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CAS in octogenarians is performed in an increasing proportion of patients. In-hospital stroke or death rates increase significantly with older age; however, there was no excess complication rate in octogenarians.

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For the first time efficacy and safety of a new prostaglandin E1 (PGE1) regimen in the treatment of intermittent claudication were evaluated in a randomized, double-blind, placebo-controlled multicenter clinical trial. The study involved 213 outpatients with a maximum walking distance of 50 to 200 m measured on the treadmill (3 km/hr, 12% grade). After a 2-week run-in phase they received a 2-hour intravenous infusion of 60 micrograms PGE1 or placebo 5 days a week for 4 weeks. It was followed by a 4-week interval treatment with the same medication administered only twice a week. Patients were monitored for 3 months when they received no study medication. In the PGE1 group the intention-to-treat analysis (n = 208) revealed an increase in walking distance after 4 weeks of 75% (placebo, 43%). At the end of the interval treatment the walking distance had improved to 101% (placebo, 60%). The results remained virtually constant during follow-up (PGE1, 104%, placebo, 63%). Between-group comparisons showed significant differences in favor of PGE1 for all three time points of measurement (p < 0.05, p < 0.01, and p < 0.05). PGE1 was well tolerated; the rate of adverse reactions related to the treatment was 12.8% (placebo, 7.7%). In summary, these results show that the new PGE1 regimen is effective and safe in the treatment of outpatients with intermittent claudication.

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The observation of a close relationship of heart rate to oxygen uptake (HR-VO2) and heart rate to minute ventilation (HR-VE) has been shown to be of particular value in rate variable pacing. However, the impact of anaerobic threshold (AT) for the HR-VO2 and HR-VE slope has been studied less. Twenty-three male and 16 female subjects, mean age 52 +/- 7 years, were selected in whom complete heart catherization and extensive noninvasive studies excluded major cardiopulmonary disease. Semisupine bicycle exercise testing with analysis of respiratory gas exchange was performed using a ramping work rate protocol with work increments of 20 watts/min. At the respiratory AT, determined by the V slope method, oxygen uptake (VO2-AT) was 15.2 +/- 3.0 mL/kg in males versus 13.8 +/- 2.3 mL/kg in females and heart rate (HR-AT) was 109 +/- 18 beats/min versus 119 +/- 20 beats/min, respectively. Heart rate was highly correlated (r > or = 0.9) to VO2 and minute ventilation (VE). A linear regression for HR-VO2, however, was found only in 16/39 and for HR-VE in 11/39 subjects. Assuming the AT as the breakpoint of two linear curves, it could be demonstrated that compared to low exercise HR appeared to increase at maximal exercise more in relation to VO2 but less in relation to VE; in men the individual slopes for HR-VO2 were 2.6 +/- 0.7 below but 3.2 +/- 1.0 above AT (P < 0.05) and the slopes for HR-VE were 1.6 +/- 0.5 below but 1.0 +/- 0.4 above AT (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)