Abstract:
AIMS:In acute coronary syndromes (ACS), the optimal revascularization strategy for unprotected left main coronary disease (ULMCD) has been little studied. The objectives of the present study were to describe the practice of ULMCD revascularization in ACS patients and its evolution over an 8-year period, analyse the prognosis of this population and determine the effect of revascularization on outcome. METHODS AND RESULTS:Of 43 018 patients enrolled in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007, 1799 had significant ULMCD and underwent percutaneous coronary intervention (PCI) alone (n = 514), coronary artery bypass graft (CABG) alone (n = 612), or no revascularization (n = 673). Mortality was 7.7% in hospital and 14% at 6 months. Over the 8-year study, the GRACE risk score remained constant, but there was a steady shift to more PCI than CABG over time. Patients undergoing PCI presented more frequently with ST-segment elevation myocardial infarction (STEMI), after cardiac arrest, or in cardiogenic shock; 48% of PCI patients underwent revascularization on the day of admission vs. 5.1% in the CABG group. After adjustment, revascularization was associated with an early hazard of hospital death vs. no revascularization, significant for PCI (hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.62-4.18) but not for CABG (1.26, 0.72-2.22). From discharge to 6 months, both PCI (HR 0.45, 95% CI 0.23-0.85) and CABG (0.11, 0.04-0.28) were significantly associated with improved survival in comparison with an initial strategy of no revascularization. Coronary artery bypass graft revascularization was associated with a five-fold increase in stroke compared with the other two groups. CONCLUSION:Unprotected left main coronary disease in ACS is associated with high mortality, especially in patients with STEMI and/or haemodynamic or arrhythmic instability. Percutaneous coronary intervention is now the most common revascularization strategy and preferred in higher risk patients. Coronary artery bypass graft is often delayed and performed in lower risk patients, leading to good 6-month survival. The two approaches therefore appear complementary.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Montalescot G,Brieger D,Eagle KA,Anderson FA Jr,FitzGerald G,Lee MS,Steg PG,Avezum A,Goodman SG,Gore JM,GRACE Investigators.doi
10.1093/eurheartj/ehp353subject
Has Abstractpub_date
2009-10-01 00:00:00pages
2308-17issue
19eissn
0195-668Xissn
1522-9645pii
ehp353journal_volume
30pub_type
杂志文章,多中心研究abstract:AIMS:The purpose of the Euro Heart Survey Programme of the European Society of Cardiology is to evaluate to which extent clinical practice endorses existing guidelines as well as to identify differences in population profiles, patient management, and outcome across Europe. The current survey focuses on the invasive dia...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehi238
更新日期:2005-06-01 00:00:00
abstract::The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approac...
journal_title:European heart journal
pub_type: 共识发展会议,杂志文章
doi:10.1093/eurheartj/ehy077
更新日期:2018-06-07 00:00:00
abstract::This study was undertaken to assess the effects of hypothermia and chemical cardioplegia on the functional recovery of hypertrophied non-failing rat hearts subjected to an extended period of global ischaemia. Left ventricular hypertrophy was produced by constriction of the abdominal aorta. Hearts were studied an avera...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_f.347
更新日期:1984-12-01 00:00:00
abstract:AIMS:Although cerebral blood flow (CBF) is known to be low in patients with advanced systolic heart failure (HF), little is known of the prognostic significance of this observation. We investigated whether CBF might be associated with the development of adverse outcomes in systolic HF, and whether it might provide prog...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehr345
更新日期:2012-02-01 00:00:00
abstract:AIMS:The increasing number of adults with congenital heart disease (CHD) has prompted the development of recommendations for the management of these patients and for the organization of their healthcare. The aim of this report is to describe the delivery of care in Europe for adults with congenital cardiac anomalies. ...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehi858
更新日期:2006-06-01 00:00:00
abstract:AIMS:We aimed to assess the contemporary outcome of Eisenmenger syndrome (ES), delineate the use of disease targeting therapies (DTT) in these patients and to investigate the effect of treatment on outcome in the community. METHODS AND RESULTS:Patients with ES were systematically identified from the German National Re...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehv743
