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1、ESC2004: LearningasajourneyValentinFusterMDDirector,CardiovascularInstituteMountSinaiMedicalCenterNewYork,NYChristopherCannonMDStaffcardiologistBrighamandWomen’sHospitalBoston,MAJamesFergusonMDAssociateDirector,CardiologyStLuke'sEpiscopalHospitalandTexasHeartInstituteHouston,TXM
2、ichaelWeberMDProfessorofMedicineSUNYDownstateCollegeofMedicineBrooklyn,NYPROVE-ITTIMI-22PravastatinoratorvastatinevaluationandinfectiontherapyAtoZAggrastattoZocorRIO-EUROPERimonabantinObesity-EuropeTopicsPravastatinorAtorvastatinEvaluationandInfectionTherapyPROVE-ITTIMI-22PROVE-
3、IT:BackgroundPreviousstudieshaveshownthatpatientswithhightitersofChlamydiapneumoniaeatgreaterriskofMIPROVE-ITTIMI-22andACESpresentedatESC2004PROVE-IT:DesignLong-termstudyofantibiotictherapyagainstChlamydiapneumoniaeontheoccurrenceofcardiovasculareventsinpatientswithcoronaryheart
4、disease4162patientswithACS(<10days)Pravastatin(40mgdaily)vsatorvastatin(80mgdaily)Patientswererandomizedasecondtimetoreceivetreatmentwitheithergatifloxacin400mg/dayforafullcourseof10dayspermonthfollowedby20dayswithouttreatmentorplaceboRepeatedeachmonthfortwoyearsPROVEIT-TIMI22:C
5、VDeventsbytreatmentgroupCannonC.ESCCongress2004;August28-September1,2004;Munich,GermanyEndpointGatifloxacinPlaceboHazardriskreduction(95%CI)PCVevents(%)23.725.15(16,-8)0.41Primaryendpointacompositeofall-causemortality,MI,unstableanginarequiringhospitalization,revascularization,a
6、ndstrokePROVE-IT:Greathope“Ithinkit’sasolid‘no’thatthisdoesn’twork.”CannonPROVE-IT:Nobenefit“We’vebeenatthisantibioticquestionacoupleoftimes.”Cantheseresultsbeextendedtopatientswhohavelessatheroscleroticburden?Forpatientswithestablishedcoronarydisease,three “resoundingstudies” s
7、uggestnobenefitFergusonACES:DesignStudycomparedtreatmentwithazithromycin600mgonceaweekforayearwithplaceboin4012patientswithestablishedcoronarydiseasePatientswerethenfollowedforfouryearsfortheoccurrenceofprimaryendpointevents,anyoneofCHDdeath,nonfatalMI,coronaryrevascularization,
8、orhospitalizationforunstableanginaRESULTSPrimar
