Abstract:
BACKGROUND:Despite clopidogrel therapy, patients undergoing percutaneous coronary intervention (PCI) with stenting are at risk of recurrent coronary events. This could be partly explained by a reduced efficacy of clopidogrel to inhibit platelet aggregation, an ex vivo defined phenomenon called clopidogrel nonresponsiveness or resistance. However, both prevalence and associated cardiovascular risks remain unclear. We systematically reviewed evidence on prevalence and clinical consequences of laboratory clopidogrel nonresponsiveness in patients undergoing PCI. METHODS:Using predefined strategies, we searched electronic databases. To be included, articles should report on PCI patients treated with clopidogrel, contain a clear description of the method used to establish the effects of clopidogrel, and report the prevalence of clopidogrel nonresponsiveness or incidence of cardiovascular events. We analyzed prevalences with a linear mixed model that accounts for study covariates and we pooled odds ratios of clinical consequences with a random-effects model. RESULTS:We identified 25 eligible studies that included a total of 3688 patients. Mean prevalence of clopidogrel nonresponsiveness was 21% (95% CI, 17%-25%) and was inversely correlated with time between clopidogrel loading and determination of nonresponsiveness and used loading dose. The pooled odds ratio of cardiovascular outcome was 8.0 (95% CI, 3.4-19.0). CONCLUSIONS:Laboratory clopidogrel nonresponsiveness can be found in approximately 1 in 5 patients undergoing PCI. Patients ex vivo labeled nonresponsive are likely to be also "clinically nonresponsive," as they exhibit increased risks of worsened cardiovascular outcomes. Our results indicate that use of a 600-mg clopidogrel loading dose will reduce these risks, which needs to be confirmed in large prospective studies.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Snoep JD,Hovens MM,Eikenboom JC,van der Bom JG,Jukema JW,Huisman MVdoi
10.1016/j.ahj.2007.04.014subject
Has Abstractpub_date
2007-08-01 00:00:00pages
221-31issue
2eissn
0002-8703issn
1097-6744pii
S0002-8703(07)00321-3journal_volume
154pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:The recovery of left ventricular function (LVF) after revascularization takes time. alpha-Adrenergic blockade acutely improves coronary blood flow and LVF, whereas the effects of more prolonged alpha-adrenergic blockade on LVF recovery after stenting are unknown. METHODS:In 32 patients (age 58 +/- 12 y) wit...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.ahj.2003.08.005
更新日期:2004-02-01 00:00:00
abstract::Nitrates are widely used for the management of congestive heart failure (CHF), as well as angina pectoris. In both situations, nitrates significantly increase exercise capacity. The mechanism of this beneficial effect is unclear, especially in CHF. Isosorbide dinitrate reduces pulmonary capillary wedge pressure (PCWP)...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(85)90494-6
更新日期:1985-07-01 00:00:00
abstract::Cardiac arrhythmias arise from disturbances in the functioning of the specific ion channels that normally control excitation or from the functional expression of previously latent channels. Antiarrhythmic agents act by blocking the membrane sodium, potassium, and calcium channels, but no agent has exclusive action on ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(92)91072-9
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Contemporary use of dual antiplatelet therapy and consistency with guideline recommendations in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) have not been well characterized. METHODS:The COAPT was a prospective, observational, multicenter, longitudinal study of patien...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2016.07.014
更新日期:2016-11-01 00:00:00
abstract::Ambulatory ECG recordings are routinely used to identify patients at increased risk of sudden cardiac death and to monitor changes in ventricular arrhythmias during antiarrhythmic drug therapy. The arrhythmia frequency established during the initial baseline has previously been reported to change during a second place...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(88)90139-1
更新日期:1988-10-01 00:00:00
abstract::Development of aortic valvular deformities was studied retrospectively in 395 inpatients with subarterial infundibular ventricular septal defect (siVSD). Aortic valvular deformities included prolapse into siVSD without aortic regurgitation (77 patients), prolapse and aortic regurgitation (95 patients), and aneurysm of...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90759-2
更新日期:1984-11-01 00:00:00
abstract::Estimation of baroreflex sensitivity (BRS) is receiving increasing attention in clinical and experimental cardiology. Until recently, in most studies BRS has been assessed on the basis of invasive blood pressure measurement, which limits its use in large-scale studies and in clinical practice. The development of conti...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(95)90443-3
更新日期:1995-08-01 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::Because of its unique ability to demonstrate the metabolic consequences of myocardial ischemia, positron emission tomography (PET) is extremely valuable in assessing myocardial viability. PET imaging can identify the myocardial segments that are likely to improve after revascularization and may be more sensitive and s...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(91)90803-p
更新日期:1991-07-01 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::Mitochondria in skeletal and cardiac muscle have been found to be less stable in aging hamsters, in contrast to preparations from young animals. We have found previously that clofibrate (Atromid-S) will reverse this degeneration in the older hamsters. This study examined the exercise tolerance of aged hamsters, to see...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80040-9
更新日期:1977-10-01 00:00:00
abstract:OBJECTIVE:The study aimed to determine the impact on eptifibatide-associated bleeding by implementing a computerized dosing algorithm in the cardiac catheterization suite. BACKGROUND:Excessive dosing of eptifibatide is associated with increased bleeding rates and hospital mortality. Although dosing adjustments based o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.10.006
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:The 6-minute walk test is a submaximal exercise test that is widely used as an outcomes measure in clinical trials and cardiopulmonary rehabilitation. An initial learning effect with repeated administration is well documented, but it is unknown whether this learning effect persists with time. METHODS:This s...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00119-4
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Insulin, in addition to its known metabolic effects, has sympatho-excitatory and vasodilatory actions on muscular blood vessels. The goal of this study was to evaluate insulin sensitivity in young women with vasovagal syncope and positive tilt test results (HUT+) and to compare it with that in patients with ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(02)94707-1
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Few data are available concerning the effects on clinical outcome and left ventricular function of abciximab administration in patients undergoing rescue percutaneous transluminal coronary angioplasty (PTCA) after failed thrombolysis for acute myocardial infarction. The aim of the study was to investigate su...
