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Etexnte;t
gilE
u
Liu
Chang Shan
EVIDENCE.BASED
MEDICINE:
A
NEW MODEL
FOR
CLINICAL
RESEARCH
After the 80s, the scientific
"evi-
dence-based
medicine" concept stipu-
lated
large,
international, welFcontrolled
trials. Still evolving, the concept
gives
good indications on
the
prognosis
according
to
treatment
category.
However, as the actual cause of death
is
too subjective, the overall
death
rate
is, appropriately, the primary end-point
for
cardiac trials,
e.9.,
the Scandinavian
Simvastatin Survival
Study,
the Choles-
terol
&
Recurrent Events
(CARE),
the
Long-term lntervention with Provastatin
in
lschemic
Disease (LlPlD).
Yet,
there
were surprises,
e.9., the
Cardiac
Arrhythmia Suppression Trial
(CAST)
found "class
l"
anti-anhythmia drugs for
irregular heart beats had significantly
increased risks
of
sudden
death,
despite reduced frequency / severity
of
the arrhythmia.
ln
the
mid-9Os, meta-
analysis (combed
results
of a
number
of
very similar
trials
for a
summary
opinion) found short-acting
calcium
antagonist for hypertension were asso-
ciated with a higher
risk
of
myocardial
infarction (apparently
dose
related), as
compared with
diuretics
plus beta-
blockers. The Amiodarone Trials Meta-
analysis
(ATMA)
found
amiodarone
effectively reduced sudden death
after
myocardial infarct (Ml). Some studies
lound
cost-effective
drugs
underused,
e.9.,
beta-blockers
and clot-dissolving
thrombolytics (like platelet glycoprotein
llb/llla
inhibitors)
but
angiotensin con-
verting
enzyme inhibitors
(ACEI),
overused...
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