of an offshore wind turbine with bottom protection, focussing on edge scour. 2. Explore the possibilities of applying Delft3D-Flow for modelling the hydrodynamic and morphodynamic processes around the foundation of an offshore wind turbine with bottom protection, focussing on edge scour. 3. Develop a model to predict the depth and rate of edge scour around the foundation of an offshore wind turbine. The research reveals that tidal asymmetry is of major concern in the development of edge scour. Edge scour develops mainly downstream of the wind turbine for the dominant tide. In addition, lee-wake vortices downstream the wind turbine play an important role in the formation of the edge scour holes. The performance of Delft3D-Flow is rather poor in this specific situation. A lack of resemblance between the bed levels computed with Delft3D-Flow and the measured bed levels in OWEZ exists. Most likely this is due to mediocre performance of the two-dimensional model with respect to the hydrodynamics in this specific situation. It is recommended to investigate this in more detail. Due to the lack of detailed measurements of the hydrodynamics, it is difficult to validate the model results. In order to calculate the edge scour depth, the Edge Scour Prediction Model (ESPM) has been developed. This is a model based on mathematical relations of development towards an equilibrium in time and empirical relations for the equilibrium edge scour depth and characteristic timescale. The Delft3D-Flow model is applied to assess the amplification factor as input for the ESPM. The ESPM has proven to reproduce the edge scour depth as function of time in OWEZ reasonably well. In addition, it can be a valuable tool for a first impression of the edge scour depth in new designs at other locations.Hydraulic EngineeringCivil Engineering and Geoscience
Efficacy of perindopril in reducing risk of cardiac events in patients with revascularized coronary artery disease
No full textBACKGROUND: The aim of the study was to assess the effect on cardiac events of adding perindopril 8 mg once daily to standard preventive therapy in the subgroup of EUROPA patients with previous revascularization and without previous myocardial infarction (MI). METHODS: We conducted a subgroup analysis of the EUROPA study patients according to their revascularization and previous MI history. Among the 12,218 patients of EUROPA, we identified 6709 (54.9%) patients who had a previous revascularization. Approximately equal proportions had undergone percutaneous coronary intervention (3122) or coronary artery bypass grafting (3136). Of the revascularized patients, 3047 (24.9%) patients had not experienced a previous MI. RESULTS: Out of the 6709 revascularized patients, 3340 were treated with perindopril and 3369 with placebo. Baseline characteristics were similar to the whole EUROPA population in terms of demographics, medical history, physical examination (heart rate, blood pressure), and medications at screening. The mean patient age was 60 years, and 85% were men. The relative risk reduction with perindopril 8 mg was 17.3% (95% CI 1.3%-30.8%, P = .035) for the composite primary end point of cardiovascular death, nonfatal MI, and resuscitated cardiac arrest and was 23% (95% CI 4.9%-37.6%, P = .015) for fatal and nonfatal MI. In the 3047 revascularized patients without a history of MI, perindopril was associated with a relative risk reduction of 31.7% for fatal and nonfatal MI (95% CI 4.4%-51.2%, P = .026). CONCLUSION: Perindopril 8 mg daily is beneficial for primary and secondary prevention of cardiac events in patients with coronary artery disease without clinical evidence of heart failure including those with previous revascularization
Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry
Get PDF<p>Aims Men and women differ in terms of presentation and management in coronary artery disease (CAD). Whether these differences translate into different clinical outcomes in stable CAD is unclear. We analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD.</p>
<p>Methods and results We analysed 1-year outcomes in 30 977 outpatients with stable CAD [23 975 (77.4%) men; 7002 (22.6%) women]. Women were older than men, more likely to have hypertension and diabetes, and less likely to exercise or smoke. They had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimized treatment for stable CAD. One-year outcomes were similar for men and women for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke [adjusted rates 1.7 vs. 1.8%, respectively, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.75–1.15]; all-cause death (adjusted 1.5 vs. 1.6%, OR: 0.91, 95% CI: 0.72–1.13); fatal or non-fatal myocardial infarction (adjusted 1.0 vs. 0.9%, OR: 0.81, 95 CI: 0.60–1.08); and cardiovascular death or non-fatal myocardial infarction (adjusted 1.4 vs. 1.4%, OR: 0.89, 95% CI: 0.70–1.12). Fewer women underwent revascularization (2.6 vs. 2.2%, OR: 0.77, 95% CI: 0.64–0.93), although appropriateness was not analysed.1522-9645</p>
<p>Conclusion The risk profiles of women and men with stable CAD differ substantially. However, 1-year outcomes were similar. Fewer women underwent revascularization. Further research is needed to better understand gender determinants of outcome and devise strategies to minimize bias in the management and treatment of women.</p>
Task force on the management of chest pain
No full textThe Task Force on the management of chest pain was created by the committee for Scientific and Clinical Initiatives on 28 June 1997 after formal approval by the Board of the European Society of Cardiology. The document was circulated to the members of the Committee for Scientific and Clinical Initiatives, to the members of the Board and to the following reviewers: J. Adgey, C. Blomstro¨m-Lundqvist, R. Erbel, W. Klein, J. L. Lopez-Sendon, L. Ryde´n, M. L. Simoons, C. Stefanadis, M. Tendera, K. Thygesen. After further revision it was submitted for approval to the Committee for Practise Guidelines and Policy Conferences. The Task Force Report was supported financially in its entirety by The European Society of Cardiology and was developed without any involvement of the pharmaceutical industry.</p
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