更新日期:2016-05-07 00:00:00
abstract:AIMS:To compare effects of heparin and hirudin on biochemical markers of coagulation. METHODS AND RESULTS:Patients (n=395) with unstable angina or myocardial infarction without ST elevation were randomized to a 72-h infusion of one of three regimens: unfractionated heparin (bolus of 5000 IU followed by an infusion of ...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1053/euhj.1999.2005
更新日期:2000-09-01 00:00:00
abstract::An exercise test was performed in 455 patients in the third week after acute myocardial infarction (AMI). One hundred and seventeen (26%) of them were considered as having a complicated AMI. During a follow-up of 4.5 years their mortality was 49% vs 23% in the remaining patients with uncomplicated AMI. The survival of...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062329
更新日期:1987-06-01 00:00:00
abstract:Aims:To determine tolerability and the optimal dose regimen of the soluble guanylate cyclase stimulator vericiguat in patients with chronic heart failure and preserved ejection fraction (HFpEF). Methods and results:SOCRATES-PRESERVED was a prospective, randomized, placebo-controlled double-blind, Phase 2b dose-finding...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehw593
更新日期:2017-04-14 00:00:00
abstract:AIMS:Hyponatraemia has been shown to be an independent predictor of mortality in selected patients with heart failure enrolled in clinical trials. The predictive value of hyponatraemia has not been evaluated in unselected patients hospitalized with heart failure. METHODS AND RESULTS:OPTIMIZE-HF is a registry and perfo...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehl542
更新日期:2007-04-01 00:00:00
abstract::To assess possible clinical and angiographic factors associated with acute coronary events following PTCA, we performed quantitative angiography in 168 consecutive patients who had undergone successful angioplasty in a native vessel (94 for stable angina, 74 for unstable angina), and who were restudied (24 +/- 15 week...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061051
更新日期:1995-08-01 00:00:00
abstract:AIMS:To assess the outcome and costs of patients with acute myocardial infarction (AMI) after initial admission to hospitals with or without catheterization facilities in Belgium. METHODS AND RESULTS:From a nationwide hospital register, we retrieved the data of 34 961 patients discharged during 1999-2001 with a princi...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehl161
更新日期:2006-11-01 00:00:00
abstract:AIM:This study reports on the results and safety of a simplified method of trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. METHODS AND RESULTS:Over 5 years, 411 patients underwent trans-septal catheterization for radiofrequency catheter ablation: 388 patients had a left-sided ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1998.0979
更新日期:1998-06-01 00:00:00
abstract:AIMS:The Pacing to Avoid Cardiac Enlargement (PACE) trial is a prospective, double-blinded, randomized, multicentre study that reported the superiority of biventricular (BiV) pacing to right ventricular apical (RVA) pacing in the prevention of left ventricular (LV) adverse remodelling and deterioration of systolic func...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehr336
更新日期:2011-10-01 00:00:00
abstract:Aims:Vascular ageing is characterized by arterial stiffening, dilation, and arterial wall thickening. We investigated the extent to which these changes are related and their heritability during 5 year follow-up in the Twins UK cohort. Methods and results:Carotid-femoral pulse wave velocity (PWVcf), carotid diameter, c...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehy165
更新日期:2018-06-21 00:00:00
abstract::Cardiac output was measured in 11 patients undergoing routine cardiac catheterization using a carbon dioxide rebreathing technique and compared with cardiac output measured by direct Fick and thermodilution. The carbon dioxide rebreathing technique gave consistently lower values for cardiac output than the other two m...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060504
更新日期:1994-03-01 00:00:00
abstract:AIMS:To evaluate the predictive value and optimum dichotomy limits for different combinations of prognostic indicators for the prediction of arrhythmic events and cardiac mortality in post-infarction patients. BACKGROUND:Studies of new interventions based on risk stratification after myocardial infarction have often u...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a015439
更新日期:1997-08-01 00:00:00
