PRACTICE
Efficacy Assessment of Meloxicam, a Preferential Cyclooxygenase-2 Inhibitor, in Acute Coronary Syndromes Without ST-Segment Elevation
The Nonsteroidal Anti-Inflammatory Drugs in Unstable Angina
Treatment (NUT-2) Pilot Study
Circulation. 2002;106:191-195
PRACTICE
RISK OF CARDIOVASCULAR EVENTS WITH VARIOUS COX-2 INHIBITORS AND NSAIDS
Drug |
Relative risk of cardiovascular |
|
event (95% CI) |
Rofecoxib <25 mg |
1.33 (1.00-1.79) |
Rofecoxib >25 mg |
2.19 (1.64-2.91) |
Celecoxib |
1.06 (0.91-1.23) |
Diclofenac |
1.40 (1.16-1.70) |
Naproxen |
0.97 (0.87-1.07) |
Piroxicam |
1.06 (0.70-1.59) |
Ibuprofen |
1.07 (0.97-1.18) |
Meloxicam |
1.25 (1.00-1.55) |
Indomethacin |
1.30 (1.07-1.60) |
McGettigan P, Henry D. JAMA 2006
PRACTICE
NEW ANTI-INFLAMMATORY
THERAPY IN ACS
V., Liuzzo G. et al. Modulation of CD4+CD28null T lymphocytes by tumor necrosis factor- blocade in patients with unstable angina. Circulation
2006;113:2272-2277.
Johnson J., Baker A. et and instability by tissue 2006;113:2435-2444.
al. Suppression of atherosclerotic plaque progression inhibitor of mettalloproteinase-2. Circulation
Franks A., Gardner S. AGI-1067 (VCAM-1 blokcer): a novel vascular protectant for prevention restenosis. Annuals of pharmacology 2006;40(1):66-73. Tardif J., Gregorie Y. et al. Pharmacologic prevention of both restenosis and atherosclerosis preogression: AGI-1067, probucol, folic acid and other therapies. Current opinion in lipidology 2003;14 (6):615-620.
Role of Lipoprotein-Associated Phospholipase A2 in atherosclerosis. Biology, epidemiology, and possible therapeutic target. Thromb. Vasc. Biol., 2005, 25, 923-931
PRACTICE
C-RP DETERMINANTS IN PTS WITH ACS
Increase
Chronic inflammation, infection
Smoking
Obesity
Diabetes
Lipids
Estrogen
Decrease
Statins
Aspirin?
Anti-inflammatory drugs?
МАРКЕРЫ ВОСПАЛЕНИЯ И НЕСТАБИЛЬНОСТИ БЛЯШКИ
•Сердечные тропонины
•C-реактивный белок
•Кол- во лейкоцитов
•Цитокины - ИЛ-1, ИЛ-6, растворимый CD40 ligand,ФНО-
•инфекция
•Myelo-peroxidase
•Monocyte chemo-attractant protein-1
•ММР
•Pregnancy-associated plasma protein A
исходы через 14 дней,%
TIMI 11b-Substudy
Troponin I and Efficacy of Enoxiparin
Тропонин I – |
Тропонин I + |
||
N=180 |
|
||
N=179 |
Р=0,007 |
||
|
|||
|
Р=0,006 |
|
|
(%)
Troponin T: 1oEP at 6 months
Death, MI, Rehosp ACS at 6 Months
CONS |
INV |
30 |
|
|
* |
OR=0.52 |
|
|
24. |
*p<0.001 |
|
25 |
p=NS |
Interaction |
||
20 |
14. |
16. |
|
P<0.001 |
15 |
|
|
14. |
|
10 |
|
|
|
|
5 |
N=414 |
N=396 |
N=463 |
N=495 |
0 |
TnT- |
(54%TnT+ |
||
|
TnT cut point = 0.01 ng/ml |
of Pts TnT +) |
||