Abstract:
BACKGROUND:Unfractionated heparin has been the primary anticoagulant therapy for percutaneous coronary intervention for >20 years. Despite the availability of rapid "point of care" testing, little clinical data defining the optimal level of anticoagulation are available. Furthermore, recent reports have advocated the use of low-dose heparin regimens in the absence of large-scale, well-conducted studies to support this practice. METHODS AND RESULTS:We pooled the data from 6 randomized, controlled trials of novel adjunctive antithrombotic regimens for percutaneous coronary interventions in which unfractionated heparin constituted the control arm. Patients were divided into 25-s intervals of activated clotting times (ACTs), from <275 s to >476 s. In a total of 5216 patients, the incidence of death, myocardial infarction, or any revascularization and major or minor bleeding at 7 days were calculated for each group and compared. An ACT in the range of 350 to 375 s provided the lowest composite ischemic event rate of 6.6%, or a 34% relative risk reduction in 7-day ischemic events compared with rates observed between 171 and 295 s by quartile analysis (P=0.001). CONCLUSIONS:Contrary to recent reports, the optimal suppression of ischemic events with unfractionated heparin therapy in patients undergoing percutaneous coronary intervention demands treatment to ACT levels that are substantially higher than currently appreciated. These data define a goal for heparin dosing within coronary interventions and establish a benchmark of optimal unfractionated heparin therapy against which future trials of novel antithrombotic regimens in percutaneous interventions can be compared.
journal_name
Circulationjournal_title
Circulationauthors
Chew DP,Bhatt DL,Lincoff AM,Moliterno DJ,Brener SJ,Wolski KE,Topol EJdoi
10.1161/01.cir.103.7.961subject
Has Abstractpub_date
2001-02-20 00:00:00pages
961-6issue
7eissn
0009-7322issn
1524-4539journal_volume
103pub_type
杂志文章,meta分析相关文献
CIRCULATION文献大全abstract:BACKGROUND:prior studies indicated that ablation of the 4 major atrial ganglionated plexi (GP) suppressed atrial fibrillation. METHODS AND RESULTS:superparamagnetic nanoparticles (MNPs) made of Fe(3)O(4) (core), thermoresponsive polymeric hydrogel (shell), and neurotoxic agent (N-isopropylacrylamide monomer [NIPA-M]) ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.940288
更新日期:2010-12-21 00:00:00
abstract:BACKGROUND:Despite early recanalization of an occluded infarct artery, reperfusion at the level of the microcirculation may remain impaired owing to a process of microvascular reperfusion injury. METHODS AND RESULTS:Microvascular reperfusion injury was studied in 91 patients with acute myocardial infarction (AMI) by e...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.15.1972
更新日期:1999-04-20 00:00:00
abstract:BACKGROUND:Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poo...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.001080
更新日期:2013-06-25 00:00:00
abstract:BACKGROUND:Degeneration of xenografts or homografts is a major cause for reoperation in young patients after pulmonary valve replacement. We present the early results of fresh decellularized pulmonary homografts (DPH) implantation compared with glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.110.012161
更新日期:2011-09-13 00:00:00
abstract:BACKGROUND:Reperfusion of acutely infarcted myocardium may be beneficial in limiting infarct expansion and ventricular remodeling even if established after the time that salvage of ischemic myocardium is possible. METHODS AND RESULTS:To examine the permanency, time course, and mechanism of this effect of late reperfus...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.6.2872
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:Long QT syndrome (LQTS) is the first described and most common inherited arrhythmia. Over the last 25 years, multiple genes have been reported to cause this condition and are routinely tested in patients. Because of dramatic changes in our understanding of human genetic variation, reappraisal of reported gen...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.043132
更新日期:2020-02-11 00:00:00
abstract:BACKGROUND:Patients with repaired coarctation are at increased risk of hypertension and cardiovascular disease despite successful repair. We studied the function of conduit arteries in upper and lower limbs of patients late after successful coarctation repair and its relation to age at surgery. METHODS AND RESULTS:Flo...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/hc37t1.094900
更新日期:2001-09-18 00:00:00
abstract:BACKGROUND:The long-term outcomes of off-pump coronary artery bypass grafting (CABG) are the subject of speculation. Our institution has >15 years of experience performing CABG both off-pump (OPCAB) and on cardiopulmonary bypass (CPB). Our null hypothesis was that there would be no difference in a long-term composite o...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.116.021933
更新日期:2016-10-25 00:00:00
abstract:BACKGROUND:Coronary perforation is a life-threatening complication of percutaneous interventions. In the past few years, the implantation of covered stents has emerged as a strategy for treatment when the traditional conservative approach (ie, prolonged balloon inflation and reversal of anticoagulation) fails. METHODS...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.102.25.3028
更新日期:2000-12-19 00:00:00
abstract::A longitudinal study was made of 62 patients with dextro-transposition of the great arteries. The patients were managed with balloon atrial septostomy (BAS), palliative surgery if any operation was needed in the first year of life, and Mustard intra-atrial baffle repair after one year of age. Of the 47 patients with i...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.51.1.32
更新日期:1975-01-01 00:00:00
abstract:BACKGROUND:There are several potential physiological differences between the atriopulmonary (AP) and the total cavopulmonary connection (TCPC) Fontan circulations. Studies suggest that the TCPC reduces energy loss due to turbulence and may have more dependence on respiratory movement for pulmonary blood flow. We compar...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.91.2.372
更新日期:1995-01-15 00:00:00
abstract::Twelve patients with medically refractory ventricular tachycardia secondary to ischemic heart disease underwent surgery for cure of their arrhythmia. Preoperatively, the tachycardia could be reproducibly initiated and terminated in each patient by programmed stimulation. In all instances, intraoperative mapping locali...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.60.7.1430
更新日期:1979-12-01 00:00:00
abstract::Hemodynamic effects of dobutamine and dopamine (both 5, 10, 15 microgram/kg/min) and epinephrine (0.04 microgram/kg/min) were studied immediately following cessation of cardiopulmonary bypass in 34 patients with preoperative evidence of left ventricular dysfunction. Significant increases in mean cardiac index were see...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.57.2.378
