Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.

OBJECTIVE: The aim of this study was to evaluate the efficacy of nebivolol, carvedilol or metoprolol succinate on the outcome of patients presenting with acute myocardial infarction (AMI) complicated by left ventricular dysfunction. SUBJECTS AND METHODS: Patients (n = 172, aged 28-87 years) with AMI and left ventricular ejection fraction ≤0.45 were randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol succinate (n = 57) groups. Baseline demographic and clinical characteristics and composite event rates of nonfatal MI, cardiovascular mortality, hospitalization due to unstable angina pectoris or heart failure, stroke or revascularization during the 12-month follow-up were compared among the groups using the x03C7;2 test, t test or log-rank test as appropriate. RESULTS: Baseline demographic and clinical characteristics were similar in the three groups. The composite end point during follow-up was lower in the patients treated with nebivolol than those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event rates were similar between the patients treated with carvedilol and those treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05). CONCLUSION: The patients treated with nebivolol experienced 12-month cardiovascular events at a lower rate than those treated with metoprolol succinate. However, event rates were similar between the carvedilol and the metoprolol succinate groups and between the nebivolol and the carvedilol groups.

Effect of smoking cessation on mean platelet volume.

The aim of this study was to assess the values of mean platelet volume (MPV) in regular smokers and the effect of smoking cessation on MPV. The study group consisted of 116 regular smokers (57 females and 59 males; mean age 46.3 ± 12.7 years) and the control group was composed of 90 healthy volunteers (49 females and 41 males; mean age 47.7 ± 8.3 years). Platelet indices were assessed in regular smokers and control participants. Platelet indices were measured at 3 months after smoking cessation in these 101 participants. The MPV values were significantly higher in smokers than those of controls (8.8 ± 0.9 vs 8.0±0.8 fL, respectively; P < .001). The MPV values decreased significantly at 3 months when compared with the baseline values (8.9 ± 1.0 vs 7.9 ± 0.7 fL, respectively; P < .001). We have found that serum MPV values were significantly higher in regular smokers than in controls. Serum MPV values decreased significantly at 3 months after smoking cessation.

Gamma-glutamyltransferase in acute coronary syndrome patients without ST elevation and its association with stenotic lesion and cardiac events.

BACKGROUND: There are limited data on prognostic value of gamma-glutamyltransferase (GGT) in acute coronary syndromes (ACS) with non-ST-segment elevation (NSTE-ACS). We investigated GGT levels and their association with significant stenosis and major cardiac events (MACE) in NSTE-ACS patients. METHODS AND RESULTS: This study included 237 patients with NSTE-ACS (ACS group), and age-matched and sex-matched controls with normal coronary arteries (control group). ACS group was divided into subgroups with and without significant stenosis. Serum creatine kinase-MB, troponin T and GGT levels were measured. ACS patients were followed up for MACE (composite of cardiac death, myocardial infarction, recurrent angina, and hospitalization) during 12 months. Median GGT level was higher in ACS group than control group (32 vs. 16 U/l, P=0.001). NSTE-ACS was independently associated with hypertension [odds ratio (OR): 2.83, P=0.001], smoking (OR: 2.19, P=0.015), GGT [OR: 1.16, 95% confidence interval (CI): 1.11-1.21, P=0.001] and ejection fraction (OR: 0.92, P=0.01). GGT level was also higher in patients with significant stenosis than those without significant stenosis (37 vs. 22 U/l, P=0.001). Presence of significant stenosis was independently associated with GGT level (OR: 1.17, 95% CI: 1.12-1.23, P=0.001). At 12 months, MACE-free survival was slightly poor in ACS patients with upper GGT tertile compared with those with lower GGT tertile (77 vs. 97%, P=0.06). CONCLUSION: In NSTE-ACS patients, increased GGT levels can be associated with significant stenosis and MACE.