Abstract:
BACKGROUND:Bleeding is associated with adverse outcome in acute coronary syndromes. However, the precise pathophysiologic mechanisms have not been elucidated. We sought to determine the relationship between bleeding and myocardial ischemia detected by concurrent continuous electrocardiogram (ECG) monitoring and their independent long-term prognostic significance. METHODS:The INTERACT trial was a randomized controlled trial of enoxaparin versus unfractionated heparin in patients with high-risk non-ST-elevation acute coronary syndromes. Continuous ECG monitoring, performed after enrollment up to 96 hours, was analyzed by an automated algorithm and reviewed by a blinded cardiologist. We centrally adjudicated all bleeding and clinical events in a blinded fashion and calculated the Global Registry of Acute Coronary Events risk score (a validated predictor of mortality) for each patient. RESULTS:Of the 746 patients enrolled, 34 (4.6%) developed major bleeding within 96 hours. After a median follow-up of 2.4 years, patients with bleeding had a higher risk of death (28.4% vs 7.3%, P < .001) and death/myocardial infarction (38.0% vs 12.9%, P < .001) compared with those without bleeding. Overall, 619 patients survived the first 96 hours with complete data on continuous ECG monitoring. Bleeding was associated with the simultaneous presence of ST-segment shifts on continuous ECG monitoring (P = .03). After adjusting for Global Registry of Acute Coronary Events risk score and myocardial ischemia detected by continuous ECG monitoring, major bleeding remained an independent predictor of death (adjusted hazard ratio = 3.48, 95% confidence interval 1.51-8.03, P = .003) and death/myocardial infarction (adjusted hazard ratio = 2.85, 95% confidence interval 1.40-5.78, P = .004). CONCLUSIONS:Bleeding is a powerful independent predictor of poor long-term outcome, even after adjusting for other associated prognostic factors such as advanced age and renal dysfunction. Although bleeding is associated with concurrent myocardial ischemia, its adverse prognostic impact may be mediated by complex pathophysiologic mechanisms rather than myocardial ischemia alone. Our findings suggest that future investigations should focus on other biologically plausible mechanisms.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Yan AT,Yan RT,Huynh T,DeYoung P,Weeks A,Fitchett DH,Langer A,Goodman SG,INTERACT Investigators.doi
10.1016/j.ahj.2008.05.022subject
Has Abstractpub_date
2008-10-01 00:00:00pages
769-75issue
4eissn
0002-8703issn
1097-6744pii
S0002-8703(08)00394-3journal_volume
156pub_type
杂志文章,随机对照试验abstract::Twelve cirrhotic patients with portal hypertension and esophageal varices were treated with nadolol for 1 month, and the effects on renal and hepatic hemodynamics and function were studied. A significant decrease in cardiac output, portohepatic gradient, and effective hepatic blood flow was found, whereas mean arteria...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90602-1
更新日期:1984-10-01 00:00:00
abstract:BACKGROUND:Anemia is now recognized as being a common finding in CHF and is associated with increased mortality and morbidity. However, it is uncertain whether the anemia is actually causing the worse prognosis or is merely a marker of more severe cardiac disease. Previous intervention studies with subcutaneous (s.c.) ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.08.005
更新日期:2006-12-01 00:00:00
abstract::We assessed the relationship between echocardiographic and hemodynamic parameters in 28 patients with documented acute myocardial infarction (AMI), who underwent M-mode echocardiography and Swan-Ganz catheterization during the same hospitalization. Patients with valvular heart disease were excluded from the study. On ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90542-8
更新日期:1984-07-01 00:00:00
abstract::The effects of two regimens for the initiation of amiodarone therapy were compared in 92 patients with inducible sustained ventricular tachycardia (VT) at baseline electrophysiologic testing. Two groups of 46 patients each received a total of 16.8 gm of oral amiodarone before follow-up electrophysiologic testing. Grou...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(92)90599-q
更新日期:1992-08-01 00:00:00
abstract:BACKGROUND:Drug-eluting stents (DES) are increasingly used for the treatment of coronary artery disease. An optimized DES performance is desirable to successfully treat various challenging coronary lesions in a broad population of patients. In response to this demand, third-generation DES with an improved deliverabilit...
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.2012.02.001
更新日期:2012-04-01 00:00:00
abstract::The acute anatomic and valvular consequences of radiofrequency catheter ablation of accessory pathways were evaluated in 62 patients by means of serial echocardiographic examinations. Semiquantitative assessment of valvular incompetence and classification into one of four grades according to the width and the extensio...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90382-4
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:In animal models, physical activity (PA) prevents cardiac myocyte cell death. Data for PA mitigating myocyte injury in humans are limited to observational studies. Using a randomized controlled trial design, we sought to determine if introducing moderate PA to previously sedentary older adults could reduce t...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2016.07.001
更新日期:2016-09-01 00:00:00
abstract::The incidence of cardiac events in Japanese men (mean age 54 +/- 10 years) with atypical or nonanginal chest pain was assessed prospectively. Three groups of patients, those with typical angina (TA; n = 134), those with atypical angina (AA; n = 192), and those with nonanginal chest pain (NA; n = 311) were studied with...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90802-3
更新日期:1992-06-01 00:00:00
abstract::Out of 156 patients with stable coronary heart disease randomized to either an exercise intervention group or a control group, 41 had complete gas analysis data. Continuous gas exchange data, including the ventilatory threshold, and selected heart rates were determined initially and at 1 year. The mean attendance for ...