更新日期:1978-02-01 00:00:00
abstract:BACKGROUND:The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management, and risk stratification of cardiovascular diseases, is unclear at present. METHODS:The LV parameters were measured from the cardiovascular magnetic resonance studies of the UK Biobank. ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.041161
更新日期:2019-10-15 00:00:00
abstract:BACKGROUND:Hypertension and other vascular diseases are more prevalent in diabetic patients than in the general population. In humans and in several animal models of diabetes, a disturbance of endothelium-dependent responses has been shown. Oxyhemoglobin is one of the most known modulators of these endothelium-dependen...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.5.2111
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition, and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.978114
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:ST-segment depression during exercise testing is frequently observed in the absence of restenosis after coronary angioplasty. METHODS AND RESULTS:We studied the determinants of this phenomenon in 70 consecutive patients with unstable angina related to a single left anterior descending coronary artery lesion...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.1.148
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:Human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs) are a promising source of cells for regenerating myocardium. However, several issues, especially the large-scale preparation of hiPS-CMs and elimination of undifferentiated iPS cells, must be resolved before hiPS cells can be used clinical...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.111.084343
更新日期:2012-09-11 00:00:00
abstract:BACKGROUND:Biventricular direct cardiac compression (DCC) has the potential to support the failing heart without the complications associated with a blood/device interface encountered with the use of current ventricular assist devices. A clinically designed DCC device that provides compression pressure around the base ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.suppl_2.ii-236
更新日期:1999-11-09 00:00:00
abstract:BACKGROUND:Activation of the sympathetic nervous system has important prognostic implications in chronic heart failure. Nonselective versus selective beta-adrenergic receptor antagonists may have differential effects on norepinephrine release from nerve terminals mediated by prejunctional beta(2)-adrenergic receptors. ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/hc4301.098282
更新日期:2001-10-30 00:00:00
abstract::In a study of aerobically perfused rat hearts, the in situ photoactivation (530-590 nm) of rose bengal (a process that leads to the production of singlet oxygen and superoxide) has been shown to lead to the rapid development of electrocardiographic abnormalities and arrhythmias. With rose bengal concentrations of 1,00...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.80.5.1432
更新日期:1989-11-01 00:00:00
abstract:BACKGROUND:Paraplegia continues to complicate thoracoabdominal aortic interventions. The elusive mechanism of spinal cord ischemia-reperfusion injury has delayed the development of pharmacological adjuncts. Microglia, the resident macrophages of the central nervous system, can have pathological responses after a variet...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.000024
更新日期:2013-09-10 00:00:00
abstract::Twenty-two patients who underwent anatomic correction of transposition of the great arteries at the arterial level at the age of 8 weeks to 14 years were reinvestigated 1-4.6 years (mean 2.0 years) after operation. A Dacron tube was used to bridge the gap between the proximal pulmonary route and the distal pulmonary a...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00
abstract:BACKGROUND:The crucial function of hepatic lipase (HL) in lipid metabolism has been well established, but the relationship between HL activity and coronary artery disease (CAD) is disputed. METHODS AND RESULTS:We measured HL activity in the postheparin plasma of 200 consecutive men undergoing elective coronary angiogr...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc5001.100795
更新日期:2001-12-18 00:00:00
abstract:BACKGROUND:Clinical studies have demonstrated the efficacy of intravenous administration of agents that block platelet glycoprotein IIb/IIIa receptors in the setting of percutaneous coronary revascularization. Although the optimal duration of treatment has not been determined, more prolonged receptor blockade has been ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.96.1.76
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Conflicting results from recent observational studies have raised questions concerning the benefit of β-blockers for patients undergoing coronary artery bypass grafting (CABG). Furthermore, the efficacy of long-term β-blocker therapy in CABG patients after hospital discharge is uncertain. METHODS AND RESULT...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.114.014209
更新日期:2015-06-23 00:00:00
abstract:BACKGROUND:Cardiomyocyte grafting augments myocyte numbers in the heart. We investigated (1) how developmental stage influences graft survival; (2) whether acutely necrotic or healing cardiac lesions support grafts; and (3) the differentiation and integration of cardiomyocyte grafts in injured hearts. METHODS AND RESU...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.2.193
更新日期:1999-07-13 00:00:00
abstract::Experimental studies have shown that among dogs with a healed myocardial infarction, depressed baroreflex sensitivity (BRS) identifies a subgroup at higher risk for sudden death. We have examined the relation among BRS, several clinical cardiovascular variables, and subsequent mortality in 78 patients below the age of...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.78.4.816
更新日期:1988-10-01 00:00:00
abstract:BACKGROUND:In patients with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) may cause thrombus dislodgment followed by reduced flow and impaired microcirculatory function. We prospectively compared conventional PCI to a strategy of additional pretreatment using the X-sizer thrombectomy system. ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.0000016350.02669.1d
更新日期:2002-05-21 00:00:00
abstract:BACKGROUND:Automatic implantable cardioverter-defibrillator therapy is considered the only effective treatment for high-risk patients with Brugada syndrome. Quinidine depresses I(to) current, which may play an important role in the arrhythmogenesis of this disease. METHODS AND RESULTS:The effects of quinidine bisulfat...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.CIR.0000143159.30585.90
更新日期:2004-09-28 00:00:00