Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value.

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Summary:Heart rate variability (HRV) has become a popular method for the studies of physiologic mechanisms responsible for the control of heart rate fluctuations. in which the autonomic nervous system appears to play a primary role. Depression of HRV has been observed in many clinical scenarios. including autonomic neuropathy. heart transplantation, congestive heart failure, myocardial infarction (MI), and othct cardiac and noncardiac diseases. However, it is important to realize that clinical implication of HRV analysis has been clearly recognized in only two clinical conditions: ( 1 ) as a ptcdictor of risk of arrhythniic events or sudden cardiac death after acute MI, and ( 2 ) as a clinical marker of evolving diabetic neuropathy. Recently, its role in evaluation and nianagenient of heart failure has also been recognized. It is pertinenl to recognize the limitations of HRV ;IS far as its clinical utility at present is concerned. The methodology of HRV had remoined poorly standardized until the recent publication of the Special Repon of the Task Force of ESC/NASPE. and thus has been presenting difficulty in comparing earlier existing data. Also, determination of the exact sensitivity. specificity, and predictive value of HRV, as well as the normal values of standard measures in the general population, still require further investigation before better standards can be set for existing and future clinical applications. This article review\ the major concepts of HRV measurements. their clinical relevance, and the recent advances in this field.