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(85)90548-4
更新日期:1985-03-01 00:00:00
abstract:BACKGROUND:The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation program...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(98)70233-9
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Neonates with critical pulmonary valve stenosis often demonstrate small or hypoplastic right ventricular structures. Relief of the obstruction enhances forward flow across the right ventricle and reduces its pressure load. Growth of the right ventricle and especially of the pulmonary valve annulus was evalua...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1053/hj.1998.v136.89576
更新日期:1998-08-01 00:00:00
abstract::A longitudinal study was performed in nine nonhydropic and nine hydropic fetuses with supraventricular tachycardia (SVT). First, because of a lack of reference methods in utero, the validity of spatial (length and area) and temporal parameters for semiquantitative grading of atrioventricular (AV) valve regurgitation b...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90997-n
更新日期:1993-05-01 00:00:00
abstract::We studied the effect of propranolol administration on risk assessment based on submaximal exercise testing performed early after myocardial infarction. A total of 70 patients with recent infarction underwent modified Bruce treadmill testing with simultaneous measurement of expired gases in the absence of antianginal ...
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(91)90009-7
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Recent data indicate that cardiac antibodies play an active role in the pathogenesis of dilated cardiomyopathy (DCM) and may contribute to cardiac dysfunction in patients with DCM. The present study investigated the influence of immunoadsorption with subsequent immunoglobulin G substitution (IA/IgG) on cardi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.01.012
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:β-Blockers relieve angina/ischemia in stable coronary artery disease (CAD), and angiotensin-converting enzyme inhibitors prevent CAD outcomes. In EUROPA, the angiotensin-converting enzyme inhibitor perindopril reduced cardiovascular outcomes in low-risk stable CAD patients over 4.2 years. This post hoc analy...
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.2015.08.018
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Prescribing rate control medications with or without antiarrhythmic drugs is often the first course treatment for atrial fibrillation (AF). Clinical trial data suggest that antiarrhythmic drugs are only marginally effective and have multiple drawbacks, whereas rate control alone is sufficient for most patien...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.03.024
更新日期:2014-07-01 00:00:00
abstract::CHD remains the leading cause of death in most developed countries; therefore, elucidation of risk factors and associated mechanisms for atherosclerosis and development of CHD has been a high priority. Data from the Framingham Heart Study and other large-scale epidemiologic studies have identified major risk factors a...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90096-4
更新日期:1996-06-01 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::Eight cases of top-ranking athletes with "repolarization disorders" are reported. All subjects were asymptomatic and were otherwise suited for excellent cardiovascular performances. Seven athletes did not show any evidence of heart disease. Seven had MVP (mitral valve prolapse). Umprompted variability of ECG tracings ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(80)90117-9
更新日期:1980-08-01 00:00:00
abstract:BACKGROUND:Type III hyperlipoproteinemia is characterized by the accumulation of chylomicron and very low density lipoprotein (VLDL) remnants. Individuals with this disorder have a high risk of premature atherosclerosis, and hypolipidemic drugs are useful in their management. METHODS:We compared, in a double-blind, pl...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-07-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究
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更新日期:2017-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1993-06-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2003-08-01 00:00:00
abstract::Thiazides produce an average loss of 2 L of extracellular fluid volume, of which about 300 ml is plasma volume, during the first 48 hours of administration, and this reduction is maintained without further loss for as long as the drug is given. Do thiazides lower blood pressure by volume depletion or by direct vasodil...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90116-3
更新日期:1983-07-01 00:00:00
abstract::A large series of 306 patients with ischemic heart disease was studied with automated systolic time intervals and left ventricular ejection fraction as determined by the angiocardiographic method. It was found the pre-ejection period, left ventricular ejection time, delta values, and PEP/LVET ratio all were related to...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80407-9
更新日期:1977-04-01 00:00:00
abstract::Pulmonary function was measured serially in two separate randomized trials of pindolol in the treatment of essential hypertension. Patients with overt obstructive airways disease were excluded. In study 1, 131 hypertensive patients were randomized to placebo (31) and 15 mg (33), 30 mg (33), and 60 mg (34) of pindolol....
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(82)90135-1
更新日期:1982-08-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1995-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2004.10.026
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Chronic total occlusion (CTO) recanalizations remain extremely challenging procedures. With improvements in technology and techniques, success rates for recanalization of CTO continue to improve. However, the clinical benefits of this practice remain unclear. The aim of the study was to determine the effecti...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
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更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coro...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2009.10.035
更新日期:2010-01-01 00:00:00