abstract::Myocardial dyssynergy does not necessarily indicate myocardial necrosis in patients with coronary artery disease. The differentiation between viable and non-viable tissue is of great clinical importance in order to make the most appropriate clinical decision in the individual patient. Several techniques are used to as...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/18.suppl_d.117
更新日期:1997-06-01 00:00:00
abstract::A possibility that can be advanced to explain the antihypertensive effect of beta-blocking drugs is that they act through the baroreflex control of the cardiovascular system. In 38 essential hypertensive patients we measured 1) The lengthening and shortening in R-R interval caused by stimulation or deactivation of art...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/4.suppl_d.19
更新日期:1983-07-01 00:00:00
abstract:AIMS:Coronary artery calcium (CAC) scoring has emerged as a tool for risk stratification and potentially for monitoring response to risk factor modification. Therefore, repeat measurements should provide robust results and low inter-scanner variability for allowing meaningful comparison. The purpose of this study was t...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehr157
更新日期:2011-08-01 00:00:00
abstract::Pulmonary arterial hypertension (PAH) can be a rapidly progressive disorder and is associated with high rate of mortality, despite medical intervention. With the availability of effective therapy, early disease detection is an important strategic objective to improve treatment outcomes. Resting echocardiography is cur...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehr160
更新日期:2011-10-01 00:00:00
abstract:Aim:Hypertrophic cardiomyopathy (HCM) exhibits genetic heterogeneity that is dominated by variation in eight sarcomeric genes. Genetic variation in a large number of non-sarcomeric genes has also been implicated in HCM but not formally assessed. Here we used very large case and control cohorts to determine the extent t...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehw603
更新日期:2017-12-07 00:00:00
abstract:AIMS:To investigate the effects of secretory phospholipase A2 (sPLA(2)) inhibition on plasma lipoproteins. Secretory phospholipase A2 isoenzymes promote atherosclerosis by mechanisms that include lipoprotein modification, retention, and oxidation. METHODS AND RESULTS:Phospholipase Levels And Serological Markers of Ath...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehq374
更新日期:2011-04-01 00:00:00
abstract::In this study, betathromboglobulin (BTG) and fibrinopeptide A (FPA) in peripheral venous blood were measured in 20 patients with stable angina pectoris before and immediately after exercise-induced myocardial ischaemia; in 5 of the 20 patients stable angina was associated with typical peripheral artery disease. A tota...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/8.7.734
更新日期:1987-07-01 00:00:00
abstract::The fundamental abnormality in syndrome X (angina pectoris, ischaemia-like stress ECG despite angiographically normal coronary arteries) might be patchily distributed increased tone in pre-arteriolar coronary vessels with compensatory release of adenosine. The aim of this study was to confirm this hypothesis and to ex...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060780
更新日期:1995-11-01 00:00:00
abstract:AIMS:Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis. METHODS AND RESULTS:Cohort study of the entire Danish population followed from 1997 to 20...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehr285
更新日期:2012-08-01 00:00:00
abstract::Hemodynamic variables were measured in 34 patients with isolated systolic hypertension before and after acute administration of propranolol. The patients were separated into two groups, those younger than and those older than 45 years of age, respectively. After drug administration, systolic pressure decreased signifi...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/4.suppl_g.51
更新日期:1983-11-01 00:00:00
abstract:AIMS:Despite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global cli...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/eht258
更新日期:2013-11-01 00:00:00
abstract:AIMS:Whether increased homocysteine is one mechanism linking obstructive sleep apnoea (OSA) to cardiovascular abnormalities is unclear. We hypothesised that plasma homocysteine would be higher in OSA patients than in control subjects, would increase further during sleep, and decrease after treatment with continuous pos...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/j.ehj.2004.05.018
更新日期:2004-08-01 00:00:00
abstract:AIMS:There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions co...
journal_title:European heart journal
pub_type: 杂志文章,meta分析
doi:10.1053/euhj.1998.1027
更新日期:1998-09-01 00:00:00