Abstract:
:Noninvasive risk assessment in survivors of AMI can effectively subdivide patients into groups with differing risk profiles after hospital discharge, but some patients at risk for late death or recurrent AMI may be incorrectly identified; data from cardiac catheterization and angiography provide complementary and generally more powerful prognostic information. Many patients may derive particular benefit from early cardiac catheterization and angiography, including: (1) patients with AMI complicated by recurrent myocardial ischemia, congestive heart failure, and/or complex ventricular arrhythmias; (2) patients with abnormal or inconclusive results of noninvasive testing or those patients unable to perform an exercise test; (3) patients with abnormal left ventricular global systolic function and those with increased left ventricular end-systolic volume; (4) "young" patients (younger than 50 years of age?); (5) older patients (older than 65 to 70 years of age?); (6) patients with non-Q wave AMI; and (7) patients who are receiving thrombolytic therapy. Performance of early cardiac catheterization and angiography in virtually all survivors of AMI, with selective use of appropriate noninvasive tests, may provide a more efficacious means of risk assessment after AMI; if all tests are performed judiciously, the cost of such an approach need not be excessive. A combination of invasive and selected noninvasive tests probably provides optimal information. The risks to the routine performance of diagnostic cardiac catheterization and angiography in all survivors of AMI are: (1) adequate care and attention may not be paid to proper performance of the procedure(s) and to detailed and proper analyses of the data; (2) the need for additional noninvasive testing in selected patients may be ignored; and most importantly, (3) premature or unnecessary revascularization procedures may be performed subsequently. For optimal patient care, the clinician must obtain all necessary data, avoid unnecessary and repetitive tests, know the accuracy of individual tests at his or her own facility, interpret all data in proper context, and then counsel patients objectively about available management strategies. With this approach, all patients who might appropriately benefit from coronary artery revascularization will be correctly identified, and patients who are truly at very low risk (minimal residual coronary artery disease and preserved left ventricular function particularly if associated with a patent infarct-related artery) may be similarly identified and managed appropriately with elimination of unnecessary additional testing and pharmacologic therapy. Finally, whatever approach to risk stratification one chooses for an individual patient, the importance of and the need to correct and/or ameliorate risk factors for coronary artery disease must be recognized and undertaken.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Kulick DL,Rahimtoola SHdoi
10.1016/0002-8703(91)90747-6subject
Has Abstractpub_date
1991-02-01 00:00:00pages
641-56issue
2 Pt 1eissn
0002-8703issn
1097-6744pii
0002-8703(91)90747-6journal_volume
121pub_type
社论abstract:BACKGROUND:Despite a survival benefit and guideline recommendation for beta-blockers in left ventricular systolic dysfunction, beta-blockers are underused in clinical practice. METHODS:Medical practices with > or = 15 patients with heart failure (HF) in the Duke Databank for Cardiovascular Disease (DDCD) were identifi...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2005.06.038
更新日期:2006-05-01 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
abstract:BACKGROUND:A strategy using coronary artery calcium (CAC) screening to refine coronary heart disease risk assessment in moderately high risk (MHR) subjects (10-year risk 10%-20%) has been suggested. The potential impact of this strategy is unknown. METHODS:Coronary artery calcium screening strategies focused on MHR su...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.03.018
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00309-0
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) is evaluating the potential benefit for reduction in major cardiovascular (CV) events from the addition of ezetimibe versus placebo to 40 mg/d of simvastatin therapy in patients who present with acute coronary syndromes and...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.05.004
更新日期:2014-08-01 00:00:00
abstract:AIMS:In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. METHODS AND RESULTS:In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2016.07.012
更新日期:2016-11-01 00:00:00
abstract::The primary objective of this study was to apply a sophisticated coagulation monitoring system including estimation of the concentration of prothrombin fragment 1 + 2 (PTF 1 + 2) and the activity of prothrombin (coagulation factor II or FII) to cases of stent implantation and to compare the results with those of stand...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(95)90433-6
更新日期:1995-08-01 00:00:00
abstract::The development of ECG Minnesota Q-QS codes and their subsequent evolution were studied in the first 692 subjects to enter the POSCH program who had had one MI. The mean interval from MI to entry into the study was 2.2 years. Sixty-three percent of the subjects developed the most significant code with the infarction. ...
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)90169-3
更新日期:1985-08-01 00:00:00
abstract::Right ventricular myocardial infarction has been reported to occur exclusively in association with inferior left ventricular infarction. To determine the frequency of right ventricular myocardial infarction in association with anterior left ventricular myocardial infarction, all hearts with anterior myocardial infarct...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90004-4
更新日期:1987-01-01 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::Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of isc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90133-9
更新日期:1984-01-01 00:00:00
abstract::Cost-effectiveness analyses are routinely performed to determine whether the additional cost of a novel therapy is balanced by additional effectiveness. The definitions of costs and effects involve a variety of assumptions, both in general economic terms and with regard to the specific medical setting under considerat...
