Abstract:
BACKGROUND:Intracranial hemorrhage is an uncommon but very dangerous complication in patients receiving thrombolytic therapy for acute myocardial infarction. Neurosurgical evacuation is often an available treatment option. However, the association between neurosurgical evacuation and clinical outcomes in these patients has yet to be determined. METHODS:The GUSTO-I trial randomly assigned 41,021 patients with acute myocardial infarction to 1 of 4 thrombolytic strategies in 1081 hospitals in 15 countries. A total of 268 patients (0.65%) had an intracranial hemorrhage. We assessed differences in clinical characteristics, neuroimaging features, Glasgow coma scale scores, functional status (disabled: moderate or severe deficit; not disabled: no or minor deficit) and 30-day mortality rate between the 46 patients who underwent neurosurgical evacuation and the 222 patients who did not. RESULTS:Mortality rate at 30 days for all patients with intracranial hemorrhage was 60%; an additional 27% were disabled. Evacuation was associated with significantly higher 30-day survival (65% versus 35%, P <.001) and a trend toward improved functional status (nondisabling stroke: 20% versus 12%, P =.15). CONCLUSIONS:Although intracranial hemorrhage is uncommon after thrombolysis for acute myocardial infarction, 87% of patients die or have disabling stroke. Although not definitive, these data indicate that neurosurgical evacuation may be associated with improved clinical outcomes. Physicians treating such patients should consider early neurosurgical consultation and intervention in these patients.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Mahaffey KW,Granger CB,Sloan MA,Green CL,Gore JM,Weaver WD,White HD,Simoons ML,Barbash GI,Topol EJ,Califf RMdoi
10.1016/s0002-8703(99)70152-3subject
Has Abstractpub_date
1999-09-01 00:00:00pages
493-9issue
3 Pt 1eissn
0002-8703issn
1097-6744pii
S0002870399003944journal_volume
138pub_type
临床试验,杂志文章,随机对照试验abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) is currently indicated in patients with moderate to severe heart failure, a wide QRS complex and significant left ventricular dysfunction despite optimal medical therapy. Adoption of these criteria for CRT results in a favorable response in only two thirds of candidate...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2004.12.013
更新日期:2005-04-01 00:00:00
abstract::The effects of lorcainide, a new antiarrhythmic drug, on serum electrolytes and osmolality are described in a series of 33 patients with organic heart disease and complex ventricular arrhythmias treated with lorcainide. In eight patients, a mean decrease in serum Na+ of 8.25 +/- 3.2 mEq/L was observed after a single 2...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90690-2
更新日期:1984-12-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) in the setting of heart failure (HF) is linked to embolic stroke and exacerbation of HF. The rate of new-onset AF in patients with left ventricular dysfunction and mild to moderate HF enrolled in the SoLVD trials was significantly lower with enalapril than with placebo (5.4% vs 24% o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.07.027
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Patients with heart failure frequently exhibit intraventricular conduction delays, which contribute to asynchronous contraction patterns and impaired hemodynamic performance. Cardiac resynchronization therapy (CRT) with biventricular (BV) and left ventricular (LV) pacing has been shown to improve both hemody...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.119616
更新日期:2002-01-01 00:00:00
abstract::Currently available internal cardiac defibrillators use a uniphasic, truncated exponential waveform morphology of about 6 msec in duration at an energy level of 23 to 33 joules. To determine if improved defibrillation could be achieved with a different waveform morphology, we implanted 4.5 cm2 titanium patches to the ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90187-7
更新日期:1989-08-01 00:00:00
abstract::The Salt Substitute and Stroke Study is an ongoing 5-year large-scale cluster randomized trial investigating the effects of potassium-enriched salt substitute compared to usual salt on the risk of stroke. The study involves 600 villages and 20,996 individuals in rural China. Intermediate risk markers were measured in ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2019.12.020
更新日期:2020-03-01 00:00:00
abstract::The effects and possible mechanisms of actions of indomethacin on systemic and coronary hemodynamics were studied in 17 patients with coronary artery disease. Group I patients (12) were given either indomethacin or placebo in the absence of prior cyclooxygenase inhibition and group II (five) were given indomethacin af...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(85)90149-8
更新日期:1985-08-01 00:00:00
abstract::Selective blockade of the angiotensin II AT1 receptor represents a novel mechanism for interrupting the renin-angiotensin system without altering the potential benefits of AT2 receptor stimulation. This selective inhibition produces none of the disadvantages associated with reduced bradykinin metabolism and angiotensi...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(99)70317-0
