Prognostic value of non-sustained ventricular tachycardias after acute myocardial infarction in the thrombolytic era: importance of combination with frequent ventricular premature beats

PURPOSE

of this study was to re-evaluate the association between ventricular arrhythmias and long-term mortality after acute myocardial infarction (AMI) in the thrombolytic era.

METHODS

MITRA (maximal individual therapy in patients with AMI) is a multicenter registry of 54 hospitals in Germany investigating patients with AMI.

RESULTS

2420 patients received Holter ECG. Positive Holter ECG was defined: > or =10 ventricular premature beats (VPB)/h, or > or =4 couplets/d, or > or =1 non-sustained ventricular tachycardia (nsusVT)/d, or their combination. Mortality rates (median 17 months) were 6.5% without ventricular arrhythmias, with > or =10 VPB/h 15.2% and with the combination of > or =10 VPB/h plus either > or =4 couplets/d or > or =1 nsusVT/d 23.4%. In multivariate analysis, none of the ventricular arrhythmias alone correlated with mortality. There was a significant association between mortality and the combination of > or =10 VPB/h plus > or =4 couplets/d (OR 2.3) or > or =10 VPB/h plus > or =1 nsusVT/d (OR 2.8).

CONCLUSION

Non-sustained VTs are only associated with poor prognosis if combined with frequent VPBs.

Anti-ischemic effects of cilazapril in patients with both hypertension and angina pectoris. Preliminary report of a pilot study

We report the preliminary findings in the first 12 patients enrolled in a double-blind randomized placebo-controlled study of the antianginal effect of the new angiotensin-converting enzyme inhibitor, cilazapril (2.5 mg once daily) in patients with both hypertension and angina pectoris. After 3 weeks of treatment, placebo had no effect whereas cilazapril significantly prolonged exercise duration. In 2 of the patients on cilazapril, exercise duration was markedly prolonged from 387 to 534 and 352 to 556 s. The maximal ST segment depression was unaltered. It is suggested that in selected patients with both hypertension and angina pectoris cilazapril may have an antianginal effect. A larger study is now underway.