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.2002.119762
更新日期:2002-02-01 00:00:00
abstract::Quantitation of coronary luminal diameter with a 20 MHz mechanically rotating intravascular ultrasound (IVUS) catheter was compared with orthogonal-view cineangiography by use of a semiautomated edge-detection algorithm in 48 patients undergoing coronary angioplasty. Quantitative comparison of 196 matched segments was...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90110-4
更新日期:1994-02-01 00:00:00
abstract::In over 30 years of surveillance of 2873 women, 574 developed initial clinical manifestations of CHD. A number of antecedent metabolic risk factors proved atherogenic, including blood lipids, glucose tolerance, uric acid, and menopause. Serum total cholesterol predicts as strongly in women as in men. The predictive po...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90511-4
更新日期:1987-08-01 00:00:00
abstract:BACKGROUND:The prognostic significance of ventricular flutter (VFL) induced during programmed electrical stimulation (PES) is currently unknown. METHODS:This study examined patients who had PES-induced VFL and assessed their long-term prognosis compared with patients who had inducible sustained monomorphic ventricular...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.11.012
更新日期:2004-04-01 00:00:00
abstract::To test the feasibility of synchronized retroperfusion (SRP) as a support device of percutaneous transluminal coronary angioplasty (PTCA) for high-risk patients, 10 patients with left main trunk or near left main trunk obstruction underwent PTCA with SRP. An 8.5F retroperfusion catheter was inserted from the antecubit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90004-s
更新日期:1993-02-01 00:00:00
abstract::The clinical spectrum and outcome of 119 patients with acute non-Q wave myocardial infarction (NQMI) were studied, in comparison with those of 354 patients with acute Q wave myocardial infarction (QMI). The patients with NQMI had a significantly higher incidence of preinfarction angina (73% vs 63%), previous myocardia...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90056-6
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:In patients with acute myocardial infarction (AMI), the rate of microvascular embolization and no-reflow promoted by coronary stenting with the use of conventional techniques (CS) appears to be greater than the one that occurs with balloon angioplasty. The minor invasiveness of direct stenting (DS) of the in...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.117778
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:All patients who present to an emergency department (ED) are triaged. The ED triage score may determine when patients are seen by a physician. Half of patients with acute myocardial infarction (AMI) were given a low priority score in Ontario in 2000/2001. We assessed the appropriateness of ED triage and its ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2011.05.015
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:31-Phosphorus-magnetic resonance spectroscopy may provide pathophysiological insights into the high-energy phosphate metabolism of the myocardium as measured by phosphocreatine to adenosine triphosphate (PCr/ATP) ratio. Aim of the present study was to determine in vivo the relation between cardiac PCr/ATP ra...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.04.012
更新日期:2011-07-01 00:00:00
abstract::The purpose of this study was to determine the normal pattern and magnitude of mitral annular velocities in diastole by Doppler tissue imaging (DTI) and to assess whether this is altered in patients with left ventricular hypertrophy. Mitral annulus velocities were measured by DTI. Peak and time-velocity integral were ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90183-0
更新日期:1996-05-01 00:00:00
abstract::Positive deviance studies combining qualitative and quantitative designs-a mixed-methods approach-can discover strategies to produce exemplary performance. We present the SAMI study, a national positive deviance study to discover hospital strategies associated with lower 30-day hospital risk-standardized mortality rat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.09.004
更新日期:2011-12-01 00:00:00
abstract::In this study, we reviewed M-mode and two-dimensional (2DE) echocardiographic observations in 13 patients with pulmonary atresia with ventricular septal defect and in six patients with truncus arteriosus in order to attempt to identify echocardiographic features distinguishing these two abnormalities in which no anato...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90528-8
更新日期:1983-02-01 00:00:00
abstract::The MAPHY Study was conducted to investigate whether metoprolol, a relatively beta 1-selective beta-blocker, given as initial antihypertensive treatment, would lower cardiovascular complications of high blood pressure to a greater extent than do thiazide diuretics as initial treatment at similar blood pressure control...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(88)90112-3
更新日期:1988-07-01 00:00:00
abstract::The effect of the reperfusion on myocardial infarction has been studied in the rat in order to assess the possible reversibility of myocardial damage. The present study deals with reperfusion of experimental myocardial infarction in the rat. Two groups of animals were compared: one was subjected to permanent ischemia ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80255-x
更新日期:1977-03-01 00:00:00
abstract::Left ventricular (LV) thrombi are responsible for significant morbidity and mortality in our society. Twenty-five percent of cardiogenic emboli are associated with acute and chronic myocardial infarction. With the development of noninvasive imaging techniques LV thrombi have been increasingly recognized as an importan...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(92)91069-d
更新日期:1992-04-01 00:00:00
abstract::Although Q wave and non-Q wave MI are often referred to as "transmural" and "nontransmural," there is no anatomic evidence to justify this distinction. Nevertheless, a distinction is important, because the two entities have a different prognosis. At the present time, between 25% and 35% of MIs are non-Q wave. They are...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(89)90629-7
更新日期:1989-04-01 00:00:00