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Tamoxifen has mixed estrogen agonist and antagonist properties in estrogen-regulated tissues. Its effect on the cardiovascular system is not well defined. We carried out a study to investigate the effect of tamoxifen on peripheral vascular endothelial function. METHODS:Three groups of postmenopausal women (...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.117323
更新日期:2001-10-01 00:00:00
abstract::Patients with diabetes were compared with nondiabetic control subjects, with respect to the prevalence of silent myocardial ischemia, by means of treadmill exercise testing and coronary angiography. Results of treadmill exercise testing showed ischemic ST depression in 41 of the 132 diabetic patients (mean age 61 +/- ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90745-h
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:The impact of race and sex on clinical outcomes after percutaneous coronary interventions remains incompletely understood. Specific data on patient demographics, lesion characteristics, and outcomes of black versus white patients are poorly described. To further evaluate these issues, we analyzed the New App...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2000.106645
更新日期:2000-07-01 00:00:00
abstract::The purpose of this study was to assess the recovery of the left ventricular pressure (PLV), and the incidence and type of arrhythmias after effective low-dose defibrillation (Imax = 18-70 A) in healthy hearts and in hearts with acute myocardial infarction (AMI) in the intact dog. In fifteen dogs 84 episodes of fibril...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90195-3
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) is associated with an adverse prognosis in patients with coronary heart disease. Cardiac rehabilitation (CR) improves morbidity and mortality among patients with coronary heart disease, but its impact on patients with concomitant CKD has not been described. METHODS:We compared b...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.01.048
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:The nested case-control study is an efficient epidemiological design whereby a case-control approach is employed within an established cohort. The large number of recent prospective studies and randomized trials conducted in cardiology provide cohorts within which the nested case-control approach is increasi...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/S0002-8703(03)00512-X
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:The ACUTE Trial studied a transesophageal echocardiography (TEE)-guided strategy compared with a conventional strategy for management of patients with atrial fibrillation undergoing direct current cardioversion. The primary aim was to determine if patient functional capacity, measured by the Duke Activity St...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.08.014
更新日期:2005-02-01 00:00:00
abstract::One hundred four patients (101 men, three women), under 40 years of age, with myocardial infarction (MI), underwent coronary arteriography. Eighty patients had significant obstructive coronary artery disease (CAD) (group 1), 23 had normal coronary arteries (group 2), and one patient had coronary ostial stenosis as a r...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90680-0
更新日期:1986-07-01 00:00:00
abstract::Exercise-induced changes in QRS duration were assessed in 25 normal subjects and in 17 patients with stable ischemic heart disease. None had bundle branch block or were taking medications, and all patients had angina pectoris induced during the test. QRS duration and ST60 amplitude were measured by computer during res...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90640-x
更新日期:1986-05-01 00:00:00
abstract::Eighty-seven patients with isolated ventricular septal defect (VSD) operated on in the first 5 years of life, that had a mean interval of 10 months between diagnostic catheterization and surgery, were studied retrospectively. The size of the VSD was correlated with diagnostic catheterization data and comparative analy...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80170-1
更新日期:1977-01-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to assess whether pharmacologic preconditioning by exogenous or endogenous adenosine prevents the deterioration of hemodynamic function and left ventricular performance during percutaneous transluminal coronary angioplasty (PTCA). Ischemic preconditioning renders the heart more ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2000.110287
更新日期:2000-11-01 00:00:00
abstract::In vitro studies have established that intravascular ultrasound is a reliable technique for accurate assessment of vascular anatomic structure and disease conditions before and after intervention. In addition, quantitative data from intravascular ultrasound studies correspond well with histologic findings, which serve...
