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(Circulation. 2006;113:1155.)
© 2006 American Heart Association, Inc.

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	PREVENTION OF SYNCOPE TRIAL (POST): A RANDOMIZED, PLACEBO-CONTROLLED STUDY OF METOPROLOL IN THE PREVENTION OF VASOVAGAL SYNCOPE, Sheldon et al.

 
Stimulation of cardiac mechanoreceptors by vigorous cardiac contraction has been implicated in eliciting the reflex sympathetic withdrawal and parasympathetic activation that causes neurocardiogenic (vasovagal syncope). ß-Adrenergic blockers are commonly prescribed, and failure to consistently confirm benefit in controlled trials has been attributed to inclusion of patients with uncharacterized causes of syncope and a spectrum of ages. Sheldon and coworkers conducted a randomized controlled trial of metoprolol in patients with recurrent vasovagal syncope that could be confirmed on tilt table testing. Metoprolol failed to provide benefit. Additional analysis of age and the requirement for isoproterenol infusion to provoke a positive tilt table test are presented. The failure of ß-blocker therapy raises further questions as to the mechanisms eliciting vasovagal syncope and has important implications for treatment. See p 1164.

	DRIVING TIMES AND DISTANCES TO HOSPITALS WITH PERCUTANEOUS CORONARY INTERVENTION IN THE UNITED STATES: IMPLICATIONS FOR PREHOSPITAL TRIAGE OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION, Nallamothu et al.

 
There is growing interest in regionalization of care for patients with ST-elevation myocardial infarction (STEMI) and the prehospital ambulance triage of these patients to PCI hospitals. However, delays that are incurred from directly transporting patients to a PCI hospital may eliminate the advantage of primary PCI or even place the patient at a disadvantage if a closer, non-PCI hospital is available but bypassed. The success of prehospital triage protocols depend in large part on how patients are geographically distributed around hospitals with and without percutaneous coronary intervention and other advanced technologies. To address this issue, investigators from the University of Michigan and Yale University estimated driving times and distances to the nearest PCI hospital for the adult population in the United . . . [Full Text of this Article]