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
doi:10.1016/s0002-8703(98)70302-3
更新日期:1998-04-01 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::This article reviews the evidence that congestive heart failure is accompanied by an increased plasma norepinephrine concentration and that this is due not only to a reduced tissue clearance of the substance but also to a marked increase in sympathetic nerve activity. It also reports data that indicate that the sympat...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(90)90054-2
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:It has been shown that transient increase in left ventricular stiffness, assessed by Doppler-derived early filling deceleration time, occurs during the first 24 to 48 hours after myocardial infarction but returns to normal within several days. It has been reported that hyperbaric oxygen treatment has a favor...
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.2004.02.009
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Device-detected subclinical atrial fibrillation (AF) refers to infrequent, short-lasting, asymptomatic AF that is detected only with long-term continuous monitoring. Subclinical AF is common and associated with an increased risk of stroke; however, the risk of stroke with subclinical AF is lower than for cli...
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.2017.04.008
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by pat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.126122
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Protease-activated receptor 1 antagonism with vorapaxar represents a novel strategy for platelet inhibition. In TRACER, vorapaxar was compared with placebo plus standard of care among 12,944 patients with non-ST-segment elevation acute coronary syndromes. We anticipated that most patients would have received...
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.2014.09.002
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to estimate the cost-effectiveness of beta-blocker therapy with either metoprolol or carvedilol in addition to conventional therapy for patients with heart failure (HF) in Canada. DESIGN:A Markov simulation was used to estimate the costs and life expectancy for treating patients...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.116479
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that cholesterol-lowering therapy prevented further events in patients with coronary heart disease and average cholesterol levels. The aim of this subgroup analysis was to assess the effects of pravastatin in women. METHOD...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,meta分析
doi:10.1067/mhj.2003.1
更新日期:2003-04-01 00:00:00
abstract::We investigated the incidence and mechanism of pulmonary artery hypertension (PAH) in a consecutive series of patients with aortic stenosis who were undergoing diagnostic cardiac catheterization. Forty-five patients with severe aortic stenosis were divided into two groups: group 1 comprised 13 patients (29%) with PAH ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90067-j
更新日期:1993-01-01 00:00:00
abstract::Major depression is a common comorbidity associated with ischemic heart disease (IHD). There is growing evidence that psychological stress in general and depression in particular predispose to cardiovascular disease. Persons who have mental stress during daily life are at twice the risk of myocardial ischemia, and pat...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1067/mhj.2000.109979
更新日期:2000-10-01 00:00:00
abstract:BACKGROUND:Plasma levels of brain natriuretic peptide (BNP) are increased in patients with left heart failure. In patients with severe pulmonary embolism (PE), primary right ventricular (RV) dysfunction is frequent. Little is known about BNP secretion in acute RV failure. METHODS:We prospectively studied 50 consecutiv...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(03)00528-3
更新日期:2004-01-01 00:00:00
abstract:CLINICAL SCENARIO:A 67-year-old man is referred to your cardiology clinic complaining of worsening angina and dyspnea on exertion. Physical examination reveals a harsh grade IV/VI late-peaking crescendo-decresendo systolic murmur, loudest at the upper sternal border. The aortic closure sound is diminished. Echocardiogr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.05.031
更新日期:2004-07-01 00:00:00
abstract::To assess relative capabilities of magnetic resonance (MR) imaging and two-dimensional echocardiography (2DE) for evaluating regional contractile dysfunction in the left ventricle after a myocardial infarction, results from 22 concurrent MR (orthogonal-transaxial, ECG-gated, multiphasic, single-spin echo) and 2DE exam...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90533-9
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Previous studies with dexamethasone-eluting stents could not elucidate the role of dexamethasone in the prevention of neointimal hyperplasia because they did not compare their results with a control group. We prospectively evaluated the clinical and angiographic outcomes of dexamethasone-eluting stents, comp...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.05.011
更新日期:2006-11-01 00:00:00
abstract::Serum digoxin and/quinidine concentration were measured before and following the institution of quinidine therapy in 11 patients who were receiving maintenance oral digoxin therapy and who required quinidine therapy for suppression of extrasystoles. Steady-state serum digoxin concentrations after quinidine administra...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90643-3
更新日期:1982-07-01 00:00:00
abstract::The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90476-6
更新日期:1994-08-01 00:00:00
abstract::Although it has been shown that early cardiac rejection can be visualized by radioimmunoscintigraphy targeting major histocompatibility complex class II antigen, the use of antibodies that bind to a polymorphic determinant of class II antigen has certain disadvantages for clinical application. This investigation was d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90050-7
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:To assess whether serum uric acid, which is a marker of impaired oxidative metabolism, might correlate with left ventricular systolic and diastolic dysfunction in patients with chronic heart failure (CHF). BACKGROUND:Uric acid levels, which are frequently elevated in patients with CHF, correlate with leg vas...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.122122
更新日期:2002-06-01 00:00:00