journal_title:American heart journal
pub_type: 社论,评审
doi:10.1016/s0002-8703(96)90263-x
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) improves symptoms, reduces heart failure (HF)-related hospitalizations, and reverses left ventricular remodeling in some patients with moderate to severe HF and ventricular dyssynchrony defined by a prolonged QRS duration. The effects of CRT on HF outcomes in patients ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.002
更新日期:2006-02-01 00:00:00
abstract::Electrolyte balance has been regarded as a factor important to cardiovascular stability, particularly in congestive heart failure. Among the common electrolytes, the significance of magnesium has been debated because of difficulty in accurate measurement and other associated factors, including other electrolyte abnorm...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90253-7
更新日期:1996-09-01 00:00:00
abstract::Although the cardiac manifestations of Lyme disease may be diverse, in general they are treatable with currently available therapies. A high index of suspicion is required to make a diagnosis, especially for patients who may lack a suggestive history of tick exposure or residence in an endemic region. Lyme disease-rel...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(91)90589-a
更新日期:1991-11-01 00:00:00
abstract::Thallium-201 redistribution pattern after exercise was related to rest and exercise left ventricular regional and global function, measured by radionuclide ventriculography, in 61 patients, 50 with coronary artery disease (CAD). Sixteen patients had exclusively transient thallium defects, suggesting ischemia: in this ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90608-6
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND:Heart failure (HF) remains a major public health issue. Data on long-term trends in the incidence of HF and survival after its onset are limited. METHODS:A prospective cohort study conducted between 1985 and 2004 in 21,906 participants of the Physicians' Health Study I who were alive and free of HF on Janua...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.07.004
更新日期:2007-11-01 00:00:00
abstract::Doxorubicin (Adriamycin) is an effective anticancer agent but its therapeutic value is limited by its myocardial cardiotoxicity. To improve early detection of doxorubicin cardiotoxicity, studies were performed in patients with long-term doxorubicin treatment using pulsed Doppler echocardiography to assess the changes ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90077-x
更新日期:1989-07-01 00:00:00
abstract::The American Cancer Society's prospective study of 1 million Americans was analyzed to determine whether coronary heart disease (CHD) mortality rates by cigarette smoking in blacks differed from those in whites. More than 22,000 blacks were followed up for nearly 200,000 person-years in the 12-year study, 1960-1972. A...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90675-6
更新日期:1984-09-01 00:00:00
abstract::To examine the relationship between the improvement of wall motion in infarcted regions after percutaneous transluminal coronary angioplasty (PTCA) and thallium-201 uptake in the delayed image of exercise thallium-201 scintigraphy before PTCA, 14 patients with anterior old myocardial infarction were studied. Exercise ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90053-c
更新日期:1993-01-01 00:00:00
abstract::Baroreflex modulation of forearm vascular resistance (FVR) has been reported to be abnormal in patients with congestive heart failure (CHF). However, the neurohumoral mechanisms for this impairment are not defined. We assessed the responses of arterial pressure, FVR, plasma norepinephrine, and plasma renin activity to...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90075-6
更新日期:1989-07-01 00:00:00
abstract:BACKGROUND:We evaluate a simple, bedside test that measures 1-minute heart rate variability in deep breathing as a predictor of death after myocardial infarction. METHODS:Bedside heart rate variability was assessed in 185 consecutive patients 5.1 +/- 2.5 days after a first myocardial infarction. Patients were instruct...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70242-5
更新日期:1999-07-01 00:00:00